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PubMed1998

Discovering confidence in clinical reasoning and critical thinking development in baccalaureate nursing students.

The purpose of this preliminary investigation was to discover students' experiences of clinical reasoning and critical thinking development. Findings are reported from one group of baccalaureate nursing students participating in a clinical reasoning course. Narrative approaches were used to reveal how students experience their developing reasoning skills. Class videotapes and reflective logs in which students described their reasoning and responses to others' reasoning provided data. An interpretive phenomenological approach was used to derive a beginning understanding of the experiences of students' developing clinical reasoning and critical thinking. Confidence emerged as a significant aspect of students' experiences. This report of the investigation focuses on only one aspect of clinical reasoning and critical thinking, namely, students' perceptions of threats to confidence and ways of building confidence.

Adaptation, Psychological↗

PubMed1996

Teaching strategies for the development of clinical reasoning.

A primary aim of occupational therapy education is to teach students how to think like practitioners, that is, how to engage in clinical reasoning. Since the early 1980s, occupational therapy clinical reasoning research has elucidated a language that describes the various types of thinking therapists use in clinical practice, a language that has the potential to make previously tacit thought processes accessible to conscious examination and improvement. Occupational therapy educators can use that language to make their teaching of clinical reasoning more explicit to students. This article examines occupational therapy teaching methods using the language of clinical reasoning, categorizing them by the types of clinical reasoning they promote. Current clinical reasoning language is reviewed, and teaching strategies to facilitate the various types of clinical reasoning are described.

Decision Making↗

PubMed1989

Diagnostic reasoning.

Research in cognitive science, decision sciences, and artificial intelligence has yielded substantial insights into the nature of diagnostic reasoning. Many elements of the diagnostic process have been identified, and many principles of effective clinical reasoning have been formulated. Three reasoning strategies are considered here: probabilistic, causal, and deterministic. Probabilistic reasoning relies on the statistical relations between clinical variables and is frequently used in formal calculations of disease likelihoods. Probabilistic reasoning is especially useful in evoking diagnostic hypotheses and in assessing the significance of clinical findings and test results. Causal reasoning builds a physiologic model and assesses a patient's findings for coherency and completeness against the model; it functions especially effectively in verification of diagnostic hypotheses. Deterministic reasoning consists of sets of compiled rules generated from routine, well-defined practices. Much human problem solving may derive from activation and implementation of such rules. A deeper understanding of clinical cognition should enhance clinical teaching and patient care.

Cognition↗

PubMed1999

Reasons for the placement and replacement of restorations in vocational training practices.

AIM: The reasons for placement and replacement of restorations are central to clinical practice. It is the purpose of this paper to assess the reasons for placement and replacement of restorations in the practices of vocational dental practitioners (VDPs) and their trainers. METHOD: VDPs and their trainers were invited to take part in the study. VDPs were asked to record the principal reason for the placement or replacement of all restorations which they provided for a one-month period and, also, to record the age, Class and materials used for each restoration replaced (if known). Trainers were also asked to participate. The data thereby collected were analysed statistically. RESULTS: 56 VDPs and 17 trainers participated. Data were obtained on a total of 9031 restorations, 4423 (49%) being initial placements and 4608 (51%) replacements. Of the total number of restorations assessed, 54% were amalgam, 30% composite and 16% glass ionomer. Principal reasons for placement/replacement of the restorations were primary caries (41%), secondary caries (22%), tooth fracture (6%), margin fracture/degradation (6%), non-carious defects (6%) and bulk fracture (5%). The type of existing restorative material was recorded for 4196 restorations: secondary caries was the most common reason for the replacement of restorations--for 46.0%, 39.6% and 39.8% of amalgam, composite and glass-ionomer restorations respectively. VDPs placed more restorations as a consequence of caries than their trainers. CONCLUSION: Primary caries is the most common reason for the placement of restorations by the participating dentists, and secondary caries is the most common reason for the replacement of restorations of amalgam, composite and glass ionomer. VDPs placed more restorations as a consequence of caries than their trainers.

Dental Caries↗

PubMed2002

[Killing of animals (a reasonable basis according to section 17 number 1 of the German Animal Protection Act?)].

The killing of cattle in order to support the market price, the millions of sorted male pullets or the killing of surplus animals in zoological gardens or breeds which do not have the right colour--the human way to deal with sentient creatures becomes more and more bizarre. How far is our treatment of animals compatible with the legal demand for killing a vertebrate animal only if a reasonable reason (also called good reason = vernünftiger Grund) according section 17 no. 1 of the German Animal Protection Act exists. An offence against this act could be punished with imprisonment up to three years or a fine. However, to constitute an offence is not necessarily illegal. The legislator has created the expression "reasonable reason" as an indefinite legal term. Therefore the animal protection law can further develop the legal term "reasonable reason" with the help of interpretation and dispensation of justice and adapt it to all social realities. Therefore an appropriate judgement on the killing of a vertebrate animal only is possible by viewing each individual case taking into regard all important factors of the relation between the animal and its owner. The killing of a vertebrate animal, which is found to be illegal according to section 17 no. 1 Animal Protection Act can not be punished in case special Community Law exists which has priority over national law. Community Law which cancels national law exists in the scope of housing, slaughtering and transporting of farm animals. There are loopholes in Community Law concerning the killing of domestic animals in their breeding that could be closed by national law. A solution to secure animal protection could be the creation of a strict law for the breeding of domestic animals in Germany.

Animal Welfare↗

PubMedDate not supplied

Challenging misperceptions about nurses' moral reasoning.

Discussions in the nursing literature about the usefulness of Kohlberg's theory of moral reasoning for women and nurses, and assertions about the level of moral reasoning scores of nurses have been clouded by inaccuracies and misperceptions. In this article, theoretical and measurement issues related to moral reasoning are clarified and a critical review of the literature is provided about the moral reasoning of nursing students and nurses as measured by the Defining Issues Test (DIT). The review indicates the need for greater rigor in studies of moral reasoning among nurses and the need for accuracy in interpreting and reporting moral reasoning scores. The data show that the moral reasoning of nurses, like that of other groups, tends to increase with formal education. Nurses' scores are usually comparable to, and sometimes higher than, scores of their academic peers.

Ethics, Nursing↗

PubMed1991

Reasons given for tooth extraction in Hong Kong.

Two hundred and seventy dentists, systematically selected from the membership lists of the Hong Kong Dental Association, were sent forms on which they were invited to record the reasons for tooth extraction in all patients aged 16 years and above over a period of five to six weeks. Third molars were excluded. Fifty-five per cent of the recording sheets dispatched were returned with usable data. Data were provided on 8516 extractions performed for 6331 patients. Overall caries was the reason given for 60 per cent of extractions; periodontal disease for 28 per cent; prosthetic indications for six per cent; trauma (which included tooth wear) for four per cent; and orthodontic and other reasons for two per cent. Extractions for periodontal reasons were more common in those aged 40 years and above, but periodontal disease did not exceed caries as a reason for extraction even in those aged 60 years and over. The tooth type most frequently extracted was the first molar. Mandibular incisors were the teeth most commonly extracted for periodontal reasons. In this community, which has benefited from water fluoridation since 1961, caries was the dominant reason given by dentists for tooth extractions in all age groups of the subjects studied.

Adolescent↗

PubMedDate not supplied

Reasons for placement and replacement of dental restorations in the United States Navy Dental Corps.

This study investigated the reasons for placement and replacement of dental restorations in the United States Navy Dental Corps. The relationship between restoration longevity and the reasons for replacement of restorations was also studied. Data on newly placed dental restorations were collected from restorative dentists working at 11 Naval Dental Clinics located throughout the United States. Participating dentists at each clinic were asked to collect data for all restorations they placed during a two-week period. Data on 4633 restorations were collected from 88 dentists. The most common reasons for placement of restorations varied by age category. Primary caries was the most common reason for patients 18-34 years of age, while noncarious reasons for placement were most common for patients 35 years of age and older. The most common reason for replacement of restorations was secondary caries. For all replacement reasons amalgam restorations had greater longevity than composite resin restorations.

Adolescent↗

PubMed1999

Why, why, why?: Reason-giving and rumination as predictors of response to activation- and insight-oriented treatment rationales.

This study examines the relationships among the reasons a person offers for depression, the tendency to ruminate in response to depression, and reactions to activation-oriented (AO) or insight-oriented (IO) treatment rationales. Adults from the community (N=51) completed self-report measures of reason-giving and rumination and rated the credibility of, and personal reactions to, AO and IO rationales presented in written and videotape formats. Participants who gave more reasons for depression also tended to ruminate more in response to depressed mood. Reason-giving and rumination predicted lower credibility ratings and more negative personal reactions to the AO rationale. Although no relationship was found between these variables and response to the IO rationale, specific reasons were associated with different reactions to the two rationales. We discuss the roles of reason-giving and rumination in predicting responses to psychotherapies for depression.

Adult↗

PubMed1997

Neural substrates of fluid reasoning: an fMRI study of neocortical activation during performance of the Raven's Progressive Matrices Test.

We examined brain activation, as measured by functional magnetic resonance imaging, during problem solving in seven young, healthy participants. Participants solved problems selected from the Raven's Progressive Matrices Test, a test known to predict performance on a wide range of reasoning tasks. In three conditions, participants solved problems requiring (1) analytic reasoning; (2) figural or visuospatial reasoning; or (3) simple pattern matching that served as a perceptual-motor control. Right frontal and bilateral parietal regions were activated more by figural than control problems. Bilateral frontal and left parietal, occipital, and temporal regions were activated more by analytic than figural problems. All of these regions were activated more by analytic than match problems. Many of these activations occurred in regions associated with working memory. Figural reasoning activated areas involved in spatial and object working memory. Analytic reasoning activated additional areas involved in verbal working memory and domain-independent associative and executive processes. These results suggest that fluid reasoning is mediated by a composite of working memory systems.

Adult↗

PubMed2003

Reasons for elderly patient hospitalization in departments of internal medicine in Lodz.

BACKGROUND AND AIMS: The number of hospitalizations of elderly patients in Poland has been increasing rapidly in recent years. For Lodz, with the oldest population among big cities in Poland, this is an especially important problem. In order to reduce the number of elderly patient hospitalizations, it is first necessary to know the main reasons for these hospitalizations. This study aimed to determine the reasons for elderly patient hospitalizations in Lodz. METHODS: Data related to elderly patients (65 and over) admitted to departments of internal medicine in three district hospitals in Lodz were collected. The reasons for hospital admission, coded according to the International Classification of Diseases-10th Revision, were used for the calculations. RESULTS: Elderly persons accounted for 53.6% of patients hospitalized at the departments studied. The most frequent reasons for hospital admission of the elderly were cardiovascular diseases (CVD) (54.7%) and respiratory tract diseases (19.9%). The most frequent specific diagnoses for hospitalization were coronary heart disease (CHD) (15.7%), pneumonia (11.5%), stroke (8.5%), hypertension (7.2%), heart failure (5.4%), non-insulin-dependent diabetes (5.3%) and insufficiency of cerebral arteries (5.3%). Hypertension was nearly twice as frequent a reason for hospital admission in women as in men. CONCLUSIONS: Elderly persons account for more than half of patients in departments of internal medicine in Lodz. The most frequent reason for hospital admission of the elderly is CVD, particularly CHD.

Age Distribution↗

PubMed1994

An analysis of the personal reasons for discontinuing IUD use.

The objective of this study was to evaluate possible factors associated with discontinuing use of TCu 380A IUDs due to personal reasons among 2748 users. Overall, a total of 88 subjects discontinued using the TCu 380A IUD within 12 months postinsertion for personal reasons. The most common reasons were planned pregnancy (32%) and husband or family opinion against IUD use (26%). The gross cumulative 12-month life table discontinuation rate for all personal reasons was 4.0 per 100 women. Having no education and/or living in a rural area were the sociodemographic characteristics associated with an increased risk of discontinuation for personal reasons. Effective and regular counseling about IUD use, especially among illiterate women, may help prevent IUD discontinuations related to personal reasons.

Attitude↗

PubMed1996

Temporal reasoning for diagnosis in a causal probabilistic knowledge base.

We have added temporal reasoning to the Heart Disease Program (HDP) to take advantage of the temporal constraints inherent in cardiovascular reasoning. Some processes take place over minutes while others take place over months or years and a strictly probabilistic formalism can generate hypotheses that are impossible given the temporal relationships involved. The HDP has temporal constraints on the causal relations specified in the knowledge base and temporal properties on the patient input provided by the user. These are used in two ways. First, they are used to constrain the generation of the pre-computed causal pathways through the model that speed the generation of hypotheses. Second, they are used to generate time intervals for the instantiated nodes in the hypotheses, which are matched and adjusted as nodes are added to each evolving hypothesis. This domain offers a number of challenges for temporal reasoning. Since the nature of diagnostic reasoning is inferring a causal explanation from the evidence, many of the temporal intervals have few constraints and the reasoning has to make maximum use of those that exist. Thus, the HDP uses a temporal interval representation that includes the earliest and latest beginning and ending specified by the constraints. Some of the disease states can be corrected but some of the manifestations may remain. For example, a valve disease such as aortic stenosis produces hypertrophy that remains long after the valve has been replaced. This requires multiple time intervals to account for the existing findings. This paper discusses the issues and solutions that have been developed for temporal reasoning integrated with a pseudo-Bayesian probabilistic network in this challenging domain for diagnosis.

Artificial Intelligence↗

PubMed2005

Reasons for dropout from drug abuse treatment: symptoms, personality, and motivation.

Previous research has identified risk factors for early attrition from substance abuse treatment, but has not assessed reasons for dropout from the client's perspective. Interview and self-report assessment data were collected from 24 clients who prematurely terminated outpatient treatment to evaluate their subjective reasons for dropping out and the association of these reasons with demographic and clinical variables. Items from scales indicating problems with client motivation or conflicts with program staff were the most commonly endorsed. The severity of participant's symptoms and logistical problems interfering with appointments were less commonly reported as reasons for dropping out. Demographic, substance abuse, and motivational stage indicators were infrequently associated with subjective reasons for dropout. In contrast, indicators of maladaptive personality functioning were strongly associated with many reasons for dropping out, especially concerns about privacy and boundary issues within the program. Results from this preliminary evaluation will guide the development of an instrument and intervention focused on dropout risk factors and treatment reengagement.

Adult↗

PubMed2005

Ethnic similarities and differences in reasons for smoking.

We examined reasons for smoking among Black and White smokers. We hypothesized that Blacks would be more likely than Whites to cite tension reduction and less likely to cite weight control as a reason for smoking. Black (n = 100) and White (n = 100) female smokers completed the Reasons for Smoking Scale and the Smoking Situations Questionnaire. Regardless of treatment status, Blacks and Whites differed in their reasons for smoking [F(6,191) = 2.24; p < .05]. Blacks, as compared to Whites, less strongly endorsed weight concern as a reason for smoking [F(1,198) = 6.10; p < .05]. Results failed to reveal differences in tension reduction, stimulation, handling, relaxation, addiction, and habit as a function of ethnicity. Results suggest that Blacks and Whites exhibit more similarity than difference in their reasons for smoking.

Adult↗

PubMed2005

Acquiring new spatial intuitions: learning to reason about rotations.

There are certain simple rotations of objects that most people cannot reason about accurately. Reliable gaps in the understanding of a fundamental physical domain raise the question of how learning to reason in that domain might proceed. Using virtual reality techniques, this project investigated the nature of learning to reason across the domain of simple rotations. Learning consisted of the acquisition of spatial intuitions: there was encoding of useful spatiotemporal information in specific problem types and a gradual accumulation of this understanding across the domain. This pattern of learning through the accumulation of intuitions is especially interesting for rotational motion, in which an elegant domain-wide kinematics is available to support insightful learning. Individual ability to reason about rotations correlated highly with mastery motivation, skill in fluid reasoning, and skill in reasoning about spatial transformations. Thus, general cognitive advantages aided the understanding of individual rotations without guaranteeing immediate generalization across the domain.

Adult↗

PubMedDate not supplied

Reasons for induced abortion and their relation to women's emotional distress: a prospective, two-year follow-up study.

OBJECTIVE: The present study aimed to identify the most important reasons for induced abortion and to examine their relationship to emotional distress at follow-up. METHODS: Eighty women were included in the study. The women were interviewed 10 days, 6 months (T2) and 2 years (T3) after they underwent an abortion. At all time points, the participants completed the Impact of Event Scale and a questionnaire about feelings connected to the abortion. RESULTS: Reasons related to education, job and finances were highly rated. Also, "a child should be wished for," "male partner does not favour having a child at the moment," "tired, worn out" and "have enough children" were important reasons. "Pressure from male partner" was listed as the 11th most important reason. When the reasons for abortion and background variables were included in multiple regression analyses, the strongest predictor of emotional distress at T2 and T3 was "pressure from male partner." CONCLUSION: Male pressure on women to have an induced abortion has a significant, negative influence on women's psychological responses in the 2 years following the event. Women who gave the reason "have enough children" for choosing abortion reported slightly better psychological outcomes at T3.

Abortion, Induced↗

PubMed2005

Domain-specific identity, epistemic regulation, and intellectual ability as predictors of belief-biased reasoning: a dual-process perspective.

To explore the hypothesis that domain-specific identity development predicts reasoning biases, adolescents and young adults completed measures of domain-general and domain-specific identity, epistemic regulation, and intellectual ability and evaluated arguments that either supported or threatened their occupational goals. Biases were defined as the use of sophisticated reasoning to reject goal-threatening arguments and the use of cursory reasoning to accept goal-supportive arguments. Across two measures of bias, hierarchical regression analyses showed that domain-specific vocational identity and epistemic regulation best predicted reasoning biases. Neither age nor intellectual ability predicted significant variance in biases after vocational identity and epistemic regulation scores were entered into the regression equations. The results support the thesis that biases in specific domains can be explained both by domain-specific personality attributes and by domain-general metacognitive dispositions to monitor reasoning and decontextualize problem structure from superficial contents. A dual-process framework is proposed to explain the relationships among identity, epistemic regulation, age, intellectual ability, and reasoning biases.

Adolescent↗