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Reasoning like a doctor or like a nurse? A systematic integrative review
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 reas...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10020202/ https://www.ncbi.nlm.nih.gov/pubmed/36936242 http://dx.doi.org/10.3389/fmed.2023.1017783 |
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author | Vreugdenhil, Jettie Somra, Sunia Ket, Hans Custers, Eugène J. F. M. Reinders, Marcel E. Dobber, Jos Kusurkar, Rashmi A. |
author_facet | Vreugdenhil, Jettie Somra, Sunia Ket, Hans Custers, Eugène J. F. M. Reinders, Marcel E. Dobber, Jos Kusurkar, Rashmi A. |
author_sort | Vreugdenhil, Jettie |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10020202 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100202022023-03-18 Reasoning like a doctor or like a nurse? A systematic integrative review Vreugdenhil, Jettie Somra, Sunia Ket, Hans Custers, Eugène J. F. M. Reinders, Marcel E. Dobber, Jos Kusurkar, Rashmi A. Front Med (Lausanne) Medicine 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. Frontiers Media S.A. 2023-03-03 /pmc/articles/PMC10020202/ /pubmed/36936242 http://dx.doi.org/10.3389/fmed.2023.1017783 Text en Copyright © 2023 Vreugdenhil, Somra, Ket, Custers, Reinders, Dobber and Kusurkar. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Vreugdenhil, Jettie Somra, Sunia Ket, Hans Custers, Eugène J. F. M. Reinders, Marcel E. Dobber, Jos Kusurkar, Rashmi A. Reasoning like a doctor or like a nurse? A systematic integrative review |
title | Reasoning like a doctor or like a nurse? A systematic integrative review |
title_full | Reasoning like a doctor or like a nurse? A systematic integrative review |
title_fullStr | Reasoning like a doctor or like a nurse? A systematic integrative review |
title_full_unstemmed | Reasoning like a doctor or like a nurse? A systematic integrative review |
title_short | Reasoning like a doctor or like a nurse? A systematic integrative review |
title_sort | reasoning like a doctor or like a nurse? a systematic integrative review |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10020202/ https://www.ncbi.nlm.nih.gov/pubmed/36936242 http://dx.doi.org/10.3389/fmed.2023.1017783 |
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