Clinical reasoning week 1 Flashcards
(43 cards)
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.
complex mental processes Individual Disability personal Social cultural uniqueness Situation
Clinical Reasoning Cycle beginning with the patient/situation.
-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
• 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.
Diagnostic Reasoning
• 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.
Scientific Reasoning
• Types of reasoning that are considered scientific
• -Diagnostic reasoning • -Procedural reasoning
• 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.
Procedural Reasoning
• 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.
Narrative and Interactive Reasoning
• 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.
Pragmatic Reasoning
• 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.
Ethical Reasoning
• 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.
Conditional
Interactive vs. Conditional Reasoning
• Interactive: framed by therapist’s world views, listening, intuition about encouragement • Conditional: Considering the what ifs (imagining different scenarios and outcomes)
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)
Ethical Reasoning
What Type of reasoning? • -What is realistic? • -awareness of context • -PRACTICE CONTEXT • PERSONAL CONTEXT
Pragmatic Reasoning
What Type of reasoning? -Motives • -Meaning of the client’s condition • -Thinking in story form (past, present, future) • -illness narrative • -occupational narrative
Narrative and Interactive Reasoning
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
Procedural Reasoning
• -Fact and information • -Logical • -Evidence based practice
Scientific Reasoning
________CONTEXT • -Available resources (time, supplies, equipment) • -Organizational c:ulture (workplace) • -Power relationships between team members • -Reimbursement and legal issues
• PRACTICE CONTEXT
________CONTEXT -abilities of the therapist: • -clinical competency • -preferences and style • -commitment to the profession • -life roles outside of work
• PERSONAL CONTEXT
Process of clinical reasoning
• -Plan • -Direct • -Perform • -Reflect on care
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
• Novice -
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.
• Advanced beginner
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.
• Competent
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
• Proficient
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.
• Expert
