case study clinical reasoning cycle

8 Stages Of The Clinical Reasoning Cycle

Last updated on August 19th, 2023

In this article, we will be exploring the clinical reasoning process and its importance in healthcare.

The clinical reasoning cycle, developed by Tracy-Levett Jones, breaks down this process into eight phases that healthcare professionals can follow to make informed decisions for their patients.

These phases include considering facts, collecting information, processing gathered information, identifying the problem, establishing goals, taking action, evaluating the effectiveness of the action, and reflecting on the experience.

By following this cycle, healthcare professionals can enhance their problem-solving and decision-making skills, leading to better patient care.

Related: Clinical Reasoning In Nursing (Explained W/ Example)

8 Stages of the Clinical Reasoning Cycle

The eight stages of the Clinical Reasoning Cycle are the following.

• considering the patient’s situation,
• collecting cues/information,
• processing information,
• identifying problems/issues,
• establishing goals,
• taking action,
• evaluating outcomes, and
• reflecting on the process.

These eight phases guide healthcare professionals in providing optimal care to patients.

Each stage is interconnected and builds upon the previous one, allowing for a comprehensive understanding of the patient’s needs and effective decision-making.

1. Consider the patient’s situation

The first phase of the Clinical Reasoning Cycle involves considering the facts presented by the patient or situation. This is where healthcare professionals receive the initial information and medical status of the patient.

For example , they may be given details about a newborn admitted to the Neonatal Intensive Care Unit (NICU) due to neonatal jaundice.

By carefully considering these facts, healthcare professionals can start to develop an understanding of the patient’s condition and determine the appropriate course of action.

2. Collect cues/ information

In the second phase, healthcare professionals gather additional information to gain a comprehensive understanding of the patient’s medical history, complaints, treatment plan, and current vital signs.

They may also review the results of any investigations or tests conducted. This information is then analyzed using the healthcare professional’s knowledge of physiology, pharmacology, pathology, culture, and ethics to establish cues and draw conclusions.

The collection of information is a crucial step in the clinical reasoning process, as it helps healthcare professionals to identify any underlying issues or potential challenges.

3. Process information

The third phase involves the processing of the information gathered in the previous step.

It is here that healthcare professionals critically analyze the data on the patient’s current health status in relation to pathophysiological and pharmacological patterns.

They determine which details are relevant and consider potential outcomes for the decisions they may make.

This phase requires healthcare professionals to use their expertise and judgment to identify the key issues that need to be addressed.

4. Identify problems/issues

Based on the processed information, healthcare professionals can identify any problems or issues that the patient may be facing.

This involves recognizing signs and symptoms, understanding the underlying causes, and determining the potential impact on the patient’s health.

5. Establish goals

Once the problems or issues are identified, healthcare professionals can establish goals for the patient.

These goals are aimed at addressing or resolving the identified problems and improving the patient’s health outcomes.

Goals should be specific, measurable, achievable, relevant, and time-bound (SMART).

6. Take action

After establishing goals, healthcare professionals take appropriate actions to address the identified problems and work towards achieving the established goals.

This may involve implementing treatment plans, providing interventions, administering medications, or coordinating care with other healthcare professionals.

7. Evaluate outcomes

The seventh phase of the Clinical Reasoning Cycle is evaluation. In this phase, healthcare professionals assess the effectiveness of the actions they have taken.

They evaluate whether the treatment plan has been successful in achieving the desired outcomes or if adjustments need to be made.

This phase allows healthcare professionals to reflect on their decisions and make informed judgments about the next steps in the patient’s care.

8. Reflect on the process and new learning

The final phase of the clinical reasoning cycle is reflection. Healthcare professionals reflect on the entire process, including their decision-making, actions taken, and the outcomes achieved.

This reflection allows for continuous learning and improvement, as healthcare professionals gain insights from their experiences and apply them to future situations.

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Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

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• About Journal

Asian Journal of Nursing Education and Research

2349-2996 (Online) 2231-1149 (Print)

Case Study Based on Clinical Reasoning Cycle

Author(s): Deepthy James

Email(s): [email protected]

Address: Deepthy James IKDRC College of Nursing, IKDRC-ITS Premises, Medicity, Asarwa Ahmedabad. *Corresponding Author

Published In:   Volume -  12 ,      Issue -  1 ,     Year -  2022

ABSTRACT: Introduction: The Clinical Reasoning Cycle is a tool that helps in making decision that enable nurses to select best care options using a process systematically which takes into consideration many factors. The Clinical Reasoning Cycle by Tracy-Levette Jones stimulates critical thinking in order to deliver appropriate management plan for the patient. Aim: The aim of the paper is to adopt and apply Clinical Reasoning Cycle into the nursing care of the patient so that they can easily understand application of Clinical Reasoning Cycle in the clinical areas. Methodology: This document illustrates a case study based on Levette Jones’ Clinical Reasoning Cycle Conclusion: This paper presents a case study in medical-surgical nursing through a discussion of patient-centered, and evidence-based care provisions through a theoretical examination using the Clinical Reasoning Cycle (CRC) of Tracy Levette- Jones (2010). This paper will help the nurses both novice and proficient ones to understand implementation of Clinical Reasoning Cycle in the clinical areas and in writing the case study for the patient.

• Clinical Reasoning Cycle
• Critical thinking
• Nursing care
• Holistic care.

Cite this article: Deepthy James. Case Study Based on Clinical Reasoning Cycle. Asian Journal of Nursing Education and Research. 2022; 12(1):82-5. doi: 10.52711/2349-2996.2022.00017 Cite(Electronic): Deepthy James. Case Study Based on Clinical Reasoning Cycle. Asian Journal of Nursing Education and Research. 2022; 12(1):82-5. doi: 10.52711/2349-2996.2022.00017   Available on: https://ajner.com/AbstractView.aspx?PID=2022-12-1-17

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Principles and Practice of Case-based Clinical Reasoning Education

Innovation and Change in Professional Education, Vol. 15

Editors: Ph.D. Olle ten Cate , Ph.D. Eugène J.F.M. Custers , and Ph.D. Steven J. Durning .

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This open access volume describes and explains the educational method of Case-Based Clinical Reasoning (CBCR) used successfully in medical schools to prepare students to think like doctors before they enter the clinical arena and become engaged in patient care. Although this approach poses the paradoxical problem of a lack of clinical experience that is so essential for building proficiency in clinical reasoning, CBCR is built on the premise that solving clinical problems involves the ability to reason about disease processes. This requires knowledge of anatomy and the working and pathology of organ systems, as well as the ability to regard patient problems as patterns and compare them with instances of illness scripts of patients the clinician has seen in the past and stored in memory. CBCR stimulates the development of early, rudimentary illness scripts through elaboration and systematic discussion of the courses of action from the initial presentation of the patient to the final steps of clinical management.

The book combines general backgrounds of clinical reasoning education and assessment with a detailed elaboration of the CBCR method for application in any medical curriculum, either as a mandatory or as an elective course. It consists of three parts: a general introduction to clinical reasoning education, application of the CBCR method, and cases that can used by educators to try out this method.

• Collapse All
• Editors and Contributors
• What Is Clinical Reasoning?
• How to Teach Clinical Reasoning to Junior Students?
• Summary of the CBCR Method
• Essential Features of CBCR Education
• Indications for the Effectiveness of the CBCR Method
• CBCR as an Approach to Ignite Curriculum Modernization
• Clinical Reasoning in the Hippocratean Era
• Bedside Teaching and Patient Demonstration
• William Osler and the Differential Diagnosis
• Abraham Flexner and the Science of Clinical Medicine
• Early Diagnostic Tools, Computer-Assisted Instruction (CAI), and Patient Management Problems
• Artificial Intelligence and Problem-Based Learning
• After Medical Problem Solving (1978): A Role Left for Teaching Clinical Reasoning?
• Teaching Clinical Reasoning: A Few General Recommendations
• Concepts and Definitions
• Introduction
• Clinical Vocabulary
• Problem Representation
• Illness Script Mental Repository
• Contrastive Learning
• Hypothesis-Driven Inquiry
• Diagnostic Verification
• How Does the CBCR Method Address These Prerequisites?
• Current Methods of Assessing Clinical Reasoning
• The Course Conditions
• A CBCR Session
• Participant Roles
• CBCR Course Management
• A CBCR Course Version Using Senior Medical Students as Consultants
• Evidence of Effectiveness
• The CBCR Test as Developed at the University Medical Center Utrecht
• CBCR Test Quality Findings Since 2010
• Three Versions of the Written Case
• Selecting Themes for CBCR Cases
• An Annotated Template for CBCR Cases
• Title: A … year old … with ….
• CBCR Case Stage I: Presentation of the Patient’s Problem
• Stage II: Results from History Taking Are Provided
• Stage III: Results from Physical Examination Are Provided
• Stage IV: The Results of Diagnostic Tests Are Provided
• Stage V: Information Is Provided About the Results of the Therapy Policy
• A Brief Introduction to Curriculum Development
• The Process of Curriculum Development
• Course Development for CBCR
• The Aim of Faculty Development
• Faculty Development for CBCR
• Student Instructions and Background Materials for the CBCR Group Meetings
• The Objectives of the CBCR Course
• What Is Clinical Reasoning and Decision-Making?
• The CBCR Sessions

About the Series

Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

• Cite this Page ten Cate O, Custers EJFM, Durning SJ, editors. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students [Internet]. Cham (CH): Springer; 2018. doi: 10.1007/978-3-319-64828-6
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The Clinical Reasoning Cycle and Nursing Case Study

The case study shows how one accident may influence and change human life and how to use of the Clinical Reasoning Cycle and realize that people may need more than just expected nursing care (Levett-Jones, 2013; Salminen, Zary, & Leanderson, 2014). The Clinical Reasoning Cycle consists of several closely connected stages that cannot be ignored and have to be implemented to offer a patient an appropriate level of nursing care in a particular situation. These stages are

• the identification of the facts about a situation,
• the collection and processing of all the necessary information,
• the recognition of nursing problems for consideration,
• the establishment of the goals to be achieved,
• the description of nursing care to be offered with the strategies to rely on
• the explanation of the outcomes (Levett-Jones, 2013).

The current paper is an attempt to analyze the situation of a particular patient, William Peterson (Bill), collect information about this person and the situation he suffers from, identify three nursing problems inherent to the situation, establish the goals for this patient’s nursing care, think about the actions that should be taken (a portion of nursing care), and the outcomes to expect from all interventions.

The situation of the patient is rather clear. Bill is a 70-year-old retired print worker, who now works as a School Crossing Supervisor part-time. Six months ago, he witnessed a fatal accident with one of school children. Now, he suffers from sleeping disorders, terrible flashbacks, and the necessity of drinking about half a bottle to take a rest. He can do nothing to block the memories and follow the same style of life. He does not get the necessary portion of support because he is alone; the wife died several years ago, and they had no children. He becomes socially isolated and thinks that he can hardly restart his communication with friends and army fellows. At the same time, it seems weird that a person, who has survived the army and seen the death of people, faces such psychological problems. Maybe, it is connected to the fact that he does not have his own children and lose the one he tried to help. His psychological problems define his physical conditions considerably. Within a short period of time, Bill’s head is bowed in a quiet tone, and the loss of eye contact is observed. Regarding his medical history with his hypertension that is usually observed in many old people, Bill has a good health and should not take many drugs to keep his organism healthy. Still, one accident that happens three years after his wife’s death because of cancer changes all his current life and requires certain nursing and professional care offered to him.

Taking into consideration the situation and facts from the patient’s life, several nursing issues can be identified and analyzed to understand how to implement appropriate patient-centered care. The first issue is a problematic patient satisfaction (Smith, Turkel, & Wolf, 2012). Bill is a patient that is hard to be satisfied because of the existing psychological trauma, personal regrets, and inability to change the past or try to improve the future. Nurses have to provide patients with the necessary portion of support and understanding to make sure he is satisfied with the conditions of treatment. Still, the case under analysis shows that it can become a serious problem for the medical staff. Another issue is the patient’s family relations (Moos & Schaefer, 2013). Nurses cannot get the patient’s family support because he is alone. He does not have children, and his wife is dead. His friends are not that credible source of information and support for nurses. Family support can become a serious nursing problem that has to be solved or even neglected in a proper way to focus on other important aspects of care. Communication between the patient and nurses is the last nursing issue for consideration that has to be properly developed (Morrissey & Callaghan, 2011). Bill suffers from social isolation he created. He does not want to talk a lot. Nurses should know how to treat such patient and promote communication on the necessary level.

All goals should be directed to choose the best treatment and make Bill feeling free from the burden of the accident. There should be several long-term goals (can be observed after Bill leaves a hospital) and several short-term goals (should be achieved before transferring to a new stage of nursing care) (Burton & Ludwig, 2014). One of the first short-term goals to be set and achieved is the choice of treatment with the help of which Bill can sleep without alcohol and be free from his nightmares and flashbacks. Some psychiatric consultations can help Bill forget about the accident and explain that he could do nothing to change the situation. Still, a properly chosen treatment is not the only goal in this case. A new goal for nurses to set is the development of the connection with a patient and explanations to him about the interventions and the reasons for why they are taken. Finally, one long-term goal in Bill’s care is connected with his ability to cope with the outcomes of the accidents similar to the one he has already survived. Bill himself should be able to achieve the goal and understand that everything can happen to him or to the people around, and his reaction to different situation is his own understanding of the problems and the abilities to cope with them.

In addition to the goals and the abilities of nurses, it is necessary to discuss the process of nursing care. It is wrong to offer as many services as possible at once. Nurses should help to pass one stage of rehabilitation and start talking about the accident without fear or anger. Bill has to be ready to understand the problems of his own and find the solutions. Nurses may perform the role of catalyst to promote the communication between Bill and the doctors and Bill and his friends. The process of rehabilitation focuses on the necessity to destroy the distance between Bill and society. It is possible to remind Bill how interesting and captivating his life was before the accident. Nurses should not rely on the medical aspect of treatment only. Their care should be supportive and personal to help Bill forget his nightmares and personal uncertainties. Finally, the options that are available to him should be mentioned: special drugs help to deal with nightmares, and renewed communication with friends can replace the social hollow Bill suffers from. His friends’ and fellows’ support is another positive addition to nursing care offered. Bill should understand that there is a wonderful world waiting for him outside, and he still has a chance to enjoy it.

To make nursing care chosen more effective, several nursing strategies can be applied to this case. For example, the strategy of hourly rounding (Potter, Perry, Stockert, & Hall, 2013) may be used to improve nursing care. Every hour a nurse visits Bill to ask about his health, discuss some issues, and make sure Bill is ok. As a rule, in the beginning, Bill does not understand the frequency of nurse’s visits. With time, as soon as his condition is improved, Bill starts expecting a nurse enters his room. It will tell about his desire, intentions, and needs. Core measurement is a strategy to rely on as it helps to record everything that happens to the patient and understand the reasons for his behavior and reactions (McDowell, 2006). Nurses are able to follow the changes Bill undergoes and develop those that are favorable for Bill and avoid or decrease the level of impact of those change that are harmful to Bill. Finally, the forcing strategy has to be admitted in this case if the conflicts take place and have to be solved (Huber, 2014). If Bill does not want to accept some nursing help or even drugs explaining it as his unwillingness to believe in the power of treatment or even the necessity to continue living. Forcing can be used to make Bill follow the order and schedules defined by the professional doctors.

In general, it is expected that Bill can survive the accident and forget about the details that bother him days and nights. All the strategies, goals, and activities described in this paper should be properly used to provide Bill with a chance to live a normal life enjoying the possibilities he still has. An optimal use of drugs and communication with the best friends and fellows should also help. The only thing to be done by nurses is the explanation that this life is still worth living, and Bill should not forget about the positive aspects of his own life. Though his wife is not with him, he has a number of friends to spend some time with. It is always possible to find some new activities to get involved in and be happy with any possible results achieved.

Burton, M.A. & Ludwig, L.J.M. (2014). Fundamentals of nursing care: Concepts, connections & skills. Philadelphia, PA: F.A. Davis.

Huber, D. (2014). Leadership and nursing care management. St. Louis, MI: Elsevier Health Sciences.

Levett-Jones, T. (2013). Clinical Reasoning: Learning to think like a nurse. French Forest, NSW: Pearson Australia.

McDowell, I. (2006). Measuring health: A guide to rating scales, and questionnaires . New York, NY: Oxford University Press.

Moos, R. & Schaefer, J. (2013). Life transitions and crises: A conceptual overview. In R. Moos (Eds.), Coping with life Crises: An integrated approach . New York, NY: Springer.

Morrissey, J. & Callaghan, P. (2011). Communication skills for mental health nurses: An introduction. Berkshire, England: McGraw-Hill Education.

Potter, P. A, Perry, A., G., Stockert, P., & Hall, A. (2013). Fundamentals of nursing . St. Louis, Missouri: Elsevier Health Sciences.

Salminen, H., Zary, N., & Leanderson, C. (2014). Virtual patients in primary care: Developing a reusable model that fosters reflective practice and clinical reasoning.” Journal of Medical Internet Research, 16 (1), 29-39.

Smith, M. C., Turkel, M. C., & Wolf, Z. R. (2012). Caring in nursing classics: An essential resource. New York, NY: Springer Publishing Company.

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IvyPanda. (2022, April 16). The Clinical Reasoning Cycle and Nursing. https://ivypanda.com/essays/the-clinical-reasoning-cycle-and-nursing/

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IvyPanda . "The Clinical Reasoning Cycle and Nursing." April 16, 2022. https://ivypanda.com/essays/the-clinical-reasoning-cycle-and-nursing/.

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Welcome to the Visible Body Blog!

How to enhance case studies with tours in vb suite.

Posted on 5/17/24 by Sarah Boudreau

Case studies are a great way to engage with students, allowing them to see “real world” applications for the content they learn in the classroom as they test their clinical reasoning skills. With Tours in Visible Body Suite , case studies can be even more engaging! 

In this blog post, we’ll show you how to create a custom Tour to accompany a case study.

A Tour is a connected series of saved Views—think of it as a custom, interactive 3D presentation. Tours give students more ways to learn and explore, and they give instructors more tools with which to present the case study. 

How do Tours enhance case studies? Say I’m a student looking at a case study involving PCOS. In addition to the text of the case study, I have an interactive 3D model to explore! I could click on the cortex to read a definition, learning about the different makeups of the cortex and the inner ovarian medulla. I could also add tags to identify the germinal epithelium and tunica albuginea at a glance. Using the related content box, I could access the ovarian cycle model to compare the PCOS pathology model with a healthy ovary. 

A custom Tour in VB Suite . 

With Tours, students have more information at their fingertips to augment the case study experience. 

Step 1: Select your model(s)

The first step is to find models that can be used to illustrate your case study. Luckily, VB Suite makes it easy to find the content you want. 

The simplest way to find models is to use the search tool—just click on the Search tab at the top of your screen to search VB Suite’s vast library. Results are then organized by asset type. 

For example, let’s say my case study is about a rotator cuff injury. When I type “rotator cuff” into the search bar, I immediately see gross anatomy models, pathology models, an animation, and a muscle action all involving the rotator cuff. 

For a more detailed walkthrough on VB Suite’s menu and search system, check out the video below. 

Step 2: Customize your View

Once you’ve selected a model, it’s time to customize! There are many ways to customize your View in VB Suite. 

Notepad . The Notepad is a core part of the case study Tour experience! Use the Notepad to add text to your View. You can adjust the font size and color, and you can add italics and bold formatting.

Draw . Using the Draw tool on the bottom toolbar, you can draw and annotate on a 3D canvas! You can add squares, circles, arrows, and freeform drawings in a variety of colors. Use this tool to highlight specific structures or elements from your case study. In the example below, we’ve used arrows to show entry and exit wounds.

Add tags . Click on a structure and then select “Add Tag” in the info box. Click, hold, and drag your tag to reposition it. 

Hide or fade anatomy . Fading a structure will make it transparent, and hiding it will get rid of it altogether. To hide or fade a structure, select it and click “Fade” or “Hide” in the info box below the “Add Tag” button. You can also use the Dissect tool on the bottom toolbar to hide structures: when the Dissect tool is selected, simply click on a structure to hide it. 

Step 3: Save 

Once you’ve decked out your view with annotations, it’s time to save it! Click “Save View” on the bottom toolbar and add a name to your View. You can also add keywords to help you find it later. 

Once you’ve created one saved View, create more Views to cover all the content in your case study. 

Step 4: Create a Tour out of saved Views

Once you’ve got all of your Views created, it’s time to combine them into a Tour! 

To do this, select the My Library tab at the top of the main menu. Next, select Tours and click the green “New Tour” button at the bottom of the screen. 

Select the Views you want to add to your Tour and click Next. Here, you’ll find the Preview page, where you can add, remove, and reorder the Views if you wish. 

When you’re done, click Save and give your Tour a name. Ta-da! You’ve created a Tour. 

Step 5: Share your Tour 

You’ve created a Tour, so your next step is to share it with your students. You can share your Tour in a few ways. 

Share link or QR code. Click the three dots on your Tour’s thumbnail, then select Share Tour from the menu that pops up. 

From here, you can download a QR code students can access with their mobile device, or you can copy the Share Link. 

On mobile, students can scan the QR code with their camera. On mobile or desktop, students can click the “Launch Link” button (located in the bottom bar of the main menu) and paste in the link. Either option will bring students straight to the Tour! 

QR codes are a fun way to enhance classroom materials—for some QR code inspiration, check out our blog post 3 Ways to Use QR Codes in the Classroom with Visible Body Suite .

Assign in Courseware. If you use Courseware, you can assign Tours to your students! 

Start by navigating to your course and clicking the “Create New Assignment” button. Next, select “Human Anatomy (Visible Body Suite)” as the source for your assignment and click Continue. 

Scroll down and select My Library. On the right, find your Tour and click the checkbox to select it. Then, click Continue to add a name, due date, description, and other details to your assignment. Hit Publish at the bottom of your screen to publish the Tour assignment for all your students to see.

VB Suite case study featured in the Forensic Science Lesson Plan Part II: Autopsies with Visible Body blog post. 

Now you know all you need to enhance case studies with Tours! For more teaching tips and tricks, check out these blog posts: 

• How to Teach Muscle Naming with Immersive Assignments
• 10 Creative Uses for Flashcards in Visible Body Suite
• 4 Methods to Boost Student Engagement
• 5 Ways to Gamify Your A&P Classroom with Visible Body

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