What have you noticed about Lillian’s situation while observing her consultation with the occupational therapist so far?
Record your observations here.
What are your initial impressions of Lillian? List them here.
Can you think of any assumptions that you could make here, and how they might influence your thoughts about Lillian’s situation?
Before watching the next video clip, consider what questions you as practitioner would like to ask Lillian to gain a better idea of her situation.
List your questions for Lillian here.
In the next space provided, also list any other information that you think you would be necessary or helpful in order to gain the best possible picture of Lillian’s situation and the best course of action to support her.
You can provide questions that are most relevant to your practice. You do not have to follow the occupational therapy line of investigation, for example, as the purpose of this module is to enable you to experience and respond to a scenario and apply clinical reasoning.
The occupational therapist has asked some questions about Lillian’s general mobility, particularly inside her house. Are there any other questions you can think of for Lillian about how she gets around inside her house?
List them here.
There is quite a lot of information to consider here. Review your notes.
Can you think of any other relevant questions you would ask of Lillian that may help you make an appropriate diagnosis? List them here.
Would you seek any other information to help you make an appropriate diagnosis from:
What and why?
Do you think the issue of Lillian’s chair is relevant to her situation? Why/why not?
What did you observe when she stood up and sat down for the practitioner?
Is there anything you can infer from this? If so, what solution/s might be appropriate?
You now have some substantial information about Lillian’s situation and how she negotiates her environment on a day-to-day basis. This provides important information for an occupational therapist, but it is also relevant to other allied health professions.
Review the notes you have taken. Analyse them carefully.
List your responses to the following questions that you should ask yourself during the information processing stage of the clinical reasoning cycle:
What information do you think is most important for assisting Lillian here?
Are there any gaps in the information gathered? What are they? (you will find there may be a multitude of gaps if you come from a different allied health practice from the one you see in the video!)
Can you recognise relationships or patterns between the cues that have been gathered so far?
Think logically about the cues. What are the cues and what do you think they are telling you/revealing to you? What can you infer from the cues?
What alternative inferences/conclusions are worth considering?
Can you match Lillian’s situation to any past situations you have encountered with clients before? (Note: this is usually an expert thought process, which relies on your accumulated wealth of clinical experience. However, you may be able to relate it to situations you have already encountered – either in clinic or outside of it.)
Can you predict any outcomes for Lillian?
What do you think Lillian can expect to gain out of having this consultation?
This is where you bring together all the information you have gathered and processed in the exercises above in order to make suggestions to help support Lillian. This step enables you to identify the most significant problems or issues for her.
It is an important step for the next stage, where you will identify the goals of care and course of action.
After identifying and prioritising any problems and issues for Lillian that may require intervention, it is time to establish the goals of care and consider how these goals can be achieved between the practitioner and client. Write your responses to the following questions:
What is the desired outcome for Lillian?
Does Lillian share this view?
What are the goals for achieving this? Make sure your goals are SMART (Specific, (Measurable, (Achievable, (Realistic and (Timely)
In this stage you select the most appropriate course of action, as well as deciding who is best placed to undertake any interventions, if you feel they are necessary.
Describe what you want to happen for Lillian.
How do you think Lillian would feel about this?
If you have recommended interventions, who should undertake these interventions?
This stage refers to your assessment of the effectiveness of the prescribed interventions and determining whether the situation has improved for the client. However, for this exercise you can consider whether … … [nb: students could evaluate outcomes of this particular consultation, in an immediate sense – alternatively, we mention this step, but state how it is different in this context because there won’t be any follow-up]
Reflection is a crucial part of clinical practice generally – as well as clinical reasoning. It is the final step of the clinical reasoning cycle and enables you to critically analyse and review your practice in order to refine, improve, or change it (Levett-Jones & Hoffman, 2013, p. 6).
Think back to your very first impressions of Lillian in Stage 1 of the clinical reasoning cycle. Look at your notes, but also try to recall whether you made any assumptions about Lillian and her situation that could have influenced your thoughts and shaped your diagnosis. This can be a challenging reflective exercise – but it is integral to being a good critical thinker, and being aware of some of the biases we may carry that can lead to errors in our clinical reasoning.
Did you make any assumptions that could have influenced your clinical reasoning? If so, why do you think you made a particular assumption?
What have you learnt from this process?
What you could have done differently?
Consider the cues that you found in the information-gathering stage. Can you think of any subtle cues that you may have missed during the consultation? What could have been the outcome of missing this/these cues?
Could any of these missed cues have resulted in an adverse event or pose health problems later on?