Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study

Background As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. Objective This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. Design A qualitative exploratory design was used with a think-aloud method. Methods A total of 13 registered nurses (mean years of experience = 11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Results Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was ‘checking accuracy and reliability.’ The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. Conclusions It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion.