A carpenter's tool is a hammer, a photographer: camera. A Doctor: perhaps stethoscope, A painter: brush and canvas. Most of the profession has a tool that they use for their trade. As an Occupational Therapist, what would it be? I am tempted not to write them down as I always enjoy watching most OT's not knowing the tools of their trade. However, I have a commitment to remind a lot of "sleeping" OT's. Tools of practice can define the profession. So what would define OT? In the UK, I realise it is commode, raised toilet seat, perching stool, kitchen practice, relaxation, bed lever and many others. These equipment are what defines an OT sad to say. This is why a lot of other professions, or even assistants think that they know how to be an OT. Well excuuuse me. NO! Tools of OT are these:
1. Use of Self
2. Use of Environment
3. Activity Analysis
4. Use of Group
5. Teaching Learning
6. Purposeful Activity
An OT will come up with a decision because he/she unconsciously used the above list of Tools which are all very abstract which is why they get lost very easily in the depths of memory.
Wednesday, February 9, 2011
Tuesday, February 8, 2011
PRAGMATIC ASPECT OF CLINICAL REASONING
I have written in my previous blog, the 4 facets of clinical reasoning: narrative, scientific, ethical and pragmatic.
As a clinician, your clinical reasoning will always be spot on if you are able to balance these 4 aspects before you make a decision on any case. The limitation as to what you and your client can do together is dependent on the pragmatic aspect of the case.
The pragmatic aspects can be rules and regulations of the facility, protocols and guidelines, criteria of admission, target time of stay in the hospital, scope and boudarries of your profession. discussions can go on and on but in the end, the Pragmatic aspect of Clinical reasoning is the playing field that an OT can play at or the canvas that an OT can paint at.
Examples:
1. you think that a patient can benefit from a bath trasfer training because he is not yet sae with it... would you keep them in a hospital becasue they havent acheived this? Definitely not!!!! community therapy team(intermediate care, reablement, community OT can folow this up - if it is their role to do so).
2, You feel a Stroke client is not yet safe to prepare their own meals and you want to spend time doing this with the patient even if there is somebody who can do it for them. Will you do it? YES... if you are in a stroke rehab facility or neuro rehab facility. NO... if you are in an acute stroke/neuro facility. YES if you are in the community rehab team.
3. Somebody asked you to order a hospital bed for a patient. will you do it? YES...if it is a job designated for an OT to do in a county or borough that you are working at. NO.... if the borough/county's policy is that district nurses should be ordering it.
4. Can you teach a person with total hip replacement to step trasfer to and from bath while standing up? YES if safe to do so and the clent can manage (scientific) and if the client wanted to do it (narrative) and because you have and obligation to empower clients to be independent (ethical).
NO.... if the department has an agreed protocol and guideline that everybody should be transferring using a bath board.
5. can you allow a person with total hip replacement to remove his shoes by having him push the shoe off the other foot using his other foot (Leg Crossing Doffing Method).
YES - this method will not cause internal rotation to the hip joint (scientific)
- if the person wants to be independent and is willing to explore many waus of being independent (narrative)
NO - if your manager tell you not to!!!(pragmatic) "ha ha ha"
- if the there is a departmental guideline that this method is banned (pragmatic)
6. Will you order a perching stool for client to be able to wash?
YES - if client cannot sustain standing and if they cannot maintain balance or if the effort of standing is a strain to their respiratory system (Scientific)
NO - if they already have a perch stool, if they have an alternative stool, if they are fine washing whilst seated on the toilet( pragmatic)
- if they choose to just have a strip wash by the bed (narrative)
So you see. in every question and decision an OT has to make, there are always opposing anwers. Most of the decision though is affected by the pragmatic aspects of the case. Remember though that the pragmatic aspect of clinical reasoning can only be outweighed by the ETHICAL merits of the case.
As a clinician, your clinical reasoning will always be spot on if you are able to balance these 4 aspects before you make a decision on any case. The limitation as to what you and your client can do together is dependent on the pragmatic aspect of the case.
The pragmatic aspects can be rules and regulations of the facility, protocols and guidelines, criteria of admission, target time of stay in the hospital, scope and boudarries of your profession. discussions can go on and on but in the end, the Pragmatic aspect of Clinical reasoning is the playing field that an OT can play at or the canvas that an OT can paint at.
Examples:
1. you think that a patient can benefit from a bath trasfer training because he is not yet sae with it... would you keep them in a hospital becasue they havent acheived this? Definitely not!!!! community therapy team(intermediate care, reablement, community OT can folow this up - if it is their role to do so).
2, You feel a Stroke client is not yet safe to prepare their own meals and you want to spend time doing this with the patient even if there is somebody who can do it for them. Will you do it? YES... if you are in a stroke rehab facility or neuro rehab facility. NO... if you are in an acute stroke/neuro facility. YES if you are in the community rehab team.
3. Somebody asked you to order a hospital bed for a patient. will you do it? YES...if it is a job designated for an OT to do in a county or borough that you are working at. NO.... if the borough/county's policy is that district nurses should be ordering it.
4. Can you teach a person with total hip replacement to step trasfer to and from bath while standing up? YES if safe to do so and the clent can manage (scientific) and if the client wanted to do it (narrative) and because you have and obligation to empower clients to be independent (ethical).
NO.... if the department has an agreed protocol and guideline that everybody should be transferring using a bath board.
5. can you allow a person with total hip replacement to remove his shoes by having him push the shoe off the other foot using his other foot (Leg Crossing Doffing Method).
YES - this method will not cause internal rotation to the hip joint (scientific)
- if the person wants to be independent and is willing to explore many waus of being independent (narrative)
NO - if your manager tell you not to!!!(pragmatic) "ha ha ha"
- if the there is a departmental guideline that this method is banned (pragmatic)
6. Will you order a perching stool for client to be able to wash?
YES - if client cannot sustain standing and if they cannot maintain balance or if the effort of standing is a strain to their respiratory system (Scientific)
NO - if they already have a perch stool, if they have an alternative stool, if they are fine washing whilst seated on the toilet( pragmatic)
- if they choose to just have a strip wash by the bed (narrative)
So you see. in every question and decision an OT has to make, there are always opposing anwers. Most of the decision though is affected by the pragmatic aspects of the case. Remember though that the pragmatic aspect of clinical reasoning can only be outweighed by the ETHICAL merits of the case.
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