Personal Narrative: Improving Clinical Reasoning

To enhance my clinical knowledge I take time to understand why I am doing a task a particular way

Johnny Obrien aged 79 years, presented to the Emergency Department after a fall at the RSL, resulting in a laceration on his left elbow which required 3 stitches. He lives by himself with no family close by, and has a history of hypertension and alcohol addiction. Clinical reasoning is a cyclic process, where cues are collected and their data processed to come to a conclusion of the patient situation so that appropriate interventions can be implemented and evaluated through reflective practices which allows for further learning (Levett-Jones 2013). Applying these clinical reasoning skills in practice is important as it has a positive impact on patient outcomes, resulting in less adverse effects due to the detection of patient deterioration throughout this process to ensure safe and effective care (Levett-Jones 2010).Subjective data is information from the patient’s point of view, including their feelings, perceptions and concerns, whereas objective data is information that is observable or measurable (Delmar Cengage Learning 2015).

Week three in clinical was difficult for me, I had a great experience overall but I hated seeing and holding a baby that had passed away at 21 weeks. To know what the family could possibly be going through was heartbreaking. I wouldn’t exactly know what to do if I was with the patient and her family exactly. I do know that I did place her in the room when she was admitted to triage. I do feel good about seeing the scenario play out, while being a student rather than being in the field alone. Other than that I was able to see the beginning stage of labor as well as a C-section. Everyone was so bent out of shape on making sure I eat and that I don’t faint, but it seriously wasn’t bad. As a matter of fact I was too intrigued with the mother rather

Common strategies are designed to enhance self-esteem and confidence and build therapeutic momentum as patients gain energy, feel better, and disconfirm negative beliefs. ABC technique help highlight situations that evoke evaluations which in turn provoke emotional and behavioural reactions. Behavioural experiments can be used to check out the validity of predictions and beliefs. Questionnaires, thought records (NAT’s) and mood diaries help increase self awareness and give concrete evidence of improvement, or if there are no changes, treatment can be adapted. Goal setting or activity scheduling all aid practical problem solving and physical interventions can include relaxation techniques, physical exercise and or appraisal of sleeping problems and In vivo exposure entails confronting the patient with the avoided object or situation. The Socratic questioning contains elements of the learning cycle and alerts clients to observe their experiences (observation); develop new understandings of their problems (reflection); synthesise new possibilities and ways forward (planning new experiences). In other words cognitive techniques help the client create insights and possibilities (observation-reflection-planning) which are tested in the field (experience). By linking experience and cognition a more affective behavioural

According to Hawkins, Elder, & Paul (2010) Clinical reasoning is “thinking through the various aspects of patient care to arrive at a reasonable decision regarding the prevention, diagnoses, or treatment of a clinical problem in a specific patient” (p. 3.) The

This theory was applied to a client that had a diagnosis of intervertebral disc prolapse. The client was in severe pain. 1) Orientation phase; the client was initially reluctant to talk due to her pain. 2) Identification phase; the client expresses the need to get relief from pain. The nurse educates the client on the pain scale to measure pain. 3) Exploitation phase; client informs nurse that there is relief from pain when she is in the supine position. 4) Resolution phase – client’s pain was reduced and tolerable.

Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill, that I have learnt and supporting this with available literature.

If I were a psychoanalyst treating disorders, I would deal with the behavioral aspect of the disorder. With the behavioral point of view, it involves a multitude of developments such as phobias, anxiety, and other various situations. I personally like the behavioral aspect the most because it starts by taking on a certain person’s fear with the same ways it was originally developed. For instance, say somebody has a social phobia and cannot handle being in certain places due to a large amount of people, this individual may love sports but will not go to events due to high volumes of people which results to watching all games on TV. I would simply start to figure out why this all began, then slowly bring in different solutions. One way could

During the feedback conversation with my supervisor I started to realize that, I was not able to support my opinion. During this conversation I started to feel frustrated and disappointed with myself. It was shocked because I didn’t expect to be so hard to put all the information that came from the patient in the right order to make the correct decision and I was afraid that I couldn’t learn how to come to a conclusion never in my life. Throughout the conversation, my supervisor mentioned the words Clinical Reasoning and Diagnostic Clinical Reasoning which was something new for me. From that time, she gave me the stimulus to look more around that area with the aim to improve my clinical reasoning skill and to get diagnostic reasoning thinking.

Medical education stimulates development clinical reasoning in medical students and residents to be able making the correct diagnosis for their patients. Clinical reasoning process in doctors develops through the time which gives them more competency to do that as experts. However, it is not known which instructional strategies that would improve clinical reasoning process in doctors. Such strategy makes medical students and residents think more effective like experts. This study focused on effects of using structured reflection on clinical reasoning process in a medical residents training program.

Reflection has its importance in clinical practice; we always seek to be successful and that can be achieved by learning every day of our life through experiences we encounter. In that way we can reconsider and rethink our previous knowledge and add new learning to our knowledge base so as to inform our practice. Learning new skills does not stop upon qualifying; this should become second nature to thinking professionals as they continue their professional development throughout their careers (Jasper, 2006).

Throughout my work experience, I developed relevant skills that will prepare me for work as a physiotherapist, such as working in close liaison with clients and professionals, working under pressure, being adaptable and having good organisational and interpersonal skills. Additionally, it has also made me more self-aware as my background and values will affect the decisions I make and more importantly others. Therefore, I can continuously improve traits that will help me become a more successful member, as my actions reflect the organisation I am

are. No strict rubric will be successful in the physical therapy field because each patient is different and should be treated as

Patient examination in physical therapy includes measures such as strength, flexibility, range of motion, motor function, and quality of life. After all of this has been done, a physical therapist uses clinical reasoning to determine what is wrong with the patient and what should be done to help the patient improve. He uses the gathered information to develop an individualized care plan for each patient, indicating the patient’s short- and long-term goals and expected outcomes as a result of the therapy sessions (U.S. Bureau, 2015).

“Chahte hi nai the, mtlb main jab apne aap ko aya, to actually ye controversial baat hai, baat bata raha hu. Ki lekin reality ye hai ki mujhe lagta hai ki ek physiotherapist jitna earn kar sakta hai, utna by economically doosra koi normal bachelor ke baad earn nai kar sakta. (Reality Oriented and Practical) IDP 7 Secondly. Third, humare haath jo working hai, without kisi cheese ki jo hum apne haath se kar sakte hai, wo normal hum kisi aur profession me hum nai kar sakte. Machinon ka role hai jaise ki suppose that ek mbbs hai, wo medicine se help kar sakte hai. Aur without medicine meri knowledge me wo bht working nai kar sakte hai. But humare pass yadi maan lijiye ki suppose that sikai ki machine nahi hai tab bhi mechanically bhi bahut kuch hum log kar sakte hain . A lot of disorder is to treat with only manual therapy jo hum log haath se karte hain us se bahut saari working main kar sakta hoon. Toh I feel proud of, from very first day of physiotherapy main laga ki....” Dr. S