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

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