Category: #COT2017

Journal Club: An exploration of the attitudes, knowledge and ability of occupational therapists in applying evidence to practice.

The interactive journal club format is new for COT2017 and I jumped at the chance to cover one of these sessions. I’m particularly interested in this format as it is something we have been discussing setting up at my workplace and having never attended a journal club before I was keen to see what the format could offer.

Sam Turner started by providing an overview of the article and outlining the key findings as well as a brief critique of her own. She proclaimed she was by no means an expert but has had experience of running journal clubs in the past and hoped for it to be an interactive critical discussion. The article she had chosen was brilliantly linked to overall conference themes around engagement in research and evidence based practice, as well as the CPD theme of this combined session.

The key finding of this systematic review is that there is disparity between our attitudes to evidence based practice and our actual real-world application of it. Perceived benefits include helping occupational therapists to demonstrate the effectiveness of our interventions, as well as fill gaps in our knowledge. However, the article also showed that there are negative perceptions of evidence based practice in terms of physical/financial resources and therapist time required, as well as the view that it can stifle creativity. What came out most strongly from this Sam’s introduction to the article was that organisational challenges and perceived barriers to implementing evidence based practice remain a key concern.

Sam’s critique touched on the validity of the research question, the methodology of the systematic review and her positive thoughts about the resulting recommendations of the article. She then opened the session up to the floor for comments and for a moment the room fell completely and utterly silent. But bit by bit the delegates, myself included, began to speak up – and what followed was an interesting and lively discussion.

Whilst some of this discussion did diverge from critiquing the research, pre-prepared guiding questions were a great way to ground the session in the article and keep us thinking about what it meant for our practice and ongoing development. Sam’s skilled facilitation allowed discussion to play out amongst delegates with some interesting points being made:

• In order to support and encourage evidence based practice we need a strong occupational therapy presence at higher levels within organisations to allow room for the application of evidence to happen. Applying evidence to practice is not easy and practitioners need to feel supported from above if they are to drive change.
• Evidence based practice isn’t just about journals. One delegate suggested for RCOT to start collecting data of when their guidelines are downloaded in the form of a quick tick box survey to capture the who/how/why/where/when of guidelines usage.
• We all do evidence based practice more than we talk about it – even a quick look at a guideline counts and we need to shout about this!
• We need to empower our service users to challenge us regarding our practice and the evidence behind it. They are the people who experience what works and what doesn’t.
• Further engagement with social media is key. OTalk has been a great forum for getting people talking about evidence based practice and we should be encouraging the use of this new technology and communication methods we are so lucky to have.
• Journal clubs are a great way to get people engaged in evidence based practice and should include all levels of therapist – combined top-down and a bottom-up approaches provide the best ideas and discussion.

That is where the session had to come to a close. Everyone was so engaged I think it could have gone on much longer. I hope the Conference Development Team decide to keep this new journal club idea going in 2018 and give just a little more time for sessions.

As a newly qualified occupational therapist there was so much to gain from seeing more experienced therapists discuss their thoughts and ideas all sparked by one piece of research, and a real confidence boost to know I could contribute to the discussion. I’m excited to take what I learnt from this experience back to my workplace and plan to taking our own journal club plans forward with renewed enthusiasm!

By Ayla Greenwood, @AylaOT

Alexandra Thompson from West London Mental Health Trust shared her thoughts on the pros and cons of preceptorship. She gave a balanced view of some of the challenges that a preceptorship can bring, and the specific factors that she feels made her preceptorship a positive one.

Alexandra’s evaluation of her preceptorship experience listed some positives as regular meetings led by an experienced therapist, the opportunity to share things she was doing in practice that she was proud of, prompts to think critically about core OT skills and a structured way to start building a CPD portfolio. The challenges were around finding time to work on the preceptorship portfolio and that programmes can be very nurse led and lacking those opportunities to address core OT issues.

Working for a trust who have recently moved away from an OT preceptorship in favour of a multidisciplinary band 5 development programme and having never experienced the other side of this, Alexandra’s Brag & Steal offered some insight in to why an organisation might instead move towards a discipline specific preceptorship programme. Alexandra encouraged delegates to speak to their seniors about implementing this kind of programme in their workplace, with parting thoughts around it being a great initiative to encourage service development, and a medium that helps newly qualified staff to increase their confidence in practice early on in their careers.

Paper: Occupational Therapists’ research engagement: enablers and challenges

I was excited to see fellow BlogSquader Laura di Bona present her research experiences and once I had grasped the idea of a Randomised Control Trial being like a big Ferris wheel with lots of different components that you can’t just set up at once I understood what we were talking about; a specific phase of a larger piece of research during which Laura and her colleagues were developing an intervention around Community OT in dementia requiring the therapist participants to act in a dual role of clinician but within a research initiative, and the challenges that this brought for individuals.

The four main challenges for the participating occupational therapists were around learning the intervention, recruiting participants, fidelity and paperwork but what I really took away from this session were the enablers. Positive attitudes was the first, with Laura and her colleagues finding that a belief that it would happen and that research has true value being a big enabler in terms of therapist engagement in the research. Next came peer support on both a practical and emotional level, as well as management support. Laura outlined the importance of experienced management supporting therapists engaging in the research by providing links to research departments, funding to backfill protected time for research engagement and promoting the value of research within their teams. Finally came protected time, for which engagement in research needed to be considered a priority on a systems level.

Laura ended her portion of the session by saying that for occupational therapists to drive forward the research agenda being promoted at the conference there needs to be a change in research culture to increase practitioner engagement. Just as we would personalise an intervention for a client, we need to be personalising research for therapist participants and their contexts – keeping the design relevant and practicable, ensuring support structures are in place and avoiding the ‘research bubble’ that if anything is a hindrance to creating a culture of active engagement in evidence based practice.

Written by Ayla Greenwood, @AylaOT

This was a lively and thought provoking debate on the motion:

“This house believes that diverse roles are a vital tool in the future of our profession.”

It’s somewhat of a challenge to distil the variety of shared viewpoints and experiences in a limited character count, and I’m very aware of the potential to upset someone on either side of the fence! However, I’ll do my best to hone in on key points, and hope it’s simply a bridge to further insight and discussion.

Session chair David Brindle, Public Services Editor at The Guardian, took an early vote before the motion was argued, to establish a baseline of opinion. In a room of 143, the vast majority were in favour, with 9 against and 1 abstention.

Miranda Thew, Senior Lecturer at Leeds Beckett University, was speaking for the motion, with the support of Yvonne Thomas, Principal Lecturer and Academic Lead for Allied Health Professions at the University of Worcester. Miranda is a passionate advocate for diverse roles, having devoted much time and research to this area, yet she opened by describing the tussle she has had with the premise of what is ‘diverse’.

She cited opportunities for diversity in most areas of practice, but how the constraints of some settings stifle the ability to practice in a person-centred, occupation focused way.

Diverse practice was linked with occupational justice, in relation to the occupational therapists who support those not able to access traditional healthcare settings, including prisoners and traveller communities.

Diverse roles at initial points of access were also referenced: GP surgeries, A&E, the ambulance service and care homes. These are diverse roles, but ones that could ensure our future in an NHS that appears to have side-lined occupational therapy in many future strategy documents.

Speaking against the motion was Kee Hean Lim, International and ENOTHE lead for occupational therapy at Brunel University. He was joined by Gabrielle Richards, Professional Head of Occupational Therapy and Trust Social Inclusion and Recovery Lead for South London and Maudsley NHS Foundation Trust.

Arguments against the motion addressed its wording – are these roles ‘vital’ to our future, or just another opportunity? The speakers also warned about the risk of diluting occupational therapy into generic therapy, rehab or care coordination roles, and trying to do all things for all people. When the profession has a hard enough challenge of promoting its worth, should it not be clear about what it is, what it does and its territory? Should occupational therapy students not be mastering basic skills and building their professional identity first, before exploring roles outside of traditional practice?

Citing the numbers of occupational therapists in the NHS, the speakers argued that we are not in a position to treat ourselves as a luxury to work across so many settings. The danger may be, we’ll spread ourselves too thinly. Another argument was the need to fill existing vacancies as a way of securing the future of the profession.

When the debate was opened to the floor, the first comment struck me: “Diverse doesn’t’ mean doing all things, it’s doing ‘real OT’ in diverse settings.” It was encouraging to hear fellow students engaging in the debate, sharing their (mostly positive) views of role-emerging placements, as an opportunity to directly translate learning into practice. Most were advocates for an experience that had allowed them to engage in unrestrained and truly occupation-focused practice.

As the final vote was cast, the number ‘against’ the motion had increased slightly, as had the rate of abstention, but there was a clear majority in support of diverse roles as a vital tool in the future of occupational therapy.

This session provided food for thought, especially the notion that role emerging placements can offer direct application of classroom learning, and help to build skills that may not be accessed elsewhere.

 Bev Goodman
1^st year pre-reg MSc student at the University of Essex
@BevG_studentOT

This session was the final keynote for the COTSS_Older People and what a way to end.

Maggy Piggot provided us with an inspiring personal insight into her journey with dance from an aspiring ballet dancer as a little girl through negotiating the charges of getting up close and person in the tango to becoming a member of a The Sage Dance Company 

This story was intertwined with perspectives on the role that dance played during a period of ill health which led ultimately to an early and unwanted retirement. Maggy described the impact of this unexpected transition into retirement on her in terms of things like loss of role, identity and purpose and physical well being. She talked about how dance helped her to navigate her way through this period of change.

She described how she became involved in Open Age (Maggy is now a Trustee). Open Age is an organisation working across Kensington and Chelsea, Westminster and Hammersmith and Fulham which aims to:

enable anyone aged 50 or older to sustain their physical and mental fitness, maintain an active lifestyle and develop new and stimulating interests.

Through a number of dance classes Maggy joined with Open Age she became involved in a number of performances and she shared with us a video of a performance in Trafalgar Square she took part in as part of the Big Dance Festival in 2016. You can watch the performance here . The dance was created by Akram Khan and participants ranged from 14-86 yrs old.

In terms of her personal story Maggy finished by telling us about her more recent experience of auditioning and, after a 3 month probationary period, being accepted into the Sage Dance Company, a community dance company for people over the age of 55. Find out about the company and watch a video of their work here. 

What an amazing journey.

In the final stages of her presentation Maggie went on to talk more about the potential positive impact that dance can have on physical, emotional and social wellbeing and in a lovely way linked her presentation back to the opening keynote of the specialist section conference by highlighting the potential of dance to contribute to 2 of the 3 factors identified by Anna Dixon from the Centre for Ageing Better as contributing to a better later life health and social connection.

She also talked about how dance is being recognised at a policy level and I’m sharing a slide which demonstrate this and the final slide with references for anyone who wants to follow this up further.

It feels only right to end with one of the quotes that Maggy used

We should consider every day lost on which we have not danced at least once. (Nietzsche)

Written by @lynnegoodacre

Reference: De Las Heras. CG. Geist R, Kielhofner, G, and Li, Y. 2003. The Volitional Questionnaire. Version 4. University of Illinois at Chicago: Chicago, IL.

Contact Email Address: rachael.coates2@nhs.net

Blog shot by @Helen_OTUK