Clinical Reasoning Questions to Promote Nurse Thinking

(Formulate and reflect before and after report, but BEFORE seeing patient the first time)

  1. What is the primary problem and what is the underlying cause/pathophysiology of this problem?

  • What clinical data from the chart is RELEVANT and needs to be trended because it is clinically significant?
  • What nursing priority will guide your plan of care?
  • What nursing interventions will you initiate based on this priority and what are the desired outcomes?
  • What body system(s) will you focus on based on your patient’s primary problem or nursing care priority?
  • What is the worst possible/most likely complication(s) to anticipate based on the primary problem?
  • What nursing assessments will you need to initiate to identify this complication if it develops?

While Providing Care(Review and note during shift after initial patient assessment)

  • What clinical assessment data did you just collect that is RELEVANT and needs to be TRENDED because it is clinically significant to detect a change in status?

  • Does your nursing priority or plan of care need to be modified in any way after assessing your patient?
  1. After reviewing the primary care provider’s note, what is the RATIONALE for any new orders or changes made?
  1. What educational/discharge priorities have you identified and how will you address them?

Caring and the “Art” of Nursing

  1. What is the patient likely experiencing/feeling right now in this situation?
  1.   What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person?
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