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OT205 Clinical Reasoning > Clinical reasoning week 1 > Flashcards

Clinical reasoning week 1 Flashcards

1
Q

What Is Clinical Reasoning? Definition: the ____ ____ _____ the therapist uses when thinking about the ___, the ___, and ___/___/___ meanings the individual gives to the disability, the _____ of the ____, and himself/herself.

A

complex mental processes Individual Disability personal Social cultural uniqueness Situation

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2
Q

Clinical Reasoning Cycle beginning with the patient/situation.

A

-Consider Patient/Situation -collect info/cues -process the info -ID problems -Establish goals -Action -Evaluate outcome -Reflect on process, new learning -reconsider the Patient/Situation

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3
Q

• This type of reasoning specifically relates to the client’s diagnosis and how that diagnosis affects the clinical picture. It is sometimes considered a component of scientific reasoning.

A

Diagnostic Reasoning

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4
Q

• This type of reasoning focuses on the facts such as impairments, disabilities, and performance contexts. It can be used to identify problems and to develop solutions.

A

Scientific Reasoning

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5
Q

• Types of reasoning that are considered scientific

A

• -Diagnostic reasoning • -Procedural reasoning

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6
Q

• This type of reasoning focuses on the process of what, when, and how interventions and other solutions will be carried out. It focuses primarily upon the process of therapy.

A

Procedural Reasoning

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7
Q

• This type of reasoning relies on story telling in order to identify problem areas and solutions. It requires interaction between client and therapist in order to gain an understanding of the situation.

A

Narrative and Interactive Reasoning

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8
Q

• This type of reasoning focuses on logistics such as cost, time, therapist’s skills, client wishes, and physical location. It looks at the problems and the contexts and focuses on developing practical and realistic solutions.

A

Pragmatic Reasoning

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9
Q

• This type of reasoning brings in the aspect of right and wrong as it looks at issues and aims to develop the best and most moral solution to a problem.

A

Ethical Reasoning

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10
Q

• This type of reasoning is the most complex, and it encompasses both an empathetic understanding of the situation, as well as a vision for its resolution. • It incorporates the other types of reasoning into an integrated picture of the client and a framework for selecting the most appropriate course of action in order to achieve the ideal end goal.

A

Conditional

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11
Q

Interactive vs. Conditional Reasoning

A

• Interactive: framed by therapist’s world views, listening, intuition about encouragement • Conditional: Considering the what ifs (imagining different scenarios and outcomes)

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12
Q

What Type of reasoning? -What should be done? • -What’s best for the patient’s situation? • -Balancing with pragmatic factors • -What is most important (means or ends)

A

Ethical Reasoning

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13
Q

What Type of reasoning? • -What is realistic? • -awareness of context • -PRACTICE CONTEXT • PERSONAL CONTEXT

A

Pragmatic Reasoning

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14
Q

What Type of reasoning? -Motives • -Meaning of the client’s condition • -Thinking in story form (past, present, future) • -illness narrative • -occupational narrative

A

Narrative and Interactive Reasoning

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15
Q

What Type of reasoning? o -Continuous throughout treatment o -what are cues of success or failure? o -what does theory suggest should be done? o -how much, when and how? o -Method o -expected outcomes o -evaluation of results

A

Procedural Reasoning

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16
Q

• -Fact and information • -Logical • -Evidence based practice

A

Scientific Reasoning

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17
Q

________CONTEXT • -Available resources (time, supplies, equipment) • -Organizational c:ulture (workplace) • -Power relationships between team members • -Reimbursement and legal issues

A

• PRACTICE CONTEXT

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18
Q

________CONTEXT -abilities of the therapist: • -clinical competency • -preferences and style • -commitment to the profession • -life roles outside of work

A

• PERSONAL CONTEXT

19
Q

Process of clinical reasoning

A

• -Plan • -Direct • -Perform • -Reflect on care

20
Q

Stages of Clinical Reasoning In Practice?

(Student or New Grad)

  • No experience, dependent on theory to guide practice
  • Uses rule-based procedural reasoning to guide actions and not skillful in adapting rules to fit situations
A

• Novice -

21
Q

Stages of Clinical Reasoning In Practice

(< 1years of experience)

  • Incorporates contextual information into rule-based thinking.
  • Recognizes differences between theory and practice.
  • Limited experience in prioritizing problems well.
A

• Advanced beginner

22
Q

Stages of Clinical Reasoning In Practice?

(3 years of experience)

o Automatically performs more therapeutic skills and attends to more issues.

o More experience in sorting out relevant data and able to prioritize treatment goals

o Uses conditional reasoning to upgrade treatment and anticipate discharge needs, but lacks flexibility

o Recognizes ethical dilemmas but less sensitive to justifiably different ethical responses.

A

• Competent

23
Q

Stages of Clinical Reasoning In Practice?

(5 years of experience)

o Brings deeper store of experience and perceive situations as wholes.

o Evaluations are more targeted and shows flexibility in treatment.

o More attentive to patient/client needs and more skillful in negotiating resources to meet patient/client needs

A

• Proficient

24
Q

Stages of Clinical Reasoning In Practice?

(10 years of experience)

Clinical reasoning becomes quick intuitive process which is deeply internalized and embedded in an extensive store of clinical experience.

• More Flexibility and creativity of an experienced practitioner which permits practice with less routine analysis.

A

• Expert

25
Q

Common Errors in Clinical Reasoning

A
  • Vagueness
  • Narrowness
  • Rigidity
  • Irrationality
  • Wastefulness
  • Insensitivity
26
Q

Measurable improvements VS Unmeasurable

A

• MEASUREABLE IMPROVEMENTS

  • improved grasp - improved balance - increased strength
  • amount of assistance

• UNMEASURABLE IMPROVEMENTS

  • commitment to therapy - problem solving skills - confidence
  • tolerance of self - self-esteem
27
Q

Value for the OTA in practice

A
  • Improves clinical decision making -tools for reflection on their decisions
  • Improves ability to explain the rationales
  • Improves job satisfaction by making OTAs more aware of the complexity & the value of their practice
28
Q

Types of Clinical Reasoning and Application

  • Implementing treatment strategies via systematic gathering of data and interpreting of client data

VS

  • Identifies what activities and roles were important (PLOF) and why
A

Procedural

Narrative

29
Q

Types of Clinical Reasoning and Application

  • Involves the therapeutic relationship between the OTA, the individual, and the caregivers
  • VS
  • Neglects larger practice area issues in which the client/practitioner interaction is occurring (pragmatic)
A

Interactive

Narrative

30
Q

Types of Clinical Reasoning and Application

  • Focuses on current and possible future social contexts

VS

  • Problem solving
A
31
Q

Types of Clinical Reasoning and Application

  • Facilitates effective treatment as it focuses on the personal meaning of the illness and disability which can influence how a person engages in treatment (how motivation affects performance)

VS

  • Requires multidimensional thinking
A
32
Q

Types of Clinical Reasoning and Application

  • The most effective OT practitioners are able to negotiate pragmatic contextual issues in favor of quality care
  • VS
  • The reasoning that is documented the most for reimbursement purposes
A

Pragmatic

Procedural

33
Q

Types of Clinical Reasoning and Application

  • Considers the treatment environment and OT practitioner’s values, knowledge, abilities, and experiences
  • VS
  • Deals with how the disability or disease affects the person; focuses on the client as a person
A

Pragmatic Reasoning

VS

Interactive

34
Q

Types of Clinical Reasoning and Application

  • Reframes the understanding of the influence of personal and practical constraints on OT practice
  • VS
  • The actual technical “doing” of practice
A

Pragmatic Reasoning

VS

Procedural

35
Q

Types of Clinical Reasoning and Application

  • Represents an integration of interactive, procedural, and pragmatic reasoning in the context of the client’s narrative
  • VS
  • Explores what valued activities and roles are possible in the future
A

Conditional

Narrative

36
Q

Types of Clinical Reasoning and Application

  • Considers the context in which the OT practitioner’s thinking occurs
  • VS
  • Analyzes what valued activities and roles the individual can perform now
A

Pragmatic Reasoning

Narrative

37
Q

Types of Clinical Reasoning and Application

  • States that mental activities are shaped by the situation
  • VS
  • Involves an ongoing revision of treatment
A

Pragmatic Reasoning

Conditional Reasoning

38
Q

Types of Clinical Reasoning and Application

  • Focuses on the treatment possibilities possible within a treatment setting

vs

  • Deals with the individual’s occupational story and focuses on the process of change needed to reach the imagined future
A

Pragmatic Reasoning

Narrative

39
Q

Describe the clinical reasoning bike analogy

A
  • Once the learning is done, the knowledge becomes tacit (a fancy word that means it’s engrained and you don’t have to consciously think about it).
    • Cannot do it first time just on verbal instructions. Needs to be experienced directly
  • First ride trycicle, then bike with training wheels, then bike with parents guidance/support, then they let go and you ride a bike!
    • student to expert progression in clinical reasoning. At first we really struggle, but receive guidance along the way from our peers, professors, and fieldwork educators until we eventually get better.
40
Q

Types of Clinical Reasoning and Application

A
41
Q

Types of Clinical Reasoning and Application

A
42
Q

Clinical Reasoning Ball room dancing analogy

A

Explain

  • When we first become therapists we focus on the actual steps of the dance (this is called procedural, we’ll explain later). These steps are what seem most basic to us, and are the easiest to grasp.
  • can be compared to how well we use all of the knowledge that we’ve picked up in school and on our placements. We have learned the steps of an assessment, the steps of identifying goals, and the steps of developing an intervention plan.
  • when we get into practice, the music changes much more than ever happened in dance class.
  • . This can be compared to having two clients with identical diagnoses
43
Q

therapist holding an umbrella diagram

A
  • Therapists have 3 track mind: Procedural, Interactive, Conditional (stripes on dress) The therapist puts all of these tracks together to form a holistic view of the person
  • When we first start out, we only get one stripe (procedural reasoning.) then
  • interactive reasoning. When we are less concerned with whether or not what we are doing is right, we are better able to interact with our clients and understand the illness experience for him/her.
  • the last stripe we earn is our conditional reasoning. This is what integrates the other two stripes/tracks to help us to see the person’s future.
  • Narrative reasoning is considered to be the umbrella over which all the other types fall (umbrella). contents of the other tracks can be organized, stored, and shared through narrative reasoning.
  • Pragmatic reasoning Not under narrative umbrella, or stripe. It’s the frame surrounding entire picture Consideres all practical issues of treatment

OT205 Clinical Reasoning (2 decks)

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