Nurses’ Clinical Reasoning Process: A Grounded Theory Study

TL;DR

This study explores how nurses make decisions in emergency departments and develops a model to explain their clinical reasoning process.

Contribution

The study introduces a new model of nursing clinical reasoning grounded in emergency care contexts.

Findings

Clinical reasoning involves two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention.

Nurses assess patient severity into two levels: life-threatening and non-life-threatening situations.

The model emphasizes the relational and contextual aspects of clinical decision-making in emergency care.

Abstract

This study examines the clinical reasoning process of nurses working in emergency departments. The resulting Nursing Clinical Reasoning Model highlights the dynamic, contextual, and relational nature of decision making in emergency care.

This study examines the clinical reasoning process of nurses working in emergency departments. The resulting Nursing Clinical Reasoning Model highlights the dynamic, contextual, and relational nature of decision making in emergency care.

What are the main findings?
The Nursing Clinical Reasoning Model conceptualizes clinical reasoning as a dynamic and iterative process.Clinical reasoning is embedded in the nurse–patient–family relationship and is shaped by contextual factors that influence how nurses assess, intervene, and respond to patient needs.

The Nursing Clinical Reasoning Model conceptualizes clinical reasoning as a dynamic and iterative process.

Clinical reasoning is embedded in the nurse–patient–family relationship and is shaped by contextual factors that influence how nurses assess, intervene, and respond to patient needs.

What is the implication of the main finding?
Applying this model in emergency settings may lead to an earlier recognition of patient severity, faster and more consistent interventions, and improved patient safety. It also implies benefits for training and protocol development by clarifying the subprocesses that underpin nurses’ decision making.

Applying this model in emergency settings may lead to an earlier recognition of patient severity, faster and more consistent interventions, and improved patient safety. It also implies benefits for training and protocol development by clarifying the subprocesses that underpin nurses’ decision making.

Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients’ clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: “How do nurses enact the clinical reasoning process in emergency departments?” The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses’ clinical reasoning determines two levels of patient severity—Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)—according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse–patient–family relationship and is shaped by the specific care context, which influences nurses’ assessments and interventions and patients’ responses and behaviors.

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