Pediatric Physiotherapists Clinical Reasoning and ICF - Literature review Example

PEDIATRIC PHYSIOTHERAPISTS CLINICAL REASONING AND ICF Pediatric Physiotherapists Clinical Reasoning and ICF Clinical knowledge is among many other medical competences just as reasoning is. According to Smith (2008, p. 375), education is key in the provision of good services. Knowledge development occurs through various stages, which are clinical assessment, knowing, knowing how, showing how as well as the actual doing. It therefore explains the process involved in becoming an expert in medical terms from being novice and then applying the knowledge efficiently within a clinical set-up. It would therefore be appreciated that familiarity, understanding as well as awareness of certain skills for something, which is gained through learning, education or even experience, is knowledge. However, clinical knowledge implies to both theoretical and practical understanding of clinical aspects as is necessary for professionalism. The clinical practice knowledge is either propositional or non-propositional where propositional is more theoretical hence; scientific while non-propositional is based on experience (Lee, 2011, p. 1-2). Competence on the other hand refers to the professional requirement that a person properly performs a specific job (Boshuizen and Schmidt, 1992, p. 153-155). In reference to clinical field, competence therefore would imply the professional requirement that a medical practitioner, especially at clinical level has high command in effectiveness of performing specific jobs, often the health care service delivery. Clinical reasoning on the other hand refers to the capacity of a clinical practitioner to think of a clinical matter logically for making an informed judgment for a conclusion. This therefore shows an increased capacity for a person to think as well as understand clinical practice matters logically for effectiveness in the profession. The definitions of knowledge, reasoning as well as competence revolve around understanding and effectiveness in clinical profession practice (Rich, 1991, p. 319-325). There is therefore an association between knowledge, competence as well as reasoning knowledge would be pointed out to emanate from the capacity to reason and apply skills developed through competence in the clinical field. In the acquisition of knowledge, complex processes of cognitive capacity coupled with the ability to apply higher reason in decision-making are involved. Moreover, the capacity of one to perform clinical practices with ease and effectively as defines competence contributes to gaining knowledge and can also be said to emanate from performing clinical duties with knowledge. Besides, clinical practices as termed as scientific involve application of scientific knowledge that requires competence and reasoning for experimentation purposes. Importance of knowledge in clinical practice Performance and competence in clinical practice are founded on knowledge according to Smith (2008, p. 375-378). Clinical practice is a relatively complex field of study where health care provision professionals rely on ‘knowledge’ while interacting with patients before, during and even after administration of medication to evaluate the results. The practitioners relies on gained knowledge in the scientific field in assessing a patient, getting the historic background of the condition and this knowledge is useful in diagnosis, treatment, as well as preventive measures of disease through higher levels of reason and judgment. As a scientific process, the practitioners also require prior knowledge in choice of and use of scientific tools for assessment and or diagnosis of medical conditions for informed decision making as to the treatment and preventive measures to be adopted for a clinical situation. This shows that knowledge in clinical practice is wholly necessary for effectiveness in medical review, physical examination as well as for reference purposes especially during and after treatment procedures (Boshuizen and Schmidt, 1992, p. 153-155). Besides, specialization in the discipline of clinical medicine and practice is informed by the knowledge specialization. This implies that a practicing clinician requires having at least an area of specialization, which is vital for effectiveness and efficiency in service delivery to the patients. For instance, there are specializations in clinical medicine, diagnostic specializations and such other specializations, which are all informed by the knowledge acquired by the clinical practitioner. Knowledge in clinical practice explains what practitioners need to know, how to know that which is required as well as application of science in clinical practices (Lee, 2011, p. 1-5). It is however to be noted that the process of gaining knowledge is continuous as mere formal education only equips the physiotherapists with the entry level knowledge in pursuing the career but learning is a lifelong experience especially within the clinical field which is very dynamic (Boshuizen and Schmidt, 1992, p. 153-155). Learning the propositional knowledge through scientific methods and non-propositional knowledge through experience in practice explains how important the ‘knowledge’ is to practicing clinical professionals. For instance, evidence based practices in clinical practice is wholly dependent on knowledge where through knowledge of patient values, research evidence as well as clinical expertise, effectiveness in practice is realized. How to examine knowledge and competence Various tools and methods would be used in evaluation of knowledge and competences in clinical practice. In fact, as the process of measuring is not spontaneous event, models are used because the process may last shortly or even for longer durations of time (Rich, 1991, p. 328-331). For instance, examination of the clinical outcome of physiotherapists assessed through rates of full recovery and effectiveness in preventing diseases among the populations would be sued to indicate the effectiveness of physiotherapists in application of knowledge and competences. Patient feedbacks would also be useful tools of assessing competences by physiotherapists as assessing personal experience with a practitioner has the capacity of indicating the level of satisfaction and the and the experience of being attended to by a particular clinician. Recurrence of referrals as well as recurrence of a condition with a patient would also show something concerning the individual physiotherapist attending to the patient especially on competence. Diffusion of innovation theory This theory explains why, how as well as the rate at which new technologies and ideas in scientific fields diffuse across cultures (Rich, 1991, p. 319-325). It is therefore most relevant in the overall understanding of how best practices especially EBP diffuse across cultures within the discipline of clinical practice. The theory is also very relevant in introducing and propagation of change within the discipline as it explains the qualities that are relevant in enhancing spread of innovations, the effects of networking or peer-peer conversations within a field as well as understanding variations in user segments. Knowledge based on the ICF in Pediatric physiotherapy Having knowledge based on the ICF in pediatric physiotherapy is important in a number of ways with decision-making processes being the most important (Adolfsson et al, 2010, p. 670-675). Pediatric physical therapists adopt the ICF for the purpose of documentation and evaluation of assumptions inherent for effectiveness in decision-making processes. The ICF provides a framework through which the assumptions made are evaluated for validity and therefore presents an opportunity for the assumptions to be made more transparent (Darrah, 2008, p. 146-151). Past studies In a study to evaluate the impact of ICF frameworks as used in pediatric physiotherapy assessment, a retrospective audit for the practices was carried out by Jelsma and Scott (2010, p. 1-7) which was based on assessments compiled by students (third years) from South Africa in 2008 and 2009 from special schools for disabled children. The method adopted was the use of a scorecard, which was used for assessment by an external person who had not participated in the exercise. A notable difference in scores was evident with the 2009 student scoring higher that their control group, 2008 who had not been taught through the ICF frameworks. The study therefore showed that the use of ICF frameworks in teaching on pediatric patients enhances reasoning as a necessity for effectiveness in physiotherapy service delivery. In another paper that was meant to evaluate enhancement of participation of disabled children Goldstein, Cohn and Coster (2004, p. 115-120), reveals that application of IFC is very pronounced in the modern day physiotherapy practices. Physical therapists are therefore well facilitated in utilizing ICF enablement framework as embraced by the WHO for reasoning and application of the frameworks to facilitate participation of disabled children in desired activities. The paper therefore shows that conceptual frameworks existing empower practitioners to critical decision making through reasoning for inclusion of disabled children in advanced participation within merely all areas of physical activities. The framework is therefore very instrumental in guiding practitioners in evaluation, setting goals as well as deciding on appropriate intervention mechanisms for cases of disabled children. In yet another study evaluating the application of ICF framework for clinical decision-making practices, Darrah (2008, p. 146-151) adopted the ICF-CY as are recently published for use in pediatric physiotherapy. The study found that the framework presents a very reliable tool to be used by clinical practitioners in documenting assumptions as well as evaluating the assumptions for validity and appropriateness in decision-making processes. Though not all assumptions are valid, the study found out that application of the ICF frameworks would make the assumptions more transparent for ease of use in decision-making processes. This therefore supports the extensive application and necessity of adoption of the framework within the pediatric physiotherapy not only for good outcome but also for effectiveness in decision-making processes. These studies have therefore centered on understanding the application of ICF frameworks within the discipline of clinical practice with special attention to pediatric physiotherapy. It is observed as a framework, the ICF presents practitioners with guidelines on decision-making besides complying with the international set standards and frameworks for clinical practice. This would therefore explain the extensive adoption of the frameworks within health care provision disciplines globally. Bibliography Adolfsson M. et al, 2010. Exploring changes over time in habilitation professionals’ perceptions and applications of the international classification of functioning, disability and health, version for children and youth (ICF-CY). J Rehabil Med 42: 670–678 Boshuizen H. P. A. and Schmidt H. G., 1992. On the Role of Biomedical Knowledge in Clinical Reasoning by Experts, Intermediates and Novices. Cognitive science 16: 153-184 Darrah J. 2008. Using the ICF as a framework for clinical decision making in pediatric physical therapy.European journal of physiotherapy. 10(3): 146-151 Goldstein D. N., Cohn E. and Coster W. 2004.Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice.PediatrPhysTher. 16(2):114-20 Jelsma J. and Scott D. 2010.Impact of using the ICF framework as an assessment tool for students in pediatric physiotherapy: a preliminary study. Physiotherapy 540: 1-8 Lee L. J., 2011. Knowledge, Science & Clinical Practice: what do we need to know, how do we know what we know and what can and can’t science tell us about how to treat our patients? .Available at: < http://s3.amazonaws.com/xlsuite_production/assets/12142120/LJLee_Knowledge.pdf?folder=docs>[Accessed 27 February, 2014]. Rich R. F., 1991. Knowledge creation, diffusion, and utilization: perspectives of founding editor of knowledge. Science communication, 12: 319 Smith C. S. 2008. Assessing Clinical Competency: A Developmental Approach to EvaluatingCompetence in Clinical Reasoning.JVME 35(3): 375-381 Read More