Clinical reasoning of Brazilian expert occupational therapists: a constructivist grounded theory study

Resumen

Introduction: Practice-based models or theories are relevant elements for understanding deliberate thinking processes in individualizing care for a specific client in occupational therapists' practice. The Dynamic Occupational Therapy Method (DOTM) is an ongoing conceptual-methodological framework developed in Brazil since the 1970s. Objective: To examine the clinical reasoning processes of expert occupational therapists employing the DOTM. Method: A constructivist grounded theory approach guided this study. Data were collected and analyzed simultaneously through Constant Comparative Analysis. Individual and in-group interviews, and a reflective journal, comprised the data collection instruments. Participants were ten expert occupational therapists with: minimum of 10 years of practice experience, minimum of five years since completion of the DOTM clinical training, employing the DOTM as the main framework in practice, and considered by peers as experts. Results: Two major categories emerged from data analysis: (1) the DOTM reasoning processes – construction of the situational diagnosis, establishment and management of the triadic relationship, and dialogical assessment of the therapeutic process/associative paths; (2) thinking ethicalaesthetically, associatively, and dynamically. Conclusion: This research advances knowledge about the reasoning processes of expert therapists, demonstrating the importance of theoretical and methodological knowledge to inform clinical reasoning. A theory on the clinical reasoning of expert occupational therapists employing the DOTM was developed, detailing how this conceptualmethodological framework underpins reasoning by providing valuable operational concepts to support a dynamic practice centered on the clients' uniqueness and situated context.