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PubMed1992

Pragmatic schemas and the selection task: to reason or not to reason.

Cheng and Holyoak (1985) have proposed that people possess classes of linguistically based schemas that have an internal structure that is determined by pragmatic considerations. They found that when permission schemas ("If you want to do P, then you must do Q") are used in the selection task, the success rate is much superior to what is usually observed. According to Cheng and Holyoak, this is due to the fact that the permission schema is defined by a set of production rules that give the same answers to problems of conditional inference as those of formal logic. In order to test this hypothesis specifically, 160 university students were given one of two tests. The first contained two sets of inferential reasoning tasks, one using a permission schema, the second using a relation of multiple causality. The second test employed the same two conditional relations, but in an appropriate context. The results indicated that subjects did better on the reasoning task with the schema of multiple causality when presented in context, but, as predicted, their performance was much worse on the inferential reasoning task with the permission schema, which generated a higher proportion of logically incorrect responses. These results suggest that contrary to what has been affirmed, permission schemas might not have a logical structure that is equivalent to conditional logic. A second experiment examined selection task performance using the same two relations in context. Performance on the permission schema was superior to that found with the relation of multiple causality. This confirmed previous results indicating that permission schemas do improve selection task performance, but also suggests that this effect is not related to understanding of conditional reasoning.

Adult↗

PubMed2003

"Clinical reasoning theater": a new approach to clinical reasoning education.

Recently the authors developed and implemented a new approach to clinical reasoning education called clinical reasoning theater (CRT). The purpose of CRT is to demonstrate the process of clinical reasoning to students through the conversation of a doctor with his or her patient. With students as the audience, the doctor's clinical reasoning skills are modeled in CRT when he or she thinks aloud during conversations with the patient, which makes clear why he or she asks particular questions. In CRT the interaction between doctor and patient is analyzed in such a way that the repeated cycles of questions and answers are revealed to the students. CRT's format and the activities of the three "actors,"(the doctor, the patient, and the audience of students) are described. Two "acts" are repeatedly performed. The first act (the communication between the doctor and the patient) deals with the history taking, physical examination, etc. The second act, the time-out period, is the most important component of CRT. In this act, the doctor explains his or her reflections and discusses suggestions from the audience for additional questions. The preliminary results of students' evaluations of the relevance of CRT reveal that they appreciate CRT. Further, the CRT format offers instructors with previous experience as lecturers only sufficient tools to apply the new approach successfully.

Clinical Competence↗

PubMed2005

Promoting clinical reasoning in undergraduate nursing students: application and evaluation of the Outcome Present State Test (OPT) model of clinical reasoning.

Promoting clinical reasoning in undergraduate nursing students through application of the Outcome Present State Test (OPT) Model of Clinical Reasoning, is a challenge that can be successfully managed through effective teaching-learning strategies. Empirical evidence to support teaching strategies that foster both cognitive and metacognitive skill acquisition is limited. The purpose of this research was to evaluate the development of clinical reasoning skills among nursing students through the application and evaluation of teaching-learning strategies associated with self-regulated learning and the OPT model (Pesut & Herman, 1998; 1999; Pesut, 2004). The model and self-regulated learning prompts were used to structure learning with junior level baccalaureate nursing students during a ten-week, medical-surgical clinical experience in acute care telemetry units. Data analysis revealed students effectively made gains in learning associated with the OPT model. Qualitative analysis of self-regulated learning prompt journal data revealed students made significant gains in self-observation, self-judgment, knowledge work and use of health care personnel resources during clinical experiences. Results indicated the intentional use of guided reflection coupled with structure and learning tools of the OPT model significantly enhanced clinical reasoning skill acquisition, and provided evidence for the effectiveness of structured teaching learning strategies.

Adult↗

PubMed1994

[Reasons for HIV testing. Casual sexual contacts are the most common reasons for voluntary HIV testing].

In Sweden, voluntary testing for HIV (human immunodeficiency virus)-antibodies has been given an important place in combating AIDS (acquired immunodeficiency syndrome). To elicit the reasons why people seek voluntary testing on their own initiative outside general screening programmes, during a three-year period (1989-91) applicants at a major urban testing locale were asked to fill in an anonymous questionnaire, which was completed by 68.6 per cent (831/1,212) of those eligible. Of the 831 respondees (both men and women), 88.9 per cent cited recent casual sexual contact as the reason why they might be at risk. Although in most cases no particular risk factors were reported to be associated with the sexual contact, in 17 cases (2.3 per cent) the partner was known to be an HIV-carrier. Of 664 people completing the item on the questionnaire 208 (31.3 per cent) reported the sexual contact to have occurred abroad. When the reason for undergoing the test was not possible recent exposure, the commonest reasons given were persistent anxiety or the establishment of a new sexual relationship. Only one of the 1,212 tests performed was HIV-positive.

Adolescent↗

PubMed1993

[Radiological reasoning and its computer-based simulation. Reasons to use computer-based diagnostic systems developed on shells].

Research on the medical applications of artificial intelligence has increased the knowledge of logical and methodological principles of clinical reasoning. Thus, computer-based diagnostic systems are developed on the basis of progress in this field, because thorough knowledge is necessary to obtain efficient simulation. This work was aimed at analyzing the structure of medical and radiological reasoning and at discussing the modalities to simulate it with computer-based diagnostic systems. The diagnostic process includes two steps: data collection and data interpretation; radiological reasoning involves the following 5 steps: procedural, executive, observative, interpretative and communicative. Each of them needs a different approach to simulation, considering, in its development, the different characteristics of each kind of reasoning. The expert system shells on the market are necessary tools to develop expert systems, but they cannot cover the whole of processes taking place during radiological work. Therefore, a particular, radiology-aimed shell should be developed to help the radiologist.

Artificial Intelligence↗

PubMed1997

Development and testing of the ethical reasoning tool (ERT): an instrument to measure the ethical reasoning of nurses.

Ascertaining the thinking of professionals as they are confronted with ethical practice issues is a prerequisite to understanding ethical decision making. Before researchers or educators can examine the effectiveness of various approaches to ethics teaching and learning, there is a need for reliable and valid tools to assess practitioners' cognition. A potential problem with the few measuring instruments currently available is the fact that they ask subjects to rank order existing lists of issues. This says little about an individuals' own thinking about ethical issues and may prompt thinking or responses which would not otherwise have occurred. This paper reports the results of a study to test the psychometric properties of a new instrument, the Ethical Reasoning Tool (ERT) that measures ethical reasoning of nurses. The ERT demonstrates a promising way to reveal unprompted ethical thinking about a practice dilemma, thereby clarifying 'real' versus 'assumed' professional reasoning. The tool allows nurse educators to identify areas of student learning/reasoning deficiency that can be addressed by educational interventions. The ERT also allows nurse educators to evaluate the effectiveness of nursing ethics study units in a trustworthy way.

Adult↗

PubMed2002

How reasonable is reasonable use? The search for safer stepladders.

Stepladder accidents continue to be a major cause of injury at home and at work. Despite this, few changes have been seen in their design or their labelling. Many of the accidents occurring appear to be whilst the stepladder is being utilised in a manner which the user considers reasonable, but the manufacturer considers abuse. This work, sponsored by the Health and Safety Executive, investigates whether this mismatch can be eliminated in order to improve safety. The research combines user profiling with dynamic trials to establish what behaviour stepladders need to sustain. Through innovative measuring techniques, the demands on the stepladder system are quantified and the margin of safety calculated. Extensive dynamic trials generated data for over 4000 user, stepladder and task combinations. Individuals were given demanding tasks, but permitted to undertake them in a manner they considered reasonable and the resulting data can be considered as representative of the demands they would place on stepladders in everyday use. From this data, the stepladder and user system has been modelled, allowing manipulation of the stepladder parameters such that a virtual stepladder can be created which provides sufficient stability to tolerate all reasonably foreseeable use. In addition this model is used to generate predictive software which can determine the level of safety provided by real, or theoretical, stepladders. In conclusion, a specification for a simple test is given which could be routinely conducted to determine whether any given stepladder will offer the minimum level of stability considered necessary for safe use.

Accident Prevention↗

PubMed2005

Is inferential reasoning just probabilistic reasoning in disguise?

Oaksford, Chater, and Larkin (2000) have suggested that people actually use everyday probabilistic reasoning when making deductive inferences. In two studies, we explicitly compared probabilistic and deductive reasoning with identical if-then conditional premises with concrete content. In the first, adults were given causal premises with one strongly associated antecedent and were asked to make standard deductive inferences or to judge the probabilities of conclusions. In the second, reasoners were given scenarios presenting a causal relation with zero to three potential alternative antecedents. The participants responded to each set of problems under both deductive and probabilistic instructions. The results show that deductive and probabilistic inferences are not isomorphic. Probabilistic inferences can model deductive responses only using a limited, very high threshold model, which is equivalent to a simple retrieval model. These results provide a clearer understanding of the relations between probabilistic and deductive inferences and the limitations of trying to consider these two forms of inference as having a single underlying process.

Humans↗

PubMed2001

Propositional reasoning: the differential contribution of "rules" to the difficulty of complex reasoning problems.

In Experiment 1, complex propositional reasoning problems were constructed as a combination of several types of logical inferences: modus ponens, modus tollens, disjunctive modus ponens, disjunctive syllogism, and conjunction. Rule theories of propositional reasoning can account for how one combines these inferences, but the difficulty of the problems can be accounted for only if a differential psychological cost is allowed for different basic rules. Experiment 2 ruled out some alternative explanations for these differences that did not refer to the intrinsic difficulty of the basic rules. It was also found that part of the results could be accounted for by the notion of representational cost, as it is used in the mental model theory of propositional reasoning. However, the number of models as a measure of representational cost seems to be too coarsely defined to capture all of the observed effects.

Adolescent↗

PubMed1999

Reasons for living versus reasons for dying: examining the internal debate of suicide.

The Reasons for Living vs. Reasons for Dying (RFL/RFD) Assessment was used to obtain suicidal outpatients' top five reasons for living and for dying, respectively. Forty-nine suicidal university counseling center patients provided 173 RFL and 145 RFD responses. These responses were organized into eight RFL coding categories and nine RFD coding categories. Two coders trained in the RFL/RFD coding system showed high levels of interrater reliability (KRFL = .81; KRFD = .80). Chi-square results for RFL and RFD coding categories showed that the coding categories were not equally salient to these suicidal patients.

Adult↗

PubMed1985

[Hypotheses and reasons for the progression of body height since the middle of the 19th century--a science history retrospect. II. A discussion of the reasons since the middle of the 20th century including some terminological considerations].

In part I of this paper, reasons for secular height-progression till the middle of our century were discussed. In the beginning, reasons were seen in the improvement of nutrition and in lightening from strong physical load. To the middle of our century, more and more hypothetical reasons were alleged. After this time, science found back to new reality. The secular height-progression is the consequence of nutritive improvements, especially of increased consumption of animal protein. An chief matter seems to be the nutrition of babies with food containing more protein than by breast-fed childs. Early child-nutrition may to be like a stamping for endocrine activity. The last phase of stature's increase is caused by intensive lightening from physical load in the course of modern mechanization, which advanced bone-growth of the legs.

Adolescent↗

PubMed2004

"In this scenario, I do this, for these reasons": narrative, genre and ethical reasoning in the clinic.

Narrative analysis has been applied by health researchers to investigate (among other things) clinical reasoning, clinical ethics and human identity. The term 'narrative' is often used as a broad category that covers a variety of spoken genres, however, and it thereby lacks delicacy as an analytic tool. We introduce genre theory, which enables us to differentiate more clearly between story genres and other spoken genres. We then apply the theory to ten narrative-style interviews with clinicians involved in the treatment and management of colorectal cancer in Sydney, Australia. We characterise the narrative-style interview as a macro-genre, and draw attention to the occurrence of spoken genres other than stories. We focus our analysis on a policy genre that occurred naturally and frequently in the spoken discourse of the informants, but which has not been described before in either the literature of social linguistics or the health and medical literature. We analyse two examples of this genre in detail in order to characterise its main semantic features, and differentiate it from story genres. We then discuss the genre with reference to Aristotelian interpretations of ethical reasoning in the clinic. We conclude that the policy genre is both the unfolding of practical wisdom in speech, and the appropriate choice of genre where a display of ethical identity is called for. Finally, we discuss the implications of our findings for ongoing research, for ethics education, for bioethical theory, and for communication between some of the different stakeholder groups in clinical medicine.

Colorectal Neoplasms↗

PubMed2001

Reasons for patients' discontent and litigation.

Introduction: Discontent and litigation among patients is a problem which increasingly preoccupies the medical profession. Aim: We aim to analyse the origin of discontent and litigation and to help avoiding these claims. Material: One hundred and seventy-eight medical expert opinions were evaluated, all made following examination of the complainant. Methods: Depending on the results of the clinical examination and the study of the files it was determined whether there was either a case of malpractice or insufficient informed consent, or no fault at all in a legal sense. In addition the patient and the surgeon were questioned as to their point of view regarding the procedure and their communication and relationship before and after treatment. Results: Frequent complaints were pain (either during treatment or afterwards), major swelling or bleeding, disturbances of trigeminal or facial nerve function, poor scar formation, loss of teeth or fixtures, faulty occlusion and discrepancies between the expected and the actual result of treatment. In 26 cases actual faults made during medical treatment were discovered. In 49 further cases, poor explanation of the proposed procedure was the reason for complaint. In the majority of remaining cases, neither faulty treatment nor insufficient information given to the patient lead to the complaint but the patient's expectations were unrealistically high. Conclusion: A considerable proportion of lawsuits originate from misunderstandings, and not treatment errors: The surgeons often concentrate on the legal requirements of informed consent and neglect to explain the practical consequences of the operation; the patients in turn tend not to ask about possible complications. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗

PubMed1996

Sexual harassment: the "reasonable person" vs "reasonable woman" standards have not been resolved.

Previous research suggests that women are more likely than men to perceive a hostile environment of sexual harassment in job-related scenarios. Such findings raise questions about whether a "reasonable woman" standard might be preferable to a "reasonable person" standard for adjudication of some sexual harassment cases. There are sound arguments for both positions, and there is no basis at the present time for unequivocal and categorical support for one position over the other.

Adult↗

PubMed2002

Breastfeeding: reasons for starting, reasons for stopping and problems along the way.

The objective of this study was to describe the problems experienced by mothers when breastfeeding and the impact that these problems have on breastfeeding duration. A cohort of 556 mothers who birthed in Perth, Western Australia were recruited to study their infant feeding practices. The mothers were interviewed in hospital and again at 2, 6, 10, 14, 18 and 24 weeks postpartum, or until they ceased to breastfeed. The results showed that most mothers were not prepared to experience any difficulties or problems with breastfeeding. Twelve percent of the mothers left hospital without having attempted to breastfeed. The most common reasons given for infant-formula-feeding related to previous problems with breastfeeding, the ability of husbands to assist with feeding and perceived ease of bottle-feeding. While in hospital 83% of breastfeeding women stated that they had experienced one or more problems related to breastfeeding. Two weeks after leaving hospital 29% of breastfeeding mothers were experiencing problems and the prevalence of problems continued to decline, reaching 13% at six months. In this study the most common reason cited by mothers for stopping breastfeeding before the baby was two weeks old, was that their baby was unsettled, a behaviour often interpreted by mothers as indicating an insufficient milk supply. Levels of anxiety over milk supply reached 23% in the early stages of breastfeeding, and a number of mothers were still experiencing anxiety through to six months. Anxiety over the sufficiency of breastmilk supply was the most serious problem, in that it often resulted in the cessation of breastfeeding Most mothers experience some problems during breastfeeding, especially in the early stages. Proper advice and management is required to ensure that the problems do not lead to cessation of breastfeeding.

Adult↗

PubMed1993

Adult day care centres in British Columbia: client characteristics, reasons for referral and reasons for non-attendance.

This paper discusses a 1989 study of new admissions to 22 adult day care centres in British Columbia and compares it to similar studies in the U.S. The B.C. study investigated clients' characteristics, reasons for referral to the centres, and why some referrals did not attend. Of the new admissions, 63% were female and 30% lived alone. Compared to those in American studies, B.C. clients were older and more likely to live with a spouse. The primary medical conditions of B.C. clients were related to diseases of the circulatory system. As for daily activities, 58% could not bathe without supervision and 43% required assistance with dressing. Some 37% were unable to prepare their own meals; 31% needed help with housekeeping and 62% with shopping. The proportion of clients with mental diseases (38%) was similar to that in American adult day care centres. The three most common reasons for referring clients to adult day care centres were: to assist those who were socially isolated; to give family caregivers some respite; and to give clients emotional help. Perceptions varied as to why referred clients did not attend: for continuing care staff there were psychosocial factors; for adult day care staff it was related to characteristics of the service delivery system; and clients themselves cited functional, physical and operational factors (e.g., problems related to hearing and vision, transportation or physical barriers).

Activities of Daily Living↗

PubMed1994

Reasonable care? Some comments on Gillett's Reasonable Care.

A discussion of some issues from Grant Gillett's book Reasonable Care. At the metaethical level, Gillett's views about the origin, scope and bindingness of morality are outlined and criticised. Against him it is argued that (a) moral capacity does not follow from linguistic abilitiy, (b) things can matter to non-concept-users and (c) universalisability arguments fail to show that immorality is irrational. At the first order level, Gillett's arguments against surrogacy and euthanasia are answered.

Animal Rights↗

PubMed1991

Occupational therapy diagnostic reasoning: a component of clinical reasoning.

The occupational therapy process involves the assessment and treatment of problems in occupational status. Assessment entails the sensing and defining of patients' problems and is accomplished through diagnosis. As a process, diagnosis involves the creation of a clinical image of the patient through cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation. This sequence of cognitive activities is called diagnostic reasoning. As a product, diagnosis summarizes a patient's occupational deficits in terms of occupational role performance, occupational performance, and the components of occupational performance. To serve adequately as a basis for planning intervention, the occupational therapy diagnosis describes the problem, explains the potential cause of the problem, gives the cues whereby the problem is recognized, and names the pathologic agent. Occupational therapy assessment is broader than diagnosis and includes a delineation of the patient's assets as well as deficits. In the resolution of problems in occupational status, assets may be used to offset deficits. The clinical image represents a balanced view of occupational status by reflecting assets and deficits.

Clinical Competence↗