Using Qualitative Research to Inform the Client-Centred Evidence-Based Practice of Occupational Therapy

Demands for increased accountability for health care expenditure, and recognition of clients' rights to interventions and methods of service delivery that are grounded in sound evidence, are compelling occupational therapists to use research findings to inform their clinical decision making. Occupational therapists also state that they embrace a client-centred orientation to practice, yet this espoused ethic seems rarely to influence decisions concerning what research is undertaken and how it is undertaken or what counts as evidence for practice. Given the widely divergent perspectives, priorities and values between health care professionals and their clients, practice based upon therapist-centred research may be neither relevant nor valid.

This paper explores the philosophical underpinning of methods used to develop theory, proposing that occupational therapy's evidence-based practice must be ethically consistent with its espoused client-centred philosophy to avoid a tendency towards hypocrisy. It explores issues concerning client-centred practice and evidence-based practice and suggests that qualitative research methods may be the most appropriate tools to identify and address client priorities. While traditional quantitative research approaches render client voices silent, qualitative methods may enable occupational therapists to explore the complexities of clinical practice and of living with a disability, thereby informing a more client-centred, evidence-based practice of occupational therapy.

Subcutaneous injections: preventing needlestick injuries in the community

Community nurses provide care to patients in a variety of settings, for example health centres, community hospitals, patients' homes, residential and nursing homes. Administering subcutaneous injections to patients in the community is an everyday activity for many nurses in clinical practice. Many problems related to being 'sharps safe' are common to both community nurses and hospital staff. The majority of subcutaneous injections administered in the community are for patients with diabetes. Reducing needlestick injuries after the administration of subcutaneous injections in the community remains paramount to all NHS staff. This article provides information on what national standards to employ when administrating subcutaneous injections and what safety practices should be undertaken for good sharps management. Staff administering subcutaneous injections in the community need to ensure that they are updated on the latest developments in safety needle devices in order to prevent needlestick injuries and provide safe, effective and individualised care for their patients.

Reducing needlestick injuries: a review of a community service

Community nurses provide care to patients in a variety of settings; for example, health centres, community hospitals, patients' homes, and residential and nursing homes. Administering intramuscular (IM)injections to patients in the community is an everyday activity for many nurses in clinical practice. A great deal of problems related to being 'sharps safe' are common to both community nurses and hospital staff. There had been a reported six needlestick injuries (NSIs) from community clinics administering depot IM injections, which required a review. An audit of practice was undertaken in clinics administering depot injections. The audit was undertaken to monitor compliance in sharps management and investigated how community nurses were administering IM injections. The review highlighted a lack of resources, gaps in knowledge and training deficits. The infection prevention and control nurses worked hard to improve practices and procedures. After a year, there had been a significant reduction in NSIs.

The Relationship Between Client-Centered Goal-Setting and Treatment Outcomes

Shifting definitions of health and well-being, prompted by the World Health Organization's International Classification of Functioning (2001), have stimulated changes in traditional clinician-client relationships in rehabilitation. Among these changes, in keeping with the concept of client-centered care, is a trend toward more collaborative goal-setting and joint determination of intervention plans. Evidence suggests that supporting clients' autonomy in prioritizing personally meaningful goals leads to increased engagement in intervention, less emotional anxiety about the rehabilitation process, and improved treatment outcomes. Supporting people with aphasia in a process of collaborative goal formulation may also serve to alter treatment priorities so that they address more relevant communication challenges embedded in post-rehabilitation life.