Did you know... occupational therapists assist in assessment and management of continence across the lifespan?

Managing a complex issue like incontinence requires a multidisciplinary approach. While the traditional roles of doctors, nurses, dieticians, and physiotherapists are generally well understood, the role of occupational therapy is often unclear. This paper aims to explain how occupational therapists can contribute to the team management of continence by addressing this across the life span. With a focus on independence and functional outcomes, occupational therapists are well positioned to enhance client outcomes, from birth to death, from assessment to longer term management

Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review

PURPOSE: Patient adherence to wearing compression stockings in the management of chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is low. Poor adherence with compression stockings contributes to recurrence and impaired healing of VLUs. As such, the purpose of this review was to report on the scientific evidence related to adherence and explore modifiable factors which impact adherence with compression stockings. METHODS: A systematic search was conducted from inception to 31 October 2019. Following the PRISMA-ScR Checklist, PubMed, Medline, CINAHL, Cochrane, Embase, OT Seeker and Web of Science were explored using search terms: compression/compression stocking/compression garment/compression sock/stockings/garments and adherence/compliance/concordance. RESULTS: We identified 2613 papers of which 125 full text papers were assessed for eligibility and 69 met inclusion criteria. Papers were grouped and charted by concepts relevant to the research questions and narratively synthesized. Several dominant themes emerged, and a conceptual framework was developed incorporating modifiable variables, adherence itself, and outcomes related to adherence. Specifically considering interventions to improve adherence, only five of 14 randomized controlled trials were able to demonstrate improvements in adherence through unidimensional approaches. All nine of the case studies/series demonstrated a positive impact on adherence, eight of which described a personalized multidimensional approach. A lack of consensus around defining, measuring, and quantifying adherence with compression stockings was identified, resulting in wide variation in reported adherence rates. CONCLUSION: Inconsistency in the definition and measurement of adherence limits meaningful interpretation of the literature. No individual intervention has consistently demonstrated improved adherence. Multidimensional interventions show promise but require further investigation with high-quality trials. Improving adherence appears to improve health outcomes in VLU /CVI populations but there is a lack of information directly linking improved adherence with cost outcomes. TRIAL REGISTRATION: Open Science Framework: ACTRN12620000544976p

Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Aims and objectives To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design Critical incident technique. Methods Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results Three themes emerged from 23 reflective accounts of fall events: “direct observation is confounded by multiple observers” and “knowing the person has cognitive impairment is not enough,” and “want to rely on the guideline but unsure how to enact it.” While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice To reduce falls, nurses can involve the family to support “knowing the patient” to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.Full Tex

School Personnel and Leadership Collaboration Model for Ideal Work Contexts

This article describes the school personnel and leadership collaboration (SPLC) model, a shared-responsibility framework for faculty, staff, and administrators. Prior research consistently demonstrates the need for (a) administrative support for teachers and other school personnel and (b) collegial support among staff. The SPLC model represents an amalgamation of this research and, moreover, integrates personnel support for leadership. In the managerial sciences, leader–member exchange (LMX) is a well-known relationship-based leadership approach that focuses on a dyadic or two-way relationship between supervisors and their employees. Though managers are responsible for overseeing operations, personnel contribute ideas, participate in decision-making, and follow through with their responsibilities. LMX is associated with positive work experiences and job performance outcomes. In contrast, schools are often run with a top–down leadership approach that solicits little to no input from staff, leading to low morale, high attrition rates, and negative school climate. Thus, the SPLC model was inspired by LMX and emphasizes practices, such as shared decision-making, staff autonomy, and shared responsibilities. Detailed examples of ways schools may apply the SPLC model to their practices are included

Development of a quality indicator framework for occupational therapy

Occupational therapists are increasingly expected to implement and monitor indicators of occupational therapy quality performance. Goals of quality measurement and improvement include enhancing satisfaction of the end-user, optimising the efficient use of resources and improving health outcomes. A Quality Indicator (QI) Framework with 56 generic indicators was developed for occupational therapy by the World Federation of Occupational Therapists for selecting, organising and reporting on quality indicators in a structured and meaningful way. A consultation involving 46 occupational therapists from 21 countries indicated the QI Framework shows promise to help occupational therapists select relevant and useful measures to evaluate their occupational therapy services. Work will, therefore, continue to further evaluate and refine the QI Framework, as well as develop resources to support the implementation and use of the tool