Topic: How have I put clinical reasoning into practice?
We are well into the second half of our physical fieldwork block and now that I look back, I cannot help but wonder where all the time has flown to.
Yes, every week of prac and campus that has gone by has been gruelling – physically, emotionally and above all mentally but now as I look back on time and read through my own reflections it seems to have all gone past so fast and development both as an individual and as a student therapist has been just as fast paced.
Moving from mere assessment of clients, to treatment has been quite intense but I have been able to see how one’s mindset changes over time. How meeting a client shifts from just conducting an interview and getting to know their likes and interests to including that but also identifying the client’s strengths and key areas to work on, screening their ability in ADLs, developing aims and rationales for treatment in your head as you make observations and having OMG moments when you see patterns that you were told about in class but could not visualize until you had seen it with your clients and this had to be done all within the same hour that you used last year just to assess.
But this is how we develop as clinicians, how our thought processes develop, and this is what we term clinical reasoning which is our topic for this week and how I have applied it in intervention.
To develop your understanding; Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012) state that [clinical reasoning is the] ability to integrate and apply different types of knowledge, to weigh evidence, critically think about arguments and to reflect upon the process used to arrive at a diagnosis (in the interest of OT, its how we arrive at our aims, and treatment plans). I personally view it as an ongoing process because we cannot retrieve all the information necessary to treat from one session alone, so we are continually applying the following cycle each time we see our clients.
When meeting a client I try to build a foundation and establish rapport by conversing generally about family, their diagnosis and how they became hospitalized, their premorbid abilities and occupations as as well as his/her current abilities are established by doing a screening/observation of how the client eats, dresses, baths and toilets from which I can then ascertain what standardized assessments to prioritise. I then come home and refer back to my notes on the diagnosis in order to judge what is the best plan for my next treatment session, my aims of intervention and a suitable subprogram which incorporates what the client deems to be important and enjoyable but also what I think is realistic and necessary to ensure recovery through rehabilitation. This is then followed through in the time period that I see the client and evaluation is done on a weekly basis as I compile my findings for my case study and presentation. It isn’t always smooth sailing though since clients get discharged prematurely or a client’s medical condition may deteriorate which then forces you to skew your plan of treatment and work with what you have now ( as is the case with my current client Mr M).
As Occupational Therapists (or aspiring ones such as myself) I’ve found that as much as your clinical reasoning is something which has to be innate, almost subconscious because we want becoming functional again to be ‘fun’ as this is what sets us apart from other health professions more specifically, Physiotherapy, it is important to find a balance between not boring your client with details of why sessions are planned and implemented the way that they are - but also discuss the relevance of certain techniques and rationale behind a proposed session.
My colleagues and I have identified a problem in which clients are poorly informed in many aspects of treatment that they receive at it is of no fault to the client but rather, the clinician. By drawing some insight into why we do certain things not only does it give a client peace of mind, but I’ve noticed that it also helps with compliance to treatment regimes and therefore a better outcome. Especially in OT, where we claim to be a client-centred profession… how better to involve a client in intervention than to have them understand why such a course of intervention has been decided upon.
I definitely feel that this speaks to our own ability to critically assess and analyse the client holistically whilst involve the proverbial man of the show as much as possible because we would want the same if we were in their shoes.
So here is to putting those knowledge and skills that you have learnt in class together with the context, needs and wants of your client to treat them in a manner, different to other health professionals because OTs follow the clinical reasoning cycle with the client at the heart of it all.
By the way, I finally know Muscle strength grading of the top of my head (does an invisible little victory dance) andddd…
Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012). Clinical reasoning - A guide to improving teaching and practice. Australian Family Physician, 41(1-2), 18-20.
Benner P., Hughes R.G., Sutphen M., (2008). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2643/
