دوره 15، شماره 3 - ( September 1396 )                   جلد 15 شماره 3 صفحات 286-277 | برگشت به فهرست نسخه ها


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Shafaroodi N, Kamali M, Parvizi S, Hassani Mehraban A. Occupational Therapists' Clinical Reasoning: A Qualitative Study . Iranian Rehabilitation Journal 2017; 15 (3) :277-286
URL: http://irj.uswr.ac.ir/article-1-695-fa.html
Occupational Therapists' Clinical Reasoning: A Qualitative Study . مجله انگلیسی زبان توانبخشی. 1396; 15 (3) :277-286

URL: http://irj.uswr.ac.ir/article-1-695-fa.html


چکیده:   (7881 مشاهده)

Objectives: Clinical reasoning is at the heart of clinical work; it is affected by different field factors. A clear understanding of the reasoning process could solve practitioners' problems on how to make their underlying theories, assumptions and values more explicit. The aim of this research is to understand how clinical reasoning process is formed in the context of occupational therapists working in different clinical settings in Iran.
Methods: A purposeful and theoretical sampling of 15 occupational therapists working in clinical settings was performed through semi-structured interviews. All the data were recorded, transcribed, and analyzed using Strauss and Corbin’s (2008) grounded theory approach and constant comparative analyses.
Results: Conceptual model was developed to explain the relationships among the main categories extracted through the grounded theory. Achieve an observable change emerged as the core category. Other important categories linked to the core category were, performing the continuum of clinical reasoning, context of clinical reasoning, and effective factors in clinical reasoning.
Discussion: Findings showed that achieving an observable change in the client was the main consequence of the action/interaction strategies. Some facilitating factors related to the therapist, helped to process reasoning with a holistic and client-centered view, while also helping to develop the self-belief and professional identity. The dominance of medical views and a lack of health insurance were two intervening factors that constrained the dynamics of clinical reasoning within the context of practice.

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نوع مقاله: پژوهشي | موضوع مقاله: کاردرمانی
دریافت: 1396/2/3 | پذیرش: 1396/5/10 | انتشار: 1396/7/10

فهرست منابع
1. Quiroga VAM. Occupational therapy: The first 30 years 1900 to 1930. Bethesda: American Occupational Therapy Association; 1995. [PMCID]
2. Mattingly C. What is clinical reasoning? American Journal of Occupational Therapy. 1991; 45(11):979–86. doi: 10.5014/ajot.45.11.979 [DOI:10.5014/ajot.45.11.979]
3. Rogers J, Masagatani G. Clinical reasoning of occupational therapists during the initial assessment of physically disabled patients. The Occupational Therapy Journal of Research. 1982; 2(4):195–219. doi: 10.1177/153944928200200401 [DOI:10.1177/153944928200200401]
4. Mattingly C, Flemming MH. Clinical reasoning: Forms of inquiry in a therapeutic practice. Philadelphia: FA Davis; 1993. [PMCID]
5. Rogers J. Clinical reasoning: The ethics, sciences, and art. American Journal of Occupational Therapy. 1983; 37(9):601-16. doi: 10.5014/ajot.37.9.601 [DOI:10.5014/ajot.37.9.601]
6. Unsworth C. Using a head-mounted video camera to explore current conceptualizations of clinical reasoning in occupational therapy. American Journal of Occupational Therapy. 2005; 59(1):31–40. doi: 10.5014/ajot.59.1.31 [DOI:10.5014/ajot.59.1.31]
7. Audétat MC, Laurin S, Sanche G, Béïque C, Fon NC, Blais JG, et al. Clinical reasoning difficulties: A taxonomy for clinical teachers. Medical Teacher. 2012; 35(3):e984–e989. doi: 10.3109/0142159x.2012.733041. [DOI:10.3109/0142159X.2012.733041]
8. Boyt Scell BA. Professional reasoning in practice. In: Willard HS, Crepeau EB, Cohen ES, Schell BAB, editors. Willard & Spackman's Occupational Therapy. Philadelphia: Lippincott Williams & Wilkins; 2009.
9. Loftus S. Rethinking clinical reasoning: time for a dialogical turn. Medical Education. 2012; 46(12):1174–8. doi: 10.1111/j.1365-2923.2012.04353.x [DOI:10.1111/j.1365-2923.2012.04353.x]
10. Carrier A, Levasseur M, Bedard D, Desrosiers J. Clinical reasoning process: Cornerstone of effective occupational therapy practice. In: Söderback I, editor. International Handbook of Occupational Therapy Interventions. Berlin: Springer; 2015. [DOI:10.1007/978-3-319-08141-0_5]
11. Robertson L, Griffiths S. Clinical reasoning in occupational therapy: Controversies in practice. In: Robertson L, Griffiths S, editors. Problem Solving in Occupational Therapy. Hoboken, New Jersey: Wiley-Blackwell; 2012. [DOI:10.1002/9781118702833]
12. Cohen S. Using cultural-historical activity theory to study clinical reasoning in context. Scandinavian Journal of Occupational Therapy. 2008; 15(2):82–94. doi: 10.1080/11038120701534975 [DOI:10.1080/11038120701534975]
13. Fleming H. Aspects of clinical reasoning in occupational therapy. In: Willard HS, Crepeau EB, Cohen ES, Schell BAB, editors. Willard & Spackman's Occupational Therapy. Philadelphia: Lippincott Williams & Wilkins; 2009.
14. Chapparo C. Clinical reasoning in occupational therapy. In: Higgs J, Jones MA, editors. Clinical Reasoning in the Health Professions. Amsterdam: Elsevier; 2008.
15. Finlay L. Through the looking glass: Inter subjectivity and hermeneutic reflection. In: Finlay L, Gough B, editors. Reflexivity: A Practical Guide for Researchers in Health and Social Sciences. Hoboken, New Jersey: Blackwell Sciences; 2003. https://doi.org/10.1002/9780470776094 [DOI:10.1002/9780470776094.ch8]
16. Ryan S, Higgs J. Teaching and learning clinical reasoning. In: Higgs J, Jones M, editors. In: Higgs J, Jones MA, editors. Clinical Reasoning in the Health Professions. Amsterdam: Elsevier; 2008.
17. Schell B. Pragmatic reasoning. In: Schel B, Schell JW, editors. Clinical and Professional Reasoning in Occupational Therapy. Philadelphia: Lippincott& Wilkins; 2008.
18. Unsworth C. The clinical reasoning of novice and expert occupational therapists. Scandinavian Journal of Occupational Therapy. 2001; 8(4):163–73. doi: 10.1080/110381201317166522 [DOI:10.1080/110381201317166522]
19. Whiteford G, Clair VWS. Occupation and practice in context. London: Churchill Livingstone; 2004.
20. Schell B, Unsworth C, Schell J. Theory and practice: New directions for research in professional reasoning. In: Schel B, Schell JW, editors. Clinical and Professional Reasoning in Occupational Therapy. Philadelphia: Lippincott& Wilkins; 2008.
21. Turpin M, Iwama M. Professional reasoning in context. In: Turpin MJ, Iwama MK, editors. Using Occupational Therapy Models in Practice: A Fieldguide. London: Churchill Livingstone; 2011.
22. Browne J. Grounded theory analysis: Coming to data with questioning minds. In: Minichiello V, Sullivan K, Greenwood R, Axford R, editors. Research Methods for Nursing and Health Science. London: Pearson; 2004.
23. Charmaz K. Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, California: SAGE; 2006.
24. Corbin JM, Strauss AL. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, California: SAGE; 2008. [DOI:10.4135/9781452230153]
25. Polit DF, Beck CT. Nursing research: Principles and methods. Philadelphia: Lippincott Williams and Wilkins; 2003.
26. Hallberg L. The "core category". Developed categories were integrated to form the of grounded theory: Making constant comparisons. International Journal of Qualitative Studies on Health and Well-being. 2006; 1(3):141-48. doi: 10.3402/qhw.v1i3.4927 [DOI:10.3402/qhw.v1i3.4927]
27. Copley JA, Turpin MJ, King TL. Information used by an expert pediatric occupational therapist when making clinical decisions. Canadian Journal of Occupational Therapy. 2010; 77(4):249–56. doi: 10.2182/cjot.2010.77.4.7 [DOI:10.2182/cjot.2010.77.4.7]
28. Harries P, Harries C. Studying clinical reasoning, Part 1: Have we been taking the wrong 'Track'? British Journal of Occupational Therapy. 2001; 64(4):164-68. doi: 10.1177/030802260106400402 [DOI:10.1177/030802260106400402]
29. Robertson L. Clinical Reasoning,part 1: The Nature of problem solving, a literature review. British Journal of Occupational Therapy. 1996; 59(4):178-82. doi: 10.1177/030802269605900407 [DOI:10.1177/030802269605900407]
30. Taylor R, Lee S, Kielhofner G. Therapeutic use of self: A nationwide survey of practitioners' attitudes and experiences. American Journal of Occupational Therapy. 2009; 63(2):198-207. doi: 10.5014/ajot.63.2.198 [DOI:10.5014/ajot.63.2.198]
31. Schell B, Harris D. Embodiment: Reasoning with the whole body. In: Schel B, Schell JW, editors. Clinical and Professional Reasoning in Occupational Therapy. Philadelphia: Lippincott& Wilkins; 2008.
32. Stineman M, Rist P, Burk J. Through the clinician's lens: Objective and subjective views of disability. Qualitative Health Research. 2009; 19(1):17-29. doi: 10.1177/1049732308327853 [DOI:10.1177/1049732308327853]
33. Salehpour Y, Adibsereshki N. [Disability and Iranian culture (Persian)]. Tehran: University of Social Welfare and Rehabilitation Sciences; 2001.
34. Kelly G. Understanding occupational therapy: A hermeneutic approach. British Journal of Occupational Therapy. 1996; 59(5):237-42. doi: 10.1177/030802269605900515 [DOI:10.1177/030802269605900515]
35. Shafaroodi N, Kamali M, Parvizy S, Mehraban AH, O'Toole G. Factors affecting clinical reasoning of occupational therapists: A qualitative study. Medical Journal of The Islamic Republic of Iran. 2014; 28:8. PMID: 25250253 [PMID] [PMCID]
36. Carrier A, Levasseur M, Bedard D, Desrosiers G. Clinical reasoning process underlying choice of teaching strategies: A framework to improve occupational therapists' transfer skill interventions. Australian Occupational Therapy Journal. 2012; 59(5):355-66. doi: 10.1111/j.1440-1630.2012.01017.x [DOI:10.1111/j.1440-1630.2012.01017.x]
37. Unsworth C. Team decision-making in rehabilitation. American Journal of Physical Medicine and Rehabilitation 1996; 75(6):483-86. doi: 10.1097/00002060-199611000-00019 [DOI:10.1097/00002060-199611000-00019]
38. Van-Ryan M, Burke J. The effect of patient race and socio-economic status on physician's perceptions of patients. Social Science and Medicine. 2000; 50(6):813-28. doi: 10.1016/s0277-9536(99)00338-x [DOI:10.1016/S0277-9536(99)00338-X]
39. Wainwright SF, McGinnis PQ. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care setting. Journal of Allied Health. 2009; 38(3):143-51. PMID: 19753425 [PMID]
40. Bannigan K, Moores A. A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy. 2009; 76(5):342-52. doi: 10.1177/000841740907600505 [DOI:10.1177/000841740907600505]
41. Carrier A, Levasseur M, Freeman A, Mullins G, Quénec'hdu S, Lalonde L, et al. Influence of societal and practice reasoning: a scoping study protocol. BMJ Open. 2013; 3(4):e002887. doi: 10.1136/bmjopen-2013-002887 [DOI:10.1136/bmjopen-2013-002887]
42. Robertson L, Griffiths S. Problem solving in occupational therapy. In: Robertson L, editor. Clinical Reasoning in Occupational Therapy: Controversies in Practice. Hoboken, New Jersey: Wiley-Blackwell; 2012. [DOI:10.1002/9781118702833]
43. Sinclair K. Model for the development of clinical reasoning in occupational therapy [MSc. thesis]. Hong Kong: The Hong Kong Polytechnic University; 2003.
44. Hambert TK. The use of clinical reasoning skills by experienced occupational therapy assistants. Pennsylvania: Pennsylvania State University; 2004. [PMID]
45. McKay E, Ryan S. Clinical reasoning story telling: Examining a student's story on the fieldwork of placement. British Journal of Occupational Therapy. 1995; 58(6):234-8. doi: 10.1177/030802269505800602 [DOI:10.1177/030802269505800602]

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