1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 30 Professional Reasoning in Practice Barbara A. Boyt Schell

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After reading this chapter, you will be able to: 1.Analyze important aspects of reasoning in occupational therapy practice. 2.Discuss how the reasoning process is embedded in the transactions which occur among the practitioner, the client and the practice context. 3.Identify the different facets of professional reasoning based on personal reflection, practitioners’ descriptions, and case studies.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (Continued) 4.Describe the process of developing expertise and discuss characteristic reasoning processes along a continuum of expertise.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Professional reasoning is: The process practitioners use to plan, direct, perform, and reflect on client care; How therapists actually think when engaged in practice; Usually performed quickly so practitioners can act on their reasoning right away; A metacognitive process; and Also called clinical reasoning or therapeutic reasoning

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reasoning in Practice: A Whole-Body Process OT practitioners use observations, sensory experiences, & theoretical knowledge to identify: –Client factors that contribute to occupational performance problems; and –Contextual factors that affect performance Some aspects of professional reasoning are tacit

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Theory and Practice Theories help practitioners to make decisions –Practice problems, however, rarely present in the straightforward manner described in textbooks Practitioners blend theories with their own personal and practice experiences to guide actions Theoretical knowledge helps the practitioner to: – Avoid unjustified assumptions –Use ineffective therapy techniques

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Processes Underlying Professional Reasoning Individuals receive, store, and organize information in complex representations of phenomena –Called frames or scripts Practitioners with extensive experience have organized and stored these scripts as long-term memories –This reduces the need to rely on working memory, which has very limited storage capacity

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Processes Underlying Professional Reasoning (Continued) Scripts help to organize both knowledge and procedural rules that guide thinking in practice Frames or scripts are used to develop efficient mental frameworks for handling complex information through a process including: –Cue acquisition; –Pattern recognition; –Limiting the problem space; –Problem formulation; and –Problem solution

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Processes Underlying Professional Reasoning (Continued) These processes are interactive and rarely linear

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Aspects of Professional Reasoning Occupational therapists use different thinking approaches, based on the nature of the clinical problem Scientific Reasoning Scientific reasoning is used to: –Understand the condition affecting an individual; and –Select interventions in the client’s best interest It is a logical process that parallels scientific inquiry

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Narrative Reasoning Understanding the meaning that a disease, illness, or disability has to an individual –Narrative reasoning goes beyond the scientific understanding of disease processes Narrative reasoning involves thinking in story form It is crucial for considering how the client’s life story can be “constituted or reconstituted” –Practitioners use narrative reasoning to help clients invent new life stories

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Pragmatic Reasoning Pragmatic reasoning goes beyond the practitioner-client relationship, addressing the world in which therapy occurs, including the: –Practice context; and –Therapist’s personal context Reasoning is a practical activity, influenced by everyday issues that affect the therapy process Examples: Resources for intervention, organizational culture, power relationships among team members, reimbursement practices, and practice trends in the profession

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Reasoning Scientific, narrative, and pragmatic reasoning help determine what can be done Ethical reasoning asks: What should be done? Interactive Reasoning Relies on a communicative process to enter the client’s life world to better understand how to help Some reasoning focused on interaction is conscious while other interpersonal acts may be automatic

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Professional Reasoning: A Process of Synthesis in Shared Activity The facets of reasoning are not separate or parallel, but interactive in practice Reasoning to Solve Problems Scientific, narrative, pragmatic, ethical, & interactive reasoning processes inform one another Conditional Process Practitioners must also flexibly modify interventions in response to changing conditions Includes anticipating situations in treatment and imagining future possibilities for clients

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ecological View of Professional Reasoning Professional reasoning represents transactions among the practitioner, the client, and the therapy context The practitioner’s reasoning is shaped by both personal and professional perspectives The client also brings life experiences and personal characteristics, as well as the situation that led to the need for OT

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal and professional lenses shape reasoning

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Schell’s Ecological Model of Professional Reasoning

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Developing and Improving Professional Reasoning Understanding the complexity of professional reasoning helps one appreciate it takes so long to become an excellent practitioner Experience alone will not create an expert –Development of expertise requires reflection in practice –Expertise develops along a continuum

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Provocative Questions 1.What are some of the personal factors in your life that you think will influence the way in which you practice occupational therapy? 2.How do you think you might deal with research evidence that is in conflict with your own experience or personal beliefs? What are some appropriate responses?