A framework for understanding clinical reasoning in community nursing

Carr, Susan (2004) A framework for understanding clinical reasoning in community nursing. Journal of Clinical Nursing, 13 (7). pp. 850-857. ISSN 0962-1067

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Official URL: http://dx.doi.org/10.1111/j.1365-2702.2004.00959.x


Background: Clinical reasoning is employed to develop solutions to health needs. The impact of the clinical environment on the organization of knowledge-guiding practice has received limited attention. This gap in the clinical landscape restricts the sharing of decision-making processes.
Aims: Focusing on the community, and specifically the patient's home as a context for nursing, this paper describes the creation of a collective conceptual map for a group of community nurses. There is a twofold aim of exploring the process of exposing and articulating the clinical framework and enhancing and sharing understanding of the clinical paradigm in this context.
Design: An interpretive research approach was utilized. Hermeneutic phenomenology guided the level of meaning accessed and constructivism was used to build an educational picture.
Methods: Multiple methods including focus groups, observation and narrative recordings were utilized to collect and analyse research data.
Results: All nurses may engage with the same concepts – health, need, care and partnerships – but organized into particular frames by the guiding practice philosophy and service organization. A four-stage framework for understanding clinical reasoning in the community setting is presented. This acknowledges the multi-faceted nature of health, the lived experience of health deficits, and is located in a participation and negotiated model of care. Practice examples are presented to expose the construction of need and response which often occurs in a triadic decision-making process.
Conclusions: Environment of care has significant implications on need identification and response. Relevance to clinical practice: Mechanisms to enhance the sharing of clinical reasoning and decision-making transparency are essential to aid inter- and intra-professional communication. Presentation of a clinical reasoning framework exposes the breath of 'signals' encountered in practice and the range of knowledge employed in understanding and responding to patient need.

Item Type: Article
Additional Information: This paper is part of a body of related publications, which has led to an invitation to join an editorial board, doctoral examining and CPHVA National Research committee membership.
Subjects: B700 Nursing
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: EPrint Services
Date Deposited: 06 May 2008 15:32
Last Modified: 12 Oct 2019 15:26
URI: http://nrl.northumbria.ac.uk/id/eprint/3247

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