Background: All occupational therapists in the UK are expected to engage in and develop evidence-based, person-centred practice in order to provide therapy that facilitates well-being through occupation. There has been recognition in occupational therapy literature that differences often exist between the values the underpin research evidence and occupational therapists’ professional values, and that practice culture and context influence the way research evidence is used in practice. However, current research into practice with persons living with dementia suggests that the contextual influences on practice have not been adequately considered. This has resulted in research and practice examples that reflect a compliance-orientated model of evidence-based practice. In such examples research guidelines and protocols are applied directly to practice, despite recognition that consideration of contextual factors and other forms of evidence enable creative practice that is meaningful for both persons living with dementia and occupational therapists. This study set out to explore the components of context that facilitate evidence-based practice congruent with professional values, and the values of the person living with dementia, as well as the nature of such practice.
Approach and methods: This research is underpinned by a theory of critical creativity, which facilitates understanding, and guides deconstruction, of context through use of creative expression, imagination, and ancient wisdom and traditions. Creativity acts as a vehicle to transform embodied knowledge about the nature of practice to language, through reflection. It also enables blending of worldviews for the purpose of developing research praxis. A critical creativity methodology facilitated exploration of context and foregrounding of the issues that were influencing occupational therapists’ practice. Observation, critical creative reflection, and critical creative dialogue were layered to develop an understanding of the interplay between context and practitioners’ values and action, and the nature of their actions in practice.
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Findings: The findings of the exploration of practice context revealed that occupational therapists appeared to feel fear and anxiety about exploring and sharing their practice as a consequence of conflicting understandings about the way research evidence should be used in practice. Occupational therapists’ engagement in evidence-based practice and intervention ‘roll-out’, which are underpinned by learning that is often removed from practice context, resulted in practice that was often compliance-orientated and devoid of critical reflection. These contextual influences limited occupational therapists’ ability and opportunity to embody person-centred values that they hold, namely to make autonomous decisions about their practice with person(s) living with dementia and their families. Additionally, their engagement in developing professional artistry and creative practice was hindered, and their energy for practice development depleted.
Conclusions and implications: Occupational therapists require contexts that are conducive to human flourishing to facilitate exploration, dialogue and development of creative, reflective practice. Such contexts consist of psychologically safe spaces, facilitative leadership, and researchers and practice developers that support all ways of knowing, being and doing in practice, to encourage contextually appropriate learning and practice enquiry. Facilitation of practice development in such contexts should be done in collaboration with practitioners. In such contexts, the contextual relevance of practice policies and guidelines that are heavily informed by technical-rational research evidence should be closely and critically considered. Development of such contexts and developmental approaches could result in authentic practice, in which occupational therapists can embody their values and blend research evidence with other ways of knowing, being and doing, and realise their professional identity.
Keywords: occupational therapy, dementia, professional artistry, critical creativity, authentic, context, person-centred, compliance
