Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting

Abstract

Introduction: Despite the current movement for health-care to become more informed by evidence, knowledge on effective implementation of evidence-based practice is scarce. To improve research application among physiotherapists, the process of implementation and clinical reasoning needs to be scrutinized. The aim of this study was to identify various experiences of factors that influence the physiotherapist's clinical reasoning in specialist care.

Methods design: A phenomenographic approach was chosen.

Subjects: Eleven physiotherapists at two acute care hospitals in nn.

Procedure: Data was obtained by observations and interviews. Phenomenographic data analysis identified various experiences of clinical decision-making.

Ethical considerations: The Ethical Review Board of the nn approved the study.

Results: The observations and the interviews enabled identification of various experiences that influenced clinical decision-making. The physiotherapists' clinical reasoning was perceived to be constrained by contextual factors. The physiotherapists collected current information on the patient by using written and verbal information exchange and used this to generate an inner picture of the patient. By creating hypotheses that were accepted or rejected, they made decisions in advance of their interventions. The decisions were influenced by the individual characteristics of the physiotherapist, his/her knowledge and patient perceptions.

Conclusions: Clinical reasoning is a complex and constantly evolving process. Contextual factors such as economy and politics are not easily changed, but factors such as the patient and the physiotherapist as a person are more tangible.

Keywords: Acute care; clinical reasoning; evidence based practice; phenomenography.