Clinical Reasoning

1. Clinical Reasoning

2. Introduction • For best practice, clinicians must make numerous decisions during the therapeutic process • Clinical reasoning: “ Complex multi-faceted cognitive process used by practitioners to plan, direct, perform, and reflect on intervention and Assessment • ” (OT practice framework, 2008)

3. Narrative reasoning • Provides a way of learning about the person’s life story • Storytelling: practitioners tell stories about clients to each other • Helps the practitioner reason how particular clients may be experiencing their disabilities and how treatments might proceed • Example: informally during breaks or formally through case-studies • Create stories: practitioner envisions how the future may be for the client so that he/she may guide intervention process • Practitioners create experiences for the client to make activities more meaningful • Example: Developing the occupational profile

4. Procedural Reasoning • Involves thinking about the client’s performance • Used to think about disability level (diagnosis) focusing mainly on the body • Using this reasoning one would choose specific occupation based intervention activities to maximize function while addressing client’s performance problems

5. Interactive Reasoning • Used to individualize the therapeutic approach and to understand the client as a human being • Suggests how a clinicians may interpret and use verbal and nonverbal cues to engage the client • Used to: • Try to understand the extent and limitation to occupational performance from the client’s perspective • Engage the client in the intervention • Individuals the treatment plan • Impart a sense of trust and acceptance to the client • Relive tension by using humor

6. Conditional Reasoning • Encompasses the holistic context of the person, his/her illness, and the possible and actual intervention • Scientific reasoning is used to understand the condition that may be affecting the person and family • Logical thinking about the nature of the client's problems and the optimal course of action in intervention • Requires clinician to consider background knowledge that might help one to understand the characteristic better

7. Pragmatic Reasoning • Used to understand the practical issues that may have an impact on the situation with the person and the family • Enables clinicians to incorporate idea into the situation the family is enduring, allowing one to identify practical strategies for intervention • Examples can include • what the family, caregiver, community resources available to support intervention and following recommendations? • What materials and interdisciplinary support is available for intervention?

8. Ethical Reasoning • Used to make sure one selects the morally justifiable choices • What “should” be done in the best interest of the person and the family

9. Best Clinical Reasoning

10. Development of Clinical Reasoning Skills • Clinical reasoning at five different stages of career development • Stage I: Novice Practitioner • Feels most comfortable with performing the techniques and procedures learned and refining these skills • Do not feel comfortable in using interactive reasoning • Stage II: Advanced beginner • learning to recognize additional cues and beginning to see the client as an individual • Still does not see the whole picture • Stage III: Competent Practitioner • Able to see more facts and to determine the importance of these facts and observations • Has broader understanding of the client’s problem and is more likely to individualize treatment • Flexibility and creativity is still lacking • Stage IV: Proficient Practitioner • Able to view situations as a whole instead of an isolated parts • Able to develop a direction and vision of where the client should be going • Can easily modifies initial plan • Stage V: Expert Practitioner • Recognize and understand rules of practice • Using intuition to know what to do next • Use both procedural and interactive reasoning without difficulties • Conditional reasoning: can rely on past clinical situations to help process imagined outcome for the client