Carolyn Murray

The Experience of Engaging in Occupation following Stroke: A Qualitative Meta-Synthesis

Introduction: A meta-synthesis is a means of extracting data from multiple qualitative studies about the same topic, re-analysing the findings and bringing them together as a collective whole. Data from six qualitative studies that investigated the experience of engaging in occupation following a stroke were extracted and reanalysed with the purpose of gaining a greater understanding of the subjective experience to inform occupational therapy practice. Methods: Six databases were systematically searched for literature published in English during 1990–2011. Seven studies were appraised using the Critical Appraisal Skills Programme tool; six of these were included in the meta-synthesis. Findings: Five conceptual themes regarding occupational engagement emerged from the review: an emotional response, impact on identity, role of significant others, community access and the process of occupational adaptation. Conclusion: Engagement in occupation following a stroke is linked to self-identity and an emotional response; both of these, in turn, have an impact on capacity for occupational adaptation. Individuals are situated within a context of significant others and community. These findings give occupational therapists greater insight into the experience of older people following stroke in community settings.

Carers’ experiences, needs and preferences during inpatient stroke rehabilitation: a protocol for a systematic review of qualitative studies

BackgroundLarge numbers of people provide carer roles for survivors of stroke. Person-centred stroke rehabilitation must consider the perspectives of carers, as stroke affects not only the stroke survivor but also the quality of life and health of the carers. There is little collective knowledge about stroke carers’ experiences, needs and preferences during the inpatient stroke rehabilitation process to then inform person-centred service improvements.Our objective is to report and synthesise experiences, needs and preferences of the carers of stroke survivors undergoing rehabilitation in inpatient settings.Methods/designWe will conduct a systematic review of qualitative studies using a thematic synthesis methodology.We will follow the Enhancing Transparency in Reporting the Synthesis of Qualitative Research Guidelines (ENTREQ) and search the following databases for relevant articles: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Embase, and Web of Science. No language or publication date constraints will be applied. Eligible studies will have to use qualitative methods of data collection and analysis and reported data from the carers of stroke survivors who underwent inpatient stroke rehabilitation. Studies will be eligible for inclusion if they report the experiences, needs and preferences of carers regarding inpatient rehabilitation environments, organisation, care systems, therapeutic interventions, information exchange, carer training, discharge and community service planning and other issues of relevance to their roles as carers. Study selection and assessment of quality will be performed independently by two reviewers. Any disagreement will be resolved by a third reviewer. Data will be extracted by one reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies’ results, discussion and conclusion sections will be entered into the NVivo software for analysis. Extracted texts will be inductively coded independently by two reviewers and analysed in three phases using thematic synthesis. Descriptive and analytical themes will be developed.DiscussionThis study is expected to provide new insights into the perspectives of stroke survivors’ carers. Increased knowledge about carer perspectives and preferences will inform person-centred improvements in stroke rehabilitation.Study registrationPROSPERO registration number: CRD42015017315.

A qualitative meta-synthesis about challenges experienced in occupational therapy practice

Introduction Information about challenges for occupational therapists is typically provided in small-scale studies from different perspectives. The purpose of this meta-synthesis was to synthesise and report about challenges in occupational therapy practice that appear to penetrate across the profession. Method Databases searched were Ovid Medline, EMBASE, AMED and CINAHL. Search terms were selected after gaining understanding of the topic: occupational therap* AND Exp burnout / OR Exp morals / OR retention OR clinical reasoning OR new graduate OR novice OR transition-to-practice. Studies were critically appraised using the criteria of credibility, transferability, confirmability and dependability. Findings, along with direct quotes, were extracted and data compared and contrasted through first, second and third order analysis. Findings Twenty-four studies were included in the meta-synthesis and three constructs were identified: ‘challenges in context’; ‘personal challenges’ and ‘social and cultural challenges’. These findings inform knowledge about constraining factors on clinical reasoning and the alignment of practice with the occupational therapy philosophy, and give insight into satisfaction with practice, ethical and professional behaviours. Conclusion These findings could inform provision of professional support, education for students and enhance agency to reform practice. More research is needed about professional socialisation, clinical reasoning and ethical issues.

Getting help quickly: older people and community worker perspectives of contingency planning for falls management

Abstract Purpose: Older people living in the community need to plan for getting help quickly if they have a fall. In this paper planning for falls is referred to as contingency planning and is not a falls prevention strategy but rather a falls management strategy. This research explored the perspectives of older people and community workers (CWs) about contingency planning for a fall. Method: Using a qualitative descriptive approach, participants were recruited through a community agency that supports older people. In-depth interviews were conducted with seven older people (67–89 years of age) and a focus group was held with seven workers of mixed disciplines from the same agency. Older people who hadn’t fallen were included but were assumed to be at risk of falls because they were in receipt of services. Thematic analysis and concept mapping combined the data from the two participant groups. Results: Four themes including preconceptions about planning ahead for falling, a fall changes perception, giving, and receiving advice about contingency plans and what to do about falling. Conclusion: Both CWs and older people agree contingency planning requires understanding of individual identity and circumstances. CWs have limited knowledge about contingency planning and may be directive, informative, or conservative. Implications for Rehabilitation Falls can result in serious consequences for older people. There is an evidence-practice gap as availability of and access to contingency planning does not necessarily mean older people will use it in a falls emergency. Older people prefer community workers to be directive or informative about contingency planning options but they do want choice and control. Increased community workers knowledge of, and collaborative decision-making about, contingency planning may promote patient-centered services and assist in closing the evidence-practice gap.

Perspectives of older people about contingency planning for falls in the community: A qualitative meta-synthesis

Objective Despite consistent evidence for the positive impact of contingency planning for falls in older people, implementation of plans often fail. This is likely due to lack of recognition and knowledge about perspectives of older people about contingency planning. The objective of this research was to explore the perspectives of older people living in the community about use of contingency planning for getting help quickly after a fall. Method A systematic literature search seeking qualitative research was conducted in April 2014, with no limit placed on date of publication. Medline, EMBASE, Ageline, CINAHL, HealthSource- Nursing/Academic Edition, AMED and Psych INFO databases were searched. Three main concepts were explored and linked using Boolean operators; older people, falls and contingency planning. The search was updated until February 2016 with no new articles found. After removal of duplicates, 562 articles were assessed against inclusion and exclusion criteria resulting in six studies for the meta-synthesis. These studies were critically appraised using the McMaster critical appraisal tool. Bespoke data extraction sheets were developed and a meta-synthesis approach was adopted to extract and synthesise findings. Findings Three themes of ‘a mix of attitudes’, ‘careful deliberations’ and ‘a source of anxiety’ were established. Perspectives of older people were on a continuum between regarding contingency plans as necessary and not necessary. Levels of engagement with the contingency planning process seemed associated with acceptance of their risk of falling and their familiarity with available contingency planning strategies. Conclusion Avoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls. This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals.

Promoting participation and engagement for people with dementia through a cognitive stimulation therapy programme delivered by students: A descriptive qualitative study

Introduction Dementia can affect participation and engagement due to deprivation of cognitive, social and sensory stimulation. To meet this need, educators and a service provider collaborated for occupational therapy students to provide cognitive stimulation therapy for people with dementia. Method We used a published, evidence-based cognitive stimulation therapy programme called ‘Making a Difference’. However, due to student availability, we adapted the programme to be conducted once weekly for 12 weeks by students in pairs. These services occurred in both community and residential settings. Following completion of the programme in 2012, perspectives of staff (n = 8), family carers (n = 5) and three people with dementia were sought about their involvement. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis. Findings We found three themes of ‘something to talk about’, ‘it was a new relationship’ and ‘wanting to have a go’. Despite some initial concerns about people with dementia becoming stressed, the programme promoted social interactions, participation and engagement. The students adopted a relationship-centred approach with empathy and deliberate planning of sessions being important. Conclusion Through provision of the adapted Making a Difference programme, occupational therapy students were able to fulfil an unmet need while learning from their experience.

Mapping an Australian Occupational Therapy curriculum: Linking intended learning outcomes with entry-level competency standards

BACKGROUND Curriculum mapping involves systematic charting of programme content against professional competencies. This process can reveal strengths, gaps and redundancies within educational programmes. METHODS Curriculum mapping occurred using intended learning (ILOs) as documented in individual courses and linking them to units and elements within the occupational therapy minimum competency standards (ACSOT) and Millers Framework of competency. Five occupational therapy academics and two impartial research assistants identified links between ILOs and units and elements of the ACSOT. Analysis of each course in the curriculum was completed by two reviewers. A systematic protocol was developed that enabled a transparent process and resolution of discrepancies between reviewers. RESULTS There were many links (47% of total) between the documented curriculum and ACSOT Unit 1 Professional attitudes and behaviours. The other six units of the ACSOT had between 5% (Unit 7) and 16% links (Unit 3). No links were made between ILOs and the elements of evaluation (4.4), cessation (3.7) and quality assurance of services (7.3). Difficulties mapping ILOs to units and elements revealed inconsistencies in specificity and language in the ILOs and also ambiguities and gaps within the standards themselves. Mapping against Millers framework showed a steady increase in performance expectations of students across the four years levels. CONCLUSION Curriculum mapping is recommended for critical reflection about content of occupational therapy programmes and to review pedagogical approaches. This process revealed strengths and weaknesses of the occupational therapy curriculum being mapped but also revealed insight into the current ACSOT that may inform future iterations.

Ethical tensions: A qualitative systematic review of new graduate perceptions

Background: New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are. Objectives: To explore the ethical tensions perceived to occur in practice for new graduate health professionals. Research design: This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis. Ethical considerations: No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour. Findings: Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice. Discussion: This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated. Conclusion: Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions.

Book & Media Reviews

Understanding Sports Culture. Tony Schirato. 2007. London. Sage Publications. 150 pp. AUS

The lived experience of older adults' occupational adaptation following a stroke.

44.36. Paperback. Rough Diamonds & Real Gems: Extraordinary stories of ordinary Australians. Rhylle. M. Winn. 2007. Camberwell, Victoria, Australia: Penguin Group. 245 pp. AUS