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

Clinical reasoning has been identified as a necessary skill for practice in 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. This analytical process of clinical reasoning is more developed in experienced nurses in contrast to novice nurses. Through the qualitative lens of the researcher, the purpose of this study was to describe the evolving pattern of clinical reasoning in senior baccalaureate nursing students as part of the decision-making process. A second purpose was to explore the meaning of clinical reasoning.

Newman’s theory of Health as Expanding Consciousness served as the theoretical framework to study the phenomenon of clinical reasoning. Newman’s Research as Praxis methodology was used to collect and analyze data. Individual interviews were conducted with seven participants. The researcher entered a dialectical approach to uncover patterns of clinical reasoning at important choice points in the participants’ lives. Together with the participants, the researcher gained an understanding of how the participants made decisions through the clinical reasoning process.

Patterns of individual participants and across participants were examined to gain an understanding of the whole pattern of clinical reasoning. The patterns of relating, knowing, and decision-making emerged in the participants and contributed to the evolving pattern of clinical reasoning. The meaning of clinical reasoning for these participants was establishing a relationship with a patient to interact and connect with them. Through formulation of a connection and trusting relationship, participants gained information to make clinical decisions that facilitated a transformation. The evolving pattern of clinical reasoning was a maturing process over time as the participants gained insight and expanded consciousness through multiple experiences and interactions with members of the interdisciplinary team and the instructor.

Implications for nursing science and research include that pattern recognition by the participants in nurse-patient interaction substantiate empirical support for the Health as Expanding Consciousness theory. The findings broadened the theory to how students think in the clinical area. In both education and practice prolonged engagement facilitates nurse-patient interaction to learn patient patterns. Collaboration with members of the interdisciplinary team inspires the understanding of another’s thinking process. A consistent clinical instructor with whom the participants engaged in a trusting interaction may facilitate a free exchange of thought that enhances decision-making. In practice, interaction between experience and novice nurse mentorship supports the development of clinical reasoning. In both education and practice, increase in complexity of assignments over time with choice points provide opportunities for students and novice nurses to make clinical decisions.