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 OPTION Accreditation Statement: University of Minnesota, Interprofessional Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. American Medical Association (AMA) The University of Minnesota, Interprofessional Continuing Education designates this enduring material for a maximum of 24.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. American Nurses Credentialing Center (ANCC) This activity is awarded up to 24.0 ANCC contact hours. Other Health Care Professionals Other 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. Registration and disclosure information is available here at http://z.umn.edu/chronicpain and pay the additional fee. Then, email your Coursera certificate statement of completion to cme@umn.edu.
3 Clinical Reasoning Web
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Do curso por University of Minnesota
Preventing Chronic Pain: A Human Systems Approach
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Na lição
Risk and Protective Factors in the Seven Realms (Week 9)
Conheça os instrutores
Dr. James Fricton, DDS, MSProfessor and Pain Specialist
University of Minnesota, HealthPartners Institute, and Minnesota Head and Neck Pain Clinic
So, let's talk a little bit more now about the complexities of clinical reasoning.
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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.
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