Clinical reasoning in acute care dietetics is influenced by factors related to the context of the dietitian: A qualitative study

The practice of acute care clinical dietetics involves daily clinical reasoning regarding patient care. The aim of this doctoral research is to uncover the nature of clinical reasoning of dietitians in the acute setting. The method is a qualitative study within the interpretive paradigm using the approach of philosophical hermeneutics. Philosophical hermeneutics is concerned with the human experience but more specifically, the interpreted meaning of this experience. The first study is completed and involved two recorded semi-structured interviews with ten acute care dietitians to which resulted in transcribed text and interpretation using the principles of hermeneutics. This research approach provides the framework for a second study which will be a hermeneutic study of the literature. Findings from the empirical study so far have shown a dietitian’s clinical reasoning is highly contextual. These contextual variables are categorised into physical, sociocultural and temporal domains and were shown to directly or indirectly influenced the nature of their clinical reasoning. Their clinical reasoning also involves dimensions of practitioner perceptions & characteristics as well as a complex yet fluid cognitive dimension that underpins each step of the process of caring for the patient’s nutritional needs. It is also dominated by an interactive reasoning process mostly with the medical practitioner illuminating themes of power and autonomy. A deeper understanding of this phenomenon will provide insight into how decision making occurs and therefore potentially contribute to education, professional development and research activities which subsequently optimise patient care.