Re-interpreting clinical reasoning: A model of encultured decision making practice capabilities

The complexity of clinical reasoning is inherent in the very nature of the task or challenge, faced by novice and expert alike. This challenge is to process multiple variables, contemplate the various priorities of competing healthcare needs, negotiate the interests of different participants in the decision-making process, inform all decisions and actions with advanced practice knowledge and make decisions and take actions in the accountable context of professional ethics and community expectations. By encompassing much of what it means to be a professional (autonomy, responsibility, accountability and decision making in complex situations), clinical reasoning is imbued with an inherent mystique. This mystique is most evident in the way expert practitioners make difficult decisions with seemingly effortless simplicity and justification and in the professional artistry and practice wisdom of experienced practitioners who produce, with humanity and finesse, individually tailored health management plans that address complicated health needs. To address and achieve these professional attributes, clinical reasoning is much more a lived phenomenon, an experience, a way of being and a chosen model of practising than it is simply a process.It is enacted through a set of capabilities that demonstrate current knowledge and practice expertise and the capacity to work in unknown and unpredictable situations.