Blog Posts

Chat will be hosted by @preston_jenny 

Despite the abundance of evidence in existence finding answers to our clinical questions can remain challenging.  Whether you are seeking to explore the evidence base or develop an idea for further research, the one thing that is key to everything is the ability to formulate a clear and specific question.  In this #OTalk I want to take you on a journey from that early curiosity through to publication of new and emerging evidence.  

My journey started 9 years ago when I was given responsibility for setting up a service for young people living with a neurological condition as they transitioned from child health to adult services. As a clinician it felt like a fairly natural thing to do.  After all I had many years of clinical experience so why should this be any different?  And there the questions began … I had spent a career working with adults living with neurological conditions so what did I know about young people and their needs?  What did I know about transition?  How might I be able to help them?  What would a service need to look like?  How will I know if it is helpful?  What interventions will I need to offer?  What about the legislation? What is everyone else doing?

As a busy clinician I didn’t necessarily have the time to commit to additional study or even time to review the evidence so like many I just started doing what “felt right.”  Yet I remained curious, fuelled by my observations that I was being asked different questions; that I was delivering different interventions; and that the more engaged I became the less I seemed to understand the concept of transitioning.  There seemed to be so many questions at this stage and even when I did engage with the evidence I didn’t really know what I was looking for as on reflection I had not yet formulated my questions.  I really did not know where to start.  

However after some reading I started to formulate my thoughts into three main categories as follows (McCombes, 2022, http://scribbr.co.uk):

1. Describing and exploring:
   1. What are the characteristics of this population?
   2. How do their needs change over time?
   3. What causes this change?
   4. How is this dealt with?

2. Explaining and testing
   1. What are the trends/relationships within/between this population and any other group?
   2. What is the role of occupational therapy within transitions?
   3. What is the impact of occupational therapy?

3. Evaluating and acting
   1. What are the advantages and disadvantages of interventions?
   2. How effective are interventions?
   3. How can interventions be improved?

Suddenly it became much clearer to me as I realised that there were many questions that required to be answered and each with very different purposes.  This structure enabled a more focussed approach to a single topic.  It helped to clarify that there was not one single question but this would in fact become a series of questions, all designed around a single topic that should aim to improve understanding rather than demand a ready-made solution (McCombes, 2022, http://scribbr.co.uk).  

We have subsequently developed three studies based on this programme of enquiry:

1. An overview of interventions used across the life span to support transitions of those with a neurological condition: a systematic review of reviews 
2. A qualitative evaluation of transition experiences from individuals living with a neurological condition 
3. Exploring the clinical interventions within a Transitions Programme through the use of the ICF

These studies are all at various stages of development and are being prepared for publication with one already accepted.  The main learning throughout this journey has undoubtedly been around the following key principles (adapted from http://scribbr.co.uk):

• Focussing on a single problem or issue
• Researching using primary and secondary sources with a clear question in mind
• Feasible to answer within time constraints and practical constraints 
• Specific enough to answer thoroughly
• Complex enough to develop the answer into a meaningful presentation, paper or publication
• Relevant to your area of interest (clinical or research)

Authors: Sam Pywell (Social Prescribing Unit coordinator, University of Central Lancashire) and Rachel Booth-Gardiner (Lead Occupational therapist TEWV NHS Foundation trust).

The first #GreenerAHPs week took place over the last week, during tonights #OTalk we want to reflect on the event and demonstrate what Occupational therapy is doing to ensure we meet the target of Net zero by 2040 for the emissions The National Health Service (NHS) controls directly; and Net zero by 2045 for the emissions the NHS has the ability to influence.

The fundamental argument is this: #GreenerAHPs role is the role and professional responsibility of every allied health profession (given the climate crisis, and pressures on services). So where do we take this from here?

Each day during #GreenerAHPs week had a theme, one that might be most suitable to focus on during tonight’s #OTalk is “Public health and prevention”.

Day 3 which highlighted the brilliant work AHPs do on public health and prevention and its links to climate change.  They stated “AHPs are an integral part of the public health workforce. There is a carbon footprint attached to all healthcare activity across all settings, however proactive rather than reactive care generally has a lower impact. This means there is a strong link between our ambitions as #GreenerAHPs to improve public health and reduce our carbon impact, as less carbon intensive healthcare is based on reducing the need to access healthcare services”.

Sam reflects on her approach to being a #GreenerAHP.  “We can be more active in being #GreenerOT #GreenerAHP as well as supporting sustainable, healthier, greener communities for all.  The United Nations (UN) (2015) Sustainable Development Goals (SDG) urges us all to focus on goals to tackle climate change, poverty, address health inequities and improve community wellbeing.  

For example, SDG 3 (good health and wellbeing), SDG 13 (climate action) and additional SDGs can be seen as interconnected.  We know access to green spaces (and meaningful activities within them) are critical for better mental health and wellbeing, yet can be inaccessible due to lack of transport and the financial means to explore what makes an individual well in these environments (Gov UK, 2022; NHSE, 2022a; Husk et al., 2021). 

This agenda is reflected in the NHS England (2022b p39) Delivering a ‘net zero’ NHS where addressing health inequalities and facilitating upstream prevention is used as an intervention to primarily meet an individuals needs but also reduce hospital admissions and therefore carbon footprint.  

AHPs can demonstrate part of this role by engaging in the preventative care and social prescribing agendas as #GreenerAHP is closely connected to social justice in the NHS England AHPstrategy (2022c).  In 2019, the Royal Society for Public Health (RSPH) stated AHPs (and therefore occupational therapists) have several roles connected to the prevention and social prescribing agenda.  Connected, thriving communities which tackle health inequalities and environmental issues are some of the healthiest communities in the world.  

Green Social Prescribing (NHS, 2023) is another intervention which springs to mind. Whether an OT signposts the individual to e.g. a community group delivering wellbeing walks in nature, delivers sessions in nature (including adventurous activities) or designs/ grows social prescribing (e.g. a new green social prescribing service with nature based interventions and education) there will be an influence on both the individual being referred and the AHP/ occupational therapist in understanding the value and importance of caring for nature and the environment as it that relationship which forms a large part of the healing and support for individuals.“ 

Rachel reflects on being a #GreenerAHP 

“The NHS says ……..One of the biggest threats to our health, and our planet, is climate change. Contributing around 4% of UK emissions, the NHS and other UK health and care organisations must be part of the solution. Tackling climate change will ensure we can deliver high quality care for all, now and for future generations. 

There are many things we can do to help our profession be greener, as both an occupational therapist myself and someone who accesses occupational therapy serviers. I have thoughts about ensuring our interventions are right the first time around which will help reduce waste, sometimes this might mean spending more, but in the long term reduces poor experiences and waste for example equipment provision that need replacing regularly, is one way we can help meet this target,  but what are your thoughts? Join in #GreenerAHP during this week find out more here, and then join us on tuesday 25th to reflect

Tonight’s questions by Rachel and Sam are therefore all about #GreenerAHP and the #GreenerOT

#OTalk #SocialPrescribing #PublicHealth #Prevention #OT #OccupationalTherapy #AHP #MakingEveryContactCount #GreenerAHP

References

Gov UK (2022) Health disparities and health inequalities: applying “All our health”

https://www.gov.uk/government/publications/health-disparities-and-health-inequalities-applying-all-our-health/health-disparities-and-health-inequalities-applying-all-our-health

Husk, K. et al., (2021).  Nature on Prescription handbook.    https://www.ecehh.org/research/nature-prescription-handbook/ 

NHSE (2022a) Green Social Prescribing.  https://www.england.nhs.uk/personalisedcare/social-prescribing/green-social-prescribing/ 

NHSE (2022b) Delivering a Net Zero NHS https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/ 

NHSE (2022c).  The Allied Health Professions (AHPs) Strategy for England: 2022 – 2027 AHPs Deliver. https://www.england.nhs.uk/long-read/the-allied-health-professions-ahps-strategy-for-england-ahps-deliver/ 

RSPH  (2019).  Driving forward Social Prescribing: A framework for Allied Health Professionals.  https://www.rsph.org.uk/static/uploaded/c4dceeb6-4ced-4bfa-9ec8a9780172fd4d.pdf 

UN (2015).  Sustainable Development Goals.  https://sdgs.un.org/goals 

Further CPD

26th April, 1.00-2.30pm, NHSE webinar on “The role of Allied Health Professions in enabling social prescribing”.  Book here: https://www.events.england.nhs.uk/events/the-role-of-allied-health-professionals-ahps-in-enabling-social-prescribing

NHSE (2023) Greener AHP.  https://www.england.nhs.uk/ahp/greener-ahp-hub/upcoming-events/ 

We all have different needs when it comes to developing our skills to use evidence to inform our practice.  This will depend on the confidence and capability we developed during our pre-registration studies, the learning and development opportunities we’ve had both in and outside the workplace, and our motivation to engage in activities to develop our confidence and capability in the research pillar.

Occupational therapists report barriers to using research and this often relates to a lack of confidence and skills. But we don’t know if occupational therapists are actively identifying evidence based practice skills as learning needs, and engaging in activities which are helping them to meet their development objectives. We’re also not sure what approaches may be most effective.  We’re really interested in knowing the types of activities occupational therapists engage in to help build their confidence and capability to use research evidence. Having a better understanding of effective activities will help us to showcase examples of good practice, identify barriers and gaps and help inform planning of learning activities to support the professional development of our occupational therapy workforce. 

In this week’s OTalk we’ll be exploring this with you. To prepare for the chat, you could complete our survey to help you to reflect on your own learning needs and previous development actives you may have engaged in. Or you might like to take part in the chat first to reflect and hear others’ experiences to help plan your own learning and development.

We’ll be asking:

The term “Leadership” has no one set definition within the literature, and arguably can be seen as subjective. One definition of leadership is “the action of leading a group of people or an organisation, or the ability to do this” (Oxford English Dictionary).  

Leadership is paramount to any health care profession, without leadership there would be no direction, growth, and/or sustainability (Tempest and Dancza, 2019). Occupational therapy like other professions relays on strong leadership to ensure the effective running of the occupational therapy teams, services, and organisations. As a result, this ensures that as a profession we can meet public demand and assist in what occupational therapists do best, helping others engage in occupations and live not exist.  Strong and daring leadership is needed more than ever, as the demand on occupational therapy services grow due to a number of factors such as having an aging population. 

Occupational therapists are arguably natural optimizers due to the nature of the profession, bringing leadership skills to the front through their interactions, structuring of the environment and commitment to helping individuals participate in meaningful occupations. Often occupational therapist lead without is knowing it and are in a strong position to lead due to the vast array of skills they hold. This is evident as roles such as Chief Allied Health Professions Officer for England, and Scotland’s new Health Secretary are both occupational therapists by background. 

Therefore, due to leadership being such an important topic, the RCOT Northern and Yorkshire Regional Committee will be holding a leadership workshop, this will make up the second half of the upcoming come back learning event in York (See details below).

In preparation for the learning event Paul Wilkinson (Vice Chair of the committee), Helen Tomes (Co-opted Retired Rep) and Ruth Ferguson (co-opted committee member) want to explore occupational therapy and leadership further with the following questions/statements: 

Useful resources: 

RCOT Career Development Framework – https://www.rcot.co.uk/publications/career-development-framework 

References: 

Tempest S, Dancza K. Embracing the leadership potential of occupational therapy in the social age: Time for a silent revolution. British Journal of Occupational Therapy. 2019;82(10):601-603. doi:10.1177/0308022619840247

Link to event: 

 RCOT Northern and Yorkshire region – Comeback learning event – https://www.rcot.co.uk/events/rcot-northern-and-yorkshire-region-comeback-learning-event 

At the start of this year the Department of Health launched Northern Ireland’s first Research, Development, and Innovation (RDI) strategy for Allied Health Professionals (Department of Health, 2023).

It addresses the need to support all AHPs in RDI activity via three key strands: the transformation of AHP professional identities, culture and roles; the delivery of excellence in evidence-based practice; and Northern Ireland strategic research priorities are explicitly inclusive of Allied Health research and innovation.

As an occupational therapist in clinical practice who also been involved in RDI, the strategy is a long-awaited roadmap; or more so, a compass that will assist fellow OTs embarking on their own unique research journey. While many people have supported me on my research adventures, there has been the occasional wrong turn or dead end but inevitably the journey has got easier as experience and networks have grown. 

The strategy addresses four interdependent domains that are necessary to achieve transformational impactful change: Capacity; Capability; Context; and Culture. These domains have been vital in the development of my research career. 

Capacity has been earned by successfully applying for research funding through my NHS Trust and demonstrating research productivity. I currently have half a day a week dedicated to research. 

Capability was established by undertaking a Masters in Clinical Research in 2008. Successive years have built upon this through private study and practicing writing in an academic style. 

Context has been channelled through building networks with clinical and academic peers close to home and globally, being alert to any relevant funding to make research happen. I am indebted to my supervisors at Ulster University and to HSC Innovations for providing me with direction across all aspects of RDI.

Culture is underpinned by the mantra that “research (and innovation) is everybody’s business” which has been integral to my clinical development. Actively appraising research as a clinician helps you decipher best evidence-based practice to help your patients. Through reading, it can build knowledge and skills. The flip side of evidence-based practice, “practice-based evidence”, may help you start to formulate research questions on interventions you value but where the evidence is lacking. You ask questions, consider solutions, and reflect on the best way to answer. You engage the creative and the academic parts of your brain. This process can be extremely rewarding and enjoyable.

This OTalk invites you to consider, wherever you live and work, how you can take that first step into RDI or help you further along that road. Becoming familiar with an RDI strategy can provide aspiring researchers with a bird’s eye view of what infrastructure, resources and support are potentially there to help. Inevitably this can only enhance OT evidence-based practice and help our patients everywhere.

Reference 

Department of Health (2023) AHP Research and Innovation Strategy Northern Ireland. [accessed 20/02/2023] Available at: https://www.health-ni.gov.uk/news/ahp-research-and-innovation-strategy-northern-ireland