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3 Clinical Reasoning Web

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Prevenção de Dores Crônicas: Uma Abordagem Sistêmica

Universidade de MinnesotaUniversidade de Minnesota

4.7 (120 classificações) | 11K alunos inscritos

Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms. The goal of this course is to blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain conditions and how a human systems approach can be applied to self-management strategies to reduce risk factors, enhance protective factors, and prevent chronic pain. There are four major objectives to the course; 1. Describe the prevalence, personal impact, and health care dilemma associated with chronic pain. 2. Recognize the clinical characteristics and underlying etiology of several common pain conditions and the peripheral, central, and genetic mechanisms of chronic pain 3. Based on the literature associated with risk and protective factors in the seven realms of our lives, learn specific strategies in each realm that can be employed daily to prevent chronic pain and enhance wellness. 4. Appreciate the value of a human systems approach to health care and how it can provide a basis for integrative, interdisciplinary, and individualized care to preventing pain and enhancing wellness. CONTINUING EDUCATION CREDIT Health Care Professionals Health care professionals who participate in this CE activity may submit this certificate statement of participation to their appropriate accrediting organizations or state boards for consideration of credit. The participant is responsible for determining whether this activity meets the requirements for acceptable continuing education. Email your Coursera certificate statement of completion to your appropriate organization.

Visualizar o programa do curso

Habilidades que você aprenderá

Chronic Pain Management, Plan, Pain Management, Opiod Addiction And Abuse Treatment

Avaliações

4.7 (120 classificações)

5 stars
96 ratings
4 stars
16 ratings
3 stars
7 ratings
1 star
1 ratings

CH

Aug 02, 2019

An excellent continuing education course for those who are health professionals interested in chronic pain. In depth material providing good value.

CS

Oct 11, 2017

Very informative! Lots of food for thought as a patient....need to redo the lessons again to fully digest it all. Well worth your time!

Na lição

Risk and Protective Factors in the Seven Realms (Week 9)

1 Outcome Present State Test (OPT) Model 5:16

2 Knowledge Representation and Framing 6:31

3 Clinical Reasoning Web 7:33

4 Listening and Understanding People's Stories 2:04

5 Creating and Activating Clinical Reasoning Dynamics 3:29

6 The Complementary Nature of Problems and Outcomes 4:08

7 The Four Cs of Clinical Judgment 11:19

Last Scroll: The Leaning Tower and Fear v25:32

Ministrado por

Dr. James Fricton, DDS, MS
Professor and Pain Specialist

Transcrição

So, let's talk a little bit more now about the complexities of clinical reasoning.

[BLANK_AUDIO].

The human mind does much to kind of put together thoughts and recognize patterns.

And in fact, clinical reasoning is one of

those complexities, and I believe it is multifaceted.

And when we're talking about clinical reasoning, we're

talking really about several different kinds of reasoning.

There's the cognitive reasoning and the critical reasoning, which most of us

are familiar with in terms of

gathering information, inputing data, understanding terms.

But then there's also the metacognitive reasoning,

which is often times referred to as reflective

reasoning, or thought taken to the second power,

where you begin to think about your thinking.

You become aware of being aware, and you begin

to realize that you develop strategies and ways of going

about mastering knowledge, skills, and abilities that become important

to you as you self-regulate yourself in diff, different situations.

And then, there is this notion about

creative thinking and the nature of complementary pairs.

So, for example you are always going to be in the, in

the situation of developing and understanding

what the opposite of a problem is.

I think someone once said, life is bipolar, everything contains its opposite.

So, when you're talking about pain as the problem,

outcome, the outcome is really comfort, or pain control.

If you're talking about anxiety, the outcome is really anxiety control.

If you're talking about fear, the outcome is really fear control.

And so thinking and understanding of the complementary nature,

of both a problem and its outcome, becomes important.

And that is the essence of creativity, a

novel association that's useful in regards to looking

at the complementary nature or the tension of

opposites that exist between a problem and an outcome.

And then there is this notion about systemic thinking, that

there are balancing and reinforcing loops in a system dynamic.

Patients don't just have one problem or one issue.

They have competing problems and issues.

And all of those are colliding and clustering at the same time.

And so the opt model that we're going to

talk about, and the clinical reasoning web, is a,

is a strategy and a tool and a technique,

for you to understand how that dynamic might work.

It kind of gives you the balcony view of how all of

these things relate to one another, and where you might find some leverage.

Where's the center of gravity of this human system dynamic in terms of

the problems that they have, and the outcomes that you want to evolve?

And then, all of this of course,

is about relationship dynamics and complexity thinking.

And so, let's move on to thinking about clinical reasoning perspectives.

And if you would, just stare at this necker

cube of clinical reasoning for a minute, and tell

me, or tell, imagine to yourself, what happens as

you begin to put your gaze on that particular cube.

For many people, the cube shifts.

It's kind of an optical illusion.

But the foreground becomes the background, and the background becomes the foreground.

And so the complexity about clinical reasoning and reflection, and self

regulated learning, and critical thinking and clinical judgement, as you begin to

think about the assistant complexity thinking

associated with clients stories and the

issues and problems with which they

struggle, it shifts sometimes foreground, background.

And so your ability to kind of be aware of that, and pay

attention to that, becomes important in

terms of developing your clinical reasoning skills.

So, I believe clinical reasoning has multiple logics associated with it.

So there's the logic of the diagnosis, and that, is often times influence

by your framing effects and your knowledge

classification, or perhaps maybe your assessment tool.

Then there's the logic of these competing diagnosis and

outcomes; which we'll talk a little bit more about.

And then there's the logic of the intervention, that will transfer,

transition a patient from a current state to a desired state.

And all of these logics you are managing at the same time, and so that

each one contributes to your understanding in

the development of the clinical reasoning skill set.

And then there's the logic of the patterns

of relationships between a problem, and outcome, and intervention.

And then there's the logic of the clinical judgement associated with

whether or not you have achieved the outcome that you want.

And then there's the logic of managing yourself,

in relationship to reasoning and thinking and your meta

cognitive ability to reflect, and make sense of sometimes

very complex and convoluted dynamics associated with patient conditions.

All of this is in support of your building

schemas in your brain, about patterns that you recognize.

And as you increase your clinical experience, and as

you see patients one after another you are building patterns

and schemas about relationship dynamics, and so that in

fact, you'll be able to recognize those patterns early on.

And it will add to your intuition as well as your

reasoning skills and abilities about multiple

kinds of patient scenarios and situations.

So OPT or opt the outcome present state test model

of clinical reasoning is really a meta model for clinical reasoning.

It's a model about a model in terms of clinical reasoning, and

it has the following elements, listening

and understanding a person's story; representation and

framing, which we've already talked about;

creating and activating a clinical reasoning

web; appreciating the emergent relationships in

a system dynamic; identification of a keystone

issue; discerning the complementary nature of problems and

outcomes; and understanding the five c's of clinical judgement.

So here's the schema of the opt model.

You can see in the far right here, we start with the client's story.

And then we develop this clinical reasoning

web of all the issues that, that client

has suggested in relationship to their story, combined

with the clinician's frame and knowledge representation system.

And then we reflect about that in order to kind of

find the center of gravity of the system dynamic, which becomes the

present state keystone issue, which is then contrasted with the outcome

state and the juxtaposition of a present state with an outcome state.

Pain versus comfort creates the test that you want to

build and transition in terms of moving the patient from

a present state to a desired state, with the decisions

and choices you make in terms of your intervention strategies.

And that will lead you to a judgement.

And the more judgements you make about multiple patient scenarios

and case studies, you are more likely to develop schemas in

regards to your understanding of the complexity of clinical reasoning

around some of the chronic dilemma of pain management with patients.

[SOUND]

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