Clinical Reasoning Flashcards
OT decision making
“involves creating therapeutic experiences in which patients must deal with very imperfect bodies…and still find some reason to struggle for a meaningful life.”
OT brand of clinical reasoning
We draw on different methods of reasoning to address different aspects of treating a specific client.
At first, it conscious, deliberate thought to use each type of reasoning but practice helps the process become more automatic and integrated.
Basic methods of clinical reasoning
Procedural reasoning
Narrative reasoning
Pragmatic reasoning
Ethical reasoning
Interactive reasoning
Conditional reasoning
Procedural reasoning
Decisions are based on an understanding of scientific evidence that gives confidence in an expected outcome.
OTs use this frequently when making decisions regarding assessment tools and treatment interventions to address an individual’s occupational performance problems.
Do not say “I don’t know what to do, so I’ll just try something.” Treatment choices should always be based on sound reasoning.
What are the 2 levels of procedural reasoning
Deductive – take what is already known/researched and draw from this info logical, reasoned conclusions about what is likely to happen. Example – deciding on treatments to improve AROM (refer to specific hand exercise protocol that has been well-researched )
Inductive – a less certain outcome that is the result is generalized from one or more indicators that a similar approach was effective. Example – no protocol/research exists that documents efficacy of playing video games after hand surgery will improve AROM but positive outcomes should be inferred based on related research and your task analysis of the movements needed to play
Narrative reasoning
The process used to help the therapist understand what the client is experiencing and how it is affecting their daily life.
This process helps clients express who they are and make sense of what is happening to them.
Pragmatic reasoning
Consists of the practical, mundane, real-world decisions involved in arranging for and delivering therapy to clients, such as scheduling therapy sessions and deciding on the best way to use the tools available in a particular treatment setting to meet clients’ needs.
These decisions represent the creativity, compromises, and adjustments the therapist makes throughout the workday to juggle busy schedules.
Ethical reasoning
Take into account the context of treatment and the types of ethical decisions that may emerge.
Some of the ethical decisions that come up in practice include issues related to confidentiality, autonomy, justice, veracity, and fidelity. These terms are all defined in the AOTA OT Code of Ethics.
Interactive reasoning
At its core, it reflects the choices the therapist makes with regard to initiating, fostering, and supporting an ongoing therapeutic relationship with each individual client.
Realization that every client will need different things from the client-therapist relationship.
Important components: active listening, trust building, affirmation and validation, genuineness, confrontation, and empathy.
Conditional reasoning
Therapists must flexibly modify interventions in response to changing conditions. We refer to this as “thinking on your feet.”
The therapist’s ability to design interventions to meet multiple goals is also an important aspect of conditional reasoning.
Consider motor performance skills…when using a neuromuscular or ortho rehab approach, the therapist needs to select and combine individual actions with process skills such as initiating, sequencing, and terminating tasks. By doing so, the therapist enables the client to develop effective performance patterns and move towards their desired occupational performance goals.
Clinical reasoning
The big idea is that you understand the differences among the various methods and combine them thoughtfully.
Using more than one type of reasoning can be a practical and realistic way to select the interventions and approaches that are best suited to help your client.
