Abstract
The purpose of this phenomenological study is to identify the types of ill-structured problems physical therapists face in the acute care setting for a computer simulation to train students in a professional physical therapist education program. Ten physical therapists who practiced in the acute care setting in four large urban Midwestern hospitals participated in semi-structured interviews. Results show that acute care physical therapists experience complex, ill-structured problems that encompass all direct and indirect patient care activities and are complicated by system factors outside of their control. Solving the problems described by the participants requires clear and accurate communication and an awareness of the role of physical therapy in the acute care setting. The use of these authentic challenges for a computer simulation can allow students in a professional physical therapist education program to develop better problem-solving skills.
TopCritical Thinking And Ill-Structured Problems
The most recent studies in the field of physical therapy education are focused on improving and measuring critical thinking or clinical reasoning skills (Brudvig, Mattson, & Guarino, 2015 & 2016; Fu, 2015; Furze, Black, Hoffman, Barr, Cochran, & Jensen, 2015; Furze, Gale, Black, Cochran, & Jensen, 2015). There is a robust history of researching the means of improving the critical thinking ability of allied health students, but the results have been mixed (Coker, 2010; Hunter, Pitt, Croce, & Roche, 2014; Kantar, 2014; O’Dell, Mai, Thiele, Priest, & Salamon, 2009; Vendrely, 2005).
This is likely due to the lack of a gold standard to measure critical thinking or clinical reasoning ability. More importantly, the definition of critical thinking changes in each study. In the physical therapy education literature, there is no agreement on the definition of critical thinking or clinical reasoning, which makes the design of courses or curricula to improve these abilities difficult. An examination of the scenarios that require critical thinking or clinical reasoning will find the fundamental cognitive ability needed is actually problem solving.
Key Terms in this Chapter
Inter-Professional Communication: Synchronous and asynchronous communication among the various healthcare professionals with the goal of making medical decisions.
Productivity: This is typically a measure of time spent on patient care that is considered billable. This includes assessment and intervention activities when a health care professional is in direct contact with the patient. This does not include interprofessional communication and consultation time.
Acute Care Setting: Physical therapy practice in a traditional hospital where patients are admitted for emergency medical, surgical, and obstetric services. This is different from an acute rehab setting where patients are admitted for high intensity rehabilitation services.
Well-Structured Problem: A problem with a single solution that can be solved by applying a specific rule or using the correct tool. Solvers are presented with the information need to solve the problem.
Discharge Planning: An interdisciplinary process with the goal of transitioning a patient from the hospital to the next level of care.
Acuity: A description of the severity of a patient’s medical status. This can include the primary diagnosis and prognosis, comorbidities, and baseline measures of health.