9 Comments

1. 

   Hello all, we both hope you have had chance to read the article in preparation for the journal club? Here is the reading record Hannah and I have completed, it is our first attempt at using the form so please feel free to add your own comments, discussion points and any constructive criticism you have is very welcome.
   We look forward to reading your comments.

   Name: Sarah Massey & Hannah Webster
   Date Record Completed: 20/10/13

   Full Harvard Reference:
   Robertson, L., Graham, F. and Anderson, J (2013) What actually informs practice; occupational therapists’ views of evidence. British Journal of Occupational Therapy, 76(7), 317- 324.

   Definitions of terms and concepts:
   Culture of evidence based practice (EPB) – use of journal clubs (McQueen et al, 2006, Stern, 2008); internships (Sabus 2008); group education (Hammond and Klompenhouwer 2005) and employing a clinical research leader role to facilitate the process (Horner et al 2007).
   Critical thinking – “About integrating individual clinical expertise and the best external evidence” (Sackett et al, 1996, p.71).
   Thematic analysis – The process involves the identification of themes through “careful reading and re-reading of the data” (Rice & Ezzy, 1999, p.258). It is a form of pattern recognition within data, where emerging themes become the categories for analysis. (Fereday, J. and Muir-Cochrane, E. (2006).

   Identification of the author’s main message:
   What occupational therapy practitioners in New Zealand are considering as evidence and how they are using it within practice.

   Identification of major themes:
   1. Finding evidence to support practice
   2. The nature of available evidence
   3. The organisational influences
   4. The importance of evidence

   Discussion of major themes and sub-themes:
   1. Finding evidence to support practice – Professional development time wasn’t allocated within workloads so talking to experienced colleagues was favoured as it was quicker and easier to find information. Many considered it’s only essential to read literature when there is no other way of finding out the information. Consulting colleagues for confirmation on practice added opportunities for peer support and professional dialogue and articles that were quick to read were favoured, such as abstracts of story-form literature as they were easy to read.

   2. The nature of available evidence – A randomised controlled trial was not considered the “OT way of working” as it’s not individualised. Qualitative research was thought to be better suited for individualised practice as it addresses individualised practice however it was a concern that EPB wasn’t capturing the importance of this. Some commented that is was hard to find peer-reviewed journals that were relevant to New Zealand practice. Some suggested that evidence could be more appropriate to certain clinical settings within the same practicing sector than others.

   3. The organisational Influences – Policies and cultural aspects influenced the use of EBP within working practitioners and it was not high on their priority list. A graduate with skills related to EBP felt they needed permission to use evidence. Competition amongst practitioners discouraged the sharing of information and time wasn’t allocated within the working day to contribute to EBP. Having to pay for articles or just read abstracts is a frustration amongst practitioners, as they didn’t have access to databases or libraries. However the use of journal clubs within settings was seen as helpful as it ‘forced’ someone to read the information.

   4. The importance of evidence – Therapists see the use of evidence as ‘core to their practice’, part of professional responsibility and ‘key…to being competent’. Many examples were given stating the importance of justifying evidence and practice is ‘sound and robust’. Evidence outside of own practice provides confidence when justifying to funders, defending approaches, working within a multi-disciplinary team and to support work with clients.

   Integration of material with other work:
   This article has been a very beneficial one to read in the eyes of a student, even to the degree of critiquing the methodology. Integrating what we’ve read from this article will be in the eyes of guiding fellow students to think “has this been evidenced?” but also using the new understandings of evidence to aid in our university studies and placement practices, such as using our core skills as OTs to effectively utilise the evidence and promoting our educators on their evidence of practice, which will in turn positively impact our learning and theirs.

   Application of material to own experience:
   As students, understanding the clinical reasoning behind particular interventions and assessments is almost second nature. Therefore, out on placement it is always a major topic of discussion with our educators, however little emphasis is on the why they do what they do: assessment tools, outcome measures and interventions are used because it’s what they do and how long they’ve been doing it for, not EBP. Hence why we can relate to the recently qualified issues with having to gain permission to use evidence (p.321, Organisational Influences). A further comment was made regarding the limited time and resources to locate and evaluate evidence, this we can relate to and we feel is a universal barrier to EBP, however to us as students using evidence proves our worth as OTs and we have the constant worry of not being able to say “we’re doing this because… however we delved into other options such as…” – which we’re sure that a lot of qualified OTs also worry about regarding maintaining their CPD and portfolio for the HCPC potential audits, not to mention the drive we all have as OTs to be continuously creative and resourceful.

   Evaluation of author’s presentation:
   For an article written about evidence and how it is used within practice, we were surprised that the authors didn’t comment on the importance EBP has within OT practice, as we all know how important it really is. Questions can also be raised about the article and the approach the authors took, for example, did you feel any of the telephone questions were leading? How did they purposively select the participants from those that replied to the survey? And are 14 participants enough for this type of study?
   We felt more emphasis could have been put on the importance of EBP (especially as this is what we have been used to) and some suggestions on how evidence can be used in a more productive manner within practice for current practitioners who can relate to these themes, and students who are about to embark in employment settings who may themselves face the same barriers.

   Application of learning to practice:
   Many strong points were made within this article that made us think about EBP and what actually constitutes as it, in a very positive manner. For instance, on the first page there is emphasis on utilising our clients’ knowledge of their own occupational concerns as a part of our evidence, noting that we do this on a regular basis with the OT process/information gathering it was quite interesting to read such a powerful statement, that does make you think twice about how many different ways there are to understanding the use of evidence in practice. Delving further into the article, there were some points that focus on using our core skills as OTs to utilise evidence effectively, and regardless of how ‘good’ the evidence may seem, it can be pretty worthless if it is not utilised effectively by someone with the appropriate skills – this applies perfectly to understanding why, at university, EBP is in our minds at all times, however it politely raises the issue of continuing this within practice – which is an ideal learning opportunity for students and practitioners as we can focus our individual learning needs on expanding our evidence within and without the prompts of university lecturers.











   Relationship to Practice/KSF Competencies:
   EBP is core to our speciality practice – with other health professionals questioning our practice, knowing we have this evidence not only expands our creative field but empowers those of our colleagues, whether they be other health professional students or those on your MDT, to understand occupational therapy. In addition, this helps create an effective therapeutic relationship with our clients: when we spend the time to explain why we’re there to see them and what we aim to achieve with them, we are ensuring they have a positive experience within our care which is tailored to a client-centered, occupational-based intervention which has been critically evaluated and reflected upon – we ensure our clients’ know that “one-size” doesn’t fit all when it comes to occupational therapy.

2. 

   Initially after qualifying there was so much to learn ‘on the job’ that how it linked to the latest evidence wasn’t at the forefront of my mind. However, once this level of learning was established, EBP became a key focus as part of the drive to continually improve services. This was driven through engaging in journal clubs and reading BJOT but specific searches weren’t conducted on my area of expertise. As a more experienced clinician this changed but access to searching the literature was more difficult and by this stage I was out of practice. In the current climate we need to be able to prove our effectiveness and justify our actions more so than ever before so we need to embrace research, it’s findings and not be afraid of being critical of our practice in our quest to continuously improve! Our service users deserve to be treated by upto date professionals and employers need to recognise this and provide protected time for clinicians to do this.

3. 

   My reflection (informal, no tool used):

   My prior experience to hosting a journal club was very limited, I’d failed to participate in the previous months’ journal club however I did make a note to go through the transcript and I did participate in my first #OTalk session on twitter so I felt I had an idea of how our journal club would plan out. I’d never been a part of an online journal club before, however I have been a part of journals clubs within the university and out in placement with other occupational therapists and their students. My experience of journals clubs is very vast and it is something I would consider to be enthusiastic about it, so this experience was almost like taking it to a new level.

   Preparation for this journal club was very early on: what I felt was one of our best tools was actually selecting the journal without pre-reading it. We’d read the title and made the decision the use the article immediately, which I feel aided in our journal club evaluations and topic discussions. We didn’t pick it because it was easy or for any other superficial reason, we chose it because of its relevancy: it relates to student OTs, OTs in practice, qualified OTs not in the working profession and retired OTs.

   Sarah and I had gotten together MANY times to discuss our individual notes and to create notes/questions ourselves that we could both agree on and felt that were appropriate. Working with another person was actually quite a weight off my shoulders, we could depend on one another for help and support as well as creating discussion pointed based on each other’s thought processes: Sarah had thought of points/made conclusions that I had not and vice versa. Even doing the online discussion was so much easier with another person. We would branch off each other’s tweets as well as dip in and out of discussions so that we both had equal input.

   I must admit, the wait beforehand was nerve wrecking: there weren’t many people tweeting which panicked me in particular. However once the ball was rolling, I think we had nice steady flow of conversations, which again I am grateful for a second person as the flow may have been too much to handle on my own.

   Journal clubs are definitely a leisurely pass time for myself and it would be a pleasure to do more of these, especially with Sarah as we do get on extremely well personally, academically and professionally. I feel that the entire experience enhanced my use of twitter as a professional tool as well as increasing rapport with other students and practising OTs out in the big working world, which is so beneficial for networking and making those vital connections. – Hannah Webster. 06/11/2013

4. 

   Great stuff. Is there a journal club on 12yh November? If so, what is the article to read up on? Thanks, Bri

   • 

     Hi Bri – the journal club is only on the first Tuesday of every month though we do meet weekly to discuss other things. You can find out topics from the google calendar at the top of the page and we normally post an introductory blog about what will guide the discussion at least a few days before. Hope that helps.

     • 

       Thanks, Kirstye- look forward to getting involved . Bri

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