Exploring the involvement of the institutional dimension of societal and practice contexts in community occupational therapists’ clinical reasoning: An institutional ethnography study protocol

Abstract

Rationale, aims and objective To optimise health services, decision-makers from both societal (e.g., national health ministry) and practice (e.g., clinical setting) contexts use institutional levers. These levers include legal, regulatory, administrative and organisational aspects of both contexts and aim to influence how professionals intervene. To guide their interventions, health professionals use clinical reasoning (CR). However, little is known about the leverage exerted by institutional elements on CR. Identifying these aspects and their impact upon CR could help tailor efforts to optimise high demand healthcare services, such as home care (community) and, more specifically, occupational therapy. To this end, this research aims to explore the involvement of the institutional dimension of the societal and practice contexts in community occupational therapists’ CR.Methods A qualitative institutional ethnography research design will be employed. Using purposeful sampling, ten community occupational therapists will be recruited in three Health and Social Services Centres in theprovince ofQuébec. Data will be collected through observations of community occupational therapists’ work during home visits and at the office as well as in semi-structured interviews. From observational charts and interview transcripts, individuals (e.g., colleagues, managers, clinical supervisors) and relevant documents will be identified and respectively interviewed and collected. Multiple and varied data sources will be analysed using the institutional ethnography two-level analysis process.Discussion Among the outcomes of this research, the results will facilitate the introduction of changes that could lead to improved access to services, optimised home care, and more prevention and health promotion interventions.