Critical thinking and clinical reasoning in new graduate occupational therapists: a phenomenological study.

The aim of this study was to examine, understand and conceptualise the critical thinking and clinical reasoning adopted by new graduate occupational therapists as they enter the workforce to become newly autonomous practitioners. The study obtained the perspectives of new graduates, their supervisors and service managers on the means by which critical thinking and clinical reasoning develop to meet the expectations of employers. Factors which impeded the transition between new graduate and autonomous practitioner were identified and explored. Ethical approval was obtained to conduct the study. The study adopted a qualitative phenomenological research approach; Interpretative Phenomenological Analysis (IPA), which informed framing, data gathering and analysis. Semi-structured interviews were conducted with new graduates (n=6), supervisors (n=7) and managers (n=7) from multiple sites within one National Health Service Board. Interviews were transcribed verbatim from audio-recordings. The findings indicate that new graduates are expected to develop critical thinking and clinical reasoning in a manner that might challenge traditional conceptualisations of the transitioning process. A phenomenon, historically named the shock of practice, was reflected on by therapists in each phase of the study and adaptive and mal-adaptive responses to this in the thinking and behaviour of new graduates was identified. The clinical supervisor-supervisee relationship appeared to be the key source of support, and the supervisor the most significant knowledge resource, for new graduates. This relationship was supplemented by both peer support and Preceptorship. Discharge planning was a significant source of anxiety and development of an algorithm to support this process is proposed. Recommendations for further research and theoretical implications for practice and undergraduate education are discussed

The therapeutic use of videogames within secure forensic settings: a review of the literature and application to practice

Engagement in leisure pursuits that involves the use of tools and objects and the exploration of a new environment can provide a success experience that leads to increased feelings of competence and mastery. Such experiences are considered important in the rehabilitation of forensic clients. The findings from videogame research within a general population are compared with those among mental health and forensic clients. Within the general population, videogames may provide opportunities for social interaction and the expression of creativity and humour as well as offering a graded approach to building computer skills. Within a forensic population, videogames have been found to be a normalising, age-appropriate and culturally appropriate activity, useful in engaging clients and improving self-concept and locus of control. The findings suggest that videogame play offers access to a safe virtual environment that encourages exploration and mastery and that it may be a useful therapeutic tool in secure settings where such opportunities are often limited. The use and potential contraindications of videogames within a forensic setting, the content of certain games and their possible influence on behaviour and the implications for future research are also discussed

Learning and Development of Diagnostic Reasoning in Occupational Therapy Undergraduate Students

[Abstract] Background/Aim. One way to facilitate occupational therapy undergraduate students transferring their academic skills of data gathering and analysis to professional settings is to ensure they can competently use diagnostic reasoning. Nevertheless, there are several obvious gaps in empirical evidence related to the learning and development of this style of reasoning in occupational therapy undergraduates. The most important are related to promoting higher-order thinking and the use of information to solve problems in the context of professional practice. This study analyses undergraduates’ diagnostic reasoning and its changes during their education. Materials and Methods. This multicentre study was conducted with a descriptive observational design. The study took place at the University of Coruña (Spain), University of Castilla-La Mancha (Spain), and University of el Valle (Colombia). The sample was n = 247. For data collection, a clinical case was specifically designed. IBM SPSS Statistics (v19) and EPIDAT 3.1 were used for the data analysis. Results. Participants identified and categorized occupational performance problems. However, they had difficulties when identifying and categorizing the occupational performance components (specifically, the symptoms and signs of the disease presented in the study case). They presented limitations to analyse and synthesize the information collected to develop an explanation of the occupational problems and their causes. Conclusions. Undergraduate students’ ability to analyse and synthesize information during data collection is poorly organized, so it makes the problem formulation difficult. This study contributes to the knowledge of undergraduates’ diagnostic reasoning features, specifically the undergraduate students’ capacities and limits to process information during the occupational assessment

Occupational Therapists’ clinical reasoning in AAT with dogs in pediatric therapy

Purpose: The purpose of the study was to understand the clinical reasoning used by occupational therapists to select animal assisted therapy with a dog to be included in a treatment plan for their pediatric occupational therapy clients Theoretical Framework. The Ecology of Human Performance model supports the study purpose and emphasizes the effect of a person’s context and environment on their ability to function and perform tasks. Methods. The descriptive qualitative study used interviews of seven occupational therapy practitioners who have included dogs in therapy sessions with children. Interactive coding and theme development was employed with member checking applied to validate the data collected. An audit trail and reflexivity journal were kept adding rigor in the process. Results. Occupational therapy practitioners reported using standard occupational therapy evaluation practices and incorporated clinical reasoning afterward to determine if animal assisted therapy (AAT) with a dog would benefit their clients. Occupational therapy practitioners used experience and expertise to develop their AAT programs and select and train their dogs. Three themes emerged: Occupational therapy decision making processes are primary and fundamental, dogs are exceptional, intuitive therapy partners with unique needs, and adding animal assisted therapy to occupational therapy practice requires expertise beyond novice. Conclusions: Occupational therapy practitioners who wish to engage with dogs in therapy need advanced experience and thorough exploration of AAT practices, to best apply occupation centered therapy in context. Further research is needed to support occupational therapy practitioners who utilize AAT with dogs in practice

Fun Anatomy: A Supplemental Website for the Upper Extremity

In accordance with the Accreditation Council for Occupational Therapy Education (ACOTE) standards, the occupational therapy program at the University of Puget Sound requires the completion of an anatomy course as part of the master’s degree curriculum. Currently, the program’s functional anatomy course does not provide any online resources to support students’ mastery of course content. Due to advances in technology, an increasing number of professional degree programs are either web-based or are adding online elements (Donovan, 2008; Friedman, Watts, Croston, & Durkin, 2002; Fallon, 2011). Course-specific online resources have been shown to enhance student learning and performance (Thompson, Ford, & Webster, 2011). A customized supplemental website was created to accompany the functional anatomy course as a learning enhancement. The website includes diagrams, flash cards, quiz questions, case studies, and additional resources. The various elements of the website were developed to address different learning styles and to cycle students through the stages of Kolb’s model of experiential learning (Kolb, 1984; Friedman, Watts, Croston, & Durkin, 2002). The goal of the website is for the user to achieve a 90% standard on the quizzes and case study questions, which is higher than the university graduate school’s 83% (3.0 GPA) requirement to maintain good standing. Use of the website in a pilot study by a sample group of the program’s students resulted in 100% positive recommendation for its use as a resource in the functional anatomy course

The Potential of Virtual Reality in Social Skills Training for Autism: Bridging the Gap Between Research and Adoption of Virtual Reality in Occupational Therapy Practice

Impairments in social functioning greatly hinder children and youth with autism spectrum disorder (ASD) from responding appropriately and adapting to various social situations. As a result, individuals with ASD get fewer opportunities for social inclusion, physical well-being, and forming interpersonal relationships. Virtual reality (VR) has been studied extensively in this area, where a large body of evidence shows that VR is a promising tool for social skills training (SST) in individuals with ASD. With the flexibility and projected effectiveness that VR offers, it can provide more opportunities to learn and practice strategies for recognizing daily challenges that involve forming social relationships and associated reasoning. This paper discusses the gap between the effectiveness of VR-based SST and its adoption in occupational therapy (OT) practice. There is a significant dearth of resources for the development of occupational therapists to effectively administer these interventions. Such resources that summarize empirically supported VR interventions to teach social skills to people with autism would be very valuable in training therapists who wish to employ them. Using theory-driven approaches, this paper intends to empower occupational therapists in becoming efficient and confident in using this technology for addressing social skills deficits in people with ASD

Using Hermeneutics as a Qualitative Research Approach in Professional Practice

This paper is targeted primarily at doctoral students and others considering hermeneutics as a research strategy. Research using hermeneutics was carried out with occupational therapy educators and clinicians in Australia, New Zealand, Canada, and the UK. A total of 53 participants engaged in focus groups and individual interviews over a one-year. The paper explores hermeneutics as a credible, rigorous and creative strategy to address aspects of professional practice that similarly need to be flexible, adaptable to particular needs, and justifiable in the contexts of evidence-based as well as client-centred practice. The hermeneutic study produced A Model of Professional Practice Judgment Artistry (Paterson, 2003) which is briefly described and the connections

Case-Based-Reasoning System for Feature Selection and Diagnosing Disease; Case Study: Asthma

Asthma is a chronic informatory disease of the respiratory canals in which it has not become obvious what is the reason for the reports argumentation on the ground of asthma prevalence. In the present research, the purpose would be to design a case-based-reasoning (CBR) model in order to assist a physician to diagnose the type of disease and also the needed therapy. At first for designing this system, the disease variables were discriminated and were at the patients' disposal as a questionnaire, and after gathering the relevant data (CBR) algorithm was rendered on the data which led to the asthma diagnosis. The system was tested on 325 asthmatic and non asthmatic adult cases and was accessed with eighty percent accuracy. The consequences were promising. With regard to the fact that the factors of the disease are different in various countries, This study was performed in order to determine risk factors for asthma in Iranian society and the results of research showed that the most important variables of asthma disease in Iran are symptoms heperresponsivity, frequency of cough, cough. Key words: data mining, case based reasoning, asthma, diagnosis

Occupational therapists’ judgement of referral priorities: Expertise and training

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The British government currently requires mental health services to be targeted at the most needy (Department of Health, 1999). For occupational therapy services, where service demand far exceeds service availability, skill in referral prioritisation is essential. The studies in this thesis describe how experienced occupational therapists’ referral prioritisation policies were used to successfully educate novices. 40 British occupational therapists’ referral prioritisation policies were modelled using judgement analysis. Individuals’ prioritisation decisions were regressed onto 90 referral scenarios to statistically model how referral information had been used. It was found that the reason for referral, history of violence and diagnosis were most important. The occupational therapists’ capacity for self-insight into their policies was also examined by comparing statistically modelled policies derived from their behaviour with their subjective view of their cue use. Self-insight was found to be moderate (mean r = 0.61). A Ward’s cluster analysis was used on the statistically modelled policies to identify if subgroups of therapists had differing referral prioritisation policies. Four clusters were found. They differed according to several factors including the percentage of role dedicated to specialist occupational therapy rather than generic work. The policies that led to more of an occupational therapy role were found to give particular importance to the reason for referral and the client’s diagnosis. The occupational therapy professional body supports this latter method of working as it has recommended that occupational therapists should use their specialist skills to ensure clients’ needs are met effectively. Therefore the policies that focussed on clients’ occupational functioning were used to train the novices. Thirty-seven students were asked to prioritise a set of referrals before and after being shown graphical and descriptive representations of the policies. Students gained statistically significant improvements in prioritisation. Students’ pre-training policies were found to be those of generic therapists; a method of working that has been found to be leading to reduced work satisfaction and burnout (Craik et al.1998b). The training is therefore needed to ensure undergraduate occupational therapy students develop effective referral prioritisation skills. This will help to ensure that clients’ needs are met most effectively and work stress is reduce

Healthcare Students’ Perceptions of Simulation Education at an Urban University

BACKGROUND: Healthcare institutions use patient simulation as a standard aspect of training healthcare students with practical skills before they graduate and encounter with real patients. Simulation can foster the learning process of clinicians as it mimics clinical scenarios. To enhance the healthcare learning environment, it is essential to examine students’ perceptions toward the use of simulation in healthcare programs and to which degree the simulation courses influence their learning process and will assist educators initiate an effective simulation course. PURPOSE: The study’s purpose was to evaluate the perceptions of students’ use of simulation in nursing, respiratory therapy, physical therapy, nutrition, and occupational therapy programs. Method: Data were collected through a descriptive survey using a convenience sample. The survey presented in 4-point Likert-type scale and consisted of 10 questions. RESULTS: Two hundred and fifty students (N=250) were surveyed from five different programs; Physical therapy students accounted for 29.2%; followed by Nursing students 28%; Respiratory Therapy students 27.6%; Occupational Therapy students 7.6%; and nutrition students 7.2%. The majority of participants were female (70.4%) while male students represented 29.6% of the population. Almost 58% of participants reported that they did not have any experience working in a healthcare setting. The majority of students (95.2%) reported that they engaged in a clinical simulation experience in their healthcare program. The study findings indicate students’ overall perceptions have a high agreement with the statement that simulation experience was a valuable learning experience with mean = 3.52 (SD ± .577). Students demonstrate a high agreement that simulation should be an integral part of clinical experience with a mean of 3.48 (SD ± .599). Moreover, Students reported that simulation debriefing experience support their understanding and reasoning (mean=3.47, SD ± .598). The study findings revealed that clinical experience have no significant effect on students’ perception toward simulation. However, female students reported that they experienced more nervousness during simulation than male students (P value = 0.005). Moreover, students who had previous simulation experience reported more agreement that simulation was realistic than students who did not have any simulation experience (P= 0.049). CONCLUSION: Healthcare professional students have a good perception toward simulation education and feel that simulation should be integral part of education. Further studies with higher number of participants and different institutions is recommended