Clinical Reasoning in Occupational Therapy: Idiosyncrasies in Content and Process

1996 ◽  
Vol 59 (8) ◽  
pp. 372-376 ◽  
Author(s):  
Anne Elizabeth Roberts
Keyword(s):  
Pattern Recognition ◽  
Problem Solving ◽  
Qualitative Study ◽  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Deductive Reasoning ◽  
Occupational Therapists ◽  
Medical Problem ◽  
Written Text ◽  
Component Processes

This article describes part of a research project that aims to examine the content and process of occupational therapists' reasoning. Thirty-eight experienced occupational therapists participated. This qualitative study gathered written text from the therapists, representing their thinking when presented with facsimiles of practice situations. Analysis of both the content of the reasoning and the component processes of the reasoning took place. The processes observed were similar to those observed in studies of medical problem solving. Some therapists demonstrated a rapid formulation of the problem, indicating the use of pattern recognition. There was also an element of hypothetico-deductive reasoning, as has been observed in medicine and physiotherapy. This article explores these findings, relating them to the research of other theorists in the field of reasoning and concluding with a discussion of some apparent idiosyncrasies in the participants' reasoning.

scholarly journals Occupational therapists’ experiences of enabling people to participate in sport

2020 ◽  
pp. 030802262097394
Author(s):  
Deborah Bullen ◽  
Channine Clarke
Keyword(s):  
Qualitative Study ◽  
Occupational Therapy ◽  
Thematic Analysis ◽  
Social Care ◽  
Occupational Therapists ◽  
Phenomenological Approach ◽  
Scope Of Practice ◽  
Local Populations ◽  
Care Services ◽  
Health And Social Care

Introduction In response to growing demands on health and social care services there is an emphasis on communities addressing the needs of local populations to improve lives and reduce inequalities. Occupational therapists are responding to these demands by expanding their scope of practice into innovative settings, such as working with refugees, the homeless and residents of nursing homes, and within sport and leisure environments. The benefits of sport are widely acknowledged, and this paper argues that occupational therapists could play a pivotal role in enabling people to participate. Method This qualitative study drew on a phenomenological approach and used interviews and thematic analysis to explore five occupational therapists’ experiences of enabling people to participate in sport. Findings Findings revealed that participants demonstrated the uniqueness of occupational therapy when enabling people to participate in sport and practised according to their professional philosophy. There were opportunities to reach wider communities and promote the value of occupational therapy by collaborating with organisations, but there were also challenges when working outside of traditional settings. Conclusion The study emphasises the unique skills occupational therapists can bring to this setting. It highlights opportunities to expand their practice, to forge new partnerships in sports and leisure environments, and to address the national inactivity crisis.

On Clinical Reasoning: Patterns of Reflection on Practice

1996 ◽  
Vol 16 (2) ◽  
pp. 98-110 ◽  
Author(s):  
Anitha Alnervik ◽  
Gunilla Svidén
Keyword(s):  
Occupational Therapy ◽  
Qualitative Analysis ◽  
Clinical Reasoning ◽  
Preliminary Investigation ◽  
Occupational Therapists ◽  
Treatment Session ◽  
Conditional Reasoning ◽  
Narrative Form ◽  
Reasoning Patterns ◽  
Reflection On Practice

Five qualified occupational therapists and their patients were videotaped during a treatment session. The occupational therapists first were asked to describe the session in a narrative form, i.e., “tell the story,” and then they were asked to describe the thoughts and considerations on which they had conducted the treatment session, i.e., “reflection on practice.” A qualitative analysis was performed in accordance with the model for clinical reasoning developed by Fleming (1991). Both quantitative and qualitative analysis showed that procedural reasoning was predominant both in storytelling and reflection on practice, and a very small number of comments was classified as interactive or conditional reasoning. The results of this preliminary investigation suggested that we should examine the role that reflection on practice plays in examining, developing, and teaching the art of occupational therapy.

Values Influencing Clinical Reasoning in Occupational Therapy: An Exploratory Study

1990 ◽  
Vol 10 (1) ◽  
pp. 41-55 ◽  
Author(s):  
Elaine D. Fondiller ◽  
Lois J. Rosage ◽  
Barbara E. Neuhaus
Keyword(s):  
Qualitative Research ◽  
Content Analysis ◽  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Research Methodology ◽  
Exploratory Study ◽  
Occupational Therapists ◽  
Qualitative Research Methodology ◽  
Interview Format

This exploratory study used qualitative research methods to identify values that influence clinical reasoning in occupational therapy. Through an interview format, selected occupational therapists were asked to respond to a predetermined list of questions about a general case study. The interviews were tape-recorded and a content analysis of the tapes yielded 18 distinct value statements. Implications of the findings and recommendations for further studies are presented. Qualitative research methodology is examined for its utility in occupational therapy.

Applying Clinical Reasoning: A Caseload Management System for Community Occupational Therapists

1996 ◽  
Vol 59 (5) ◽  
pp. 207-211 ◽  
Author(s):  
Tracy Fortune ◽  
Susan Ryan
Keyword(s):  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Occupational Therapists ◽  
Occupational Therapist ◽  
Therapy Assessment ◽  
Therapy Services ◽  
Subjective Phenomenon ◽  
Experienced Therapist ◽  
Perceived Complexity ◽  
Complex Cases

This article presents a system of caseload management for community occupational therapists. Using the clinical reasoning work of Mattingly and Fleming as a framework, the perceived complexity of each case for a community occupational therapist was analysed and then paralleled with the type and amount of clinical reasoning required. Following an initial occupational therapy assessment, each case is given a numerical weighting, graded at 3 for complex cases and from 1 for non-complex or simple cases. The degree of complexity or weighting is recognised to be a subjective phenomenon dependent on the experience, knowledge and skills of the therapist. The cases held by an occupational therapist are able to be mixed so that the experienced therapist holds a varied caseload of complex and simple work. Beginning therapists can follow the same measured approach thus augmenting their background experience. This method promotes continuing education, assists experiential learning and provides variety. Using this system, it is proposed that occupational therapy services are enhanced by reducing unnecessary casework from therapists' active caseloads, allowing increased time to work on complex cases and using expertise more efficiently.

Understanding Occupational Therapy: A Hermeneutic Approach

1996 ◽  
Vol 59 (5) ◽  
pp. 237-242 ◽  
Author(s):  
Greg Kelly
Keyword(s):  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Occupational Therapists ◽  
Research And Practice ◽  
Hermeneutic Approach ◽  
Adequate Definition ◽  
Definition Of

The term ‘hermeneutic’ has recently been appearing in the occupational therapy literature related to clinical reasoning but without an adequate definition of its meaning. The purpose of this article, therefore, is to offer a simple introduction to the term and discuss how it applies to clinical reasoning, thus providing occupational therapists with some of the language they will need to understand this relatively new concept fully. Drawing on literature from nursing, physiotherapy, psychology and occupational therapy, this article examines a hermeneutic approach to occupational therapy research and practice and, indeed, to an understanding of the concept of occupational therapy itself.

The Importance of Independence in Toileting: the Views of Stroke Survivors and their Occupational Therapists

2005 ◽  
Vol 68 (4) ◽  
pp. 165-171 ◽  
Author(s):  
Joanne Clark ◽  
Sue Rugg
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Occupational Therapy ◽  
Health Care Professionals ◽  
Daily Activity ◽  
Occupational Therapists ◽  
Self Esteem ◽  
Stroke Survivors ◽  
Perceived Importance

The profession of occupational therapy claims to be patient centred; however, research shows that the views of patients and health care professionals often differ. Toileting is a fundamental daily activity, yet to date there have been few studies investigating the perceived importance of independence in toileting. A qualitative study was conducted to determine the views of stroke survivors and their occupational therapists regarding the importance of independence in toileting. A symbolic interactionistic framework was used, allowing the views of these two disparate groups to be compared. Thirteen stroke survivors and seven occupational therapists were interviewed. Five categories were identified in the data collected: the occupational form normally used in toileting; incontinence and continence; independence and dependence in toileting; issues relating to toileting and hospital discharge; and the role of occupational therapy. Both participant groups agreed that independence in toileting was important in avoiding the need for assistance and in avoiding feelings of decreased self-esteem. However, the patient participants' views extended further in that they stated that the method of toileting was important, not merely that it was conducted independently. In conclusion, it is essential that occupational therapists consider how they can facilitate a return to the method usually undertaken for toileting by patients. If a return to the previous methodology for toileting will not be possible, then the occupational therapists must give consideration as to how to facilitate adjustment by the patients.

Mediational Techniques: Origins and Application to Occupational Therapy in Paediatrics

1998 ◽  
Vol 65 (4) ◽  
pp. 202-209 ◽  
Author(s):  
Cheryl Missiuna ◽  
Theresa Malloy-Miller ◽  
Angela Mandich
Keyword(s):  
Problem Solving ◽  
Occupational Therapy ◽  
Occupational Therapists ◽  
Occupational Performance ◽  
Top Down ◽  
Cognitive Approach ◽  
Cognitive Approaches ◽  
Problem Solve

For a variety of reasons, occupational therapists are beginning to explore the use of cognitive, or “top-down” approaches during intervention. While these approaches have a long history within education and psychology, the steps involved in problem-solving and the techniques that are used to mediate a child's occupational performance are unfamiliar to most therapists. In this paper, the historical underpinnings of cognitive approaches and mediational techniques are reviewed and the steps involved in teaching a child to problem solve are outlined. As each is described from the literature, it is interpreted and applied to paediatric occupational therapy practice. Finally, the problem-solving steps and techniques are combined to demonstrate usage of a cognitive approach in order to address a common occupational performance issue in childhood.

scholarly journals Clinical reasoning in veterinary practice

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Claire Elaine Kirsty Vinten
Keyword(s):  
Working Memory ◽  
Pattern Recognition ◽  
Problem Solving ◽  
Clinical Reasoning ◽  
Treatment Options ◽  
Veterinary Surgeons ◽  
Clinical Reasoning Skill ◽  
Memory Type ◽  
The Brain ◽  
Reasoning Skill

Abstract Clinical reasoning is the process by which veterinary surgeons integrate a multitude of clinical and contextual factors to make decisions about the diagnoses, treatment options and prognoses of their patients. The brain utilises two methods to achieve this: type one and type two reasoning. Type one relies on shortcuts such as pattern-recognition and heuristics to deduce answers without involving working memory. Type two uses working memory to deliberately compute logical analyses. Both reasoning methods have sources of errors, and research has shown that diagnostic accuracy is increased when they are used together when problem-solving. Despite this, it appears unlikely that clinical reasoning ‘skill’ can be improved; instead, the most effective way to improve reasoning performance experimentally appears to be by increasing and rearranging knowledge. As yet, there is no evidence that overall clinical reasoning error can be reduced in practice.  

Clinical Reasoning of Occupational Therapists during the Initial Assessment of Physically Disabled Patients

1982 ◽  
Vol 2 (4) ◽  
pp. 195-219 ◽  
Author(s):  
Joan C. Rogers ◽  
Gladys Masagatani
Keyword(s):  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Medical Information ◽  
Empirical Studies ◽  
Occupational Therapists ◽  
Assessment Process ◽  
Initial Assessment ◽  
Therapy Process ◽  
Reasoning Process ◽  
Clinical Thinking

Clinical reasoning lies at the core of the occupational therapy process. Although several models of clinical thinking have been presented in the literature for use by occupational therapists, no empirical studies have been conducted to examine the process in action. This article reports a pilot study of the first component of the occupational therapy process—assessment. Ten therapists, working with patients with physical problems in medical settings, were observed and interviewed as they assessed patients and summarized their impressions. The aim of the study was to describe the reasoning process used to determine functional problems and treatment goals. A six-stage model to describe the reasoning process was derived from the data. The first stage involved a search for medical information and led to the second stage in which assessments were selected. In stages three through six, the assessment plan was implemented, client problems were defined, treatment objectives were specified, and the assessment process was evaluated. The salient features of each stage are described. Overall, the therapists found it difficult to outline the progression of their thoughts. The medical diagnosis played a key role in their thoughts as did the therapist-patient relationship. The therapists' perspective for assessment focused on musculoskeletal and self-care functions. The data were interpreted in the light of the present status of occupational therapy theory.

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