Use of clinical judgment and reasoning by clinical nurses in delivering high-quality patient care while preventing negative outcomes and patient harm is investigated in connection to different ways of thinking.
Higgs (2008) defines clinical reasoning as “an inferential procedure utilized by practitioners to gather and assess evidence and make decisions regarding the diagnosis and management of patient problems. Basically, it happens as a medical practitioner interacts with a patient. During this process, the therapist gathers data, develops and tests hypotheses, and then uses this data to determine the best course of action for diagnosis and therapy.
Clearly, clinical reasoning is connected to other crucial skills, such as physical examination and communication skills, and it relates to the delivery of high-quality patient care. In taking the OSCE, what role does clinical reasoning portray?
Clinical Reasoning in OSCE
As Objective Structured Clinical Examination tests the readiness of aspiring nurses, it is crucial that they are able to clearly and objectively give clinical reasons for any circumstance in the test.
Since OSCE is used to rate healthcare practitioners in a clinical context, it evaluates the healthcare professional’s performance, like communication skills and the capacity to deal with unpredictable patient behavior. In the context of actual practice, unpredictable circumstances are unavoidable thus requiring sound judgment and reasoning for the situation.
During the examination, aspiring nurses are placed in a simulated clinical environment. They will be tested on their knowledge and skills in their field and be observed on their reasoning for emerging situations. This displays that aspirants are expected to place themselves within a web of connections, with concerns constrained by the circumstances should they become practicing nurses in the future.
Clinical Reasoning in Nursing
Clinical reasoning is relatively straightforward in concept, but it can be challenging and error-prone in reality. Clinical reasoning aims to eliminate deception (Jones, 1995). Thus that the threshold of suspicion of significant pathology is at an adequate level, and a strong clinical reasoning process is essential (Greenhalgh, n.d.).
How a nurse clinically justifies their conclusions can have a significant impact on how the case is viewed. This has an impact on how the nurses interpret any warning signs and provides credence to any red herrings that may be raised.
Experience affects how quickly and effectively nurses can use clinical reasoning. The process may be challenging for inexperienced nurses, but an experienced nurse should rely on her intuition and take prompt action.
Five Dimensions of Clinical Reasoning
In their study, Levett-Jones et al. (2009) identified five rights to clinical reasoning These ‘rights’ include right cues, right patient, right time, right action, and right reason.
- Right Cues
Cues are recognizable physiological or psychosocial changes that the patient experiences, are noticed through history or evaluation, and are understood in light of a certain body of information and set of philosophical principles (Levett-Jones et al, 2009). Additionally, the care setting and the surrounding clinical situation also add to the cues.
In terms of OSCE, nursing aspirants can be challenged to notice the right cues for it calls on them to be able to synthesize and apply their knowledge to clinical circumstances, which are frequently complicated and fluid. As such, they must hone how to pay attention to pertinent cues and contextual issues, how cues influence clinical judgments, and how accurate cue collection affects patient outcomes (Benner, 2001).
- Right Patient
In this context, a patient at risk for a critical disease or a catastrophic adverse event is referred to as the “right patient” (Levett-Jones et al, 2009). The ability to recognize and prioritize patients in need of urgent treatment is a skill that nursing students must develop especially in the field of practice.
In contrast, Tanner (2006) argues that background information and relationships with patients serve as the foundation for nurses’ initial understanding of the clinical situation; clear physiological parameters must also be understood if the “correct” patient is to be identified quickly.
- Right Time
The ability of a nurse to quickly recognize patients who are clinically at risk and to carry out nursing interventions at the appropriate time and in the appropriate order is referred to as acting at the “right” moment (Levett-Jones et al, 2009).
Expertise has an impact on how long it takes to make a choice (Hamers et al., 1997). Thus, aspiring nurses who are taking the OSCE must have multiple simulated situations to have more chances to practice clinical reasoning.
- Right Action
Nursing “action” refers to “the behavior that results from a judgment or decision” (Thompson and Dowding, 2002, p. 14). Practical skills, intellectual activities, and communication abilities make up this dimension of clinical reasoning (Levett-Jones et al, 2009) During OSCE, nursing aspirants must choose which aspect of the plan is most important, who is best suited to carry out the nursing action/s, what procedures and rules apply, and who needs to be informed when.
- Right Reason
There are several implications when thinking about the “right reason.” In this context, “right” refers to the use of ethical, legal, and professional reasoning in addition to the proper use of reasoning processes (Levett-Jones et al, 2009). The underlying rationale is what constitutes the “right” argument; it does not only refer to the process of thinking.
This can be seen, for instance, in nurses’ CRs connected to fall prevention, when the need for speed and finishing duties took precedence over patient safety in the decision-making process (Dempsey, 2004).
If the ‘five rights’ of clinical reasoning are not well-managed and understood, assessments may put the clinical situations and patients at risk. Aspiring nurses are encouraged to be guided and master the dimensions of clinical reasoning.
Where can you practice and enhance your clinical reasoning?
Reasoning happens almost in every aspect of our life. In medical situations, reasoning particularly referred to as clinical reasoning requires expertise and experience to achieve near to perfect accuracy.
For aspiring nurses, the best way to practice and enhance their clinical reasoning for the OSCE is to enroll in a nursing review center. This allows multiple chances to encounter possible situations in the field and possible scenarios that will happen during the test.
Being one of the top nursing review centers in Australia, AuRNPathway constantly checks and perfectly aligns its course to prepare enrollees to pass the OSCE by providing multiple medical simulations which test their knowledge, skills, and reasoning. The earlier you enroll, the better the outcomes will be. Enroll with us now at AuRNPathway, and be at your best clinical reasoning for the OSCE test!
References:
Higgs J, Jones M. Clinical decision making and multiple problem spaces. In: Higgs J, Jones MA, Loftus S, Christensen N. Clinical reasoning in health professions. Amsterdam: Elsevier;2008. p. 4-19.
Jones, M. Clinical reasoning and pain. Manual Therapy. 1995; 1:17-24.
Dempsey, J., 2004. Falls prevention revisited: a call for a new approach. Journal of
Clinical Nursing 13, 479–485
Greenhalgh, S. Red Flags, and clinical Presentation Mapping. Available from: https://macpweb.org/home/index.php?m=file&f=873. (accessed 21 October 2008)
Levett-Jones, T. Hoffman, K. Dempsey, J. Yeun-Sim Jeong, S. Noble, D. Norton, C.A. Roche, J. Hickey, N. 2009. The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today: 515–520. DOI: 10.1016/j.nedt.2009.10.020
Tracy Levett-Jones. Kerry Hoffman a,1, Jennifer Dempsey b,2, Sarah Yeun-Sim Jeong b,3, Danielle Noble a,4, Carol Anne Norton b,5, Janiece Roche a,6, Noelene Hickey b,7
Benner, P., 2001. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Prentice Hall, Upper Saddle River, NJ.
Tanner, C., 2006. Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education 45 (6), 204–211
Hamers, J., van den Hout, M., Halfens, R., Abu-Saad, H., Heijltjes, A., 1997. Differences in pain assessment and decisions regarding the administration of analgesics between novices, intermediates, and experts in pediatric nursing. International Journal of Nursing Studies 34 (5), 325–334.
Thompson, C., Dowding, D., 2002. Clinical Decision Making and Judgement in Nursing. Churchill Livingstone, Sydney
