Kinsella Niamh, Pentland Duncan, McCormack Brendan
Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Musselburgh, Edinburgh, UK.
Queen Margaret University, Edinburgh and The Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.
Scand J Occup Ther. 2023 Apr;30(3):398-414. doi: 10.1080/11038128.2022.2119162. Epub 2022 Sep 8.
Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear.
To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice.
MATERIAL & METHODS: A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods - Think Aloud, practice observation, creative expression and reflective dialogue.
Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions.
CONCLUSIONS & SIGNIFICANCE: Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity.
鼓励职业治疗师运用研究证据来指导全面应对痴呆症后果的治疗干预措施。近期在实践中运用研究证据的努力强调了以符合以人为本和专业原则的方式这样做所面临的挑战。运用研究证据是一个受多种背景因素和层次影响的复杂过程。目前尚不清楚背景在痴呆症职业治疗中的影响。
探讨在与痴呆症患者的实践中运用研究证据的背景复杂性，并发展相关知识以改进在以人为本、以职业为重点的实践中运用证据的方法。
采用案例研究方法，通过运用以下方法促进批判性和创造性反思来阐明实践的背景条件——大声思考、实践观察、创造性表达和反思性对话。
影响证据运用的文化信念包括对循证实践的技术导向性理解。这些信念的基础是担心失去专业身份，以及在调整源自研究证据的流程以纳入个人职业时承担风险。这些文化因素在背景的组织层面持续存在，在这些层面，系统优先事项和其他团队成员的需求对职业治疗师的决策产生了不成比例的影响。
职业治疗师通过调整循证流程做出反思性和响应性决策的潜力可能会受到他们在应对组织紧张关系时所感知到的自由度的影响。提高对组织背景对证据运用决策影响的认识，可以调整职业治疗师对其以人为本的自由度和能力的认知。在实践中的反思过程中需要有意图性来促进反思性。
