volume 34 number 2 / February 2019 / 37 nursingstandard.com | PEER-REVIEWED | communication / CPD evidence & practice Permission To reuse this article or for information about reprints and permissions, contact permissions@rcni.com Abstract Clinical reasoning and effective communication are fundamental skills for nurses working at an advanced level of practice. Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient’s presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment. This article explores the concept of clinical reasoning in advanced practice and outlines the various approaches that nurses can take. It also details the role of effective communication in advanced practice. A case study is used to demonstrate the specific stages involved in clinical reasoning. Author details Julian Barratt, head of post-registration education, Institute of Health, University of Wolverhampton, Wolverhampton, England Keywords advanced practice, clinical reasoning, communication, diagnosis, differential diagnosis, interpersonal skills, practice development, professional issues Aims and intended learning outcomes This article aims to develop nurses’ understanding of problem-solving and effective communication in advanced practice using a clinical reasoning approach. After reading this article and completing the time out activities you should be able to: » Understand the concept of clinical reasoning and its role in advanced practice. » Explain the various approaches to clinical reasoning. » Understand the role of effective communication in clinical reasoning. » Outline the stages model of clinical problem-solving. » Reflect on your practice and how your clinical reasoning could be enhanced. Introduction Clinical reasoning and effective communication are fundamental elements of practice for nurses working at an advanced level, such as nurse practitioners, enabling them to identify the nature and severity of patients’ presenting conditions. Clinical reasoning is a complex process that uses cognition and specialist knowledge to collate and analyse patient information, evaluate its significance and guide practice (Simmons 2010). The specialist knowledge required by advanced-level nurses includes (Johnson and Webber 2015): » Applied knowledge of pathophysiology, including diagnostic indicators of disease. » History-taking and clinical examination skills. » Specific cognitive skills such as reflective enquiry, analysis, synthesis and evaluation. » Self-awareness to reflect on one’s clinical limitations and respond to unexpected and inconsistent clinical findings. Clinical reasoning underpins the process of establishing differential diagnoses, making prescribing decisions such as initiating a new medicine, altering the dosage of an existing medicine, or discontinuing a medicine (Royal Pharmaceutical Society 2016). The process of clinical reasoning may vary from nurse to nurse or on a case-to-case basis, depending on the nurse’s clinical experience, knowledge base, Citation Barratt J (2018) Developing clinical reasoning and effective communication skills in advanced practice. Nursing Standard. doi: 10.7748/ns.2018. e11109 Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software Correspondence Julian.barratt@wlv.ac.uk Conflict of interest None declared Accepted 12 March 2018 Published online December 2018 Why you should read this article: ● ● To understand the role of clinical reasoning in establishing differential diagnoses and supporting shared decision-making regarding treatment ● ● To enhance your awareness of the importance of effective communication in clinical reasoning and optimum patient care ● ● To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) ● ● To contribute towards your professional development and local registration renewal requirements (non-UK readers) Developing clinical reasoning and effective communication skills in advanced practice Julian Barratt