Holder Amy Golden
East Tennessee State University, Nursing, P.O. Box 70551, Johnson City, TN, USA.
Int J Nurs Educ Scholarsh. 2018 Nov 7;15(1):/j/ijnes.2018.15.issue-1/ijnes-2016-0024/ijnes-2016-0024.xml. doi: 10.1515/ijnes-2016-0024.
Clinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.
临床推理是护士用于收集信息并将其整合到更广泛的个人知识体系中的认知过程。这种整合后的信息指导治疗行动，并有助于确定患者护理方案。由于该过程指导与患者护理相关的治疗行动，未能有效运用该过程会导致临床决策不佳、行动不当或不作为。鉴于此过程的关键性，本文对文献进行了分析，揭示了临床推理科学的现状，找出了知识空白，并阐明了未来的研究领域。对护理及相关健康文献累积索引数据库（CINAHL）、教育资源信息中心（ERIC）、心理学文摘数据库（PsychInfo）、教育全文数据库（H.W. Wilson）和医学期刊数据库（PubMed）进行的系统综述显示，有873篇关于临床推理主题的文章。质量评估将范围缩小至27篇文献。附录A给出了用于确定本研究中所选用文献的科学现状编码表。附录B包含了这些文献的总结。尽管对这些文献的分析表明，目前关于如何最有效地运用临床推理过程存在三种理论；但缺乏清晰一致的定义。进一步的研究应聚焦于弥合在定义该过程、理解该过程、建立与非临床推理过程的联系以及制定培养和准确衡量临床推理的措施方面存在的差距。
