Susan L. Stark, Emily Somerville, Marian Keglovits, Aliza Smason, Kelsey Bigham; Clinical Reasoning Guideline for Home Modification Interventions. Am J Occup Ther 2015;69(2):6902290030. https://doi.org/10.5014/ajot.2015.014266
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© 2020 American Occupational Therapy Association
OBJECTIVE. The objective of this study was to develop and validate a clinical reasoning tool to describe an occupational therapist’s clinical reasoning process while delivering home modification interventions.
METHOD. We used a two-phase, mixed-methods approach. In Phase 1, we developed a personal factors guideline to support clinical reasoning in home modification interventions based on in-depth interviews, a focus group, and field observations of 6 home modification experts. In Phase 2, the guideline was validated by a second group of 6 home modification experts.
RESULTS. During analysis, 16 personal and environmental factors with a corresponding set of conditions and strategies for each factor emerged to form a clinical reasoning guideline, which was validated by a second group of experts.
CONCLUSION. Unpacking the “black box” of the clinical reasoning process has yielded a useful clinical reasoning tool that will allow occupational therapists to deliver complex interventions with fidelity.
The upkeep of the item or what it’s going to take to keep it [is an important consideration], if it’s a one-time thing and it’s done . . . and there’s nothing really that they have to do to kind of keep it up . . . [or] if there’s going to be routine things that might need to be done—changing batteries, for example.
You look at what they’re doing . . . you look at all the factors and then . . . in your mind think of lots of possibilities, but then I think you start narrowing that down. . . . What’s the financial situation—are they [going to] really use this?
A person had very few financial resources. . . . It made me think that sometimes it’s discouraging for me to go in there and enlighten them on all these possible things that could help that they can’t get. . . . At the same time, you don’t want to discourage them . . . or make them feel depressed about their situation by telling them all the ideal solutions. . . . You just kind of have to figure out what is ideal for them within their range of . . . realistic possibilities.
Chronic—Static disease process
Chronic—Progressive disease process
Temporary health condition or aggressively progressing, terminal disease
Amenable to personal assistance to complete the task (formal or informal assistance)
Prefers to be independent or no personal assistance present
Has adequate personal resources to maintain solutions (e.g., financial, functional, cognitive)
Does not have personal resources to maintain the solution in good working order (e.g., financial, functional, cognitive)
Precontemplation: Not considering possibility of change, does not feel there is a problem
Contemplation: Thinking about change in the near future
Preparation: Making a plan to change, setting gradual goals
Action: Implementation of specific action steps, behavioral changes
Maintenance: Continuation of desirable actions or repetition of periodic recommended steps
Likely to follow through with recommendations and use compensatory strategies to complete daily tasks
Not likely to follow through with recommendations (e.g., cognitive limitations)
A high value placed on appearance of home (rejection of “medical-looking” devices)
Function valued over appearance
Has financial resources (or family does) to afford modifications
Is a veteran
Has a disease-specific organization (e.g., Multiple Sclerosis Society, American Parkinson Disease Association) or age- and residency-specific organizations (Area Agencies on Aging)
Physical assistance available and accessible
No personal support available
Family, friends, neighbors available, able, and willing to provide assistance
Active in a community organization (social clubs, religious organization)
Adults without disability
Adults with disability
Home in disrepair
Unsafe flooring conditions
Overall integrity of the interior walls, ceilings, plumbing, and drainage
Privately owned, single-family home
Privately owned, multifamily home
Climate of geographic area
Limited amount of space or floor plan
Availability and characteristics of land adjacent to home
Client wants equipment to be able to be used in different places (both in their own house and others' houses)
Literacy issues present
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