Dynamic and diverse ways of knowing in mental health occupational therapy

This study focused on evidence based practice in mental health occupational therapy. It investigated the theoretical, evidentiary and practical knowledge that occupational therapists use to support consumers and understand the relationship between occupation and health.

A model for predicting clinician satisfaction with clinical supervision

Clinical supervision can improve staff satisfaction and reduce stress and burnout within the workplace and can be a component of organizational readiness to implement evidence-based practice. This study explores clinical supervision processes in alcohol and drug counselors working in telephone and online services, assessing how their experiences of supervision link to workplace satisfaction and well-being. Standardized surveys (Manchester Clinical Supervision Scale and the TCU Survey of Organizational Functioning) were completed by 43 alcohol and drug telephone counselors. Consistency of supervisors and good communication were the strongest predictors of satisfaction with clinical supervision, and satisfaction with supervision was a good predictor of overall workplace satisfaction. © 2014 Copyright Taylor and Francis Group, LLC.

Development of a management algorithm for post-operative pain (MAPP) after total knee and total hip replacement: study rationale and design

Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described.

Distorted representations of the‘capability approach’ in Australian school education

Recently, curriculum developments in Australia have seen the incorporation of functionalist ‘general capabilities’ as essential markers of schooling, meaning that any pedagogical expression of classroom-based practice, including subsequent instruction, should entail the identification and development of operational general capabilities. The paper questions and critiques recent curriculum developments in Australia that characterises capabilities purely in functionalist terms, something that the broader capabilities literature eschews. The analysis is informed by aspects of the theoretical frameworks of Martin Heidegger and Pierre Bourdieu. It examines the notion of ‘general capabilities’ in the Australian Curriculum. The paper argues that there is an inherent contradiction in Australian education policy, namely a vocationally oriented national school curriculum with implied functionings that cannot fulfil designated purposes. The paper finds that the curriculum's connection to increased individual and national economic prosperity, one championing ‘jobs and careers of the twenty-first century’, is evident, although current populous forms and categories of employment seem to suggest otherwise.

The Integrating Theory, Evidence and Action (ITEA) method: a procedure for helping practitioners translate theory and research into action

Introduction: The aim of this article is to describe and explain a new method for integrating theory and evidence that enables practitioners to translate evidence into action applied in their practice. Method: A new multiple methods procedure called the Integrating Theory, Evidence and Action method is described. It is a mixed method that progresses through seven distinct steps: clinical question, framework, identification, deconstruction, analysis, reconstruction, and transfer/utilization. An example of using this method to review evidence around occupational therapy with people recovering from alcohol misuse and/or abuse is provided. Findings: This method highlights the importance of theory, tests the empirical strength of theories, includes diverse forms of evidence, and encourages the integration of knowledge within clinical practice. Conclusion: The Integrating Theory, Evidence and Action method is accessible and useful to practitioners and will support their efforts to make their practice evidence based. Current methods of evidence-based practice focus mostly on research evidence (particularly quantitative evidence); however, research is only one of the ways of knowing that practitioners draw upon to guide their practice. This method enables occupational therapists to integrate theory, evidence, and practice in a coherent and translatable way.

Idle central venous catheter-days pose infection risk for patients after discharge from intensive care

This prospective observational study measured idle central venous catheter (CVC)-days (no medical indication), and ward clinicians' adherence to evidence-based practices for preventing short-term central line-associated bloodstream infections (CLABSIs). In 340 patients discharged from ICU over a 1-year period, 208 of 794 CVC-days (26.2%) were idle. Interventions to prevent CLABSIs were poorly implemented. Ward clinicians need education regarding risk management strategies to prevent CLABSIs, and clear accountability processes for prompt catheter removal are recommended.

Reliability and validity of the Alberta context tool (ACT) with professional nurses: Findings from a multi-study analysis

Although organizational context is central to evidence-based practice, underdeveloped measurement hindersitsassessment. The Alberta Context Tool, comprised of 59 items that tap10 modifiable contextual concepts, was developed to address this gap. The purpose of this study to examine the reliability and validity of scores obtained when the Alberta Context Tool is completed by professional nurses across different healthcare settings. Five separate studies (N = 2361 nurses across different care settings) comprised the study sample. Reliability and validity were assessed. Cronbach's alpha exceeded 0.70 for9/10 Alberta Context Tool concepts. Item-total correlations exceeded acceptable standards for 56/59items. Confirmatory Factor Analysescoordinated acceptably with the Alberta Context Tool's proposed latent structure. The mean values for each Alberta Context Tool concept increased from low to high levels of research utilization(as hypothesized) further supporting its validity. This study provides robust evidence forreliability and validity of scores obtained with the Alberta Context Tool when administered to professional nurses.

Programs to improve the social and emotional wellbeing of Aboriginal and Torres Strait Islander communities

Attending to the social and emotional wellbeing of those from Aboriginal and Torres Strait Islander cultural backgrounds is widely recognised to play a key role in effective social work practice. However, relatively little is currently known about what effective practice comprises, and significant challenges exist in any effort to demonstrate that programs do achieve significant change both for individual participants and the communities in which they live. This paper considers one program, Seasons for Healing, to illustrate the type of intervention that holds promise when working with adults and discusses the difficulties that arise in both defining and assessing program outcomes.

Sedation protocols to reduce duration of mechanical ventilation in the ICU: a Cochrane Systematic Review

AIMS: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. BACKGROUND: Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. DESIGN: Cochrane systematic review of randomized controlled trials. DATA SOURCES: Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. REVIEW METHODS: Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. RESULTS: Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature

Background: Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. Methods: In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. Results: There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. Conclusion: There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.

Systematic reviews: a social work perspective

Systematic reviews are gaining prominence and recognition as being an important methodological approach to dealing with ever growing amounts of research data, and recent years have seen the development of guidelines for both the conduct and reporting of systematic reviews. Initially systematic reviews came to prominence as a method for synthesising data emerging from Randomised Control Trials (RCTs) but increasingly the term “systematic review” is being used in regards to reviews of studies of a wide range of research designs. However, among Australian social workers, utilisation and conduct of systematic reviews has been limited. This paper will explore the question of what a systematic review is, introduce some of the key issues in undertaking such a review, and explore the implications of the emergence of systematic reviews from a social work perspective.

Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals

Aim: Poor nutritional status has negative effects on post-operative outcomes, further compounded by surgical stress and fasting, places gastrointestinal surgery patients at high risk of malnutrition. Recent published research has challenged historic surgical nutrition practices; however, changes to practice in Australia have been slow. The aim of this study was to investigate current nutritional management of gastrointestinal surgery patients and compare this with the best practice guidelines, while exploring enablers to implementation of best practice. Methods: A 30-question telephone survey was developed to explore demographics and nutritional management of gastrointestinal surgical patients during pre-admission, inpatient stay and post-operative care. Forty-one gastrointestinal surgery dietitians were identified and contacted from 31 public hospitals in Victoria, Australia, and invited to participate. Results: Twenty-five dietitians participated in the survey (response rate 61%). Very few dietitians (12%) were funded for pre-admission clinics or outpatient clinics, and, overwhelmingly, dietitians reported not being involved in nutritional decision-making, and reported feeling unsatisfied with current nutritional management of patients. Despite half the hospitals reporting following best practice guidelines, only 22% implemented guidelines completely. There was no correlation observed between dietitian experience, department size or full-time equivalents allocated to surgery and nutritional intervention; however, the presence of a care pathway made a significant difference to the dietitian's overall satisfaction with dietetic care (P = 0.002). Conclusions: Current nutritional management of gastrointestinal surgery patients in Victorian hospitals is far from best practice. The implementation of a care pathway is the most effective way of ensuring best practice nutritional management of gastrointestinal surgical patients.

Occupational therapy with people with depression: using nominal group technique to collate clinician opinion

AIMS: This aim of this study was to obtain a consensus from clinicians regarding occupational therapy for people with depression, for the assessments and practices they use that are not currently supported by research evidence directly related to functional performance. The study also aimed to discover how many of these assessments and practices were currently supported by research evidence.

METHODS: Following a previously reported systematic review of assessments and practices used in occupational therapy for people with depression, a modified nominal group technique was used to discover which assessments and practices occupational therapists currently utilize. Three online surveys gathered initial data on therapeutic options (survey 1), which were then ranked (survey 2) and re-ranked (survey 3) to gain the final consensus. Twelve therapists completed the first survey, whilst 10 clinicians completed both the second and third surveys.

MAJOR FINDINGS: Only 30% of the assessments and practices identified by the clinicians were supported by research evidence. A consensus was obtained on a total of 35 other assessments and interventions. These included both occupational-therapy-specific and generic assessments and interventions. Principle conclusion. Very few of the assessments and interventions identified were supported by research evidence directly related to functional performance. While a large number of options were generated, the majority of these were not occupational therapy specific.

Transformation from student to occupational therapist : using the Delphi technique to identify the threshold concepts of occupational therapy

BACKGROUND/AIM: Understanding and facilitating the transformation from occupational therapy student to practitioner is central to the development of competent and work-ready graduates. However, the pivotal concepts and capabilities that need to be taught and learnt in occupational therapy are not necessarily explicit. The threshold concepts theory of teaching and learning proposes that every discipline has a set of transformational concepts that students must acquire in order to progress. As students acquire the threshold concepts, they develop a transformed way of understanding content related to their course of study which contributes to their developing expertise. The aim of this study was to identify the threshold concepts of occupational therapy. METHOD: The Delphi technique, a data collection method that aims to demonstrate consensus in relation to important questions, was used with three groups comprising final year occupational therapy students (n = 11), occupational therapy clinicians (n = 21) and academics teaching occupational therapy (n = 10) in Victoria, Australia. RESULTS: Participants reached consensus regarding 10 threshold concepts for the occupational therapy discipline. These are: understanding and applying the models and theories of occupational therapy; occupation; evidence-based practice; clinical reasoning; discipline specific skills and knowledge; practising in context; a client-centred approach; the occupational therapist role; reflective practice and; a holistic approach. CONCLUSION: The threshold concepts identified provide valuable information for the discipline. They can potentially inform the development of competencies for occupational therapy and provide guidance for teaching and learning activities to facilitate the transformation to competent practitioner.