Clinical reasoning: concept analysis

Abstract

simmons b. (2010) Clinical reasoning: concept analysis. Journal of Advanced Nursing 66(5), 1151–1158. Title. Clinical reasoning: concept analysis. Aim. This paper is a report of a concept analysis of clinical reasoning in nursing. Background. Clinical reasoning is an ambiguous term that is often used synonymously with decision‐making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Review methods. Rodgers’s evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Results. Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision‐making. Our concept analysis defines one of these terms, ‘clinical reasoning,’ as a complex process that uses cognition, metacognition, and discipline‐specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. Conclusion. This concept analysis provides a middle‐range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.