Nurses' Clinical Reasoning Process: A Grounded Theory Study

Background: Nurses' clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients' clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: "How do nurses enact the clinical reasoning process in emergency departments?" The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses' clinical reasoning determines two levels of patient severity-Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)-according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse-patient-family relationship and is shaped by the specific care context, which influences nurses' assessments and interventions and patients' responses and behaviors.