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Reasoning about reasoning: using recall to unveil clinical reasoning in stroke rehabilitation teams
Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.;Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden.;Mälardalen Univ, Sch Hlth Care & Social Welf, Box 883, S-72123 Västerås, Sweden..
Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..ORCID iD: 0000-0002-5616-2397
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.ORCID iD: 0000-0002-4302-5529
Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
2024 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 46, no 25, p. 6086-6096Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2024. Vol. 46, no 25, p. 6086-6096
Keywords [en]
Clinical reasoning, decision-making, participation, person-centered care, stimulated recall, stroke care, stroke rehabilitation
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-555161DOI: 10.1080/09638288.2024.2320263ISI: 001172514200001PubMedID: 38392962Scopus ID: 2-s2.0-85186401619OAI: oai:DiVA.org:uu-555161DiVA, id: diva2:1954312
Funder
Mälardalen UniversityAvailable from: 2025-04-24 Created: 2025-04-24 Last updated: 2025-04-24Bibliographically approved

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