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Clinical reasoning is defined as the process used by OT practitioners to understand the client’s occupational needs, make decisions about intervention services, and think about what we do. J A communicative approach to collaboration emphasizes the plurality of choices and the necessity of “means to ends” approaches to problem solving that relate to a person's values and beliefs. Our objective was to generate further theory concerning clinical reasoning in physical therapy. This will facilitate efficient and effective decision-making by the clinician to optimize outcomes … , Masagatani G. Jones She chooses to contradict the medical “defense.” Narelle has been a witness in this situation to a narrative protesting the havoc of iatrogenesis (or medically induced harm to the patient). One example in our study was where the physical therapists expressed regret or failure. SB TY - JOUR. J I 3). The data reduction and analysis for the study was organized around a set of cognitive processes identified by Morse53(p27): (1) comprehending, (2) synthesizing, (3) theorizing, and (4) recontextualizing. The Physical Therapy Clinical Reasoning and Reflection Tool (PT-CRT) illustrates the usage of the International Classification of Functioning, Disability and Health (ICF) model while capturing the complexities of patient-therapist interaction 2. Sometimes we get into the habit of just gritting our teeth and … keeping going when we're in pain. [Narelle is currently doing intertarsal glides. The instrumental and communicative forms of collaboration are not being set against one another, and both could occur within a single treatment session. Narelle: Well, my mum's father died of one, and my sister's had one, so … [with an ironic laugh] they do run in families unfortunately. Results. Methods: The third and final conceptual framework involves the dialectical nature of reasoning within the clinical reasoning strategies. Narelle appears to act from these principles, and yet there is that self-revelation both at the beginning and near the end of the interaction that personalizes her perspective. The second wave of data collection consisted of written material from each of the 6 physical therapists. The breadth and variation in the skills required, as the demands of each area are considered, is vast. C DA . The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy. While she was away (no more than 2 minutes), N began to cry. The following vignette illustrates how clinical reasoning strategies may be used in combination and is drawn from the field notes (and later discussion) of an observed treatment between manual therapist Michael and his patient T: T has continued pain following diskectomy 5 weeks previously. OD , Hunt A. Payton Variations in students' characterizations of physical therapy practice may explain some of the differences observed in … Clinical Reasoning in Physical Therapy: A Concept Analysis - free recording; Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students - free recording; Collaborative Clinical Education: Success in the 2:1 Model Webinar - free recording Clinical Reasoning in Physical Therapy: A Concept Analysis - free recording Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students - free recording Collaborative Clinical Education: Success in the 2:1 Model Webinar - free recording The story that Neve told M regarding the plasterer with headaches appeared to have the aim of providing her with the insight that people sometimes may be unaware that their own responses, or coping behaviors can contribute to the production or perpetuation of symptoms. The determination of the sample size of 6 primary informants (2 clinicians from each field) rested on Kluzel's argument that, “[t]he validity, meaningfulness and insights generated from qualitative inquiry have more to do with the information richness of the cases selected and the observations/analytical capabilities of the research than the sample size.”49, The research panel (consisting of an orthopedic physical therapist who was the primary researcher; 3 other physical therapists with various expertise in qualitative research, adult learning, and teaching; and one other member, a lecturer in ethics) agreed that 6 cases would yield a large and sufficient amount of data. 2019 Sep 4;75(1):1332. doi: 10.4102/sajp.v75i1.1332. Physical therapy students' application of a clinical decision-making model. Waddell Benner . Lincoln A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. J: Well, I've suffered from headaches since I was 16, well over 30 years, and I'm sure it must have been my aneurism. … I spoke to someone yesterday. Rogers Clinical Reasoning is the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained. The visit had been very problem oriented, without any particular expression of how Mr G or his wife was feeling about the situation. Neurological therapist Narelle works with J, who had hemiplegia and was introduced in the collaborative reasoning section. . Therefore, academic faculty must intentionally incorporate specific clinical reasoning strategies within curricula to ensure student growth and development in this area. The treatment sessions and interviews were audiotaped to enable the researcher to focus on the more subtle exchanges (such as nonverbal interaction) between physical therapist and patient, while still permitting detailed analysis of the overall dialogue on later occasions. , Guba EG. One such example is narrative reasoning.27 Narrative reasoning seeks to understand the unique lived experience of patients—a reasoning activity that could be termed “the construction of meaning.” In patients' (or therapists' for that matter) telling of stories or narratives, there is a choice in which some elements are expressed, some elements are emphasized over others, and still other elements may not find expression.40 For example, the particular “telling” of a story or history by patients represents their interpretation of events over time. The terms “narrative” and “communicative” and the terms “hypothetico-deductive” and “instrumental,” as applied to the reasoning strategies, may be considered synonymous. N was depressed and, understandably, experienced mood swings. Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. T The aim of communicative learning and action, however, is not to establish cause-effect relationships but to increase insight and a common understanding of a situation through a mutual learning process between the therapist and the patient. A different mix of clinical reasoning skills may be needed for therapists working in the same settings according to their own particular interests, beliefs, or clinical and life experiences. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, and well-tolerated examination and intervention strategies, as well as mitigate the risk of diagnostic error. . J: But I mean if I had the ultimatum, what do I do? Search for other works by this author on: Clinical reasoning in the health professions, Clinical Reasoning in the Health Professions, Building a customer perspective into evidence-based physiotherapy practice, Proceedings of the Fifth International Congress of the Australian Physiotherapy Association; Hobart, Tasmania, Australia, Australian Physiotherapy Association (Tasmanian branch), Rethinking the beginning practitioner: introducing the “Interactional Professional, Clinical reasoning process in physical therapy, Clinical problem solving in physical therapy and its implications for curriculum development, Proceedings of the Tenth International Congress of the World Confederation for Physical Therapy; May 17–22, 1987; Sydney, Australia, The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management, Medical Problem Solving: An Analysis of Clinical Reasoning, Reflections on the nature of expertise in medicine, Deep Models for Medical Knowledge Engineering, Knowledge-based solution strategies in medical reasoning, Issues of generality in medical problem solving, Hypothesis generation and the coordination of theory and evidence in novice diagnostic reasoning, Clinical reasoning of occupational therapists during the initial assessment of physically disabled patients, Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings, Physiotherapy practice: practitioners' perspectives, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Clinical judgment: how expert nurses use intuition, Intuition: a neglected hallmark of nursing knowledge, Intuitive knowing as a dimension of nursing, From beginner to expert: gaining a differentiated clinical world in critical care nursing, Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics, The narrative nature of clinical reasoning, Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice, Clinical decision making in familiar cases: a model of the process and implications for practice, Achieving intersubjective understanding: examples from an occupational therapy treatment session, Narrative-Based Medicine: Dialogue and Discourse in Clinical Practice, The Illness Narratives: Suffering, Healing, and the Human Condition, Transformative Dimensions of Adult Learning, The Reflective Practitioner: How Professionals Think in Action, Methods in the study of clinical reasoning, Qualitative Research and Case Study Applications in Education: A Qualitative Approach, Finding meaning after the fall: injury narratives from elderly hip fracture patients, Expert decision making in physical therapy: a survey of practitioners, Clinical Pattern Recognition in Physiotherapists: A Pilot Study Investigating the Effect of Different Levels of Experience, The Development and Preliminary Testing of an Assessment Tool for Clinical Reasoning in Physiotherapy, Hypothesis generation in the clinical reasoning behavior of manual therapists, Qualitative Research in Health: An Introduction, Theory innocent or theory smart [editorial], Qualitative Evaluation and Research Methods, Curriculum in the Making: Teacher Choice and the Classroom Experience, “Emerging from the data”: the cognitive processes of analysis in qualitative inquiry, Critical Issues in Qualitative Research Methods, Establishing rigour in qualitative research: the decision trail, Collins Dictionary of the English Language, Clinical reasoning in three different fields of physiotherapy: a qualitative study; The Australian Digitized Theses Program, Narrative(s) versus norm(s): a misplaced debate in bioethics, Stories and Their Limits: Narrative Approaches to Bioethics, International Classification of Functioning, Disability and Health, © 2004 American Physical Therapy Association. There is no question that the physical therapists in our study often appeared to socialize or interact with their patients out of pure enjoyment. Benner This meant that when listening to the audiotapes later, there was a written commentary supplying both contextual information and a workable “index” to material on the audiotapes—an important factor for coding and the later construction of case studies. Using clinical outcomes to explore the theory of expert practice in physical therapy. Epub 2006 Jun 14. Instead, they attended to the cues provided by patients: And I don't always know when I start with them how I'm going to … you know … what path I'm going to take, if you see what I mean. All clinicians, therefore, have an interest in improving their decision making. This kind of interaction was instrumental insomuch as it was carried out to produce a particular effect. Collaborative reasoning is the nurturing of a consensual approach toward the interpretation of examination findings, the setting of goals and priorities, and the implementation and progression of intervention. After a silent moment, N uttered, in response to Narelle's proximity rather than to any question: “God, it's heavy!” The session then slowly resumed its course. The knowledge frameworks and sources of knowledge coding definitions were adapted from Jensen et al.19(p71) The knowledge framework codes included physical therapists' content knowledge of their field or speciality, their knowledge of patients (including of human behavior), a knowledge of teaching, a knowledge of self (including evidence of reflective ability, confidence, and growth as a person and as a professional), and a knowledge of context (relating more to understanding the larger picture and the role of their work, the work environment, and the workings of the health care system). 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