Thinking in Stories: Narrative Reasoning of an Occupational Therapist Supporting People with Profound Intellectual Disabilities’ Engagement in Occupation

Abstract

This article illustrates narrative reasoning using the findings from research into an occupational therapy intervention promoting changes in the ways a staff team facilitated meaningful engagement in occupation. Qualitative critical ethnographic case study research explored a single case over one year of an occupational therapist working with five people with profound intellectual disabilities and their support network. Data were collected using participant observation, interviews and document analysis. Illustrated by an ethnodramatic vignette, the findings demonstrate how the occupational therapist reasoned narratively by eliciting, telling and creating stories and how this supported individualization of her intervention to the specific context. Creation of a prospective story that the support network were invited to share, guided and propelled the intervention toward its hoped-for ending. Narrative reasoning was particularly apparent in opportunities to reflect aloud, supporting occupational therapists’ need of opportunities for reflection through story-sharing and story-making. Case study and ethnographic research methodologies may be useful in further clinical reasoning research to better understand narrative reasoning.

Keywords:

• Case study methodology
• clinical reasoning
• ethnodrama
• ethnography
• narrative reasoning
• occupational therapy
• qualitative

Acknowledgements

The authors would like to acknowledge the support of Dr Huguette Comerasamy.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Ethics statement

This research was approved by the University of Brighton Faculty of Health and Social Sciences Research Ethics and Governance Committee and the National Health Service National Research Ethics Service (NRES) (Ref: 12/LO/0319).

All research participants have been fully anonymized and either consented to participate in the research themselves, or participated on the basis of best interests decisions (as described within the article).

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

David Haines

David joined the University of Brighton in 2006 and was Course Leader of the part-time BSc (Hons) Occupational Therapy between 2012 and 2021. David’s research interests have focused on occupational therapy with people with intellectual disabilities (learning disabilities) and in particular those with complex needs, including profound intellectual and multiple disabilities. He is interested in how we can support and enable people with intellectual disabilities to engage in occupations and how occupational justice can be promoted, in particular through improving the quality of support people receive. In 2015, he completed research for a PhD exploring the ways an occupational therapist supported people with profound and multiple learning disabilities to engage in their occupations at home. David is particularly interested in ethnographic, case study and action research methodologies and in finding ethical means of involving those who may not have capacity as research participants in order that their needs may be researched and their support improved.

Jon Wright

Dr Jon Wright, University of Brighton

Formerly Principal Lecturer in Occupational Therapy at University of Brighton.