•
Ability to identify the components of clinical reasoning
•
Knowledge of the types of thinking used in clinical
reasoning
•
Understanding of the relationship between clinical
reasoning and the processes of care
•
How to apply a clinical reasoning framework to analyse
current and potential health problems in order to reach a
clinical judgement.
To enhance your learning and facilitate further
understanding of this chapter, refer to thePoint
and LNPS online resources.
267
Chapter 14 Thoughtful practice: Clinical reasoning, clinical judgement, actions and the process of care
BOX 14-6 Example of the application of the clinical reasoning framework
(continued)
assessment findings and with the care of Matthew’s
grandparents, and medical staff for more detailed
medical assessment and initiation of investigations
and/or interventions. Physical assessment tools
include a stethoscope, a tympanic thermometer and a
pulse oximeter. Treatment resources include oxygen
and suction equipment available and in working order.
5.
The clinical
judgements
you make will be dependent
on your appraisal of the urgency of intervening in
Matthew’s breathing difficulties. One of your key
objectives is to reduce his anxiety, so you spend a
little time chatting with him to develop his trust in you,
although you avoid directing questions at him to
decrease his requirement to talk. You assess his
respiratory function and oxygenation using vital signs,
physical assessment and pulse-oximetry data. You
compare the cues with normal so you can decide
whether you need to report abnormalities and request
medical assessment. Your
decision
is to administer
medications as ordered, taking measures to minimise
adverse effects, and you encourage Matthew to use
the inhaler correctly even though it is difficult. Your
aim is to increase the amount of oxygen measured by
the oximeter so that his supplemental oxygen may be
reduced as his condition improves. When Matthew’s
grandparents ask questions you try to answer them
and keep them informed of management plans and
actions. You enable his grandparents to stay with him,
placing him in a quiet location and explaining all
procedures and interventions. You discuss contacting
his parents, you ensure access to the nurse call
system and you maintain close observation of
Matthew. After checking with a more experienced
nurse you have determined that if Matthew’s response
to inhaler medication is not favourable or if oxygen
saturation is not kept over 95% by his supplemental
oxygen, he will need an IV, which will exacerbate his
anxiety further.
problems to planning and implementation of her care. Each
chapter will explore aspects of the scenario pertaining to the
relevant component of the processes of care. Critical think-
ing questions will be posed and some reflective cues will be
included, to encourage you to reflect on the particular com-
ponent, building your skills for thoughtful practice. At the
end of Unit 3 you will be able to review what you have
learnt in this unit by evaluating the plan of care that you
have created for Claire.
Throughout the rest of this text there will be additional
opportunities for you to develop your clinical reasoning
skills through consideration of various scenarios relevant to
the particular chapter you are reading. When you encounter
the icon you will undertake critical thinking exercises
that will enable you to apply the learning you are acquiring
to a particular clinical situation. The questions relating to
each scenario will require you to think through a problem
and, in some instances, make a clinical decision.
Use the method demonstrated in Box 14-6 to work
through an intellectually challenging situation you have
faced during a clinical placement, and then critique the
method in the light of the following standards for clinical
reasoning. Was it is clear, precise, specific, accurate, rel-
evant, plausible, consistent, logical, deep, broad,
complete, significant and adequate (for the purpose)?
Was it fair and free from prejudice and false assump-
tions? Do you think you could apply this method
in the future?
Your learning in thoughtful practice will increase as you
work through the remaining chapters in Unit 3. In each of
these chapters you will be asked to consider a particular
clinical scenario featuring ‘Claire’, a young university
student who has a typically active social life and who has
Type 1 diabetes. You will encounter Claire in various situa-
tions, from the assessment and identification of her health
Developing knowledge skills
In this chapter you have been learning about clinical reason-
ing as part of the processes of thoughtful practice and
person-centred care. Once you have had the opportunity to
put these skills into practice you will become more confi-
dent in the identified competencies of thoughtful practice
and person-centred care.
What have you learnt?
•
Basic knowledge of the foundation elements upon which
clinical reasoning is built
