A framework for understanding clinical reasoning in community nursing

Area of Science:

• Nursing Science
• Healthcare Management
• Qualitative Research

Background:

• Clinical reasoning is crucial for addressing health needs but its environmental impact is understudied.
• Limited attention to the clinical environment hinders knowledge sharing in decision-making.
• The patient's home as a community nursing context requires specific attention.

Purpose of the Study:

• To explore the articulation of the clinical reasoning framework within community nursing.
• To enhance and share the understanding of the clinical paradigm in home-based care.
• To develop a collective conceptual map for community nurses.

Main Methods:

• Utilized an interpretive research approach guided by hermeneutic phenomenology.
• Employed constructivism to develop an educational picture of clinical practice.
• Collected and analyzed data through focus groups, observation, and narrative recordings.

Main Results:

• Identified that nurses organize concepts like health and care based on practice philosophy and service organization.
• Presented a four-stage framework for understanding community-based clinical reasoning.
• Highlighted that need identification and response are influenced by the care environment and often involve triadic decision-making.

Conclusions:

• The environment of care significantly impacts how patient needs are identified and addressed.
• Mechanisms for sharing clinical reasoning are essential for inter- and intra-professional communication.
• A clinical reasoning framework reveals the complexity of practice signals and knowledge application.