Professional Reasoning in Healthcare E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 351

Veröffentlichungsjahr: 2024

Beschreibung

Professional Reasoning in Healthcare A guide to decision-making and critical thinking in diverse healthcare practice contexts. Professional reasoning is an essential component of health practice. To thrive in a world that demands constant change where there is not necessarily a right or wrong answer, strong frameworks are needed to support effective decision making. Critical to safe, ethical and culturally responsive practice decisions is the ability to integrate information from research evidence, the client, and the context/environment. Practitioners draw from these elements, along with the expertise of others, and through integration of the information with who they are, what they know, and how they operate. This creates a way forward that is right for the client, applicable to the context, and a good fit with themselves. This book provides such a framework. Professional Reasoning in Healthcare: Navigating Uncertainty Using the Five Finger Framework aims to drive a revolution in professional decision-making and critical analysis among healthcare professionals. Built around an innovative framework for fostering thinking, this book illustrates the situated nature of learning and the uniqueness of practice decisions to individual practitioners and clients. The simplicity of the Five Finger framework belies the complexity of reasoning it stimulates. Written using narratives, the reader is able to imagine the situation as the thinking is made visible. It provides simple yet effective tools and techniques for promoting reflective and reflexive thinking and for integrating the evidence into effective decisions. It promises to help readers develop habits of critical thinking that lead to healthier, more effective decision-making processes. Readers will find: * Scenarios that bring the professional reasoning to life * Tools and techniques to help translate theory into immediate practice * Strategies to enhance reflective thinking skills, transformative learning, and sense-making * Detailed discussion of topics including team culture, person-centred practice, social learning theory, cultural influences on reasoning, emotional intelligence, and more * An overview of transdisciplinary thinking and a complexity-based view on ethics and values Professional Reasoning in Healthcare is ideal for healthcare professionals, managers, students, and educators who are charged with developing skills in making critical decisions in diverse practice contexts.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

List of Contributors

Foreword

REFERENCE

Preface

Acknowledgments

Praise for

Professional Reasoning in Healthcare: Navigating Uncertainty Using the Five Finger Framework

CHAPTER 1: Synthesizing Knowledge for Situated Practice: The Five Finger Framework

INTRODUCTION

PART ONE: HISTORICAL PERSPECTIVES

PART TWO: INFLUENCES ON REASONING

PART THREE: OVERVIEW OF THE CHAPTERS

REFERENCES

CHAPTER 2: The Five Finger Framework: Development and Rationale

INTRODUCTION

THE COMPLEXITY OF PRACTICE DRIVES THE NEED FOR PROFESSIONAL REASONING SKILLS

EVIDENCE‐BASED PRACTICE

THE FIVE FINGER FRAMEWORK

CONCLUDING REMARKS

REFERENCES

CHAPTER 3: Grasping the Whole: The Practitioner Perspective

INTRODUCTION

PROFESSIONAL KNOWLEDGE AND IDENTITY

EMOTIONAL INTELLIGENCE

THERAPEUTIC USE OF SELF

REFLECTIVE PRACTICE

SUPERVISION

SUMMARY

REFERENCES

Chapter 4: Using the Expertise of Others: Many Hands Make Light Work

INTRODUCTION

WHO IS THE CLIENT?

ACCESSING EXPERTISE WITHIN THE WORK SETTING

SUPERVISION

COLLABORATIVE DECISION MAKING

KNOWLEDGE TRANSLATION

COMMUNITIES OF PRACTICE

ONLINE ACCESS TO EXPERTISE OF OTHERS

PEER LEARNING

SHARING THE BENEFITS OF THE FIVE FINGER FRAMEWORK AT IN‐SERVICE SESSIONS

REFERENCES

CHAPTER 5: Walking Hand in Hand: Collaborative Practice

INTRODUCTION

WHO IS THE CLIENT?

RELATIONSHIP FIRST

COLLABORATION

SHARED EXPERTISE

REFERENCES

CHAPTER 6: Knowing the Context like the Back of Your Hand

INTRODUCTION

COMMUNITY CONTEXT: SERVICES

COMMUNITY CONTEXT: CULTURAL

ORGANIZATIONAL CULTURE

SERVICE PROCESSES

TEAM CULTURE

SUPPORTING EVIDENCE‐BASED PRACTICE

CLIENT CONTEXT

LEADERSHIP

ENDING THE PROCESS

REFERENCES

CHAPTER 7: Letting the Research Lend a Hand

INTRODUCTION

ABOUT THE SERVICE

THE SEARCH TO DEVELOP A NEW APPROACH TO MANAGING THE PAIN SERVICE

THE LITERATURE SEARCH

THE TRIAL SESSION

TIPS FOR USING RESEARCH AND LITERATURE

TYPES OF LITERATURE

CHECKING CREDIBILITY OF SOURCES

REFLECTIONS OF THE TEAM ON THEIR PROJECT

DISCUSSION

IMPLICATIONS FOR EDUCATION

CONCLUSION

REFERENCES

CHAPTER 8: Synthesizing World Views

INTRODUCTION

CONTEXT

TRANSDISCIPLINARITY: ORIGINS, PHILOSOPHY, AND PRACTICE

IDENTITY AND A TRANSDISCIPLINARY VALUE SYSTEM

THE FIVE FINGER FRAMEWORK AND TRANSDISCIPLINARYPRACTICE

CONCLUDING REMARKS

REFERENCES

CHAPTER 9: Tools for Implementing the Five Finger Framework

RESOURCE ONE

RESOURCE TWO

RESOURCE THREE

RESOURCE FOUR

RESOURCE FIVE

RESOURCE SIX

RESOURCE SEVEN

RESOURCE EIGHT

RESOURCE NINE

RESOURCE TEN

Index

End User License Agreement

List of Tables

Chapter 2

TABLE 2.1 The Hand is Positioned in the Field of Practice and the Problem S...

TABLE 2.2 The Five Fingers Come into Play

TABLE 2.3 A Solution is Iteratively Crafted in the Palm of the Hand

Chapter 3

TABLE 3.1 Key Points

Chapter 5

TABLE 5.1 Key Points

Chapter 6

TABLE 6.1 Key Points

Chapter 7

TABLE 7.1 Key Points

List of Illustrations

Chapter 1

FIGURE 1.1 The Five Finger Framework.

FIGURE 1.2 Factors in globalization.

Chapter 2

FIGURE 2.1 The Five Finger Framework and the metaphor of the hand.

FIGURE 2.2 The Five Finger Framework overview.

Chapter 3

FIGURE 3.1 Use of self in the Five Finger Framework for professional reasoni...

Chapter 4

FIGURE 4.1 The expertise of others in the Five Finger Framework for professi...

Chapter 5

FIGURE 5.1 The client perspective in the Five Finger Framework for professio...

Chapter 6

FIGURE 6.1 The context and environment perspective in the Five Finger Framew...

Chapter 7

FIGURE 7.1 Research and literature in the Five Finger Framework for professi...

Chapter 8

FIGURE 8.1 Overview of transdisciplinary concepts.

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

List of Contributors

Foreword

Preface

Acknowledgments

Praise Page

Begin Reading

Index

WILEY END USER LICENSE AGREEMENT

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Professional Reasoning in Healthcare

Navigating Uncertainty Using the Five Finger Framework

Edited by

Helen Jeffery

Principal Lecturer, School of Occupational Therapy, Te Pūkenga|Otago Polytechnic, New Zealand

Linda Robertson

Associate Professor Emeritus, Occupational Therapy, Te Pūkenga, New Zealand

Jan Hendrik Roodt

Advanced Academic Facilitator, Te Pūkenga, New ZealandInstitute of Skills and Technology, New Zealand

Susan Ryan

Emerita Professor, University College Cork, Ireland

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Library of Congress Cataloging‐in‐Publication DataNames: Jeffery, Helen (Of Otago Polytechnic) editor. | Robertson, Linda, 1947– editor. | Roodt, Jan Hendrik, editor. | Ryan, Susan (Susan Elizabeth), editor.Title: Professional reasoning in healthcare : navigating uncertainty using the Five Finger Framework / edited by Helen Jeffery, Linda Robertson, Jan Hendrik Roodt, Susan Ryan.Description: Hoboken, NJ : Wiley‐Blackwell, 2024. | Includes bibliographical references and index.Identifiers: LCCN 2023045745 (print) | LCCN 2023045746 (ebook) | ISBN 9781119892113 (paperback) | ISBN 9781119892151 (Adobe PDF) | ISBN 9781119892168 (epub)Subjects: MESH: Clinical Reasoning | Clinical Decision‐Making–methods. | Decision Support Techniques | Evidence‐Based Medicine | NarrationClassification: LCC RA399.A1 (print) | LCC RA399.A1 (ebook) | NLM WB 142.5 | DDC 616–dc23/eng/20231108LC record available at https://lccn.loc.gov/2023045745LC ebook record available at https://lccn.loc.gov/2023045746

Cover Design: WileyCover Images: © Sergey Ryumin/Getty Images; dTosh/Adobe Stock Photos

List of Contributors

Luciana Blaga, MOccTher. Luciana practices as an occupational therapist in New Zealand. Her experience is in acute hospital and in persistent pain. Luciana has worked in several interdisciplinary and multidisciplinary teams and maintains a focus on occupational engagement.

Sian E. Griffiths, MSc, DipCOT. Sian is a British‐qualified occupational therapist with many years of practice as a therapist and educator. She has a keen interest and research background in the development of clinical/professional reasoning of occupational therapists. Sian is a principal lecturer and academic supervisor at Te Kura Whakaora Ngangahau|School of Occupational Therapy, Te Pūkenga, New Zealand.

Helen Jeffery, MOT, GCLT(7). Helen is an occupational therapist with extensive experience in community and mental health practice settings, health service management, and teaching in health and education environments. She has an interest in how therapists use theory and make decisions in practice. Her research interests are in the areas of adventure therapy and professional reasoning. Helen is a principal lecturer and academic supervisor at Te Kura Whakaora Ngangahau|Occupational Therapy School, Te Pūkenga, New Zealand.

Elizabeth Martin, PhD, GDTE, BOT(Hons), BSc (Hons). Elizabeth has practiced as an occupational therapist within orthopedic, community, and outpatient physical health. She is a senior lecturer with Te Kura Whakaora Ngangahau|Occupational Therapy School, Te Pūkenga, and researched the impact of surviving bowel cancer on occupations for her PhD study.

Kim Reay, BSc(Hons), MSc, PGCEd. Kim is a UK‐trained occupational therapist and has worked in UK‐based health and social services, and as an occupational therapy educator in New Zealand. Kim's interests are in exploring the meaning of evidence‐based practice for learners and new practitioners, and the impact of collaborative relationships between occupational therapy and communities. Kim is a lecturer at Auckland University of Technology.

Linda Robertson, PhD has been involved in occupational therapy education for about 40 years in Scotland and New Zealand and has a special interest in professional reasoning. She has researched in the area and edited a textbook: Clinical Reasoning in Occupational Therapy, Controversies in Practice (2012). In 2021, Linda was awarded the NZ Order of Merit for services to occupational therapy and services to seniors.

Jan Hendrik Roodt, PhD (EngSc) (linkedin.com/in/drjanroodt) is an experienced practitioner and academic specializing in technology business establishment and management, and he contributes actively to diverse industrial and agricultural projects. Jan Hendrik also supervises postgraduate students at the New Zealand Institute of Skills and Technology, Te Pūkenga. Affiliated with professional organizations, he serves as a project and publication reviewer, as well as a journal editor.

Susan Ryan, PhD is Emerita Professor of University College Cork, Ireland. She has extensive experience in professional reasoning development and adult learning theories. She has co‐authored textbooks on practice education and reasoning using narratives. She supervises qualitative research for Irish students with a focus on dementia care in Ireland.

Foreword

Dr Linda Robertson and I have had a long‐distance “academic romance” for many years. It started in the 1990s when I was transitioning from being an occupational therapy and rehabilitation administrator to engaging in my doctoral work on clinical reasoning. My long‐standing motivation for being in healthcare management was to support clinicians so that they in turn could provide the best care to our clients. After over twenty years in the field, I was inspired by the fascinating work of Mattingly and Fleming (1994), as their findings seemed to hold the key to a whole new understanding of how to promote effective professional reasoning and thus better practice. By then, Dr Robertson was already engaged in academics and following the same work. She, along with several of her colleagues, continued to advance our understanding of what we now call professional reasoning. I am so pleased they joined to offer this new text: Professional Reasoning in Healthcare: Navigating Uncertainty using the Five Finger Framework edited by Jeffery, Roodt, Robertson, and Ryan. I am honored to introduce this important new contribution, as they make the leap from understanding professional reasoning to improving professional reasoning.

My overriding emotion while reading this new text is one of gratitude. So let me start by saying thank you. Thanks for synthesizing the many things we know about professional reasoning into a very practical and digestible resource. Thanks for working with the complexity to offer real, concrete, and doable approaches for improving professional reasoning. Thanks for making your suggestions both profound and easy to read. Thanks for using real stories of real practitioners to show how this works in practice. Thanks for broadening the views on client and culture. Thanks for opening new horizons for research to improve practice. In short, thanks for “handing us” the five‐finger framework. It will work for students, it will work for practitioners, it will work for educators, and it will work for scholars. Well done.

Barbara A. Boyt Schell, PhD, OT, FAOTA

Professor Emeritus, School of Occupational Therapy, Brenau UniversityCo‐owner, Schell Consulting

REFERENCE

Mattingly, C., & Fleming, M. H. (1994).

Clinical reasoning – forms of inquiry in a therapeutic practice

. F.A. Davis.

Preface

This book, written for practitioners, students, and educators, is a response to changes in society's expectations of health professionals and the impact on delivery of services. Traditionally, specialization was the hallmark of the expert. However, in the current world of complex practice, professionals require systems‐level thinking where it is the generalist who becomes the “artful master.” In order to thrive in a world that demands constant change where there is not necessarily a right or wrong answer (the so‐called “wicked” problems), strong frameworks are needed for decision making.

In response to this acknowledged threat to “practice as usual,” a framework has been developed that will impact on reasoning and assist professionals to work effectively in the current working environment. This has been named the Five Finger Framework (FFF) and provides a simple structure to guide complex thinking. Essentially, it encourages the use of evidence from a diverse range of sources to inform decisions and stimulates a questioning approach. It uses the metaphor of the hand to stimulate complicated critical thinking: the fingers trigger the reader to explore research‐based literature, the environment where the practice is situated, the client/family, the expertise of others, and what is integral to the self. The FFF has the potential to stimulate habitual scrutiny of multiple sources of information and viewpoints in a straightforward way to provide an awareness of the problem solver's situation. From this awareness, anticipatory thinking can be encouraged to ensure that a range of possible contributory factors are considered and helpful solutions generated. The FFF provides a structure that enhances both the visibility and traceability of thinking.

This book is written using narratives – each of the fingers on the framework is portrayed in a chapter written in the first person as a story from the perspective of a health practitioner. Story telling enables natural engagement with content and enhances focus on and motivation for the reading. The stories provide the reader with a way to imagine the situation and the professional reasoning that is informing the practitioner's response. Importantly, the nonlinear reality of professional reasoning processes and the messiness of everyday practice are illustrated. Despite the narrative nature of the writing style making the chapters potentially an “easy read,” theory is integrated and the complexity integral to reasoning processes and decision making is made evident. The writing style further enhances the visibility of thinking provided in the Five Finger Framework.

Both the FFF itself and how it is described, justified, and illustrated in this text are fundamentally based on the concept of situated learning. This learning theory follows a premise that knowledge and resultant action are uniquely formed by individuals in direct response to their situation, environment, and the people they interact with. Each of the chapters related to the fingers brings to life how learning is situated, and the power of reflexivity in deepening and strengthening the impact of learning.

For readers looking for the rigorous underpinnings of the work, the theoretical and practical motivators for the FFF are covered in some detail in Chapter 2. The situated and reflexive practice in fields spanning several disciplines is discussed with a focus on reflective thinking skills, transformative learning, and sense making. Chapter 8 covers the increasing need for transdisciplinary thinking in these fields and introduces a complexity‐based view on ethics and values. The final chapter contains tools and tips for using this book in practice and in an educational setting.

Acknowledgments

Our belief is that professional reasoning is fundamental to the quality of health service provision. This contribution to literature in professional reasoning is the culmination of effort on the part of many. It represents not only our own research, but a drawing from and synthesis of theory and discourse from other academics. We commend and are grateful for all who are working on advancing healthcare practice through deepening and sharing knowledge of professional reasoning.

We would like to acknowledge the willing sharing of ideas, opinions, and practices from clinicians, lecturers, and students in our own research. The basis of the Five Finger Framework emerged from those discussions and interviews – thank you for your insights and openness.

Writing in a style that is relaxed and accessible but also portrays complex theories and processes is challenging. We are grateful to the many people from diverse professions and practice areas who were prepared to read chapters through a particular lens. These included Indigenous practitioners and academics, and those from the disciplines of speech and language therapy, physiotherapy, social work, counseling, and occupational therapy. We also thank Dr Sheena Blair (occupational therapist) whose deep knowledge and sharp mind helped us tighten and tidy the work and reassured us of its value. Special thanks is also due to Professor Barbara Schell for her willingness to immerse herself in the manuscript and write a foreword for the text.

Finally, we acknowledge you, the reader of this text, whether you are an educator, student, practitioner, or manager. Your preparedness to read and ponder how a professional reasoning framework such as this might influence your work and ultimately enhance the outcomes for the people who access your services is commendable.

Helen Jeffery, Linda Robertson, Jan Hendrik Roodt, Susan Ryan

Praise for Professional Reasoning in Healthcare: Navigating Uncertainty Using the Five Finger Framework

An essential tool and a great insight to the decision‐making skills that health professionals go through on a daily basis – a must‐read for all practitioners, new, and seasoned!Lara Gallichan, BSc(Hons), Speech and Language Therapist, NZSTA

Written in a clear and accessible manner, there is no doubt this book will be an invaluable resource for students, clinicians, and teachers alike. By providing real‐world examples, the reader easily appreciates the value of the Five Finger Framework and how it can improve their professional reasoning and practice. This book should be compulsory reading for all students, and I would highly recommend it to all practicing healthcare workers.Dr Ruth Jeffery, PhD, MSc, PGDip Med Rad Sci(NM), LLB(Hons), BA, BSc, NZDMI

The ability to critically reflect upon the way that professional reasoning and judgment occurs is pivotal and is profoundly ethical for practice, research, and leadership. Amongst the unique features of this text is the introduction of the Five Finger Framework to assist lifelong learners to comprehensively problem pose and problem solve. This resonates well with situated learning with its focus upon context, interpersonal relationships, and shared decision making.

The book is culturally aware, transdisciplinary, and has the potential to become a core text for learners at all levels of education, particularly for those within practice‐based education and mentorship relationships.Dr Sheena E.E. Blair, DipOT, MEd, ED, FRCOT

Thanks for offering real, concrete, and doable approaches for improving professional reasoning, using real stories of real practitioners to show how this works in practice, broadening the views on client and culture. In short, thanks for “handing us” the Five Finger Framework. It will work for students, practitioners, educators, and scholars. I would adopt it in a heartbeat if I were still teaching!Barbara A. Schell, Professor Emerita, School of Occupational Therapy, Brenau University, PhD, OT/L, FAOTA

This internationally relevant text presents the Five Finger Framework as a tool for enabling practice reasoning, critical reflection, and decision making across a range of transdisciplinary approaches in health and social care settings. The metaphor of a hand unfolds a structured process for thinking through many‐layered aspects to reach the end goal we all aim for – working effectively, visibly and in a traceable and thus accountable manner for collaborative solution‐focused approaches.Margaret McKenzie, Associate Professor, Registered Social Worker (NZ)

CHAPTER 1Synthesizing Knowledge for Situated Practice: The Five Finger Framework: Historical Influences on Professional Reasoning

Helen Jeffery1 and Susan Ryan2

1Principal Lecturer, School of Occupational Therapy, Te Pūkenga|Otago Polytechnic, New Zealand

2Emerita Professor, University College Cork, Ireland

INTRODUCTION

Professional reasoning is the thinking that sits behind practice decisions. It informs what we do and how we do it, and is influenced by who we are, where we are and what we know, believe, and value. How we reason in practice depends on the knowledge networks that we develop as we practice. Experienced clinicians have difficulty explaining their reasoning because it is based on their own experiences and stored in an idiosyncratic way. The task for the novice is to develop their own knowledge base as they practice and to organize this so that it makes sense to them and can be recalled as needed. Learning from experience is an ongoing process which can be enhanced by ensuring the learner has opportunities to recall learning experiences and to make sense of them. Frameworks that provide guidelines for reflection can assist the learner to have a greater awareness of potential influences on their actions.

This textbook presents the Five Finger Framework as a metaphor that identifies and integrates elements of reasoning (see Figure 1.1). The framework was developed following research conducted by lecturers in occupational therapy education (Jeffery et al., 2021). The aim was to better prepare occupational therapy students to be effective evidence‐based practitioners by identifying strategies that could be used in the curriculum to hone professional reasoning skills.

FIGURE 1.1 The Five Finger Framework.

The Five Finger Framework draws together the key elements that inform professional reasoning. Depicted as a hand, with the decision to be made or the problem to be solved in the palm of the hand, the framework provides an easy‐to‐remember structure that enables reasoning that is both broad and deep. The comprehensiveness of decision making can be made visible and therefore be shared with and used by learners and facilitators of learning both in education and in practice. Additionally, the framework enables the development of habits and strategies that promote considered professional reasoning throughout the practitioner's career (Benfield & Jeffery, 2022).

Each of the five fingers represents an essential source of information and evidence to inform professional decision making. The palm of the hand holds the decision or problem posed, i.e., about what you will do, what you are doing or what you did do. The thumb, representing the self (you), touches base with each of the other fingers as the situation is worked through. The sources of evidence to inform professional decision making represented by the fingers of the hand are as follows.

Research and literature:

from policy, published research, textbooks and reports, practice models and theories, foundational knowledge of the profession – practice decisions that are based on academic rigor.

Context and environment:

include the workplace culture, systems and resources, the local community culture and resources, protocols, and procedures – practice decisions that reflect local best practice.

Client:

collaboration with client, client's knowledge and expertise, families and carers' perspective and situation – practice decisions that are right for the client.

Expertise of others:

informed by local practitioners with helpful knowledge through to international experts, accessed through conversations, conferences, and internet resources – practice decisions are in part informed by knowledgeable others.

Use of self:

the knowledge held by the practitioner in conjunction with the therapeutic use of self, relationship‐building skills, self‐awareness, reflective practice, and awareness of one's own culture – practice decision that are right for you.

This introductory chapter is in three parts. Part One provides some historical context to set the scene in terms of the development of professions and the introduction of professional reasoning. An overview of the history of the growth of health professions related to knowledge generation is presented to provide context for the complexities experienced in professional reasoning today. Part Two describes some of the external influences that need to be taken into consideration when working through reasoning in practice. This includes changes internationally in healthcare provision and growing awareness of cultural safety, two of many factors that influence professional reasoning processes and practices. These are linked to and provide justification for the development of the elements in the Five Finger Framework. Part Three gives a brief overview of subsequent chapters.

PART ONE: HISTORICAL PERSPECTIVES

This section provides an overview of the important historical factors in the development of healthcare that have influenced professionals' thinking and practice. Most contemporary health professions date back to their commencement in the nineteenth or early twentieth centuries. Over time, each has altered profoundly as new knowledge is generated through science and research, and as society has changed. New knowledge is synthesized into existing bodies of knowledge (Higgs & Edwards, 1999) and both strengthens some knowledge and makes some obsolete. This synthesis of diverse knowledge creates innovative practices within professions, as new theory is used as a stepping stone to expand professional boundaries. So, keeping in mind these constant changes, professions should be thought of as being fluid entities within their own lifecycles (Dower et al., 2001). They have constantly evolved, developed, and changed through the decades as they are exposed to influences within and outside the profession, and will continue to do so.

Professionalization

To become a health professional involves long periods of theoretical and practical training resulting in a formal qualification (Dower et al., 2001). Although many professions have a world body or organization charged with maintaining international professional standards, their work is bound by understanding that what works in one country may not work in another – context of practice and cultural mores are powerful influences on practice. The understanding a practitioner has of their professional scope and responsibilities, the nature of their professional identity, and the context they are situated in all form a basis for their professional decision making.

The profession that a person is a part of will contribute to determine what practice decisions are made, e.g., an occupational therapist will view a particular client through a different lens from a nurse, physiotherapist, or social worker, and have very different assessments and intervention parameters to work within. However, decisions are also influenced by who the practitioner is and the relationship they hold with the client – professional identity is broader than the parameters of the profession itself.

As professions have widened and deepened their knowledge base and practices, work has become more complex and multilayered. Of note is the concept of specialization – the increase in what can be known creates space for increasing numbers of specialist people and services, consequentially compartmentalizing the work within professions and the experience of the client (Skinner et al., 2015). Even professions that are philosophically grounded in holistic practice offer specialist services, for example occupational therapists in the role of hand therapist. Conversely, practice settings are also becoming more diverse in what they offer and many new fields, specialties, and services are being promoted and developed (Skinner et al., 2015). In many settings, the pace of healthcare practice has accelerated, and specialist service is expected, with increased demands placed on early career practitioners to work at higher levels of knowledge and responsibility and at a faster pace. Health professionals now, more than ever, need to be able to remain current in their evidence base for practice, be responsive to change and prepared to handle the dissonance that is often apparent between specialist practice and client‐centered holistic healthcare.

Professional Reasoning

Exploration of professional reasoning processes and practices has been evident in health literature over recent decades and has resulted in the development of theories and models to explain, teach, and guide the processes that enable safe decision making in health practice. This has its roots in part in North American and Canadian medical educators (Cranton, 1983; Eisner, 1979). These academics introduced different learning and assessment methods to examine the thinking and reasoning of their medical students to encourage them to be more systematic and scientific. After that introductory work, other professions followed suit.

In the mid‐1980s, the American Occupational Therapy Association (AOTA) employed an anthropologist, Dr Cheryl Mattingly (1991), to study the reasoning of a group of occupational therapists. Coming from a different discipline entirely, she used a “bottom‐up” grounded approach to this study which was different from the analytical and comparative methods the medical educators used. She employed qualitative research methods and gathered narratives and stories to explore the decision making of therapists. Her work was later complemented by an occupational therapy educator, Fleming, who analyzed and presented Mattingly's work in the form of different tracks – procedural, interactive, and conditional, each focusing on a different aspect of professional reasoning (Fleming, 1991; Mattingly & Fleming, 1994).

PART TWO: INFLUENCES ON REASONING

This section focuses on some of the recent changes in society, foundational knowledge, and contexts of health practices that have influenced professional reasoning in the five areas that form the Five Finger Framework.

Influences of “Self” on Reasoning

All professional decisions are centered to a greater or lesser degree in the “self” – who we are, our culture, our knowledge, skills, and attitudes all impact the decisions we make. However, our ways of knowing are developed from personal experiences of practice and include technical, practical, social, political, and economic knowledge as well as self‐knowledge (Kinsella, 2001). Some of our knowledge is explicit and can clearly be identified while other knowledge is implicit and is difficult to explain to others but is evident in our actions. “Reflective approaches suggest that it is important to examine our actions in practice in order to discover this implicit knowledge which influences what we actually do in practice” (Kinsella, 2001, p. 196).

In the 1980s, Professor Donald Schön, a North American educator, developed an influential framework for reflection (Schön, 1983). The framework was intended for learners to reflect on their ideas retrospectively, having made decisions or completed piece of work, to recognize potential improvements to their practice. In Australia, Boud et al. (1985) also designed a model of reflection consisting of three parts whereby a learner/practitioner reflected on their ideas before, during, and after an event to encourage intentional thinking about what they might do (prospective), what they are doing (in the moment), and what they did do (retrospective). Subsequently, many models to guide reflection have been developed, and for many people, being reflective has become habitual. It is now often advocated in professional practice as a way of enabling practitioners to develop a critical understanding of their own practice.

There is more to the personal influence on reasoning than the capacity to reflect. Practitioners require self‐awareness of their skills, attitudes, knowledge, and their own culture, including their cultural biases (both conscious and unconscious). How they understand the world around them and the perspectives they hold influence the decisions they come to. Practitioners therefore have an ethical responsibility to maintain awareness of and pay attention to their own perspective in any situation. Being able to recognize, acknowledge, and consider this positionality, the influence it has on the decisions we make and the potential influence on clients' decisions is important (Delany et al., 2010). Additionally, the capacity to hear and respond to feedback, to form, maintain, and repair therapeutic relationships, and to develop practice that is aligned with personal values are all influences on practice decisions.

The Influence of the Expertise of Others on Reasoning

An integral element of professional reasoning and influence on professional decisions is know‐how shared with us and recommendations made by others who are more knowledgeable or experienced than we are (Wieringa & Greenhalgh, 2015). We create and refine ways of viewing our world, based in part on the opinions of colleagues and experts and our agreement and consensus with them.

One way to make use of new knowledge is through direct contact with local and international experts – seeing and hearing ideas to augment reading articles enhances understanding. The internet and modern communication platforms have enabled the capacity for rapid dissemination of knowledge and research findings in this way. It is not just newly published knowledge but also access to those holding expertise that is now readily available. For instance, the availability of recorded presentations, online discussions, online conferences, and a variety of web‐based presentations make learning from this expertise accessible and affordable for most. These opportunities enhance the capacity to connect with and learn from developments in our respective professional fields across different nations.

Internet‐based communication has developed through platforms and applications which make it easier to connect directly with knowledgeable others and to engage directly with them – a practice that is becoming normalized. This access is, of course, open to the world – we not only have the capacity to explore knowledge from our own discipline but also from others, borrow from theory, merge concepts, and deepen understanding of each other and the work we do. This is immensely helpful in this era of interdisciplinary work, where in many practice areas there is more blurring of professional boundaries than in the past. In contrast to specialization, there is also a trend toward more generic work within specialist teams.

A challenge can be for practitioners to rationalize their profession‐specific reasoning to maintain professional identity in a close work environment where there is a tendency to merge roles (Best & Williams, 2019).

Influences of the Client on Reasoning

The professional's relationship with a client has shifted over time as professionals have gained greater awareness of the importance of knowing the overall client's needs and the value of working in collaboration with that client. This movement toward a collaborative approach with the client was first emphasized in the work of psychologist Carl Rogers (1951) who founded the humanistic approach to healthcare. The overall movement seen in this approach is from a place where the client seeks intervention from an expert practitioner to a place where they can work alongside a practitioner to achieve their goals. It is now crucial that the notion of “one size fits all” is not followed and that personalized practice is enhanced as much as is reasonably possible (Dower et al., 2001).

The advent of the internet also facilitated a profound change in the place clients have in their healthcare. Represented on the Five Finger Framework as the client finger, the people we work with now have easy access to information. Consequently, the level of health/knowledge literacy in many populations has increased exponentially. People are becoming more articulate and more educated and may be more demanding of better professional services. Clients may now have more specific expectations of health professionals and be more informed of their options in terms of service. There is more openness and discussion in the media, highly developed internet‐based communication platforms that support client‐led support groups, discussion forums, and shared problem‐solving avenues for clients. This access to knowledge and education by everyone is one of many drivers toward client empowerment and involvement in practice decisions.

As clients are empowered to voice their opinions, and professionals are no longer seen as the fount of all knowledge, collaboration in joint professional decision making is enabled. The client voice is also evident in the increase of value and recognition placed on qualitative research. Its use of stories, narratives, and interviews over the more scientific research has added to the knowledge base around client experiences, and what works and does not work for them. This has in turn led to their involvement not just in their own healthcare decisions but in service development, monitoring of and advising on quality of services, and input into legislation. Clients are more able to voice their perspective so the challenge is for practitioners to hear this and to ensure their professional reasoning processes are made in collaboration with the client.

Context – Influence of Resources and Culture on Reasoning

The knowledge explosion has had a profound impact on what is possible in professional practice, with resultant challenges related to access, equity, and affordability. An individual's access to best practice is dependent on where they live, the health structures in their country and local community, and the management of financial and other resources. Management structures and resultant decisions in many countries now revolve more around finances than care, and efficiencies must take precedence. Managers have tight budgets to administer whilst having greater diversity in products to fund, services to include, and specialists to employ, as well as other demands from practitioners and clients. Managerial decisions impact the number of staff employed, the model of service provision used, and, importantly, the amount of time available for intervention, as well as the environments in which intervention can occur. For many practitioners, professional reasoning is influenced by their compliance with organizational management requirements, and “decisions are made to meet the demands of work and where the individual is a cog in the machine” (Fish & de Cossart, 2019, p. 102). These demands, which include workflow, work structure, and access to material and human resources, influence professional reasoning on a day‐to‐day basis.

People have, of course, traveled throughout history but more so in recent centuries and dramatically so in recent decades, and globalization has become a norm. As health beliefs and values are culturally bound, the cultural influence on professional reasoning is of paramount importance. A significant population movement in previous centuries was through colonization of countries with established Indigenous populations. Those countries colonized in more recent history are now grappling with the challenges associated with the resultant health, social, and political wellbeing of their Indigenous people and the systemic racism that developed through the dominance of the colonizing culture (McIntosh et al., 2021). In these countries, there is now a growing call for past wrongs to be put right, for enablement of Indigenous power and autonomy, for restoration of Indigenous language and traditions and, importantly, equity in health outcomes. An integral part of choices regarding professional decisions is whether the client is Indigenous and how connected they are to their culture. Although there are a growing number of Indigenous health providers, in a large proportion of these countries services are provided by the still dominant culture through a Eurocentric lens. “A single western scientific model of the world is no longer the only acceptable model of reality” (Dower et al., 2001, p. 2). Intentional consideration of this influences who the service providers should be, what intervention is appropriate, and where and how it can be implemented.