Using the International Classification of Functioning, Disability and Health (ICF) to promote biopsychosocial clinical reasoning and person-centred practice (PCP) in two multi-disciplinary teams

Abstract

Title: Using the International Classification of Functioning, Disability and Health (ICF) to promote biopsychosocial clinical reasoning and person-centred practice (PCP) in two multi-disciplinary teams. Background: The ICF has been advocated as a way to enhance the biopsychosocial analysis of functioning and as a vehicle for implementing PCP. PCP has been recommended as a model to address contemporary healthcare needs. This action research study has identified factors required to facilitate biopsychosocial clinical reasoning and promote PCP through the implementation of the ICF. Setting and aims: Two multi-disciplinary teams, with different contexts, cultures and characteristics, participated in this study. One was community-based, included all members within the study group and sought to promote biopsychosocial multi- disciplinary clinical reasoning. The other was unit- based, utilised a sub-group of research participants and required a clinical reasoning model that embraced all disciplines and enhanced PCP. Methods: Data were generated through the use of iterative action research cycles which employed a variety of qualitative and quantitative methods. Findings were analysed through immersion and thematic analysis and descriptive statistics. Key findings were drawn from across all the data sources. Findings: Through the process of developing and implementing ICF-based clinical reasoning tools six themes emerged. The need for: a shared team culture aligned to that of the organisation; a resilient and innovative team culture and; the adaptation of the ICF to the context of practice reflecting the patients’, teams’ and organisational needs and capabilities. When present, these led to: enhanced communication and reasoning between team members and with patients; a greater awareness of the biopsychosocial needs of individuals and; enriched PCP. Conclusions: This thesis makes an original contribution about the prerequisites, contextual conditions, modifications and developments required to implement the ICF to promote biopsychosocial clinical reasoning and PCP.