The aim of this action research study was to embed the theoretical tenets of the Canadian Model of Occupational Performance and its structures in a way that was appropriate to, and would be used by, all staff within an integrated health and social care setting. The action research involved 10 phases of reflection and action, with data analysis occurring between the cycles.
The findings showed the importance of taking time to embed theory before implementing model structures in order to prevent those structures, and particularly the paperwork, becoming superficial. In addition, the importance of using theoretical structures (models) flexibly and adapting them to particular services was identified.
A more generally applicable finding was that occupational therapists can and should demonstrate their theory through their practice and that this can be done by using a model to illustrate their clinical and, more specifically, their conditional clinical reasoning (Mattingly and Fleming 1994). In addition, the demonstration of clinical reasoning proved vital in making the client-centred and occupational beliefs of the model overt.
It was concluded that implementing theory and using occupation-based literature (Williams and Bannigan 2008) in this way can take a long time but is worthwhile because it provides a sound and strong base for the profession's identity.
Cancer survival rates have improved dramatically over recent years, however, health-related quality of life (HRQoL) for many patients, survivors and their families remains low even after successful treatment. This mixed-methods observational study explored the effects of participation in community choirs on HRQoL in individuals who have had cancer (patients) or have been affected by cancer (non-patients). This included a longitudinal analysis of choristers commencing the Tenovus Cancer Care "Sing with Us" choirs across Wales and a series of semi-structured interviews and focus groups. Participants completed the Short-form 36 and the Hospital Anxiety and Depression Scale on commencement of the choir and 3 and 6 months later. On joining the choir, several domains of the SF36 were lower, indicating worse HRQoL and greater depression in patients than non-patients (p < .05). In patients, choir participation improved vitality, overall mental health and anxiety. In non-patients, choir participation improved anxiety (p < .05). Participants experienced the choirs as both an uplifting musical activity and a supportive community group. The results support the provision of a spectrum of support options to meet the different needs and preferences of people affected by cancer.
Aims: Evidence-based practice is an approach to clinical decision making which combines the best available evidence with individual patient care. Debate as to what makes good evidence and how this should be applied in practice as well as ambiguity about the meaning of evidence-based practice and concern regarding its confl ict with other models of occupational therapy, have created uncertainty for occupational therapists attempting to become ‘evidence-based’. The aim of this study was to explore the meanings attributed to evidence-based practice by occupational therapists and to propose a defi nition and framework of evidence-based practice that refl ects participants’ perceptions. Method: A mixed methodology qualitative design incorporating focus groups, in-depth interviews and observation was used to explore perceptions of evidence-based practice by occupational therapists at one setting in England. Findings: The fi ndings indicate that evidence-based practice is typically associated with use of research but that this is only partially relevant to occupational therapy and the treatment of individuals. A defi nition of and framework for evidence-based occupational therapy which refl ects these fi ndings is presented. Conclusion: Acknowledgement of a range of evidence, from research fi ndings to clients’ selfreports, corresponds with participants’ conception of clinical reasoning as a complex process that takes multiple factors into account. This, together with participants’ client-centred approach and emphasis on the human experience of health encounters, forms the basis of a reconfi guration of evidence-based occupational therapy.
Evidence-based practice.Evidence-based practice is the buzzword of policy makers, managers and practitioners alike and yet there is confusion as to what it actually means and how it should be implemented in practice. One difficulty arises from the inherent tension between theories derived from research (particularly large-scale clinical trials) and practice based upon the needs of individuals. In this opinion piece, data from the authors' own research are used to advocate an alternative model of evidence-based practice, which recognises the value of multiple sources of evidence and which is congruent with occupational therapy philosophy.
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