the recognition and interpretation of a stimuli that serves as the basis for understanding or for...
TRANSCRIPT
Speaking the Language of Medicine: The Larger
Benefits of Evidence Based Practice
Jim Shea MS, [email protected] Hospital
Bridgeport CT
The recognition and interpretation of a stimuli that serves as the basis for understanding or for motivating a particular action or reaction
It All Begins With...
PERCEPTION
Direct input creates our perception
Each fact we receive builds the case
What you see is what you get
Bottom Up
We make inferences about what we see and try to make a best guess
Prior knowledge and past experiences are critical
We develop a PERCEPTUAL HYPOTHESIS based on this prior knowledge
Top Down
We actively construct our perception of reality
Input enters and is combined with what we already know
The First Way Errors Can Occur
When things are presented in a familiar context, we rapidly judge
When we rapidly judge, we no longer look for details that we assume to be present
The 2nd Way Errors Can Occur
Hypothesis testing occurs to make sense of the input coming in
The formation of an incorrect hypothesis will lead to errors in perception
Filtering incorrectly validates this hypothesis
The 3rd Way Errors Can Occur
Previous experience working in a nursing home◦Diversion◦Quantity = Quality
How did this error occur?(prior knowledge)
The word RECREATION Implies diversion Implies fun, non clinical……..
•Para professional provide recreation•He saw some of the similar activities being conducted that he saw being offered in the nursing home
How did this error occur?(prior knowledge)
Treatment Team Meetings ◦Too much emphasis was placed by the CTRS in discussing the details of the activity and not enough emphasis on the outcome example: baking
Some Was Our Own Doing
The patient played... The patient had fun doing… The patient enjoyed...
Words That Worked Against Us
Despite efforts to educate and highlight the therapeutic nature of what we were doing, the hypothesis was established filtering confirmed the hypothesis
“Patients have told me…”
On the one hand, we believed that we were a good department that provided high quality, effective therapy.
On the other hand, we were being told we were nothing more than a service that is providing diversional activities to keep people busy.
This Created Cognitive Dissonance For Us
Focus on more supportive beliefs that outweigh the dissonant belief or behavior (He doesn’t know what he is talking about)
Reduce the importance of the conflicting belief (What he believes is not important)
Change the conflicting belief so that it is consistent with other beliefs or behaviors
We Had Three Choices
Part of the answer was close by (music therapy)
Part was to pay attention to what was valued
What to do?
EvidenceOutcomesBest Practice
The Language of Healthcare
Mission/purpose of unitLength of stayAvailable resources (space/budget/staff)
AssessmentActivity AnalysisA belief that there was evidence
Interventions were selected using traditional considerations
To bring it in line with other disciplines
To improve patient careTo change perception
Decision was made to go through a process to validate (or invalidate) programming
Research to validate current interventions
Research (or lack of research) that does not support the use of some interventions
Research to add additional interventions
Examine the research that supports the treatment provided
Limited studies to directly link specific RT interventions with desired outcomes◦ Diagnosis◦ Interdisciplinary treatment goals◦ Setting
Some practical challenges
Studies that directly connect an intervention with the exact desired outcome for the exact population
Studies that show an intervention with similar characteristics linked to the exact desired outcome for the exact population ◦ Intervention◦ Outcome◦ Population
Look for studies that are as close as possible to the ideal
Once The Evidence Was Established, We Validated The Results
Creation of an outcomes tool that consisted of 4 questions
◦ The Therapist Was Respectful◦ Goals Of The Session Were Explained◦ The Session Kept My Interest◦ The Session Helped Me Make Progress Towards My
Treatment Goals
As Well As Patient Comments
There were 204 surveys completed in a 3 month period
A report was created that summarized the findings
The overall rating was 4.6/5
The report examined the 4 variables for each intervention (group).
Particular attention was paid to the question asking the patient to rate to what degree the session helped them achieve their overall treatment goals (4.5/5).
There were 46 patient comments made and 44 were positive comments (95.65%).
How Did Perception Change?
Formal presentation of evidence to support clinical practice to psychiatric leadership team
Outcome Measure◦ Each session for 3 months
Development of departmental treatment team report guidelines
Words Matter The patient played...
The activity
The game
The patient came to recreation
The patient engaged in…
The session
The structured task
The patient came to therapy
Invited MD’s to monitor report in treatment team (forced filtering)
Recent Vacancy
How Did Perception Change?
How Did Self Perception Change?