Dissertations / Theses on the topic 'Clinical reasoning'
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Khatami, Shiva. "Clinical Reasoning in Dentistry." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27095.
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Background: Clinical reasoning is the core competency of healthcare. It involves cognition and interaction with the environment to understand clinical situations, make diagnostic and therapeutic decisions, and address clinical problems. Defining competency in clinical reasoning is a difficult objective for dental educators because of our limited understanding of this phenomenon which compromises the validity of any curricular model and assessment method that have been used to date.
Objectives: To describe the process and strategies of clinical reasoning used by dental clinicians across different levels of expertise to develop a conceptual framework for curricular design and assessment of competency.
Methods: Using “think-aloud” method, I interviewed 18 dental students about biopsychosocial issues influencing oral health identified in 6 vignettes; and 8 orthodontic residents plus 11 orthodontists about problems of craniofacial growth and malocclusion presented in 2 vignettes. The interview transcripts were analyzed to explore the process and strategies of clinical reasoning used by the participants.
Results: The reasoning process in both groups included: 1) a ritualistic approach to collect information for a treatment plan; 2) forward and backward reasoning to make and test hypotheses from clinical information; 3) pattern recognition and an integrated script of knowledge and experience triggered by related attributes of the script leading to a clinical diagnosis and plan; and 4) decision trees to evaluate treatment options and maximize the probability and utility of outcomes. Seven reasoning strategies (scientific, conditional, collaborative, narrative, ethical, pragmatic and “part-whole”) were used by both groups. However, experienced clinicians were more confident in their appraisal of uncertain situations and dilemmas as they integrated several reasoning strategies in the process; used refined scripts of knowledge and experience in familiar situations; and were able to reflect on the impact on their reasoning of the larger social, cultural and political context.
Conclusions: Clinical reasoning in dentistry is a contextual and interactive phenomenon that requires integration of specific reasoning strategies to address the biopsychosocial factors influencing oral health. Expertise in clinical reasoning develops through continuous framing and solving problems to refine networks of knowledge and experience and develop adaptive strategies to address the contextual determinants of oral health.
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Rahayu, Gandes Retno. "Clinical reasoning skills: measurement and development." Thesis, University of Dundee, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574680.
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Cruz, Eduardo José Brazete Carvalho. "Clinical reasoning in musculoskeletal physiotherapy in Portugal." Thesis, University of Brighton, 2010. https://research.brighton.ac.uk/en/studentTheses/5d5210fe-b5d1-4bc6-be38-aa29f91a1178.
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Clinical reasoning refers to the process in which practitioners, interacting with their patients, structure meaning, goals, and health management strategies based on clinical data, patient/client choices, and professional judgment and knowledge (Higgs & Jones, 2000, p. 11). Recent literature in physiotherapy and other allied health professions describes clinical reasoning as moving between cognitive and decision-making processes required to optimally diagnose and manage impairment and physical disabilities (hypothetic-deductive), and those required to understand and engage with patients' experience of disabilities and impairments (narrative reasoning). Clinical reasoning has been described as a universal process, common to all clinicians, in particular in the musculoskeletal area. However, clinical reasoning models emerged from research developed in specific and well-developed health care and professional cultures, such as Australia and United States, but there has been little discussion of their relevance and applicability to other cultural groups. Since research literature concerning physiotherapy in Portugal is almost non-existent, the aims of this study were twofold. The first aim was to explore clinical reasoning processes in a sample of Portuguese expert physiotherapists and secondly, to identify the current perspective of clinical reasoning held by educators and students, and how it is promoted in the undergraduate curriculum. The focus of the study was musculoskeletal physiotherapy. The research was influenced by the interpretative/constructivist paradigm of inquiry. The study consisted of three parts. In part one, the clinical reasoning approach of a sample of Portuguese expert therapists in musculoskeletal physiotherapy was investigated. The study focused on Portuguese clinicians' interaction with their patients in order to define and manage clinical problems. Data was collected through non-participant observation, semi-structured interviews, memos and field notes, and analysed thematically to identify and compare the practice and reasoning approach used. In part two, the generic aspects of undergraduate physiotherapy curricula in Portugal were analysed to provide a first insight of how educational programmes are organized and delivered in Portugal. Then, current musculoskeletal physiotherapy curricula in Portuguese entry-level physiotherapy programs were analysed by a questionnaire survey and documentary analysis. The specific aim was to capture the educational process and actions underlying current educational practice across undergraduate courses. In part three (Study 3 and 4), a sample of musculoskeletal lecturers and a sample of near graduate students were selected against criteria relating to the diversity of institutions that offer undergraduate physiotherapy courses (private versus public institutions) and length of time as a Physiotherapy education provider. Each course was examined from lecturer and student perspectives (through individual interviews and focus groups) to see what kind of clinical reasoning approach were most emphasised in relation to physiotherapy intervention in musculoskeletal conditions. Data were transcribed and subjected to thematic analysis. Findings showed some similar characteristics in the reasoning process of this group of Portuguese expert physiotherapists in the study when compared with other studies in the musculoskeletal physiotherapy field. However, findings also highlighted that Portuguese physiotherapists were more likely to use and value an instrumental approach to clinical practice. There was little evidence of patients sharing their perspectives about their problems or participating in clinical decisions made. An instrumental approach to reasoning and practice was also dominant in current Portuguese musculoskeletal programs as well in educators' and students' perspectives. The focus was on diagnostic and procedural strategies of reasoning with little emphasis on promoting student competences to involve patients in the decision making process. In this sense, the practice and reasoning of this sample could be seen as more instrumental than communicative. Perspectives on clinical reasoning differ between cultures and contexts of practice and this has implications for the quality of health care education and service delivery. This research has identified the current model of clinical reasoning in Portuguese Physiotherapy practice. The findings have significant implications for clinical practice in musculoskeletal physiotherapy, curriculum development, and wider education and health service policy.
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Fu, Wing. "Assessing student physical therapists' clinical reasoning competency." Diss., NSUWorks, 2013. https://nsuworks.nova.edu/hpd_pt_stuetd/2.
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LeGrande, Stefanie Lynn. "Evaluation of Clinical Reasoning of Nursing Students in the Clinical Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3110.
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The primary focus of nursing education in the 21st century is to graduate students with well-developed critical thinking and clinical reasoning skills. This descriptive case study explored the perceptions of 6 faculty and 6 unit staff nurses concerning the assessment of critical thinking and clinical reasoning skills of nursing students in the clinical setting. Benner's novice to expert theory served as the conceptual framework for the research. The guiding research questions focused on faculty and staff perceptions concerning unit staff nurses' level of preparedness to assess the critical thinking and clinical reasoning ability of nursing students, and explored how faculty and unit staff nurses perceived the process of evaluating nursing students' clinical reasoning and critical thinking skills in the clinical setting. Data were collected using semi structured interview questions, then coded and analyzed following Creswell's approach. This analysis identified six themes: (a) lack of consistency, (b) faculty and staff clinical expectations of students, (c) barriers to clinical education, (d) faculty and staff differences in educational definitions, (e) faculty and staff comfort level with students, and (f) resources needed for clinical education. Learning how faculty and staff nurses assess student nurses' ability to demonstrate effective clinical reasoning and critical thinking skills can positively impact social change in nursing education on the local and state level by informing best practice in how critical thinking and clinical reasoning are taught and assessed in nursing education. This facilitates graduating nurses who are prepared to deliver patient care that affect positive outcomes.
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Arocha, José F. (José Francisco). "Clinical case similarity and diagnostic reasoning in medicine." Thesis, McGill University, 1991. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=74638.
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This thesis describes a study of novice problem solving in the domain of medicine. The study attempts to answer questions pertaining to the diagnostic accuracy, the generation and change of diagnostic hypotheses, and the use of clinical findings in the course of solving clinical cases with similar presenting complaints. Two specific issues are addressed: (1) how does the initial case presentation suggesting a common disease schema affect the diagnostic problem solving process of novices and intermediate subjects? (2) what are the processes the subjects used in coordinating hypothesis and evidence during diagnostic problem solving?Medical trainees (students and a resident) were given four clinical cases to solve and think-aloud protocols were collected. The verbal protocols were analyzed using methods of protocol analysis. The results show that second year medical students interpreted clinical cases in terms of the more common disease schema, regardless of the initial presentation of the case. More advanced students, although unable to make a correct diagnosis in most instances, were less susceptible to such confusions. Only the resident was able to interpret the cases in terms of different disease schemata, reflecting knowledge of the underlying disease process. The semantic analysis of the protocols revealed that most students, especially at lower levels of training, misinterpreted or ignored the evidence that contradicted their initial hypotheses and made use of a mixture of forward and backward reasoning; a finding consistent with previous research. Implications for educational training and for a theory of novice problem solving in medicine are presented.
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Nikopoulou-Smyrni, Panagiota. "A model of clinical reasoning in health informatics." Thesis, Keele University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401075.
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Adams, Linda. "Clinical reasoning and causal attribution in medical diagnosis." Thesis, University of Plymouth, 2013. http://hdl.handle.net/10026.1/1535.
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Forming a medical diagnosis is a complicated reasoning process undertaken by physicians. Although there has been much research focusing on clinical reasoning approaches, there is limited empirical evidence in relation to causal attribution in medical diagnosis. The research on which this thesis is based explored and examined the social process of medical diagnosis and provides an explanation of the clinical reasoning and causal attribution used by physicians. The research was undertaken in an Emergency Department within an acute hospital, the data were collected using mixed method approach including one to one semi-structured interviews with individual physicians; observation of their medical assessments of patients and secondary data analysis of the subsequent recorded medical notes. The study involved 202 patients and 26 physicians. The analysis of the physicians’ semi-structured interviews, shows how physicians describe the diagnostic step process and how they blend their clinical reasoning skills and professional judgment with evidence-based medicine. Physicians apply prior learning of taught biomedical and pathophysiological knowledge to question patients using pattern recognition of common signs and symptoms of disease. These findings are portrayed through taped narratives of the physician/patient interaction during the medical diagnostic process, which shows how physicians control the medical encounter. The analysis/interpretation of documentary evidence (recorded medical notes) provides an insight into the way in which physicians used the information gathered during the diagnostic step process. By using SPSS it was possible to cluster the cases (individual patients) into groups. This stage-ordered classification procedure demonstrated commonality amongst individual cases whilst highlighting the uniqueness of any cases. A pattern emerged of two groups of cases: Group 1 - comprised of patients with the presenting complaints of chest pain, shortness of breath, collapse, abdominal pain, per rectal bleed, nausea, vascular and neurological problems and Group 2 - comprised of patients presenting with trauma, mechanical falls, miscarriage/gynaecological problems, allergies/rashes and dental problems. Findings show that the clinical reasoning approaches used varied according to the complexity of the patient’s presenting complaint. The recorded medical notes for the patients in Group 1, were comprehensive and demonstrated a combined approach of hypothetic-deductive and probabilistic reasoning which enabled the physicians to deal with the degree of uncertainty that is inherent in medicine. The recorded process in the medical notes was shortened for the majority of patients in Group 2, and here the clinical reasoning approach used was found to deterministic. It is acknowledged, that this is not always the case. By using crisp set QCA it was possible to explore causal conditions consistent with Group 1. Further analysis led to examination of the link of causal conditions presented in the medical notes with the individual impression/working diagnosis made by physicians.
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Vinten, Claire. "The development of clinical reasoning in veterinary students." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33728/.
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Clinical reasoning is the skill used when veterinary surgeons make a decision regarding the diagnosis, treatment plan or prognosis of a patient. Despite its necessity and ubiquity within clinical practice, very little is known about the development of clinical reasoning during undergraduate training. Even less is understood about how veterinary schools should be helping students improve this skill. The aim of the research presented within this thesis was to, firstly, examine the development of clinical reasoning ability within veterinary students and, secondly, to investigate possible methods to aid this process. The University of Nottingham School of Veterinary Medicine and Science (SVMS) was used as a case study for this research. In study one, focus groups and interviews were conducted with SVMS staff, students and graduates to investigate the development of clinical reasoning. A curriculum document content analysis was also performed. The findings suggested that clinical reasoning development is not optimal, with alumni facing a steep learning curve when entering practice. These results were used to design study two, in which a simulated consultation exercise utilizing standardised clients was created and implemented for final year students. The success of the simulation was measured using both quantitative and qualitative methods – all of which supported the use of the session for clinical reasoning development. The final study, also building on the findings of study one, aimed to improve the accessibility of veterinary surgeons’ decision-making processes during student clinical extramural studies placements (CEMS). A reflective Decision Diary was created and trialled with third and fourth year SVMS students. Diary content analysis showed the study aim was met, triangulated by survey and focus group findings. During the research, wider issues relating to clinical reasoning integration into veterinary curricula were unearthed. These included low student awareness of the subject and the misalignment between the skill learnt during training and the skill required when in practice. Several recommendations have been made to improve the design of the undergraduate curriculum in relation to clinical reasoning.
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Ajjawi, Rola. "Learning to communicate clinical reasoning in physiotherapy practice." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1556.
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Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.
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Ajjawi, Rola. "Learning to communicate clinical reasoning in physiotherapy practice." University of Sydney, 2006. http://hdl.handle.net/2123/1556.
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Doctor of Philosophy (PhD)Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.
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Cefo, Linda M. Dr. "Qualitative Study Exploring the Development of Clinical Reasoning in Nursing's Clinical Education Settings." Cleveland State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=csu1556456523899578.
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Munroe, Helena A. "Clinical reasoning in community occupational therapy : patterns and processes." Thesis, Heriot-Watt University, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.315181.
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Collins, Mark. "Clinical reasoning in image guided radiotherapy : a multimethod study." Thesis, Sheffield Hallam University, 2018. http://shura.shu.ac.uk/23419/.
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Introduction 3D Image Guided Radiotherapy (IGRT) using cone beam computer tomography has been implemented into the UK over the last decade. There is evidence to suggest that the training of therapeutic radiographers and the development of departmental processes may not have kept pace with the implementation. A literature review highlighted a paucity of evidence relating to how therapeutic radiographers make clinical decisions during image interpretation in the IGRT processes. Purpose The study aimed to investigate the types of decision-making processes used by therapeutic radiographers during image interpretation in IGRT. In addition, the study aimed to investigate the factors that impact on the decision-making processes of therapeutic radiographers during IGRT. Method A multimethod research design was adopted that utilised a think-aloud observational method with follow-up interviews. Thirteen participants were observed and interviewed across three United Kingdom (UK) radiotherapy centres. Participants were observed reviewing and making clinical decisions in a simulated environment using clinical scenarios developed in partnership with each centre's Clinical Imaging Lead. Protocol analysis was used to analyse the observational data. Thematic analysis was used to analyse the interview data. Member checking was carried out using an online presentation and questionnaire, along with periodic peer debriefing by the supervisory team. Findings from the observations and semi-structured interviews were then combined using a triangulation protocol. Results Therapeutic radiographers were observed using one of three decision-making processes. These assume the titles simple linear process, linear repeating process and intuitive process. Participants were found to prioritise the target volume to be treated over the organs at risk. There were notably mixed opinions on the impact of overall therapeutic radiographer experience on decision-making. The findings of the study align with general principles of expert performance, which claims that expertise is only improved by seeking out particular kinds of experience and carrying out deliberate practice in this specific task or specific area of practice. A descriptive module was developed to demonstrate the factors that impact on decision-making. The centre structure, training and the wider involvement of the multidisciplinary team were all found to be key factors that impacted on the decision-making process during IGRT. Staffing levels and communication patterns between the multidisciplinary team were found to be highly variable across the three centres. Greater communication and involvement of the multidisciplinary team was found to improve therapeutic radiographers' confidence in making clinical decisions. Issues in relation to pre-registration training were highlighted, with a consensus that recent graduates do not always demonstrate the skills and experience required to make clinical decisions. A lack of education in relation to clinical decision-making was highlighted at both pre-registration and post-qualification levels. A conceptual model to improve clinical decision-making in image interpretation during IGRT was developed and is presented in the thesis. Conclusion This research has provided new and original insight into the decision-making processes of therapeutic radiographers. It has demonstrated that therapeutic radiographers utilise complex processes during image interpretation in IGRT. It has shown that numerous factors affect the decisions that therapeutic radiographers routinely make, and that with improvements in education and radiotherapy centre infrastructure, therapeutic radiographers can be better placed to make safer, more effective decisions during the IGRT process.
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Van, Wyngaarden Angeline. "Educational practices for promoting student nurses' clinical reasoning skills." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/61674.
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Background: Clinical reasoning is the ability to reason as a clinical situation changes and is an
essential component of competence in nursing practice. However, some traditional teaching
and learning strategies do not always facilitate the development of the desired clinical
reasoning skills in nursing students.
Problem statement: Nurse educators at a military nursing college in Gauteng are
predominantly utilising traditional teacher-centred teaching and learning strategies. The
concern is that if students are predominantly taught by means of traditional teacher-centred
strategies this may not contribute to the development of the desired clinical reasoning skills
required for nursing practice. To improve educational practices to promote the development of
student nurses' clinical reasoning skills, the researcher conducted an action research study.
Aim: The aim of the study was to facilitate a process of change towards improving educational
practices in order to promote the development of undergraduate student nurses' clinical
reasoning skills.
Methodology: Action research was used to conduct the research study by means of three
phases. During Phase 1: the Baseline phase, data was collected by means of unstructured
interviews with nurse educators and head of departments to explore and describe the
challenges experienced by nurse educators in utilising alternative educational practices.
During Phase 2: the Action Research Process phase, an action research group was
established to co-construct an action plan to address the identified challenges. Four action
research cycles each comprising four steps, namely plan, act, observe and reflect was
implemented. Phase 3, the Evaluation of the Action Research Process phase, evaluated the
outcomes of the action research process by means of the World Café data collection method.
Qualitative data from Phase 2 was analysed using the steps outlined in Saldaña (2013). The
activities conducted during the action research group workshops were recorded and minutes
were kept. Data from the World Café was analysed using the creative hermeneutic data
analysis method as suggested by Boomer and McCormack (2010).
Findings: The challenges encountered by nurse educators were explored and the following
four main themes emerged: educational practices; clinical learning environment; military learning environment; and role players in the teaching and learning environment. The
challenges were prioritised by the action research group into four strategies: teaching, learning
and assessment strategies; the clinical learning environment; continuous professional
development; and support and selection of students and nurse educators. An action plan was
co-constructed during Phase 2 by the action research group participants. The project was
evaluated by the action research group as successful. The action research process contributed
to the professional development of the nurse educators and resulted in the utilisation of more
student-centred teaching, learning and assessment strategies.
Conclusions: An action plan was developed to improve educational practices at the South
African Military Health Service Nursing College. The researcher also developed a conceptual
framework to promote clinical reasoning skills. Addressing nurse educator challenges in
collaboration and empowering them with the means, opportunity and skill to utilise studentcentred
teaching and learning strategies may contribute to the development of undergraduate
student nurses' clinical reasoning skills.Thesis (PhD)--University of Pretoria, 2017.
Nursing Science
PhD
Unrestricted
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Junkin, Victoria. "Improving Clinical Reasoning Skills by Implementing the OPT Model." Thesis, The University of Alabama, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10830485.
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Clinical reasoning is the cognitive process and strategies used to understand the significant patient data to identify and diagnose actual or potential problems in order to make competent clinical decisions that will affect patient outcomes (Fonteyn & Ritter, 2000). The purpose of the study was to determine if implementing the Outcome-Present State Test Model of Clinical Reasoning with guided reflection activities was an effective method to improve clinical reasoning skills in senior nursing students at a large southeastern university. The overall research questions involve comparing participants Health Sciences Reasoning Test scores before and after implementation of the OPT Model as clinical paperwork, secondly the experimental group was given a guided reflection activity to complete in conjunction with use of the OPT Model during clinical experience.
Kolb’s Experiential Learning Theory is the theoretical framework used throughout this study. Nursing education has historically blended didactic learning with clinical experiences to transfer knowledge. The OPT offers a frame to organize thoughts and guides the learner to decide what data is important to each patient situation.
This study reports the findings for 62 senior nursing students that completed the HSRT prior to implementation of the OPT Model and a guided reflection activity. Clinical instructor’s scored participants using the Lasater’s Clinical Judgment Rubric each week. There were no statistically significant differences between the experimental group and the control group. The only statistically significant difference that was identified was in the Lasater’s Clinical Judgment Rubric scores between week one and week 2, and week 3 and week 4.
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Loftus, Stephen Francis. "Language in clinical reasoning: using and learning the language of collective clinical decision making." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1165.
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The aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
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Loftus, Stephen Francis. "Language in clinical reasoning learning and using the language of collective clinical decision making /." Faculty of Health Sciences, School of Physiotherapy, University of Sydney, 2006. http://hdl.handle.net/2123/1165.
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Doctor of PhilosophyThe aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
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Helmkay, Owen. "Information representation, problem format, and mental algorithms in probabilistic reasoning." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ66153.pdf.
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Abeysinghe, Geetha Kalyani. "Event calculus to support temporal reasoning in a clinical domain." Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.238888.
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Nafea, Ebtihaj. "Clinical reasoning in dental students : a comparative cross-curricula study." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/30395/.
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Clinical reasoning is a skill required by all health professionals in managing patients. Research in clinical reasoning has come mostly from medicine and nursing, less from dentistry. The effect of curriculum on the development of clinical reasoning is still not well understood. Moreover, no research has been conducted to understand what clinical reasoning means to students and what educational strategies are valued by them. The aim of this research is to explore the effect of different educational strategies in different dental schools on clinical reasoning and to discover how students perceive clinical reasoning. Final year students from four different dental schools participated in the current research; a school using an integrated curriculum with conventional teaching, a school using Problem Based Learning (both from the UK) and two Saudi Arabian dental schools; a school using a traditional curriculum and a school using an integrated curriculum. Both UK schools participated in both studies, whereas each one of the Saudi Arabian schools participated in a different study. The research used both quantitative and qualitative methodology. An innovative clinical reasoning test measured final year students’ skills. An interview captured their own understanding of clinical reasoning and its acquisition plus they ‘talked through’ a clinical problem, using a ‘think aloud’ technique. Thematic analysis was used to analyse the transcripts of the recorded interviews. Results obtained were related to curriculum structure. The results indicated that the effect of curriculum structure, unlike teaching and assessment strategies, appeared to be minimal in final year students. Unfamiliarity with the term clinical reasoning was common in students. Students from different schools used different strategies to reason when discussing clinical vignettes. Different behaviours seemed to be affected by cultural factors. This research contributes to a greater understanding of how students learn, understand and apply dental clinical reasoning which hopefully will improve educational practices in the future.
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LaRosa, Nicholas. "Effect of Case Presentation on Physical Therapy Students’ Clinical Reasoning." UNF Digital Commons, 2019. https://digitalcommons.unf.edu/etd/895.
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This mixed-methods study investigated the effects of case method presentation on the clinical reasoning hypotheses generated, strategies implemented, and errors made by physical therapy students working through a musculoskeletal clinical problem. The study was framed by Marton and Säljö’s levels of processing, McCrudden’s et al. goal-focusing model, Cognitive Load Theory, and the Model of Domain Learning. Verbatim transcriptions for each problem-solving session was created and coded. Cohen’s kappa was κ = .75 indicating substantial inter-rater reliability for the finalized coding schemes. Quantitative analysis included mean and standard deviation calculations followed by Mann Whitney-U comparisons which detected several significant differences between groups regarding clinical reasoning hypotheses generated, reasoning strategies implemented, and errors made during the problem-solving sessions. Moderate-to-large effect sizes, ranging from r2 = .64–.78, indicated that differences in clinical reasoning between groups was mostly attributed to the case presentation method. Additionally, a qualitative profile enriched the data set by identifying differences in type of knowledge regulation each group exhibited and timing of treatment considerations. Specifically, participants in the simulated patient group were found to regulate more psychomotor skill knowledge compared to the written case study group who exhibited more regulation of propositional knowledge. This research project has already impacted the educational experiences physical therapy students receive in their professional education program. Future research should include multi-institutional investigations with a larger number of participants allowing for better representation of physical therapy students across professional education programs before generalizing any findings.
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Zimmerman, Kurt L. "Extending Snomed to Include Explanatory Reasoning." Diss., Virginia Tech, 2003. http://hdl.handle.net/10919/11073.
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The field of medical informatics comprises many subdisciplines, united by a common interest in the establishment of standards to facilitate the sharing, reuse, and understanding of information. This work depends in large part on the ability of controlled medical terminologies to represent relevant concepts. This work augments a controlled terminology to provide not only standardized content, but also standardized explanatory knowledge for use in expert systems.
This experiment consisted of four phases centered on the use of the controlled terminology-- Systemized Nomenclature of Medicine (SNOMED). The first phase evaluated SNOMED's ability to express explanatory knowledge for clinical pathology. The second developed the Normalized Medical Explanation (NORMEX) syntax for expressing and storing pathways of causal reasoning in the domain of clinical pathology. The third segment examined SNOMED's capacity to represent concepts used in the NORMEX model of clinical pathology. The final phase incorporated NORMEX-based pathways of influence in a Bayesian network to assess ability to predict causal mechanisms as implied by serum analyte results.
Findings from this work suggest that SNOMED's capacity to represent explanatory information parallels its coverage of clinical pathology findings. However, SNOMED currently lacks much of the content necessary for both of these purposes. Additional explanatory content was created with an ontology-modeling tool. The NORMEX syntax was defined by SNOMED hierarchy names. Complex sequences of explanations were created using the NORMEX syntax. In addition, medical explanatory knowledge represented in the NORMEX format could be stored in an architectural framework consistent with that used by a controlled terminology such as SNOMED. Once stored, such knowledge could be retrieved from storage without loss of meaning or introduction of errors. Lastly, a Bayesian network constructed from the retrieved NORMEX knowledge produced a network whose prediction performance equaled or exceeded that of a network produced by more traditional means.Ph. D.
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Munro, Kenneth D. "Clinical reasoning for manual handling risk assessments in community settings : moving from rule based to intuitive reasoning." Thesis, University of Strathclyde, 2017. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=28279.
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Background: There has been a shift in recent years to caring for patients with complex needs in their homes. In order to provide this care safely, tasks involving moving and handling need to be risk assessed. Little is known about how healthcare professionals conduct manual handling risk assessments (MHRAs) in community settings. Research Questions and Objective: There are three research questions used to investigate this thesis. To inform the research, âHow is safety and risk management legislation (MHOR, MHRA) used by professionals in the identification of hazards and in the risk evaluation of these hazards relating to a manual handling task?â. Secondly using these hazards and the risks associated with them the research has considered and has posed the following question, âin the community setting in what context can hazard identification and risk evaluation data be used and applied by HCPs when dealing with complex cases?â. Thirdly, there is the question, âto what exten t and in what ways is clinical reasoning relevant when undertaking MHRA in the community settings.â Methods: A qualitative design with thematic analysis was used to investigate the research questions. Training Workshops, based on two clinical cases, were conducted with healthcare professionals to determine the hazards they perceived in those cases, how they made risk decisions, and the way in which they communicated their risk information and findings. Semi-Structured Interviews were then used to investigate the effect of experience on the development of clinical reasoning in manual handling risk assessments. Participant Validation Interviews were then conducted on the resultant model and level descriptors. Main Findings: The findings from the workshops suggest that healthcare professionals should consider Medical Condition, Equipment, Home Environment, Complexity and Community Care when conducting MHRA in community settings. The findings from the interviews suggest three stages (Nov ice, Competent, and Expert) in the development of clinical reasoning in manual handling risk assessments in community settings. The resultant model and level descriptors were validated through participant validation interviews. Unique Contribution: This thesis develops a model about how healthcare professionals use clinical reasoning when conducting manual handling risk assessments in community settings. This model is presented as an (sic) unique theoretical contribution to knowledge and is based on the HSEs âFive Steps to Risk Assessmentâ, highlighting the processes of risk perception, risk decision making, and risk communication. The model integrates these processes with cyclical models of clinical reasoning and stages of development in clinical reasoning, yielding level-descriptors. Two methodological contributions to knowledge were made by firstly developing clinical case studies (Personas) that can be used to study MHRAs in community settings, and secondly a specific programme ^using MHRA training workshops that incorporate the âThink Aloudâ procedure. Implications: The theoretical implications of the model have to do with how HCPsâ clinical reasoning in conducting MHRAs develops with experience from rule-based to more holistic, intuitive-based reasoning. The model also points to a role for Non-Analytical Reasoning by experts, and the development of a safety culture in community care organisations. Practical implications of the model have to do with training, and the integration of health and social care in the community.
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Wiseman, Jeffrey. "The patient problem list and clinical reasoning : linking education to practice." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=83167.
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This study examined how medical tutors used a tool from clinical practice known as the patient problem list to support students' clinical reasoning in a natural internal medicine ward setting. A grounded 2 case comparative study was conducted with 2 real patient case discussions by a tutor and 3 pre-clerkship students and a resident and 1 clerkship level student respectively. Codes that emerged by verbal analysis of the data were related to each other in a discourse map. In both cases evidence of cognitive apprenticeship teaching strategies and the patient problem list shaped and were shaped by a spiral model of increasingly elaborate shared knowledge. The patient problem list links tutor support to student education for practice with complex medical patients.
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Silva, Ana L. "Clinical reasoning development in medical students : an educational transcultural comparative study." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13623/.
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Clinical reasoning research has concluded that experts use less, but more selective, knowledge in a more efficient way, based on the construction of schema, scripts and other representations of the relation between signs, symptoms and diagnoses, derived from their experience. However, this conclusion does not help Medical Schools to decide which pedagogical strategies should be adopted to foster clinical reasoning in undergraduates. This study aims to investigate how medical students, approach clinical cases and the impact of three types of curriculum upon their clinical reasoning. Two studies were carried out. The first analysed 60 hours of Problem-Based Learning sessions using electronic content analysis and corpus analysis. A second used a cross-sectional approach assessing and comparing students’ clinical reasoning in three different medical schools (Derby, Nottingham and Coimbra)based on a Clinical Reasoning Test (CRT) developed and validated for the purposes of this research. The clinical reasoning test prove to be a valid and reliable tool to assess clinical reasoning. The analysis of the PBL sessions indicated that early contact with clinical cases might favour students’ encapsulation of knowledge. First year students use more words, are more descriptive and make significantly more use of explanations. Second year students are more focused using less words, focusing more on the biomedical sciences aspect of the cases and engaging more in questions. The comparisons between different medical curricula show some differences between groups, at the entry to practice level in favour of the PBL and the integrated curricula. However, at the graduation level only small differences remain between the groups. Clinical exposure has a significant impact in improving students’ clinical reasoning, with differences in exposure time between curricula possibly accounting for such results. Additionally, differences in the strategies used to approach the cases were noted. Students from the traditional curriculum seem to be waiting until all information is displayed to make a decision, while their peers from other curricula seem to be more willing to make decisions based on initial patient’s information. No significant correlations with knowledge about the cases, or confidence on the diagnosis were found; possible reasons for these results will be discussed and implications for curriculum development and future research highlighted.
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Runcorn, Nigel Alan. "Professional knowledge in therapeutic practice : clinical reasoning as a 'hazardous journey'." Thesis, University of Derby, 2004. http://hdl.handle.net/10545/279058.
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This thesis explores the therapist's use of professional knowledge in their relationship with patients. It addresses a gap between theory and practice and the challenges to therapist expertise in a postmodern climate in which there are a multiplicity of competing perspectives about psychological problems. In semi-structured interviews eight NHS Psychodynamic Psychotherapists revealed narratives that underpinned their practice about the nature and treatment of psychological problems. These were organised as narratives about living the `good life' psychologically, and the origins and treatment of psychological problems. The central finding of this thesis is that, rather than relying on professional knowledge conceived as conventional psychodynamic theory, therapists engage in a largely intuitive process I have termed `clinical reasoning' which is practice-based, `reflection-in-action' that involves tacking principally between their professional knowledge base, their experience with the patient and their personal beliefs and experience. Such a process, I argue, constitutes a `hazardous journey' in a postmodern climate in which the value of a psychodynamic perspective cannot be taken for granted. A key implication is the value of therapists becoming more explicitly aware of their own particular narratives and the effect these have on the therapeutic encounter.
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Vedin, Elin. "The clinical reasoning among master students specializing in Orthopedic Manual Therapy." Thesis, Luleå tekniska universitet, Institutionen för hälsa, lärande och teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-85765.
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The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) describes Orthopedic Manual Therapy (OMT) as a specialist field in physiotherapy for the treatment of neuromusculoskeletal conditions based on clinical reasoning. The aim of this study was to explore how students in a OMT physiotherapy master programme describe their clinical reasoning. Nine participants were included in the study. Data was collected using a semi-structured interview guide and were analyzed with qualitative content analysis. The analysis resulted in one main category: “A multidimensional picture of clinical reasoning” and three categories: 1) Confidence in the role as physiotherapist; 2) Decision making, a cognitive analytical process 3) Creating alliance and involving the patient in the clinical reasoning. The participants described a multidimensional picture of clinical reasoning which gradually developed and eventually encompassed several aspects in the subcategories. The conclusion of the study is that all the parts above are needed in the clinical reasoning and it takes years to develop effective clinical reasoning. For future studies, it would be of interest to explore how recently graduated physiotherapists with a bachelor degree describe their clinical reasoning.
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Zacharzuk-Marciano, Tara. "Nursing faculty experiences of virtual learning environments for teaching clinical reasoning." Thesis, Capella University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10260999.
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Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for research to include a clearer understanding of potentially significant insights that nurse educators may gain from teaching clinical reasoning skills with virtual learning tools. This qualitative study identified and described nursing faculty experiences with teaching clinical reasoning skills when using virtual learning environments. The researcher interviewed eight nursing faculty and content analyzed the data from those interviews. Findings from this qualitative study supported past research and added to the body of knowledge regarding faculty members’ use of virtual learning environments. For example, faculty experiences indicated that virtual learning environments included patient situations that offered faculty a way to better assess students. It was found that assessing a student in the clinical setting could be very subjective, while the virtual environment is finite. Faculty experiences indicated that one of the challenges to teaching clinical reasoning skills with virtual learning environments was that students found that virtual communication was difficult and faculty claimed that using virtual environments increased faculty workload. The findings of this study provided deeper understanding into experiences reported by nursing faculty on the teaching of clinical reasoning skills when using a virtual learning environment. Recommendations for further research include using a larger sample size, a specified education level population, traditional, face-to-face classes as compared to classes from an online, or blended program, and investigating use of a specific virtual learning environment, in new research.
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Burge, Tracey Ann. "The usability of virtual patients to facilitate clinical reasoning in physiotherapy." Thesis, Brunel University, 2016. http://bura.brunel.ac.uk/handle/2438/12446.
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Clinical reasoning is essential for effective physiotherapy practice, but its complexity makes it difficult to teach and learn. The literature suggests it is learnt within the practice environment and improves with patient-centred experience. However, physiotherapy education has a diminishing availability of practice-based learning. Patient simulation is used within medicine to counteract the decline in practice-based learning and to ease the theory-practice gap. This thesis explores the use of patient simulation to ease the theory-practice gap within physiotherapy. The literature relating to clinical reasoning, technology enhanced learning, simulation and virtual patients was reviewed. An institutional focus study was undertaken which explored the implementation of technology enhanced learning in physiotherapy education and detailed the development of a virtual patient simulation. A case study approach was used to explore the usability of virtual patient simulation to facilitate clinical reasoning and ease the theory-practice gap. Twenty-six physiotherapy students participated. Three virtual patients were made available for three months for self-directed learning. Data was collected using focus groups and the think-aloud method was employed to capture the verbalised thought processes of nine participants while assessing a virtual patient. This was supported by electronic data capture methods within the virtual patient software. Thematic analysis was used to interpret the qualitative data sets. Findings showed the fidelity of virtual patients facilitated clinical reasoning and eased the theory-practice gap. Participants perceived the virtual patient concept had merit and should be used in peer learning as part of their curriculum. Usability issues were identified and improvements suggested The think-aloud method revealed the value of educators supervising physiotherapy students verbalise their clinical reasoning, to identify errors and improve learning.
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Anderson, Kirsty Jane. "Factors affecting the development of undergraduate medical students' clinical reasoning ability." Click here to access, 2006. http://hdl.handle.net/2440/37850.
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It is important for doctors to be clinically competent and this clinical competence is influenced by their clinical reasoning ability. Most research in this area has focussed on clinical reasoning ability measured in a problem - solving context. For this study, clinical reasoning is described as the process of working through a clinical problem which is distinct from a clinical problem solving approach that focuses more on the outcome of a correct diagnosis. Although the research literature into clinical problem solving and clinical reasoning is extensive, little is known about how undergraduate medical students develop their clinical reasoning ability. Evidence to support the validity of existing measures of undergraduate medical student clinical reasoning is limited. In order better to train medical students to become competent doctors, further investigation into the development of clinical reasoning and its measurement is necessary. Therefore, this study explored the development of medical students' clinical reasoning ability as they progressed through the first two years of a student - directed undergraduate problem - based learning ( PBL ) program. The relationships between clinical reasoning, knowledge base, critical thinking ability and learning approach were also explored. Instruments to measure clinical reasoning and critical thinking ability were developed, validated and used to collect data. This study used both qualitative and quantitative approaches to investigate the development of students' clinical reasoning ability over the first two years of the undergraduate medical program, and the factors that may impact upon this process. 113 students participated in this two - year study and a subset sample ( N = 5 ) was investigated intensively as part of the longtitudinal qualitative research. The clinical reasoning instrument had good internal consistency ( Cronbach alpha coefficient 0.94 for N = 145 ), inter - rater reliability ( r = 0.84, p < 0.05 ), and intrarater reliability ( r = 0.81, p < 0.01 ) when used with undergraduate medical students. When the instrument designed to measure critical thinking ability was tested with two consecutive first year medical student cohorts ( N = 129, N = 104 ) and one first year science student cohort ( N = 92 ), the Cronbach Alpha coefficient was 0.23, 0.45 and 0.67 respectively. Students ' scores for clinical reasoning ability on the instrument designed as part of this research were consistent with the qualitative data reported in the case studies. The relationships between clinical reasoning, critical thinking ability, and approach to learning as measured through the instruments were unable to be defined. However, knowledge level and the ability to apply this knowledge did correlate with clinical reasoning ability. Five student - related factors extrapolated from the case study data that influenced the development of clinical reasoning were ( 1 ) reflecting upon the modeling of clinical reasoning, ( 2 ) practising clinical reasoning, ( 3 ) critical thinking about clinical reasoning, ( 4 ) acquiring knowledge for clinical reasoning and ( 5 ) the approach to learning for clinical reasoning. This study explored students' clinical reasoning development over only the first two years of medical school. Using the clinical reasoning instrument with students in later years of the medical program could validate this instrument further. The tool used to measure students' critical thinking ability had some psychometric weaknesses and more work is needed to develop and validate a critical thinking instrument for the medical program context. This study has identified factors contributing to clinical reasoning ability development, but further investigation is necessary to explore how and to what extent factors identified in this study and other qualities impact on the development of reasoning, and the implications this has for medical training.Thesis (Ph.D.)-- Medicine Learning and Teaching Unit, 2006.
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Rowe, Michael. "Blended learning in physiotherapy education: designing and evaluating a technology-integrated approach." Thesis, University of the Western Cape, 2012. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_1973_1365674895.
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Background: Practice knowledge exists as a complex relationship between questions and answers in a context of meaning that is often intuitive and hidden from the novice practitioner. Physiotherapy education, which aims to develop patterns of thinking, reflection and reasoning as part of practice knowledge, is often based on didactic teaching methods that emphasise the learning of facts without highlighting the relationships between them. In order to improve health outcomes for patients, clinical educators must
consider redesigning the curriculum to take into account the changing and complex nature of physiotherapy education. There is some evidence that a blended approach to
teaching and learning may facilitate the development of graduates who are more capable of reflection, reasoning and critical thinking, and who can adapt and respond to the
complex clinical environment. The purpose of this study was to develop principles that could be used to guide the design of blended learning environments that aim to develop
capability in undergraduate physiotherapy students. Method: The study took place in a university physiotherapy department in the Western Cape in South Africa, among
undergraduate students. Design research was used as a framework to guide the study, and included a range of research methods as part of that process. The problem was
identified using a systematic review of the literature and a survey of students. The design of the blended intervention that aimed to address the problem was informed by a
narrative review of theoretical frameworks, two pilot studies that evaluated different aspects of blended learning, and a Delphi study. This process led to the development of a set
of design principles which were used to inform the blended intervention, which was implemented and evaluated during 2012. Results: The final results showed that students had undergone a transformation in how they thought about the process and practice of learning as part of physiotherapy education, demonstrating critical approaches towards
knowledge, the profession and authority. These changes were brought about by changing teaching and learning practices that were informed by the design principles in the
preliminary phases of the project. These principles emphasised the use of technology to interact, articulate understanding, build relationships, embrace complexity, encourage
creativity, stimulate reflection, acknowledge emotion, enhance flexibility and immerse students in the learning space. Discussion: While clinical education is a complex undertaking with many challenges, evidence presented in this study demonstrates that the development of clinical reasoning, critical thinking and reflection can be enhanced through the intentional use of technology as part of a blended approach to teaching and learning. The design principles offer clinical educators a framework upon which to construct learning environments where the affordances of technology can be mapped to the principles, which are based on a sound pedagogical foundation. In this way, the use of technology in the learning environment is constructed around principles that are informed by theory. However, clinical educators who are considering the integration of
innovative strategies in the curriculum should be aware that students may initially be reluctant to engage in self-directed learning activities, and that resistance from colleagues
may obstruct the process. Conclusion: The development of clinical reasoning, critical thinking and reflection in undergraduate physiotherapy students may be enhanced through
the intentional use of appropriate technology that aims to fundamentally change teaching and learning practices. Design research offers a practical approach to conducting
research in clinical education, leading to the development of principles of learning that are based on theory.
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Smith, Julie MacAulay. "The transition from Final Year Medical Student to Foundation Doctor : the clinical reasoning journey." Thesis, University of Dundee, 2015. https://discovery.dundee.ac.uk/en/studentTheses/ec05577b-d97e-45a2-b0fe-010fc5dd0835.
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Although clinical reasoning is both broad and complex, the term “clinical reasoning” is contested and multiple definitions have been mooted within different contexts. In its simplest form, clinical reasoning is regarded as a “decision-making” process. Other definitions outline it in terms of a complex cognitive process, posited within multiple contextual factors. Traditionally, clinical reasoning models have been based upon cognitive theories. More recently, interpretive theories have been applied. Despite extensive research over the past four decades, no consensus on how clinical reasoning actually occurs has been achieved. Accurate clinical reasoning is vital to patient safety. Its importance as an essential clinical competence for healthcare professionals is well established. Indeed, it is the crux of a clinician’s work. Frequently, Foundation doctors are the first to review acutely unwell patients. During out-of-hours shifts senior help can be scant and Foundation doctors may have to rely on their own initial clinical reasoning to manage acutely unwell patients. This PhD explores clinical reasoning development in the transition phase between final year medical student and Foundation doctor (5MB-FY1 transition) in relation to acutely unwell patients. It follows a cohort of final year medical students from a single UK university on their clinical reasoning journeys as they transition into Foundation doctors, focusing on the role of the simulated healthcare setting and the workplace. The principle research question for this PhD was how does clinical reasoning develop across the transition phase between final year of medical school and Foundation year one? Within this overarching research question, the following sub-questions were posed: What do participants understand by the term clinical reasoning? What types of clinical reasoning experiences do participants narrate? How do participants clinically reason for acutely unwell patients? Which factors do participants perceive as being facilitating and hindering to their clinical reasoning? How do participants’ clinical reasoning processes develop across the 5MB-FY1 transition phase? This PhD uses multiple methodologies derived from interpretive approaches in innovative ways to tap into clinical reasoning processes and its development across four data collection points: T1: group and individual interviews; T2: Ward Simulation Exercise observations and stimulated recall interviews; T3: workplace observations and stimulated recall interviews; T4: final interviews. Data were collected from T1/T2 and T3/T4 during the final year of medical school and Foundation year one respectively. Primary thematic analyses were carried out cross-sectionally and longitudinally in terms of what participants said and how they said it. Secondary narrative analyses were undertaken of participants’ Personal Incident Narratives. By taking an interpretive approach, the complexities of clinical reasoning processes, both in terms of internal cognition and external socio-cultural influences were illuminated, drawing upon clinical reasoning, complexity and situated learning theories. The key findings of this PhD were that participants conceptualised clinical reasoning as a “decision-making” and “thinking” process, leading to a clinical judgement for patient care; participants narratives aided understanding of clinical reasoning process and factors which facilitated and hindered them; participants used experiential knowledge and protocols to clinically reason for diagnosis, investigation, management and prioritisation; participants retained flexibility and contextual variability in the processes of making their clinical judgements; multiple factors facilitated and hindered the equilibrium of clinical judgement processes; and clinical reasoning development is dependent upon a complex interplay of individual, interpersonal and systemic factors which are deeply embedded in social-cultural theory. This study has multiple strengths and original features such the high participant retention rate throughout the longitudinal study, the exploration of the 5MB-FY1 transition, contemporaneous observations of clinical interactions with patients, the exploration of the out-of-hour setting contemporaneously and the multiple methods of data collection used in innovative ways. This PhD develops the published literature further in these domains. However, its challenges were predominantly ethical, such as lack of patient capacity to consent in the workplace.
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Lit, Keith. "Moral Reasoning and Moral Emotions Linking Hoarding and Scrupulosity." NSUWorks, 2017. http://nsuworks.nova.edu/cps_stuetd/111.
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Hoarding and scrupulous OCD are part of the Obsessive-Compulsive and Related Disorders, which are characterized by obsessional preoccupation and ritualistic behavior. Prior research has found a statistical relationship between hoarding and scrupulosity after controlling for these common factors, suggesting the existence of other features shared by these two disorders. Clinical accounts and empirical research of hoarding and scrupulosity suggest three such shared factors: a tendency to experience intense guilt and shame, rigid moralistic thinking, and general cognitive rigidity. However, results of the current study show that, although both hoarding and scrupulosity were related to cognitive rigidity and a tendency to experience guilt and shame, they are not associated with rigid moralistic thinking. Instead, beliefs about the importance of emotions as moral guides were related to both disorders. These results are interpreted in terms of dual-process theories of moral reasoning. Additionally, implications for the conceptualization and treatment of hoarding and scrupulosity are discussed.
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Chong, Florenca. "Effects of mood induction on reasoning." Thesis, University of Macau, 2012. http://umaclib3.umac.mo/record=b2588829.
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Cowell, John. "Placement Experiences and Clinical Reasoning of Undergraduate University Paramedic Science Students in Victoria, Australia." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/365838.
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Paramedic science students undergo additional clinical training in hands-on skills and clinical reasoning by attending clinical placements. Little is known of the efficacy of paramedic clinical placements or the student’s clinical reasoning skills during training. This study documents the paramedic placement experience and the clinical reasoning responses of paramedic science students. Two instruments were introduced: the Clinical Placement Questionnaire (CPQ), which measures placement experiences; and the Sequence of Learning Instrument (SOLI) and accompanying plotting technique, which allow mapping of clinical reasoning and responding. Clinical placement should provide a positive and enjoyable learning environment that supports the development of clinical reasoning, and clinical reasoning and responding should proceed sequentially in line with clinical practice guidelines. The study comprises Part 1–Clinical placement, a cross-sectional study using quantitative and qualitative methods concurrently; and Part 2–Clinical reasoning, an analytical cross-sectional study using qualitative (interview) methods with repeated measures to counterbalance two mock emergency call-out conditions: pain and MVA trauma.Thesis (Masters)
Master of Philosophy (MPhil)
School of Medical Science
Griffith Health
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Lockwood, P. "Teaching clinical reasoning skills to undergraduate medical students : an action research study." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3018657/.
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Introduction Clinical Reasoning is an important competency for medical students to learn. I am a Clinical Lecturer in Medicine and I run a course which has clinical reasoning as a key component. It was identified at curriculum meetings, that Clinical reasoning can be challenging to teach and that there was some evidence that it is an area of the curriculum that could be further developed and improved upon. Study Aim To address the concern about improving the teaching of clinical reasoning skills, my study aimed to; • Develop effective approaches for teaching clinical reasoning to medical students and evaluate them, • Identify educational principles that would help students learn clinical reasoning and share them with curriculum developers, The questions that I identified to support this aim were; • What enhances the students’ ability to learn clinical reasoning? • What makes it harder to learn clinical reasoning? New knowledge was developed by exploring how the theories around clinical reasoning and its teaching could be applied in a practical setting. Methodology An action research approach was used to identify the concerns and issues around teaching clinical reasoning, look for solutions, plan and implement changes and evaluate the changes. The last element of the study was the development of principles when developing a curriculum or teaching sessions for clinical reasoning. Results A new teaching session was designed and delivered to third year medical students. Several key factors important in designing a teaching session around clinical reasoning were identified. Scenarios used in clinical reasoning teaching should be written so that the information in the history is nonspecific and broad enough to allow for thinking across different body systems. They also should be well written to allow actors to play the simulated patient role realistically. The tutors involved need to have the skills to encourage the students to apply knowledge to the scenario through interaction. The tutors need to be able to engender a feeling of safety within the group being taught. There are some indications that the tutors need to have a high level of metacognition themselves. Students need to practice using the clinical reasoning processes and receive feedback on their thought processes. The teaching sessions need to allow time for the students to think and a stop start method was highly rated by the students as a method for doing this. Assessments and teaching materials around clinical reasoning need to avoid the use of “buzz words” or formulaic thinking. Further research into how novices use the clinical reasoning process is needed, as the study suggested that students use inductive reasoning and leave it late to start the reasoning process. They also try and use pattern recognition using “buzz words” very early on in their career.
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Booher, Cynthia D. "A classroom activity to enable nursing students to develop clinical reasoning skills." Thesis, University of Phoenix, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10165983.
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One of the challenges in nursing education is the need to enable students to internalize the skills needed to implement the thought processes of critical thinking and clinical reasoning. The research of Patricia Benner has been instrumental in explaining the need to improve the critical thinking and clinical reasoning skills of newly licensed registered nurses. Dr. Benner’s research has changed the focus of nursing to include these skills in the education process. The study was designed to evaluate the efficacy of a classroom educational method designed to help students improve these skills. The ex post facto study was conducted at one Southern community college with students enrolled in an Associate Degree nursing program. The study used the nursing educational theory of Patricia Benner and the general educational theory of constructivist educational theory as a theoretical base. Archived data was collected from the results of two cohorts of nursing students based on their performance on two separate administrations of the Assessment Technologies Institute (ATI) critical thinking examination. The data was analyzed using central tendency statistics and an independent samples t-test. Analysis of the data indicate that the educational implementation was effective in increasing the skills needed for clinical reasoning as evaluated by the ATI critical thinking examination. The cohort that used the Critical Thinking Teaching Method (CRTM) increased their scores by 5.62 percent while the cohort that did not use the CRTM scores remained relatively static
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Abuzour, Aseel. "An investigation into the learning and clinical reasoning processes of independent prescribers." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/an-investigation-into-the-learning-and-clinical-reasoning-processes-of-independent-prescribers(251d6258-6f7c-4674-8e1d-57ff4da4c803).html.
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The prescribing rights of non-medical healthcare professionals in the United Kingdom (UK) are some of the most extensive in western medical practice. Nurses, pharmacists, physiotherapists, optometrists, chiropodists, podiatrists, therapeutic and diagnostic radiographers and dieticians, with appropriate training have the authority to prescribe. They are often referred to as non-medical prescribers (NMPs). These non-medical healthcare professionals should have a specified number of years of post-registration experience in order to undertake specific training in prescribing. There has been a limited amount of research exploring how non-medical healthcare professionals acquire their expertise during the prescribing programme. In addition, there is a gap in the literature on how NMPs apply their acquired expertise during the process of making clinical prescribing decisions. A programme of research was conducted to explore the learning processes and decision-making skills of pharmacist and nurse independent prescribers working in secondary care. The research used current literature on pharmacist and nurse independent prescribing by conducting a systematic review to assess how their expertise development is reported in the literature. In addition, the learning experiences of secondary care pharmacists and nurses undertaking the independent prescribing programme was explored by employing a novel audio-diary technique followed by semi-structured interviews on 7 nurses and 6 pharmacists. Students were mainly recruited via their non-medical prescribing programme leaders at a number of accredited universities across the UK. There was little opportunity in this study to explore the clinical reasoning processes of students as they were learning to prescribe. Therefore, the final study aimed to explore how secondary care pharmacist and nurse independent prescribers make clinical prescribing decisions. A total of 21 independent prescribers working in secondary care took part in this study, mainly recruited via their non-medical prescribing lead and social media. This study employed a think-aloud protocol method using validated clinical vignettes followed by semi-structured interviews. Students and NMPs occupied a wide range of roles. Ethical approval from the University of Manchester Research Ethics Committee (UREC) and governance approvals from a number of National Health Service (NHS) hospitals were obtained before conducting the research. NMPs were influenced by a number of intrinsic and extrinsic factors during the process of learning to prescribe and when making prescribing decisions. Students also experienced an affective phase of transition in which students became highly metacognitive as they began to form their identities as prescribers and reflect on their confidence and competence. There were notable differences between how pharmacists and nurses learned to prescribe, which were also seen during the process of clinical decision-making as independent prescribers. Despite this, pharmacists and nurses revealed a similar pattern in their decision-making processes as prescribers. Findings from this programme of research provide further insight into the specific training and support requirements of these healthcare professionals. Additional research with NMPs would be beneficial to contribute to the currently limited understanding of the learning and clinical reasoning processes of NMPs.
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Langridge, Neil. "The clinical reasoning processes of extended scope physiotherapists assessing low back pain." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/354124/.
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The role of the extended scope physiotherapist has developed relatively recently within health-care. The extended role has utilised the skills of allied health professionals including physiotherapists, and given them autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) as part of the diagnostic process. These requests and processes are delivered outside their traditional scope of practice. Further knowledge on how these practitioners clinically reason is therefore needed as there is little within the literature regarding reasoning in this specific group of clinicians. This research aids in the development of future roles, the governance of services, whilst supporting the training of clinical reasoning for new recruits to this work. This qualitative study has explored the processes by which extended scope physiotherapists clinically reason decisions regarding patients reporting low back pain. The study has used a multiple case study design informed by grounded theory methodology with focus groups and semi-structured interviews as a method to investigate these processes. The themes identified included prior thinking, patient interaction, formal testing, time, safety and accountability, external/internal and gut feeling. Subtle differences in clinical reasoning were seen in the focus group study between ESP and non-ESP clinicians. The processes of clinical reasoning are presented that suggests how these clinicians reason whilst highlighting how they differ to non-extended scope physiotherapists.
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Holder, Amy G. "The Relationship of Self-Efficacy and Clinical Reasoning of Undergraduate Nursing Students." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etd/3710.
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Aim. This investigation aimed to discover if a there is a correlation between a student’s clinical reasoning self-efficacy and a student’s actual clinical reasoning ability. Also, this research sought to discover the connection between an undergraduate nurse’s self-efficacy of clinical reasoning and the locus of control of that student. Finally, this investigation sought to discover if perceived self-efficacy of clinical reasoning changed over time.
Background. The ability to successfully navigate the process of clinical reasoning is critical to providing safe, effective care for patients. For nurses, this process begins to develop in nursing school. Unfortunately, evidence suggests that newly graduated nurses struggle to navigate this process successfully, placing patients’ safety in jeopardy. While much research has been dedicated to a student’s clinical reasoning development, little is understood about the variables that impact clinical reasoning development in the student population.
Method. Partial correlation was utilized to discover the connection between students’ perceived self-efficacy of clinical reasoning and the students’ actual clinical reasoning ability. Also, a one-way ANOVA, to assess changes over time and reliability assessment of the Nurses’ Clinical Reasoning Scale, was completed.
Results. Fifty-two undergraduate nursing students from across 35 states in the United States were included in the sample for this study. Neither a significant relationship between the students’ self-efficacy of clinical reasoning and the students’ actual clinical reasoning ability, nor a significant change over time in perceived self-efficacy scores was detected.
Conclusion. By understanding the impact certain factors have on the formation of clinical reasoning ability in students, educators are better equipped to identify those students that might struggle to develop clinical reasoning and intervene in the early stages of development. Additional studies need to be initiated to completely understand the influence these variables have on the development of clinical reasoning.
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Kelly, Stephanie Piper. "Clinical instruction in physical therapy: novice and expert approaches to instructional reasoning." Diss., NSUWorks, 2008. https://nsuworks.nova.edu/hpd_pt_stuetd/6.
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Purpose. Clinical education is a critical component of the education of physical therapists (PT). Clinical instructors (CIs) are primarily responsible for coordinating and supervising this clinical learning. However, little has been published about how CIs make decisions and solve problems related to clinical teaching and how this instructional reasoning changes with experience with clinical teaching. Therefore, the purpose of this study was to explore the instructional reasoning of novice and experienced CIs. Methods. A qualitative multiple case-study design was used. Data were collected through in-depth interviews and review of clinical teaching artifacts. A coding framework was developed for coding each individual case. Cross-case analysis to examine the impact of experience on clinical teaching was performed. Trustworthiness was established through peer review of data. Credibility was established through triangulation of the data and member checks. Participants. A sample of convenience of PTs who were credentialed as CIs in Indiana was used. Six participants with a range of experience as CIs and clinicians were selected and consented to participate. Results. Four major themes emerged to describe the instructional reasoning of CIs. These themes were communicating expectations for the student's role in the learning process, creating an environment conducive to learning, facilitating student achievement of learning goals, and balancing dual roles and responsibilities. The more experienced CIs clarified expectations for students to be active participants in a challenging learning environment and used well-defined teaching strategies to facilitate student achievement of learning goals that were integrated into the patient care responsibilities. The novice CIs were less likely to clarify expectations and to connect learning goals with teaching strategies. They focused on creating a comfortable environment for learning and were challenged by balancing the dual roles of clinical teacher with responsibilities for patient care. Conclusions. This study provided an in-depth description of the instructional reasoning of CIs and how this instructional reasoning changes with experience. The results indicated that instructional reasoning matures with clinical teaching experience. Clinical education faculty should consider developing strategies to support the development of novice CIs. Strategies to supplement development of student clinical reasoning should also be considered.
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Baker, Jacqueline Deborah. "Nurses' Perceptions of Clinical Decision Making in relation to Patients in Pain." Thesis, The University of Sydney, 2001. http://hdl.handle.net/2123/489.
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Clinical decision-making (CDM) research has focused on diagnostic reasoning, CDM models, factors influencing CDM and the development of expertise. The research approaches used, including phenomenology, have not addressed the question of how CDM is perceived and approached by nurses. This study describes perceptions of CDM in relation to patients in pain using a phenomenographic methodology. At semi-structured interviews, participants were asked to recall their responses to a situation involving a patient in pain. The responses fell into four categories: (1) the effect of the clinical environment; (2) the role of other health professionals; (3) the place of the patient; and (4) the role of experience. Examples of differences in perceptions that were likely to impact on the nurses� approach to CDM include: the ongoing effects of time and workload demands on CDM; nurses are initially dependent but were eventually able to make decisions autonomously; the patient who may be peripheral or central to CDM; and the nurses� move from the use of theoretical principles to experiential knowledge as reflection-on-practice is employed. Perceptions in all categories are strongly implicated in the nurses� sense of confidence and independence. Implications for nursing practice and nursing education suggested by the findings relate to the number of areas in which graduates work in the first year of practice, the size of new graduate workloads, graduate transition programs, the place of reflection-on-practice and undergraduate (UG) program clinical experience patterns. Among issues for further research arising from the study are: replication of the study; detailed examination of the development of CDM in the first year of nursing practice and during UG nursing education programs; the role of other health professionals in the development of CDM behaviour; the links between CDM and clinical knowledge development; and the type of clinical environments that foster confidence and independence. A conclusion of the study is that the way CDM is approached is influenced by the amount, quality, relevancy and recency of clinical experience. In this study, phenomenography was shown to be an appropriate approach to the description of nurses� perceptions of CDM in relation to patients in pain. In addition, nurses� changing perceptions over two years and the subsequent effect on CDM behaviour were described.
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Baker, Jacqueline Deborah. "Nurses' Perceptions of Clinical Decision Making in relation to Patients in Pain." University of Sydney. Family and Community Nursing, 2001. http://hdl.handle.net/2123/489.
Full textAbstract:
Clinical decision-making (CDM) research has focused on diagnostic reasoning, CDM models, factors influencing CDM and the development of expertise. The research approaches used, including phenomenology, have not addressed the question of how CDM is perceived and approached by nurses. This study describes perceptions of CDM in relation to patients in pain using a phenomenographic methodology. At semi-structured interviews, participants were asked to recall their responses to a situation involving a patient in pain. The responses fell into four categories: (1) the effect of the clinical environment; (2) the role of other health professionals; (3) the place of the patient; and (4) the role of experience. Examples of differences in perceptions that were likely to impact on the nurses� approach to CDM include: the ongoing effects of time and workload demands on CDM; nurses are initially dependent but were eventually able to make decisions autonomously; the patient who may be peripheral or central to CDM; and the nurses� move from the use of theoretical principles to experiential knowledge as reflection-on-practice is employed. Perceptions in all categories are strongly implicated in the nurses� sense of confidence and independence. Implications for nursing practice and nursing education suggested by the findings relate to the number of areas in which graduates work in the first year of practice, the size of new graduate workloads, graduate transition programs, the place of reflection-on-practice and undergraduate (UG) program clinical experience patterns. Among issues for further research arising from the study are: replication of the study; detailed examination of the development of CDM in the first year of nursing practice and during UG nursing education programs; the role of other health professionals in the development of CDM behaviour; the links between CDM and clinical knowledge development; and the type of clinical environments that foster confidence and independence. A conclusion of the study is that the way CDM is approached is influenced by the amount, quality, relevancy and recency of clinical experience. In this study, phenomenography was shown to be an appropriate approach to the description of nurses� perceptions of CDM in relation to patients in pain. In addition, nurses� changing perceptions over two years and the subsequent effect on CDM behaviour were described.
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Harries, Priscilla Ann. "Occupational therapists' judgement of referral priorities : expertise and training." Thesis, Brunel University, 2004. http://bura.brunel.ac.uk/handle/2438/3110.
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The British government currently requires mental health services to be targeted at the most needy (Department of Health, 1999). For occupational therapy services, where service demand far exceeds service availability, skill in referral prioritisation is essential. The studies in this thesis describe how experienced occupational therapists’ referral prioritisation policies were used to successfully educate novices. 40 British occupational therapists’ referral prioritisation policies were modelled using judgement analysis. Individuals’ prioritisation decisions were regressed onto 90 referral scenarios to statistically model how referral information had been used. It was found that the reason for referral, history of violence and diagnosis were most important. The occupational therapists’ capacity for self-insight into their policies was also examined by comparing statistically modelled policies derived from their behaviour with their subjective view of their cue use. Self-insight was found to be moderate (mean r = 0.61). A Ward’s cluster analysis was used on the statistically modelled policies to identify if subgroups of therapists had differing referral prioritisation policies. Four clusters were found. They differed according to several factors including the percentage of role dedicated to specialist occupational therapy rather than generic work. The policies that led to more of an occupational therapy role were found to give particular importance to the reason for referral and the client’s diagnosis. The occupational therapy professional body supports this latter method of working as it has recommended that occupational therapists should use their specialist skills to ensure clients’ needs are met effectively. Therefore the policies that focussed on clients’ occupational functioning were used to train the novices. Thirty-seven students were asked to prioritise a set of referrals before and after being shown graphical and descriptive representations of the policies. Students gained statistically significant improvements in prioritisation. Students’ pre-training policies were found to be those of generic therapists; a method of working that has been found to be leading to reduced work satisfaction and burnout (Craik et al.1998b). The training is therefore needed to ensure undergraduate occupational therapy students develop effective referral prioritisation skills. This will help to ensure that clients’ needs are met most effectively and work stress is reduced.
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Cain, Spannagel Sarah A. "THE RELATIONSHIP BETWEEN INTERPERSONAL THEMES IN PLAY AND PROSOCIAL MORAL REASONING." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1195142625.
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Tetik, Cihat Public Health & Community Medicine Faculty of Medicine UNSW. "Relationship between students??? approaches to learning and the development of clinical reasoning ability." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/29513.
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This study investigates the relationship between learning approaches and the development of clinical reasoning ability. The main questions for the study were: Is there a statistically significant relationship between students??? learning approaches and development of clinical reasoning ability? If there is a relationship between approaches to learning and development of clinical reasoning ability, which students develop this ability faster? And How does learning approach change relate to the development of reasoning ability? The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was used in order to evaluate participants??? learning approaches and Diagnostic Thinking Inventory (DTI) to measure participants??? diagnostic thinking ability. In order to determine changes of learning approaches, the same students were invited to fill out the same questionnaires one year later. This quantitative study was followed by a qualitative inquiry including in-depth interviews aimed at exploring the association of a change in learning approach score with the development of clinical reasoning ability. These interviews also explored the factors influencing learning approaches of these students. Those students with the greatest change in R-SPQ-2F scores between the two surveys were selected for interview. Analysis of the findings of both the quantitative and qualitative phases of this research leads the researcher to conclude that; - there is a correlation between ongoing learning approaches and the development of clinical reasoning ability; this correlation is positive if the approach is deep and it is negative if the approach is surface, - progress towards either end of the learning approach continuum is associated with observation of experts, reasoning practice and/or feedback from experts, and - progress towards either end of the learning approach continuum seems an earlier and better indicator of developing reasoning ability than categorization of learning approach because both learning approach change and the factor causing this change were associated with the development of clinical reasoning ability. This study contributes to understanding of the importance of ongoing learning approaches and the development of clinical reasoning ability by encouraging deep learning approach characteristics. Factors affecting learning approaches are also associated with the development of clinical reasoning ability. Their effect is more than expected.
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Robertson, David M. "Critical thinking and clinical reasoning in new graduate occupational therapists : a phenomenological study." Thesis, Robert Gordon University, 2012. http://hdl.handle.net/10059/792.
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The aim of this study was to examine, understand and conceptualise the critical thinking and clinical reasoning adopted by new graduate occupational therapists as they enter the workforce to become newly autonomous practitioners. The study obtained the perspectives of new graduates, their supervisors and service managers on the means by which critical thinking and clinical reasoning develop to meet the expectations of employers. Factors which impeded the transition between new graduate and autonomous practitioner were identified and explored. Ethical approval was obtained to conduct the study. The study adopted a qualitative phenomenological research approach; Interpretative Phenomenological Analysis (IPA), which informed framing, data gathering and analysis. Semi-structured interviews were conducted with new graduates (n=6), supervisors (n=7) and managers (n=7) from multiple sites within one National Health Service Board. Interviews were transcribed verbatim from audio-recordings. The findings indicate that new graduates are expected to develop critical thinking and clinical reasoning in a manner that might challenge traditional conceptualisations of the transitioning process. A phenomenon, historically named the “shock of practice”, was reflected on by therapists in each phase of the study and adaptive and mal-adaptive responses to this in the thinking and behaviour of new graduates was identified. The clinical supervisor-supervisee relationship appeared to be the key source of support, and the supervisor the most significant knowledge resource, for new graduates. This relationship was supplemented by both peer support and Preceptorship. Discharge planning was a significant source of anxiety and development of an algorithm to support this process is proposed. Recommendations for further research and theoretical implications for practice and undergraduate education are discussed.
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Vlietstra, Thomas. "The impact of social class bias on psychological and psychotherapeutic practitioners' clinical reasoning." Thesis, University of Surrey, 2017. http://epubs.surrey.ac.uk/842235/.
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Objective: To explore the impact social class biases may have on the treatment of clients by psychological and psychotherapeutic professionals in Britain. Design: A cross-sectional on-line study among 156 psychological and psychotherapeutic professionals working in the NHS incorporating a comparison between two groups - video vignettes representing ‘lower’ and ‘upper’ class clients. Methods: The video vignette depicted a psychological assessment session of a client who had been referred by his general practitioner after incidences involving deliberate self-harm. The accent and dress of the client were varied. Study participants completed measures of clinical reasoning relating to diagnosis, risk and treatment, measures of their awareness of the influence of social class on their work and a social class brief implicit association test. Results: Within the context of this study participants tended not to discriminate against clients in relation to their class. However, they believed that a ‘lower-class’ client was more likely to receive an ‘alcohol or substance misuse’ diagnosis (p= .002; d=0.40). They also scored the ‘lower-class’ client as more motivated to make changes (p=.032; d=.29). Seeing a ‘lower-class’ client resulted in significantly higher scores indicating participants reflection on personal conflicts relating to their own social class and the impact such biases may have on their work. Conclusions: There was no general pattern of discrimination against clients in relation to their social class. This may be due to client class cues priming the psychologist to reflect on their position. Practitioner Points: •Training and professional development for Psychological and Psychotherapeutic Professionals in ways to raise awareness of their personal beliefs about social class may help reduce class bias. •Working with clients such professionals perceive to be a ‘lower’ class allows them to reflect on these personal beliefs.
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Madi, Mohammad Abdelfattah Atallah. "Investigating the impact of postgraduate musculoskeletal physiotherapy education on practitioners' clinical reasoning skills." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8702/.
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Advancing clinical reasoning skills is one of the main outcomes of postgraduate master's level (M-level) programmes approved by the Musculoskeletal Association of Chartered Physiotherapists (MACP). While, the outcomes of these programmes were investigated in multiple retrospective studies, there is a limited understanding of the learning culture that drives change. Thus, the aim was to examine the learning culture of an MACP approved programme to capture the sociocultural mediators that advanced clinical reasoning skills. An empirical longitudinal mixed-methods theory-seeking case study was conducted over a period of 18 months. Participants included seven educators and six students. Data analysis was premised on the methods of a Constructivist Grounded Theory. Gradual and progressive advancement of clinical reasoning skills was identified. A model of a culture of convergence and synergy was constructed to conceptualise the relationship between students, the programme and the wider context. It demonstrates the value of convergence and synergy in supporting professional learning. This novel conceptual understanding of advancing clinical reasoning through M-level education suggest that pedagogues need to actively seek to create a culture convergence and synergy to achieving successful learning outcomes. The context-bounded knowledge provided in the thesis aid pedagogues to better design M-level curriculums.