It’s like a virus - the number of occupational therapy bloggers is growing, and the online community of occupational therapists is becoming more connected. Join in if you want to be challenged and enthused!
I’m passionate about people knowing why they make the decisions they do in therapy, so this month I set the topic of ‘clinical reasoning’ to find out what other occupational therapists do when they are working their way through a therapeutic decision.
Clinical reasoning is ‘the ability to select and use information effectively in solving problems…a teachable cognitive skill independent of specific clinical knowledge.’ (Elstein, 1995). Another way of looking at it is the ‘process of making sense of a clinical encounter.’ Clinical reasoning ‘is a dynamic process that occurs before, during, and after the collection of data through history, physical examination, clinical testing and observation.’ (Weiner, 1996).
Occupational therapists have been called the ‘problem solving’ profession, and one clear strength in occupational therapy is the ability to work out ‘what to do’ in a given clinical situation. It can also be a limiting factor because the ability to intuitively work out what to do is influenced by cognitive biases and errors that therapists may not be aware of or accommodate.
The first time a therapist attempts a new assessment or intervention is often the time he or she examines exactly what factors will influence the clinical decision. Cheryl presents Jobsite Analysis posted at Occupational Therapy Notes. In this post she explores the process she used to prepare for her first jobsite analysis. (As a quick aside, Cheryl apologises for the length of her posts - if you take a look at mine, I think we’re about equal!) What Cheryl illustrates to me is the iterative process that is an integral part of clinical reasoning - back and forth from the literature to the clinical situation to the literature and back again.
You can pretty much bet that Chris will have something to interest a curious mind - Chris Alterio presents Monday morning spaghetti posted at ABC Therapeutics Occupational Therapy Weblog. This post especially highlights the way a therapist needs to consider the question: who has the problem? If occupational therapy is a key problem solving profession, it’s important to decide whether the person thought to have the problem actually has one, or whether it might be about the cultural context in which the person is living. Remember that in a ‘medical model’, hormone changes at mid-life can be called ‘hormonal insufficiency’ - or we might call it simply menopause!
Now this next post is not an occupational therapy one, and it’s not even about clinical reasoning - but I did like it, it was submitted to the carnival and for my own perverse reasons I’m going to include it. I am not, however, including the couple of entries on skin care products, nor the adverts for computer services or training! Anna Farmery presents 10 Reasons Why Your Relationship with You Matters posted at The Engaging Brand. I liked this because Anna makes some good points about being true to yourself especially when being involved in an on-line community.
The Salford University Occupational Therapy Blog discussed whether occupational therapists have core values or core skills. This is probably one of the things I have come to acknowledge in my practice in occupational therapy. While some of what an occupational therapists does is ‘unique’ to occupational therapy, there are an awful lot of areas that are common to many health professions - some of them are skills such as being able to establish rapport, being able to ask open-ended questions; others are values such as respect, empathy, honesty and valuing the individual’s perspective.
Alece Kaplan presents Death With Dignity Act Implemented on March 4th posted at OT Advocacy, saying, “A blog post about the ways that Washington State’s new Death With Dignity Act impacts occupational therapists.” I don’t come from the US, but I think everyone who works in health will at some point need to take time to think about death and dying.
Ouch! Not something I’ve experienced, thankfully, but some of the people I see have had one, and proceeded to experience chronic pain - so it’s good to learn how to identify and manage this pretty common injury.
One of the most enthusiastic members of the international occupational therapy e-community is Claire. Claire Hayward presents I don’t want to make people independant: occupational heresy? posted at E-nableOT. Do you think she’s being a heretic by not always wanting to ‘make people independent’? My own reflection is this: we need to be guided by a balance between what is culturally appropriate in terms of independence, what the person within his or her own context wants, and what the literature suggests is the most appropriate approach in the long term for the individual-in-context. Do you notice that ‘contextual’ part of my definition? Context isn’t just about the person and his or her beliefs, but also about the family, the neighbourhood, the local community - and the larger community at both the societal and political levels.
I think occupational therapy can benefit from going outside the occupational therapy literature to see what other scientists have found out about factors that influence human behaviour. For that reason I am probably just as heretical as Claire in that I often adopt therapeutic methods and models from other fields of learning in order to help the people I work with achieve their occupational performance goals.
My own contribution to this carnival involves several musings on the way we as clinicians might be tripped up by our cognitive errors. I posted these three posts last year, but I think they’re both relevant and practical. Go here, here and here for my take on decision-making and what we can learn from cognitive psychology.
If you’ve enjoyed this carnival, and want to read more - you can visit each of the blogs mentioned in today’s post, and you’ll be sure to find out some interesting things.