理解整骨疗法中的临床推理：一种定性研究方法。
Understanding clinical reasoning in osteopathy: a qualitative research approach.
作者信息
Grace Sandra, Orrock Paul, Vaughan Brett, Blaich Raymond, Coutts Rosanne
机构信息
School of Health & Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480 Australia.
College of Health & Biomedicine, Victoria University, 301 Flinders Lane, Melbourne, Australia.
出版信息
Chiropr Man Therap. 2016 Mar 8;24:6. doi: 10.1186/s12998-016-0087-x. eCollection 2016.
BACKGROUND
Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions.
METHODS
This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories.
RESULTS
According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions.
CONCLUSIONS
The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care. Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines.
背景
临床推理被描述为一个严重依赖于每个健康专业所特有的知识、技能和特质的过程。然而，不同学科从业者的临床推理过程表现出许多相似之处，包括假设生成和反思性实践。本研究的目的是从整骨疗法临床教育工作者的角度理解整骨疗法中的临床推理，以及它与其他健康专业的临床推理在何种程度上相似或不同。
方法
本研究以建构主义扎根理论为依据。参与者是澳大利亚、新西兰和英国整骨疗法教学机构的临床教育工作者。焦点小组和书面批判性反思提供了丰富的数据集。使用持续比较法对数据进行分析以形成归纳类别。
结果
根据参与者的说法，整骨疗法中的临床推理与其他健康专业的临床推理不同。整骨疗法医生采用两阶段方法：首先对严重病理进行生物医学筛查，然后使用基于人体结构与功能关系的整骨疗法推理模型。整骨疗法中的临床推理也被描述为发生在多种情境（如患者、从业者和社区）中，并借鉴了其他健康专业中描述的一系列元技能（如假设生成和反思性）。
结论
基于人体结构与功能关系的诊断推理模型使整骨疗法中的临床推理有所不同。这些模型并非用于命名医疗状况，而是用于指导治疗方法的选择。如果进一步的研究证实整骨疗法中的临床推理与其他健康专业的临床推理不同，那么整骨疗法医生可能会为多学科决策带来独特的视角，并有可能提高患者护理质量。在整骨疗法和其他健康专业的临床推理过程存在共性的地方，可能会有共享的学习机会，包括在健康学科之间交流有支架的临床推理练习和评估实践。
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