Health as Expanding Consciousness: Patterns of Clinical Reasoning in Senior Baccalaureate Nursing Students

Clinical reasoning has been identified as a necessary skill to practice nursing.  Multiple studies suggest that a gap exists between the education of nurses and their ability to transition into practice.  In addition to possessing necessary knowledge and skills specific to the discipline of nursing, nurses must possess clinical reasoning skills to think through a situation as the patient’s condition changes.  To make a clinical judgment, nurses use an analytical process that includes pattern recognition, an attribute of clinical reasoning.  Newman’s theory of Health as Expanding Consciousness and Research as Praxis methodology was used to collect and analyze data.  Patterns of individual and across participants revealed the emergence of patterns of relating, knowing, and clinical decision-making as contributing to the evolving pattern of clinical reasoning.   The findings of this study were consistent with Newman’s theory and support the theoretical framework and methodology.  An implication for nursing science was that the nurse-patient interaction broadened the use of this theory to how study participants think in the clinical area.  In nursing education and practice the importance of the nurse-patient interaction and pattern recognition facilitated knowing the patient to make effective decisions.  Trusting relationships with faculty and members of the interdisciplinary team, confirmed participants’ thinking related to a clinical decision.  Future research included a longitudinal qualitative study of the emergence of clinical reasoning over time as participants evolve from novice to experience nurses.  A quantitative study to measure patterns of relating, knowing and decision-making will further clarify the definition of clinical reasoning.