6 minute read
Celebrating Rural Health Research in the Australian Occupational Therapy Journal
Dr Nerida Hyett, Australian Occupational Therapy Journal Editorial Board Member
Robyn Soulsby, Neurological Stream Leader, Outpatient Rehabilitation Services, Bendigo Health
Siobhan Branagan, Occupational Therapist, Outpatient Rehabilitation Services, Bendigo Health
Fay Wallis, Occupational Therapist, Senior Clinician, Community Allied Health Services, Bendigo Health
To celebrate the theme of ‘Regional, Rural and Remote’ we discussed an article from the Australian Occupational Therapy Journal to highlight the value of rural health research for occupational therapists. The article was selected from the journal’s Virtual Issue for the Virtual OT Exchange 2020 hosted by Occupational Therapy Australia.
The Virtual Issue is a new initiative for events held in alternate years to the biennial national conference. The article by Pighills, Tynan, Furness, and Rawle (2019) was titled ‘Occupational therapist-led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service’.
I, Nerida, met with three occupational therapists from Bendigo Health who have experience in Environmental Assessment and Modifications (EAM) for falls prevention to discuss how this research can inform practice. The following is a summary of our discussion highlighting their perspectives.
Siobhan: I work across both the falls specialist assessment and generic rehabilitation clinics, which have different approaches to occupational therapist-led EAM. I read the article from this clinical perspective and reflected on my experience with a Knowledge Translation (KT) project with the Falls and Balance Assessment Clinic.
Robyn: I read the article with two hats—as an occupational therapist and operational manager—and considered applications to practice from both perspectives.
Fay: I read the article from the perspective of a senior clinician working in a multidisciplinary Community Allied Health Services team. We provide services under the Commonwealth Home Support Programme and our core business is to support people to remain living at home and prevent admission to residential care.
Siobhan andRobyn: The article prompted us to reflect on the range of factors that support and hinder the conduct of evidence-based falls assessment across the continuum of care. In outpatient and community settings we have greater capacity to conduct home falls assessment (more time and fewer resource constraints). However, as highlighted in this research, there is variability in knowledge of EAM and falls prevention interventions. Evidencebased EAM was rarely reported in the study setting and we reflected on the importance of therapists having a good understanding of falls assessment and prevention irrespective of setting in the continuum of care. This research made us reflect on how evidence-based EAM is supported at Bendigo Health through clinical supervision, professional development, a falls specific learning program for new staff in specialised roles, and ongoing quality improvement via KT and consumer engagement.
Fay: Our service is more generalist, and while we are not a falls prevention service, the evidence is clear that falls prevention enables people to remain at home. Reading this article prompted me to reflect on how we conduct orientation and clinical supervision, and I reflected on how EAM fits within the occupational therapy practice process.
The researchers discuss the role of the rural generalist occupational therapist which resonated with us. We discussed the differences between roles that require specialist falls knowledge in comparison with roles that require more generalist knowledge.
Fay: At Bendigo Health, occupational therapists in outpatient and community settings often have more generalist roles, and falls prevention is part of the scope of practice, compared with our specialist Falls and Balance Assessment Clinic.
Siobhan:For example, there is a difference between an occupational therapist’s EAM scope of practice working in a specialist falls assessment clinic compared to an orthopaedic rehabilitation clinic.
Robyn: Specialist knowledge of falls assessment and prevention also requires greater knowledge of factors that contribute to falls, such as medical comorbidities, medications, cognition, and vision. A more generic focus is common in rehabilitation clinics, which is where we could continue to build clinician knowledge of evidence and advocate for use of standardised assessment tools.
We discussed the importance of KT for EAM and reflected on experiences of KT at Bendigo Health.
Robyn:Following a KT process was really helpful in reviewing how our Falls and Balance Assessment Clinic is delivered. This helped us to understand how to apply the evidence in the local context and address context-specific and service-level barriers (e.g. staff grade and experience, and client geographical considerations). We used a KT process to effectively advocate for resources and to deliver evidencebased assessment (e.g. integrating a standardised home safety assessment).
Siobhan: Our KT process has resulted in the geriatrician and physiotherapist being able to flag concerns early in preparation for home assessment, which gives clients more time to consider recommendations and increases acceptance.
Robyn:Utilising a KT process was useful and positive for applying evidence to our local context with consideration of clinician knowledge and experience.
We agreed with the researchers’ recommendations for peer support from experienced occupational therapists, and reflected on clinical supervision as a structure to support occupational therapists’ practice.
Fay: Clinical supervision provides the supervisee the opportunity for reflection on practice and discussion, to explore learning needs, and opportunities to address them. This provides a framework for exploring clinical reasoning through a variety of
approaches (e.g. case and documentation reviews, and joint home visits). Bendigo Health therapists are supported by an organisation-wide Clinical Supervision Protocol for Allied Health and the Victorian Allied Health Clinical Supervision Framework to promote a consistent approach. Access to clinical supervision might address some of the issues identified in this research.
Robyn:Clinical discussion with peers, alongside clinical supervision, is important for occupational therapists experienced in EAM because there are ongoing developments in options and equipment, and approaches to client communication.
Fay andSiobhan: Communication skills and how recommendations are introduced to clients is strongly linked to acceptance and behaviour change, which is the key focus of this research: successful and sustained change. Orientation and training in the use of standardised home assessments is also important.
A key issue identified by the researchers was a lack of documentation regarding occupational therapists EAM.
Fay: My initial thoughts were that if it is not written down it didn’t happen. Communication of the occupational therapy process, including clear clinical reasoning, is also a valuable tool for promoting understanding of our role. At Bendigo Health we have overarching documentation guidelines with program specific examples. There are guidelines for the completion of initial and home assessment. This provides clear expectations for documentation, a reference point for new staff, tools for reflection for existing staff, and promotes consistency across program areas.
We reflected on the application of this research in our local rural/regional context.
Siobhanand Robyn:We address the barrier of geographical distance in the Falls and Balance Assessment Clinic through administering the Westmead as part of occupational therapist assessment via telehealth for clients who reside greater than 45 minutes away. The use of a standardised home assessment tool helps to identify factors contributing to falls risk that might not have otherwise been identified through a generalist occupational therapist assessment.
Robyn: Using telehealth for clients who live further away creates collaborative opportunities between our specialist clinic and local generalist services.
Fay: Our program can provide face to face service to clients up to two hours away.
Overall, we found it useful to reflect and discuss this research as a collective of clinicians across settings. This allowed us to consider how we align with the evidence base, areas for further practice review, and opportunities for further learning.
Reference
Pighills, A., Tynan, A., Furness, L. and Rawle, M. (2019) Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service. Australian Occupational Therapy Journal, 66, 347-361. doi:10.1111/1440-1630.12560
