職能治療之臨床推理

Clinical Reasoning in Occupational Therapy

張玲慧(Ling-Hui Chang) ； 羅鈞令(Jin-Ling Lo)

《職能治療學會雜誌》 17卷 (1999/09) Pp. 14-24

https://doi.org/10.6594/JTOTA.1999.17.02

摘要

本文回顧相關文獻，對職能治療臨床推理一個簡單的介紹。臨床推理是臨床工作者在治療患者時用來引導治療師設計與實施治療的一種思維方式。國外研究提出職能治療師為因應病人的多層次問題而有多種臨床推理模式，可略分爲五種：科學推理、敘事推理、情境推理、互動推理、與實際推理。傳統上，相關研究以科學推理為主，偏向探討治療師針對患者的生理或身體機能障礙做評估與找出問題的推理模式。敘事推理是職能治療推理中最獨特的，用來瞭解每個患者的生病經驗，並據此，嘗試賦予治療活動意議。情境推理為治療師用各種思維方式與患者共同建立未來的願景。互動推理則是職能治療師用來認識病患“這個人”以及增進患者治療的參與合作。外在環境因素與職能治療師的個別差異也同樣影響治療師的臨床推理，此爲實際推理。國內對臨床推理訓練正在起步階段，作者謹以此篇文章與大家共勉。

關鍵字

臨床推理 ； 職能治療

並列摘要

This article reviews current literature on clinical reasoning in occupational therapy. Clinical reasoning is a thinking process that guides practice. Five modes of clinical reasoning in occupational therapy have been identified to deal with the multiplicity of the problems the patient faces with. They are scientific reasoning, narrative reasoning, conditional reasoning, interactive reasoning, and pragmatic reasoning. Traditionally, scientific reasoning had been the trend in relevant research, with focus on how clinician to evaluate and treat patients' physiological impairments or physical disabilities. Narrative reasoning is, most unique with occupational therapists, to understand patients' illness experiences, and, based on this understanding, therapists are able to bring meanings in therapeutic activities to their patients. Therapists use conditional reasoning to establish shared visions for the future with their patients. Interactive reasoning is used when therapists want to know their patients as a person and to facilitate collaboration. In addition, environmental issues and individual variability of the therapists have influences on therapists' reasoning, this is called pragmatic reasoning.

並列關鍵字

clinical reasoning ； occupational therapy