Group C
October 8, 2021 4:40 PM CST
Clinical Reasoning in Occupational Therapy Practice: A Scoping Review
Angelica da Silva Araujo, PhD Student (OT), BSc (OT), MSc (Sciences)
Elizabeth Ann Kinsella, PhD
Abstract
Rationale: The occupational therapy clinical reasoning literature includes a large proportion of peer-reviewed qualitative and conceptual papers. These papers can contribute to our understanding of trends in clinical reasoning scholarship however have not yet received in-depth analytic attention.
Objective: To map the breadth and depth of peer-reviewed qualitative and conceptual literature on clinical reasoning in occupational therapy.
Method: A scoping review was conducted with database searches in Scopus, Web of Science, PsychINFO, Embase, and Medline. Twenty-six articles met the inclusion criteria: published between 2009-2019, peer-reviewed, addressed clinical reasoning in occupational therapy, qualitative or conceptual papers, focused on practitioners, in English language. Data were analyzed numerically and thematically.
Findings: Major trends in the publication of peer-reviewed qualitative and conceptual literature are reported. Four themes were identified: clinical reasoning processes, factors influencing clinical reasoning, new models or frameworks to guide clinical reasoning, and emergent perspectives on clinical reasoning.
Discussion: The review highlights discussions about types of clinical reasoning in occupational therapy, its dynamic and iterative nature, contextual dimensions of reasoning, client-centred and occupation-based approaches, new frameworks and models, and emergent and innovative perspectives. Engagement with interdisciplinary perspectives, how contexts shape clinical reasoning, and emerging trends are recommended.
Clinical Reasoning and Reflection in Occupational Therapy: A Scoping Review
Hannah K. Burke, MS, OTR/L, Graduate Research Assistant
Shelly J. Lane, PhD, OTR/L, FAOTA
Marco A. Leao, MS, OT
Abstract
Clinical reasoning and reflection are integral to the nature of occupational therapy, and a relationship between them is often assumed. However, a clear and consistent definition of either term within occupational therapy literature is missing. We conducted a scoping review examining how clinical reasoning and reflection are conceptualized and differentiated in the occupational therapy literature. Preliminary results suggest that these terms are often described by referencing seminal reasoning and reflection researchers. When one or both of these concepts are the focus of an article, authors often provide multiple definitions with specific modifications. When authors discuss both clinical reasoning and reflection, reflection is often mentioned as a component of the clinical reasoning process. Confusingly, “reflective practice” is also presented as a larger construct, thought to encompass clinical reasoning. Other related terminology has changed over time; “decision-making” used to be a common synonym for clinical reasoning and now more authors are substituting the term “professional reasoning” to capture occupational therapy’s diverse practice settings. Initial interpretation of this data points to inconsistency in use of terminology and a corresponding lack of clarity in the application of these constructs. Results from this review will inform occupational therapy by clarifying terminology for future research.
Clinical Reasoning and Professional Reflection – Necessary Bedfellows in the Pursuit of Therapeutic Excellence
Virginia Spielmann, PhD, MOST, Executive Director of STAR Institute
Abstract
Professional reflection (PR) in healthcare is widely recognized as a crucial support for learning and staff resilience. However, clinical reasoning and PR are often confused with one another, and even experienced practitioners struggle to implement PR activities. This study, founded in an action research perspective, explores the implementation of PR in relationship-based, family-centered practice alongside well-established clinical reasoning practices. Three separate investigations are represented in this study: (1) a participatory action research project using mixed methods to explore introduction of PR within a team of advanced allied health clinicians, (2) phenomenological interviews with Directors of relationship-based, family-centered practices on experiences and activities related to PR and (3) a concept development of PR following Rodger’s evolutionary analysis. The study established working definitions of PR, reflective practice and reflective supervision. Study findings indicate that allied health professionals are constantly navigating states of being that are in tension and determined that PR is a means of establishing autonomy within this paradox. The necessity of dynamic and mutually supportive clinical reasoning AND professional reflection activities is explored. Implications for practitioners, administrators and theory builders are discussed. A new fit-for-purpose epistemology of PR is proposed.