Overview Of Clinical Reasoning Flashcards
term commonly used in medicine that involves the recognition of clinical patterns and the establishment of expected clinical trajectories based on disease or impairment
Diagnostic Reasoning
Effective practitioners should:
Be confident that they can respond to these questions
Assimilate new information
Make reasoned clinical decisions
Advocate for both the profession and the client
Strong clinical reasoning skills are an attribute of
Expert practitioners
people who possess a strong knowledge base that enables them to compare a current problem with their recollections of past cases
also better able to filter information so that they use less irrelevant information when making decisions
experts
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
Clinical reasoning
essential in all aspects of the occupational therapy role, not just in clinical care
goes beyond learning the basic protocols that guide care based on a medical diagnosis that is focused on a disease or medical condition
has a broad impact at all levels of professional practice
Clinical reasoning
includes all of the information gathered by the OT regarding a specific diagnostic condition
provides data to jump-start the clinical reasoning process
only one tool that offers a shortcut to the expert practitioner
Diagnostic reasoning
Other tools besides diagnostic reasoning include:
Theory
Frames of reference
Data driven decision making
strategies that serve as an aid to learning and problem solving by relying on familiarity with the condition or prior clinical experiences
The use of short cuts in reasoning
heuristics
Intervention based on _______ is likely to be effective in some clients, but consideration of individual factors such as the client’s occupational history and experiences, patterns of daily living, interests, values, and needs that form a complete occupational profile, are likely to improve the efficacy of the intervention.
heuristics
An essential tool in the hypothesis-generating process
are simply strategies that rely on familiarity with the condition or prior clinical experience to help streamline the questioning process
It is an informed idea that guides the interview in process so additional data through specialized assessments should be gathered to support or refute this idea
Heuristic shortcuts
The clinical reasoning process has 5 steps:
Step one: Consider the client and the referral information
Step two: Develop clinical hypotheses to guide collection of cues and information
Step three: Use targeted data collection and problem strategies to process information and evaluate the hypothesis
Step four: Test and refine the clinical hypotheses
Step five: Appraise the evidence
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
Step 1 – Client and referral Information
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
Step two- clinical hypotheses
Evaluation and 4 main problem-solving strategies
Step three- data collection, problem solving, and hypotheses
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.
Evaluation
4 main problem-solving strategies
Algorithm
Heuristic
Trial and error
Insight
uses a formula or step-by-step procedure that will always produce a correct solution.
not always the best approach to problem solving
not practical or efficient for many clinical situations because the variability of individual goals, values, impairments, and contexts makes algorithms excessively long and complex
Algorithm
general rule that may or may not work in certain circumstances
do not always guarantee a correct solution
allows clinicians to simplify complex problems and reduce the total number of possible solutions to a more manageable and time-efficient set
Heuristic
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
Is often used in cases in which the problem is ill-defined, multiple interacting diagnostic conditions, or challenging contextual factors are present
Trial and error
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
Grounded in clinical knowledge and experience and is more likely to be used by expert clinicians
Insight
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
Step 4: Test and refine hypothesis
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
hypotheses evaluation of step 4
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
Step five: Appraise the evidence
Has many meanings and is used widely in daily life and science
“a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena”
Supposition intended to explain something
Theory
The big picture
The generally accepted perspective of a particular discipline at a given time
Provides a very broad framework that can include many specific theories and theoretical concepts
Informs the consideration of theory
Paradigm
Set of assumptions or concepts, often drawn from theory or science, that explains how assessment and intervention work in routine practice.
Action focused, whereas a theory reflects an ideal that includes scientifically acceptable general principles to explain a phenomena of interest
A tool used to approach a narrowly focused clinical problem and identify strategies for intervention
Frame of reference
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
More than one frame of reference may be used
Model
