Unit III Thoughtful practice and the process of care
254
interrelationships between such aspects as reflection and crit-
ical thinking are very strong. Each of the chapters in Unit 3
explains the processes of care through a more detailed discus-
sion of assessing, identifying health problems, planning care,
implementing care and evaluating care. Critical thinking
activities and reflective cues are used throughout this chapter
and throughout this text.
As well as learning the skills necessary for thoughtful prac-
tice, you must understand the influences that shape your
reasoning and judgements. Figure 14-1 illustrates the trajec-
tory and interrelationships of the components of thoughtful
practice, and portrays these influences as personal attributes,
knowledge base and clinical experience. You must draw on a
broad knowledge base to underpin the decisions you make in
clinical practice. The knowledge that progresses from these
perspectives must be supported by sound and well-developed
thinking skills gained through parallel clinical experience.
Applied skills in clinical reasoning enable you to identify
options for care and to choose a course of action that provides
a solution or temporary relief of a health problem. This is
called clinical judgement. Clinical judgement involves deci-
sion making and can be influenced by your personal attributes
and by how you respond within the specific health setting.
The following section explains how clinical reasoning in the
Personal attributes
Clinical experience
Problem
solving
Critical
thinking
Creative
thinking
Intuitive
thinking
Context of
thoughtful
nursing and
midwifery
practice
Knowledge base
Clinical
judgement
Decision
making
Clinician’s
actions
Process
of care
Clinical reasoning
Evaluation and reflection
Figure 14-1
Clinical reasoning and the process of care trajectory
Source: Adapted from Fowler, 1998, p. 85; Martin, 2002, p. 244; and Tanner, 2006, p. 208.
context of nursing and midwifery practice emerges from these
combined influences. The processes of clinical reasoning and
the types of thinking involved are then explored, followed by
an explanation of clinical judgement and decision making.
The chapter concludes with an example of a clinical situation
explored through a clinical reasoning framework.
CONTEXT OF THOUGHTFUL
PRACTICE
In Chapter 13, the professional context of thoughtful nursing
and midwifery practice is discussed, and the professional
attributes that the clinician should bring to the clinical
encounter are explained. The first component of thoughtful
practice, reflective practice, is outlined. This chapter contin-
ues the discussion of thoughtful practice and outlines its
second component—clinical reasoning.
The following section explores the influence of personal
attributes, knowledge and experience on clinical reason-
ing, and then the next section looks at problem solving,
ways of thinking, clinical judgement and decision making,
each of which interrelate with reflective practice to form
thoughtful practice.
