How do occupational therapists practising in forensic mental health know? A practice epistemology perspective.

Abstract

My research explored the knowledge of occupational therapists practising in forensic mental health. There is no ‘gold standard’ evidence in this practice area but other forms of evidence, including experience and “intuition”, are used in practice. My research aimed to identify the knowledge formed from and used in this practice area. My research design used qualitative methodology that was informed by American pragmatist, social constructivist and post-modern theory. In particular, I used grounded theory and situational analysis to generate and to analyse the data. The practitioners were three occupational therapists working in various forensic services in one London based NHS trust. My data was generated longitudinally over eight to twelve months, where the practitioners participated in email and face-to-face interviews. The critical incident technique and the critical decision method enabled practitioners to describe and explain their knowledge about one patient with whom they were working over the interviews. The practitioners also reflected upon participating in the research. My findings demonstrated that the practitioners’ knowledge was created from practice through the interaction of three categories. First, steps of practice were structures through which knowledge was generated about the service user. Second were rules for practice where expectations had to be met. Unpredictable situations and knowledge gaps prevented meeting expectations, so new knowledge was created from practice to meet them. The third category was a blend of the practitioners’ personal and professional experiences and emotions. Practitioners created a connection with service users in order to build a therapeutic relationship, alongside creating a nuanced narrative with their service users, which helped to build empathy. In conclusion, the practitioners in my research used various forms of knowledge in practice. My thesis contributes to existing scholarship by supporting a practice epistemology approach. Thus knowledge for occupational therapy in forensic mental health is created from practice.