COMPONENTS OF CLINICAL REASONING
NURS 491 - Nursing Management (D)
Liberty University
Name
2022
Clinical reasoning is the analysis of a clinical situation as it unfolds or develops. It requires the nurse to
use cognitive and metacognitive processes. Cognitive processes are the thinking processes based on the
knowledge of aspects of client care. Cognitive skills are learned through reading and applying health-
related literature. Cognitive skills are enhanced through the use of critical thought to understand and
apply content the nurse has previously learned.
Metacognitive processes include reflective thinking and awareness of the skills learned by the nurse in
caring for the client. The nurse reflects on the client’s status, and through the use of critical thinking
skills determines the most effective plan of care. Benner, Sutphen, Leonard, and Day (2010) state that
thinking like a nurse requires clinical reasoning (p. 85). They identify clinical reasoning as the ability to
reason about a clinical situation as it unfolds (p. 46). It is important for the nurse to be “tuned in” to the
client’s experiences and concerns. As the client’s condition changes, the nurse must assess the client
and then identify the interventions that will lead to the improvement of the client’s health-related
outcomes.
Changes in a client’s condition can occur in an instant. It is the responsibility of the nurse to detect these
changes, implement nursing assessments and interventions, notify members of the health care team,
and evaluate the client’s response. Benner et al. (2010) describe the components of clinical reasoning to
include setting priorities, developing rationales, learning how to act, clinical reasoning-in-transition, and
responding to changes in the client’s condition. It is also important to reflect on the care provided and
the client’s response.
Setting Priorities
In the current nursing world, nurses have to think quickly to resolve problems. In the often fast-paced
clinical environment, the nurse must know what assessments, tasks, requests, and concerns need to be
completed first. Priority setting needs to be dynamic or flexible because the clinical environment can
change quickly, requiring changes in priorities. Beginning nursing students often view everything as
being of equal importance. They are often task oriented and focused on what needs to be done and not
necessarily on what is most important.
As they gain more clinical experience, they start to determine which data are most relevant and
important to each client’s situation. Most nursing programs require beginning students to complete
preclinical preparation. This is a strategy to help them set their priorities based on information they
gathered before the actual clinical experience. It is important for students to remember that, once they
begin providing client care, the priorities they set in the preclinical preparation may change based on the
current client situation. See Box 10–3 for examples of questions for nursing students to ask themselves
before and during client care that will help increase their clinical reasoning abilities.
Developing Rationales
After assessing the data and determining what is relevant to the client’s condition and concerns, the
nurse identifies interventions and sets priorities for the most urgent needs (Benner et al., 2010). This is
when the nurse transfers nursing knowledge to the clinical situation to justify the plan of care. Nursing
students are often asked to explain the “why” of their priority setting and subsequent interventions.
Being able to state the rationale, based on nursing knowledge, acts as a check for potential errors,
justifies the nurse’s actions, contributes to client safety, and helps the beginning nursing student learn
how a nurse thinks in practice.
Learning How to Act
The nurse must know how and when to respond in a clinical situation by recognizing what is most urgent
or significant. To take action, the nurse needs to understand the relevant medical and nursing
information and translate this knowledge into a plan of care (Benner et al., 2010). An example is thinking
about potential complications given the client’s current problems. Applying this knowledge increases the
nurse’s ability to quickly identify assessment data that indicate a potential complication. Thus, the nurse
can initiate nursing interventions or actions quickly because he or she prepared for the possibility.
Avoiding potential complications promotes client safety.
Clinical Reasoning-in-Transition
It is important to realize that clinical situations are complex and always changing, especially given the
acuity level of clients in today’s hospital settings. Clinical reasoning-in-transition is the ability to
recognize subtle changes in a client’s condition over time. It includes the evaluation of nursing
interventions and the trending of relevant assessment data. Nurses need to develop a sense of what is
most important in each changing clinical situation and remember that the primary focus is on the
client’s well-being.
Responding to Changes in the Client’s Condition
Nurses spend more time with clients than do other health care providers. As a result, an important
aspect of nursing practice and the nurse’s responsibility is to detect changes in the client’s condition,
recognize a change in priorities, adjust nursing care, and alert the primary care provider when
appropriate. Clinical reasoning involves an understanding and assessment of the client’s relevant history
and current condition and how it may be changing. By closely monitoring and comparing any changes
from previous assessment data, the nurse is able to recognize a change in status that may prevent an
adverse outcome.
Reflection
Reflection is a key to the success of clinical reasoning. Through reflection the nurse identifies factors
that improved client care and those that required changing or elimination. It is important to reflect on
whether the client was assessed accurately and in a timely manner. The nurse thinks back on the
interventions implemented and whether they were effective. Most importantly, reflection includes
information on the outcome of care. The nurse also reflects on previous clinical experiences similar to
this one to determine if the outcomes of care improved the clients’ conditions.
