Academic Year 2022 - 2023

Semester Semester 2
Module Number HS2135
Module Title Contextualising Personal and Professional Development
Assessment Method Coursework
Deadline (time and date) 12th June 2023 by 2pm
Submission Assessment Dropbox in the Module Study Area in Campus Moodle.
Word Limit
(see Assessment Word Limit A maximum of 3000 words
Statement)
Module Co-ordinator Elaine Stewart
Student Matias Arguello Narganes (1909319)

Essay on case study from Placement 1:

Person-centredness and evidence-based practice are concepts that are closely linked in

Occupational Therapy, as they must coexist with each other. This is because evidence-

based research must be appropriate and accurate for each individual patient in order to

achieve a person-centred care approach. The academic literature on centredness in

healthcare itself is extensive and encompasses exploring its concept and implementation

as well as the study of its measurement and conservation (Feldthusen et al. 2022). This

essay will comprehensively demonstrate, justify, and discuss the evidence-based practice

related to a specific individual within a person-centred approach. The person-centred

approach is a core foundation in occupational therapy because every intervention is

focused on the individual (Duncan 2020). This methodology recognises and appreciates

the competencies, skills, characteristics, interests, and independence of the recipients of

the services. This approach promotes self-assurance and empowers individuals to

participate in meaningful activities and tasks (Taylor 2020). O'Brien (2021) suggests that

the person-centred approach is vital in occupational therapy. This methodology gives a

degree of autonomy to the user in ascertaining their standard of living while

simultaneously facilitating the clinician's comprehension of their viewpoint. Duncan

(2020) claims that implementing a person-centred approach in occupational therapy

enables individuals to identify and prioritise their needs and assess the effectiveness of
the intervention process. Malfitano and Sakellariou (2019) recognise the transformation

of the person-centred approach from a biomedical paradigm to a more inclusive

methodology, whereby the individual is not viewed as a passive beneficiary of healthcare

but rather as an engaged contributor to the intervention. According to Brown (2013), an Commented [ES(1]: This is excellent and insightful with
good academic references to support your points
essential aspect of providing person-centred care is to gain a thorough comprehension

of the patient's distinct needs and situation. This involves paying specific attention to the

physical, organisational, and environmental factors. Taylor (2020) emphasises the

significance of accurately identifying and appreciating the user's evolving needs across

the diverse stages of person-centred care incorporated within the intervention. The

concept and execution of person-centred care have been widely recognised as the

fundamental principle of providing excellent occupational therapy services, as stated by

Pulvirenti, McMillan, and Lawn (2014). The person-centred approach highlights the ethical

principles of the healthcare profession, which recognise the right of all individuals to

strive for optimal well-being, with occupation acting to attain this objective (McCormack

and Pentland 2022). Evidence-based practice is a term closely associated with the person-

centred approach. According to O'Brien (2016), evidence-based practice requires

practitioners who can produce and evaluate reliable research to validate interventions

while assessing evidence. Evidence-based practice involves integrating research findings

and clinical experience to inform decision-making in clinical settings. Occupational

therapists must utilise evidence-based practice to maximise resources and provide the

most efficient interventions for their clients. Failing to provide clients with suitable and

innovative treatments is regarded as unethical (Fristedt, Areskoug Josefsson and

Kammerlind 2016). Evidence-based practice is a crucial competency and professional

responsibility that involves utilising the most up-to-date research evidence in conjunction

with clinical expertise (Thomas et al. 2017; Benfield and Jeffery 2022). Occupational

therapists are required to engage in evidence-based practice and incorporate evidence-

based measurements into their interventions and services to demonstrate their

effectiveness (World Federation of Occupational Therapy 2016; Royal College of

Occupational Therapists 2022). Commented [ES(2]: This introductory section sets the
scene and provides depth and clarity on the terms of person
centred care and EBP which is supported by literature
throughout
The individual analysed was a patient at a community hospital from a small village.

Typically, a community hospital serves as a regional centre for primarily rural

communities, offering a suitable system and configuration of accessible healthcare

facilities and resources delivered by interdisciplinary groups. In the current dynamic

healthcare system, characterised by limited resources and a growing population of

elderly individuals with multiple chronic conditions, community hospitals play a crucial

role in integrating services within small communities (Winpenny et al. 2016). In every OT Commented [ES(3]: excellent

intervention, there are diverse human factors that take place, shape and frame the OT

practice. O'Connor et al. (2021) lay out the concept of human factors as a discipline that

bridges three key dimensions: the job, the individual, and the organisation. In other

words, human factors represent a shared domain that involves the interaction between

individuals and their work settings across various disciplines, including psychology,

anatomy, physiology, social sciences, engineering, design, and organisational

management. Incorporating human factors into workplace design and operations has

historically enhanced safety, quality, and efficiency (O'Connor et al. 2021). Commented [ES(4]: This is a clear explanation of human
factors and how they coexist and interrelate with each other
Comprehending human factors and their influence on work practices improves

workplace safety and boosts team spirit and well-being. Factors affecting performance

include staff performance, communication (verbal, non-verbal, and written), situational

awareness, fatigue, emotion, stress, and professional expertise (Brennan and Oeppen

2022). On the other hand, Timmons et al. (2015) suggest there should be greater

awareness of human factors among healthcare staff to improve patient safety. A human

factor approach considers the interaction between healthcare staff and the

organisational and clinical contexts in which this care is delivered. This approach has been

implemented for decades in the aviation industry (Timmons et al. 2015). However, on

other fields, human factors are a more complex factor. An inefficient care provision is

usually limited by complex socio-technical systems and links to broader organisational

performance and risk management contexts, such as guidelines and policies, and not

human staff factors (Timmons et al. 2015). t On this case in particular, several human
factors were interrelated with the patient during the placement in the community
hospital. However, the primary factors associated with the individual itself were the
Commented [ES(5]: His section here analyses human
factors more to an extent as this is not an easy concept to
understand - your academic writing is of a high standard also
with clear structure and clarity in your points

absence of adequate support and the essential requirement for health education.
Various human factors have also impacted the implementation of a person-centred

approach towards the individual during practice. For example, some factors identified in

the hospital included a shortage of personnel and the need for accurate record-keeping

and documentation within the multidisciplinary team. The absence of assistance is a

human element that has impacted the prognosis of this individual and determined the

necessary intervention. The absence of home-based support has led to an intervention

approach that prioritises independence and the use of environmental factors to enhance

occupational performance by transforming potential barriers into assets. Adjusting and

modifying specific behaviours related to mobility have been essential in facilitating the

intervention and subsequent transition to discharge. Furthermore, this individual had

become familiar with facing chronic pain without using any aid from medical facilities for

an extended time, leading to certain adverse practices. Consequently, including health Commented [ES(6]: This is good application to the person
- possibly adding more references here to support your
education as an essential factor in occupational therapy interventions conducted in points would have been useful

hospital settings enables individuals to engage in diverse interventions, which can

significantly enhance the overall outcome of the process (Timmons et al. 2015). Staff

shortage in healthcare services, primarily through NHS Grampiand, is a problem with Commented [ES(7]: Don’t need this and be careful re
confidentiality
many intertwined factors. Although this essay aims not to analyse this aspect deeply, it is

essential to mention that staff shortage has dramatically impacted the interventions with

this individual. For example, not being able to perform specific interventions because the

OT team was short of staff or not being able to perform a PADL practice because the

nursing team was short of staff have been an example of this aspect. Maintaining precise

and adequate documentation is a fundamental expectation in occupational therapy as

part of the professional standards. Effective record-keeping safeguards the well-being of

service users, it is a component of the duty of care, and it is the evidence of the OT input

(RCOT 2022). Therefore, the use of SOAP notes in Trakcare and other documentation has

been significant to this individual as it serves as a way of monitoring the advancement of

the intervention, re-evaluating and modifying objectives as needed, and maintaining

effective communication with various professionals while obtaining information in the

absence of occupational therapy intervention. Another crucial aspect of OT interventions Commented [ES(8]: A clearer link to human factors here
would have been useful but some good examples in this
in any setting is the relationship between research and practice. section related to placement
Research is a scientific and methodical process that involves identifying a significant

problem, formulating a testable hypothesis or research question, and collecting primary

objective data. Occupational therapy is a methodical and objective approach to studying

interventions to enhance health, prevent illness, and restore or develop function in

people with disabilities. According to the RCOT (2019), occupational therapists are

entitled to engage in research to improve their assessments and interventions, prioritize

the needs of their clients, and enhance and contribute to the development of evidence-

based practice. The Health and Care Professional Council (2022) and RCOT (2022) have

established professional and ethical standards for occupational therapists. These

standards require professionals to utilize research as evidence-based practice, improve

the quality and effectiveness of their services, and engage in relevant Continuing

Professional Development (CPD) opportunities. Occupational therapy utilises evidence-

based practice to assess the credibility and applicability of research studies to inform

practice (Rice et al. 2019). Research aims to evaluate treatment methods and

interventions, communicate the effectiveness of occupational therapy interventions in

enhancing health and restoring function, investigate the correlation between associated

variables, analyse the reasons for the success or failure of a particular intervention,

compare different intervention strategies, assist clinicians in planning action research in

specific environments, and facilitate the transfer of clinical research outcomes to practice

(Rice et al. 2019). Commented [ES(9]: This provides an overall definition and
explanation of the importance of research in practice which
sets the scene and clearly provides evidence that you
Two different assessments that took place with this individual were a home assessment understand the need for this

and a kitchen assessment. Both assessments primarily were based on mainly qualitative

approach to comprehensively understand the specific patient, prognosis, background

without bias, by observing their performance during interventions. This qualitative Commented [ES(10]: O you need ref to support what
qualitative means and why this is relevant
approach was supported by clinical reasoning and observations by staff. On the one

hand, the home assessment related to fall prevention after this patient's discharge. The

evaluation of this assessment included observations of physical ability, spatial awareness,

the layout of the home environment and resources in place to facilitate daily living after

discharge. After the home assessment, different health-related habits and knowledge

topics were discussed with the patient in the hospital. The primary objective of the home
assessment conducted with this patient was to prevent falls. The research on this topic is

comprehensive and well-articulated, based on evidence. However, for this essay a specific

article resumes the several factors that evidence the OT practice with this individual: a

journal article by Mohr et al. (2022). On the other hand, the kitchen assessment was

mainly focused on analysing the cognitive functioning of this individual. Throughout the

kitchen assessment, staff analysed cognitive functioning, alertness, problem-solving

ability, attention span and memory. This assessment also facilitated knowledge related

to the capacity to work in the kitchen with a zimmer frame and upper limb strength.

Soderback (2016) illustrates how to evaluate and assess the individual's performance in

the kitchen. Precisely, this study employed evidence-based practice to assess the

patient's cognitive functioning during various tasks. Commented [ES(11]: I like here how you have linked
specific studies to the assessment used in practice

On the journal article previously mentioned before, Mohr et al. (2022) assert that falls are

a principal reason for injury and mortality in the elderly. They are the primary risk factor

for fractures, resulting in chronic pain syndromes, functional limitations, elevated

healthcare expenses, and heightened mortality. This patient's previous falls were

influenced by intrinsic factors such as age, prior medical prognosis, chronic pain, and

extrinsic factors such as inadequate lighting, uneven flooring, and insufficient risk

awareness. Prevention strategies prioritised behavioural prevention via strength and

balance training in the hospital and within a broader team, mainly among

physiotherapists and occupational therapists with this individual. Assessing the living

environment has been crucial for this specific intervention because it involved analysing

the house and its environment, providing advice, and making adaptations to enhance

safety in the home environment, preventing falls, and avoiding limitations and barriers in

daily activities. The home visit enabled the occupational therapist team to prioritise

patient-centred care by knowing the patient's conditions and resources at home. The

home assessment also helped to mitigate patient-specific fall risk factors through health

education, such as the correct use of the zimmer frame, use of a Buckingham caddy,

making more space where the patient usually walks or moving elements closer to where

the patient spent more time. All these aspects have been examples of a person-centred

approach and how to use evidence and research into practice. However, one of the most
critical aspects of the home assessment was respecting the patient’s views and values to

keep the person-centred approach in place. Above all, the patient has spent most of their

life in that home environment. Another relevant aspect of the assessments was the one

related to avoiding falls at home. Fall prevention is such a broad topic that it requires the

collaboration of various healthcare professionals, such as occupational therapists,

physiotherapists, podiatrists, nurses, general practitioners, care managers and other

specialists, as well as the participation of patients and their families (Mohr et al. 2022).

Soderback (2016) affirms that to evaluate an individual's requirements, it is essential to

possess a comprehensive understanding of the specific aspects that need to be assessed.

The intervention begins with two fundamental questions: What challenges the patient

encounters while carrying out routine tasks, and what requirements must be fulfilled to

enhance the patient's capacity to execute daily activities (Soderback 2016). With this

patient, kitchen assessments have been crucial as a milestone in assessing cognitive

functioning. The patient made tea, and the team analysed multiple factors through

observation and clinical reasoning. The aspects of the tasks were problem-solving skills,

multi-tasking, decision-making, spatial and body awareness, attention and alertness.

Soderback (2016) maintains that problem-solving as a therapeutic intervention is crucial

in managing intricate health issues, such as chronic ailments or functional limitations

commonly associated with ageing. Problem-solving approach serves clients in a dynamic

process to identify and modify contributors to problems, increasing self-efficacy and

empowering clients to take ownership of their health problems and solutions, and

establishing a therapeutic partnership between the occupational therapist and client.

Furthermore, because this patient does not have support at home, the occupational

therapist's role brings specialised training, knowledge of techniques, and evidence-based

practices, combined with the client's understanding and knowledge of their daily

challenges and previous experiences with problem-solving. Overall, the patient’s will, and

choice was to stay at home after discharge rather than stay in a healthcare institution. So,

despite the potential benefits of evidence-based practice and research in occupational

therapy interventions for this individual, not all were put in place because the patient

chose not to modify the home environment exponentially. The decision was respected
throughout the OT process, and necessary precautions were taken to ensure the safety

of the home environment because of respecting a person-centred approach.
One of the most relevant learning experiences I have obtained from the placement that
has contributed to my personal and professional growth is to recognize the importance
Commented [ES(12]: His section provides detail in
relation to each of these interventions and relates this to the
study identified - some additional analysis of the type of
study and the research methods used /principles used within
the study would have further enhanced this in relation to
understanding of research principles

of person-centred care in practice. Despite being familiar with that definition from a

theoretical point of view, the placement has allowed me to work with a person-centred

approach in the OT practice. The uniqueness of each individual is evident in each

intervention in the hospital ward or their home setting (Duncan 2020; Curtin et al. 2017;

Bryan et al. 2022). Moreover, the evidence and research must be examined and altered
in different interventions to keep a person-centred approach and personal choice. In
most circumstances, difficult decisions are needed to meet that person-centred
Commented [ES(13]: Good - your reflections in this
section are robust and link specifically to the essay
questions, providing depth to your understanding and clarity
around the topics. Insightful and clear throughout

approach. For those decisions, it is essential to trust clinical reasoning and professional

expertise throughout the intervention group and with colleagues. Besides, social

awareness is a vital tool to be critical and sensitive in how to get that information from

others and transfer it onto the intervention appropriately in those settings. There is

always a strong emphasis on teamwork within a community hospital because many

professionals are involved in the same environment. At the same time, as the community

hospital is usually small, it is feasible to have a person-centred approach and be close to

patients and families. It is important to emphasize that knowing the cultural and social

background of the place where the community hospital is situated is highly beneficial for

a person-centred approach. Another vital learning from my placement has been to be

involved in multidisciplinary work and having discovered the crucial role it plays on OT

practice. Acknowledging the significance of teamwork in establishing and maintaining

positive professional connections is crucial. It is vital to acknowledge and appreciate the

diversity, responsibilities, practices, and roles of various professionals (RCOT 2022). It has

also been very relevant for me to participate in the multidisciplinary meetings, and

discharge planning meetings with all the professionals, relatives and patients. Shadowing

specialists to understand more about different OT roles within the hospital, but also

within the community. Examples of that include, in reach team occupational therapists,

stroke rehab occupational therapists, care managers, rehab enablement team members,
care managers, nurses, etc. On that discharge planning meetings, I could listen the voices

of the different professionals referring to that specific individual (that was a perfect

example of person-centred approach), and how the OT process takes place by consensus,

analysing all the stages that the patient is with each specialist. A significant

multidisciplinary discharge meeting during my placement provided a fascinating

opportunity to observe the diverse perspectives of healthcare professionals regarding a

patient, and their collaborative efforts to arrive at a consensus regarding a patient's

discharge. Simultaneously, the diverse approaches and methods were clearly laid out and

presented to the interdisciplinary cohort, family members, and patient. At the same time,

it is fascinating to see how different professionals work together, overlapping practices,

and how each of the professionals try its best to understand the other practice. With all

this new knowledge, I have been able to improve my relationship management through

finding and creating new strategies for improving communications and relationships

between myself as a student and professionals in the different teams. In addition,

maintaining a collaborative approach will be an aspect that will be developed among my

different stages at university and on the different placements. All things considered, this

essay has tried to provide insight into human factors, person-centredness, research

methodology, and evidence-based practice identified in the interventions associated with

a patient in placement and how all of them that have contributed to my personal and

professional development.

References: Commented [ES(14]: Ensure on a separate page

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