Group A
October 8, 2021 2:40 PM CST
Developing an Intercultural Framework to Support Clinical Reasoning in Practice Among Chilean Occupational Therapists
Jennifer Garcia, BscOccThy, MPhil, PhD (c)
Jodie Copley, PhD, BOccThy (Hons); Associate Professor, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland;
Merrill Turpin, PhD, Grad Dip Counsel, BOccThy, Associate Professor
Abstract
Rationale
Professional reasoning (PR) has gained increased recognition as a cornerstone of occupational therapy practice and education during the last three decades. Available body of knowledge shows that researchers from Anglophone countries have explored in depth the complexity of PR and created resources to support its development. Nevertheless, recent research conducted among occupational therapists from Latin American communities suggest that they face barriers that limit their access to information and resources to assist their PR and decision-making in practice, which is currently based predominantly on intuition.
Objectives
To develop a training and mentoring program to support professional reasoning in practice for Chilean occupational therapists.
Methods
Community-based participatory research was used as a methodological approach to collaboratively work with four Chilean occupational therapists in clinical settings and academic positions.
Findings
A framework that considers principles of intercultural partnerships and intercultural knowledge implementation was developed, providing a structure for critical PR and building capacity in practice.
Discussion and implications
PR is crucial to sustain quality occupational therapy practice and education worldwide. Intercultural and inter-lingual partnerships are needed to bridge the gap and support the development of critical PR of occupational therapists that remain isolated from the global progress made within the profession.
A Pragmatist Perspective for Occupational Therapy Professional Reasoning
Tais Quevedo Marcolino, Associate Professor, BSc(OT), MSc (Education), PhD (Education), Department of Occupational Therapy, Federal University of Sao Carlos, Sao Paulo, Brazil
Elizabeth Anne Kinsella, Professor, PhD, MAEd, BSc(OT), School of Physical and Occupational Therapy, McGill University, Montreal, Canada
Abstract
Rationale: Clinical reasoning in occupational therapy was initially described using Aristotle's practical reasoning concept as deliberation about appropriate actions in a given situation. Current literature however has moved away from this emphasis.
Objective: Drawing on the philosophy of pragmatism, we return to the idea that a situation, in its unified whole, can allow for deliberative exploration.
Method: A conceptual study of the occupational therapy professional reasoning literature was carried out drawing on Dewey's pragmatic philosophy and three integrated concepts - situation, inquiry, and reflection - as an analytic approach.
Findings: A practical situation, uncertain in its current condition, can be seen as an indeterminate situation which opens to inquiry. Its results are not a purely pre-meditated cognitive process, given that events unfold differently according to actions taken in the immediate practical situation. An iterative process between perceived facts and ideas creates new understandings and consequent new actions in a situated context. Conditional reasoning in occupational therapy encompasses elements of a pragmatist perspective, but a more robust pragmatist framework increases awareness of practical deliberations within professional reasoning processes.
Discussion: A pragmatist view for professional reasoning offers a generative framework for understanding decision-making processes in practice and for considering the situation as a whole.
Applying the Ecological Model of Professional Reasoning in Family Centered, Relationship-Based Practice
Virginia Spielmann, PhD, MS OT, Executive Director STAR Institute
Abstract
An interpretative phenomenological interview study is presented on the meaning, experiences and application of reflective practice in occupational therapy-lead, relationship-based, family-centered clinics. Three super-ordinate themes emerged from interviewee’s descriptions of their sense-making experiences of reflective practice: personal, professional and practice context. On reflection the author identified that these three themes could be framed by Schell’s Ecological Model of Professional Reasoning (Boyt Schell, 2014). This framework is used to explicate the meanings shared by participants during the interview process. The mutually supportive processes of reflective practice/professional reflection and clinical reasoning are explored and concrete suggestions for implementation are discussed.
Situating Oneself in Professional (Clinical) Reasoning
Sian E. Griffiths, Principal Lecturer, Otago School of Occupational Therapy
Abstract
A grounded theory study of Occupational therapists with a minimum of five years experience, working with clients with physical disabilities. It initially set out to explore how occupational therapists invoke specific skill sets and particular strategies when they conduct initial interviews and assessments with their clients.
The findings identified three types of occupational therapist which related to how the therapist situated themselves within the therapeutic encounter, reflected in their language, their interaction with their client’s and their way of being or embodying being an occupational therapist.
It is submitted that, in part, the types are a developmental component of forming a professional personal identity. Of moving from a feeling of general uncertainty of being an occupational therapist to a feeling of clarity of one’s role, with clear structures and boundaries, to an acceptance of the uncertainty and complexity of understanding a client’s experience of their disability.
It is also suggested that the type adopted by the therapist could be a strategy for controlling their (emotional) exposure during a therapeutic encounter, of protecting oneself from the negative experiences and uncertainties of being a (new) practitioner. With a realisation for some therapists of the limitation of this approach.
Implications, support of (new) staff, and clarity of the endpoint of occupational therapy.