involving acute hospital inpatients in the evaluation of an occupational therapy service cathy...
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Involving acute hospital inpatients in Involving acute hospital inpatients in the evaluation of anthe evaluation of an
occupational therapy serviceoccupational therapy service
Cathy RobertsonCathy Robertson
Senior occupational therapistSenior occupational therapist
Wirral Hospital NHS TrustWirral Hospital NHS Trust
Presentation outlinePresentation outline
Background.Background. Involving acute hospital inpatients – Involving acute hospital inpatients –
anticipated challenges.anticipated challenges. Undertaking the research. Undertaking the research. Reflections.Reflections. Conclusions.Conclusions.
BackgroundBackground
Research award for novice researchersResearch award for novice researchers– 6 month secondment, Jan – June 20066 month secondment, Jan – June 2006
Evaluation of occupational therapy (OT) Evaluation of occupational therapy (OT) service by involving service usersservice by involving service users
A pilot studyA pilot study
Occupational Therapy Occupational Therapy in an acute hospitalin an acute hospital
Occupational therapists use meaningful Occupational therapists use meaningful activities to assess and treat patients.activities to assess and treat patients.
The aim is to maximise independence, The aim is to maximise independence, reduce risk, and improve quality of life.reduce risk, and improve quality of life.
Typical activities include:Typical activities include:– Personal care (washing and dressing)Personal care (washing and dressing)– Kitchen (drink and snack preparation)Kitchen (drink and snack preparation)– Mobility and transfers (on and off furniture)Mobility and transfers (on and off furniture)– Pre and post discharge home visitsPre and post discharge home visits– Provision of equipmentProvision of equipment
Involving acute hospital inpatients – Involving acute hospital inpatients – anticipated challengesanticipated challenges
Motivation to be involved with researchMotivation to be involved with research– Little contact with occupational therapist Little contact with occupational therapist
before discharge.before discharge.– No anticipated need for occupational therapy No anticipated need for occupational therapy
after discharge.after discharge.
Lack of understanding about occupational Lack of understanding about occupational therapytherapy– Confusion with physiotherapyConfusion with physiotherapy
How would service users be involved?How would service users be involved?
Designing the researchDesigning the research Choosing research topics / questionsChoosing research topics / questions Giving feedback on the findingsGiving feedback on the findings Making recommendations for changeMaking recommendations for change Evaluating changesEvaluating changes
Research design - focus groupResearch design - focus group
Describe experiences of the OT service as Describe experiences of the OT service as inpatients.inpatients.
Identify issues of particular importance.Identify issues of particular importance.
Develop a list of interview questions.Develop a list of interview questions.
Decide on any further involvement.Decide on any further involvement.
Recruiting participants from acute Recruiting participants from acute hospital wards - challengeshospital wards - challenges
I did not make contact with everyone who I did not make contact with everyone who had been referred to Occupational had been referred to Occupational Therapy:Therapy:
– Already discharged homeAlready discharged home– RIPRIP– Obviously unwell / confusedObviously unwell / confused– With visitors / doctorsWith visitors / doctors– Protected meal timeProtected meal time– Advice of nursing staffAdvice of nursing staff
Recruiting participants from acute Recruiting participants from acute hospital wards - challengeshospital wards - challenges
Not everyone I contacted was asked to Not everyone I contacted was asked to take part:take part:
– Deaf / other communication difficultiesDeaf / other communication difficulties– Confused / lack of understanding of requestConfused / lack of understanding of request– Lack of understanding of OT / confusion with Lack of understanding of OT / confusion with
physiotherapyphysiotherapy– Advice of nursing staff / medical diagnosisAdvice of nursing staff / medical diagnosis– Adverse social situationAdverse social situation– Length of time before dischargeLength of time before discharge
Focus groupFocus group
Nine service users were asked to take part.Nine service users were asked to take part.
Three service users consented to participate.Three service users consented to participate.
One withdrew consent after discharge.One withdrew consent after discharge.
One unable to attend on the day due to illness.One unable to attend on the day due to illness.
Focus group abandoned.Focus group abandoned.
InterviewsInterviews
38 people agreed to take part in an 38 people agreed to take part in an interview.interview.
Not everyone could take part:Not everyone could take part:– RIP before or soon after dischargeRIP before or soon after discharge– Transfer to other hospital before dischargeTransfer to other hospital before discharge– Not discharged in time to conduct interviewNot discharged in time to conduct interview– No reason givenNo reason given
27 interviews conducted.27 interviews conducted.
What did service users expect from What did service users expect from their interviews?their interviews?
““I didn’t know what you wanted, I didn’t know what I didn’t know what you wanted, I didn’t know what it was for. But I don’t mind being interviewed”. it was for. But I don’t mind being interviewed”.
““I suppose just giving my own ideas and opinions. I suppose just giving my own ideas and opinions. Whether it’s useful or not I leave up to you. You Whether it’s useful or not I leave up to you. You
just hope that your opinion has at least been just hope that your opinion has at least been looked at. Whether it’s acted upon is a different looked at. Whether it’s acted upon is a different
thing”.thing”.
““If it helps the OT department, and patients If it helps the OT department, and patients ultimately, then it’s worth doing”. ultimately, then it’s worth doing”.
Service users wanted to be involvedService users wanted to be involved
Altruistic motives Altruistic motives – Giving something backGiving something back– Helping others and improving the OT serviceHelping others and improving the OT service
Personal motivesPersonal motives– Keeping your mind activeKeeping your mind active– Feeling useful when other activities are Feeling useful when other activities are
restricted due to disabilityrestricted due to disability Benefit to the OT serviceBenefit to the OT service
– Hearing the service user’s voiceHearing the service user’s voice– Understanding the service user’s perspectiveUnderstanding the service user’s perspective
Reflection – motivation for involvementReflection – motivation for involvement
People were willing to take part in People were willing to take part in interviews, if it meant helping others.interviews, if it meant helping others.
People were willing to be involved in People were willing to be involved in research about the OT service after they research about the OT service after they had been discharged from hospital.had been discharged from hospital.
I underestimated peoples’ altruistic I underestimated peoples’ altruistic motives for continued involvement.motives for continued involvement.
Reflection – lack of understanding Reflection – lack of understanding of occupational therapyof occupational therapy
Many people did not know the difference Many people did not know the difference between occupational therapy and between occupational therapy and physiotherapy.physiotherapy.
How much should I have prompted / How much should I have prompted / reminded them?reminded them?
Not asked to take part.Not asked to take part.
Who should comment on the results?Who should comment on the results?
Not all participants invited to comment on Not all participants invited to comment on findings – a subjective decision based on:findings – a subjective decision based on:– Interest in the topic, and ability to discuss issuesInterest in the topic, and ability to discuss issues– Ability to describe their OT treatment and their Ability to describe their OT treatment and their
thoughts about it (not all uncritical)thoughts about it (not all uncritical)
Some feedback on findings is better than Some feedback on findings is better than none – but perhaps:none – but perhaps:– Should have asked a random selection?Should have asked a random selection?– Should have asked everyone?Should have asked everyone?
Conclusions – conducting the researchConclusions – conducting the research
Involving acute hospital inpatients in Involving acute hospital inpatients in research is not straightforward.research is not straightforward.
Data protection and confidentiality for Data protection and confidentiality for hospital inpatients.hospital inpatients.
Conclusions – service user involvementConclusions – service user involvement
Involvement in an interview, or by Involvement in an interview, or by commenting on findings, worked well. commenting on findings, worked well.
Involving people in research design was Involving people in research design was less successful.less successful.
Offer different levels of involvement, and Offer different levels of involvement, and plenty of time.plenty of time.
A very positive experienceA very positive experience
Acute hospital inpatients are willing to be Acute hospital inpatients are willing to be involved in research about OT.involved in research about OT.
Service users have gained from their involvement Service users have gained from their involvement in this research.in this research.
Valuable feedback and recommendations for the Valuable feedback and recommendations for the occupational therapy service. occupational therapy service.
Learning from this pilot study will benefit future Learning from this pilot study will benefit future research with acute hospital inpatients.research with acute hospital inpatients.
““People who use the service are People who use the service are on one side of the fence, if you on one side of the fence, if you
like. And the OTs are on the like. And the OTs are on the inside. And the idea surely is to inside. And the idea surely is to
get the two together, with a plan, get the two together, with a plan, and get on with it”.and get on with it”.
Thank you.Thank you.
AcknowledgementsAcknowledgements
Dr Sam SartainDr Sam Sartain
Anne McGinnity, Marilyn Wallace, Melanie Anne McGinnity, Marilyn Wallace, Melanie Jones, Jane MarriottJones, Jane Marriott
All the service users who took part in All the service users who took part in interviews and provided feedback on the interviews and provided feedback on the resultsresults
