The clinical reasoning of an occupational therapy assistant.

This qualitative case study focused on the clinical reasoning of a certified occupational therapy assistant who had 16 years of practice experience. Observation and interview methods were used to collect data. Transcripts and field notes were coded using a priori codes of the forms of clinical reasoning of occupational therapists identified in published research. The study participant demonstrated the use of pragmatic, procedural, interactive, conditional, and narrative reasoning. We encourage further research to support these findings and to increase the understanding of the forms of clinical reasoning used by occupational therapy assistants.

The predictive power of narrative data in occupational therapy evaluation.

OBJECTIVE: This study examined whether adding the Canadian Occupational Performance Measure (COPM) to existing occupational therapy evaluation measures used in a subacute skilled nursing facility unit enhanced the accuracy of therapists' predictions of the functional status of clients at discharge. METHOD: This study utilized a prospective comparison design. Two independent predictive variables were developed using the standard Functional Independent Measure (FIM), and an enhanced FIM that included narrative information from the Canadian Occupational Performance Measure (FIM/COPM). These variables were subsequently compared with the actual FIM discharge (DFIM) scores for 31 clients. The primary author (D.S.) gathered data from chart review and conducted the statistical analysis. The data were analyzed using descriptive correlations (Pearson r) and comparison statistics (Wilcoxon signed rank test). RESULTS: Comparison statistics (Wilcoxon signed rank test) revealed a statistically significant difference between the standard FIM predictive score and the discharge FIM score. No statistically significant difference was found between the FIM/COPM predictive score and the discharge FIM score. These findings suggest that predictive scores based solely on information attained from the standard FIM resulted in less accuracy in outcome predictions. Correlational analyses further supported these conclusions. CONCLUSION: The findings support the study hypothesis that use of the COPM in combination with the FIM enhances accuracy in prediction of outcomes for rehabilitative services for persons in adult physical disabilities settings.

Reconstructing Gloria: a narrative analysis of team meetings.

This article focuses on the role of stories told about a patient in geropsychiatric team meetings in the construction of an image of the patient. Using the narrative techniques described by Gee, Labov, and Riessman, three team meeting discussions about a geropsychiatric patient are analyzed. The role of stories and the various images these engender are examined in relationship to (a) the team's evolving understanding of the patient, (b) the team's conception of the role of the patient, and (c) how the thematic components of these stories may influence patient care.

Academic Juggling Act: beginning and sustaining an academic career.

Rapid expansion in the number and size of occupational therapy academic programs has resulted in a crucial need for faculty recruitment and retention. To encourage occupational therapy practitioners to consider academia as a career option, and to support those who choose this option, this article reviews higher education literature related to socialization into academia, the different types of academic institutions, the tenure system, and the process of entering into and sustaining an academic career. This literature is then correlated with issues in occupational therapy education. The article closes with specific literature-based suggestions for creating and sustaining an academic career through development of teaching skills, research agendas, and support systems.

"My secret life": the emergence of one gay man's authentic identity.

This qualitative study explores the life history of Bruce, a gay man, from the perspective of homophobia. Homophobia is the fear and hatred expressed toward gay men, lesbians, and bisexual women or men as well as persons suspected of being gay, lesbian, and bisexual. Homophobia may become internalized, creating a form of self-hatred derived from the negative stereotypes associated with homosexuality. Bruce's life was shaped by the homophobia of others and his own self-hatred, leading to isolation and a lack of a projected authentic identity. This article focuses on the affective meanings related to significant events in Bruce's life history and how they contributed to transformation in his life from victimic to agentic themes. It is important for occupational therapy practitioners to recognize the influence that homophobia and internalized homophobia have on therapeutic interventions.

Three images of interdisciplinary team meetings.

Teams are an essential aspect of health care today, especially in rehabilitation or chronic illness where the course of care is frequently long, complex, and unpredictable. The coordinative function of teams and their interdisciplinary aspects are thought to improve patient care because team members bring their unique professional skills together to address patient problems. This coordination is enacted through the team meeting, which typically results in an integrated care plan. This professional image of team meetings is explicit and addresses the description and provision of care as objective and rational activities. In contrast, the constructed and ritualistic images of health care team meetings are implicit and concern the less objective and rational aspects of planning care. The constructed image pertains to the definitional activity of team members as they try to understand patient troubles and achieve consensus. This process involves the individual clinical reasoning of team members and the collective reasoning of the group. The ritualistic image is that aspect of team meetings in which the team affirms and reaffirms its collective identity. Drawing from field research of geropsychiatric team meetings, this article defines and explicates these images, focusing on the constructed and ritualistic aspects of team meetings and the influence of these images on group function.

Achieving intersubjective understanding: examples from an occupational therapy treatment session.

Occupational therapists, like other health care professionals, must balance their application of treatment techniques with an understanding of their patients' life experiences. This paper reviews the literature from interpretive and medical sociology regarding the interplay between professional power and the achievement of an understanding of another person. It analyzes how an occupational therapist, during a single treatment session, enters into her patient's life-world and simultaneously controls and manages the treatment process. The concepts of knowledge schemata (the expectations and beliefs people bring to a situation) and footings (the shifts in alignment, or focus, that occur during interaction) are central to this analysis. The process of achieving a balance between professional power and an understanding of the patient's experience may be fostered in education and in clinical supervision through increased emphasis on the importance of understanding the values and beliefs of patients and on the development and refinement of interactive skills.