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Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear. To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice. A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods – Think Aloud, practice observation, creative expression and reflective dialogue. Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions. Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity. [ABSTRACT FROM AUTHOR]

To understand the challenges in delivering comprehensive care for patients recovering from stroke in Guangdong Province, China. A cross-sectional qualitative study was conducted in two tertiary hospitals with different socio-economic characteristics in Guangdong Province, Southern China. Interviews were conducted with 16 stroke care providers including doctors, nurses, rehabilitation therapists and care workers. The interviews were audiotaped, transcribed and translated from Mandarin to English. Thematic analysis was used to draw out descriptive and analytical themes relating to care providers' experiences of existing routine stroke care services and the perceptions of challenges in delivering comprehensive stroke care. The interviews with stroke care providers highlighted three key factors that hinder the capacity of the two hospitals to deliver comprehensive stroke care. First, expertise and knowledge regarding stroke and stroke care are lacking among both providers and patients; second, stroke care systems are not fully integrated, with inadequate coordination of the stroke team and inconsistency in care following discharge of stroke patients; third, stroke patients have insufficient social support. While comprehensive stroke care has become a priority in China, our study highlights some important gaps in the current provision of stroke care. Comprehensive integrated stroke care is essential to maximize the effectiveness of stroke services and in China it needs to be further improved. Multidisciplinary stroke care systems should strengthen collaborations across all relevant disciplines and should include a clear role for registered nurses. Follow-up care after discharge needs more engagement with family caregivers. [ABSTRACT FROM AUTHOR]

Purpose: Current rehabilitation models emphasize therapy that attempts to return to "normal" the lives of persons who are disabled. An opportunity is available to scrutinize whether this recovery orientation of rehabilitation is necessarily optimal. Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines. Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin "ultra", beyond, to "habilitare", make fit. The resulting term, "ultrabilitate", commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning. Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas. Implications for rehabilitation: Despite significant progress, rehabilitation limits some people with disabilities. Modern health systems still benchmark therapy for rehabilitation against "normal" or species-typical standards to aid recovery. "Ultrabilitation", meaning "beyond fitness", promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery. Biological, social and technological conditions are needed to support ultrabilitation. Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth. [ABSTRACT FROM AUTHOR]

Heavy feet of stone Seeking transformation Dancing rocks and flows Critical creativity is a paradigmatic synthesis linking critical social science with creative and ancient traditions. Our haiku summarises the essence of this three part paper. Heavy feet of stone describes the rationale for our creation of critical creativity. Seeking transformation sets out the background and methodology for our inductive, methodological development. Dancing rocks and flows unfolds a new methodological framework for action-oriented, transformational practice development and research that is concerned with human flourishing for those who engage in such work, as well as those for whom the work is intended. Through interplay of story, metaphor, poetry and critical dialogue, we present our methodological development approach for critical creativity and the evolving methodological framework. Within the framework, we focus on conditions and principles that enable our worldview of critical creativity to be used in action research and practice development. [ABSTRACT FROM AUTHOR]

Human skin is a complex multi-layer material. Many existing numerical skin models accurately simulate several of its complex mechanical characteristics. However, few models simulate wrinkling - a phenomenon common to all human skin. In this study, a multi-layer model of skin was developed to simulate wrinkling. The model consisted of the stratum corneum, dermis and underlying hypodermis. The results of the simulations were compared with results of in vivo wrinkling experiments performed on the volar forearm. The proposed three-layer skin model simulates wrinkling more realistically than models of fewer layers. The size of the wrinkles predicted by the model fell within the range of the wrinkle sizes measured in the experiments. The maximum range and average roughness differed by 34 and 43% from the corresponding mean experimental results, respectively. Applications of the model include simulating skin aging, designing more realistic artificial skin and the development of surgical simulators. [ABSTRACT FROM AUTHOR]

This paper explores the concept of practice development in the context of professional development and strategies for facilitating learning in practice. In this paper we present the background to the methodology of emancipatory and transformational practice development. Key concepts underpinning a contemporary definition of practice development are unravelled and nine principles for effective practice development proposed. An example of a large-scale national practice development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which practice development systematically uncovers the deeply embedded characteristics of practice cultures – characteristics that often inhibit effective person-centred practice to be realised. [ABSTRACT FROM AUTHOR]

Action Learning is now a well established strategy for reflective inquiry in healthcare. Whilst a great deal is know about action learning there has been inadequate research on the process of learning that takes place, and the impact that this holds for individuals, groups or organisations. This article reports on the findings of 15-month action learning program based in a special care nursery. A realistic evaluation of the program uncovered individual and group journeys and provide evidence that action learning is an effective strategy in practice development. [ABSTRACT FROM AUTHOR]

Action learning is being increasingly utilised as a strategy to underpin practitioner focused development and research projects in healthcare generally and nursing in particular. Whilst facilitators of and participants in action learning have a variety of resource materials to guide their practice and participation, there continue to be few systematic and/or evaluative accounts of the experience of participating in action learning for potential action learning participants to draw upon. This paper attempts to address this agenda. The paper presents an interpretive evaluation of the experience of nurses participating in action learning as the learning strategy underpinning a 3-year emancipatory practice development/practitioner research programme. In particular, the paper focuses on the experience of 'joining a learning set'. This focus has been adopted as the theory of action learning emphasises the principle of 'voluntariness', but yet action learning is increasingly being pre-prescribed as a component of development and research programmes. Such was the case with the programme reported on in this paper. The paper describes an approach used to evaluate learning that was adopted in this programme and in particular the initial evaluation stage that focuses on participants' feelings about joining an action learning set. The data collection and analysis processes are described and the key themes arising from the analysis ('self-preservation' versus 'development of self') discussed. It is concluded that working with principles of enlightenment is essential to successful action learning and the transformation of workplace cultures. [ABSTRACT FROM AUTHOR]

In this article, the authors expose, for critical review and public scrutiny, their challenge to the critical paradigm as an adequate location for the transformational practice development and research approaches that they are developing in healthcare. Whilst they accept the fundamental assumptions of the critical paradigm, in their view it does not recognise the creativity required in their approaches. Neither does it explicitly acknowledge that creativity often requires moral and sacred dimensions as people push out the boundaries of the known within their own practices. In particular, the authors expose these gaps within Fay’s eight critical theories for practice. Over the last decade, the authors have addressed these gaps by combining the assumptions of the critical paradigm with their experiences of using creative imagination and expression in their practice development (PD) and action research work. Then through a critical review of their work, they have created a new paradigmatic synthesis to add to the critical paradigm. They call this synthesis ‘critical creativity’. In this article, the authors set out their reflexive journey that has led to the articulation of ‘critical creativity’ as a paradigmatic synthesis for action‐oriented development and research. [ABSTRACT FROM AUTHOR]

This article explores the work of a group of ward leaders who worked in a large acute NHS Trust in London in identifying the need for practice development in their clinical settings and their own leadership development needs. The ward leaders worked with a facilitator over a period of 6 months to develop knowledge, skills and experience in leading practice developments. The project was deliberately focused on helping the ward leaders become aware of the need for change and increase their potential as leaders of changes arising from the project. The ward leaders worked with the facilitator (the lead author) over a 7-month period, utilising a variety of integrated developmental and data collection techniques. The methods employed included reflection on practice, observation of practice, discussions with practitioners, 360-degree feedback and the use of a variety of creative arts. The project was based on the narrative framework of Frank (1995), and this framework was utilised to shape the interpretation of the processes and outcomes of the project. This article thus presents the combined narrative journey of the facilitator and the participants. [ABSTRACT FROM PUBLISHER]

This paper provides a reflective account of my journey of self-discovery through academic study and reflective practice. The importance of understanding one's personal agendas when commencing research work is highlighted. Utilising a hermeneutic approach, the background to the research endeavour is described as a 'backdrop' to the subsequent journey of discovery that unfolded. The paper describes a culture of custodial and institutionalised practice that influenced my work and my attitudes towards nursing. The essence of such practice is articulated through 'metaphorical stories' that illustrate the prevailing practice culture. The impact of this practice is outlined and the importance of recognising and dealing with unresolved practice conflicts as a legitimate 'chapter' in the research process is highlighted. It is concluded that if nurses are to achieve therapeutic competence then active engagement with learning in practice is required. Dealing with such conflicts is considered to be important to the development of expertise in practice and the achievement of therapeutic competence. [ABSTRACT FROM AUTHOR]