Reasoning like a doctor or like a nurse? A systematic integrative review

Frontiers in Medicine

Medicine

Jos Dobber¹  Eugène J. F. M. Custers²  Marcel E. Reinders³  Sunia Somra⁴  Hans Ket⁵  Rashmi A. Kusurkar⁶  Jettie Vreugdenhil⁷ 

[1] Center of Expertise Urban Vitality, Faculty of Health, Amsterdam School of Nursing, Amsterdam University of Applied Sciences, Amsterdam, Netherlands;Faculty of Educational Sciences, Open Universiteit, Heerlen, Netherlands;Family Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands;GGD Haaglanden, The Hague, Netherlands;Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands;Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands;Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands;Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands;Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands;VUmc Amstel Academie, Institute for Education and Training, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands;Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands;

关键词: clinical reasoning;    nursing;    medical;    practitioners;    layered analysis;    concept analysis;    interprofessional education;   

DOI  :  10.3389/fmed.2023.1017783

 received in 2022-08-12, accepted in 2023-02-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.

【 授权许可】

Unknown   
Copyright © 2023 Vreugdenhil, Somra, Ket, Custers, Reinders, Dobber and Kusurkar.

【 图 表 】

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