A clinical reasoning framework for community occupational therapists:A formative evaluation study
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Community occupational therapy in New Zealand brings challenges to the clinical reasoning process because the caseloads of individual therapists are high and the scope of the role is wide and generalist in nature. In addition, working alone in isolated locations is common and each case presents a substantially new situation for the therapist in the form of the client, their outlook, family dynamics and environment. The literature suggests that therapists can improve their clinical reasoning; contributing to positive outcomes for the client, the service and the profession, by using a framework, model or protocol as a practice guide. A practice guide can provide a structure that encompasses all of the elements for consideration; which helps therapists make good therapeutic decisions and keeps interventions relevant to practice. No literature was found that indicated community occupational therapists in New Zealand were using a practice guide for clinical reasoning. This small scale formative evaluation study presents a clinical reasoning framework, developed by the researcher from concepts influential in the occupational therapy literature. The framework aims to increase users’ knowledge of the multifaceted nature and types of clinical reasoning and how they interrelate, to provide clarity to complex clinical situations to improve decision making and communication of reasoning processes. Four community occupational therapists in the mid North Island of New Zealand evaluated the clinical reasoning framework over a six week period and describe the impact and value of using the framework to their practice. The participants of the study concluded that the clinical reasoning framework brought value to their clinical practice. In particular the value identified was: a) structure to practice, b) encouraged critical reflection, c) identified gaps in knowledge, d) brought to the foreground the multi aspects of clinical reasoning, e) encouraged theory and best practice and, f) improved understanding and articulation of the clinical reasoning process. The framework was considered to be useful to the practice of all community occupational therapists, particularly students and new graduate therapist.
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