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.

scholarly journals Team Focus: Occupational Therapist

2008 ◽  
Vol 10 (3) ◽  
pp. 94-98
Author(s):  
Susan J. Forwell ◽  
Kathleen M. Zackowski
Keyword(s):  
Occupational Therapy ◽  
Health Care Professionals ◽  
Occupational Therapists ◽  
Well Being ◽  
Therapy Process ◽  
Functional Difficulties ◽  
Care And Support ◽  
Symptomatic Management ◽  
Home Work ◽  
Health And Well Being

Occupational therapists (OTs) have a unique and valued role in the health and functional recovery of individuals with multiple sclerosis (MS). To maximize the benefit of occupational therapy by both health care professionals who refer patients and the patients who use the services, an understanding of the scope of services that OTs offer is essential. This article describes the breadth of the OT evaluation and intervention specific to the treatment of individuals who have MS. As an overriding goal, the OT assists clients in processing the implications of physical, cognitive, and emotional changes and creatively developing strategies to cope with and, when appropriate, minimize the effects of these changes. The occupational therapy process is described, beginning with evaluation and providing guidelines and resources for appropriate client-centered goal setting. The OT and client then discuss intervention that ensures optimal functional outcome and includes symptomatic management, according to the specific functional difficulties and implications and the particular symptoms of each patient. Through discussion, the OT helps each client achieve health and well-being with remedial and compensatory techniques that enable participation in meaningful activities and roles in the home, work, and community. OT services are essential to the appropriate and optimal delivery of comprehensive care and support to individuals with MS.

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.

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.

Head Injury: Developing Community Occupational Therapy to Meet the Challenge

1992 ◽  
Vol 55 (3) ◽  
pp. 99-102 ◽  
Author(s):  
Heather Warnock ◽  
Debbie Northin ◽  
Susan Carberry ◽  
Elizabeth Ward ◽  
David Hughes ◽  
...  
Keyword(s):  
Head Injury ◽  
Occupational Therapy ◽  
Social Services ◽  
Occupational Therapists ◽  
Occupational Therapist ◽  
City Council ◽  
Initial Assessment ◽  
The Social ◽  
Administrative Area ◽  
Injured Patients

A project has been established to try to improve the quality of care given to patients after discharge from neurosurgery following a head injury. Set within the administrative area of Leeds City Council with a population of nearly three-quarters of a million people, it attempts to focus a small part of the social services occupational therapy service to respond to head injured patients and their families. During 1990, 56 patients were discharged from neurosurgery after 2 or more days' stay following a head injury, and were visited by one of three community occupational therapists specialising in head injury. They were given a comprehensive assessment of need after which the occupational therapist responded by (a) implementing a treatment programme and/or (b) providing equipment/adaptations and/or (c) referring to another agency. The average time taken to date for the initial assessment has been 2½ hours, with a range of 1–4 hours. Questions have arisen about the expanding role for the community occupational therapist with this group of service users.

Occupational therapists’ experiences and perspectives towards occupation-based practice in Thailand: A mixed-methods study

2020 ◽  
Vol 84 (1) ◽  
pp. 54-64
Author(s):  
Anuchart Kaunnil ◽  
Supalak Khemthong ◽  
Sarinya Sriphetcharawut ◽  
Peeradech Thichanpiang ◽  
Veerawat Sansri ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Thematic Analysis ◽  
Daily Living ◽  
Occupational Therapists ◽  
Mixed Methods Study ◽  
Medical Sciences ◽  
Strongly Agree

Introduction Occupation-based practice is a core tenet of occupational therapy. This study explores perspectives and experiences with occupation-based practice among Thai occupational therapists. Method Using mixed methods, a focus group was conducted with eight occupational therapists, and the results were interpreted using thematic analysis. A questionnaire survey was also completed concerning practitioner perspectives ( n = 216). Findings Three major themes were identified: (a) perspectives on occupation-based practice were related to practice areas and felt to strengthen the identity of occupational therapy (52% strongly agree), leading to improved services and better outcomes for clients (44% strongly agree); (b) approaches focused on activities of daily living were appropriate for cross-practice areas; and (c) occupation-based practice is consistent with integrated medical sciences and occupations for clients (52% strongly agree). Conclusion Implementing occupation-based practice will be of value to clients, provide benefits as a compass to direct processes, and enhance clinical reasoning and outcomes.

Clinical Reasoning in Community Occupational Therapy

1996 ◽  
Vol 59 (5) ◽  
pp. 196-202 ◽  
Author(s):  
Heli Munroe
Keyword(s):  
Decision Making ◽  
Qualitative Research ◽  
Occupational Therapy ◽  
Clinical Reasoning ◽  
Research Study ◽  
Occupational Therapists ◽  
Contextual Influences ◽  
Qualitative Research Study ◽  
Clinical Action ◽  
Reflection In Action

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 departments 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. Reflection-in-action 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 thinking, 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.

Sign in / Sign up

Export Citation Format

Share Document