W & S Chapter- Professional Reasoning in Practice (Prof Dev)

professional reasoning

• process OT practitioners use to plan, direct, perform, and reflect on client care

• involves look at the client from multiple perspectives

How do we use critical thinking for problem solving

information→interpretation→decision→action→reflection (what worled and what did not)

Basic process of problem solving

1. identify the problem

2. gather info

3. analyze info

4. generate possible explanations/solutions

5. evaluate options

6. make a decision and act

7. reflect and modify

types of professional reasoning

• scientific/diagnostic reasoning

• procedural reasoning

• interactive reasoning

• narrative reasoning

• conditional reasoning

• pragmatic reasoning

• ethical reasoning

Scientific/diagnostic

What’s happening/causing the problem

ex) determine why client can’t dress

procedural

what should I do?

ex) choosing dressing interventions

interactive

how do I work with this person?

ex) buid rapport/motivate client

narrative

what’s the client’s story/meaning?

ex) understand why returning home matters

conditional

what if…?

ex) predict how performance may change at home

pragmatic

whats realistically possible

ex) consider cost/resources/time

ethical

what should I do?

ex) balances safety and autonomy

Novice

• expertise isn’t determined solely by years of experience

• familiarity with the task and context matters

• someone can be highly skilled in one setting but much less competent in another

levels of proficiency

Novice→Advanced beginner→competent→proficient→expert

Novice main characteristics

• little/no experience

• relies heavily on rules and guidelines

• thinking is more rigid

• has difficulty recognizing patterns

• needs external guidance

• focuses on individual pieces of info

novice example

• student OT is treating a stroke client for the first time

• they think: “the textbook says this intervention is appropriate for this impairment, so I’ll use it”

• need FWE to guide them

• key word: RULES

advanced beginner characteristics

• has some experience

• begins incorporating context

• recognizes differenes between textbook/theoretical expectations and real-life presentations

• still relies on external guides

• begins developing pragmatic and narrative reasoning

• begins recgonizing more sublte ethical issues

advanced beginner example

• student realizes: the textbook says this should work, but this client isn’t responding the same way

• starting to see that every client isn’t exactly like the textbook

• key word: CONTEXT

Competent characteristics

• usually around 1-3 years

• automatically performs more therapeutic skills

• can identify and prioritize relevant info

• develops goals based on desired outcomes

• planning becomes more deliberate and efficient

• uses conditional reasoning to modify interventions

• recognizes ethical dilemmas in practice

competent example

• OT looks at a complicated client": these 3 problems are present, but this one is the priority because it is preventing the client from completing their morning routine

• key word: PRIORITIZE

proficient characteristics

• usually around 3-5 years

• begins seeing situations as wholes rather than individual pieces

• uses experience to evaluate situations more effectively

• greater flexibility

• combines different diagnositic and procedural approaches creatively

• more attentive to the client’s occupational story

• better at negotiating resoueces

• more sophisticated ethical reasoning

proficient example

• instead of “poor balance +weakness + dressing difficulty

• sees: this client’s physical limitations, home environment, routines, family expectations, and personal goals are all affecting dressing independence

• key word: WHOLE

Expert characteristics

• usually around 5-10 years

• clinical reasoning becomes quick and intuitive

• procedural and pragmatic reasoning become more detailed

• conversation and action flow smoothly

• uses deep understanding of the client and their perspective

• relies more on internal guides/images rather than external rules

expert example

• experienced OT notices something during a client’s movement and immediately recognizes that client is compensating for a problem

• key word: INTUITION