1. Involving acute hospital inpatients in the evaluation of an occupational therapy service Cathy Robertson Senior occupational therapist Wirral Hospital NHS Trust

2. Presentation outline  Background.  Involving acute hospital inpatients – anticipated challenges.  Undertaking the research.  Reflections.  Conclusions.

3. Background  Research award for novice researchers –6 month secondment, Jan – June 2006  Evaluation of occupational therapy (OT) service by involving service users  A pilot study

4. Occupational Therapy in an acute hospital  Occupational therapists use meaningful activities to assess and treat patients.  The aim is to maximise independence, reduce risk, and improve quality of life.  Typical activities include: –Personal care (washing and dressing) –Kitchen (drink and snack preparation) –Mobility and transfers (on and off furniture) –Pre and post discharge home visits –Provision of equipment

5. Involving acute hospital inpatients – anticipated challenges  Motivation to be involved with research –Little contact with occupational therapist before discharge. –No anticipated need for occupational therapy after discharge.  Lack of understanding about occupational therapy –Confusion with physiotherapy

6. How would service users be involved?  Designing the research  Choosing research topics / questions  Giving feedback on the findings  Making recommendations for change  Evaluating changes

7. Research design - focus group  Describe experiences of the OT service as inpatients.  Identify issues of particular importance.  Develop a list of interview questions.  Decide on any further involvement.

8. Recruiting participants from acute hospital wards - challenges  I did not make contact with everyone who had been referred to Occupational Therapy: –Already discharged home –RIP –Obviously unwell / confused –With visitors / doctors –Protected meal time –Advice of nursing staff

9. Recruiting participants from acute hospital wards - challenges  Not everyone I contacted was asked to take part: –Deaf / other communication difficulties –Confused / lack of understanding of request –Lack of understanding of OT / confusion with physiotherapy –Advice of nursing staff / medical diagnosis –Adverse social situation –Length of time before discharge

10. Focus group  Nine service users were asked to take part.  Three service users consented to participate.  One withdrew consent after discharge.  One unable to attend on the day due to illness.  Focus group abandoned.

11. Interviews  38 people agreed to take part in an interview.  Not everyone could take part: –RIP before or soon after discharge –Transfer to other hospital before discharge –Not discharged in time to conduct interview –No reason given  27 interviews conducted.

12. What did service users expect from their interviews? “I didn’t know what you wanted, I didn’t know what it was for. But I don’t mind being interviewed”. “I suppose just giving my own ideas and opinions. Whether it’s useful or not I leave up to you. You just hope that your opinion has at least been looked at. Whether it’s acted upon is a different thing”. “If it helps the OT department, and patients ultimately, then it’s worth doing”.

13. Service users wanted to be involved  Altruistic motives –Giving something back –Helping others and improving the OT service  Personal motives –Keeping your mind active –Feeling useful when other activities are restricted due to disability  Benefit to the OT service –Hearing the service user’s voice –Understanding the service user’s perspective

14. Reflection – motivation for involvement  People were willing to take part in interviews, if it meant helping others.  People were willing to be involved in research about the OT service after they had been discharged from hospital.  I underestimated peoples’ altruistic motives for continued involvement.

15. Reflection – lack of understanding of occupational therapy  Many people did not know the difference between occupational therapy and physiotherapy.  How much should I have prompted / reminded them?  Not asked to take part.

16. Who should comment on the results?  Not all participants invited to comment on findings – a subjective decision based on: –Interest in the topic, and ability to discuss issues –Ability to describe their OT treatment and their thoughts about it (not all uncritical)  Some feedback on findings is better than none – but perhaps: –Should have asked a random selection? –Should have asked everyone?

17. Conclusions – conducting the research  Involving acute hospital inpatients in research is not straightforward.  Data protection and confidentiality for hospital inpatients.

18. Conclusions – service user involvement  Involvement in an interview, or by commenting on findings, worked well.  Involving people in research design was less successful.  Offer different levels of involvement, and plenty of time.

19. A very positive experience  Acute hospital inpatients are willing to be involved in research about OT.  Service users have gained from their involvement in this research.  Valuable feedback and recommendations for the occupational therapy service.  Learning from this pilot study will benefit future research with acute hospital inpatients.

20. “People who use the service are on one side of the fence, if you like. And the OTs are on the inside. And the idea surely is to get the two together, with a plan, and get on with it”.

21. Thank you.

22. Acknowledgements  Dr Sam Sartain  Anne McGinnity, Marilyn Wallace, Melanie Jones, Jane Marriott  All the service users who took part in interviews and provided feedback on the results

23. Discussion and questions? cathy.robertson@whnt.nhs.uk