Professional reasoning is an all-encompassing
concept of logical thought which guides practise and action. It includes utilization
of modes of reasoning, such as: narrative, diagnostic, scientific, conditional
and ethical types of reasoning.
Clinical reasoning is a component
of professional reasoning that uses logical thinking to plan, direct, provide, influence
and reflect on patient care.
Reasoning enables professionals
to better understand and utilize the best evidence, as well as to allow them to
maintain their intuitive processes to stimulate innervation. When reflected on
professionally it can help bring to life potential biases in our own
professional decision making.
I will be reflecting on my own
clinical reasoning according to the clinical reasoning cycle:
Consider the patient situation:
The interview process to gather cultural, environmental, socio economic and client-based
interests, values and spirituality is essential to establish a
patient-therapist relationship with client centred treatment goals.
As I develop into a therapist, I
am discovering the importance of this with my patients. A session which has not
considered culture or context may even be written off as untherapeutic and ineffective.
Collect cues/ info.: This has to
date been my weakest point as a student. I have been so focused on getting the
jobs done that I have been unsuccessful at researching, gaining knowledge and
interpreting facts which provide evidence to support my points. This forms the
base of treatment as all treatment performed should be objective. I have since downloaded
Trombly from my phone onto my laptop and have been reading chapters such as CVA.
Gaining knowledge from this chapter made me realise the importance of building
a foundation in research.
Process information: I need to
improve in my ability to interpret, discriminate, relate and predict data. This
will come with practise and gained knowledge to ensure an expert thought
process.
Identify problems/ Issues: I am
able to discover the problems my client is faced with; however, my integration
requires improvement. I also need to synthesize facts to make a definitive
diagnosis including co-morbidities.
Establish goals: I am learning to
prioritize my patient specific goals appropriately. This co-insides with
identifying the most important problems. I therefore need to put effort into planning
my short term, medium term and long term aims.
Take action: This refers to the
choice of approaches and frame of reference one establishes for their client.
This skill will develop into second nature over the next two years. A well
thought-through subprogramme is necessary to prioritize goals.
Evaluate outcomes: I feel as
though my research base leading to midterms was poor and this is important in
order to evaluate how the client performed and how the therapist performed.
This base will now help develop my skill in analysing how the sessions could
have been improved
Reflect on process and new
learning: My supervisor discussed that my blogging reflections show increased
insight. I need to implement this into the real world and learn to accept criticism
and feedback with less emotion. Criticism is essential for students to improve as
therapists and develop their clinical reasoning. I also need to become less
nervous when the supervisor asks me questions. I sometimes start thinking of detailed
and complicated answers when she is mainly wanting the simple, obvious
response. E.g. “What do you need to assess with Pt X with regards to her
cognitive problems in reading”. I started to think of specific reading disorders
and go off on a tangent when I know very well already at the beginning of my
session with the client that cognition and perception using MOCA is what is
needed
I am feeling more confident in my
activity choices; however, I need to ensure I do not over structure an activity
and that I think carefully about context. My client managed reasonably well on
the rough terrain and learnt how to propel herself slowly down a gradual
incline. She was also able to get over a medium sized bump. The client’s
endurance is one of her prioritized problems for wheelchair mobility. On Monday
I learnt a lot about my client’s decreased orientation to basic colours, shapes
and numbers through my Geostacks activity, which was structured to improve
dynamic sitting balance.
I structured my sandwich making
activity to include trunk rotation towards the affected right side by including
a table behind the client towards her right. This encouraged balance reactions
and improvement of posture awareness when returning to meal preparation. The
activity was also structured to incorporate bilateral hand functioning and
walking.
In my make up activity with my client
I could have stabilized her at the hip (Key point of control) for a greater
trunk rotation as the items were placed relatively close to her on the affected
right side. I learnt about the importance of spontaneous cognition. Instead of answering
my own question I should be asking and waiting for client response. ‘Why she
chose the eye shadow colour’.
In conclusion, I will develop my
knowledge of NDT components and normal movement patterns and continue to research
in order to develop my clinical reasoning skills.
References:
1. Ferguson, R. (2014). Clinical and
Professional Reasoning in OT. https://www.youtube.com/watch?
2. Isaac Asimov (1982). “Isaac Asimov's Science
Fiction Magazine”
3. (2018). clinical reasoning | nursing student clinical
documents -clinical reasoning cycle. Retrieved from Pinterest on the 02/04/19
No comments:
Post a Comment