The Narrative Nature of Clinical Reasoning

“(1) Types of text (2) Those represented (3) Stated allegiance / position (4) Setting (5) Geographical context (6) Cultural context (7) Logic of argument (8) Author’s conclusions (9) Reviewer’s comments”

“(See Mattingly, 1991, for further discussion of this per­ spective in a somewhat different vein.)”

“In retro spect, I think when Penny told me the tales of her child hood, we were in the genre of what Mattingly (1991) called the storytelling facet of clinical reasoning, but, in this case, the stories were explicitly constructed around the theme of occupation.”

“…also touched on the need for therapists to comprehend clients’ perspectives and interact with clients to facilitate their unfolding life stories (Clark, 1993; Crepeau, 1991; Fleming, 1991; Kielhofner, 2007; Lyons & Crepeau, 2001; Mattingly, 1994; Rogers, 1983; Schell, 2003; Schell & Cervero, 1993).”

“These forms of reasoning include: intuitive reasoning (Benner & Tanner, 1987); narrative reasoning (Mattingly, 1991); interactive and conditional reasoning (Fleming, 1991); practical reasoning (Jensen, Gwyer, Hack & Shepard, 1999); and pragmatic reasoning (Schell & Cervero, 1993).”

“By using a narrative approach to elicit the thoughts, feelings, and perceptions of their clients, therapists may begin to understand which occupations are meaningful as well as to determine how their clients express themselves through these occupations (Mattingly, 1991; Vrkljan, 2000).”

“way things appear in conscious experience) (Greenfield and Jensen, 2010; Mattingly, 1991).”

“In particular, Mattingly (1991) described how therapists used a phenomenological process to understand individuals' meanings.”

“Encourage the individual to express, and listen with respect, to the story that he or she is telling with his or her life (Mattingly, 1991).”

“Models of clinical reasoning that derive from the interpretive paradigm have been more recently proposed for clinical practice in allied health (31,36,39,44).”

“Additionally, storymaking involves the therapist and client creating stories to be enacted in the future (Mattingly, 1991).”

“Construction of the narrative of the case plays an important role in the consolidation of current knowledge, formulating and not merely recording clinical opinions and plans (Hunter, 1992; Kay & Purves, 1996; Mattingly, 1991).”

“The ther apist is able to enter the patient's context by using narra tive clinical reasoning (Mattingly, 1991a) that focuses not on treatment needs by diagnosis but on an understanding of the particular aspects of a case.”

“The intervention was based on principles defined by Ayres (1972), emphasized use of a clinical reasoning process (Mattingly, 1991), and focused on attaining”

“In deciphering needs, nurses also call upon narrative reasoning, which aims at understanding the lived experience of the patient and their choices to express particular elements of their experience (Mattingly, 1991).”

“…literature suggesting that the occupational narrative shapes the direction of a person’s life in as much as it reflects how the person interprets life and is motivated to act (Helfrich, Kielhofner, & Mattingly, 1994; Jonsson, Kielhofner, & Borell, 1997; Mattingly, 1991; Mattingly & Fleming, 1994).”

“Through narrative approaches to clinical reasoning, therapists are trained to carefully incorporate their clients’ real-world life narratives into decision-making processes during the therapeutic process (Cohn & Crepeau, 2019; Mattingly, 1991a, 1991b, 1994).”

“For example, Mattingly (1991) described how storytelling helps facilitate understanding of patients’ illness experiences and the clinical reasoning process.”

“…replicates the clinical model of a one-to-one relationship with patient or client (Clark, 1993; Crepeau, 1991; Frank et al., 1991; Helfrich & Kielhofner, 1994; Helfrich, Kielhofner, & Mattingly, 1994; McCuaig & Frank, 1991; Mattingly, 1991; 1994; Mattingly & Fleming, 1993; Pierce & Frank, 1992).”

“This process of integrating past, present and future selves involves the construction of personal narratives (Gergen and Gergen, 1988; Mattingly, 1991; Helfrich et ai, 1994).”

“Given the possibility that clinical nar rative can be unconstrained during authoring, others share Mattingly's view that patient involvement in the re process [36].”

“In narratives or stories, people’s actions are explained by their placement within a specific context, and by identifying how their motivations and intentions are linked with seemingly separate events and actions (Mattingly, 1991).”

“One important account of clinical reasoning from this research approach is narrative reasoning (Mattingly, 1991).”

“In this study a choice was made to make explicit the intervention strategies used by occupational therapists, by listening to how they described their experience of conducting self-care training and ‘what they were doing and thinking during the therapeutic process’ (Mattingly, 1994).”

“…of personal and practice contexts on clinical 12 British Journal of Occupational Therapy January 2004 67(1) reasoning was not directly labelled by Mattingly (1994a, 1994b) or Fleming (1994), the influences of both the environment and the therapist’s personal values and beliefs on reasoning were…”

“Importantly, clinical reasoning encompasses more than just the process of reaching a diagnosis, which while pivotal, is just part of a range of clinical reasoning strategies at a clinicians’ disposal.(17,18,19,20,21) Research in the health sciences has identified the clinical reasoning strategies used in different hea…”

“McQuaig and Frank (1991) described a narrative process in which meaning was attributed by a woman with cerebral palsy to her own personal competence through a series of interviews.”

“Although the knowledge and practice surrounding the use of chores seems consistent with the work of enabling empowerment, this knowledge tends to remain unconscious or tacit unless brought to light through observation, questioning, and reflection (Mattingly, 1991; Schon, 1983).”

“For occupational therapy practitioners, whose interventions are frequently focused on the unfolding narrative of the individual (Mattingly, 1991), this disadvantage can make the use of manuals particularly problematic.”

“Mattingly (1991, 1994) evaluates the narrative structure of clinical acts and contends that clinical encounters involve patient and carer together in the creation of and negotiation about the plot structure, which then gives meaning to particular therapeutic tasks by placing them in a larger…”

“Mattingly (1991) appears to be speaking of collaborative practice when she discusses the concept of narrative reasoning.”

“Although the patient is recognised as being the expert in matters of his or her own life (Mattingly 1991, Hammell 1994), the above account would suggest that a balance between professional expertise and the views of the patient is required.”

“Rather, occupational therapists shape the narrative process through therapy experiences so that clients perceive the disability and a future life in a more favorable light (Mattingly, 1994; Ward et al., 2007).”

“Roxanna’s narrative image (Mattingly, 1991, 1994, 1998) of him wavered between hope and worry, describing the unrelenting uncertainty: It’s just incessant, relentless, non-stopping, every day, every night worry.”

“The use of narrative reasoning, in which therapists create and tell stories to bring coherence to a client ’ s lived experience (Mattingly, 1991), is particularly emphasized as a means to identify how each client ’ s past and present life circumstances, and future goals, affect their performance of…”

“Within the body of literature on clinical reasoning, Mattingly (1991) suggested that "perhaps occupational therapy as a profession needs to take its phenomenological tasks more seriously" because the phenomenological”

“Closely related, narrative theory focuses on how actors interpret and construct coherence when making sense of the world in which they act [14; 15].”

“…"breathe" which I did while he walked al'Ound the room admiring m\' nOWClS. ga7ing out rhe wimJo\V and rcmarking whar a lovell' day it was (p, 13) Mattingly (1991) gave occupational thel'apists pause for reflecrion when she argued that "therapists can come to reduce their practice to a…”

“…an occupational perspective into medically measurable components, a practice that neither encompassed the full scope of enabling occupation (Mattingly, 1991; Cockerill, Scott, & Wright, 1996; Wilcock, 1998), nor was connected to the meaningful occupations that our profession valued and…”

“Many authors have described the clinical reasoning process itself (Fleming, 1991a, 1991b; Mattingly, 1991; Mattingly & Fleming, 1994; Robertson, 1996a; Rogers & Holm, 1991, 1997; Schell & Cervero, 1993), while others have investigated potential differences between the clinical reasoning of the novice and the experienc…”

“The TTM is an application in clinical practice that looks at the client’s life pattern in a holistic perspective which enables the client to look back at her/his progress through life, and which results in what Mattingly (38) has characterized as conditional clinical reasoning.”

“For example, one participant’s therapist used occupational storymaking (Clark et al., 1996; Mattingly, 1994, 1998; Price-Lackey & Cashman, 1996) to help the client develop his identity as a traveler.”

“Mattingly (1994, 1998) noted that therapists attempt to draw on a client’s desire and sometimes have to negotiate meanings of the therapy experiences as they relate to movement toward or away from the occupational outcome goal.”

“In the first interview, parents were asked to tell the “story of their family.” They were asked for their stories because, “in a story, a person’s actions are accounted for, or explained, by their placement in some specific historical context” ( Mattingly, 1991, p. 999 ).”

“T he value of interpretive or meaning-centered approaches to understanding others’ perspectives is well-documented in the occupational therapy literature (Clark, 1993; Frank, 1996; Mattingly, 1991, 1998; Mattingly & Fleming, 1994; Spencer, Krefting, & Mattingly, 1993).”

“The emotional component that inter-links with the cognitive element of the clinical examination is generated by the clinicians' empathy and the ability to interpret and appreciate the patient experience enhancing the patients' sense of being listened to and understood (Mattingly, 1991; Orme andMaggs, 1993).”

“All of these cognitive processes, from each section of the report, are collectively referred to as skills of clinical reasoning.(36) Whereas multiple domains of reasoning are the hallmark of clinical expertise, the narrative report is structured to encourage CCAPFGERIATRIC EDUCATION FOR MEDICAL INTERNS 523 JAGS MARCH…”

“Mertens (1998) wrote that in qualitative research, “The burden of transferability is on the reader to determine the degree of similarity between the study site and the receiving context.”

“In her 1993 Eleanor Clarke Slagle Lecture, Clark (40) expanded Mattingly’s (32,63) description of clinical reasoning to propose the term occupational storytelling to describe how the self is formed through past narratives of activities and conduct.”

“Recent explorations into this topic have considered a range of types of reasoning, such as procedural, narrative and pragmatic (Fleming, 1991a; Mattingly, 1991).”

“…reasoning has begun to focus on reasoning in occupational therapy on the basis of the uniqueness of the profession's fundamental philosophy and the treat ment context (Burke & Depoy, 1991; Crepeau, 1991; Fleming, 1991a, 1991b; Mattingly, 1989, 1991a, 1991b; Schell & Cervero, 1993; Schwartz, 1991).”

“The findings also identified other reasoning terminologies, such as ‘narrative reasoning’ (Mattingly 1991).”

“For occupational therapists, this view of clinical reasoning as the application of knowledge and theory did not fully explain the complexity of the task of treating the 'illness experience' (Mattingly, 1991b), that is, the way in which the illness/disease affects the individual.”

“For example, Mattingly [4], Rogers & Masagatani [9] have identified collaboration and narrative reasoning as important features of occupational therapy.”