Anne McIntyre

Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation

Purpose. The International Classification of Functioning, Disability and Health (ICF) is advocated as a tool to structure rehabilitation and a universal language to aid communication, within the multi-disciplinary team (MDT). The ICF may also facilitate clarification of team roles and clinical reasoning for intervention. This article aims to explore both factors in stroke rehabilitation. Method. Following a review of the literature, a summary was presented and discussed with clinicians working within stroke rehabilitation, to gather expert opinions. The discussions were informal, being part of service development and on-going education. The clinicians summarised key themes for the potential use of the ICF within clinical practice. Results. Two key themes emerged from the literature and expert opinion for the potential use of the ICF in stroke rehabilitation: (i) to aid communication and structure service provision, (ii) to clarify team roles and aid clinical reasoning. Expert opinion was that clarification of team roles needs to occur at a local level due to the skill mix, particular interests, setting and staffing levels within individual teams. The ICF has the potential to demonstrate/facilitate clinical reasoning, especially when different MDT members are working on the same intervention. Conclusion. There is potential for the ICF to be used to clarify team roles and demonstrate clinical reasoning within stroke rehabilitation. Further experiential research is required to substantiate this view.

A meta-review of stress, coping and interventions in dementia and dementia caregiving

BackgroundThere has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014.MethodA meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches.ResultsThe meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”.ConclusionsThis meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.

Awareness, requirements and barriers to use of Assistive Technology designed to enable independence of people suffering from Dementia (ATD)

This article is available through the Brunel Open Access Publishing Fund. Copyright @ 2012 IOS Press

Occupational therapists’ perceptions about the clinical utility of the 3D interior design software

Purpose: The 3D interior design software (3DIDS) is a technology, which primarily allows users to simulate their homes and visualize any changes prior to implementing them. This feasibility study aimed to examine occupational therapists’ perceptions about the clinical utility of the 3DIDS. A secondary aim was to explore the attitudes of occupational therapists towards technology in general. Method: Three focus groups were conducted with 25 occupational therapists working with older people in the UK. The qualitative data were analysed using inductive thematic analysis. Results: The three main themes that were identified were usage and attitudes of technology, opportunities for realistic application of the 3DIDS and related threats and benefits for the occupational therapy profession. Occupational therapists had a positive attitude towards technology. They suggested that the 3DIDS could be used in discharge planning and in rehabilitation. They viewed it as a tool that could enhance their status within the health care profession and improve communication, but not as a tool that should replace the role of the occupational therapist. Conclusions: This research offers new and important findings about the utilization of the 3DIDS by occupational therapists and provides information as to where this technology should be trialled. Implications for Rehabilitation Gaining occupational therapists’ perceptions of the 3D interior design software (3DIDS) gives valuable information as to the clinical utility of the software. The 3DIDS was perceived as a tool that could be used as enhancing the rehabilitation process as well as a facilitating tool in discharge planning. The 3DIDS was viewed as a tool that could enhance clinical practice and communication among various agencies, but it was suggested that it should be used with caution to avoid confusion and replacement of important services.

Risks with Older Adults in Acute Care Settings: Occupational Therapists' and Physiotherapists' Perceptions

Introduction: In acute care hospitals, risk assessments are integral to therapy practice. However, to date, this area has not been explored in any specific depth within occupational therapy or physiotherapy, although there is evidence that the management of risk causes uncertainty and anxiety among professionals. Different perspectives of risks may have an influence on the discharge end point. Method: This study explored the self-reported risk-taking behaviours of occupational therapists and physiotherapists. A qualitative approach was taken, with reflective diaries used to record the self-reported risk-taking behaviours of therapists in a teaching hospital. Eight therapists recorded 16 reflections in total, which were analysed using template analysis. Findings: The findings suggest that support from members of the team, collegiality and clinical confidence were important to manage risks. Therapists were willing to take risks in order to meet patient goals, to facilitate the rehabilitation process or to enhance the patients quality of life. However, there may be instances of interprofessional differences that need to be managed. Conclusion: This research has highlighted the need for therapists to reflect continually upon risk situations in professional practice. There is a need for support and guidance to be put in place to enable positive risk taking.

How are service users instructed to measure home furniture for provision of minor assistive devices

Abstract Purpose: Measurements play a vital role in providing devices that meet the individual needs of users. There is increasing evidence of devices being abandoned. The reasons for this are complex but one key factor that plays a role in non-use of equipment is the lack of fit between the device, environment and person. In addition, the abandonment of devices can be seen as a waste of public money. The aim of this paper is to examine the type, the readability, and the content of existing guidance in relation to measuring home furniture. Method: An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated. Results: From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9–11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths. Conclusion: There is a need to standardize guidance to ensure that measurements are reliable. Implications for Rehabilitation Our research has highlighted the need to confirm and agree measurement techniques for home furniture in the provision of assistive devices. Inaccurate guidance can lead to abandonment of devices. Inaccurate guidance could prevent service users from not participating within the self-assessment process for devices.

Use of the physical environment to support everyday activities for people with dementia: A systematic review

Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.

Exploring the role of occupation for spouse-carers before and after the death of a spouse with dementia:

Introduction When a person with dementia dies, their former spouse-carer can find their personal resources so depleted that re-engaging in life can be difficult, leaving their mental health vulnerable. This qualitative study aimed to explore whether the occupations of spouse-carers contribute in the transition to the post-care period. Method Purposive sampling was used to recruit nine spouse-carers, who were between 1 and 5 years post-bereavement, via two branches of the Alzheimer’s Society, in the United Kingdom. In-depth interviews collected data for this interpretative phenomenological study, which were subject to template analysis. Findings Exploration of the data produced themes of continuity, roles and occupations, support and change and transition. Many of the findings supported published literature. However, a new finding emerged, where spouse-carers’ engagement in a ‘sustaining occupation’ (researcher’s term) appeared to counter the effect of role overload. Conclusion Four key ways that occupations of spouse-carers contributed to the transition to post-care were identified: ‘sustaining occupations’; occupations that maintain spouse-carers’ identity; continuing bonds with the deceased care-recipient; developing new roles. The first two of these began before bereavement and assisted in equipping spouse-carers for the transition to post-care. The second two followed bereavement and enabled spouse-carers to build confidence and re-engage with life.

WFOT survey about the use and utility of the International Classification of Functioning, Disability and Health (ICF)

Abstract A global study about the use of the International Classification of Functioning Disability and Health (ICF) (WHO 2001) by occupational therapists was commissioned by the World Federation of Occupational Therapists in 2008–09. The objectives of the study were: to gain a greater understanding of how the ICF is being used by occupational therapists in clinical practice, education, research, administration and policy; to identify and share strategies to address the challenges and barriers to using the ICF in these different areas; and to articulate the profession’s unique perspective of the ICF and its key concepts of function, disability and health. An online survey was conducted first, and over 1200 occupational therapists from 60 countries responded. Statistical analysis of the responses were compiled and shared at a workshop held at the WFOT Congress in Chile in 2010. Over 50 workshop participants reviewed the data about use of the ICF by occupational therapists in the five areas of practice and made recommendations to the WFOT and the WHO. Strategies to increase use of the ICF among occupational therapists in clinical practice, education, research, administration and policy are outlined in this report. The full report is available in the document centre of the WFOT website.

The positive impact of portfolios on health care assistants’ clinical practice

© 2008 The Authors. Journal compilation