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Journal of Acute Care Physical Therapy:
doi: 10.1097/01.JAT.0000446089.28525.f2
Clinical Practices

How Clinical Reasoning Can and Should Impact Interprofessional Communication to Address Behaviors That Hinder Acute Care Practice

Ryan, Jennifer M.; Gorman, Sharon L.

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Abstract

Purpose: Many therapists practicing in acute care encounter health professionals who lack understanding of the fast-paced, complex decision making required to determine a safe physical therapy plan of care that challenges a patient without exceeding their physiologic limits.

Problem: Conversations occur where the therapist is confronted with statements from other members of the health care team like, “Just get them up.” or, “Just walk them.” A broader view of clinical reasoning, not solely focused on deductive reasoning, and adept communication skills are necessary for therapists to recognize and resolve these difficult situations.

Outcomes: Strategies to address the limited understanding that other professionals have of the potential safety concerns when the activity is progressed before medical issues are optimized are discussed. By using interprofessional tactics such as SBAR (situation, background, assessment, recommendation) and motivational interviewing, these situations can be resolved without conflict, and not undermine therapists' autonomy or professional development, while also improving the patient's outcomes. Four cases will explore these clinical challenges in hospital culture, describe methods to address and/or improve the lack of interprofessional understanding of the therapist's expertise and clinical reasoning, and suggest strategies to use to overcome these challenges while incorporating current research.

© 2014 by Lippincott Williams & Wilkins, Inc.

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