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Abstract

There are repeated calls for evidence-based practice (EBP) in therapeutic recreation (TR) as a means to improve client outcomes, ensure consistency and communication among professionals, create protocols and criteria for client assessments, and increase recreation therapists' (RTs) research capacity. The purpose of this study was to understand what influences RTs' clinical decision-making in a mental health setting. A qualitative research approach with ethnographic techniques was used. The study consisted of two phases: journaling and a focus group. A systematic, inductive approach guided analysis of the data from 10 RTs located in different workplaces within one Canadian health region. Findings suggested that while RTs had a common practice philosophy, their use of research evidence in decision-making was limited. A lack of infrastructure supporting service provision including minimal clinical leadership, few opportunities for mentorship, and contextual factors such as limited resources influenced clinical decision-making. Implications for research and practice are provided.

Keywords

clinical decision-making, clinical leadership, contextual factors, evidence-based practice, therapeutic recreation

Purpose of Study

There are repeated calls for evidence-based practice (EBP) in therapeutic recreation (TR) as a means to improve client outcomes, ensure consistency and communication among professionals, create protocols and criteria for client assessments, and increase TR research base (Ferguson, 1992; Gerken, Costello, & Mrkic, 2013; LeBlanc & Singleton, 2008; Lowe-Heistad, Adams, Giesbrecht, & Krahn, 2014; Mrkic, 2011; Stumbo & Pegg, 2010). Some authors go further by contending that TR's survival and permanent inclusion as an allied health profession rely on the uptake of EBP (Stumbo & Pegg, 2010). Yet fewer than half of recreation therapists (RTs) use EBP (Mrkic, 2011), and the feasibility of EBP for many health professionals has been questioned due to shortages of evidence, the limitations of applying research results to individuals, and an overall dearth of training, time and resources (Mullen & Streiner, 2004). To date, little attention has been paid to the contexts that impact RTs' daily decision-making as a means to elucidating the possibilities and challenges of engaging in EBP. The purpose of this study was to determine how RTs working in a mental health setting, including community, outpatient, inpatient, and tertiary settings in a local health authority in British Columbia, Canada, made clinical decisions in their day-to-day practice. The research question was: What factors influence...

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