ABSTRACT
PURPOSE: To examine the clinical decision making of novice, intermediate, and expert pediatric rehabilitation therapists from various disciplines. METHODS: Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the 'think aloud' technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach. RESULTS: Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge. CONCLUSION: With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.
Subject(s)
Clinical Competence , Rehabilitation , Adolescent , Adult , Attitude of Health Personnel , Behavior Therapy , Child , Child, Preschool , Cognition , Decision Making , Emotions , Humans , Interviews as Topic , Occupational Therapy , Physical Therapy Specialty , Professional-Family Relations , Professional-Patient Relations , Recreation , Rehabilitation/education , Retrospective Studies , Self Concept , Speech-Language Pathology , Task Performance and Analysis , Thinking , Videotape RecordingABSTRACT
Adequate preparation by anesthesia providers promotes quality care and decreases the likelihood of morbidity and mortality. Unfortunately, many trauma cases occur after hours when support resources are less readily available. At a large midwest academic medical center, it was determined that a website on the institution's Intranet relating to anesthetic care of trauma patients would be a readily accessible, user-friendly resource for improved care. In recent years, media tools such as computers have become increasingly popular and accessible as effective learning tools. A comprehensive literature search was completed on anesthetic care of trauma patients and on adult and Web-based learning principles. Information was gathered from textbooks, research journals, existing web links on the institution's intranet, and staff at the medical center. Assistance was obtained from the institution's Internet/website Development Department for creation of the website. The information was placed on the institution's Intranet. The web page contains 17 subject categories, including initial considerations, common trauma drugs, circulation and fluid resuscitation, management of pregnant trauma patients, and intraoperative death. It is our goal that the systematic developmental process described in this article may provide a model for other institutions wanting to develop websites.
