Types of Clinical Reasoning in OT

Today we're going to talk about clinical reasoning. We're going to unpack the types of clinical reasoning that's used in occupational therapy, what they are, how to use them, and how to distinguish between them. My name is Arno. I'm a third-year occupational therapy student. Welcome to the OT Minute. I'm excited to talk about clinical reasoning today. First, let's think about what clinical reasoning is. Clinical reasoning is the different ways in which we process information, make decisions, during the OT process. Therefore, clinical reasoning is used constantly. As soon as we meet a client or read through their medical chart, we're starting to use different types of clinical reasoning to begin painting a picture of what's going on with this case, who this person is, and what our next steps might be. Now, there are eight types of clinical reasoning that we'll be going over today. Please keep in mind that this is how I think of them based on the resources that I've looked at and the feedback that I've received in graduate school. I'll post resources. below because there are slight variances on how they can be classified and defined. So I always recommend do your own research, but this should give you a good overview. I'll also be using an example throughout to help make it tangible along with a visual summary at the end for all my fellow visual learners to hopefully make it easy to remember the different types of clinical reasoning as well as how to actually think of them in practice. The first type of clinical reasoning is scientific reasoning. Scientific reasoning is a type of reasoning that processes the client's medical conditions and related scientific information that the person who is coming to us for services are experiencing. This is where all of our conditions, our anatomy, our physiology, content, lectures, and working knowledge comes into play. This is recalling any evidence-based research regarding signs, symptoms, or risk factors, or other statistical information that might be relevant. to the client's situation and their condition. This is also where we consider theoretical perspectives and make hypotheses based on that information. Let's look at an example. Say we're working with Susan who's recently experienced an above elbow amputation to her left arm due to a traumatic vehicle accident. If we're working with her, we know that her medical condition is a left above the elbow imputation. It is scientific. reasoning that starts to break down all the scientific, statistical, and theoretical information that may be pertaining to her condition. It allows us to recall and process information like that she's likely experiencing phantom limb pain, which evidence correlates with amputations. She's also probably experiencing some swelling and edema, which we know is part of the wound healing process. Next, let's look at diagnostic reasoning. This type of reasoning take scientific reasoning a step further and can be considered a subcategory of scientific reasoning. I think this is where our role as OT and occupational therapy students really comes into play. So having an understanding and having processed the scientific information about the condition, the signs and symptoms, and research, we now move into thinking and making hypotheses about what would be the functional outcomes or deficits when considering the client and their condition. The sixth, the impersonal information. that is derived from the scientific reasoning and applies it to the personal information of a specific client to understand how this is affecting their meaningful occupations. For example, if we take the case of Susan who has experienced an above the elbow amputation of her left upper extremity, we know that bimanual occupations or tasks that she did before will be more difficult. A good example is if she's a single mother who does all the cooking in our household. we can reasonably hypothesized that cutting and opening jars will now be difficult for her. We are essentially starting to diagnose occupational deficits by thinking through what would be the logical functional repercussions of a left above elbow amputation. This takes into account both the impersonal scientific information and the personal information that you or I as the clinician has. We know that most people would cut food using their one hand to stabilize and one hand to cut. Therefore, if Susan is right-handed, we know that she's most likely stabilizing food with her left and cutting with her right. Since she cannot do it the same way she did before, it is fair to hypothesize that her cooking performance will be negatively affected. She may not be able to fulfill her role as a mother to her satisfaction. Diagnostic reasoning is what brings us to that conclusion. The third type of reasoning is procedural reasoning. Procedural reasoning is what it sounds like. And this is thinking through procedures. related to intervention protocols, intervention routines, and the hospital or specific settings, culture, and habits. For example, if we're treating Susan in an inpatient hospital setting, procedural reasoning is the type of thinking we are using to know how to document according to to the hospital. policies. It dictates the type of PPE we might use. It might even guide us on what we need to do next. For example, in the case of Susan, it might be the routine of this setting for the occupational therapist to focus on patient education regarding limb formation and edema management. So the setting procedure or policies guide that the OT does this and not a different discipline like nursing or Therefore, our procedural reasoning would help us form the conclusion that because of the hospital's culture and procedures, we need to address these topics in our treatment sessions. The fourth type of reasoning is interactive reasoning. This focuses on the type of thinking that addresses interpersonal aspects of interaction between the OT, the client, in order to foster a positive relationship. This helps to improve collaboration through the OT process. The way I see it playing out in cases or in practice is when me ask Questions such as, what does the client like? What would make them more comfortable? How can I relate to them? This affects what we talk about, how we posture ourselves, and how we use social interactions and our therapeutic use of self to build good therapeutic relationships. Let's keep running with our Susan example. Susan may feel depressed or down. Interactive reasoning allows us to reason and think through what would be a good response if we see her showing some melancholic behavior, an encouragement, or some extra positive feedback regarding wins in the small things such as just getting out of bed or affirming her even for participating a little bit. These small intentional acts of encouragement comes from interactive reasoning focusing on asking the question, what would foster a positive therapeutic relationship by building trust and collaboration with Susan? Next is narrative reasoning. Narrative reasoning among all the types of reasoning that we will go over today is where I feel us as OTs should have a special appreciation, emphasis, and sensitivity. This type of reasoning is processing the occupational story of the client. So it's looking at what were their previous meaningful experiences and roles. It's also thinking about what their future occupational story might reasonably be. How can we carry their meaningful activities, experiences, and roles forward? forward in this next season. This type of reasoning is where we really get to dig into what's important to the client and why. By understanding the context of their lived experiences and their personal narrative, we are able to understand the person better and use our other forms of clinical reasoning to continue to help their personal life story flourish and continue. So what does this look like tangibly? Well, in the case of Susan, this reasoning would come into play as we're thinking about her role as a mother. Understanding how her decreased participation and performance in certain meaningful tasks, such as cooking or bathing her kids, is affecting meaning in her life story. For example, she may now see herself as not as effective of a mother now, and her personal narrative might now be lacking what was once meaningful to her. Narrative reasoning is the type of reasoning that explains that and puts her life story or occupational story variables together to make sense of the meaningfulness of her personal narrative and just her personal life, both pre and post injury. Pragmatic reasoning. This is common sense reasoning. It is looking at what is possible given the context, the situation, and realistically our skills as a practitioner. When looking at the case we have been working with, with Susan, pragmatic reasoning is the type of reasoning that considers practically How many sessions will Susan be seeing you in your setting? What makes sense as far as goals go? What's the biggest priority given her situation? And what is achievable? In the inpatient setting, we may not be able to address IDLs such as driving because insurance may not reimburse for that. Also, what type of adaptive equipment recommendations would be practical given her financial circumstances and community context? For example, recommending expensive... adaptive equipment if she doesn't have the means to purchase it. It simply isn't practical no matter how great they might be. The seventh type of clinical reasoning is ethical reasoning. Make sure you review the AOTA code of ethics because these are the values that should be guiding our ethical reasoning as OTs. This is a pretty straightforward type of reasoning. It helps us think through what's the right thing to do in this scenario or case. In the case of Susan, an example of ethical reasoning would be When we're asking ourselves what would be the right thing to do regarding discharge, if you think that she may not be safe to go home yet but she wants to go home to be with her kids, ethical principles being weighed are Beneficence and autonomy. Beneficence refers to wanting what is good for the client. So for Susan, she may not be medically stable enough due to medications or complications to go home. So the principle of beneficence would say keep providing medical treatment and therapy in the inpatient setting. It's what's best for her. Autonomy refers to the ethical principle of respecting the fact that a person should be allowed to make decisions and have control over their own lives. Therefore, autonomy would suggest that we have to respect control over her own life and her decisions. Ethical reasoning engages these two variables to help make an ethical decision during Susan's treatment. We can't necessarily have both at the same time, so ethical reasoning is required to figure out, okay, what's the right thing to do in order to move forward and make a discharge recommendation. The final type of clinical reasoning essentially describes the integration and functional use of all the other types of reasoning. into one advanced, mature clinical reasoning style that's able to respond to each situation with the correct types of clinical reasoning. This is called conditional reasoning. This is the type of clinical reasoning that adapts to whatever the situation or condition demands. And not only does it deal with the current person, environment, and occupational variables of the case or client that you might be working with, conditional reasoning also thinks through multiple possible outcomes to make the best decision about what to do next. Conditional reasoning is what allows the experienced clinician to be a step or two ahead because they have thought about more than one potential outcome of the intervention. All right, let's just do a quick visual summary of these before we finish up with a an example of conditional reasoning in Susan's case study here that we've been walking through. So the first here is scientific reasoning. I signify it by the beaker and a test tube. Again, sorry for my lack of artistic skill, but I hope this is helpful for you. Again, here is a magnifying glass signifying, you know, the fact that with diagnostic reasoning, which is our second type of reasoning that we went over, we're looking at the scientific, you know, evidence regarding signs and symptoms but really applying it to function. So now that we know the clues of scientific information. Third is procedural reasoning. What are the steps one, two, three of what we should be doing next, whether that's certain intervention protocols or procedures related to more of your setting. Fourth is interactive reasoning. This is again about building a positive relationship between you and the client, thinking through what would make that, how do you maintain that relationship. and make it functional at the same time so that it's helpful and therapeutic. Fifth is narrative reasoning. This is when what's their past, what's their present, what's their future occupations and lived experiences and goals. And so this is really looking at that life story. And six is practical or pragmatic reasoning. What's practical for this client? And then Seventh is ethical reasoning. I used a little judge's hammer just to remind me that this is, again, about what's right is what we're looking at. And then all of these are weighed here in conditional reasoning, which is our eighth and final type of clinical reasoning. And again, this is the ideal. This is what mature clinicians are doing constantly as they're using all these clinical reasoning processes and weighing, you know, what which ones do I need for this specific moment? And they're applying that. This type of reasoning is, again, opening them up to seeing, you know, what are the potential repercussions, whether good or bad, I guess I should say, or effects of this specific intervention. So that's kind of my visual summary. I hope it's helpful for you. Make it your own. But let's apply it to Susan specifically. So if we're working with Susan and we want to apply conditional reasoning, a good example would be maybe during discharge. Because we're looking at what's the condition, the status of the condition, where is she in the wound healing process, what does evidence say about that, is there a risk for infection? So that is being looked at upon discharge. Is she medically stable? We're also looking at functional outcomes. Is she functionally ready to go home? Is she going to be safe? We're also looking at the procedures. What does the hospital say regarding discharge? parameters do they want you to work in who do you need to talk to in order to make that recommendation each setting is going to have their own procedures regarding discharge what forms to fill out and so forth fourth is you know interactive reasoning still going to play a big factor because she may not be happy about the recommendation of maybe she maybe she can't go to a um Another rehabilitation center, she has to go home. So using your relationship and continue to foster that so that it's a smooth transition for her. It's going to be important. Your narrative reasoning is, again, super important because we want to make sure that whatever the recommendation is will be the best recommendation to foster not only her physical health but also her occupational life story. And then pragmatic or practical reasoning is huge because insurance may not pay for certain locations or certain types of treatment. So pragmatic reasoning is what's going to allow us to make a practical discharge recommendation that makes sense. And then finally, ethical reasoning is, we talked about it previously, considered what's beneficence versus autonomy or whatever other ethical factors might be at play here, weighing those. So in discharge, you can see how all of these are critical. And in just that one moment of discharge and making that recommendation, you're using all of these in conjunction with each other. Thank you so much for joining me on the OT Minute. I hope this was helpful. in exploring the types of clinical reasoning. If you like content like this, please go ahead, take a second, click the subscribe button and turn on the notification bell. That allows you to be up to date regarding what new content is coming out. Also, go ahead and drop a comment in the section. We'd love to hear from you answering the question, what is the type of clinical reasoning that you feel like is a strength of yours? Maybe an example of how you see that playing out in your coursework as a student or in practice as a clinician. Thanks so much. We'll see you in the next video.

I'm a third-year occupational therapy student. Welcome to the OT Minute. I'm excited to talk about clinical reasoning today.

First, let's think about what clinical reasoning is. Clinical reasoning is the different ways in which we process information, make decisions, during the OT process. Therefore, clinical reasoning is used constantly.

As soon as we meet a client or read through their medical chart, we're starting to use different types of clinical reasoning to begin painting a picture of what's going on with this case, who this person is, and what our next steps might be. Now, there are eight types of clinical reasoning that we'll be going over today. Please keep in mind that this is how I think of them based on the resources that I've looked at and the feedback that I've received in graduate school.

I'll post resources. below because there are slight variances on how they can be classified and defined. So I always recommend do your own research, but this should give you a good overview. I'll also be using an example throughout to help make it tangible along with a visual summary at the end for all my fellow visual learners to hopefully make it easy to remember the different types of clinical reasoning as well as how to actually think of them in practice. The first type of clinical reasoning is scientific reasoning.

Scientific reasoning is a type of reasoning that processes the client's medical conditions and related scientific information that the person who is coming to us for services are experiencing. This is where all of our conditions, our anatomy, our physiology, content, lectures, and working knowledge comes into play. This is recalling any evidence-based research regarding signs, symptoms, or risk factors, or other statistical information that might be relevant. to the client's situation and their condition. This is also where we consider theoretical perspectives and make hypotheses based on that information.

Let's look at an example. Say we're working with Susan who's recently experienced an above elbow amputation to her left arm due to a traumatic vehicle accident. If we're working with her, we know that her medical condition is a left above the elbow imputation.

It is scientific. reasoning that starts to break down all the scientific, statistical, and theoretical information that may be pertaining to her condition. It allows us to recall and process information like that she's likely experiencing phantom limb pain, which evidence correlates with amputations.

She's also probably experiencing some swelling and edema, which we know is part of the wound healing process. Next, let's look at diagnostic reasoning. This type of reasoning take scientific reasoning a step further and can be considered a subcategory of scientific reasoning.

I think this is where our role as OT and occupational therapy students really comes into play. So having an understanding and having processed the scientific information about the condition, the signs and symptoms, and research, we now move into thinking and making hypotheses about what would be the functional outcomes or deficits when considering the client and their condition. The sixth, the impersonal information.

that is derived from the scientific reasoning and applies it to the personal information of a specific client to understand how this is affecting their meaningful occupations. For example, if we take the case of Susan who has experienced an above the elbow amputation of her left upper extremity, we know that bimanual occupations or tasks that she did before will be more difficult. A good example is if she's a single mother who does all the cooking in our household.

we can reasonably hypothesized that cutting and opening jars will now be difficult for her. We are essentially starting to diagnose occupational deficits by thinking through what would be the logical functional repercussions of a left above elbow amputation. This takes into account both the impersonal scientific information and the personal information that you or I as the clinician has.

We know that most people would cut food using their one hand to stabilize and one hand to cut. Therefore, if Susan is right-handed, we know that she's most likely stabilizing food with her left and cutting with her right. Since she cannot do it the same way she did before, it is fair to hypothesize that her cooking performance will be negatively affected.

She may not be able to fulfill her role as a mother to her satisfaction. Diagnostic reasoning is what brings us to that conclusion. The third type of reasoning is procedural reasoning.

Procedural reasoning is what it sounds like. And this is thinking through procedures. related to intervention protocols, intervention routines, and the hospital or specific settings, culture, and habits. For example, if we're treating Susan in an inpatient hospital setting, procedural reasoning is the type of thinking we are using to know how to document according to to the hospital. policies.

It dictates the type of PPE we might use. It might even guide us on what we need to do next. For example, in the case of Susan, it might be the routine of this setting for the occupational therapist to focus on patient education regarding limb formation and edema management.

So the setting procedure or policies guide that the OT does this and not a different discipline like nursing or Therefore, our procedural reasoning would help us form the conclusion that because of the hospital's culture and procedures, we need to address these topics in our treatment sessions. The fourth type of reasoning is interactive reasoning. This focuses on the type of thinking that addresses interpersonal aspects of interaction between the OT, the client, in order to foster a positive relationship.

This helps to improve collaboration through the OT process. The way I see it playing out in cases or in practice is when me ask Questions such as, what does the client like? What would make them more comfortable?

How can I relate to them? This affects what we talk about, how we posture ourselves, and how we use social interactions and our therapeutic use of self to build good therapeutic relationships. Let's keep running with our Susan example.

Susan may feel depressed or down. Interactive reasoning allows us to reason and think through what would be a good response if we see her showing some melancholic behavior, an encouragement, or some extra positive feedback regarding wins in the small things such as just getting out of bed or affirming her even for participating a little bit. These small intentional acts of encouragement comes from interactive reasoning focusing on asking the question, what would foster a positive therapeutic relationship by building trust and collaboration with Susan?

Next is narrative reasoning. Narrative reasoning among all the types of reasoning that we will go over today is where I feel us as OTs should have a special appreciation, emphasis, and sensitivity. This type of reasoning is processing the occupational story of the client. So it's looking at what were their previous meaningful experiences and roles. It's also thinking about what their future occupational story might reasonably be.

How can we carry their meaningful activities, experiences, and roles forward? forward in this next season. This type of reasoning is where we really get to dig into what's important to the client and why. By understanding the context of their lived experiences and their personal narrative, we are able to understand the person better and use our other forms of clinical reasoning to continue to help their personal life story flourish and continue.

So what does this look like tangibly? Well, in the case of Susan, this reasoning would come into play as we're thinking about her role as a mother. Understanding how her decreased participation and performance in certain meaningful tasks, such as cooking or bathing her kids, is affecting meaning in her life story. For example, she may now see herself as not as effective of a mother now, and her personal narrative might now be lacking what was once meaningful to her. Narrative reasoning is the type of reasoning that explains that and puts her life story or occupational story variables together to make sense of the meaningfulness of her personal narrative and just her personal life, both pre and post injury.

Pragmatic reasoning. This is common sense reasoning. It is looking at what is possible given the context, the situation, and realistically our skills as a practitioner. When looking at the case we have been working with, with Susan, pragmatic reasoning is the type of reasoning that considers practically How many sessions will Susan be seeing you in your setting?

What makes sense as far as goals go? What's the biggest priority given her situation? And what is achievable? In the inpatient setting, we may not be able to address IDLs such as driving because insurance may not reimburse for that. Also, what type of adaptive equipment recommendations would be practical given her financial circumstances and community context?

For example, recommending expensive... adaptive equipment if she doesn't have the means to purchase it. It simply isn't practical no matter how great they might be.

The seventh type of clinical reasoning is ethical reasoning. Make sure you review the AOTA code of ethics because these are the values that should be guiding our ethical reasoning as OTs. This is a pretty straightforward type of reasoning.

It helps us think through what's the right thing to do in this scenario or case. In the case of Susan, an example of ethical reasoning would be When we're asking ourselves what would be the right thing to do regarding discharge, if you think that she may not be safe to go home yet but she wants to go home to be with her kids, ethical principles being weighed are Beneficence and autonomy. Beneficence refers to wanting what is good for the client. So for Susan, she may not be medically stable enough due to medications or complications to go home.

So the principle of beneficence would say keep providing medical treatment and therapy in the inpatient setting. It's what's best for her. Autonomy refers to the ethical principle of respecting the fact that a person should be allowed to make decisions and have control over their own lives.

Therefore, autonomy would suggest that we have to respect control over her own life and her decisions. Ethical reasoning engages these two variables to help make an ethical decision during Susan's treatment. We can't necessarily have both at the same time, so ethical reasoning is required to figure out, okay, what's the right thing to do in order to move forward and make a discharge recommendation.

The final type of clinical reasoning essentially describes the integration and functional use of all the other types of reasoning. into one advanced, mature clinical reasoning style that's able to respond to each situation with the correct types of clinical reasoning. This is called conditional reasoning.

This is the type of clinical reasoning that adapts to whatever the situation or condition demands. And not only does it deal with the current person, environment, and occupational variables of the case or client that you might be working with, conditional reasoning also thinks through multiple possible outcomes to make the best decision about what to do next. Conditional reasoning is what allows the experienced clinician to be a step or two ahead because they have thought about more than one potential outcome of the intervention. All right, let's just do a quick visual summary of these before we finish up with a an example of conditional reasoning in Susan's case study here that we've been walking through. So the first here is scientific reasoning.

I signify it by the beaker and a test tube. Again, sorry for my lack of artistic skill, but I hope this is helpful for you. Again, here is a magnifying glass signifying, you know, the fact that with diagnostic reasoning, which is our second type of reasoning that we went over, we're looking at the scientific, you know, evidence regarding signs and symptoms but really applying it to function. So now that we know the clues of scientific information.

Third is procedural reasoning. What are the steps one, two, three of what we should be doing next, whether that's certain intervention protocols or procedures related to more of your setting. Fourth is interactive reasoning.

This is again about building a positive relationship between you and the client, thinking through what would make that, how do you maintain that relationship. and make it functional at the same time so that it's helpful and therapeutic. Fifth is narrative reasoning.

This is when what's their past, what's their present, what's their future occupations and lived experiences and goals. And so this is really looking at that life story. And six is practical or pragmatic reasoning. What's practical for this client? And then Seventh is ethical reasoning.

I used a little judge's hammer just to remind me that this is, again, about what's right is what we're looking at. And then all of these are weighed here in conditional reasoning, which is our eighth and final type of clinical reasoning. And again, this is the ideal. This is what mature clinicians are doing constantly as they're using all these clinical reasoning processes and weighing, you know, what which ones do I need for this specific moment? And they're applying that.

This type of reasoning is, again, opening them up to seeing, you know, what are the potential repercussions, whether good or bad, I guess I should say, or effects of this specific intervention. So that's kind of my visual summary. I hope it's helpful for you.

Make it your own. But let's apply it to Susan specifically. So if we're working with Susan and we want to apply conditional reasoning, a good example would be maybe during discharge. Because we're looking at what's the condition, the status of the condition, where is she in the wound healing process, what does evidence say about that, is there a risk for infection?

So that is being looked at upon discharge. Is she medically stable? We're also looking at functional outcomes.

Is she functionally ready to go home? Is she going to be safe? We're also looking at the procedures.

What does the hospital say regarding discharge? parameters do they want you to work in who do you need to talk to in order to make that recommendation each setting is going to have their own procedures regarding discharge what forms to fill out and so forth fourth is you know interactive reasoning still going to play a big factor because she may not be happy about the recommendation of maybe she maybe she can't go to a um Another rehabilitation center, she has to go home. So using your relationship and continue to foster that so that it's a smooth transition for her. It's going to be important.

Your narrative reasoning is, again, super important because we want to make sure that whatever the recommendation is will be the best recommendation to foster not only her physical health but also her occupational life story. And then pragmatic or practical reasoning is huge because insurance may not pay for certain locations or certain types of treatment. So pragmatic reasoning is what's going to allow us to make a practical discharge recommendation that makes sense. And then finally, ethical reasoning is, we talked about it previously, considered what's beneficence versus autonomy or whatever other ethical factors might be at play here, weighing those. So in discharge, you can see how all of these are critical.

And in just that one moment of discharge and making that recommendation, you're using all of these in conjunction with each other. Thank you so much for joining me on the OT Minute. I hope this was helpful. in exploring the types of clinical reasoning. If you like content like this, please go ahead, take a second, click the subscribe button and turn on the notification bell.

That allows you to be up to date regarding what new content is coming out. Also, go ahead and drop a comment in the section. We'd love to hear from you answering the question, what is the type of clinical reasoning that you feel like is a strength of yours?

Maybe an example of how you see that playing out in your coursework as a student or in practice as a clinician. Thanks so much. We'll see you in the next video.

Transcript for:Types of Clinical Reasoning in OT

Transcript for:
Types of Clinical Reasoning in OT