The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

THE CLINICAL REASONING OF EXPERT, COMPETENT, AND NOVICE RESPIRATORY THERAPISTS WORKING IN THE ACUTE CARE SETTING ABSTRACT.

Rhonda Bevis1, John W. Schell2; 1Respiratory Therapy Department, Armstrong Atlantic State University, Savannah, GA; 2Occupational & Adult Education, University of Georgia, Athens, GA

Background: The purpose of this qualitative case study was to develop an understanding of when and how respiratory therapists used clinical reasoning in the acute care settings. Method: The framework for this study included clinical reasoning, the novice-to-expert continuum, and reflective practice. This qualitative study was designed to gain an understanding of therapists'decision making in the acute care settings of neonatal and pediatric intensive care units from the perspective of the therapist themselves. After obtaining IRB approval from both the University of Georgia and the Medical Center of Central Georgia, observation and interviews were conducted with therapists working in intensive care units. Results: The findings of this study indicated that respiratory therapists used nine different types of clinical reasoning as components of their work in the neonatal and pediatric intensive care units. It also revealed a difference in the types of reasoning used to solve problems based on a therapist's years of experience and the quality of those experiences. These therapists used multiple types of clinical reasoning almost simultaneously. The results also indicated that these respiratory therapists could rapidly shift from one method of reasoning to another, depending on which aspect of complicated clinical problems attracted their attention. They also revealed the presence of practice contextual factors they believed affected their development of expert clinical reasoning skills. Those hindering their development of good reasoning included; limited or lack of experiences, lack of time and staffing, and limited expectations and nonsupport of physicians. Those that facilitated good reasoning, included previous similar experiences, a good scientific base of knowledge, well written guidelines from which a strong system of unwritten protocols could be developed, collaborative reasoning, and the expectations and support of physicians. Conclusion: The reasoning of respiratory therapists can be facilitated by increasing the similar experiences, providing well written guideline in the forms of policy and procedures and providing the expectations that their reasoning is expected and valued. Sponsored Research - None