Clincal Reasoning - 2 views

• 
  #1 christenhopkins on 01 Aug 15

   

  This article discusses how 13 experienced OTs utilized head-mounted video cameras to capture their clinical reasoning data in order to collect and analyze it within a focused ethnographic framework. It was found that clinical reasoning is often times revealed within a therapists thinking process¬¬ or debriefing period. It was also found that therapists use aspects of pragmatic reasoning and a new form known as generalization reasoning. This new form is based on past experience/knowledge to assist an individual in making sense of the current situation. The research that has been conducted in this article builds upon previous work that reports OTs are able to 'think in action'.
  According to extensive research being conducted, OTs and other health professionals have documented more than a dozen types of clinical reasoning including: scientific, diagnostic, pragmatic, management, procedural, interactive, collaborative, predictive, conditional, narrative, ethical, intuitive, propositional and client-centered. Clinical reasoning is a complex construct, and with the terminology being used loosely it has led to fragmentation of our current knowledge on this topic.
  Many of the studies that have been conducted on clinical reasoning have included written or filmed case scenarios rather than actual client-therapist interactions which has been a limiting factor in theory development. This can be enhanced by capturing real therapy encounters with video technologies within the therapy process, which inspired the current research method.
  Focused ethnography was used in order to examine 13 experienced OTs clinical reasoning abilities while providing therapy services for 13 clients with head-mounted video cameras and debriefing interviews. The participants were among a convenience sample in a large metropolitan city in Australia within three rehabilitation centers. During the study, each OT made a video of an evaluation, intervention, and discharge planning session with the client and discussed the clinical reasoning utilized within each session. The OT was able to watch the play-back of the session in order to best discuss the clinical reasoning being used because it was believed that image prompting is a better form of recall over memory alone. The head-mounted camera also allowed for the therapist to have the same visual and cognitive perspective as the original session, while also not having to worry about additional researchers observing. The major disadvantage may have been the awareness and awkwardness of having the head-mounted camera during a therapy session.
  The results revealed that procedural, interactive, and conditional reasoning were all collectively used by the OTs as well as the client being treated among three levels-physical ailment, client as a person, or client as social being in the context of their culture, environment and family. A small number of instances were revealed that the OTs used pragmatic reasoning, which seemed to relate to environment that therapy was conducted and personal philosophy. Lastly, generalization reasoning was revealed when the therapists were able to draw on their own experiences of knowledge base about a particular client or situation.
  Future research should be conducted in various settings, rather than just physical rehabilitation in order to see if patterns of clinical reasoning differ. Additional research on head-mounted cameras influence on data collection could also be conducted, in order to determine if having a camera operator deters from the research or the awkwardness.
  In conclusion, it has been revealed that OT's used procedural, interactive, conditional, pragmatic and generalization reasoning in their clinics. Being able to clinically reason is often times a skill that OTs are able to do without even thinking about which is a very valuable attribute within therapy practice.
  
  Unsworth, Carolyn. (2005). Using a Head-Mounted Video Camera To Explore Current Conceptualizations of Clinical Reasoning in Occupational Therapy. American Journal of Occupational Therapy. 59(1). p 31-40.

   

  <div class="cArrow"> </div><div class="cContentInner">This article discusses how 13 experienced OTs utilized head-mounted video cameras to capture their clinical reasoning data in order to collect and analyze it within a focused ethnographic framework. It was found that clinical reasoning is often times revealed within a therapists thinking process¬¬ or debriefing period. It was also found that therapists use aspects of pragmatic reasoning and a new form known as generalization reasoning. This new form is based on past experience/knowledge to assist an individual in making sense of the current situation. The research that has been conducted in this article builds upon previous work that reports OTs are able to 'think in action'. <br /> According to extensive research being conducted, OTs and other health professionals have documented more than a dozen types of clinical reasoning including: scientific, diagnostic, pragmatic, management, procedural, interactive, collaborative, predictive, conditional, narrative, ethical, intuitive, propositional and client-centered. Clinical reasoning is a complex construct, and with the terminology being used loosely it has led to fragmentation of our current knowledge on this topic. <br /> Many of the studies that have been conducted on clinical reasoning have included written or filmed case scenarios rather than actual client-therapist interactions which has been a limiting factor in theory development. This can be enhanced by capturing real therapy encounters with video technologies within the therapy process, which inspired the current research method. <br /> Focused ethnography was used in order to examine 13 experienced OTs clinical reasoning abilities while providing therapy services for 13 clients with head-mounted video cameras and debriefing interviews. The participants were among a convenience sample in a large metropolitan city in Australia within three rehabilitation centers. During the study, each OT made a video of an evaluation, intervention, and discharge planning session with the client and discussed the clinical reasoning utilized within each session. The OT was able to watch the play-back of the session in order to best discuss the clinical reasoning being used because it was believed that image prompting is a better form of recall over memory alone. The head-mounted camera also allowed for the therapist to have the same visual and cognitive perspective as the original session, while also not having to worry about additional researchers observing. The major disadvantage may have been the awareness and awkwardness of having the head-mounted camera during a therapy session. <br /> The results revealed that procedural, interactive, and conditional reasoning were all collectively used by the OTs as well as the client being treated among three levels-physical ailment, client as a person, or client as social being in the context of their culture, environment and family. A small number of instances were revealed that the OTs used pragmatic reasoning, which seemed to relate to environment that therapy was conducted and personal philosophy. Lastly, generalization reasoning was revealed when the therapists were able to draw on their own experiences of knowledge base about a particular client or situation. <br /> Future research should be conducted in various settings, rather than just physical rehabilitation in order to see if patterns of clinical reasoning differ. Additional research on head-mounted cameras influence on data collection could also be conducted, in order to determine if having a camera operator deters from the research or the awkwardness. <br /> In conclusion, it has been revealed that OT's used procedural, interactive, conditional, pragmatic and generalization reasoning in their clinics. Being able to clinically reason is often times a skill that OTs are able to do without even thinking about which is a very valuable attribute within therapy practice. <br /> <br /> Unsworth, Carolyn. (2005). Using a Head-Mounted Video Camera To Explore Current Conceptualizations of Clinical Reasoning in Occupational Therapy. American Journal of Occupational Therapy. 59(1). p 31-40.</div>

  ...

  Cancel

To Top