Supporting therapist engagement in evidence based practice: Developing a continuing education programme through participatory action research

Therapists find it challenging to integrate research evidence into their clinical decision-making because it may involve modifying their existing practices. Although continuing education (CE) programmes for evidence-based practice (EBP) have employed various approaches to increase individual practitioner’s knowledge and skills, these have been shown to have little impact in changing customary behaviours. To date, there has been little attempt to actively engage therapists as collaborators in developing educational processes concerning EBP. The researcher collaborated with seven clinical therapists (one occupational therapist, four physiotherapists and two speech and language therapists) enrolled in a new post-qualification Implementing Evidence in Therapy Practice (IETP) MSc module to monitor and adapt the learning programme over ten weeks. The participating therapists actively engaged in participatory action research (PAR) iterative cycles of reflecting→ planning→ acting→ observing→ reflecting with the researcher. Mixed methods were used to evaluate the IETP module and its influence on therapists’ subsequent engagement in EBP activities. Data were gathered immediately on completion of the module and five months later. Immediate post-module findings revealed four components as being important to the therapists: 1) characteristics of the learning environment; 2) acquisition of relevant EBP skills; 3) nature of the learning process; and 4) acquiring confidence. The two themes and sub-themes which emerged from individual interviews conducted five months post-module expanded on the four components already identified. Theme 1: Experiencing the learning (sub-themes: module organisation; learning is relational; improving the module); and theme 2: Enacting the learning through a new way of being (sub-themes: criticality and reflection; self agency; modelling EBP behaviours; positioning self in an EB work culture). The therapists’ perspectives had by then shifted from that of a learner to that of a clinician constructing a new sense of self as an evidence-based practitioner. Findings from this study underline the importance of the process of socially constructed knowledge and of empowering learners through collaboratively designed continuing education programmes. In the student-driven learning environment, therapists chose repetitive skill-building and authentic problem-solving activities which reflected the complexity of the environments to which they were expected to transfer their learning. These findings have implications for educators designing EBP continuing education programmes, during which students develop professional ways of being.

Human interfaces to structured documents

This research investigates some of the reasons for the reported difficulties experienced by writers when using editing software designed for structured documents. The overall objective was to determine if there are aspects of the software interfaces which militate against optimal document construction by writers who are not computer experts, and to suggest possible remedies. Studies were undertaken to explore the nature and extent of the difficulties, and to identify which components of the software interfaces are involved. A model of a revised user interface was tested, and some possible adaptations to the interface are proposed which may help overcome the difficulties. The methodology comprised: 1. identification and description of the nature of a ‘structured document’ and what distinguishes it from other types of document used on computers; 2. isolation of the requirements of users of such documents, and the construction a set of personas which describe them; 3. evaluation of other work on the interaction between humans and computers, specifically in software for creating and editing structured documents; 4. estimation of the levels of adoption of the available software for editing structured documents and the reactions of existing users to it, with specific reference to difficulties encountered in using it; 5. examination of the software and identification of any mismatches between the expectations of users and the facilities provided by the software; 6. assessment of any physical or psychological factors in the reported difficulties experienced, and to determine what (if any) changes to the software might affect these. The conclusions are that seven of the twelve modifications tested could contribute to an improvement in usability, effectiveness, and efficiency when writing structured text (new document selection; adding new sections and new lists; identifying key information typographically; the creation of cross-references and bibliographic references; and the inclusion of parts of other documents). The remaining five were seen as more applicable to editing existing material than authoring new text (adding new elements; splitting and joining elements [before and after]; and moving block text).

Eleanor Roosevelt: supporting Zion, denying Palestine

Eleanor Roosevelt, as a renowned humanitarian, portrayed an inconsistency by supporting Zionist ambitions for a national homeland in Palestine while simultaneously ignoring the rights of the indigenous Palestinians. Because of this dichotomy, this dissertation explores her attitudes, her disposition and her position in light of the conflict in the region. It conveys how her particular character traits interplayed with the cultural influences prevalent in mid-century America and encouraged her empathy with the plight of European Jews after the Holocaust. As she evolved politically, initially under the tutelage of Franklin Roosevelt and latterly as a UN delegate, she outgrew the anti-Semitism of the period to become a committed Zionist. Judging the Palestinians as ‘primitives’ incapable of self-government and heartened by Jewish development, she supported the partition of Palestine in November 1947. After the 1948 Arab-Israeli war the 800,000 Palestinian refugees encamped in neighbouring Arab states threatened to destabilise the region. Her solution was to discourage repatriation and to re-settle them in Iraq – a plan that directly contravened the principles of the December 1948 Universal Declaration of Human Rights proclaimed by the UN committee she had chaired. No detailed work has been conducted on these aspects of Eleanor Roosevelt’s life; this dissertation reveals a complex person rather than a model of ‘humanitarianism’, and one whose activities cannot be so simply categorised. In the eight chapters that follow, her own thoughts are disclosed through her ‘My Day’ newspaper column, through letters to friends and to members of the public that petitioned her, through a scrutiny of her articles, books and autobiography. This information was attained as a result of archival research in the US and in The Netherlands and was considered against an extensive range of secondary literature. During the Cold War, to offset Soviet incursion, Eleanor Roosevelt promoted Jewish usurpation of Palestinian lands with equanimity in order that an industrious Western-style democracy would bring stability to the region. These events facilitated the exposure of a latent Orientalism and an imperialistic lien that fostered paternalism in a woman new to the nuances of international diplomacy.