Clinical reasoning

• Clinical reasoning


  The process used by practitioners to plan, direct, and reflect on client care
• Clinical reasoning


  A specialized cognitive process that uses thinking, & sometimes talking (narrative) to facilitate effective problem solving and decision making
• Clinical reasoning


  The types of inquiry or thinking that a therapist does to understand client and their problem in doing routine occupation
• Clinical reasoning process


  1. Ongoing and developmental

  2. Begins as therapist first read a patients referral

  3. Assessment

  4. Treatment

  5. Discharge

  6. Dynamic, influenced by the clinician's experience and personal situation
• Primary clinical reasoning concerns

  • What are the person's occupational performance concerns?
  • What is the person's occupational performance status and potential?
  • What will be done to improve occupational performance?
  • How are effective are intervention?
  • When & How should intervention stop?
• Types of clinical reasoning process

  • Scientific reasoning
  • Narrative reasoning
  • Pragmatic reasoning
  • Ethical reasoning
• Scientific reasoning


  Used to understand the condition that affect an individual and to decide on interventions that are in the best interest of clients
• Diagnostic reasoning


  1. Cue identification

  2. Hypothesis generation

  3. Cue interpretation

  4. Hypothesis evaluation
• Procedural reasoning


  When the therapist think about the disease or disability and deciding which treatment activities (procedures) they might employ to remediate the person's functional performance problems
• Procedural reasoning


  1. Assessment

  2. Analysis

  3. Planning

  4. Intervention

  5. Reassessment
• What scientific reasoning is used to understand

  • The nature of the illness, injury, or development problem
  • The common disabilities resulting from this condition
  • The typical impairments associated with this conditions
  • The typical contextual factors that affect performance
  • The theories and research available to guide assessment and intervention
  • The intervention protocols applicable to this person's condition
• Narrative reasoning


  Provides the Occupational Therapist with a way to understand a person's illness experience<|>Use of stories to help frame practice decision about what to do<|>Understanding of client's past occupation stories, enable practitioners help individual create new stories and new futures for themselves
• What narrative reasoning is used to understand

  • The person's life story
  • The nature of this person as an occupational being
  • How the health condition affected the person's life story or ability to continue his or her life story
  • What occupational activities are most important to this person
  • What occupational activities are both meaningful to this person and useful for meeting therapy goals
• Pragmatic reasoning


  Clinical reasoning that goes beyond the practitioner client relationship and address the practice context and personal context
• Practice context issues in pragmatic reasoning

  • Treatment resources
  • Organizational culture
  • Power relationship among team members
  • Reimbursement issues
  • Practice trends in the profession
• Personal context issues in pragmatic reasoning

  • Interpersonal and group issues
  • Client interest
  • A person's clinical competencies
  • Preference
  • Commitment to the profession
  • Role demands outside of work
• What pragmatic reasoning is used to understand

  • Who is paying for services and what are the expectations?
  • What family or caregiver resources are there to support intervention?
  • What are the expectations of the OT's supervisor and workplace?
  • How much time is there to see this person?
  • What therapy space and equipment are available?
  • What are the OT's clinical competencies?
• Ethical reasoning


  Idealistic thinking about what should be done on behalf of this individual<|>Related to moral and ethical basis of practice<|>Therapist requires to think about what is good and best
• All individuals have equal rights, privilege and status
• All individuals have the rights to expect the freedom to choice in their lives
• Professionals are dedicated and concerned with the welfare of others and are able to use sound judgment in their daily work
• What ethical reasoning is used to understand

  • The benefits and risks to the person related to service provision and do the benefits warrant the risks?
  • In the face of limited time and resources, what is the fairest way to prioritize care?
  • How can the OT balance the goals of the person receiving services with those of the care giver when they don't agree?
  • To what degree should OT customize documentation of services to improve reimbursement?
  • What should the OT do when other members of the treatment team are operating in ways that the OT feels conflict with the goals of the person receiving services?