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Clinical Reasoning
504
63
Medical
Graduate
08/11/2009

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Term
Clinical reasoning
Definition
the process used by practitioners to plan, direct, perform and reflect on client care.
Term
Professional resoning
Definition
using the term professional resoning broadens the discussion to include the reasoning that occurs in non-medical environments, such as schools and community settings, as well as resoning done by supervisors, fieldwork educators, and occupational therapy managers as they conceptualize occupational therapy practice.
Term
scientific reasoning
Definition
-systematic approach to creating, testing and using knowledge to make decisions.
Term
Diagnostic resoning
Definition
-a process of methodical thinking by which problems or needs are detected or inferred. ex. seeing person can't breath well so decrease physical level of activity.
Term
Procedural resoning
Definition
the thinking steps involved in working through the intervention reoutines for identified conditions.
-guides therapist in thinking about the patients; physical performance problems. Using identified conditions and then predicting the value.
Term
narrative reasoning
Definition
resoning process used to make sense of people's particular circumstances, prospectively imagine the effect of illness, disability, or occupational performance problems on their daily lives, and create a collaborative, story that is enacted with clients and families through intervention.
Term
pragmatic resoning
Definition
practical reasoning used to fit therapy possibilities into the current realities of service delivery, such as scheduling options, payment for services, equipment availability, therapists' skills, management directives, and the personal situation of the therapist.
-generally not focused on client or client's condition, but rather on all the physical and social "stuff" that surrounds the therapy encounter as well as the therapists' internal sense of what he or she is capable of and has the time and energy to complete.
Term
ethical reasoning
Definition
reasoning directed to analyzing an ethical dilemma, generating alternative solutions, and determining actions to be taken; systematic approach to moral conflict.
-tension often evident as therapist attempts to deterine what is the "right" thing to do, particularly when faced with dilemmas in therapy, competing principles, and risks and benefits.
Term
Interactive reasoning
Definition
used when the therapist want to understand the patient as a person.
thinking directed toward building positive interpersonal relationships with clients, permitting collaborative problem identification and problem solving.
-therapist concerned with what client likes or doesn't like; use of praise, empathetic comments, and nonverbal behaviors to encourage and support client's cooperation.
Term
conditional reasoning
Definition
-conditional reasoning used to project an imagined future condition or situation for the person.
a blending of all forms of reasoning for the purposes of flexibly responding to changing conditions or predicting possible client futures.
-typically found with more experienced therapists who can "see" multiple futures, based on therapists' past experiences and current information.
Term
-ADLs
-IADLs
-rest and sleep
-education
-work
-play
-leisure
-social participation
Definition
Area's of Occupation (8
Term
Values, beliefs and spirituality
-body functions
-body structures
Definition
Client factors (3)
Term
-Sensory perceptual skills
-motor and praxis skills
-emotional regulation skills
-cognitive skills
-communication and social skills
Definition
Performance skills (5
Term
habits
-routines
-roles
-rituals
Definition
Performance patterns (4)
Term
cultural
-personal
-physical
-social
-temporal
-virtual
Definition
context and environment (6)
Term
objects used and their properties
-space demands
-social demands
-sequencing and timing
-required actions
-required body functions
-required body structures
Definition
Activity demands (7)-
Term
novice, advanced beginners, competant, proficient workers, experts.
Definition
5 succeding stages of expertise
Term
Novice
Definition
apply basic rules but do not particularly pay attention to the surroundings.
Term
advanced beginners
Definition
learn thru experience in a variety of situations but still rely on the rules when making decisions
Term
competant
Definition
-adopt a plan for making a decision based on a limited number of factors to ascertain a conclusion.
Term
proficient workers
Definition
more engaged in their task of paying attention to the present situation in light of past encounters with similar circumstances.
Term
experts
Definition
-more intuitive and take reflexive actions based on past practice/experiences and greater understanding of the situation.
Term
assumptions
Definition
that which is taken for granted as the basis for argument or action. Shape what therapists see, affect the interpretation they make and guide what course of action they select.
Term
Therapists reasoning is influenced by at least 4 sources
Definition
-client
-practice setting
-profession
-internal valuses, beliefs, and assumptions of therapists.
Term
habbits of expectation
Definition
- act to selectively determine the scope of our attention by filtering infor and guiding perceptions toward what to notice, what to ignor, what is relevant and what is irrelevant.
Term
perceptual filters
Definition
assumptions form the screen through which therapists view and understand therapeutic experiences.
Term
intrinsicality
Definition
-a personal philosophy of meaning with which we interpret our lives... that informs life choices and life satisfaction (spirituality)
Term
Information processing
Definition
organization of our memories and processes used to learn and use information in those memories, use past memories to learn and recall to think quick on our feet. Like if we need to modify or change an activity we can recall past memories.
Term
frames or scripts
Definition
memories are organied in these and they include what works and what doesn't work.
Term
working memory
Definition
aka short term memory. mediates our perceptions of the world with our memory or knowledge of the world. Purpose to process but not store info enables us to make sense of incoming information and reflect on what we experience.
Term
long term memory
Definition
storage system for both declaritive knowledge and procedural knowledge
Term
declaritive knowledge
Definition
-what we know and declare
Term
procedural knowledge
Definition
avility to do something such as perform various intervention or assessment techniques.
Term
Frame theory
Definition
Long term memory comprises frames that include semantic concepts, their attribute-values, structural invariants, and constraints.
frames make it easy to describe the rich complex knowledge involved in therapy and many options OTs have for therapy
Term
ACT model
Definition
describes how we store semantic, conceptual knowledge as well as how we store information necessary for carrying out actions. Information from procedural and declaritive knowledge interacts, and can only be acted on, only when it is activated and brought into working memory. work together in working memory. All problem solving occurs in working memory.
Term
Dual code theory
Definition
assumes knowledge is represented in memory using sensory-based codes of sight, hearing, smell, touch, and taste rather then semantic representation
Term
cues
Definition
anything in the environment that prompt the therapist to consider a specific diagnosis.
Term
Metacognition
Definition
cognition about cognition, and is a contributer to expert problem solving. (ex. taking notes because we are aware of our limitations)this emerges with experience.
Term
automaticity
Definition
occurs as we dolidify our knowledge an skills so they become both fast and efficient at problem solving. Happens with practice.
Term
expert vs. novice.
Definition
expertise is having experience and knowledge to work at a high level in a given domain. Novice is just beginning to learn a new domain and may be slow and inefficient in problem solving. More experience = expert knowledge.
Term
logical reasoning
Definition
seeks to establish structured rules for reaching conclusions that are irrefutable.
Term
evidence based practice
Definition
scientific reasoning overlaps partly with this in that both are concerned with the evaluation and application of research evidence to clinical practice. evidence based practice includes clinical experience and expert opinion, and takes into account the wishes, goals, and values of the clinet.
Term
scientific inquiry
Definition
-a disciplined investigation of an empirical question.
The act of creating and testing knowledge.
Analysis of principles and scientific method in actual practice
uses many of the same cognitive techniques that scientific reasoning uses, but scientific inquiry is directly focused on the generation of generalizabile knowledge, whereas scientific reasoning concerns itself with decision making in practice.
Term
syllogism
Definition
-A scheme of a formal deductive argument with a major and minor premise and a conclusion.
example: all OTRs are registered with NBCOT
gayle is an OTR
therefore gayle is registered with NBCOT.
Term
Deductive reasoning
Definition
using rules of logic with premises to reach irrefutable conclusions. always uncertainty
Term
inductive reasoning
Definition
use of empirical data and confirming or disconfirming hypotheses to draw conclusions. uncertainty
Term
Evidence based practice includes (3things)
Definition
1. published evidence of an interventions effectiveness. 2. clinical experience and expertise of the practionar and the experience of others. 3. values, goals, preferences, and wishes of client.
Term
When does reasoning begin?
Definition
moment referal is recieved and read reasoning may begin
Term
If problimatic referral....
Definition
questions arise....is it appropriate for OT service? Is it appropriate for me? Do I have the qualification? then the practioner and collegues would need to consider their qualification to provide effective therapy for this individual.
Term
Frame of reference selection can come from..... (4 things)
Definition
1. attendence at work shop 2. past sussessful experience 3. preliminary published evidence 4. studies proven that it worked.
Term
OT profile
Definition
-logical thing to do and includes...who, what occupations are important and why, relevant contexts for the client and carefivers, history, interests/values/motivations; goals and priorities amoung goals; and desired and feasible outcomes.
Term
analysis of OT performance
Definition
assessment is in early stages of OT process, usually involves decision making to identigy unknowns. observations what a client can and can't do.
Term
Intervention plan
Definition
formulation involves collaborative prioritization of goals b/n therapist and client/family/caregiver. in accordance with evidence based practice.
Term
reductionism
Definition
-things can best be understood by taking it apart and studying the individual pieces.
Term
Phenomenology
Definition
how an individual experiences phenomena. the way I tell a stoy tells you a great deal about me and my life, even when i tell a story about some one or something else.
Term
narrative thinking
Definition
deals in subjective, personalized paticulars and specifics of lived experiences, human intention, and action that connects events across time and defines possibilities.
Term
storymaking
Definition
creating stories about future
Term
story telling
Definition
telling stories about past/present.
Term
illness naritive
Definition
specific aspects of the life story deal with health and deviations from it.
Term
volitional narrative
Definition
type of occupational narritive that expresses the persons volition as a set of ideas, percaptions and values that are assembled into a meaningful account by an investigator through a process of elicting parts of a person's life story and selectively retelling those aspects which are exemplory of volition.
Term
4 common errors of scientific reasoning
Definition
1. too few cues observed or too many leading to confusion. 2. inaccurate interpretation of cues. 3. not generating multiple hypotheses, premature closing of reasoning. 4. favoring the search for confirming evidence, instead of seeking disconfirming evidence of hypothesis.
Term
Practice errors
Definition
empirically discoveredmistakes made by professionals in practice.
Term
hypothesis testing
Definition
the use of decuctive and inductive reasoning to confirm or disconfirm possible explanations of a phenomenon.
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