The OT process is when we apply the theories of occupation in an ordered way to a practical situation. Many different models of the OT process have been developed, and they each attempt to guide a therapist through the stages of applying occupational theory to a practical client situation. Some models may be more useful in particular situations or with particular clients than others.
Part of the artistry of an being an OT, and the difference between being a technician and a professional, is being able to adopt a holistic approach and use a model most appropriate to the individual client’s unique blend of problems in order to achieve a positive outcome. Technicians follow instruction in order to carry out processes whereas professionals use a blend of artistry with science to determine the best model and interventions for each unique patient.
CMHTs (Community Mental Health Teams) provide specialist care to people experiencing mental health crises, as well as ongoing primary care support for people with chronic mental health conditions with the aim to prevent admittance to secondary or tertiary health care. Different professionals make up a CMHT but usually includes specialisms such as psychiatrists, psychologists, community psychiatric nurses, social workers, and occupational therapists.
This article examines the referral stage of the OT process: the attitudes of CMHTs receiving referrals, and the GPs who refer patients to them. The qualitative information was gathered via semi-structured interviews, referral meeting transcripts and questionnaires.
Problems with the referral process in CMHTs
Overall, Chew-Graham et al found a lack of consistency between CMHT teams, and referral criteria boundaries varied depending on the individual attitudes of CMHT team leaders. Referring GP’s knowledge of mental health issues and caution around risk also varied between individuals. Read more ›
As a student getting your ideas across in essays is crucial in order to convey you have grasped the ideas and can see both sides. These skills will still be needed when you are writing or reading research papers once you’re qualified, or when you need to convey one or both sides of a treatment approach in a report about patient care to others in an MDT. Any points you make need to be backed up with evidence to make them valid.
Critical thinking requires quite a few skills to be carried out effectively, including observation, categorisation, analysis, judgement/reasoning, making final decision, persuasion, perseverance in repetition of examining facts, and objectivity. This last skill forms the basis of being able to critically analyse both sides of a situation or concept.
Evidence used in essays must be:
Appropriate – Making the same point as you and not similar or just on the same topic. Also must be recent unless it’s a historically seminal piece of work about principles or foundations.
Proportionate – Specific statements about defined populations or findings may only need one piece of evidence, but the bigger the statement the more evidence you need- views from for and against camps are needed to represent the whole debate.
Synthesised – How is it synthsised or worked into the flow of the essay? How does the evidence move your point towards its conclusion? So what if the research shows that ‘banana therapy is most effective for under 30s’ …what statement that you’ve made in your essay is it proving?
According to Sackett et al’s (1997) hierarchy of evidence, grey literature such as this is shouldn’t usually be the first source you turn to for evidence since there are other sources which are more reliable, for example because they have been peer-reviewed. However sometimes there may be an absence of quality sources or you are trying to gain an understanding of public opinion on a topic.
To help me assess the website I am going to use Aveyard et al’s (2001) ‘six questions to trigger critical thinking’, which are:
Where does this information come from?
What is being said?
How did they write this?
Who is telling me this?
When was this written?
Why has this been written?
Where does this information come from? I found this by searching for “guidelines stroke recovery eating” using the search engine DuckDuckGo to avoid any tracking cookies from Google biasing the results according to my previous search history. Read more ›
I can’t use any old piece of evidence which has an abstract and a few relevant keywords to base my clinical actions on.
It could be biased (such as being funded by someone with an interest in the study’s outcome), not statistically significant, methodically flawed or irrelevant to the precise patient problem I am investigating. I could be challenged by a well-informed ‘expert patient’ who has free and easy access to information themselves via the internet, so I need to make sure I can back my decisions up.
Instead I’ll need to identify the patient’s problem, find relevant studies, critically evaluate them, and then apply them to the problem taking into account the patient’s individual needs.
Research + Clinical Expertise + Patient Preference = EBP
The process of EBP has five steps, although Melnyk (2010) later added two additional ones shown in italics below. It should also be noted that sometimes ‘Health Service Restrictions’ are included in the above formula (DiCenso et al 1998), meaning that limitations due to resource cost/access are taken into account as part of pragmatic reasoning.
0. CULTIVATE SPIRIT OF INQUIRY essential starting point
1. ASK questions that are answerable!
2. ACQUIRE search for the best evidence from the research available
3. APPRAISE critically appraise/evaluate the evidence – is it relevant, valid, reliable, applicable to you clinical question?
4. APPLY integrate the evidence with clinical expertise and patient’s preferences and values, and then implement it
5. ASSESS evaluate and reflect on the outcomes of your decision
6. DISSEMINATE EBP RESULTS share good practice and support other healthcare professionals Read more ›
Lots of different information sources are available to OTs when they are searching for evidence to guide their Evidence Based Practice. The different types each have different levels of usefulness related to patient care.
Some example sources and their uses are:
Guidelines – help OTs to make decisions quickly as you do not need to search and review literature yourself. Someone eg NICE has done this (plus taken into account the cost/benefit) already for you.
Protocols – defined steps or rules used to describe the process for a particular treatment or assessment. Often specific to local contexts; stricter and hold more weight legally than a guideline.
Blogs – useful to understand public opinion around a certain issue; can read a wide range of opinions and see what evidence is used to back each up (or question whether any has!). Is this where patients have researched healthcare in the absence of journal access, and does this explain their viewpoints?. Some professional organisations also have blogs, such as this BMJ evidence based nursing blog.
Theories – explanations of phenomena. They can be tested to see if they work in practice via research hypotheses, so in this way evidence could prove or disprove theory.
I’ve chosen to review the quality of a piece of qualitative research titled “Strategies used by older women with intellectual disability to create and maintain their social networks: An exploratory qualitative study” by Katharine White and Lynette Mackenzie. I chose this because prior to starting my Masters I worked for a social inclusion charity with people with learning disabilities, so I was interested in whether the results were something that could have potentially influenced my work there.
This article is a research paper and not an opinion piece, which you can tell by the fact that it has an Abstract, collates data methodically from a subject group (Method section), analyses it (Data Analysis/ Results sections), and then draws conclusions based on the factual results (Discussion, Implications for Occupational Therapy sections).
The authors are Katharine White who is an Occupational Therapist with the Department of Aging, Disability & Care in Sydney, and Lynette Mackenzie who is an Associate Professor at the University of Sydney. They are both interested in researching the effects of aging on disabled individuals and this is plausible as Mackenzie is part of the ‘Aging and Health Research Team’ at the university and White currently specialises in aging and disability in her job role.
They have not declared any conflicts of interests and the research was not funded by anyone, but it was given ethical approval by the University of Sydney. It’s important to check these details because if the sponsor or researcher has a vested interest in the results of the study it’s possible they will be intentionally or unintentionally biased- for example the selection criteria for subjects may be manipulated in favour of one result, or only positive findings are published. Read more ›