Ryan-Wenger N A, Lee J E
College of Nursing, Ohio State University, USA.
Nurse Pract. 1997 May;22(5):66-7, 70, 76-9 passim.
This article describes the limitations of typical published case studies with respect to their congruence with actual clinical practice and their utility in teaching clinical decision making to novice or student health care providers. The authors propose a Clinical Reasoning Case Study that closely resembles an actual patient encounter, yet is also a rigorous academic exercise. In which health care providers must think aloud as the encounter unfolds. The Clinical Reasoning Case Study explicates and substantiates health care providers' thought processes underlying each decision to collect objective and subjective data. Other unique characteristics of this case study include a discussion of the working diagnosis and the provider's relative certainty about that decision; selection of the single most important objective and subjective finding that led to the diagnosis; a chronological list of diagnostic hypotheses that were generated throughout the patient encounter; and an analysis of costs, including the office visit, diagnostic tests, medications, and treatments. The Clinical Reasoning Case Study is a powerful tool for teaching and evaluating the clinical reasoning process. Two sample case studies are provided: "A Child with a Heart Murmur" and "An infant with Diaper Rash."
本文描述了典型的已发表病例研究在与实际临床实践的一致性以及在向新手或学生医疗保健提供者传授临床决策方面的实用性方面的局限性。作者提出了一种临床推理病例研究，它与实际的患者诊疗过程非常相似，但也是一项严谨的学术练习。在这个过程中，医疗保健提供者在诊疗过程展开时必须大声思考。临床推理病例研究阐明并证实了医疗保健提供者在收集客观和主观数据的每个决策背后的思维过程。该病例研究的其他独特特征包括对初步诊断以及提供者对该诊断的相对确定性的讨论；导致诊断的最重要的单一客观和主观发现的选择；在整个患者诊疗过程中产生的诊断假设的时间顺序列表；以及对成本的分析，包括门诊就诊、诊断测试、药物和治疗。临床推理病例研究是教学和评估临床推理过程的有力工具。提供了两个样本病例研究：“一个有心脏杂音的孩子”和“一个有尿布疹的婴儿”。
