scholarly journals Factors That Influence the Clinical Decision Making of Novice and Experienced Physical Therapists

2011 ◽  
Vol 91 (1) ◽  
pp. 87-101 ◽  
Author(s):  
Susan Flannery Wainwright ◽  
Katherine F. Shepard ◽  
Laurinda B. Harman ◽  
James Stephens
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Structure Learning ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Inpatient Rehabilitation ◽  
Clinical Decision ◽  
Novice Learners ◽  
Multiple Data ◽  
Insight Into

Background The depth and breadth of prior experience informs clinical decision making in novice and experienced physical therapist clinicians. Objectives The aims of this research were to identify differences in clinical decision-making abilities and processes between novice and experienced physical therapist clinicians and to develop a model of the factors that influence clinical decision making. Design Qualitative research methods and grounded theory were used to gain insight into the factors and experiences that inform clinical decision making. Methods Three participant pairs (each pair consisted of 1 novice physical therapist and 1 experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries from each participant provided the basis for within- and across-case analyses. The credibility of the results was established through checking of the case summaries by the participants, presentation of low-inference data, and triangulation across multiple data sources and within and across participant groups. Results The factors that influenced clinical decision making were categorized as informative or directive. Novice participants relied more on informative factors, whereas experienced participants were more likely to rely on directive factors. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities for students and novice learners with the aim of facilitating the development of skills and abilities consistent with expert clinical decision making.

scholarly journals Novice and Experienced Physical Therapist Clinicians: A Comparison of How Reflection Is Used to Inform the Clinical Decision-Making Process

2010 ◽  
Vol 90 (1) ◽  
pp. 75-88 ◽  
Author(s):  
Susan Flannery Wainwright ◽  
Katherine F. Shepard ◽  
Laurinda B. Harman ◽  
James Stephens
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Structure Learning ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Inpatient Rehabilitation ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Multiple Data ◽  
Reflection On Action

Background Prior experience informs clinical decision making and shapes how reflection is used by novice and experienced physical therapist clinicians. Objectives The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists. Design Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making. Methods Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups. Results Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners.

scholarly journals Is there an agreement among the items of the Korean physical therapist licensing examination, learning objectives of class subjects, and physical therapists’ job descriptions?

2016 ◽  
Vol 13 ◽  
pp. 3 ◽  
Author(s):  
Min-Hyeok Kang ◽  
Oh-Yun Kwon ◽  
Yong-Wook Kim ◽  
Ji-Won Kim ◽  
Tae-Ho Kim ◽  
...  
Keyword(s):  
Decision Making ◽  
Physical Therapy ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Clinical Decision ◽  
Learning Objectives ◽  
Job Descriptions ◽  
University Courses ◽  
Licensing Examination

Purpose: To determine the agreement among the items of the Korean physical therapist licensing examination, learning objectives of class subjects, and physical therapists’ job descriptions. Methods: The main tasks of physical therapists were classified, and university courses related to the main tasks were also classified. Frequency analysis was used to determine the proportions of credits for the classified courses out of the total credits of major subjects, exam items related to the classified courses out of the total number of exam items, and universities that offer courses related to the Korean physical therapist licensing examination among the surveyed universities. Results: The proportions of credits for clinical decision making and physical therapy diagnosis-related courses out of the total number credits for major subjects at universities were relatively low (2.06% and 2.58%, respectively). Although the main tasks of physical therapists are related to diagnosis and evaluation, the proportion of physiotherapy intervention-related items (35%) was higher than that of examination and evaluation-related items (25%) on the Korean physical therapist licensing examination. The percentages of universities that offer physical therapy diagnosis and clinical decision making-related courses were 58.62% and 68.97%, respectively.Conclusion: Both the proportion of physiotherapy diagnosis and evaluation-related items on the Korean physical therapist licensing examination, and the number of subjects related to clinical decision making and physical therapy diagnosis in the physical therapy curriculum, should be increased to ensure that the examination items and physical therapy curriculum reflect the practical tasks of physical therapists.

scholarly journals Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure

2020 ◽  
Vol 100 (1) ◽  
pp. 14-43
Author(s):  
Michael J Shoemaker ◽  
Konrad J Dias ◽  
Kristin M Lefebvre ◽  
John D Heick ◽  
Sean M Collins
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Clinical Decision

Abstract The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

scholarly journals Blood transfusion prescribing in the ACT: an insight into clinical decision making

2005 ◽  
Vol 29 (2) ◽  
pp. 240 ◽  
Author(s):  
Philip J Crispin ◽  
Bethany J Crowe ◽  
Anne M McDonald
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Early Discharge ◽  
Organisation Of Care ◽  
Metropolitan Hospital ◽  
Loss Of Appetite ◽  
Insight Into ◽  
Structured Questionnaire

This study aimed to determine the perspectives of a group of patients categorised as ?long-stay outliers? at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

Diagnostic conversations: Clinical Decision Making in surgery – Part 2

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 189-193 ◽  
Author(s):  
David Allan Watters ◽  
Spencer Wynyard Beasley ◽  
Wendy Crebbin
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Opportunities ◽  
Clinical Decisions ◽  
Decision Making Processes ◽  
Royal Australasian College ◽  
Insight Into ◽  
Made In

AbstractProceduralists who fail to review their decision making are unlikely to learn from their experiences, irrespective of whether the operative outcome is successful or not. Teaching junior surgeons to develop ‘insight’ into their own decision making has long been a challenge. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to help explain the processes around clinical decision making and incorporated this model into a Clinical Decision Making (CDM) training course. In this course, faculty apply the model to specific surgical cases, within the model’s framework of how clinical decisions are made; thus providing an opportunity to identify specific decision making processes as they occur and to highlight some of the learning opportunities they provide. The conversation in this paper illustrates the kinds of case-based interactions which typically occur in the development and teaching of the CDM course.The focus in this, the second of two papers, is on reviewing post-operative clinical decisions made in relation to one case, to improve the quality of subsequent decision making.

scholarly journals Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline

2016 ◽  
Vol 96 (2) ◽  
pp. 143-166 ◽  
Author(s):  
Ellen Hillegass ◽  
Michael Puthoff ◽  
Ethel M. Frese ◽  
Mary Thigpen ◽  
Dennis C. Sobush ◽  
...  
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Patients At Risk

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

How Do Physical Therapists Approach Management of People With Early Knee Osteoarthritis? A Qualitative Study

2019 ◽  
Vol 100 (2) ◽  
pp. 295-306 ◽  
Author(s):  
Crystal MacKay ◽  
Gillian A Hawker ◽  
Susan B Jaglal
Keyword(s):  
Knee Osteoarthritis ◽  
Weight Management ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Continuing Professional Development ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Knee Oa

Abstract Background Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists’ perceptions and clinical behaviors related to early knee OA management. Objective The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population. Design We used a qualitative, descriptive research design. Methods Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis. Results Five main themes were constructed: (1) Physical therapists’ experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist “toolbox:” participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating “buy-in” to management: physical therapists used a range of strategies to gain “buy-in.” Limitations Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years. Conclusions Participants’ accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).

scholarly journals Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project

2009 ◽  
Vol 89 (9) ◽  
pp. 918-933 ◽  
Author(s):  
Joe Schreiber ◽  
Perri Stern ◽  
Gregory Marchetti ◽  
Ingrid Provident
Keyword(s):  
Decision Making ◽  
Formative Evaluation ◽  
Research Evidence ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Physical Therapists ◽  
Pilot Project ◽  
Clinical Decision ◽  
Evidence Based ◽  
Practice Behaviors

BackgroundThe physical therapy profession has been perceived as one that bases its practice largely on anecdotal evidence and that uses treatment techniques for which there is little scientific support. Physical therapists have been urged to increase evidence-based practice behaviors as a means to address this perception and to enhance the translation of knowledge from research evidence into clinical practice. However, little attention has been paid to the best ways in which to support clinicians’ efforts toward improving evidence-based practice.ObjectivesThe purpose of this study was to identify, implement, and evaluate the effectiveness of strategies aimed at enhancing the ability of 5 pediatric physical therapists to integrate scientific research evidence into clinical decision making.DesignThis study was a formative evaluation pilot project.MethodsThe participants in this study collaborated with the first author to identify and implement strategies and outcomes aimed at enhancing their ability to use research evidence during clinical decision making. Outcome data were analyzed with qualitative methods.ResultsThe participants were able to implement several, but not all, of the strategies and made modest self-reported improvements in evidence-based practice behaviors, such as reading journal articles and completing database searches. They identified several barriers, including a lack of time, other influences on clinical decision making, and a lack of incentives for evidence-based practice activities.ConclusionsThe pediatric physical therapists who took part in this project had positive attitudes toward evidence-based practice and made modest improvements in this area. It is critical for the profession to continue to investigate optimal strategies to aid practicing clinicians in applying research evidence to clinical decision making.

scholarly journals FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis

2019 ◽  
Vol 8 (1) ◽  
pp. 187-191
Author(s):  
Alexa Profozich ◽  
Trevor Sytsma ◽  
Ryan Arnold ◽  
Kristen Miller ◽  
Muge Capan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Initial Point ◽  
Clinical Decision ◽  
Sepsis Management ◽  
Insight Into

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

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