Visual reflections

Visual reflections

Visual reflections are one way of representing and structuring a reflection you’re making about an event. Rather than writing out a page of text, use text within pictures and symbols to convey emotion and meaning clearly. Drawing it out like a mind map or with symbols can make it easier to notice and connect themes together, as well as being quicker to both do and interpret. It can also make going through the different stages more clear and force you to not omit any difficult stages.

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An example will be shown here shortly…

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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Client-Centred Care & Ethical Dilemmas

Client-Centred Care & Ethical Dilemmas

Client-centred care (or patient-centred care or patient preference) is one of the core philosophies underpinning Occupational Therapy.  In any modern healthcare practice, it also forms part of the Evidence Based Practice (EBP) equation:

Research + Clinician Expertise + Patient Preference = EBP

How much weight each part of the formula should contribute to the overall treatment ‘answer’ is not clear cut, and when an extreme weighting from one or another element is proposed, it causes ethical dilemmas. Ethical dilemmas cannot be solved alone, but through collaboration with colleagues and professional body standards (such as the RCOT).

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I find myself almost never listening to Radio 1 anymore instead tuning in to BBC 6, BBC 2 and even 4… is this a reflection of becoming more interesting or more boring? Or that I need talk radio to keep me awake on the more frequent long car journeys I seem to do now? Either way, in the BBC 4 programme ‘Inside the Ethics Committee’ one episode discusses a woman who wants her leg amputated in order to forego any further knee surgeries. Read more

Menu: Conducting a literature review

Menu: Conducting a literature review

Clicking on the category to the right ‘How to conduct a literature review’ does bring up all blog posts related to doing a lit review, but there were getting to be too many to keep track of the order.Otter menu

So this is just a menu of all the blog posts related to writing a literature review, and also EBP in general, so they are in some kind of order and all in one place.


What is Evidence Based Practice? Why does it matter in everyday life?

Barriers to Evidence Based Practice

Article review: “Evidence-based medicine: a movement in crisis?” by Greenhalgh et al (2014)

Conducting a literature review:

Conducting a literature review: Where do I look for evidence to use in my Evidence Based Practice?

Conducting a literature review: creating a good question

Conducting a literature review: How to accurately evaluate any evidence before basing your practice on it

Conducting a literature review: evaluating the quality of research methods used in an article “Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement” by Richards et al. (2015)

Protected: All aboot Statistics

Conducting a literature review: Quality reviewing a research article “Strategies used by older women with intellectual disability to create and maintain their social networks: An exploratory qualitative study” by Mackenzie & White (2015)



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: “Evidence-based medicine: a movement in crisis?” by Greenhalgh et al (2014)

Article review: “Evidence-based medicine: a movement in crisis?” by Greenhalgh et al (2014)

If you need reminding what Evidence Based Practice (EBP) is, check here.

Not sure what Trish was up to but this article is printed in really small font and I had to zoom to 170% in order to be able to read it.


Zoom activated, I could now tell the article discusses some limitations of EBP, and the authors argue that although EBP has many benefits it has created some unintended negatives as well, which they describe as:

Drug companies controlling the research agenda, meaning evidence base is biassed according to their vested interests. Examples include fiddling inclusion criteria to make it likely people who will create desired results will participate, and only publishing positive results.

Volume of evidence has become unmanageable. We’ve all done a CINAHL search and returned 1,062 results. You don’t see how you can narrow your search terms anymore and you certainly can’t read all the abstracts…

Benefits identified as statistically significant may actually provide negligible  difference to patients in real life situations. Especially when research is carried out poorly, eg small sample size or drug company fiddling as mentioned above, the efficacy of treatment is falsely inflated for what it would actually be on a real population.

Inflexible rules risk healthcare becoming management-driven (following technical instruction) rather than client-centred (using clinical expertise). Eg creating protocols or checklists from EBP and then only following these in patient care. Like the QOF, where GPs get money for achieving health targets- Greenhalgh suggests that patients are monitored and provided check-box medication if they meet the QOF criteria, without consultation about their individual circumstances (client-centred care). This is a point Cohen & Hersh (2004)  agree with. O’Halloran et al (2010) follow on by saying that the technical guidelines produced by EBP stifle creativity.

Evidence available for individual conditions and not for co-morbidity, making it difficult to find evidence for patients with multiple diagnoses.  An aging population plus better management of chronic disease means more people have multiple conditions, which research studies don’t cover, removing individualised patient care.


Greenhalgh et al (2014) suggest overcoming these negatives by providing individualised care taking the context and even professional creativity into account. Patient advocacy groups should dictate areas of research more than companies. Peer-reviewed publishers should up their standards for article inclusion, and information should be disseminated in more user-friendly ways/methods (like infographics/via YouTube).


Note: apparently comorbidity is more than one illness in a person, and multimorbidity is more than two illnesses in the same person.



Cohen AM and Hersh WR (2004) Criticisms of Evidence–Based Medicine. Evidence-based Cardiovascular Medicine 8(3): 197–198.
Greenhalgh T, Howick J, Maskrey N and for the Evidence Based Medicine Renaissance Group (2014) Evidence based medicine: a movement in crisis? BMJ 348(jun13 4): g3725–g3725. Available at: [Accessed on 03.05.2017]
O’Halloran P, Porter S and Blackwood B (2010) Evidence based practice and its critics: what is a nurse manager to do? Journal of Nursing Management 18(1): 90–95.