Clinical reasoning

Question 1

List the types of clinical reasoning

Think P.I.C.N

Answer 1

Procedural
Interactive
Conditional
Narrative

Question 2

What is “the thought process that guides practice”?

Or “A thinking process that happens over time, as the therapists interacts with the client”?

Answer 2

Clinical reasoning

Question 3

Fill in the blanks:
____ reasoning guides treatment.
____ reasoning guides therapy

Answer 3

Procedural reasoning guides treatment.

Interactive reasoning guides therapy.

Question 4

Which type of reasoning is the ‘how to’ of the therapeutic process?

Answer 4

Procedural reasoning

Question 5

Which type of reasoning focuses on the client as a person?

Answer 5

Interactive

By using interactive reasoning we can begin to understand the person better, and can appreciate the disability or illness experience for the client. This type of reasoning “humanizes” the conditions that you identified through your procedural reasoning.

Question 6

Which type of reasoning is usually seen in therapists at the expert level and can be described as a multidimensional process that involves complicated forms of reasoning?

Answer 6

Conditional

Question 7

What are the three types of knowledge?

Answer 7

1. Propositional knowledge
2. Professional craft knowledge
3. Personal knowledge

Question 8

Which two types of thinking did the philosopher Bruner identify?

Answer 8

Narrative – thinking through story telling, trying to understand a person’s experience and unique life story.

Paradigmatic – thinking through a propositional argument, taking a particular and seeing it in general terms, as an instance of a general type (e.g. diagnosis
or problem) or a particular theoretical perspective

Question 9

Clinical reasoning involved the skilful combination of what three things?

Answer 9

1. Scientific knowledge
2. The art of therapy
3. Ethical considerations

Question 10

How is therapeutic reasoning different to clinical reasoning?

Answer 10

The term “therapeutic reasoning” is used to avoid the medical model connotations of the term “clinical” and to highlight the client-focused collaborative nature of the proposed reasoning process.

Question 11

What is therapeutic reasoning?

Answer 11

How therapist uses the theory to understand a client and to develop, implement and monitor a plan of therapy with a client.

Therapeutic reasoning using MOHO should be client- centred, theory driven, and evidence-based.

Question 12

What is professional reasoning?

Answer 12

The process that practitioners use to plan, direct, perform, and reflect on client care.

Question 13

What is the process that practitioners use to plan, direct, perform, and reflect on client care?

Answer 13

Professional reasoning

Question 14

____ reasoning is typically performed quickly because the practitioner has to act on that reasoning right away.

Answer 14

Professional reasoning

• the process that practitioners use to plan, direct, perform and reflect on client care.

Question 15

What is the process that practitioners use to plan, direct, perform and reflect on client care?

Answer 15

Professional reasoning

Question 16

____ reasoning is included as one of the curriculum threshold concepts, identified as troublesome knowledge for students to grasp.

Answer 16

Clinical reasoning

Question 17

What are the five threshold concepts identified as troublesome knowledge for students to grasp?

Answer 17

1) purposeful and meaningful occupation,
2) client-centred practice,
3) integral nature of occupational therapy theory and practice,
4) identity as an occupational therapist, and
5) thinking critically, reasoning and reflecting.

Question 18

What are the two forms of narrative reasoning

Answer 18

1. Story making or therapeutic emplotment.

2. Story telling (by the therapist)

Question 19

Name the type of reasoning used when a therapist thinks about a client’s ailments and possible procedures?

Answer 19

Procedural

Question 20

In ____ reasoning the focus is on problem definition intervention selection

Answer 20

Procedural

Question 21

____ _____ is used to help the therapist _____ with and better understand the client as a person, his/her experience of the illness or disability and intervention in order to tailor therapy to the client’s needs

Answer 21

Interactive reasoning

Question 22

Interactive reasoning

Answer 22

Used to help the therapist interact with and better understand the client as a person, his/her experience of the illness or disability and intervention in order to tailor therapy to the client’s needs

Question 23

Which type of therapy helps the therapists better under the client as a person?

Answer 23

Interactive

Question 24

_____ reasoning moves beyond the person and the clinical problems and places them in a broader social and temporal context.

Answer 24

Conditional

Question 25

A complex form of social reasoning used by experienced therapists to help the client in the process of reconstructing a life that is now impacted by injury or disease. Considered to be the most elusive of the 4 forms.

Answer 25

Conditional reasoning

Remember P.I.C.N

Question 26

Which form of reasoning is considered to be the most unique to OT?

Answer 26

Conditional reasoning

Question 27

Why is conditional reasoning called ‘conditional’?

Answer 27

Because the therapist thinks about the whole condition including the person, the illness or disability, the meanings of the illness/disability for the person, the family, and the social and physical contexts in which the person lives.

Question 28

What’s the difference between inductive and deductive reasoning?

Answer 28

Deductive reasoning starts with a general theory, statement, or hypothesis and then works its way down to a conclusion based on evidence.

Inductive reasoning starts with a small observation or question and works it’s way to a theory by examining the related issues.

Question 29

What kind of reasoning starts with a general theory, statement, or hypothesis and then works its way down to a conclusion based on evidence?

Answer 29

Deductive

dominant quantitative research paradigm thinking

Question 30

What kind of reasoning starts with a small observation or question and works it’s way to a theory by examining the related issues?

Answer 30

Inductive

dominant qualitative research paradigm thinking

Question 31

List three types of clinical reasoning identified outside the field of OT

Answer 31

1. Content/knowledge
2. Diagnostic
3. Ethical reasoning
4. Inductive reasoning
5. Deductive
6. Teaching as reasoning
7. Pragmatic
8. Interpretive

Question 32

The most highly valued skill by ‘expert clinicians’ was what?

Answer 32

Good communication and gaining an understanding of the illness as it affected the individual client.

Question 33

The development of clinical reasoning skills is broken into how many stages?

Answer 33

Five

Question 34

What are the stages of development of clinical reasoning skills?

Answer 34

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

Question 35

Which stage of development of clinical reasoning skills recognises and understands rules of practice, uses intuition to know what to do next, uses
conditional reasoning?

Answer 35

Expert

Question 36

Which stage in the development of clinical reasoning skills views situations as whole instead of in
isolated parts, able to develop a vision of where the client should go, able to modify easily?

Answer 36

Proficient

Question 37

Define the ‘competent’ stage of development of clinical reasoning skills.

Answer 37

Sees more facts, understands client’s problems, individualises treatment, but may lack creativity and flexibility.

Question 38

Community OT’s clinical reasoning was found to be influenced by ___ and ___ factors.

Answer 38

Internal and external

Question 39

List some of the internal factors which were found to influence OT’s clinical reasoning.

Answer 39

Internal factors included past experiences, expertise and perceived complexity of a problem. Plus personal habits, personality and conception of teaching.

Question 40

List some of the external factors which were found to influence OT’s clinical reasoning.

Answer 40

The practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community OTs’ clinical reasoning.