Clinical Reasoning in Occupational Therapy: An Integrative Review

Schell, Barbara A. Boyt; Cervero, Ronald M.

doi:10.5014/ajot.47.7.605

Cited by 127 publications

(130 citation statements)

References 19 publications

(29 reference statements)

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“…Later research suggests expanded dimensions of clinical reasoning which are distinct from hypothetico-deductive reasoning. These forms of reasoning include: intuitive reasoning (Benner & Tanner, 1987); narrative reasoning (Mattingly, 1991); interactive and conditional reasoning (Fleming, 1991); practical reasoning (Jensen, Gwyer, Hack & Shepard, 1999); and pragmatic reasoning (Schell & Cervero, 1993).…”

mentioning

confidence: 99%

Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork

Ladyshewsky

Gardner

2008

AJET

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The use of peer assisted learning in clinical education is explored in this case study. Groups of undergraduate physiotherapy students were structured into communities of practice during the second half of their clinical fieldwork program. They collaborated online in an asynchronous manner, using information communications technology (blogs) and focussed their discussion on professional practice and evidence based practice issues. Each blog group was composed of four to five fourth year physiotherapy students in their final year of clinical fieldwork. Each blog group was moderated by an academic moderator. Focus groups were structured to collect information on the experience and outcomes associated with the community of practice experience. The blog was very valuable and heightened learning, built trust, and supported learners to integrate theory to practice. A range of issues were also identified, however, that need to be considered to improve the blogging experience such as increasing the size of the group and providing more detailed guidelines. Clinical fieldwork programs looking to elevate the reflective practice component of professional development should consider blogging as an option.

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confidence: 99%

Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork

Ladyshewsky

Gardner

2008

AJET

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“…Pragmatic reasoning was first proposed by Schell and Cervero (1993) and further developed by Boyt Schell and Schell (2008). Pragmatic reasoning starts from the middle part of the contextual framework described above and encompasses bands 4-6.…”

Section: Putting Mary's Practice In Contextmentioning

confidence: 99%

Context and How it Influences Our Professional Thinking

Ryan¹,

Hills²

2012

Clinical Reasoning in Occupational Therapy

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“…Narrative reasoning can focus on either the illness or occupational perspective or narrative of the client's story (Hamilton, 2008). Schell and Cervero (1993) described the effects of context on therapy as pragmatic reasoning and viewed this as consistent with the emerging sociological concept of situated cognition. This form of reasoning focuses on the practical realities and considers the possibilities related to the practice context and the client and therapist's personal contexts (Barris, 1987;Schell, 2008b).…”

Section: Clinical Reasoning Tracksmentioning

confidence: 89%

“…For example, cue acquisition is evident when using each of the procedural, interactive and conditional reasoning tracks but what differs between these tracks is the type of cues occupational therapists attend to, therefore providing some evidence of a common underlying problem solving process. Thus these cognitive operations of problem solving; cue acquisition, hypothesis generation, refinement and verification (Carrier et al, 2010, Chapparo & Ranka, 2008, Leicht & Dickerson, 2001, also described by several occupational therapy authors as scientific reasoning (Chapparo & Ranka, 2008;Schell & Cervero 1993;Tomlin, 2008), may deserve greater attention than they have to date.…”

Section: Cognitive Processes Of Reasoning and Decision-makingmentioning

confidence: 99%

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

Doyle¹

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BackgroundStroke survivors form the largest client group seen by occupational therapists and a large proportion of these stroke survivors experience upper limb post-stroke sensory impairments (ULPSSI) which impact upper limb function and participation. This thesis addresses the clinical decision-making (CDM) of occupational therapists when managing ULPSSI. No appraised and synthesised summary of the research evidence related to the effectiveness of interventions for ULPSSI is available to support therapists' CDM.Information on occupational therapists' practice choices and decisions about managing ULPSSI and the survivors' perspective on ULPSSI is scant. This information could support occupational therapists CDM when addressing ULPSSI and potentially improve stroke survivors' outcomes. Thesis AimsThis thesis aims to:1. Synthesise the effectiveness of interventions for ULPSSI; 2. Explore how occupational therapists make and manage decisions regarding ULPSSI management; 3. Describe practice choices occupational therapists commonly make when managing ULPSSI and the sources of information they use to make these decisions; 4. Compare current assessment choices and intervention practices with recommendations from the research evidence and clinical practice guidelines; 5. Describe the stroke survivors' perspective with regard to ULPSSI; and 6. Design and pilot an evidence-based, theory-driven educational intervention to support occupational therapists' CDM when addressing ULPSSI. Thesis MethodsFive distinct studies addressed the above aims. A Cochrane systematic review evaluated the evidence for the effectiveness of ULPSSI interventions.iii  Twelve occupational therapists participated in a qualitative descriptive study exploring therapists' practice choices and CDM related to ULPSSI. Based on the qualitative study, a survey of 187 occupational therapists described therapists' current practice choices regarding ULPSSI management and factors impacting CDM. A qualitative descriptive study using semi-structured interviews with 15 stroke survivors explored their experience of ULPSSI and the associated rehabilitation encounter. Finally, based on the need for training expressed by the survey participants, a one group pre-and post-test design, feasibility study evaluated the effect of a one day, theory-based educational intervention on 19 occupational therapists' knowledge, perceived behavioural control, attitudes and intended behaviour regarding ULPSSI management, research utilisation, and shared decision-making. Workshop content incorporated information from the prior research studies forming this thesis. ResultsA Cochrane systematic review located 13 randomised controlled trials (RCTs) addressing ULPSSI interventions, with benefit shown from individual RCTs evaluating mirror therapy, a graded thermal stimulation, and intermittent pneumatic compression. Other single RCTs reporting statistically significant results for repetitive peripheral magnetic stimulation, early intensive task-orientated training and graded...

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Clinical Reasoning in Occupational Therapy: An Integrative Review

Cited by 127 publications

References 19 publications

Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork

Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork

Context and How it Influences Our Professional Thinking

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

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