Clinical reasoning for manual handling risk assessments in community settings : moving from rule based to intuitive reasoning

Awarding institution
  • University of Strathclyde
Date of award
  • 2017
Thesis identifier
  • T14598
Person Identifier (Local)
  • 201351932
Qualification Level
Qualification Name
Department, School or Faculty
  • Background: There has been a shift in recent years to caring for patients with complex needs in their homes. In order to provide this care safely, tasks involving moving and handling need to be risk assessed. Little is known about how healthcare professionals conduct manual handling risk assessments (MHRAs) in community settings. Research Questions and Objective: There are three research questions used to investigate this thesis. To inform the research, "How is safety and risk management legislation (MHOR, MHRA) used by professionals in the identification of hazards and in the risk evaluation of these hazards relating to a manual handling task?". Secondly using these hazards and the risks associated with them the research has considered and has posed the following question, 'in the community setting in what context can hazard identification and risk evaluation data be used and applied by HCPs when dealing with complex cases?'. Thirdly, there is the question, 'to what extent and in what ways is clinical reasoning relevant when undertaking MHRA in the community settings.' Methods: A qualitative design with thematic analysis was used to investigate the research questions. Training Workshops, based on two clinical cases, were conducted with healthcare professionals to determine the hazards they perceived in those cases, how they made risk decisions, and the way in which they communicated their risk information and findings. Semi-Structured Interviews were then used to investigate the effect of experience on the development of clinical reasoning in manual handling risk assessments. Participant Validation Interviews were then conducted on the resultant model and level descriptors. Main Findings: The findings from the workshops suggest that healthcare professionals should consider Medical Condition, Equipment, Home Environment, Complexity and Community Care when conducting MHRA in community settings. The findings from the interviews suggest three stages (Novice, Competent, and Expert) in the development of clinical reasoning in manual handling risk assessments in community settings. The resultant model and level descriptors were validated through participant validation interviews. Unique Contribution: This thesis develops a model about how healthcare professionals use clinical reasoning when conducting manual handling risk assessments in community settings. This model is presented as an (sic) unique theoretical contribution to knowledge and is based on the HSEs 'Five Steps to Risk Assessment', highlighting the processes of risk perception, risk decision making, and risk communication. The model integrates these processes with cyclical models of clinical reasoning and stages of development in clinical reasoning, yielding level-descriptors. Two methodological contributions to knowledge were made by firstly developing clinical case studies (Personas) that can be used to study MHRAs in community settings, and secondly a specific programme using MHRA training workshops that incorporate the 'Think Aloud' procedure. Implications: The theoretical implications of the model have to do with how HCPs' clinical reasoning in conducting MHRAs develops with experience from rule-based to more holistic, intuitive-based reasoning. The model also points to a role for Non-Analytical Reasoning by experts, and the development of a safety culture in community care organisations. Practical implications of the model have to do with training, and the integration of health and social care in the community.
Resource Type
  • Strathclyde theses - ask staff. Thesis no. : T14598
Date Created
  • 2017
Former identifier
  • 9912551887902996