The gate control theory of pain (Melzack & Wall 1965) proposes that non-painful input closes the “gates” to painful input, which prevents pain sensation from travelling to the central nervous system. Activation of nerves which do not transmit pain signals but transmit information about touch, pressure & vibration (called non-nociceptive fibres; nociception [no-see-sep-shun] is the perception of pain by beings) can interfere with signals from pain fibres, thereby inhibiting pain. Therefore, stimulation by non-harmful input is able to suppress pain.
The team in a pain clinic will typically be up of a clinical psychologist, nurse, occupational therapist, physiotherapist, an advising pharmacist, CBT therapist and counsellor. The International Association for the Study of Pain recommends the use of OTs for assessments an treatment of chronic pain (Loesler 1991). A pain clinic can be hospital (inpatient) or community (outpatient) based.
Questions can be created to answer a question in practice, or as an aim for research, so you must be clear which goal you are aiming for!
For both, you must first think of the question in narrative format, that describes the purpose and aim of your review.Then you need to break down the narrative question (using PICOT, SPICE, ECLIPSE or SPIDER tools) so you can identify each concept that needs to be searched for. To create a good research question, there are different tools you can use as a guide to identify the different concepts your question is made up of. Each of them is best suited to a different type of aim and question:
PICOT tool (Riva et al 2012) for clinical quantitative diagnosis-type questions, where there are two well-defined alternatives you are comparing. Eg. Does medication A more effectively reduce glaucoma in adults aged over 70 than medication B?
SPICE tool (Booth 2004, 2006) for intervention qualitative evidence-type questions, especially where there’s policy or practical implications to consider,
such as whether a policy/intervention has improved patient health or not.
Eg. Do hip fracture patients who stay in hospital for over four days recover more quickly on wards where staff have completed a training course in compassionate care?
ECLIPSE tool (Wildridge & Bell 2002) for health service questions, especially where exploring relevant information rather than comparing two options. Eg. Has the new advertising campaign run by the Stop Smoking Service resulted in increased smoking cessation amongst smokers as reported by GPs ?
SPIDER tool (Cooke et al 2012) for qualitative-type questions, focusing on study design and samples more than interventions. Eg What are young parents’ experiences of attending antenatal education?
Examples of questions produced from these tools can be found here. Fink (1998) asserts that a good search will attempt to use MeSH terms (Medical Subject Headings), which are a bit like using a thesaurus to find similar words so you can ensure you’re not missing out anything in your search because someone else calls it by a different name!
“Difficult, but important”
Reflection is an important yet ethereal skill that all Occupational Therapists need to master.
Part of completing a reflection is an inner sense of discomfort (in fact the first stage of reflection as described by Boyd & Fales 1983) so it’s no wonder many people put it off and may even try to get by without it, perhaps carrying out token reflections just to comply with CPD or course requirements. To begin with, reflecting on your actions is something that requires conscious effort after the event but eventually, according to Johns (2000), it will become an automatic thought process even when you’re in the middle of experiencing the event. When deciding which model to use, it can helpful to find out what learning style you are according to Honey & Mumford. You can relate these to the knowledge types shown in Carper/Johns’ reflective models.
Below is a rough guide to the different models of reflection out there, and which situations they’re best geared towards. They are ordered (in my opinion) from the easier ones for the beginner who is trying to break down and evaluate a situation, to the more complex ones that build on the basics and hope to elicit a change in your personal beliefs and challenge your assumptions. Gillie Bolton suggests exercises for creative ways to reflect in her book Reflective Practice: Writing and Professional Development (chapter 4).
Like Inception, you’ll naturally find yourself going deeper with your analysis of an event the more experience you gain with reflective models. Enjoy the ride!
Gibbs reflective cycle (1988)
Good for: Good old Gibbs. Basic, good starting point, six distinctive stages. Makes you aware of all the stages you go through when experiencing an event.
Criticisms are: superficial reflection- no referral to critical thinking/analysis/assumptions or viewing it from a different perspective (Atkins & Murphy 1993). Does not have the number or depth of probing questions as other models.
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