Group G
Group G
October 9, 2021 2:10 PM CST
October 9, 2021 2:10 PM CST
Supporting New Graduate Occupational Therapists Clinical Reasoning: Making Space to Learn While Doing
Merrill Turpin, PhD
Jodie Copley, PhD
Cate Fitzgerald, BOccThy
Susan Laracy, BOccThy
Beverly Lewis, BOccThy
Rationale
Adapting to the realities of service provision can be challenging. New graduate occupational therapists require support to develop their practice-based clinical reasoning skills while working safely, effectively and skilfully.
Objectives
This research explored the support provided to new graduate occupational therapists at a major metropolitan hospital to develop their clinical reasoning.
Methods
Interpretive Description was used to explore experiences of and support provided to new graduates as they developed their clinical reasoning in their first year of practice. A hospital-based occupational therapy service that provided a well-established and well-regarded formal support program to new graduates was recruited. In-depth semi-structured interviews were conducted with nine new graduates, their supervisor and the department manager. Data were analysed thematically.
Findings
The nature of support provided changed over time. Foundational support in the first three months equipped new graduates with reasoning strategies which became habits, allowing them to reason more autonomously and prioritise when to intentionally seek guidance for complex cases. Supervisors used questioning and ‘talking through’ to model the process of independent clinical reasoning.
Discussion
Staged support, modelling and a supportive workplace in which the process of learning clinical reasoning was normalised helped new graduates develop autonomous clinical reasoning habits.
Experiences of New Graduate Occupational Therapists Learning to Make Intervention Decisions in Diverse Paediatric Workplace Contexts
Elizabeth Moir, BOccThy (Hons), PhD Candidate
Jodie Copley, PhD, Associate Professor in Occupational Therapy
Merrill Turpin, PhD, Senior Lecturer in Occupational Therapy
School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Rationale: When making clinical decisions within paediatric practice, clinicians must consider factors relating to children and their families and evidence regarding how best to intervene. New graduate occupational therapists commonly experience challenges with reasoning and decision-making. However, limited exploration of new graduates’ experiences of decision-making within paediatric practice has been undertaken.
Objectives: To explore new graduates’ experiences of learning to make intervention decisions within diverse paediatric service delivery contexts.
Methods: A case study approach, involving a range of data collection methods, enabled exploration of the experiences and reflections of eighteen new graduate and eight experienced occupational therapists working in three service delivery contexts – private practice, an acute hospital and non-government organisations. Data were analysed using inductive thematic analysis, and patterns across the three cases were examined.
Findings: Common support mechanisms assisted new graduates’ intervention decisions across the three cases, including informal support, formal supervision and workplace and online resources. New graduates also drew on their own developing knowledge and experience. Contextual factors relating to each case shaped their experiences of learning to make intervention decisions.
Implications: Challenges with decision-making may impact client service provision and outcomes. Understanding new graduates’ experiences is vital for supporting development of reasoning and decision-making.
Developing a Mobile Mind in Practice
Dr. Susan Ryan, Emerita Professor, University College Cork, Ireland
Rationale: Any health profession that works in a wide variety of contexts, with people of all ages and across many disciplines cannot apply standard procedures. This paper illustrates the importance of students developing a mobile and creative mind building on from foundational concepts. This ability needs to be nurtured from the beginning of their professional program as well as on all their practice education experiences.
Objectives: 1) To analyse client contact over a prolonged period of time. 2) To interpret this contact through the lens of professional Models of Practice. 3) To illustrate the mobile mind when delivering best practice.
Methods: An Autoethnographic approach was used in analysing and interpreting a set of diaries kept by the author over a period of seven years with reference to the declining condition of Alzheimers Disease.
Findings: Although one over-arching model was applicable to this spectrum of practice, as the disease progressed different, more detailed conceptual models of practice were used to guide interventions.
Implications: A knowledgeable and mobile mind was needed to alter reasoning as the downward trajectory happened. Educational and practice placements need to foster this mobile mind ability throughout programs and with practitioners.
The Five Finger Framework for Professional Reasoning
Helen Jeffery, Senior Lecturer
Kim Reay, Senior Lecturer
Qualitative description methodology was utilised to understand the uptake, use and development of EBP in novice practitioners, and to identify strategies used to nurture its development. Focus groups were conducted with year 3 students and experienced clinicians; and interviews were conducted with occupational therapy lecturers. Analysis found that what constitutes evidence is broad, EBP and professional reasoning concepts merge, and ascertaining local best practice is important. Additionally, novices need to develop skills and habits in professional reasoning that will hold them in good stead for lifelong learning and ongoing continuing competence.
The Five Finger Framework was consequently developed as a tool to enhance novice and experienced practitioners’ use of evidence in their professional decision making. The tool encourages practitioners to consider and question evidence from five areas as they grapple with professional decisions. The image and metaphor of a hand is used to provide a simple visual reminder of the five areas. The practitioner’s own knowledge, experience and self is situated on the thumb, illustrating the ease with which they can touch base with the other sources of evidence (fingers). Using the framework enhances the practitioner’s ability to habitually consider and respond to influences from cultural, client, and knowledge perspectives.
Research Snapshot
Using Quality Indicators for School-Based Practice to Support Professional Reasoning
Yvonne Swinth, PhD, OTR/L, FAOTA
Patricia Laverdure, OTD, OTR/L, BCP, FAOTA
Professional reasoning is defined as the process used by practitioners to plan, direct, perform, and reflect on client care (Alvarez, Arenillas, Moruno-Millares, 2019). Many school based practitioners struggle with implementing effective professional reasoning. Thus, Quality Indicators of School Occupational Therapy Practice were developed to provide occupational therapy practitioners and stakeholders a mechanism to examine practice, consider its contextual meaning, and illustrate the principle in practice. The resource provides a baseline to strengthen the profession’s knowledge of school practice, reduces the knowledge to practice gap, provides practice data for practitioner reflection and best practice decision-making, help with the development of professional reasoning specific to school practice, and provides occupational therapy and its stakeholders a deepened and consistent understanding of what effective and efficacious occupational therapy looks like in school settings. Now that the Quality Indicators of School Occupational Therapy Practice have been developed and are being implemented in practice, research is needed to examine how this tool can and does support the professional reasoning of practitioners as well as how to best frame the tool so that it is a guide for the development of professional reasoning rather than a prescriptive tool for practice.