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Abstract
The purpose of this study was to identify the nature of clinical reasoning of expert, competent, and novice respiratory therapists while making decisions within acute care settings. Other purposes included the differences years and quality of experiences made, and determining the contextual factors, which either facilitated or hindered their development of ability to make good clinical decisions. The theoretical framework for this study included clinical reasoning, the novice-to- expert continuum, and reflective practice. The nine well-documented methods of clinical reasoning used for this study were associated with these theories. This qualitative study was designed to gain an understanding of therapists decision making in the acute care settings of neonatal and pediatric intensive care, from the therapists own perspectives. Data collection consisted of observations of therapists in the acute care setting followed by indepth interviews. Bracketing and constant comparative method analysis was used to capture recurring themes. The findings of this study indicated that respiratory therapists used nine different methods of clinical reasoning as components of their work in the acute care units. Their use of these different methods allowed for almost every task or activity therapists performed in patient care to be associated with clinical reasoning. It revealed a difference in the method of reasoning used to solve problems based on a therapists years of experience and the quality of those experiences. Therapists also used multiple methods of clinical reasoning almost simultaneously. The results of this study indicated that these respiratory therapists would rapidly shift from one method of reasoning to another, depending on which aspect of complicated clinical problems attracted their attention. Therapists revealed the presence of practice contextual factors with they believed affected their development of expert clinical reasoning skills. The issues they identified as hindering their development of good clinical reasoning skills included; limited or lack of experiences, lack of time and staffing, and limited expectations and nonsupport of physicians. Those that facilitated good clinical reasoning, included previous similar experiences, 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.