Clinical Reasoning

Question 1

Applied FORs as described by Mosey have 4 basic elements. What are they?

Answer 1

Focus
Basic assumptions
Function-disability continuum
Postulates of change

Question 2

Describe the focus element of FORs.

Answer 2

clearly defined domain, scope, or focus of concern in occupational therapy. It is usually defined in the frame of reference

Question 3

Describe the basic assumptions element of FORs.

Answer 3

the guiding beliefs that lead the clinical reasoning process. They are the ideas and concepts that explain possible explanations for the patterns of performance and participation observed. They are often not clearly defined and must be critically explored to effectively apply the frame of reference

Question 4

Describe the function-disability continuum element of FORs.

Answer 4

the expectation of what is normal or the best outcome versus what is a poor or limited outcome within the scope of a theory. The continuum is often described in terms of function, especially when the focus of the frame of reference is based in occupation. (for example: behaviors that are interfering or inhibiting functional performance, thus limiting occupational engagement)

Question 5

Describe the postulates of change element of FORs.

Answer 5

explanations offered within frames of reference about what is needed to cause change. These explanations are often described in terms of occupational engagement and participation, especially when the focus of the frame of reference is based in occupation.

Question 6

FORs allow OTPs to…

Answer 6

be collaborative in their clinical reasoning and to be reflective in their clinical practice and offer heuristic tools that add rigor and evidence to clinical reasoning

Question 7

What is collaborative reasoning?

Answer 7

the assimilation of perspectives of key individuals in the clinical reasoning process. The client is the essential “key individual” in collaborative reasoning, and other key individuals may include the client’s family, members of the health care or educational team and employers

Question 8

What is interprofessional collaborative practice?

Answer 8

involves interaction and communication between varied professionals and the clients receiving health care

Question 9

What are core ideals associated with interprofessional collaborative practice?

Answer 9

Client and family centeredness
Community-oriented care
Relationship-focused service delivery

Question 10

What is the standard of best practice in OT?

Answer 10

interprofessional collaborative practice

Question 11

What skills are needed to work effectively in interprofessional contexts?

Answer 11

Ability to clearly articulate the unique nature of occupation and the value of occupation to support:
- Performance
- Participation
- Health
- Well-being

Question 12

Trends are often…

Answer 12

data driven, responding to scientific evidence

Question 13

How has the trend toward interprofessionally collaborative, family-guided, routine-based intervention been supported?

Answer 13

been supported by studies that found that “parents” perceptions of efficacy and satisfaction increased when interventions are embedded in family routines and settings

Question 14

What is the interprofessional team-guided strategy?

Answer 14

An interprofessional team-guided strategy that embeds intervention consistently by all family members and service providers throughout the day rather than in individual isolated therapy sessions.

Question 15

What is the routine-based assessment process?

Answer 15

The routines-based assessment process looks beyond child function to include aspects of family function.

Question 16

What are family guided routines?

Answer 16

Family-guided routines are functional and predictable schedules of the child and family.
In this approach, the family guides the selection of routines and contexts for intervention.
The process is initiated in the evaluation process with the completion of a routines-based interview.

Question 17

Effective practitioners should:

Answer 17

Be confident that they can respond to these questions
Assimilate new information
Make reasoned clinical decisions
Advocate for both the profession and the client

Question 18

What is diagnostic reasoning?

Answer 18

Diagnostic reasoning is a term commonly used in medicine that involves the recognition of clinical patterns and the establishment of expected clinical trajectories based on disease or impairment.
In-depth diagnostic reasoning provides data to jump-start the clinical reasoning process
Diagnostic reasoning includes all of the information gathered by the OT regarding a specific diagnostic condition

Question 19

What is an expert in clinical reasoning?

Answer 19

People who possess a strong knowledge base that enables them to compare a current problem with their recollections of past cases.
Experts are also better able to filter information so that they use less irrelevant information when making decisions.

Question 20

What is clinical reasoning?

Answer 20

Clinical Reasoning is defined as the process by which occupational therapy practitioners collect information, process this information, come to an understanding of a client’s needs and values, and then plan and implement a reflective process consistent with the Occupational Therapy Practice Framework: Domain and Practice

Question 21

What are heuristics?

Answer 21

The use of short cuts in reasoning is called heuristics
Heuristics are strategies that serve as an aid to learning and problem solving by relying on familiarity with the condition or prior clinical experiences

Question 22

What are the 5 steps of the clinical reasoning process?

Answer 22

1. Consider the client and the referral information
2. Develop clinical hypotheses to guide collection of cues and information
3. Use targeted data collection and problem strategies to process information and evaluate the hypothesis
4. Test and refine the clinical hypotheses
5. Appraise the evidence

Question 23

Describe step 1 of the clinical reasoning process.

Answer 23

Client and referral Information
- The typical reasoning process begins with a reference followed by a meeting between the OT and the client.
- The occupational profile, which includes compiled data on the client’s needs, problems, and concerns about his/her performance in occupations, is developed on the basis of the information from all sources in which personal goals and concerns are explored

Question 24

Describe step 2 of the clinical reasoning process.

Answer 24

In step 2, the practitioner first develops a working hypotheses and uses it to lead the initial data gathering.
This approach requires the use of problem-solving strategies to consider the information in context.
These strategies require reflection and creativity and should be used to test clinical hypotheses

Question 25

Describe step 3 of the clinical reasoning process.

Answer 25

Data collection, problem solving, and hypothesis evaluation
Problem solving refers to the thought processes that people use to discover, analyze, and resolve difficulties.
The thought processes used by OTs in clinical settings depend on both the nature of the problem being addressed and the expertise of the clinician.

Question 26

What are the 4 main problem-solving strategies?

Answer 26

Algorithm
Heuristic
Trial and error
Insight

Question 27

Describe the algorithm problem-solving strategy.

Answer 27

An algorithm uses a formula or step-by-step procedure that will always produce a correct solution.
Although an algorithm guarantees an accurate answer, it is not always the best approach to problem solving
It is not practical or efficient for many clinical situations because the variability of individual goals, values, impairments, and contexts makes algorithms excessively long and complex.

Question 28

Describe the heuristic problem-solving strategy.

Answer 28

A heuristic is a general rule that may or may not work in certain circumstances
Unlike algorithms, heuristics do not always guarantee a correct solution
Using a heuristic allows clinicians to simplify complex problems and reduce the total number of possible solutions to a more manageable and time-efficient set

Question 29

Describe the trial-and-error problem solving strategy.

Answer 29

Involves trying several solutions and ruling out the ones that do not work
This approach is time-consuming by itself, so it is typically used in clinical problem solving after narrowing down possible options using either heuristics or algorithms
Trial and error is often used in cases in which the problem is ill-defined, multiple interacting diagnostic conditions, or challenging contextual factors are present

Question 30

Describe the insight problem solving strategy.

Answer 30

sight is distinct from the other problem-solving strategies because it is not a structured reasoning process but a mental process that often happens outside of awareness as a sudden novel idea to address the problem
Clinical problems that trigger insight often require that something new and nonobvious must be done to address the issues
Insight is grounded in clinical knowledge and experience and is more likely to be used by expert clinicians

Question 31

Describe step 4 of the clinical reasoning process.

Answer 31

Test and refine hypothesis
- A typical OT evaluation process usually balances one or more of these clinical hypotheses and influences what the practitioner emphasizes as he or she identifies the multiple demands, required skills, and potential meanings of the activities and occupations of the individual
- The clinical hypotheses are modified and refined as the occupational profile is further developed and forms a context for clinical reasoning
- It is during the evaluation process that clinical hypotheses are developed, tested, and refined by the occupational therapy practitioner
- These hypotheses form a context for further clinical reasoning
- Each clinical hypothesis evokes a template of possible clinical findings against which the client’s performance can be compared

Question 32

Describe step 5 of the clinical reasoning process.

Answer 32

It is important to understand that appraising the evidence includes more than a search for confirmatory evidence.
It requires exploration of current science and its applications that are specific to contextual and client factors affecting the hypothesis

Question 33

What is theory?

Answer 33

At its most basic level, it is a supposition intended to explain something
It is “a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena”
A theory is supposition intended to explain something

Question 34

What is a paradigm?

Answer 34

The overall context for the discussion of clinical reasoning is the philosophy, values, ethics, and science that make up the professional worldview of occupational therapy.
The big picture is called the paradigm of occupational therapy
A paradigm is the generally accepted perspective of a particular discipline at a given time

Because a paradigm is a philosophical and theoretical foundation that contains basic assumptions and ways of thinking, it provides a very broad framework that can include many specific theories and theoretical concepts
The paradigm informs the consideration of theory

Question 35

What is a FOR?

Answer 35

A frame of reference is a set of assumptions or concepts, often drawn from theory or science, that explains how assessment and intervention work in routine practice.
A frame of reference is action focused, whereas a theory reflects an ideal that includes scientifically acceptable general principles to explain a phenomena of interest
The frame of reference is a tool used to approach a narrowly focused clinical problem and identify strategies for intervention

Question 36

What is a model?

Answer 36

A model is an abstract way of schematizing a process to generalize a foundational theory or theories to solve problems that are similar to, but outside, the focus of that theory
Within a model of practice, more than one frame of reference may be used