16
Unit 1
Contemporary concepts in nursing
take (Chang et al., 2011).
Cue acquisition
is when the impor-
tance of these pieces of data are recognised and collected.
Experience influences the type and number of cues that are
collected as experienced clinicians appear to be able to focus
on the most important cues and anticipate others, whereas less
experienced clinicians collect cues according to rules that are
learnt. These cues can be clustered into patterns that can be
compared with those previously encountered. Through clinical
experience, the clinician retains memories of previous patients
and clinical situations. Similarities and differences between
the situations is called pattern recognition, and as the clini-
cian gains more experience, more patterns are retained in the
memory bank (Buckingham & Adams, 2000b). For example,
experienced nurses who have performed many respiratory
assessments have memory banks that enable comparing the
current breath sounds with others they have heard in the past
consolidated by what they have learnt from the evidence-based
literature. New practitioners may have to rely initially on assis-
tance with assimilation of ideas from other more experienced
nurses, as this memory bank has not yet developed.
Reasoning process
The terms clinical reasoning, problem solving, clinical judge-
ment and decision making are often used interchangeably
(Simmons, 2010); however, most acknowledge this cyclical
process of cue collection, interpretation, pattern matching
and decision making. Indeed, it could be said that the need
to reason is driven by a problem; therefore, problem solving is
fundamental to the processes of care. Unfortunately, problem
solving does not always involve clinical reasoning, so the
solution to a problem may be limited to traditional solutions
with other potential solutions being ignored. Therefore the
reasoning process must be expansive and unlimited exploring
all possibilities in order to solve a problem.
Problem solving
Problem solving is a basic life skill which involves identifying a
problem and then taking steps to resolve it. However, different
approaches to problem solving yield different results. Problem
solving that takes into account critical thinking, creative,
non-traditional and reflective approaches enables additional
solutions to be formulated (Chabelli, 2007). Trial-and-error
problem solving involves testing a number of solutions until
one is found that works for that particular problem. This type
of problem solving in healthcare is limited to those situations
where the wrong option that may harm the patient can be
eliminated. Scientific problem solving is closely related to this
more general problem-solving process; however, it involves
identifying a problem, collecting some data, interpreting
the results to form a hypothesis that is based on previously
acquired scientific knowledge that in turn drives the action.
This is often the point at which research commences. It can
be informed by intuitive problem solving in which experienced
clinicians act upon a ‘gut feeling’ or an ‘inner prompting.’ The
type of knowledge that underpins this form of problem solving
is referred to as tacit knowledge, and is built up over years
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 2-2
Clinical reasoning and the process of care trajectory
(Dempsey, J., Hillege, S. & Hill, R. (2013). Fundamentals of nursing and midwifery: A person-centred approach to care (2nd ed., Figure 14-1). Sydney:
Lippincott Williams & Wilkins.)
