wk 2 clinical reasoning OT Hospital

Clinical reasoning

 

Processes used to plan, direct, perform, and reflect on client care. You consider why and how we are making these decisions, and reflect on knowledge, experience, and the situation at hand

Scientific: diagnostic, procedural reasoning

Based on what we know based on the condition

 

Making decisions based on protocols, and based on scientific reasoning.

Eg infection risk protocols, following THR precautions

Narrative reasoning

Considering the individual as an occupational being and make decisions based on client interests, roles, and occupational profile.

Eg THR: Communication with client to create an occupational profile, then making decisions based on clients specific needs.

Pragmatic reasoning

Based on considerations of environmental context and constraints:

• Physical constraints: eg access to resources, funding schemes, equipment

• Organisational considerations: eg only one OT in a ward, making decisions on  how quickly and what order they will see the clients

• Sociopolitical constraints: Eg: client has complex social situations which need to involve other members of the multidisciplinary team as well.

Ethical reasoning

Balancing clients values with OT's values and belief systems

 

Eg: conflict between client's wishes and family's wishes

Interactive reasoning

 

Decisions about how the OT interacts with client:

 

Eg: developing working relationship with a client, discussing their interests, asking about family members

Conditional reasoning

Blending of all forms of reasoning to predict future outcomes and respond to changing conditions when working with clients.

 Responding flexibly to conditions

Used by experienced therapists.

Ecological view of professional reasoning

Factors that impact on how clinical reasoning and decision making are applied. Therapists bring characteristics which influence their everyday practice with clients.

Professional self

professional knowledge and experience. May influence practice theories and models that the OT chooses.

Personal self

personal values, beliefs etc. affects how they communicate with client, client family, other team members

Practice context

Context in which the service occurs. Provides enablers and constraints.

Time.

• In a busy hospital, OT will need to address ability to maintain ADL's and IADLs. May not have time to discuss leisure or personal fun occupationals

Physical resources

Discharge options

Social environment

Caseload

Payment for services

Team members

Organisational norms and policies

Clinical reasoning used in step 1 OPPM

What are the OP issues? Why?

Scientific procedural and diagnositc

Clinical reasoning used in step 2 OPPM

What is the best approach for this client/group/community? Why?

Narrative, scientific procedural. Ethical

Clinical reasoning used in step 3/4 OPPM

What are specific strengths and limitations?

Scientific procedural, narrative

Clinical reasoning used in step 5 OPPM

What are the most important things to achieve right now? How are we getting there?

Interactive, narrative, pragmative, ethical, scientific procedural

Clinical reasoning used in step 6 OPPM

What shall we modify, adapt, practice, or learn? Lets do it together.

Interactive, ethical, scientific

Clinical reasoning used in step 7 OPPM

How well did we do? Why?

Ethical, interactive, procedural, conditional