Effective Clinical Reasoning: A Case Study

Registered nurses perform a fundamental role in caring for a surgical patient. Effective clinical reasoning involves a method of planning and implementing interventions by processing information, collecting cues, understanding the patient situation, evaluating the outcomes and reflecting and learning from the procedure performed. ‘Failure to rescue’ is one of the key causes of adverse patient outcomes due to nursing compliance, the advances in medical technology, more complex conditions being faced and the increased patient to nurse ratios. Throughout this assignment, a patient has been admitted to hospital for a left knee replacement. This discussion will relate to the appropriate nursing actions performed by a nurse in order to prevent post-operative complications and promote discharge planning.

As a registered nurse on any shift, critical thinking is used within each medical situation.

Clinical reasoning has been defined by Tanner (2006) as ‘a process by which nurses make clinical judgements by selecting from alternatives, weighing evidence, using intuition and by pattern recognition’. It involves the judgements of what is wrong and clinical decision-making of what to do (Levett-Jones et al.,

2010).

A nurse performs clinical reasoning performs through their level of ability. This is determined by various factors such as person attributes, culture and context of care, motivation, education, the nurses' level of experience and the understanding of the individual patient (Alfaro-LeFevre, 2009). When a nurse is caring for a patient post knee replacement, they will need to carry out the appropriate nursing actions for this patient. Vital signs must be monitored every four hours to determine the patient's cardiovascular status and provide any early indications if there is any post-operative complication arising (Levett-Jones et al., 2010). As this patient has had surgery on a limb it is important that neurovascular observations are conducted hourly for the first 12 to 24 hours. These checks will outline the temperature, colour, movement, sensation and pulses and capillary refill of the affected extremity (Levett-Jones et al., 2010).