ABSTRACT
IMPORTANCE: The occupational therapy clinical reasoning literature includes a large proportion of peer-reviewed qualitative and conceptual articles. Although these articles can contribute to the understanding of how clinical reasoning has been conceptualized in occupational therapy, they have not yet received in-depth analytic attention. To address this gap, we conducted a scoping review. OBJECTIVE: To examine how qualitative and conceptual literature has addressed clinical reasoning in occupational therapy. DATA SOURCES: Database searches were conducted in Scopus, Web of Science, PsycINFO, Embase, and MEDLINE. STUDY SELECTION AND DATA COLLECTION: Included articles were published between 2010 and 2019, were peer reviewed, addressed clinical reasoning in occupational therapy, were qualitative or conceptual articles, focused on practitioners, and were in English. Twenty-six articles met the inclusion criteria. Data were extracted according to relevant categories and were analyzed numerically and thematically. FINDINGS: Four themes were identified: clinical reasoning processes, factors influencing clinical reasoning, new models or frameworks to guide clinical reasoning, and emergent perspectives on clinical reasoning. CONCLUSIONS AND RELEVANCE: This review advances knowledge about how clinical reasoning has been conceptualized in occupational therapy and has been applied in a range of practice contexts. The review highlights discussions about types of reasoning, the dynamic and iterative nature of reasoning, contextual dimensions of reasoning, client-centered and occupation-based approaches, new frameworks and models, and emergent and innovative perspectives on clinical reasoning in occupational therapy. What This Article Adds: This scoping review represents an important contribution to knowledge about how clinical reasoning has been conceptualized in occupational therapy by mapping key themes and illuminating scholarly conversations in the qualitative and conceptual clinical reasoning literature.
Subject(s)
Occupational Therapy , Clinical Reasoning , Communication , Humans , Occupational Therapy/methods , Occupations , Peer ReviewABSTRACT
O início da prática é um período de intensa socialização profissional e de vivências dilemáticas e estressantes. Este artigo apresenta parte dos resultados de uma pesquisa-ação que objetivou compreender aspectos do desenvolvimento profissional em terapia ocupacional, e contou com participação de seis terapeutas ocupacionais iniciantes, da pesquisadora e de dois terapeutas ocupacionais experientes em uma comunidade de prática, com encontros presenciais gravados e transcritos, e atividades virtuais dados analisados tematicamente. A temática dos dilemas vividos na prática iniciante e a construção de sentidos sobre eles organizaram-se em quatro subtemas: O não-saber como alimento para o desenvolvimento profissional; Ser terapeuta na saúde mental; O uso de atividades em saúde mental e o que é específico em terapia ocupacional; Aprender a encontrar o foco em atendimentos de curto tempo. Esperamos que este artigo possa ampliar reflexões sobre a formação inicial e continuada em terapia ocupacional, além de indicar novas possibilidades de pesquisa na temática.
El inicio de la práctica profesional es un período de intensa socialización y vivencias de dilemas y estrés. Este artículo presenta parte de los resultados de una investigación-acción con el objetivo de comprender algunos aspectos del desarrollo profesional en terapia ocupacional; participan seis terapeutas ocupacionales que inician su trabajo , la investigadora y dos terapeutas ocupacionales con experiencia, en una comunidad de práctica. Los encuentros presenciales fueron grabados y transcritos, además de actividades virtuales y los datos fueron analizados por tema. La temática de los dilemas vividos en la práctica inicial y la construcción de significados de éstos se organizaron en cuatro subtemas: La falta de conocimiento para el desarrollo profesional; ser terapeuta en la salud mental; el uso de actividades específicas de TO en salud mental y qué es para terapia ocupacional; aprender a encontrar el foco de la intervención de corto tiempo. Esperamos que este artículo pueda ampliar reflexiones sobre la formación inicial y continuada en terapia ocupacional, e indicar nuevas posibilidades de investigación en la temática.
The beginning of practice has been considered an intense professional period of socialization and high level of stress. This article presents some results from an Action Research which included the participation of six beginners occupational therapists, the researcher and two experienced occupational therapists in a community of practice. The meetings were recording and transcribing beside virtual activities. All data were thematically analyzed. The theme of dilemmas in the beginning of practice and the construction of meaning were organized in four themes: Non-knowing nurturing professional development; being a therapist in mental health; use of activities and occupational therapy specificity; learning to find the focus of the intervention on short-term care. We hope this study could expand reflections on initial and continuing training in occupational therapy, and to indicate new possibilities for research in the subject.
