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A Descriptive Overview Of Clinical Reasoning Cycle -

A Descriptive Overview Of Clinical Reasoning Cycle

Amanda Haynes has always dreamt of making a career in the field of nursing. But once she started pursuing her degree in nursing, she realised it’s a lot more demanding than she had thought. She had to deal with many complicated topics while studying and one of them is clinical reasoning cycle.

Like Amanda, if you wish to have a flourishing career in nursing or medicine you need to have complete clarity on this topic. On that note, we have tried to explain some crucial aspects about clinical reasoning cycle to simplify the topic even further for you.

What is Clinical Reasoning?

In general terms, clinical reasoning, clinical judgment, decision making and critical thinking are often implemented interchangeably. The term clinical reasoning is used to describe the process by which nurses (and other clinicians) collect the details, process the information, derive the understanding of a problem of the patient, plan and implement interventions, assess outcomes, and reflect on and learn from the process.

The clinical reasoning process is relies on critical thinking and is influenced by an individual’s attitude, philosophical perspectives and conceptions. Clinical reasoning isn’t a linear process but can be conceptualised as a series of linked and ongoing clinical encounters.

Different Stages of the Clinical Reasoning Cycle

There are precisely eight stages of clinical reasoning and the interesting thing to note here is that this process, though divided into stages, is inter-connected. In reality, one does not always move from one stage to the other, but instead move back and forth from one step to another until a proper evaluation of a patient’s health status is put together.

1. Consideration of the facts from the situation or patient

This is the stage where you’re first presented with a clinical case. Here you receive the background information and prevailing medical status of the patient. For instance, a new-born admitted in the NICU on account of neonatal jaundice.

2. Gathering relevant details

At this stage, you must think about the past medical history of the patient, the history of persistent complaints, the present treatment plan, outcomes of treatments done, and the persisting vital signs. Then, you’ll need to analyse the findings with the help of your knowledge of physiology, pathology, pharmacology, culture, and ethics, to develop connections and draw information.

3. Processing the information accumulated

This is a crucial step and the mainstay of clinical reasoning. At this step, you process the details on the patient’s present health status in relation to pharmacological and pathophysiological patterns, understand what details are relevant, and check the potential outcomes for possible decisions you make.

4. Recognise the problem

After you have gone through information processing phase, you will be able to find out the reason behind the patient’s present situation.

5. Establish proper goals

At this point, you determine the treatment goals for the patient’s situation. Treatment plans must not be open-ended or without a time-oriented goal. Know what stage to take, and how fast you want the desired results.

6. Take adequate action

Now, you implement proper action and adequate steps needed to meet the patient’s treatment goals. This stage will involve other members of the healthcare team, so everyone has to be updated about the treatment goals for the particular patient.

7. Evaluation

At this stage, you analyse the efficacy of the course of action you have implemented. This will let you decide whether to readjust or continue the course you’re following.

8. Reflection

This phase of clinical reasoning strengthens your skill. At this point, you will reflect on new aspects you’ve learned about the case, what you could have changed to achieve a better outcome, or what should must be avoided in similar secanarios in the future.

Moving through these phases of the clinical reasoning cycle will foster problem-solving and decision making, enabling you as a health care professional to offer the best possible care for your patients.

The Significance of Clinical Reasoning

In order for medical or nursing students to deal with complicated medical situations effectively and successfully, a proper understanding of the clinical reasoning process is a mandatory. Clinical reasoning is often perceived as the most significant aspect of a clinician’s skill set because it has the power to decide the result of patient care.


Inadequate clinical reasoning skills often lead to a failure to deliver appropriate or satisfactory health care. The three most commonly acknowledged reasons for adverse or undesired patient care outcomes are:

  • Inability to implement relevant medical treatment(s).
  • Failure to recognise the accurate diagnosis.
  • Ineffective management of medical complications.

With proper clinical reasoning skills, accurate patient care can be carried out instinctively, increasing the possibility of enhanced quality of care. However, it’ll take a lot of practice.

Today, medical practitioners can develop their clinical reasoning skills with comprehensive courses designed specifically for them.

The Types of Clinical Reasoning

Clinical reasoning is known to be a process that guides the practice. Now, let’s focus on the types of clinical reasoning that the students have to learn in theory.

1. Narrative reasoning

Narratives are the stories you develop about your patients. In a way, you’re opening up a particular chapter in a patient’s life. There are chapters behind him/her, and then there are chapters still to come. With narrative reasoning, the patient becomes the main character. The individual’s experience and situation turns out to be the focus.

Narrative reasoning is the umbrella for all other types of reasoning (except pragmatic reasoning). It guides the other types of reasoning. The contents of the other types can be organised, saved, and shared through narrative reasoning. The patient’s story unfolds with narrative reasoning. Sometimes what happens along the way in a patient’s story is just as significant as where the story goes.

2. Procedural Reasoning

This is the easiest for most medical or nursing students to understand. There are a few reasons for this:

Procedural is the “how to” of the clinical reasoning process. In this process, you may find something wrong, you try to fix it. The focus is on the ailment itself an you will have to draw on your knowledge of diseases and conditions to ward them off. Things like identification of the problem, setting goals, and intervention planning all fall under this type of reasoning.

3. Interactive Reasoning

This type of reasoning focuses on the patient as a person. By using this type of reasoning you can try to understand the person better, and can appreciate the experience for the patient with the illness. This kind of reasoning “humanises” the health conditions that you identified through your procedural reasoning. Some reasons why a health care provider might use interactive reasoning include:

  • Engaging the patient in the intervention session
  • Getting to know the patient as a person
  • Learning about the ailments from the patients’ point of view
  • Matching the goals and interventions to the client
  • Conveying a sense of hope, trust, and acceptance to the students
  • Deciding if the intervention is going well

4. Conditional Reasoning

This is the most complex type to decipher. As per various studies, conditional reasoning requires experience, but students will obviously lack behind in this aspect. The seasoned healthcare practitioners at the expert level generally possess the thorough knowledge about this type.

Conditional reasoning can be recognised as the multidimensional process that involves critical thinking. The medical practitioners reflect on the success/failures of the interactive and procedural reasoning. The expert perceives what the future of the patient would be like, and is able to revise the treatment to suit their vision. The thought process moves beyond the present to a deeper level of interpretation of the individual as a whole.

  • Have you ever had difficulties while deciding where your patient will be in a few years down the road?
  • Have you ever grappled with what realistic long-term objectives might be for your patients?

Addressing these questions comes with considerable experience, and with conditional reasoning.

5. Pragmatic Reasoning

This type of reasoning doesn’t fall under narrative reasoning umbrella. This type of reasoning considers all the practical issues of treatment. The type is also easy for us to decipher; it is very concrete. In a way, this provides the reality check, because it highlights the limitations that you may face in practice. Some examples include:

  • The treatment environment (physical size, quality and quantity of equipment, amount of interaction with others/privacy etc.)
  • The medical practitioner’s knowledge and abilities
  • The practitioner’s values
  • Insurance coverage/finances available to the patient
  • Patient’s social supports

Pragmatic approach of reasoning may be too obvious. This is probably because the considerations are very concrete. You learn develop intervention plans in an ideal world through this type.

Parting thoughts,

Clinical reasoning cycle is crucial topic that you need to master if you want to become successful in the domain of nursing or medicine. The information provided in the post will help you gain some valuable insights on how the process can be implemented practically while caring for patient.

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