Clinical reasoning cycle

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Clinical Reasoning Cycle

3801NRS: Advanced Clinical Decision Making

Discharge Planning

Nurses play a crucial role in the discharge of patients and the continuation of care and medication at home involves the measures addressed by a clinician prior to the patients leaving the hospital. The measures are made relevant from the reasoning and factual outcome of the deliberations by clinicians (Pretz & Nolse, 2011). In this context, effective clinical reasoning promotes nursing practice by enhancing the quality of care and treatment, which in turns results in improved recovery process. The essay outlines the importance behind effective clinical reasoning in the discharge of the duties of a nurse. To actualise this concept, this essay looks into a firsthand case scenario that happened during my placement that involved the discharge of a patient with mental health disorder. By use of the clinical reasoning cycle, factors that impact on the decision making processes in the clinical settings will be evaluated.

Effective decision making plays a great role in the overall realisation of patients’ recovery and safety. The failure of a clinician or nurse to consider the efficiency and accuracy of their clinical reasoning, the safety of a patient is put at stake (White 2014). Clinical reasoning in health care settings involves collecting cues, processing the information and coming to an understanding of the problem facing a patient, then plan and implement interventions, evaluate outcomes while reflecting on, and learning from the process (Levett-Jones et al., 2010). These stages are key aspects in the clinical reasoning and nurses are bound to put them to practice to achieve quality practice. As a key competency skill, effective thinking enhances clinical reasoning and relates to self-appraisal, professional development and valuing evidence based practice. Subsequently, as per the Nursing and Midwifery Board of Australia (2010), having a critical reflection the nursing practice, feelings and beliefs, coupled with the consequences that arise is also a key professional standard which enhances the recovery of a patient. The figure below outlines the eight stages of clinical reasoning by Levett-Jones that form the basis of this discussion.

Clinical reasoning cycle

Figure showing the eight stages of the clinical reasoning cycle (Source; Levett-Jones, 2012).

Prior to the discharge of a patient, critical consideration of the patient’s situation is necessary to ensure proper post hospital care at home. Failure to give consideration to the patient’s situation results in jeopardising the safety and subsequent recovery of patient resulting to re-admission (White, 2014). Clinicians are also at liberty to collect cues and information that is relevant to the case scenario at hand. With the right information, nurses are able to understand the patients’ conditions, as well as any other underlying issues that may affect the recovery process. With clear processing of information, there is need to identify problems or issues that may hinder recovery of a patient once discharged (Graham, Gallagher & Bothe, 2013). The issues at hand will involve the need for observation, constant care and prompt taking of medication for patients with mental cases. Due to memory problems or disregard of the need to take medication, there is need for a patient to be monitored whether they are taking their medication promptly (Ryan, 2013). Thus, a nurse is required to establish the availability of persons to offer such assistance once the patient is discharged.

Planning is aimed at realising certain goals and objectives with a professional practice. In clinical reasoning, the ability of a nurse to reason effectively is a critical factor in the provision of care, as well as subverting the occurrence of adverse patient outcomes (Ryan, 2013). Every practice is expected to give rise to specific goals and objectives. After identifying problems and establishing how to overcome them, a nurse is required to establish goals to be achieved in their practice (Levett-Jones et al., 2010). The main goal of a discharge plan of full recovery of a patient, and hence, effective reasoning is required to ensure the realisation of this goal. Actions to be taken will involve engaging the social worker in the event of patient having no carers to check on their recovery process at home (White, 2014). This will be followed by outlining expected outcomes after discharge of the patients to lay out a target to the recovery process. Finally, as a student nurse, reflecting of the discharge planning is necessary for future professional practice as it enhances skills in actual nursing practice.

Clinical practices ensure nurses involve in effective clinical reasoning as well as undertake each case scenario on its own (Graham, Gallagher & Bothe, 2013). The need for having effective clinical reasoning among nurses is apparent in the sense that patients’ outcomes are pegged on the nurses’ practice. Effective planning coupled with engaging in situational reasoning helps to establish the case at hand and coming up with relevant interventions for the care expected (Ryan, 2013). In this case scenario, discharge planning aims at realising full recovery of a patient and avoid disease re-emergence or relapse. The full recovery is a process that is expected to be achieved after discharge, and the home care programme is to be planned by a nurse with a mindset of effective clinical reasoning (Pretz & Nolse, 2011). With determination and active engagement in deliberate practice for continued learning, nurses engage in reflections that enhances their performance in their professional practices. Observation during clinical reasoning is crucial as a clinician is able to acquire all relevant data to draw conclusions and make recommendations on the discharge plan. Failure to have effective observation may result in inconsistencies in the discharge plan hindering patient’s recovery process.

In conclusion, it is apparent that clinical reasoning a learnt skill and nurses are expected to acquire effective reasoning in their professional practice. From the discharge plan based on my experience during the placement practice, profound skills were acquired in respect to the importance of effective clinical reasoning. One key aspect from the experience is that learning to reason effectively as a nurse in the clinical settings does not happen serendipitously. Nevertheless, it occurs with determination coupled with active inclusion of the desire to practice efficiently and engage in effective reasoning. Thus, effective clinical reasoning is continuous learning process in nursing practice.


Graham, J., Gallagher, R. & Bothe, J. (2013). Nurses’ discharge planning and risk assessment: Behaviours, understanding and barriers. Journal of clinical Nursing, 22(15-16), 2338-2346.

Levett-Jones, T. (Ed.) (2012). Clinical reasoning: Learning to think like a nurse. Sydney: Pearson Australia.

Levett-Jones, T., Hoffman, K., Dempsey, Y., Jeong, S., Noble, D., Norton, C., Roche, J. 7 hickey, N. (2010). 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, 30(6), 515-520.

Nursing and Midwifery Board of Australia (2010). National Competency Standards for Registered Nurses.

Pretz, J. & Nolse, V.N. (2011). Nursing experience and preference for intuition in decision making. Journal of Clinical Nursing, 20, 2878-2889.

Ryan, B. (2013). Flipping over: Student-centred learning and assessment. Perspectives in Applied Practice, 1(2), 30-30.

White, K.A. (2014). Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making. Journal of Nursing Education, 53, 14-22.