Professional Experience Placement

Levett-Jones, Hoffman, Dempsey, Yeon-Sim Jeong, Noble, Norton, Roche and Hickey (2009) introduce the concept of using the clinical reasoning cycle to identify ‘at risk’ patients in acute care settings. They discussed the need for practitioners to develop the ability to collect the right cues, and to take the right action for the right patient, at the right time for the right reason.

The authors indicated that nurses with poor clinical reasoning skills can fail to detect impending patient deterioration resulting in a ‘failure to rescue’.  The clinical reasoning cycle was developed in response to the need for enhancing the ability to identify and manage patients. Management of ‘at risk’ patients is an  essential for competence as a nurse.

The clinical reasoning cycle is described in this paper and information can be found here. I have previously blogged about the clinical reasoning cycle and the importance of clinical facilitators and preceptors guiding and supporting their students in integrating the theoretical knowledge, skills, attitudes and behaviour that is the clinical reasoning cycle. This paper provides background about how the clinical reasoning cycle is suited to problem- based learning across a variety of educational and clinical or professional experience settings. This paper focuses on the relevance of the clinical reasoning cycle to the prevention and management of adverse patient incidents in the acute care setting.

The authors discuss the need to learn how to engage in clinical reasoning and the process required to use it effectively with this group of patients/clients. The right patient refers to ensuring nurses learn how to identify and prioritise care of patients. The authors state using the right cues is imperative and the need to be aware that during the process of cue collection there is opportunity for stereotypes, prejudices and assumptions to impede the cue collection process. Determining the right time is a complex of clinical judgements that result in the ability to identify and undertake appropriate nursing interventions  or actions in the appropriate sequence  in a timely manner. This synthesis of facts and inferences requires the development of a framework that allows nurses to distinguish  clinical noise from clinical data that signal risk. The right reason is discussed by the authors to include social and cultural contexts within workplaces and values and beliefs.

The authors conclude that learning clinical reasoning processes has the potential to improve preparedness for practice.

Do you have any examples of using the clinical reasoning cycle to identify ‘at risk’ patients or clients? If you have any comments about the clinical reasoning cycle, you are welcome to post them here.