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Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..ORCID iD: 0000-0001-5356-916X
Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..ORCID iD: 0000-0002-4302-5529
Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..ORCID iD: 0000-0002-1110-0782
2024 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

PurposeThe 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 methodsAn 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.ResultsA 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.ConclusionsInterprofessional 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. The findings provide insights into the clinical reasoning process of interprofessional stroke teams, which can increase awareness and support the development of competencies among health care providers.To increase patient participation in the clinical reasoning process, stroke teams are recommended to clarify the function of goals and the decision-making process in management.Stimulated recall is recommended as a reflective activity in the work of stroke teams to develop awareness and skills in clinical reasoning performed in collaboration between health care providers and patients.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2024.
Keywords [en]
Clinical reasoning, decision-making, participation, person-centered care, stimulated recall, stroke care, stroke rehabilitation
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-66239DOI: 10.1080/09638288.2024.2320263ISI: 001172514200001PubMedID: 38392962Scopus ID: 2-s2.0-85186401619OAI: oai:DiVA.org:mdh-66239DiVA, id: diva2:1844189
Available from: 2024-03-13 Created: 2024-03-13 Last updated: 2025-02-18Bibliographically approved

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Elvén, MariaHolmström, IngerEdelbring, Samuel

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