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Clinical Reasoning (clinical + reasoning)
Terms modified by Clinical Reasoning Selected AbstractsEvaluation of the Implementation of Nursing Diagnoses, Interventions, and OutcomesINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2009Maria Müller-Staub PhD PURPOSE.,This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies. METHODS.,Two systematic reviews, instrument development and testing, a pre,post intervention study, and a cluster-randomized trial were performed. FINDINGS.,The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses' clinical reasoning skills. CONCLUSIONS.,Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes. IMPLICATIONS.,Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested. [source] Using NANDA, NIC, and NOC (NNN) Language for Clinical Reasoning With the Outcome-Present State-Test (OPT) ModelINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2006CRRN-A, Donald D. Kautz RN PURPOSE.,To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS.,A scoring instrument was developed and 100 worksheets were retrospectively analyzed. FINDINGS.,NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. CONCLUSIONS.,NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. IMPLICATIONS FOR PRACTICE.,If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use. [source] Clinical reasoning: concept analysisJOURNAL OF ADVANCED NURSING, Issue 5 2010Barbara Simmons simmons b. (2010) Clinical reasoning: concept analysis. Journal of Advanced Nursing,66(5), 1151,1158. Abstract Title.,Clinical reasoning: concept analysis. Aim., This paper is a report of a concept analysis of clinical reasoning in nursing. Background., Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources., Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Review methods., Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Results., Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, ,clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. Conclusion., This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations. [source] Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapistAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2009Kathy Kuipers Background/aim:,The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as a result of brain injury. Method:,Repertory grid interviews were completed before and after exposure to a protocol designed to guide clinical reasoning and decision-making in relation to upper limb neurological rehabilitation. Data were subjected to both qualitative and quantitative analyses. Results:,Qualitative analysis focussed on clinical reasoning content. Common themes across the pre- and post-exposure interviews were the use of theoretical frameworks and practice models, the significance of clinical expertise, and discrimination of ,broad' and ,specific' aspects, as well as differentiation between ,therapist and client-related' aspects of the clinical situation. Quantitative analysis indicated that for both pre- and post-exposure repertory grids, clinical reasoning was structured in terms of two main concepts. In the pre-exposure grid, these were related to the therapist's role, and to the ,scope' of practice tasks (either broad or specific). In the post-exposure grid the two main concepts were upper limb performance, and client-centred aspects of the therapy process. Conclusions:,The repertory grid technique is proposed as an effective tool for exploring occupational therapy clinical reasoning, based on its capacity for accessing personal frames of reference, and elucidating both the meaning and the structure supporting clinical reasoning. [source] The introduction and perception of an OSCE with an element of self- and peer-assessmentEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2008T. Larsen Abstract The purpose of the present study was to encourage reflective dental students by performing an educational Objective Structured Clinical Examination (OSCE) with an element of self- and peer-assessment. An interdisciplinary OSCE comprising cariology, endodontics and microbiology was set up for all third-year students. A blueprint secured representation of the skills to be tested, i.e. knowledge, interdisciplinary knowledge, communication, clinical reasoning and practical procedures. At each station positive and constructive feedback was given to the students based on predefined criteria. Further, the students received written marks after completion of the OSCE. At one station the feedback and marks were replaced by self- and peer-assessment performed by the students in groups after the OSCE. Afterwards, the 68 students and 8 teachers participating in the OSCE answered a questionnaire on their opinion and perception of the examination. The results showed good correlation between the marks given and the students' perception of task difficulty. Generally, there were no systematic variations in the marks given during the week or by individual assessors at the same station, except for one, as well as agreement with marks of the ordinary clinical assessment. The marks given during self- and peer-assessment differed widely, indicating a need for training in this aspect. The questionnaires revealed a very positive perception of the OSCE from both students and teachers. Thus, the majority found the examination relevant and of educational benefit, capable of improving the learning of the students and useful for assessment purposes. Also, the self- and peer-assessment was found useful by the students. In conclusion, this interdisciplinary OSCE stressing constructive feedback to the students was perceived very positively by students and teachers and recognised for its beneficial possibilities in education and assessment. [source] The cultural,ecological orientation of graduate nurses (novice) in medical,surgical nursingINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2008Mary Oliver The aim of this research was to understand the process of clinical reasoning and decision-making and the impact that trajectory of experience has on the decision-making of graduate nurses by investigating the clinical practice of 10 novice nurses. An ethnographic interpretive approach was used to study the clinical practice of novice nurses in medical,surgical nursing. An in-depth interview was conducted following the periods of observation. The findings of this research demonstrate that the graduates who participated in this study were instrumental in creating a cultural,ecological orientation to their practice, and inherent in their practice was a highly developed perceptual awareness of the individual needs of patients and their families, which resulted in a close bond with their patients. [source] Patient Response to the Fast-Track ExperienceINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Jane Flanagan PURPOSE To describe patients' functional health, symptom distress, and recovery at home across a fasttrack perioperative experience. METHODS A nonexperimental, descriptive, correlational design using pre/post test measures and openended questions captured the fast-tracking experience. A convenience sample included 77 patients entering the same-day surgery unit to undergo arthroscopy with general anesthesia and planned fast-track recovery. In the preadmission test area, patients were asked by a nurse to participate in the study. If they agreed and met selection criteria, a nurse completed a demographic sheet, the Foster and Jones Functional Health Pattern Assessment Screeing Tool (FHPAST), and the Symptom Distress Scale (SDS). On the evening of surgery, a nurse called the patient to review the SDS to be completed by phone. At 72 hours after surgery, the FHPAST, the SDS, and a 72-hour open-ended questionnaire were administered to understand the patient experience of fast-tracking. FINDINGS At 12 hours nurses reported patients were "euphoric" and it was difficult to imagine pain or other symptoms. Some patients complained of nausea and fatigue. Most patients had family present. At 72 hours patients described unmet expectations, fatigue, immobility, ineffective pain management, sleep disturbance, and nausea. Interventions included teaching, coaching, and reassurance. Some patients continued to have nursing problems at 72 hours and benefited from a telephone follow-up call. CONCLUSIONS Preliminary results suggest that nursing diagnoses, interventions, and outcomes can be used to describe patient responses to the fast-track experience. Results indicate a need for practice changes to include innovative models and further research to measure outcomes. Fast-tracking can be effective, but requires clinical reasoning by nurses to guide the individual's healing. A coaching intervention seems to enhance patient satisfaction and a sense of being cared for. [source] Clinical reasoning: concept analysisJOURNAL OF ADVANCED NURSING, Issue 5 2010Barbara Simmons simmons b. (2010) Clinical reasoning: concept analysis. Journal of Advanced Nursing,66(5), 1151,1158. Abstract Title.,Clinical reasoning: concept analysis. Aim., This paper is a report of a concept analysis of clinical reasoning in nursing. Background., Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources., Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Review methods., Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Results., Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, ,clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. Conclusion., This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations. [source] The Columbia Cooperative Aging Program: An Interdisciplinary and Interdepartmental Approach to Geriatric Education for Medical InternsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006Mathew S. Maurer MD Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns. [source] Design of a clustered observational study to predict emergency admissions in the elderly: statistical reasoning in clinical practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Gillian A. Lancaster MSc PhD CStat Abstract Objective, To describe the statistical design issues and practical considerations that had to be addressed in setting up a clustered observational study of emergency admission to hospital of elderly people. Study design and setting, Clustered observational study (sample survey) of elderly people registered with 18 general practices in Halton Primary Care Trust in the north-west of England. Results, The statistical design features that warranted particular attention were sample size determination, intra-class correlation, sampling and recruitment, bias and confounding. Pragmatic decisions based on derived scenarios of different design effects are discussed. A pilot study was carried out in one practice. From the remaining practices, a total of 4000 people were sampled, stratified by gender. The average cluster size was 200 and the intra-class correlation coefficient for the emergency admission outcome was 0.00034, 95% confidence interval (0,0.008). Conclusion, Studies that involve sampling from clusters of people are common in a wide range of healthcare settings. The clustering adds an extra level of complexity to the study design. This study provides an empirical illustration of the importance of statistical as well as clinical reasoning in study design in clinical practice. [source] Closing the gap: collaborative learning as a strategy to embed evidence within occupational therapy practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2006Amanda Welch Dip COT Pg Dip ED MSc Abstract Rationale, The principles of clinical governance apply as guidelines for good practice to all practitioners. However, evidence-based practice (EBP) is proving a challenge for practitioners who lack the confidence to consume published research. For therapists not wishing to undertake formal study there is a risk of becoming disempowered within a culture of EBP. Opportunities to develop skills in consuming research have focused on the information dissemination model that has limited effect. Mutual reflective learning processes are recommended to empower practitioners to bridge the theory-practice gap. Aim, An action research approach investigated practice based collaborative learning as a catalyst to increase therapist's competence and confidence in consuming research and to explore the transition toward EB practitioner. Method and Results, A diagnostic survey reaffirmed therapist's lack of confidence in EBP. Formative interviews (n = 5) found an over reliance on professional craft and personal knowledge. Research knowledge was not included in participants' construct of a good practitioner and engagement in higher order critical reflection was limited. Collaborative learning groups (n = 6) embedded in practice integrated research, theory, practice and critical reflection. Supported by the collegial learning environment, a learning package developed participants' confidence and competence in consuming published research. Summative interviews (n = 5) evaluated the group and found that therapists were empowered to incorporate propositional knowledge into their clinical reasoning, engage in critical reflection and challenge their practice. They felt confident to incorporate EBP into their continuing professional development plans. Sustainability of these changes requires commitment from the therapists and the workplace. [source] An undergraduate paediatric curriculum based on clinical presentations and ,key features'JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2008Ralph Pinnock Aim: We wanted to develop and define an undergraduate paediatric curriculum in a way that would facilitate the development of clinical reasoning. Method: We sent a series of four questionnaires to paediatricians in New Zealand to explore their perceptions of common presenting complaints for an undergraduate paediatrics curriculum. The final group of paediatricians consulted had no further suggestions to add to the twenty five presentations that had already been listed. Further consultation lead to the determination of the knowledge and skills students' require in order to assess and manage these presentations. Result: We have defined with wide consultation, a framework for an undergraduate paediatric curriculum suitable for New Zealand. Conclusions: When consulting with a range of experts it can be difficult to reach agreement. By describing the curriculum as a series of presenting complaints and using the concept of ,key features' we were able to reach agreement on the content and details of an undergraduate curriculum for paediatrics. [source] Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nursesJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2009M. MCALLISTER rn edd Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change , acknowledgment and respect. [source] Integrating Evidence-Based Practice in Nurse Practitioner EducationJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2004APRN-C, FAANP, Mary Jo Goolsby EdD ABSTRACT This column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence-based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student-published CPG. When students research and analyze available scientific evidence for a CPG, they learn to critically evaluate and logically organize knowledge for use in clinical practice, and those critical-thinking skills can lead to improved clinical reasoning and decision making. [source] Nested peer tutoring in clinical reasoningMEDICAL EDUCATION, Issue 11 2009Ingeborg Zijdenbos No abstract is available for this article. [source] Design principles for virtual patients: a focus group study among studentsMEDICAL EDUCATION, Issue 6 2009Sören Huwendiek Objectives, This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning. Methods, A total of 104 Year 5 medical students worked through at least eight VPs representing four different designs during their paediatric clerkship. The VPs were presented in two modes and differed in terms of the authenticity of the user interface (with or without graphics support), predominant question type (long- versus short-menu questions) and freedom of navigation (relatively free versus predetermined). Each mode was presented in a rich and a poor version with regard to the use of different media and questions and explanations explicitly directed at clinical reasoning. Five groups of between four and nine randomly selected students (n = 27) participated in focus group interviews facilitated by a moderator using a questioning route. The interviews were videotaped, transcribed and analysed. Summary reports were approved by the students. Results, Ten principles of VP design emerged from the analysis. A VP should be relevant, of an appropriate level of difficulty, highly interactive, offer specific feedback, make optimal use of media, help students focus on relevant learning points, offer recapitulation of key learning points, provide an authentic web-based interface and student tasks, and contain questions and explanations tailored to the clinical reasoning process. Conclusions, Students perceived the design principles identified as being conducive to their learning. Many of these principles are supported by the results of other published studies. Future studies should address the effects of these principles using quantitative controlled designs. [source] Structured assessment using multiple patient scenarios by videoconference in rural settingsMEDICAL EDUCATION, Issue 5 2008Tim J Wilkinson Context, The assessment blueprint of the Australian College of Rural and Remote Medicine postgraduate curriculum highlighted a need to assess clinical reasoning. We describe the development, reliability, feasibility, validity and educational impact of an 8-station assessment tool, StAMPS (structured assessment using multiple patient scenarios), conducted by videoconference. Methods, StAMPS asks each candidate to be examined at each of 8 stations on issues relating to patient diagnosis or management. Each candidate remains located in a rural site but is examined in turn by 8 examiners who are located at a central site. Examiners were rotated through the candidates by either walking between videoconference rooms or by connecting and disconnecting the links. Reliability was evaluated using generalisability theory. Validity and educational impact were evaluated with qualitative interviews. Results, Fourteen candidates were assessed on 82 scenarios with a reliability of G = 0.76. There was a reasonable correlation with level of candidate expertise (, = 0.57). The videoconference links were acceptable to candidates and examiners but the walking rotation system was more reliable. Qualitative comments confirmed relevance and acceptability of the assessment tool and suggest it is likely to have a desirable educational impact. Conclusions, StAMPS not only reflects the content of rural and remote practice but also reflects the process of that work in that it is delivered from a distance and assesses resourcefulness and flexibility in thinking. The reliability and feasibility of this type of assessment has implications for people running any distance-based course, but the assessment could also be used in a face-to-face setting. [source] Beyond multiple-choice questions: using case-based learning patient questions to assess clinical reasoningMEDICAL EDUCATION, Issue 11 2006Kristi J Ferguson No abstract is available for this article. [source] Assessment in the context of uncertainty: how many members are needed on the panel of reference of a script concordance test?MEDICAL EDUCATION, Issue 3 2005R Gagnon Purpose, The script concordance test (SCT) assesses clinical reasoning in the context of uncertainty. Because there is no single correct answer, scoring is based on a comparison of answers provided by examinees with those provided by members of a panel of reference made up of experienced practitioners. This study aims to determine how many members are needed on the panel to obtain reliable scores to compare against the scores of examinees. Methods, A group of 80 residents were tested on 73 items (Cronbach's ,: 0.76). A total of 38 family doctors made up the pool of experienced practitioners, from which 1000 random panels of reference of increasing sizes (5, 10, 15, 20, 25 and 30) were generated with a resampling procedure. Residents' scores were computed for each panel sample. Units of analysis were means of residents' score, test reliability coefficient and correlation coefficient between scores obtained with a given panel of reference versus the scores obtained with the full panel of 38. Statistics were averaged across the 1000 samples for each panel size for the mean and test reliability computations, and across 100 samples for the correlation computation. Results, For sample variability, there was a 3-fold increase in standard deviation of means between a sample panel size of 5 (SD = 1.57) and a panel size of 30 (SD = 0.50). For reliability, there was a large difference in precision between a panel size of 5 (0.62) and a panel size of 10 (0.70). When the panel size was over 20, the gain became negligible (0.74 for 20 and 0.76 for 38). For correlation, the mean correlation coefficient values were 0.90 with 5 panel members, 0.95 with 10 members and 0.98 with 20 members. Conclusion, Any number over 10 is associated with acceptable reliability and good correlation between the samples versus the full panel of 38. For high stake examinations, using a panel of 20 members is recommended. Recruiting more than 20 panel members shows only a marginal benefit in terms of psychometric properties. [source] Supporting the problem-based learning process in the clinical years: evaluation of an online Clinical Reasoning GuideMEDICAL EDUCATION, Issue 6 2004Greg Ryan Purpose, Implementing problem-based learning (PBL) in the clinical years of a medical degree presents particular challenges. This study investigated the effectiveness of using an online Clinical Reasoning Guide to assist integration of PBL in the clinical setting and promote further development of students' clinical reasoning abilities. Method, A total of 52 students in 6 PBL groups, together with their 6 clinical tutors, participated in the study. Data were analysed from videotaped observations of tutorial activity and follow-up, semistructured interviews. Results, From both the student facilitators' and the clinical tutors' perspectives, the Guide proved an effective tool for augmenting the PBL process in clinical settings and promoting the development of clinical reasoning. By combining computer-aided learning with collaborative PBL tutorials it promoted individual as well as collaborative reasoning. There is also evidence to suggest that the Guide prompted students to look more critically at their own, their colleagues' and other clinicians' reasoning processes. [source] Development of the Competency Based Fieldwork Evaluation (CBFE)OCCUPATIONAL THERAPY INTERNATIONAL, Issue 4 2001Linda T Miller PhD Abstract Recent changes in health care have contributed to an increase in community care and a consequent increase in community fieldwork sites in professional practice education. Evaluations of student performance designed before this transition are limited in their applicability across diverse settings. This article describes the development of a student performance evaluation, the Competency Based Fieldwork Evaluation (CBFE), based on a set of core competencies. Specifically, the CBFE was created to be used across a variety of rehabilitation professions: (a) to evaluate student performance in a variety of fieldwork settings, (b) to provide a cumulative record of student competency acquisition, and (c) to ensure competency for entry to practice. Focus group discussions and review of evaluations across disciplines led to the compilation of seven competencies common to all rehabilitation professions: (1) practice knowledge, (2) clinical reasoning, (3) facilitating change, (4) professional interactions, (5) communication, (6) professional development, and (7) performance management. A pilot version of the CBFE, using a visual analogue scale (VAS) for each competency, was field tested. Content analysis supported the seven competencies. However, concerns regarding the use of a VAS led to revision to a numeric rating scale with descriptors reflecting the stages of professional development. Evidence to date supports the use of the CBFE as a measure of developing clinical skills across diverse settings. However, most data have come from occupational therapy students. Future research is needed to evaluate the numeric rating scale, the reliability of the CBFE, and to evaluate the applicability of the CBFE across rehabilitation professions. Copyright © 2001 Whurr Publishers Ltd. [source] Australian occupational therapy practice in acute care settingsOCCUPATIONAL THERAPY INTERNATIONAL, Issue 3 2001Dr Susan D. Griffin Lecturer, Faculty of Health Sciences Abstract A national sample of occupational therapists was surveyed to explore the nature of Australian occupational therapy practice in acute care settings. Self-care was the major client need that therapists reported they addressed, with an initial interview being the most common assessment procedure. Client education was the most frequently used intervention. The most important skills therapists reported for effective practice in acute care were time management, quick clinical reasoning and lateral thinking. Important workplace characteristics included a cooperative health-care team and early referral. Therapists reported that their most important resources were supportive senior therapists and a well-resourced equipment pool. Three attitudinal factors emerged. Therapists in interdisciplinary teams and those with more experience had more positive attitudes. Younger therapists experienced more concern about not being able to do more for their patients. Results suggest a need for graduates to be better prepared in some skill areas and to have more realistic expectations of practice in this area. Department managers need to ensure younger therapists receive adequate support from senior therapists. Further research is needed to determine how best to provide this support and to further examine the influence of the education experience on practice expectations. Copyright © 2001 Whurr Publishers Ltd. [source] "We Seem to Have Always Spoken in Prose . . ." Policy Analysis Is a Clinical Profession: Implications for Policy Analysis Practice and InstructionPOLICY STUDIES JOURNAL, Issue 2 2007Iris Geva-May The purpose of this article is (i) to propose the concept of policy analysis as a clinical profession, (ii) to relate to the clinical intellectual processes involved in policy analysis, and (iii) following studies in other clinical disciplines, to infer implications for policy analysis and policy analysis instruction. The article will highlight notions of clinical reasoning and clinical cognitive processes relevant to policy analysis and will address reasoning errors associated with bounded rationality and uncertainty in the clinical analytic process. The article seeks to promote awareness of clinical notions and of their relevance for policy analysis practice and instruction. [source] Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environmentsRESEARCH IN NURSING & HEALTH, Issue 3 2003Marianne C. McCarthy Abstract In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26: 203,212, 2003 [source] Situated clinical reasoning: Distinguishing acute confusion from dementia in hospitalized older adultsRESEARCH IN NURSING & HEALTH, Issue 2 2003Marianne McCarthy Abstract In this study a dimensional analysis approach was used to explore the clinical reasoning of nurses who care for hospitalized older adults to identify factors that might explain their failure to detect acute confusion and to distinguish it from dementia in this patient population. Data analysis yielded a grounded theory of situated clinical reasoning, which proposes that the ability of nurses to identify acute confusion varies widely. This variation can be attributed to the differences in nurses' philosophical perspectives on aging. According to this theory, three distinct perspectives are unwittingly embraced by nurses who care for older patients. These perspectives influence how nurses characterize aging and the aged and condition the ways in which they judge and ultimately deal with older adults in clinical situations. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26:90,101, 2003 [source] Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapistAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2009Kathy Kuipers Background/aim:,The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as a result of brain injury. Method:,Repertory grid interviews were completed before and after exposure to a protocol designed to guide clinical reasoning and decision-making in relation to upper limb neurological rehabilitation. Data were subjected to both qualitative and quantitative analyses. Results:,Qualitative analysis focussed on clinical reasoning content. Common themes across the pre- and post-exposure interviews were the use of theoretical frameworks and practice models, the significance of clinical expertise, and discrimination of ,broad' and ,specific' aspects, as well as differentiation between ,therapist and client-related' aspects of the clinical situation. Quantitative analysis indicated that for both pre- and post-exposure repertory grids, clinical reasoning was structured in terms of two main concepts. In the pre-exposure grid, these were related to the therapist's role, and to the ,scope' of practice tasks (either broad or specific). In the post-exposure grid the two main concepts were upper limb performance, and client-centred aspects of the therapy process. Conclusions:,The repertory grid technique is proposed as an effective tool for exploring occupational therapy clinical reasoning, based on its capacity for accessing personal frames of reference, and elucidating both the meaning and the structure supporting clinical reasoning. [source] Identification of occupational therapy clinical expertise: Decision-making characteristicsAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2009Mehdi Rassafiani Background:,Experts are usually determined on the basis of length of experience, reputation, peer acknowledgement, and certification. While these characteristics are important they may, however, not be sufficient for this purpose. Another method for determining clinical expertise is to look at how individuals make decisions in their area of expertise. This study aims to identify clinician expertise on the basis of participants' decision performance and examines this in relation to their length of experience and type of decision-making. Methods:,The Cochran,Weiss,Shanteau (CWS) is a statistical method that can be used to examine individuals' expertise on the basis of how they discriminate between hypothetical cases and consistency in their decision-making. Participants comprised 18 occupational therapists, each with more than 5 years of experience working with children with cerebral palsy. They were required to make treatment judgements for 110 cases (20 of which were repeated) of children with cerebral palsy. The CWS was calculated for each participant. Results and conclusions:,Two groups of participants were identified on the basis of their CWS index , one with both high consistency in decision-making and the ability to discriminate between cases, the other with low consistency and poor discrimination. These two groups did not differ significantly on the basis of length of experience or work setting but did differ on the basis of intervention chosen and their type of decision-making. The CWS method seems to offer promise as a means of determining clinical expertise on the basis of clinical decision-making. Its application to the investigation of clinical reasoning and education is discussed. [source] 15 Assessing the Clinical Reasoning Skills of Emergency Medicine Clerkship Students Using a Script Concordance TestACADEMIC EMERGENCY MEDICINE, Issue 2008Aloysius Humbert Fourth-year medical students in emergency medicine (EM) clerkships are evaluated by various methods. Multiple choice examinations are frequently used to supplement clinical evaluations. These are limited in their ability to evaluate students' clinical reasoning skills. The Script Concordance Test (SCT) is an innovative assessment method developed to evaluate clinical reasoning. The SCT consists of a series of clinical vignettes, each followed by a series of specific questions that present an additional piece of data (a lab result, a physical finding, etc.) to the student. The students then indicate how the additional data affect their thinking regarding a possible diagnosis, an investigational strategy, or a therapeutic intervention, using a 5 point Likert scale (-2,-1,0,+1,+2). SCT questions have no single correct answer; instead, students receive credit based upon the level of agreement between their answers and those of a panel of 10 to 20 expert physicians who take the test to derive the answer key. The SCT is easily administered. In other disciplines, the SCT has demonstrated the ability to differentiate between the clinical reasoning skills of experienced and novice clinicians. The clerkship directors developed an EM SCT using an expert panel of 10 EM attending physicians. For the 07-08 academic year, SCT questions have been incorporated into the EM clerkship end-of-rotation written examination. The EM SCT shows promise as a measure of a student's clinical reasoning ability. Future studies will assess in greater detail the performance and statistical properties of the SCT in the setting of the EM clerkship. [source] | |||||||||||||||||||||||||