Theories: October 1
Explain why OT practice should be evidence based and theory driven.
We have to be able to prove what we are doing it working We must be able to help our clients, and we have to have evidence to back us up we are a scientific field We must incorporate many different sciences to keep us different from other medical jobs.
definition of theory
"Describes, explains, and predicts behavior and/or relationship between concepts or event" (Cole & Tufano, 2008, p. 66). "Provide an explanation of some problem or circumstance as well as a rationale for what can be done to change it" (Kielhofner, 2009, p. 60). "An organized body of concepts and principles intended to explain a particular phenomenon" (Leedy & Ormrod, 2013, p.20). Different types of research we use to use theories explanation of phenomenon, help us understand what we observe Descriptive research we may have used Theory and research are so important, predictive research
Conceptual Practice Model
-Attempts to answer the question: what doe sOT evaluate and treat and why? -Provides theory, evidence to support theory in practice and resources to support practice -Steamed from problem or circumstances that needed to be addressed. -Concept models and models of practice are same thing? -How we think / and our assessment resources (doing) - combining both. -Focused in practice -All stemed from problem or circumstances that needed to be addressed -How we think and the intervention and assessment resources. Combining both of these *provide theory, evidence, and resources that directly support practice* usually a mix of models are used
application to OT practice
-Guide for decision making throughout the OT process (evaluation, intervention: planning, implementation, and review, and targeted outcome) As a student: -You will use and apply conceptual models of practice learned in OTH 303 in your other OT coursework -You will learn about additional models of practice in practice based coursework -On fieldwork-you will discuss guiding theoretical principles utilized for practice decisions.
Paradigm
-Shared common vision -"Knowledge base, values, and work view upon which Its can agree" -Most fundamental beliefs about the profession, our core. -Our shared common belief or value -Our most fundamental CORE. -Roots of occupation
conceptual practice models: components
-Start here: Theory (support practice model) -Practice Resources (assessment and intervention) ----> Use in -Practice how do we assess it and why do we do it? -Research and evidence base why behind what we are doing with our clients. -Use different theories to guide us in everything we do with the OT process Guide OT process: How OT services are delivered -> problem solving and decision making -Evaluation -Intervention -Outcomes
Theory
-at first all theories are hypothetically tested through research -explains phenomena or "predict how things work" -ALl theories are hypothetic, educated guess. Trying to make a relevant connection -Used to describe or explain an occurrence
Explain the process for theory development and relvance to occupational therapy practice.
1. Ask a question -Examine a concept or idea 2. Build a Hypothesis -Educated Guess on why your question is happening 3. Test the hypothesis -Figure out a way to test this hypothesis 4. Theory development -Develop a theory to your hypothesis 5. Test the theory -Using a control and experiment group, prove your theory to be correct or incorrect 6. Theory development -You now have a theory. This theory will be added to. This could also be an addition to other theories that are already made. *Theories are important in occupational therapy because they give us a guide on what practice model to use. 1. shapes OT process: evaluation, intervention, outcome 2. Helps understand data and hypothesis 3. Helps select specific assessments needed for the client 4. Helps create goals for the client 5. helps pick which intervention plan should be used
Summarize the key components of a conceptual model of practice.
1. theory that explains something important to practice 2. practice resources for application 3. research and evidence base that investigate and improve the theory and resources
Theory development process
1.) Starts with a question (why?) Concept or idea examining Why? EX: working in peds and increased number of referals because of behavior in the classroom. Why are these kiddos misbehaving in school? 2.) Form a hypothesis Logical educated guess to explain that phenomenon. What is cauing that? This will help identify these variables. EX: shool children midbehavior because they cannot integrate sensory input so they cannot sit still int eh classroom. -> relationship 3.)Test the hypothesis Tst it. Create a way to measure that. Through a specific sensory tequnique. Graded sensory input thorough play activities. Measurement capacity. 4.)Hypothesis leads to theory development Rational trying to support thorugh resreach and seew hat the outcome is with the child behavior. And you do that thorugh testing the theory. 5.) Test the theory: experimental research design (2 groups: experimental and control) Not receiving graded sensory input and the expeiemtnal where they are getting the sensory input through play 6.) Research studies lead to theory development Often existing theories are modified through research studies Modified through hadditional research stides rather than new ones being created. Driven through reserach
conceptual practice models (examples)
Biomechanical Model: most commonly used (all 5) Cognitive Model Model of Human Occupation Motor Control Model Sensory Integration Model Intentional Relationship Model (used across the board with all my clients) Functional Group Model (type of model that is used to direct roup process and insight into group dynamics)
theory factors for consideration -> what is needed to make a theory usable and credible
It makes a significant contribution to current thinking -What is new, what is the value added or unique contirbtion that would be added ot current practice, what is significant about it. -KAWA model: looked out rehab outside of western culutre It changes current practice -Will the theory change how things are being sdon e in a spefici area -EX: changed approach, or how a problem is being change diwth clients, new approach to wound care It is logical and supported by compelling evidence -Necessary for theory to have current links -Support logic behind theory -Know th etheory is true, and is not just someones thoughts. -------Support reason behind it. It is thorough, well written , and developed over time allowing for integration of feedback -Develop over evolution over time. Not quicly developed May ask to a theory that is already out there, making modifications. It is relevant and will advance current ideas -Wh now? Does the theory advance dicussions which will create newdiscussions? -Future reaserach implciations or new research opportuntities
the contemporary paradigm: a return to occupation
Mary Reilly: call to return to roots of profession (occupation) Incorporation of elements from previous paradigms -We have become more evidence and scientifically driven. We had to support why we were doing. Use of occupation based practice with clients -Research now that supports value of ocupation Interaction of person, environment, and occupation factors-occupational performance -Not just ooking at person, we cannot just change the prson we have to erecognzie the environemtn plays a role on their occupation -Change the set up to improtove occupational performance. Value: client centered practice, meaningful client participation, and importance of therapeutic relationship -Client centered is so improtantant. Must be meaningful to the client.
Describe contemporary paradigm of occupational therapy profession
Reilly created a new paradigm that relied on occupational behavior and motivation, the organization of occupation in time through habits and roles, and the importance of the environment in supporting or impeding adaption core constructs: centrality of occupation to health and well being Focal point: interaction of person, environment and occupation values: occupation!
Kawa Model
River Flow: life flow, who were are, harmony is no obstructions River Banks: Personal and social environment (family, friends, community, culture) Rocks: Obstacles (broken leg) Drift Wood: Personal resources (skills, personality, friends) Spaces: Occupations
Theory driven practice -> why is theory important
Theories/Models of Practice -Shapes the evaluation, intervention, and outcome phases of the OT process-what is the reasoning behind the OT process -Can help the OT understand data and formulate hypothesis about a client's occupational performance issues ----What will target outcomes be for the client? ----Hypothesising they will make gains. -> decreasing risk for falls based on interventions. Can guide the OT in selecting appropriate assessments -Need for new assessment? Can help create collaborative goals based on theory constructs and not opinion -Maybe using different assessment methods, etc. -Contemporary paradign, knowledge with evidence to support our practice decisions. -Why behind what we are doing. Improving outcomes. Nuts and bolths behind practice Can help develop intervention plans supported by best practice and evidence
Differentiate between a theory and conceptual practice models.
Theory: this describes or explains a certain phenomenon -> to know what to do about a challenge, it is necessary to understand the different theories. They provide rationale and a way to change it. -Provides an understanding of some problem or circumstance faced in practice and a rational for what can be done about it. -Use this to make sense of their client. Conceptual Practice Models: Evaluation, theory, and resources in practice -what does the OT evaluate and treat and why? -Provides evidence to support the theory
conceptual practice model (picture)
Through use in practice we could use another assessment tool, intervention which can bring us back to creating new practice resrouces or more questions to futher develop this model. Use to frame and guide decision making with clients. May use more than one based on what the client needs Using models to frame what you are doing with your client. We may use more than one based on the needs of you client. May use motor and cognitive models. Want to develop relationship with all clietns (so will always use that model)
what are the theoretic building blocks
What how why who, where, when WHAT: Identifying variables, concepts related to what you are interested in lookin gat May describe or define something EX: looking at variables of patient handleing tequniques and handling HOW How are those different conepts related? How are they used to facilitate muscle activity? Relationship piece, looking at connections between variables. WHY? Why is it important or a piece of interest What is the relevance Why would the other professions be interested in this Are you seeing good outcomes? WHO, WHERE, WHEN? Boundaries for generalizability. How do they apply ot others? Looking at how do they apply to others? What is the patient population? Is the sample I the reserch similar to what I am seein in practice Where did research occur Were there other variables that caused the outcome and impacted that ability to generalize it to toher populations
what is the paradigm made up of
core constructs -why are the services needed? -the kinds of problems the services addresses -how service solves these problems focal viewpoint -directs attention to certain things in practice -offers a way of seeing those things values -why practice matters -what ought to be done in practice
what are the three types of knowledge Its use everyday
defines the nature, purpose, scope and value of OT enables them to understand the problem their clients are having and to know how to wok with their clients to overcome those borrowed from other fields that also informs what they do in their practice PARADIGM
what are the layers of knowledge
paradigm (center) -> root -Uniquie to profession, our core. What defines us, our nature an dpurpose of OT. And value of OT Conceptrual practice model -Practice resrouces, tools that help with internvention - Evidence to support the why - Used in practice, which generations more questions and research. Related Knowledge: -Theory, practice resrouces, and additional tools to help Ots with interventions, evidence to support the why -> used in practice which generates more practice or research to convise these -Driving more form medical sceinces. -What we know, that is not unique to us but we use in our clinical decision making -Signs and symptoms of infection -Stages of wound healing or fracture healing -Driving knowledge form medicine but we are using this knowledge so we know what types of interventions should be used. -Psychology (bring into decision making) -Related knowledge: knowledge driving from medical sciences. Although we are not tested on this, we know it. It is not unique to us. -We know different digns and symptoms with infection, stages of wound and fracture healing. ---Diving knowedge from medicine and using that in our clinical decision making so we can decide the interventaions. Helps guide our decision making. -Psychology: behavioral therapy and bring that into our decision making.
occupational therapy paradigm: changed over time
paradigm of occupation 1900-1940 mechanistic paradigm 1950-1970 New paradigm: contemporary Paradigm 1980 - now Paradigm: using occupation to address both mental an dphyscial wellbeing. And seeing some effectiveness of that in practice. We can see it is working, but did not have the evidence to support what we were seeing. Mechanistic: Crisis as profession. Wanted to be resepcted within healthcare professionals. other professions, wanted you to be proved. How does using occupation actually work? - shifted away form occupation as our focus and looking more at components and addressing them and how they impact function. We wanted to fix problem rather than looking at the big picture of occupation. Research and evidence it actually works. We said wait we do not have that. We shifted away form occuatpionl as our focus an dlooked more at inner ocmponenets for underlying thigns and how they impacted functions. Just addressing neuromuscular and fixing that but not looking at occupation. Contemporary Paradigm: We can stil address those underlying ipairments but in a better way. We have to help them realize their occupation and help them reach their occupation instead of using tools -> using the actual function (getting things down down cabinet) -> meaningful way. We took stuff with us form the mechanizsitic. We became more scientificly driven, but we are looking more at a bigger picture.
What are the focal viewpoints of the paradigm
personal factors: Sensorimotor, cognitive, emotional capacities , and impairments Occupation The nature/goals of the task or activity being performed Environment Physical, social, economic, political, and temporal contexts what you are looking with conceptual practice models
