Im about buggard - but i felt that i had to get all this excitement out of my head so i can sleep!
Made a link between support and confidence
Intereting points about the new grads responsibility when they are feeling anxious, and chekcing things out before they do it
And developing the individual factors starts at having the attitude to want to work on them
Very interesting point around how new grads dont have the same caseload as a more experienced therapist in terms of level of difficulty and amount - and developing over time
Over confidence came up again - and a nice link between over confidence and patient safety
Being competent to practice you have to be confident
That confidence is not only related to new grads - but experienced therapists also - and the cycle confidence can go on
And that confidence is part of the communication style
Ohhhh - very very intereting data about clinical reasoning!!! And that you do alot of assess and discharge - but missing out on a lot of certain clinical reasoning skills to do with treatment becuase of that - and building on interactive reasoning - knowing how the disability impacts on the person - so yes clincial reasnoing skills develop to be really quick in some areas but missing out in others - not indpeth clinical reasoning
Being safe is the responsibility of the new grad
Prioritisation - doing it together in the morning - but "things change"!! Getting advice from charge nurse.
Possibly a link between priorisation and working at pace
And not giving to much to the new grad - but i think this is purely the type of program that this DHB offers...becuase this is certainly not my experience!
The role of pre experiences - a few examples
Team support in options/resources
The context vs the OT role and professional background
I like this quote "we are not promoting occupation, we’re promoting safety"
Disucssions around people occupations - and the OT role on the ward - and essentially what the OT is employed to be there for
And finally - using the OT models - basically none of the OT tranditional models that we learn about are applicable to the acute physical setting.
But anyways - i need to get some shut eye
Jess
Thursday, October 16, 2008
Monday, October 13, 2008
Great data discovered i think!
Interview one is done and transcriped! Total of 4 hours out of my day :) Getting speedy at transcription now!
Well so carnt wait to discuss this interview with my superviser... Interesting comments around "pace" and how compentence goes alongside confidence. Also another interesting comment around the role of OT within the MDT!!!
Quite excitement im feeling right now!
New ideas came up e.g. "live supervision" and different types of confidence within that.
Abit more depth about "safe" - providing two different views
Sme good examples around knowing that the new grads are making sound clinical judgments
Alot of talk about prioritisation and possibly its fit with working at "pace" - being clinically affective!
Pace - an interesting perspective on this!
And i think more and more is coming out about managing the caseload - and how you can do this to be clinically effective.
Overall - wonderful data i think haha
So exciting :)
Well so carnt wait to discuss this interview with my superviser... Interesting comments around "pace" and how compentence goes alongside confidence. Also another interesting comment around the role of OT within the MDT!!!
Quite excitement im feeling right now!
New ideas came up e.g. "live supervision" and different types of confidence within that.
Abit more depth about "safe" - providing two different views
Sme good examples around knowing that the new grads are making sound clinical judgments
Alot of talk about prioritisation and possibly its fit with working at "pace" - being clinically affective!
Pace - an interesting perspective on this!
And i think more and more is coming out about managing the caseload - and how you can do this to be clinically effective.
Overall - wonderful data i think haha
So exciting :)
Sunday, October 12, 2008
Interiews next
Next up is the semi structured interviews this week - ive got some nice questions as a result of constant comparison analysis and im hoping to get some really nice information to build on what i already have. I will transcribe those interviews and then see where im at - i then should be able to work with all the catergories and concepts and work on a theory as to the "fit" between new grads working in acute physical settings.
I have been working on my literature review and just seeing what information is out there already and what information i can use to confirm the quality of my findings. Ive found that there is some literature on supporting the transition of new grads that will fit in quite nicely. There is also some information on the challenges new grads face as well as strategies to overcome these.
Its all quite exciting at the moment - because im actually getting somewhere!!! Im developing theory grounded in the data that i have collected! Weird but its a good feeling!
Off to sleep now - had a huge weekend of coding, reading literature and getting organised for this busy week that is coming up
I have been working on my literature review and just seeing what information is out there already and what information i can use to confirm the quality of my findings. Ive found that there is some literature on supporting the transition of new grads that will fit in quite nicely. There is also some information on the challenges new grads face as well as strategies to overcome these.
Its all quite exciting at the moment - because im actually getting somewhere!!! Im developing theory grounded in the data that i have collected! Weird but its a good feeling!
Off to sleep now - had a huge weekend of coding, reading literature and getting organised for this busy week that is coming up
Friday, October 10, 2008
Literature chapter
Im so glad i did an anotated bibliography!!!!!!!!! Im understand how "literature" fits in now!!!!!!!!
First it helped me to see what was out there...then this helped me focus my initial data collection.
Now that i have some data i can see how i can use the literature out there to validate my findings. Pretty good this grounded theory thing i recon!!!!!!!!!!
P.S - i found some literature to back that up in my literature review chapter!
Plan to continue working through the literature chapter this week.
But boy its gonna be a big week - 2 interviews 2 transcriptions! and 4 days of work all before Friday.
First it helped me to see what was out there...then this helped me focus my initial data collection.
Now that i have some data i can see how i can use the literature out there to validate my findings. Pretty good this grounded theory thing i recon!!!!!!!!!!
P.S - i found some literature to back that up in my literature review chapter!
Plan to continue working through the literature chapter this week.
But boy its gonna be a big week - 2 interviews 2 transcriptions! and 4 days of work all before Friday.
The categories and subcategories
Ive learnt something today - ive learnt that using the direct quotes and putting them alongside the subcategories is starting to develop the dimensions and characteristics of my categories! It took 6 hours but i have something to show for it!!!! And this time i have more than one word - in some cases i have several sentences that show the context of the subcategory. There are pages and pages - but i think open coding is well on its way...and axial coding as well.
Monday, October 6, 2008
The core category?
Core Category Criteria [GLASER78, pp. 94-95)
must be central
reoccur frequently
takes more time to saturate
connections with other categories comes quick and richly
clear and grabbing implication for formal theory
considerable carry through, does not lead to dead ends
completely variable
is also a dimension of the problem
tend to prevent two other sources (social interest and logical deductive) of establishing a core which are not grounded
to see if #9 is a false criteria
can be any kind of theoretical code: a process, a condition, dimensions, a consequence.
At this stage i am thinking "the individual" may be the core category...or maybe it is the transition
So the Categories/Subcategories...
Support
-Informal
-formal
-active
-transition (or is this separate??)
Clinical reasoning
-decision making
-safety
Skills and Knowledge
-prioritisation
-managing referrals
-standardised assessments
-communication
Rotation
-purpose???
-grounding
-preparation
-consolidation
Individual
Safety
Occ Focused OT
HMMMMMMMMMMMMM I guess this core will come - just have to keep working
CALLED VALIDATION OF THE DATA - BUT FILLING IN THE CATEGORIES NEEDS TO HAPPEN FIRST :)
must be central
reoccur frequently
takes more time to saturate
connections with other categories comes quick and richly
clear and grabbing implication for formal theory
considerable carry through, does not lead to dead ends
completely variable
is also a dimension of the problem
tend to prevent two other sources (social interest and logical deductive) of establishing a core which are not grounded
to see if #9 is a false criteria
can be any kind of theoretical code: a process, a condition, dimensions, a consequence.
At this stage i am thinking "the individual" may be the core category...or maybe it is the transition
So the Categories/Subcategories...
Support
-Informal
-formal
-active
-transition (or is this separate??)
Clinical reasoning
-decision making
-safety
Skills and Knowledge
-prioritisation
-managing referrals
-standardised assessments
-communication
Rotation
-purpose???
-grounding
-preparation
-consolidation
Individual
Safety
Occ Focused OT
HMMMMMMMMMMMMM I guess this core will come - just have to keep working
CALLED VALIDATION OF THE DATA - BUT FILLING IN THE CATEGORIES NEEDS TO HAPPEN FIRST :)
All of the categories of data
The individual
“Better suited for some types of OT’s than others”
Confidence
Attitude
Previous experience
Personality
Willingness to learn/interested
Teachable
Reflective
Analytical -think out of the square
Anxiety
Maturity
Support
“With appropriate support...”
“We make it suitable”
Formal
-Supervision
-In-services
-Rotation programme
-Orientation programme
-Clinical supervision
-Peer review group
-New Grad learning programme
-Observing & active supervision
-Overlap - one OT leaving/one coming
-Young department - not so good
Informal
- Buddy
- Other disciplines
- Team
- OT department staff
- Interdisciplinary
- Peer support
- Morning/afternoon tea/lunch room/office
- Daily basis
Prioritisation
How to
What’s important?
Learnt rapidly
Deal with things thrown at you that morning
Factors to determine which one to see first
Getting information to
Gaining confidence
Referrals
Appropriate
Take responsibility
Prescribed to do…
Dealing with
Pace/volume
Reasoning/decision-making
Scope to develop strong clinical reasoning
Develop ability to think quickly on feet
Become conditioned
Unsure of
Opportunity to have reasoning backed up by other professions
Struggle bridging gap between theory and practice
Pressure to make speedy decisions
Occupational focused OT
Use OT skills in an acute setting
Not just there to be part of the discharge process
Short time-frame - can still do valuable OT work
Using OT process
Cannot develop long term relationships
Grounding/Preparation
“good way to prepare a new grad for virtually anything they might do”
Sets them up
Range of experience in a wide variety of clinical settings
Builds on core skills
Manage in any other area
Good place to consolidate their learning
Help consolidate
Good grounding
Basic occ ther skills
Opportunity to do a lot
Nuts and bolts
Simple occ ther skills
Medical Team
Call on at last minute
No idea what an OT does
Inappropriate referrals
Prescribe what an OT should do
Politics/personality types
Dealing with
Knowledge
Treatment options,
Resources
Manual handling
Standardised assessments - cognistat
What’s available?
Conditions, what should I be doing
Can teach
Training
Communication
Asking the right questions
Good at listening
If they don’t understand
Ability to talk
Speaking to people
Get the right information
Confidence
Coping & Managing
Appropriate/lots of support in place - manage challenges & cope
Taking on responsibility
Safety
Clinical
-Knowing the boundaries
-How much they can do with their level of expertise/competence
-Working at level of experience/competence
Cultural
“Better suited for some types of OT’s than others”
Confidence
Attitude
Previous experience
Personality
Willingness to learn/interested
Teachable
Reflective
Analytical -think out of the square
Anxiety
Maturity
Support
“With appropriate support...”
“We make it suitable”
Formal
-Supervision
-In-services
-Rotation programme
-Orientation programme
-Clinical supervision
-Peer review group
-New Grad learning programme
-Observing & active supervision
-Overlap - one OT leaving/one coming
-Young department - not so good
Informal
- Buddy
- Other disciplines
- Team
- OT department staff
- Interdisciplinary
- Peer support
- Morning/afternoon tea/lunch room/office
- Daily basis
Prioritisation
How to
What’s important?
Learnt rapidly
Deal with things thrown at you that morning
Factors to determine which one to see first
Getting information to
Gaining confidence
Referrals
Appropriate
Take responsibility
Prescribed to do…
Dealing with
Pace/volume
Reasoning/decision-making
Scope to develop strong clinical reasoning
Develop ability to think quickly on feet
Become conditioned
Unsure of
Opportunity to have reasoning backed up by other professions
Struggle bridging gap between theory and practice
Pressure to make speedy decisions
Occupational focused OT
Use OT skills in an acute setting
Not just there to be part of the discharge process
Short time-frame - can still do valuable OT work
Using OT process
Cannot develop long term relationships
Grounding/Preparation
“good way to prepare a new grad for virtually anything they might do”
Sets them up
Range of experience in a wide variety of clinical settings
Builds on core skills
Manage in any other area
Good place to consolidate their learning
Help consolidate
Good grounding
Basic occ ther skills
Opportunity to do a lot
Nuts and bolts
Simple occ ther skills
Medical Team
Call on at last minute
No idea what an OT does
Inappropriate referrals
Prescribe what an OT should do
Politics/personality types
Dealing with
Knowledge
Treatment options,
Resources
Manual handling
Standardised assessments - cognistat
What’s available?
Conditions, what should I be doing
Can teach
Training
Communication
Asking the right questions
Good at listening
If they don’t understand
Ability to talk
Speaking to people
Get the right information
Confidence
Coping & Managing
Appropriate/lots of support in place - manage challenges & cope
Taking on responsibility
Safety
Clinical
-Knowing the boundaries
-How much they can do with their level of expertise/competence
-Working at level of experience/competence
Cultural
Saturday, October 4, 2008
Working with data and categories
Over the last wee while i have been continuously working with the data. Having completed 2 focus groups i have alot of information to be working with.
Ive been drawing up "models" and trying to sort out how all the categories fit together.
My supervisor and I have realised that the "fit" for new grads in acute care practice is all about being able to clinically reason at pace. The models i have been playing with are no where near right YET, but every time i do another one it changes in some aspect and new bits get added. At the moment i am i guess focusing on the transition period and i have identified more questions that im interested in asking the participants about. Just picking the "right' participant is hard because they all to a degree have talked about some aspects of things i wish to go "futher into".
The transition is all around "bridging the gap" between student and new graduate or theory and practice. A comment that i am really interested in is "becoming conditioned" - and i guess this seems to fit with the idea of clinical reasoning at pace.
Ive been thinking today about how all this data is going to fit with my literature review section. This is something that im going to need to get clear relatively quickly so i can get on to making sure it is all going to fit together.
Another thing that is interesting me at the moment is the theme around support, and if this is different dependant on the individuals prev experience. Also how this relates to the hospital context and the support available. I have tried drawing some diagrams to compare the new grad with and without prev experience in acute and how long it takes them to establish clinical reasoning at pace. Im nto happy with these diagrams either - as i wanted to include the support in there but i not understanding if it is the same at first for all, then grad decreases - or if its different, or even changes over the course of the rotation.
Im also interested in what the particiants think about different types of acute settings. Whether one is "easier", "good to start in", not great for a new grad" or whether its one that they will be ready for after a few other rotations.
Another thing that is popping up in my head is - does clinically reasoning gradually develop or does it just happen one day? Also how can we determine that one person can reason at pace - in all clinical situations how complex or simple they are..
The "individual" is an interesting theme i think. We all know that everyone is different and that some people are more confidient..mature etc. But does the type of setting make any difference to how a new grad's "personality" or "attitude" fits or transitions into the work context?
Anyways these are the questions that popped up in my head during coding - memos etc.. so things i want to find out more about..
Those new grads that have no acute experience, how many struggle or jump straight in and strive?
How many new grads struggle all the way through a particular rotation?
How well do they reflect?
How much support do they need?
Does reflection help them develop and gain clinical reasoning skills at pace?
How many think outside the square?
How important is peer review and in-services, compared to supervision?
How well do they use the OT process?
Why is support from PT, SW and SLT good?
Is having enough support an issue for new grads?
How often do they respond to inappropriate referrals?
How do they take responsibility for referrals?
How well do they prioritise?
What are the implications of poor prioritisation? Examples.
What coping strategies do they use to manage rapid learning of skills such as prioritisation?
How well do they multi task?
How well do they make speedy decisions?
What factors make it hard to make speedy decisions?
Does a new grads support stay the same throughout the rotation/year or does it change. If it changes, how and why?
How would you define being safe in clinical practice?
Why is clinical reasoning different at first?
How long does clinical reasoning take to develop?
What is the purpose of a rotation programme?
What is it about the medical model acute service that makes it hard for new grads?
Is clinical reasoning different across cases?
What’s simple? What’s complex?
How do they balance working within a medical model, and applying the OT process/models?
How do they deal with team members who don’t value/know the OT role?
How do you know if a new grad is making sound clinical reasoning judgments?
Do the new grads realise the role as a new grad I as learning process?
Do you think the attitude of new grads differs across different acute settings e.g. orthopaedics vs. medical/neuro?
How well do they communicate with
a) OT collegues
b) The medical team
c) clients
Is the fit between new grads and acute looking at the context of the hospital or the clinical reasoning?
Is clincial reasoning in acute about knowing the recipe? Clinical reasoning or knowing the recipe??
How important is it having an acute placement in the fit and the speed of fitting?
Anyways meeting my superviser on Wed - then it will be time to organise the semistructured interviews
All 4 now
Ive been drawing up "models" and trying to sort out how all the categories fit together.
My supervisor and I have realised that the "fit" for new grads in acute care practice is all about being able to clinically reason at pace. The models i have been playing with are no where near right YET, but every time i do another one it changes in some aspect and new bits get added. At the moment i am i guess focusing on the transition period and i have identified more questions that im interested in asking the participants about. Just picking the "right' participant is hard because they all to a degree have talked about some aspects of things i wish to go "futher into".
The transition is all around "bridging the gap" between student and new graduate or theory and practice. A comment that i am really interested in is "becoming conditioned" - and i guess this seems to fit with the idea of clinical reasoning at pace.
Ive been thinking today about how all this data is going to fit with my literature review section. This is something that im going to need to get clear relatively quickly so i can get on to making sure it is all going to fit together.
Another thing that is interesting me at the moment is the theme around support, and if this is different dependant on the individuals prev experience. Also how this relates to the hospital context and the support available. I have tried drawing some diagrams to compare the new grad with and without prev experience in acute and how long it takes them to establish clinical reasoning at pace. Im nto happy with these diagrams either - as i wanted to include the support in there but i not understanding if it is the same at first for all, then grad decreases - or if its different, or even changes over the course of the rotation.
Im also interested in what the particiants think about different types of acute settings. Whether one is "easier", "good to start in", not great for a new grad" or whether its one that they will be ready for after a few other rotations.
Another thing that is popping up in my head is - does clinically reasoning gradually develop or does it just happen one day? Also how can we determine that one person can reason at pace - in all clinical situations how complex or simple they are..
The "individual" is an interesting theme i think. We all know that everyone is different and that some people are more confidient..mature etc. But does the type of setting make any difference to how a new grad's "personality" or "attitude" fits or transitions into the work context?
Anyways these are the questions that popped up in my head during coding - memos etc.. so things i want to find out more about..
Those new grads that have no acute experience, how many struggle or jump straight in and strive?
How many new grads struggle all the way through a particular rotation?
How well do they reflect?
How much support do they need?
Does reflection help them develop and gain clinical reasoning skills at pace?
How many think outside the square?
How important is peer review and in-services, compared to supervision?
How well do they use the OT process?
Why is support from PT, SW and SLT good?
Is having enough support an issue for new grads?
How often do they respond to inappropriate referrals?
How do they take responsibility for referrals?
How well do they prioritise?
What are the implications of poor prioritisation? Examples.
What coping strategies do they use to manage rapid learning of skills such as prioritisation?
How well do they multi task?
How well do they make speedy decisions?
What factors make it hard to make speedy decisions?
Does a new grads support stay the same throughout the rotation/year or does it change. If it changes, how and why?
How would you define being safe in clinical practice?
Why is clinical reasoning different at first?
How long does clinical reasoning take to develop?
What is the purpose of a rotation programme?
What is it about the medical model acute service that makes it hard for new grads?
Is clinical reasoning different across cases?
What’s simple? What’s complex?
How do they balance working within a medical model, and applying the OT process/models?
How do they deal with team members who don’t value/know the OT role?
How do you know if a new grad is making sound clinical reasoning judgments?
Do the new grads realise the role as a new grad I as learning process?
Do you think the attitude of new grads differs across different acute settings e.g. orthopaedics vs. medical/neuro?
How well do they communicate with
a) OT collegues
b) The medical team
c) clients
Is the fit between new grads and acute looking at the context of the hospital or the clinical reasoning?
Is clincial reasoning in acute about knowing the recipe? Clinical reasoning or knowing the recipe??
How important is it having an acute placement in the fit and the speed of fitting?
Anyways meeting my superviser on Wed - then it will be time to organise the semistructured interviews
All 4 now
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