Module 1: Client-Centred Practice & Professional Reasoning Flashcards
What is Professional Reasoning?
The process that practitioners use to plan, direct, perform, and reflect on client care.
It is a FAST and COMPLEX process.
What does “embodied process” mean?
Using our senses (touch, smell, sight, and experience) to understand & experience something.
Where do we get KNOWLEDGE from to inform our REASONING?
- straightforward knowledge
- whole-body experience
- tacit knowledge
All 3 above are influenced by our values, beliefs, assumptions, and biases.
Why is professional reasoning important?
Understanding and being able to explain our professional reasoning makes the complexities and expertise of our work visible and tangible.
It also facilitates professional development by highlighting any gaps
6 MODES of REASONING
- scientific
- narrative
- pragmatic
- ethical
- interactive
- conditional
What is scientific reasoning?
Diagnostic: understand condition, OPI’s
Procedural: determine treatment plan
informed by scientific methods: hypothesis generation & testing, pattern-recognition, theory-based decision-making, evidence-informed
What is narrative reasoning?
Using client perspectives, values, and meanings to make decisions. Focuses on understanding the client’s experience and the meaning they attach to their experiences (past, present, and future).
What is Pragmatic Reasoning?
Practical considerations.
Practice: scheduling, equipment availability, management directives
personal: OT’s competency, preference, values, life demands
What is ethical reasoning?
Reasoning used in response to an ethical dilemma, i.e., “what should be done?”
Generating options, to determine a defensible, ethical course of action
Systematic approach that uses available resources: ethics board, COTBC code of conduct, risk assessment frameworks
What is interactive reasoning?
Intentional and intuitive processes used with the goal of fostering effective therapeutic relationships
What is conditional reasoning?
Using multiple modes of reasoning in conjunction with each other to determine a variety of potential outcomes.
Capacity to engage in this kind of reasoning builds with experience.
Describe the Ecological view of professional reasoning
Using information from the practice context, and perspectives and experiences from the client and the therapist to inform professional reasoning.
How to develop professional Reasoning
Be a reflective, life-long learner: think about thinking, reflect ON action, and reflect IN action, be reflexive.
examples: how did that go? why did I make that decision? what went well? what needs to change?
Developing professional reasoning: timeline for progression (what are the stages?)
- Novice (0 years)
- Advanced beginner (<1 year)
- Competent (1-3 years)
- Proficient (3-5 years)
- Expert (5-10 years)
What are some BARRIERS to effective professional reasoning?
- Early hypothesis generation (not collecting all information first)
- Unchecked assumptions
- Over-reliance on standard techniques (not being reflective on technique usage)
- Time pressures
- Workload demands (becoming robotic/automatic)
- Practice expectations
Occupational Engagement
Concept of occupational engagement broadens the scope of OT practice to help characterise people’s social participation in occupation REGARDLESS of their capacity to perform an occupation.
Engagement includes consideration of the nature (active vs passive), intensity, degree, etc.
Describe the concept of engagement
- strong cognitive-affective dimension - it is the inward facing component of occupation
- DOING may not be required for engagement
- subjective experience of doing
ex: mental activities when engaging in a specific occupation may vary from context to context, over time, etc.
What are the 4 modes of engagement along the disengagement-engagement continuum?
- disengagement
- partial engagement
- everyday engagement
- full engagement
Disengagement
fully disengaged from occupation
lack of agency
feeling “numb and heavy”
may hold a protective function
Partial engagement
Engagement with immediate environment
Can be used as an escape from business of life
Everyday engagement
Direction, commitment, shared experiences, attuned
Full engagement
Transcendent, engrossed, can be compared to “flow”
How do we find out about occupational engagement?
Interviewing: life history, interests, motivation, and passion; assess capabilities; determine what is meaningful for them; provide them with choice
Understand their foundational values and beliefs
Enablement as a Core Competency
Drawing on enablement skills that are value-based, collaborative, attentive to power inequities and diversity and charged with visions of possibility for individual and/or social change
CLIENT CENTRED, occupation-based
CCP & Indigenous Knowledge: Indigenous Health Characteristics
Indigenous Health Characteristics: diverse medical and healing traditions
- surgical & community-based responses to illness and injury
- holistic understanding of health & wellbeing
CCP & Indigenous Knowledge
Generally, knowledge is contextual: built from the land and environment, experience, given & not necessarily for everyone
Western science does not need to validate indigenous knowledge
As OT’s: advocate for indigenous knowledge for clients, connect them
CCP & Indigenous Knowledge: Wise Practices
“Locally-appropriate actions, tools, principles, or decisions that contribute significantly to the development of sustainable and equitable conditions”
Less dogmatic than “best practice” guiding principles
- make space for multiple ways of knowing
Assume indigenous peoples & communities have the wisdom, strength, and abilities to create their own solutions
Implement reconciliation into healthcare
Colonialism
Process that employs modes of control to manage a population and/or expropriate land, resources, and people
purpose is to secure wealth and/or privilege and power for colonizers.
Often enacted through policies and laws
Is a KEY DETERMINANT OF HEALTH for Indigenous Peoples.
Colonialism & OT: understanding “occupations”
Benefits of occupation understood from a white perspective - focused on reintegrating back into white, middle-class society
Daily occupations experienced through a filter of british colonialism
- “occupy” the land = removal of indigenous people from their land and is built into how Indigenous land rights are understood and upheld in canada
- consequence: limits opportunities for Indigenous people
Core assumptions about Occupation
Not necessarily shared by Indigenous People - but our models, assessments, and research are shaped by these assumptions
ex:
1. evidence-based practice and best-practice guidelines are appropriate for ALL clients
2. the approach and values of our services are beneficial and wanted by ALL clients
3. clients can/will tell us when our services are not a good fit for them
How can we practically move forward? Self Reflection
understanding of own identities and social positions
birthplace, language, culture
community and safety
govt systems working for or against us (ex: child welfare, police)
family belief systems and histories
adherence to colonial narratives
How can we practically move forward? Cultivate cultural humility
Express humility - recognize your own social positions, assumptions, and biases and respectfully acknowledge and build space for diverse worldviews and experiences
Week diverse perspectives and ask whose voices are missing? How can they be included?
Looks different for everyone - based on history, indigeneity, relationships
Listen to and prioritize indigenous experiences and knowledge (94 calls to action, MMIWG calls to justice, include indigenous resources and scholarship.
Learn and Respect Indigenous Rights
Right to self-determination
right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them
What are the critiques of CCP?
- negates the real differences in power and types of knowledge held between a person seeking health care and a health care provider and focuses on an individualistic perspective.
- relatively silent on therapists’ acknowledgment of their own social positionality and how their social positions affect therapy relationships.
- limited acknowledgement of oppressive structures and practices.
