Elvén Maria, Prenkert Malin, Holmström Inger K, Edelbring Samuel
School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden.
School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Disabil Rehabil. 2024 Dec;46(25):6086-6096. doi: 10.1080/09638288.2024.2320263. Epub 2024 Feb 23.
PURPOSE: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. MATERIALS AND METHODS: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. RESULTS: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. CONCLUSIONS: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
目的:本研究的目的是调查中风团队中的医疗保健提供者如何与患者及其家属合作,对他们的临床推理过程进行思考。 材料与方法:采用探索性定性设计并运用激发性回忆。来自三个康复对话的音频记录被用作对相关工作人员进行临床推理访谈的提示。采用主题分析法。 结果:一个主要发现是,以专业为中心和以患者为中心的临床推理之间存在明显的矛盾,这在数据中很突出。确定了五个主题:不同视角对于全面了解情况和做出明智决策的重要性;分析和决策中的共同理解——意图良好但难以实现;医疗保健提供者的专业知识主导对话;背景对康复对话的影响;以及对错过了解患者观点并做出决策机会的见解。 结论:跨专业中风团队将临床推理视为重视患者及其家属观点的过程;然而,他们的专业知识可能会阻碍个体需求的显现。专业人员以患者为中心的意图与临床推理的实际情况之间存在差异。激发性回忆可以揭示以患者为中心的实践,并提高专业人员对其临床推理的认识。