clinical reasoning - critical thinking

Clinical Reasoning & Critical Thinking Overview

Course Title

• OCCU 5003: Dimensions of Professional Practice

• Institution: Dalhousie University

Outline of the Session

• Key Topics Covered:

  • What is clinical reasoning?

  • What is critical thinking?

  • Methodologies for implementation

What is Clinical Reasoning?

• Definition:

  • Schell & Schell (2008): "The process used by practitioners to plan, direct, perform and reflect on client care."

  • AOTA, Boyt et al. (2014): "Same definition emphasizing planning and reflection."

  • Young et al. (2020): "Reflective thinking or reasoning in managing clinical problems."

Importance of Clinical Reasoning for Occupational Therapists

• Guides Practice: Provides structure for effective clinical practice.

• Encourages Best Practices: Promotes the use of theory and evidence-based practices.

• Enhances Problem Solving: Increases effectiveness in addressing client challenges.

• Supports Client-Centered Care: Fosters self-reflection and critical thinking.

• Improves Safety: Decreases misunderstandings and misdirections in care.

• Professionalism: Enhances autonomy, competence, and accountability.

• Identifies Knowledge Gaps: Helps clinicians recognize areas needing further development.

Therapeutic Thinking Processes

• Antecedents and Attributes:

  • Scientific evidence-driven

  • Professional ethics-driven

  • Practical context-driven

  • Client's narrative-driven

Key Aspects of Each Process

1. Scientific Evidence-Driven:

   • Based on hypothesis formulation and testing;

   • Focus on systematic information gathering;

   • Important for novice practitioners.

2. Professional Ethics-Driven:

   • Emphasizes 'what should be done' over 'what could be done';

   • Manages complex issues and ethical dilemmas;

   • Engages in self-reflection and dilemma analysis.

3. Practical Context-Driven:

   • Considers time, space, and economics in therapy;

   • Integrates practical considerations into intervention recommendations.

4. Client’s Narrative-Driven:

   • Focuses on the meaning of occupations;

   • Encourages client and family participation in care.

Basic Clinical Reasoning Process

• Description of Steps:

  1. Description: Understand the characters and goals.

  2. Observe: Identify contributing factors and client reactions.

  3. Link to Knowledge Base: Recognize existing knowledge and gaps.

  4. Hypothesis: Analyze cues and interpretations.

  5. Implement: Decide on actions and responsibilities.

  6. Evaluate: Assess the outcomes versus expected results and client feedback.

Case Study Example

• Alice:

  • 87-year-old with right hemiparesis after a stroke;

  • Experienced extensive therapy but struggles with basic activities;

  • Desires to return to swimming, highlighting the importance of valued occupations.

What is Critical Thinking?

• Definition:

  • An engaged process for examining beliefs and knowledge;

  • Challenges dominant ideologies and power structures.

• Core Characteristics:

  • Involves questioning assumptions;

  • Not merely problem-solving or reasoning.

Critical Thinking Skills

1. Interpretation: Categorize and clarify meaning.

2. Analysis: Examine ideas and identify arguments.

3. Inference: Query evidence and draw justified conclusions.

4. Evaluation: Assess credibility and quality of arguments.

5. Explanation: State results and justify methods.

6. Self-Regulation: Engage in self-monitoring and correction.

Critical Thinking in Practice

• Literature Review Questions:

  • Assess arguments and supporting evidence;

  • Identify theoretical perspectives and underlying assumptions.

• Clinical Practice Questions:

  • Evaluate messages and evidence presented to clients;

  • Reflect on power dynamics within client interactions.

Case Example: Anja and Jude

• Clinical Scenario:

  • Anja's experiences with Jude, a client with a complex case;

  • Issues with attendance resulting in discharge per clinic policy.

Summary of Key Reasons

• Clinical Reasoning: Enhances decision-making and problem-solving capabilities.

• Critical Thinking: Challenges problematic assumptions, guiding effective professional interactions.

• Reflection: Identifying gaps in knowledge aids in professional development and future practices.

Next Class

• Topic: Professional Boundaries