What is CLINICAL REASONING? Flashcards
What is CLINICAL REASONING?
“An inferential process used by practitioners to collect and evaluate data and to make judgments about the diagnosis and management of patient problems”
(Edwards et al. 2004)
Part of clinical reasoning is also “__”
prognosis
“Clinical Reasoning*** –
the sum of the thinking and decision-making processes associated with clinical practice
Collect and analyze ___ variables
multiple
Determine ___ limitations (the ability to execute a task or action in a standard environment) and ___ deficits (what the patient can do in his or her own current ___).
capacity
performance
environment
Generate ___ to explain these factors that includes identifying the impact on the patient’s life
hypotheses
Interacts with the patient and ___ (family, other health care professionals)
others involved
Find ___ goals and health management strategies
meaningful
Decisions and actions are in line with professional ___ and community ___
ethics
expectations
Core dimensions:
Knowledge
Cognition
Metacognition
Knowledge =
derived from theory and research, professional and personal experience
Cognition =
also called: reflective inquiry
analysis, synthesis and evaluation of data collected
Metacognition =
bridge knowledge and cognition
identify limitations in the quality of information, monitoring their reasoning and practice
seeking errors and credibility
Additional dimensions:
Mutual decision-making
Contextual interaction
Task impact
No single model of clinical reasoning because:
> Complex nature of clinical reasoning
> Context dependent nature
> Individuality of expertise
> Changing conceptions of quality and error
> Challenge to novices in developing clinical reasoning skills and to educators in facilitating this development
Clinical reasoning is an invisible ___ but linked with more visible ___ (e.g. making diagnosis, interventions, case conference)
process
behaviors
Clinical reasoning is ___
developmental
Clinical reasoning can be implemented as a ___ practitioner process or a ___ process
sole
group
Clinical reasoning is grounded on ____
evidence-based practice and public accountability
____ are required
Language and interactive behaviors
Clinical reasoning requires a range of capabilities such as ____
emotional and social
Clinical reasoning is ____
quality assurance or quality improvement
“These 3 things”
Clinical reasoning is a complex process
Clinical reasoning is making sense of data
Clinical reasoning takes practice
(ICF)
International Classification of Functioning, Disability, and Health
Examination =
History
Systems review
Specific tests and measures
Evaluation leading to
Diagnosis
Prognosis
Intervention =
Intervention
Outcomes =
Measurement of Individual versus group outcomes
Is This My Patient?
What types of questions must you ask before determining your relationship to this person?
Legal
Ethical
Practitioner competence
Practitioner status
Legal Q’s=
Can I legally provide services of a first aid nature to this person?
Can I legally provide services of a physical therapy nature to this person? In this setting?
Is there a Good Samaritan law in this jurisdiction that will protect me if my actions cause harm? Does such a law protect me as a citizen, as well as a health care provider?
Ethical Q’s =
Am I obliged by my code of ethics to provide first aid services to this person?
Can I refuse to help this person?
Must I seek the person’s permission before giving advice or direct care?
Practitioner Competence Q’s =
Am I a qualified first aid provider?
Am I skilled at diagnosing injuries of the ankle?
If I initiate an evaluation of this person, will I know what to do with the information I gather?
Practitioner Status Q’s=
Am I impaired in any way at this point in the day based upon what I have done or ingested?
Am I reluctant to become involved to the extent that my judgment might be impaired?
Importance of Early Decisions
Take time to think broadly about the implications of early decisions, envisioning the long-term outcomes.
Decisions about Who to Treat, and When to Treat are reported as some of the most difficult decisions to make in practice.
What types of diagnostic reasoning will be most helpful?
Legal
Ethical
Diagnostic
Prognostic
Intervention
Legal diagnostic reasoning =
- Get the patient’s verbal consent for your examination.
Ethical diagnostic reasoning =
- Determine what will maximize patient comfort first.
- Determine what actions would make the injury worse and avoid these.
Diagnostic diagnostic reasoning =
Determine how to perform your examination.
Determine the extent of the injury to the ankle and surrounding tissues.
Assess your confidence in your diagnosis.
Prognostic diagnostic reasoning =
Determine the need for additional medical attention immediately or within the next 24 hours.
Intervention diagnostic reasoning =
Select immediate necessary care and implement.
Identify follow-up care and make recommendations.
Perform the interventions or delegate them to the patient and family.
Seek treatment supplies or delegate this to the patient and family.
Types of Diagnostic Reasoning
Hypothetico-Deductive Reasoning (or backward reasoning)
Pattern Recognition Reasoning (or forward reasoning)
Hypothetico-Deductive Reasoning (or backward reasoning) =
Gather clues
Formulate the hypothesis
Test the hypothesis (e.g. re-evaluation, return visits)
Helpful in simple scenarios
Pattern Recognition Reasoning (or forward reasoning) =
Used by experienced clinicians with well-organized knowledge base
Depends upon well-recognized combinations of symptoms, called patterns
Helpful in complex scenarios
Basic science + practical knowledge + reflexive practice
Physical therapist are not concerned with a correct diagnosis of pathology as they are with a ____
correct understanding and labeling of significant impairments and functional limitations of the patient.
