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PROFESSIONAL REASONING IN
PRACTICE, COGNITVE PROCESSES,
ASPECTS, ECOLOGICAL VIEW,
DEVELOPING, IMPROVING
PROFESSIONAL REASONING
LEARNING OBJECTIVES
1. To Analyze important aspects of reasoning in occupational
therapy practice.
2. To learn the reasoning process is embedded in the
transactions that occur among the practitioner, the client, and
the practice context.
3. To identify the different facets of professional reasoning
based on personal reflection, practitioners’ descriptions, and
case studies.
4. To learn the process of developing expertise and discuss
characteristic reasoning processes along a continuum of
expertise.
Learning Outcome

Will be able to explain the various aspects involved in

professional reasoning.
Will be able to understand and explain the methods of
developing and improving professional reasoning.
Will be able to know the importance of Professional
reasoning in practice and the cognitive process
underlying the same.
Introduction
Professional reasoning is the process that practitioners
use to plan, direct, perform, and reflect on client care. It
is typically performed quickly because the practitioner
has to act on that reasoning right away.
It is a complex and multifaceted process, and it has
been called by several different names.
In the past, many authors referred to it as clinical
reasoning (Mattingly & Fleming, 1994; Rogers, 1983;
Schell & Cervero, 1993), and terms such as professional
reasoning (Schell & Schell, 2018) and therapeutic
reasoning (Kielhofner & Forsyth, 2002).
REASONING IN THEORY AND
PRACTICE
In the role of theory in professional practice (Kessels &
Korthagen, 1996),theories help practitioners to make
decisions, although (Cohn, 1989) noted that the
problems of practice rarely present themselves in the
straightforward manner.

In problem identification and problem solution,

practitioners blend theories with their own personal and
practice experiences to guide their actions.
Cognitive Processes Underlying
Professional Reasoning
In cognitive process the mind appears to use frames, scripts
to support effective processing of information by providing
efficient mental frameworks for handling complex
information (Carr & Shotwell, 2018;Norman, 2005). Each
person individually constructs them. It is no surprise that
students and new practitioners often struggle to retain and
effectively use their therapy knowledge.

It takes time and repetition of experiences to develop

effective reasoning based on efficient storage in long-term
memory allowing for targeted use of short-term memory as
therapy happens.
Important aspects of the process are as follows (Roberts, 1996):

 Cue acquisition: searching for the helpful and targeted information through observation and
questioning.

 Pattern recognition: noticing similarities and differences among situations.

 Limiting the problem space: using patterns to help focus cue acquisition and knowledge
application on the most fruitful areas.

 Problem formulation: developing an explanation of what is going on, why it is going on, and what
a better situation or outcome might be.

 Problem solution: identifying courses of action based on the problem formulation

These cognitive processes are interactive and rarely occur in a linear fashion. Rather, the mind
jumps around between the information at hand and that which has been stored up from prior
learning while attempting to make sense of the situation.
Aspects of Professional Reasoning
Fleming (1991) was the first within OT to describe how
occupational therapists seemed to use different
thinking approaches depending on the nature of the
clinical problem they were addressing.

There are different aspects of professional reasoning

in occupational therapy and they are:
Scientific Reasoning:
It involves in the use of applied logical and scientific
methods, such as hypothesis testing, pattern recognition,
theory-based decision making, and statistical evidence.
It is used to understand the condition that is affecting an
individual and to decide on interventions that are in the
clients best interest. It is also referred to as treatment
planning.
 Forms of scientific reasoning are diagnostic reasoning
and procedural reasoning in addition to the general
use of hypothetical- deductive reasoning.
Diagnostic reasoning:
It is concerned with clinical problem sensing and problem definition.
Investigative reasoning and analysis of cause or nature of conditions requiring
OT intervention can be considered.

Procedural reasoning:
It is when the practioners are thinking about the disease or disability and
deciding which intervention activities they might employ to remediate a
person’s functional performance problems.
Narrative Reasoning:
Here we understand the meaning that a disease, illness, or
disability has to an individual is a task that goes beyond the
scientific understanding of disease processes and organ systems.
It is so named because it involves thinking in story form.

Pragmatic Reasoning:
Practical reasoning that is used to fit therapy possibilities into
the current realities of service delivery, such as scheduling
options, payment for services, equipment availability, therapists’
skills, management directives, and the personal situation of the
therapist.
Ethical Reasoning :
Reasoning directed toward analyzing an ethical dilemma,
generating alternative solutions, and determining actions to be
taken.

Interactive Reasoning :
Thinking directed towards building positive interpersonal
relationships with clients, permitting collaborative problem
identification and problem solving.
Therapist is concerned about what the client likes or does not
like, use of praise, empathetic comments to encourage and
support client’s cooperation.
Ecological View of Professional
Reasoning
Professional reasoning is an ecological process that involves multiple therapist,
client, and context factors. SCHELL’S ECOLOGICAL MODEL OF
PROFESSIONAL REASONING have additional assumptions include the
following:
 1. Occupational therapy is a co-constructed process between the therapist
and the client.
 2. What actually happens in therapy is the result of a transaction
 among the therapist, the client, and the practice context.
 3. There are a number of personal and practice context factors that influence
professional reasoning, the client, and the therapy process. Some of these
factors are known to the participants and some are tacit or unknown.
 4. Therapy outcomes are affected by this nexus of factors, along with the
nature of the occupational performance/participation problem, and the
client’s therapy-related actions outside of therapy.
 The practitioner’s reasoning is shaped by both personal and
professional perspectives. Each practitioner brings to the therapy
situation knowledge and skills that are grounded in life experiences,
including personal characteristics such as physical capacities,
personality, values, and beliefs. These form personal self that
consists of person’s characteristics. These factors shape the
perception and interpretation of life events.

The professional self consists of therapists knowledge through

education, experience from prior clients , along with knowledge of
specific technical skills and therapy routines available for use in
practice.
Developing and Improving
Professional Reasoning
Here we understand the complexity of professional reasoning helps
students and practitioners alike to appreciate why it takes so long to
truly become an excellent practitioner.

Reflection in Practice:

Schön (1983) proffered the term reflective practitioner to

describe how experts think critically about their own experience.
Reflection happens in 2 ways:
Reflection in action-the practitioners ability to think in the middle
of action and adapt to meet the demands of situation.
Reflection on action-critical thinking that occurs after the fact.
Expertise Continuum:

There is a slowly growing body of evidence about the nature of reasoning in OT.
1. Novice (no experience in practice area)
Its characteristics :
No experience in situation of practice; depends on theory to guide practice,
Recognizes overt ethical issues.
2. Advanced beginner (<1yr)
Its characteristics :
Begins to incorporate contextual information into rule-based thinking .
Recognizes differences between theoretical expectations and presenting problems.
3. Competent (1–3 yr)
Its characteristics :
Automatically performs more therapeutic skills and attends to more issues.
Is able to develop communal horizon with people receiving service.
 Proficient (3–5 yr)
Its characteristics :
Reflects on expanded range of experiences, permitting more focused
evaluation and more flexibility in intervention.
Creatively combines different diagnostic and procedural approaches.
More attentive to occupational stories and relevance for intervention
.
Expert (5–10 yr)
Its characteristics :
Clinical reasoning becomes a quick process.
Procedural and pragmatic reasoning more detailed.
Able to flow conversation and action smoothly.
Conclusion
Professional reasoning is the process that practitioners
use to plan, direct, perform, and reflect on client care.
It is an embodied multisensory process that requires
complex cognitive activity. Practitioners develop
cognitive frames and scripts as they gain experience,
forming the basis of professional knowledge and
action.
Professional reasoning is multifaceted and enables
practitioners to understand client issues from different
perspectives.
CASE STUDY
 TERRY AND MRS. MUNRO: DETERMINING APPROPRIATE RECOMMENDATIONS

 Terry, an occupational therapist, goes up to a client’s room in the neurology unit of a regional medical
center. Along the way, she shares her thoughts with Barb, a researcher who is observing Terry’s practice.
Terry fills Barb in on the client they are about to see. The client, Mrs. Munro, is a widow who lives alone in
a house in town. A couple of days earlier, she had a stroke—a right cerebrovascular accident—and was
brought by a neighbor to the hospital. Mrs. Munro has made a rapid recovery and demonstrates good
return of her motor skills. She still has some left-sided weakness and incoordination, along with some
cognitive problems. She is a delightful, pleasant older woman and is anxious to return home.
 Terry is seeing this client for the third time, and her primary concern is to assess whether Mrs. Munro has
any residual cognitive effects from her stroke that would put her at serious risk if she returned home alone.
Terry plans to do some more in-depth activities of daily living with Mrs. Munro to see how well she
demonstrates safety awareness. Terry thinks that she will probably have Mrs. Munro get out of bed, obtain
her clothing and hygiene supplies, perform her morning hygiene routines at the sink, and then get
dressed. Terry wants to see the degree to which Mrs. Munro is spontaneously able to manage these tasks as
well as how good her judgment appears to be. Terry’s thought is that if she can engage Mrs. Munro in
several multistep activities that also require her to perform in different positions, Terry should be able to
detect any cognitive and motor problems that pose a serious safety threat.
 When Terry arrives at the room, she greets Mrs. Munro who says, “I am so excited. The doctor says I can go
home today.”
Terry turns to Barb and raises her eyebrows as if to say, “I told you so.” On the way to the
room, Terry had told Barb that she was worried that the physician who was managing
Mrs. Munro’s case tended to think that as soon as clients could physically get up, they
should go home. Terry went on to defend the physician by saying that in today’s
costconscious environment, doctors were under a lot of pressure not to keep clients in
the hospital.

As Terry converses with Mrs. Munro about generalities, she notices that Mrs. Munro is
already dressed in her housecoat. When she talks to Mrs. Munro about doing some self-
care activities, it becomes apparent that Mrs. Munro has already completed her bathing
and dressing routines, with help from a nurse. When Terry suggests that she perhaps
brush her teeth and comb her hair, Mrs. Munro is happy to get up out of bed but notes
that her neighbor never did bring in her dentures. Mrs. Munro sits on the edge of the
bed and, after a reminder from Terry, put on her slippers. She then stands and walks to
the nearby sink, finds her comb, and combs her hair. While she is doing this, Terry looks
around for some other ideas what to do because Mrs. Munro has already completed the
self-care tasks Terry had planned to do with her.
 Terry’s eyes light on some wilted flowers by the bed. She suggests to Mrs. Munro that she
might want to dispose of the flowers and clean the vase so that it will be ready to pack when it
is time to go home. Mrs. Munro agrees and proceeds to walk somewhat unsteadily over to the
vase. Picking it up, she carries it to the sink, where she pulls out the dead flowers. Terry follows
her, staying slightly behind and within reach of Mrs. Munro. When Mrs. Munro stops after
removing the flowers, Terry suggests that she rinse out the vase, which she does. She then dries
it and returns the vase to the bedside table. Terry reminds her to throw out the dead flowers.
While Mrs. Munro does this, they talk some more about her plans to return home.

 Mrs. Munro tells Terry that she has lived in her home for 40 years, and even though her
husband died more than 10 years ago, she still feels his presence there. He used to love her
cooking, and she still cooks three meals a day for herself. Mrs. Munro starts to cry when they
talk about cooking but then cheers up. Terry tells her that it might be safer if she had someone
around the house for a few weeks until she recovers a bit more from her stroke. Mrs. Munro
thinks that she can get some help from her neighbor. Terry says she is also going to suggest
some home care therapy, just to make sure Mrs. Munro is safe in the kitchen, bathroom, and so
on, noting, “We sure don’t want to see you have a bad fall just when you are doing so well after
your stroke.”
 After reviewing some coordination activities for Mrs. Munro’s left hand, Terry says good-bye. Terry and Barb
leave the room. Terry stops at the nurses’ station to note in the chart that Mrs. Munro demonstrated good
safety awareness in familiar tasks at her bedside but did require cueing to complete multistep tasks. Terry
also notes some motor instability in task performance during ambulation. Terry recommends a referral to a
home health OT practitioner “to assess safety and equipment needs during bathroom activities, meal
preparation, and routine homemaking tasks.” Terry comments to Barb, as they walk off the unit, that she
thinks Mrs. Munro did pretty well, but Terry remains concerned about the risks once Mrs. Munro goes
home, particularly when she is tired. Terry wants someone to monitor Mrs. Munro in a familiar setting to
see whether she handles her daily routines adequately. Terry would really like to see Mrs. Munro start to
consider a more supported living environment, but the client doesn’t have either longterm care insurance or
the personal finances to support that. Terry believes that she might at least be able to get one home care visit
to evaluate home safety, particularly fall prevention. Staying in her own home seems to be Mrs. Munro’s
major goal, and Terry is going to do what she can to try to help her attain that goal. Terry will catch up with
the social worker later to discuss the need for Mrs. Munro to have good support from any neighbors, friends,
or relatives.

 Questions and Exercises

 1. How did Terry develop her concerns about Mrs. Munro?

 2. How did Terry know what to do when her initial plans did not work out?
 3. What factors seem to guide Terry’s recommendations at the end?
References
Occupational Therapy, By: Willard & Speckman- 13th
Edition
Occupational Therapy for Physical Dysfunction, By:
Pedretti, 8th Edition