Clinical Reasoning in Community Occupational Therapy

Abstract

A qualitative research study was undertaken In order to ascertain the scope and nature of clinical reasoning In community occupational therapy. Thirty occupational therapists based in social work depart· ments in Scotland participated In this study, which required them to describe the content and meaning of their thinking during routine Interventions with clients and carers living In their own homes.The findings Indicated that the participants adopted patterns of reasoning that consisted of three elements: reflection, decision making and reasoning. Refiectloi'Hn-actlon was commonplace during the home visits, while decision making was found to be concerned more with Interactive than with technical or procedural issues. Reasoning was relativistic or pragmatic In response to contextual Influences. In addition, It was found that the respondents tended to use coded meaning when explaining their thlnkln••. Which ' , may In part account for the difficulties In articulating the reasoning that underpins clinical action. These , , 'Issues are discussed In the context of current research on thinking.

Community occupational therapists’ clinical reasoning: Identifying tacit knowledge

“…Observations were followed by semi‐directed interviews. This qualitative study showed that reasoning (defined by the author as the process of accounting for and ascribing meaning to clinical actions) is difficult to articulate and follows decision making instead of preceding it (Munroe, 1996). Decision making is of three types: technical (e.g.…”

“…interpersonal behaviour). Munroe (1996) maintains that, surprisingly given the mostly technical interventions community occupational therapists must do, interactive decision making is the most frequent, leading to greater use of the interactive dimension [e] of CR. That prominence might be explained by the therapeutic relationship between occupational therapists and clients and factors related to the community practice context, such as organisational or cultural imperatives (e.g.…”

Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist

“…Quantitative methodologies have not been as widely used as qualitative methodologies in occupational therapy clinical reasoning research (Table 2), nevertheless they are proposed to have several strengths. These strengths (Creighton, Dijkers, Bennett & Brown, 1995) • Participant recall of an assessment session (Hagedorn, 1996) • Focus groups; participant recall of therapy experience (Kuipers, McKenna & Carlson, 2006) • Participant observation, videotaping and in-depth interviewing (Mattingly & Fleming, 1994;Mattingly, Fleming & Gillette, 1997;Mattingly & Gillette, 1991) • Video of a supervision session, retrospective reflection (Medhurst & Ryan, 1996) • Field observation; participant interview based on observation notes (Munroe, 1996) • Video of treatment session; participant story telling and reflection during videotape review (Roberts, 1996) • Participant interview based on audiotapes of assessment sessions (Rogers & Masagatani, 1982) • Reflection while watching a video of client performance (Sviden & Hallin, 1999) • Head-mounted video cameras worn during intervention sessions; participant interview during videotape review (Mitchell & Unsworth, 2005;Unsworth, 2001b,c) Studies using simulated cases • Written responses to simulated referral letters (Alnervik & Sviden, 1996) • Focus groups centred around a written case study (Daniels, Winding & Borell, 2002) • Semistructured interviews based on paper case studies (Gibson et al, 2000) • Survey questionnaire based on paper case scenarios (Mitchell & Unsworth, 2004) • Verbal report generated while reading simulated case stories (Ryan, 1995) Decision-making on the basis of simulated case vignettes • Discharge accommodation following stroke (Unsworth & Thomas, 1993Unsworth, Thomas & Greenwood, 1995) • Management of community health referrals (Harries & Gilhooly, 2003;Harries & Harries, 2001b) • Upper limb treatment for children with cerebral palsy (Rassafiani, Ziviani, Rodger & Dalgleish, 2006, 2007 include capacity for determining reliability and consistency of decision-making (Harries & Harries, 2001b), for ...…”

Professional Expertise of Community-Based Occupational Therapists

“…In this setting, therapists also need to be able to work effectively as part of health care teams (Shannon, 1985). There is also evidence that the clinical reasoning of community-based occupational therapists is unique, and deserves emphasis in an educational curriculum (Munroe, 1996).…”