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Institutional context: What elements shape how community occupational therapists think about their clients’ care?

2020; Wiley; Volume: 28; Issue: 4 Linguagem: Inglês

10.1111/hsc.12954

1365-2524

Annie Carrier, Andrew Freeman, Johanne Desrosiers, Mélanie Levasseur,

Healthcare Systems and Technology

Health & Social Care in the CommunityVolume 28, Issue 4 p. 1209-1219 ORIGINAL ARTICLE Institutional context: What elements shape how community occupational therapists think about their clients’ care? Annie Carrier OT, BA(psy), LLM, PhD, Corresponding Author Annie Carrier OT, BA(psy), LLM, PhD Annie.Carrier@USherbrooke.ca orcid.org/0000-0002-8890-6098 School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada Correspondence Annie Carrier, 3001 12e avenue nord, Sherbrooke, Québec, Canada J1H 5N4. Email: Annie.Carrier@USherbrooke.caSearch for more papers by this authorAndrew Freeman OT, PhD, Andrew Freeman OT, PhD Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CRESSPL-UL), CIUSSS de la Capitale-Nationale, Québec, CanadaSearch for more papers by this authorJohanne Desrosiers OT, PhD, Johanne Desrosiers OT, PhD School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, CanadaSearch for more papers by this authorMélanie Levasseur OT, PhD, Mélanie Levasseur OT, PhD School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, CanadaSearch for more papers by this author Annie Carrier OT, BA(psy), LLM, PhD, Corresponding Author Annie Carrier OT, BA(psy), LLM, PhD Annie.Carrier@USherbrooke.ca orcid.org/0000-0002-8890-6098 School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada Correspondence Annie Carrier, 3001 12e avenue nord, Sherbrooke, Québec, Canada J1H 5N4. Email: Annie.Carrier@USherbrooke.caSearch for more papers by this authorAndrew Freeman OT, PhD, Andrew Freeman OT, PhD Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CRESSPL-UL), CIUSSS de la Capitale-Nationale, Québec, CanadaSearch for more papers by this authorJohanne Desrosiers OT, PhD, Johanne Desrosiers OT, PhD School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, CanadaSearch for more papers by this authorMélanie Levasseur OT, PhD, Mélanie Levasseur OT, PhD School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, CanadaSearch for more papers by this author First published: 31 January 2020 https://doi.org/10.1111/hsc.12954Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Clinical reasoning (CR) is the cognitive process that therapists use to plan, direct, perform and reflect on client care. Linked to intervention efficiency and quality, CR is a core competency that occurs within an institutional context (legal, regulatory, administrative and organisational elements). Because this context can shape how community therapists think about their clients’ care, its involvement in their CR could have a major impact on the interventions delivered. However, little is known about this involvement. Our study thus aimed to describe the elements of the institutional context involved in community therapists’ CR. From March 2012 to June 2014, we conducted an institutional ethnography (IE) inquiry in three Health and Social Services Centres in Québec (Canada). We observed participants and conducted semi-structured interviews with 10 occupational therapists. We also interviewed 12 secondary key informants (colleagues and managers) and collected administrative documents (n = 50). We analysed data using the IE process. Of the 13 elements of the institutional context identified, we found that four are almost constantly involved in participants’ CR. These four elements, that is, institutional procedures, organisation's basket of services, occupational therapists’ mandate and wait times for their services, restrictively shape CR. Specifically, occupational therapists restrict their representation of the client's situation and exploration of potential solutions to what is possible within the bounds of these four elements. In light of such restrictions on the way they think about their clients’ care, therapists should pay close attention to the elements of their own institutional context and how they are involved in their CR. Because of its potentially important impact on the future of professions (e.g. further restrictions on professionals’ role, reduced contribution to population health and well-being), this involvement of the institutional context in CR concerns all professionals, be they clinicians, educators, researchers or regulatory college officers. CONFLICT OF INTEREST The authors declare that they have no conflict of interest. Volume28, Issue4July 2020Pages 1209-1219 RelatedInformation