Welcome back to Concepts 1, everyone! I'm Emily Harper, joined by Jessica, Fiona, and Michael. Today, we're breaking down clinical reasoning in nursing. It's one of those topics that, honestly, gets confused with critical thinking and clinical judgment all the time. Michael, I know you've got a story about that from your classroom?Oh absolutely, Emily. Happens every semester—I've got new students coming into simulation and, you know, they're using the terms critical thinking and clinical judgment like they're interchangeable. And, well, I get it—they sound similar, right? But there's a big difference. So, just to sort of clarify: clinical reasoning is the thinking process nurses use to arrive at a judgment. It's iterative—think of it as "noticing," "interpreting," "responding," and being finely attuned to how the patient reacts as you go along. I usually reference Giddens and Tanner here; they both break this process down really well. Caputi even says clinical reasoning is about recognizing every patient's unique situation, which I like because, as we know, nursing is never just black or white.That's a lovely way to put it, Michael. And, just to add, critical thinking is more the cognitive process behind analyzing a problem, but it's not necessarily tied to the specific context of a patient. It's knowledge-based, it helps with analysis, but it's... how would you say... more general? Whereas clinical judgment, well, that's actually what comes out at the end—a decision about what the patient needs and what you're going to do. That might mean you follow the rules or you need to improvise a bit, depending on the patient's response.Exactly! So, just to recap for anyone listening and maybe, like, taking notes—the process is kind of like: you start with critical thinking as that broad, cognitive tool, then you use clinical reasoning to apply that thinking to a specific patient, and finally, clinical judgment is the actual conclusion you reach. Oh! And don't forget, the models help us visualize this: Giddens gives us that iterative cycle, Caputi highlights the uniqueness of each situation, and Tanner's model, with "Noticing, Interpreting, Responding, Reflecting"—super practical, in my experience.So, in a way, critical thinking is our toolkit, clinical reasoning is how we use the tools, and clinical judgment is... well, it's whether the bookshelf actually stands up at the end of it all! Sorry, that's a bit of a messy analogy, isn't it? But you get my drift. Michael, did you say your students often mix these up during simulations?Yeah, they do. They'll say, “I used my critical thinking”—but what they're really doing is making a clinical judgment based on the specific patient in front of them. I try to remind them: clinical reasoning is the thinking path, clinical judgment is the destination. Simulation really brings out the gray areas, too—which, like Caputi says, is where actual nursing happens.That makes a lot of sense. I think once folks see how these pieces interact, it gets way less confusing. Shall we dig into how these ideas map onto the steps of the nursing process next?Yeah, let's go for it. So, the nursing process—most folks know the AAPIE steps: Assessment, Analysis, Planning, Implementation, Evaluation. Each of those steps aligns almost perfectly with Tanner’s Clinical Judgment Model, which is all about Noticing, Interpreting, Responding, and Reflecting. Like, Assessment is when we’re “noticing” what’s happening with the patient. Analysis is about interpreting that data—making sense of what you’ve just seen or heard. Planning and Implementation—that’s our response. Finally, Evaluation? Totally the "reflecting" phase: did it work, what would we do differently next time?And those connections show up in real practice, don’t they? I was looking at the two case examples from our lecture—first, there’s the 59-year-old woman post-knee arthroplasty, right? Two days post-op, she’s walking with her walker and suddenly she gets chest tightness, shortness of breath, wants to get back into bed. Vitals show oxygen saturation of 88%, RR 28, pulse 102. Those are your cues that need immediate follow up. That’s us noticing and interpreting at the same time, really.Aye, and if you think about the younger patient—the 28-year-old teacher, feeling “very sick” after her school’s HVAC system failed. She’s got respirations at 30, O2 at 92%, intercostal retractions, bilateral expiratory wheezing, and she’s got known allergies to mold. You see that set of data—you’re not just collecting it, you’re clustering those symptoms and thinking forward to the possible complications, like respiratory distress. Immediate action is needed there as well.Yeah, that’s where digital case studies come in handy. I mentor a lot of nursing students, and we use digital scenarios to practice, like, picking out those critical details. Sometimes, new students focus on numbers that look unusual but aren’t urgent—missing things like low oxygen or signs of respiratory distress. Through interactive cases, they learn to prioritize. For example, everyone remembers their first time realizing that a patient’s anxiety about going home is important but—well, chest pain and an O2 sat of 88% takes priority! I always remind them: use the models as your guide, but keep your eyes open to the whole picture.And that goes back to what we said earlier: clinical reasoning is all about being adaptable, recognizing patterns but also individualizing care. By mapping the nursing process to Tanner’s model, you’re training yourself to be systematic but flexible—which is exactly what you need when things get complicated or messy.One hundred percent, Michael. I think it’s also reassuring for new nurses—they don’t have to reinvent the wheel every time. There’s a structure to follow, but like we discussed in our first episode, autonomy and reflection factor in at every stage.And as we learned in last week’s episode on ethics, reflection’s also key for making sound, morally grounded judgments—not just clinical ones.Right, let’s dig into how we actually apply all this on the floor. One of my favourite strategies is clustering information—looking for patterns in the assessment findings rather than getting distracted by every single data point. I remember, just last year, during some community outreach, we had a post-op patient—he'd had abdominal surgery, was doing quite well at first, but then I started noticing subtle things: a rising temperature, mild tachycardia, a bit of abdominal tenderness. Now, any one of those on its own may not seem alarming, but clustered together they pointed to a possible infection or complication. Getting that early meant we could intervene before things got worse.That’s such a good point, Fiona. And anticipating complications is really where experienced nurses shine. It's about thinking ahead—“What could go wrong here? What clues do I have?”—and planning accordingly. That links really nicely to the SMART goal method too. Goals should be Specific, Measurable, Attainable, Realistic, and Timed. For example, “The patient will breathe unlabored at 14 to 18 breaths per minute by the end of the shift.” That’s way clearer than something like “The patient will be comfortable.”Yeah, and nursing interventions—love this part. They break down into independent, dependent, and collaborative actions. So, like, independent: a nurse raises the head of the bed for someone with shortness of breath, doesn't need a doc's order. Dependent: administering a prescribed medication—needs an order. And collaborative: maybe working with respiratory therapy for a patient with new wheezing. Digital case studies show these differences really well and, honestly, you see how all three types happen constantly in even a single shift.And these skills—we’ve touched on before how they link right back to professional identity and ethics. To be the nurse who catches a complication early, or helps set realistic goals for patients, really ties into that sense of responsibility we talked about in Episode One. And having the confidence and systems to document, reevaluate, and update your care plan—that’s all part of the ongoing cycle. Any final tips before we wrap up?Just that clinical reasoning isn’t something you nail in one go. It’s continuous, and you’ll get better with each patient you see. Reflecting—in the moment and afterwards—really cements what you learn.Couldn’t have said it better myself, Michael. For anyone listening, never be afraid to ask for help or revisit your thinking process. There’s always something to learn, no matter how experienced you become.And keep practicing with case studies and real patient scenarios, even if it’s just running through some mental drills on your commute. That kind of practice makes all the difference.Alright, I think that’s a great place to end for today. We’ll be digging into more Strategies for Evidence-Based Practice in our next episode, so definitely stay tuned. Thanks as always, Jessica, Fiona, Michael—loved this conversation!Thanks, guys, this was awesome as always. See you next time!Take care, everyone, and happy learning!See you all soon—keep reflecting, keep reasoning.

Episodes

Breaking Down Clinical Reasoning in Nursing