Margo Paterson

Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice

AIM To synthesis the literature relevant to guideline dissemination and implementation strategies for healthcare teams and team-based practice. METHODS Systematic approach utilising Joanna Briggs Institute methods. Two reviewers screened all articles and where there was disagreement, a third reviewer determined inclusion. RESULTS Initial search revealed 12,083 of which 88 met the inclusion criteria. Ten dissemination and implementation strategies identified with distribution of educational materials the most common. Studies were assessed for patient or practitioner outcomes and changes in practice, knowledge and economic outcomes. A descriptive analysis revealed multiple approaches using teams of healthcare providers were reported to have statistically significant results in knowledge, practice and/or outcomes for 72.7% of the studies. CONCLUSION Team-based care using practice guidelines locally adapted can affect positively patient and provider outcomes.

Validity and community utility of the Canadian Occupational Performance Measure.

This study addressed the validity and community utility of the Canadian Occupational Performance Measure (COPM) (Law et al., 1991; 1994; 1998): a measure that now represents a national standard in clinical practice and research in occupational therapy in Canada. The study employed a crosssectional design. Participants for the study were former consumers of occupational therapy services, recruited from the Queens University catchment area (Kingston, North Bay, Oshawa, Perth, Peterborough). A sample of 61 disabled individuals living in the community were recruited. Each individual was sent a package of self-administered measures including the Satisfaction with Performance Scaled Questionnaire, the Reintegration to Normal Living Index, the Life Satisfaction Questionnaire, and the Perceived Problems List. An interview was also arranged with the project coordinator, which was based on the COPM and the Consumer Utility Questionnaire. Multivariate analyses showed that construct validity was supported; scores on the COPM were significantly related to theoretically related constructs: satisfaction with performance, reintegration to normal living and life satisfaction. In addition, criterion validity was supported. A majority of participants (53%), when asked about problems of daily living, spontaneously reported at least one of the problems raised on the COPM. Community utility was evaluated highly by participants, 75% of whom found the COPM useful in identifying and rating their problems, and 100% of whom reported no problems in understanding the COPM.

Development and pilot testing of the collaborative practice assessment tool

Collaborative practice is receiving increased attention as a model of healthcare delivery that positively influences the effectiveness and efficiency of patient care while improving the work environment of healthcare providers. The collaborative practice assessment tool (CPAT) was developed from the literature to enable interprofessional teams to assess their collaborative practice. The CPAT survey included 56 items across nine domains including: mission and goals; relationships; leadership; role responsibilities and autonomy; communication; decision-making and conflict management; community linkages and coordination; perceived effectiveness and patient involvement; in addition to three open-ended questions. The tool was developed for use in a variety of settings involving a diversity of healthcare providers with the aim of helping teams to identify professional development needs and corresponding educational interventions. The results of two pilot tests indicated that the CPAT is a valid and reliable tool for assessing levels of collaborative practice within teams. This article describes the development of the tool, the pilot testing and validation process, as well as limitations of the tool.

Experiences of Burnout and Coping Strategies Utilized by Occupational Therapists

Background. Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. Purpose. The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. Methods. Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. Findings. High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. Implications. This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.

Self-Study In Professional Practice*

Professionals across fields claim to learn much from experience. Self-study as an approach to learning about one’s work and theories in use offers explicit methodologies, including reflective reading, transformative professional development and inquiry to inform professional artistry. These three approaches look for patterns of beliefs and values that assist practitioners to know themselves more authentically within the dimensions of their work. Most professions set standards for individual growth and development that, in turn, a3ect organizational progress. Nevertheless, few, if any, consider self-study as an explicit means for reaching personal/professional goals or gaining insight into individuals’ strengths and weaknesses. This chapter addresses the needs of both nOffice and seasoned practitioners who continue to learn about themselves within the context of their work. It offers both rationale and examples for learning how to examine personal motives and assumptions within the explicit technical and implicit human expectations of the helping professions, this chapter draws on three examples the: librarian, postsecondary teacher and, occupational therapist.

Exploring Canadian occupational therapists' understanding of and experiences in community development.

Background. Occupational therapists are increasingly recognizing the importance of working with communities as a way to enhance health and well-being. Such work can occur through community development, a community-driven process in which communities are supported in identifying and addressing their health priorities. Purpose. This paper presents the qualitative findings of a study that explored the experiences of occupational therapists in Canada working in community development including how they understand community development and how they designed their role in this field. Methods. Occupational therapists working in community development shared their experiences and understanding of community development during 12 interviews. Results. The results of this study describe the iterative, reflexive process occupational therapists have undergone in coming to establish their role in this field. Implications. Recommendations are made regarding the preparation of future occupational therapists and for supporting those currently working in this field.

Conceptualizing Community Development: Occupational Therapy Practice at the Intersection of Health Services and Community:

Background. Despite occupational therapys theoretical commitment to community development (CD) approaches, current practice models focus on individual interventions rather than community issues. Purpose. This research examined three cases of Canadian occupational therapists working in CD to conceptualize CD from an occupational therapy perspective. Method. Data collection occurred over 12–14 days at each site and included observations, document reviews, and interviews with 14 colleagues and program participants. Constructivist grounded theory informed data analysis. Findings. A conceptual framework was developed that describes the contextual background to CD initiatives and the strategies used: nurturing community partnerships, building community capacity, influencing health services, and linking sectors. Underlying these strategies was the strategic use of self, which allowed the sharing of power and legitimacy to create opportunities for meaningful occupational engagement. Implications. The conceptual framework helps articulate CDs underlying processes and can be used to understand and guide practice.

The Artistry of Judgement: A Model for Occupational Therapy Practice

This paper reports on a model developed through qualitative research to examine the intriguing topic of the artistry of judgement in occupational therapy. The construct of professional practice judgement artistry or PPJA was developed (Paterson and Higgs 2001) to explore the cognitive, metacognitive and humanistic aspects of judgement in professional practice. Fifty-three occupational therapy educators and practitioners from four Commonwealth countries (Australia, Canada, New Zealand and the United Kingdom) participated in focus groups and individual interviews over a one-year period in 2001–2. This research identified a number of dimensions and elements that constitute judgement artistry. The model offers a valuable insight into understanding expertise in professional practice in an era when practitioners are struggling with a demand for increased scientific research knowledge to provide evidence for best practice. This research paper recognises the value of the art of occupational therapy and supports a client-centred approach to practice.

Developing empathy as a foundation of client-centred practice: Evaluation of a university curriculum initiative

Background. The foundation of client-centred practice is the therapists capacity to view the world through the clients eyes and to develop an understanding of the lived experience of disability. Purpose. This paper describes the evaluation of an educational initiative promoting student empathy to the lived experience of disability. Methods. Pairs of first-year occupational therapy students visited adults with disabilities who shared their knowledge and experience of living with a disability. Students reflected on their visits in journals, which were later analyzed using pattern matching. Findings. Students appeared to appreciate the co-existence of health and disorder and demonstrated a holistic understanding of living with a disability. Little attention was focused on cultural and institutional environments. Students struggled to define the nature of their relationship with their tutors. Practice Implications. The evaluation confirmed our belief that this educational initiative could facilitate student empathy, consistent with critical features of client-centred practice.

Developing Expertise in Judgement Artistry in Occupational Therapy Practice

This paper presents a follow-up to an earlier paper (Paterson et al 2005) on the topic of judgement artistry. Here the expertise literature is reviewed and the research findings related to developing judgement artistry are presented. Experts use cognitive, metacognitive and humanistic aspects of professional artistry to make highly skilled micro-, macro- and meta-judgements that are optimal for the given circumstances of the client and the context. The professional practice judgement artistry (PPJA) model presented in the earlier paper makes a unique contribution to professional development by offering a creative and challenging perspective on expertise. Finally, the overall research approach is critiqued, considering issues of credibility and rigour, and suggestions for future research are provided.