Creating a research proposal: deciding on the sample

Creating a research proposal: deciding on the sample

The sample is the people you will experiment on in your research to obtain results. In an ideal world the study should examine an unbiased representative mini-chunk of the actual population, so that the results can easily be extrapolated and applied to the real world. To get your sample as close to the real world as possible, you must consider:

  • sample size
  • who should be in your sample?
  • the ethics of all this experimenting on the poor sample people
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Free sample madam?

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Article review: “Clinical governance and the drive for quality improvement in the new NHS in England” by Scally & Donaldson (1998)

Article review: “Clinical governance and the drive for quality improvement in the new NHS in England” by Scally & Donaldson (1998)

Scally and Donaldson are best friends who fight crime in the in King’s Lynn area in their spare time. Scally is street smart whereas Donaldson is book smart. Their adventures always reveal a moral lesson about the importance of compromise in teamwork.

double-act-otters
Double act: Scally & Donaldson

In 1997 (two decades ago now!) the Government issued guidance that health organisations now had a duty to improve quality rather than just attain financial and activity targets. This was in response to concerns that the Tory ‘marketplace model’ for the NHS had led to price being more important that quality of care. They were to improve quality through clinical governance.

“Clinical governance is being held accountable for continuously improving the quality of services, which safeguards high standards of care”

On a practical level clinical governance can be split into the areas of: Read more

Trends in the Private Sector

Trends in the Private Sector

Money from us (from our taxes) is passed to the government, which is passed down to the NHS to fund it. But how does the NHS department should get which money? And which departments should exist and get funded by the NHS at all?  How are private companies involved if the NHS is a public organisation?  The system set up to decide how the NHS’ money is spent is complicated, and it’s easiest if you just watch this video to understand:

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Article review: “Rethinking reflective education: What would Dewey have done?” by Rolfe (2014)

Article review: “Rethinking reflective education: What would Dewey have done?” by Rolfe (2014)

Rolfe (2014) goes straight for the jugular and says that reflective practice has failed to become an everyday part of healthcare practice (and as a result failed to improve it), and that this is the fault of managers and educators as well as practising therapists.umm not sure otter

He thinks reflection has been misunderstood- it’s really how we DO reflection-in-action (Schön 1987), not how we WRITE about reflection-on-action after the fact using structured models. Rolfe says believing that reflection-on-action is reflection is how managers/educators/therapists have misapplied it. they should be focusing on reflection-in-action, the bit that Schön thought reflection actually was anyway.

So most reflection takes place at a desk with pen and paper after the event, whereas the people who ‘invented’ it thought it was more reflecting with the situation while you were in it. If you’re rationalising things afterwards it’s the same as a technician carrying out research recommendations, which is fine if it’s an easy patient “tame problem” but if it’s a complicated “wicked problem” which is complex and unique and cant be applied to other previous situations… it’s not much use.

Fish & Coles (1998) also looked at clinical judgement in relation to reflection and tame/wicked cases (except they called them technical rationality and professional artistry). Technical rationality/tame problem are being a drummer in a pop band- following predictable formulaic beat patterns from instructions that already exist; whereas wicked problems requiring professional artistry are like a saxophonist in an improvised jazz ensemble- you’ve got to play along in harmony to sounds you haven’t heard before or will hear again. It is like being a mini-researcher experimenting on small scale on individual case in the moment, rather than carrying out actions based on existing research done by someone else.

 

Being taught in a classroom doesn’t allow you to experience the complex wicked problems of the real world and the associated reflection-in-action. Rolfe therefore sees the current classroom method as an inefficient way of training healthcare professionals and he thinks apprenticeships -which involve more exposure to practical elements than placements do- would be better.

Should students be exposed to tame or wicked problems in their learning? Schell & Schell (2008) said a series of similar tame problems are helpful so a student can recognise patterns and build up a repertoire of ‘answer templates’ to problems. Solving wicked problems happens when one can piece together tame problems relevant to the complex one. It can be seen that the student/novice needs to have tame solutions down to pat first before they can successfully solve wicked problems.

Standing on the shoulders of giants- learning something by building on the existing knowledge/experiences others (Sir Issac Newton)

Rolfe stresses that this opinionated article isn’t written as fact, but a one-sided opinion in order the stimulate a response and a debate. He thinks that more opinion pieces and proposed hypotheses for complex problems should be included in professional journals and not just research studies, because it would create official debate in order to decide which new areas needed research.

 

 

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Reference

Fish D and Coles C (1998) “Professionalism eroded: professionals under siege” In Fish and Coles (editors) Developing professional judgement in health care: learning through the critical appreciation of practice. Oxford: Butterworth-Heinemann
Rolfe G (2014) Rethinking reflective education: What would Dewey have done? Nurse Education Today 34(8): 1179–1183.
Schell BAB and Schell JW (2008) Clinical and Professional Reasoning in Occupational Therapy. Lippincott Williams & Wilkins.
Schön D (1987) Educating the reflective practitioner (1st edition). San Francisco: Jossey-Bass.
Trends and Contexts in Occupational Therapy

Trends and Contexts in Occupational Therapy

trendy-otter-meme-mug
#trendy

Trends are a something (like a style of therapeutic practice) that is popular at the moment. Example:

  • mindfulness
  • adult colouring books
  • active ageing
  • life stories
  • use of Sensory Integration in settings other than paediatrics
  • paternalism being challenged
  • holistic approach to health
  • in society, being in debt is acceptable whereas in the past it wasn’t

Contexts are the circumstances that influence or affect something (like a trend):

  • Politics and the resulting government policies on access to services and funding
  • the culture
  • the attitudes of individual therapists

 

Contexts in healthcare are often influenced by political and legislation, because in the UK healthcare is funded by the government because we have the NHS. In other countries where healthcare is paid for by insurance or individuals consumers, it may be be more heavily influenced by these other factors?  Anyway, in the UK the Care Act (2014) is a recent policy that supersedes the previous health-related acts such as NHS act (2006). Because of what the Care Act (2014) states, some expected trends to happen in healthcare will be

  • integration of services:
    • health and social care working more closely
    • between hospitals and GPS (primary & secondary care)
    • between mental and physical care