The Pros & Pitfalls of Clinical Reasoning in Healthcare
November 25, 2019
Best practices in the world of healthcare generate are a moving target, which is understandable given the complexity and rapid evolution of the industry. There’s always something “buzzy” happening when it comes to workplace performance in particular, and lately the concept of clinical reasoning has been getting a lot of attention.
Clinical Reasoning Defined
Simply put, clinical reasoning—or clinical judgment in some quarters—is defined as the way clinicians (nurses in particular) gather information about a patient, assess his or her condition, plan and deploy care, and evaluate outcomes. The thinking is that they will then take this process and continue it with each patient they see all through the care continuum, building a positive feedback and experience loop that helps them become more adept at their jobs while also providing strong outcomes and increasing operational efficiency.
The Clinical Reasoning Process
The clinical reasoning process is described as having eight phases, each with a specific activity and outcome that leads to the next:
- Observe: Carefully observe the patient and their symptoms, listing what is seen.
- Collect: Collect detailed information that includes the patient’s medical history and current status.
- Process: Review and assess that information in order to create the most optimal treatment plan or regimen.
- Decide: Decide on the best plan for diagnosis, treatment, and/or prevention based on the analysis that has been performed in previous steps.
- Plan: Create a detailed treatment plan (at this stage, input from a treatment team may be optimal).
- Act: Implement the treatment plan.
- Evaluate: Review the plan to see if it is effective and performing as needed.
- Reflect: Review outcomes to see if the treatment plan needs additional work, or if it is producing the desired result. Input this information into the patient’s record.
Clinical Reasoning in Nursing
Clinical reasoning is seen as the best way for nurses and other clinicians to capture a vast and growing amount of data around a patient, sift through it for the most important elements in regard to the presenting care issue or issues, and then act upon it. Without clinical reasoning, or some other mechanism that acts in a similar fashion, the risks include failure to identify a care issue, failure to implement needed care, and inefficient management of staff and facility resources.
Clinical Reasoning Is Not Without Potential Peril
Even so, clinical reasoning should not be seen as a standalone way to get everything right in patient care. For instance, if a provider becomes committed to a specific feature in the patient’s current condition or medical history, he or she may determine a course of treatment too early and overlook other factors that indicate something else may be occurring as well. This is known as confirmation bias, when evidence supporting a diagnosis is sought rather than the reverse.
Clinical Reasoning Issues
Other slip-ups around clinical reasoning include:
Attribution errors: Focusing on patient behavior for illnesses rather than exploring the entire set of circumstances that may be involved.
Overconfidence bias: A caregiver’s thinking he or she knows more than they do and acting on intuition or hunches rather than the data at hand.
Premature closure: Checking off all the boxes and moving on rather than assessing each and every element of the forming treatment plan.
Just like anything else in healthcare (or most any other profession), clinical reasoning only works if a thoughtful, deliberate, and well thought out approach is taken. A literal rush to judgment can impair the treatment’s success as well as have negative consequences for the patient and providing institution. This is a learned skill, and one that is highly desirable and effective once it is mastered—and that takes time.