Clinical Reasoning and Critical Inquiry
Professional nurses are expected to deliver patient-centered, safe, quality care while working as members of collaborative interprofessional teams. In addition, they act as transformative change agents for patients and health care at microsystem and societal levels (AACN, 2008; Institute of Medicine of the National Academies [IOM], 2010, 2011). To do this requires nurses to “integrate reliable evidence from multiple ways of knowing to inform practice and make clinical judgments” (AACN, 2008, p. 16). “Nurses need multiple ways of thinking, such as clinical reasoning and clinical imagination as well as critical, creative, scientific, and formal criterial reasoning” (Benner, Sutphen, Leonard, & Day, 2010, p. 85) in order to fulfill their professional roles and potential. This curriculum incorporates many ways of knowing in student learning experiences but emphasizes clinical reasoning and critical inquiry as cornerstones of evidence-based nursing practice.
Clinical reasoning is “the practitioner’s ability to assess patient problems or needs and analyze data to accurately identify and frame problems within the context of the individual patient’s environment” (Murphy, 2004, p. 227). Inherent in clinical reasoning is practical reasoning, enhancing nurses’ basic analytic processes with evidenced, reflective clinical judgment, which also takes into account the unpredictable, ever-changing nature of patient care situations and contexts (Benner et al., 2010; Sullivan & Rosin, 2008).
Critical inquiry is a process involving examining existing assumptions, knowledge, and questions, gaining (and creating) new information, and acquiring new perspectives. It then requires using critical analysis to reflect, take action, examine responses, and share learning with others (Jennings & Smith, 2002). Critical inquiry skills allow a person to identify a problem, propose solutions, find evidence for and against proposed solutions, and evaluate the solutions based on this evidence (Suthers, 1997). Critical inquiry assists students to examine and challenge the status quo and the power relations that produce inequalities, in ways that can lead to advocacy and community action (Wright, 2004).
Learning to think and act like professional nurses involves using clinical reasoning and critical inquiry with elements of reflective judgment resulting in a reasoned, analytic cyclical process which incorporates scientific evidence, objective thought, contextual elements, values, and ever-changing conditions. Teaching students to reason and “think like a nurse” (Benner et al., 2010, p. 85) involves elements of focused reflection, written and/or verbal articulation of thoughts, assignments that connect new experiences to existing knowledge, critical inquiry, creative thinking, and nursing judgment.