Evaluate factors integral to clinical reasoning.
Scenario
You recently started a new position as a nurse manager in a 28-bed oncology unit. One of the staff nurses who returned from bereavement leave one week prior has been assigned to care for an elderly client, newly diagnosed with stage IV pancreatic cancer. While you are visiting with the client, the nurse completes the assessment. During the client interview, the client requested assistance to set up hospice care, complete an advanced directive, and reach out to their estranged daughter. The nurse stated, "I can get you the paperwork for the advance directive, but I can't call your child for you; I do not specialize in mental health." The nurse leaves the room and asks to speak with you, stating, "I can't care for this client; I need my client assignment changed now or else I will go home."
As the nurse manager, you agree to change the nurse's client assignment and offer to assist the client with their requests. Later, you debrief the nurse regarding their reactions and decisions with this client and make recommendations regarding how the nurse could have responded differently. You write a summary of the events and debrief with the nurse.
Instructions
Compose a written memo of the situation and debrief for the employee's personnel file.
Include the following in the memo:
• Analysis of the cues impacting the responses of the staff nurse and the nurse manager.
• Description of how these cues influenced the clinical decision-making of both nurses, including supporting rationales and examples.
• Prioritized strategies the nurse could use for self-compassion and compassion toward others when demonstrating emotional intelligence, including supporting rationales, examples, and credible resources.
• Alternative responses more appropriate for the nurse and nurse manager, including supporting rationales, examples, and credible resources.
Sample Answer
Clinical reasoning is a complex process that involves gathering and analyzing information, evaluating the situation, and making appropriate judgments to provide safe and effective patient care. For this scenario, I'll evaluate the factors integral to clinical reasoning and compose the requested memo.
Factors Integral to Clinical Reasoning
Clinical reasoning is built upon several interconnected factors, which can be grouped into cognition, metacognition, and contextual awareness.
Cognition (Knowledge and Data Processing)
This involves the factual knowledge base, critical thinking, and the ability to recognize and interpret cues.
Knowledge: A solid foundation of nursing, medical, and psychosocial knowledge is essential. In the scenario, the nurse's knowledge of the scope of practice regarding psychosocial support was inaccurate.
Cue Recognition and Interpretation: The ability to notice significant data (cues) and assign them meaning. The nurse recognized the client's requests but misinterpreted them as solely "mental health" issues outside their scope. The nurse manager recognized both the client's needs and the nurse's distress.
Critical Thinking/Analysis: Systematically examining the evidence. The nurse failed to analyze the client's requests as standard end-of-life care needs.
Metacognition (Thinking About Thinking)
This is the ability to self-monitor, self-assess, and reflect on one's own thinking process and emotions.
Self-Regulation/Self-Awareness: The nurse's recent bereavement heavily impacted their ability to self-regulate, leading to an emotional reaction ("I will go home") rather than a professional one.
Reflection: The nurse failed to reflect in action (during the client interaction) to consider alternative responses. The nurse manager's debrief facilitates reflection on action later.
Contextual Awareness (Environment and Emotional Intelligence)
This relates to understanding the patient's situation and the nurse's own emotional state and its influence.
Emotional Intelligence (EI): This includes empathy (understanding the client's feelings) and self-management (handling one's own feelings). The nurse's personal grief prevented the appropriate use of empathy and self-management.
Patient Context: The client's new Stage IV diagnosis and requests for hospice and advanced directives establish a critical end-of-life care context that requires immediate, compassionate action.
Memorandum
To: Employee Personnel File From: [Nurse Manager Name/Title] Date: October 19, 2025 Subject: Summary of Clinical Event and Debrief with Staff Nurse (Assignment: Oncology Unit)