Construções teóricas sobre o raciocínio clínico de terapeutas ocupacionais experts que utilizam o Método Terapia Ocupacional Dinâmica

Abstract

Introduction: Clinical reasoning is recognized as a complex phenomenon, intrinsic to practice, studied in Occupational Therapy since the 1980s. One of the factors underpinning clinical reasoning is the framework employed in professional practice. The Dynamic Occupational Therapy Method is a Brazilian framework that has been constructed since the 1970s. Objective: To explore the clinical reasoning of Brazilian expert occupational therapists employing the Dynamic Occupational Therapy Method as the main framework in their professional practice. Methodology: The Constructivist Grounded Theory approach was used to guide this qualitative study. The participants were 10 expert occupational therapists employing the Dynamic Occupational Therapy Method as the main framework in their professional practice. The data were collected through: participant characterization form, individual interviews, group interview, and field journal. The constant comparative analysis method was used for data analysis. The data were collected and analyzed simultaneously. Results: As the Dynamic Occupational Therapy Method was being constructed, specific ways of thinking about practice and acting in practice were also being proposed. Expert occupational therapists who employ the Dynamic Occupational Therapy Method as the main framework in their practice have a clinical reasoning largely supported by this framework. They employ, throughout the practice, three types of reasoning: ethical-aesthetic, associative, and dynamic, structuring their practice dynamically around the three processes proposed in the Dynamic Occupational Therapy Method: 1) construction of the situational diagnostic; 2) establishment and management of the triadic relationship; and 3) dialogical assessment of the therapeutic process/associative paths, processes along which specific characteristics of thinking are also employed. Engaging in post-undergraduate formation and in reflective strategies – such as training after completing their undergraduate in Occupational Therapy, supervision, peer-discussion about their practice, theoretical studies based on their professional practice, and writing about their practices – were factors that contributed to the reasoning expansion of the participants, that became less focused on biomedical aspects and more focused on the health and on the expansion of the everyday life of their clients, based on what is important, singular, and situational for each target-person. Discussion: This research advances: 1) by proposing a grounded theory about how a Brazilian framework underpins the clinical reasoning of occupational therapists; 2) by describe three types of reasoning – ethical-aesthetic, associative and dynamic; 3) by detailing how the clinical reasoning of the participants is dynamically constructed based on the processes of the Dynamic Occupational Therapy Method; 4) by showing that several factors - especially the training in the Dynamic Occupational Therapy Method and the supervision - contribute to the expansion and improvement of the occupational therapists’ clinical reasoning. Conclusions: It was possible to identify that the Dynamic Occupational Therapy Method is a framework that supports a situated, singular, ethical-aesthetic, associative, and dynamic reasoning, which allows occupational therapists to consider, in the construction of their clinical reasoning, several important aspects for a client-centred care, based on the needs and on the desires of the target-person.