Student Attainment Objectives: Strand #2

Clinical Reasoning

Mattingly & Flemming (1994) refer to clinical reasoning as the process used by practitioners to plan, direct, perform, and reflect on client care. Whenever one is engaged in thinking about, doing or planning occupational therapy services, he or she is involved in the clinical reasoning process. Clinical reasoning refers to the relationship that exists between formal theory and actual practice.  It involves a total body process that uses our senses to help make clinical decisions. Flemming refers to this as “knowing more than we can tell.” This is referred to as tacit knowledge. It is the practical knowledge, the common sense knowledge or the intuitive knowledge that binds the theoretical components to the “doing” aspect of treatment (Mattingly & Flemming, 1994).

The clinical reasoning process is complex and contains many components. The four major areas of clinical reasoning include:

  1. Scientific reasoning used to understand the condition affecting the individual and decide treatment interventions in the best interest of the client.
  2. Narrative reasoning goes beyond scientific reasoning by allowing the clinician to understand the meaning of the illness or disability from the client's perspective as you enter their “life world.”
  3. Pragmatic reasoning addresses the whole world in which therapy occurs.  It considers the personal as well as the practice context in every given clinical situation.
  4. Ethical reasoning asks, "What should be done?  What is the eventual outcome?" It deals with the ethical issues that are involved in the client experience.

Synthesis of all four processes occurs through two components of reasoning that are intertwined throughout the process. These types of reasonings are referred to as the:

  1. Interactive process, which involves “doing with” not “doing to” the client. It is a crucial process that clinicians use to gain the trust of their clients. It helps the clinician to enter the clients “life world” to help reduce performance deficits and promote meaningful experiences with each client.
  2. Conditional process, which refers to the flexibility needed by practitioners to modify treatments and interventions with changing conditions. Novice therapists tend to rely on a more systematic approach to treatment versus the expert clinician that quickly adapts to any given situation.

Students must develop an understanding of the clinical reasoning process to assist them in making competent and sound judgments when caring for clients. Understanding how the process applies to the entire scope of client treatment prepares them for their professional journey.

Under the following clinical reasoning processes, students who complete the Occupational Therapy program will be able to:

Scientific Reasoning

  • Enhance the ability to address problems from a logical and holistic perspective when assessing client performance areas, performance components, and performance contexts during the assessment/intervention process.
  • Demonstrate an ability to apply and interpret frames of reference and models of practice to the evaluation and intervention process with clients.
  • Display an ability to utilize standardized and non-standardized screening tools and employ information received from consultants, health professionals, and family/client/significant others to determine need for occupational therapy services.
  • Select and administer a variety of standardized and non-standardized assessment tools using appropriate procedures and protocols that assist the clinician in fostering a creative problem solving approach.
  • Discuss ways to adapt life skills, occupations, and the environment of clients that are served and demonstrate the ability to instruct client/caregivers/family members/significant others on compensatory strategies for task completion.

Narrative Reasoning

  • Display an appreciation for an individual’s perception of illness or disease process and assist them to foster the promotion of health and wellness according to client need and respected culture and values.
  • Create occupationally and goal priority-based intervention plans that meet the individual, “life world,” needs of the client while acknowledging the client as an active participant in the intervention and discharge planning process.
  • Understand the importance of client-centered occupations associated with the intervention process before, during, and upon the discontinuation of occupational therapy service.
  • Produce evidence-based intervention plans that attend to performance areas, performance components, and performance contexts that are meaningful for the client.

Pragmatic Reasoning

  • Demonstrate ability to use safety precautions in professional situations including during client screening, evaluation, and intervention process.
  • Express the ability to collaborate with other professionals through documentation, oral communication, and client problem solving opportunities.
  • Display an understanding of socioeconomic, cultural, education, and models of health care and the relationship to occupational therapy practice.
  • Acknowledge the importance of the referral process to both internal as well as external specialists for assessment and intervention to best meet the needs of the client.
  • Recognize treatment resources available in the environmental context; acknowledge reimbursement regulations, time constraints, and social and institutional constraints that may impact the client treatment process.

Ethical Reasoning

  • Develop an appreciation of OT practice trends while demonstrating a personal commitment and positive attitude towards the profession.
  • Promote home and community services as an adjunct plan to support client adjustment to home or work setting, or alternative work or home situation
  • Display the ability to effectively communicate, educate, and train clients, family members, caregivers, or significant others in facilitating skills that will enhance occupational success, ensure safety and promote goal attainment.
  • Demonstrate ability to plan appropriately for discharge from occupational therapy services and terminate services in a timely and cost effective manner as goals and objectives are attained.

Interactive Process

  • Display an understanding of the importance of “doing with” not “doing to” the client receiving occupational therapy services.
  • Acknowledge the relevance of establishment of trust in the client-therapist relationship in order to reduce performance deficits and enhance meaningful life experiences.

Conditional Process

  • Develop an awareness of the importance of allowing for flexibility in clinical, professional, and non-professional situations, and the importance of making sound decisions within or outside of the practice environment, or in relationships with client, family, caregivers, and other professionals and or co-workers.