In this blog, final year occupational therapy students Victoria Bell and Katie Jackson share their experience of facilitating a journal club whilst on clinical practice placement, and how this gave them an insight into the professional and service development that can come from evidence-based practice.
On placement we are working alongside the Children’s Therapy team in Scarborough and were recently asked to facilitate a journal club as part of a staff meeting. After a search of Google Scholar, we identified an article entitled ‘Pediatric Telehealth: Opportunities Created by the COVID-19 and Suggestions to Sustain Its use to Support Families of Children with Disabilities’ (Camden and Silva, 2021). We chose this article because it was relevant to both Occupational Therapy and Physiotherapy, where telehealth is currently being used to deliver services. At the beginning of this pandemic, the Children’s therapy team were forced into a new way of working – virtually. While this was not to everyone’s liking, the service had to adapt to accommodate the restrictions surrounding COVID-19 and to enable them to continue to deliver therapy to children in need.
This article we selected by Camden and Silva (2021) is not a typical journal article but more of a perspective piece, discussing the pros and cons of telehealth. A standard critical appraisal tool would therefore not have been appropriate and so we developed our own critical appraisal tool to help guide our discussion during the journal club around the key points of the article. This included considering the advantages of telehealth, and the extent to which appointments conducted virtually are more accessible to a broader variety of patient. The article showed telehealth to be cost effective, feasible and client centred, delivering the right information and support at the right time in the right place. Within the journal club discussion an advantage highlighted for clinicians was a reduction in travel time. With some locations of service delivery being rural and covering a wide area (Scarborough, Whitby and Ryedale) telehealth was felt by the team to be efficient. However, it was also highlighted that there are limitations to the use of telehealth. For example, those most in need are generally those with reduced access to technology and therefore unable to participate or engage in virtual appointments. In addition, telehealth was considered a good concept for use with children, but not suitable for every child. There were concerns regarding appointments that required a face-to-face approach, prompting discussion around the understanding of when telehealth is the most appropriate approach. Both the recommendations of the paper and the clinicians attending the journal club concluded that a blended approach would be conducive to best practice.
The advance in technology and access to the correct IT systems were identified to be a barrier of working virtually. Under normal circumstances, the introduction of telehealth into this service would have taken years and correct training would have been provided. However, due to the pandemic, technology and clinicians had to adapt fast with little training to provide essential therapy for those children in critical need. A discussion took place about the competence of clinician’s IT skills and the continuous IT problems that still regularly occur throughout services. To approach this, the article suggested that if this way of working is to continue in the future, IT consultants should be included as part of multiple disciplinary teams. This would reduce/minimise disruption to delivering services via telehealth, reducing the stress levels and anxiety of professionals who regularly experience technical difficulties.
The article also discussed the need for more support for the physical and mental wellbeing of therapists engaging in telehealth. Clinicians at the journal club expressed elevated feelings of fatigue whilst continuing to use telehealth to deliver services. Telehealth can for instance impact on physical health through reduction in movement, and emotional health through exhaustion from continual videoing. Broadly, they voiced a positive outlook towards telehealth and a motivation to continue working in this way, however were in agreement that if virtual ways of working are to continue, this would be something that needs addressing within the service.
Other areas of discussion were focussed around uncertainties into the effectiveness of their delivery of service and how this impacted on patient satisfaction. As a new way of working, participants found it beneficial to use this evidence to reflect and to compare techniques, critically evaluating what is needed and suggested for best practice. After discussion, clinicians felt more confident in providing healthcare through telehealth as from the journal club, they were able to provide a clear rationale, backed up by evidence for their decision making within practice. Overall, the journal club prompted the clinicians to reflect on their own professional skill set and adapt their approach to a more evidence-based approach. The journal club prompted the sharing of ideas for service development that would benefit both patients and healthcare professionals.
From facilitating and participating in a journal club, we have now seen first-hand and learnt the true value of evidence base practice, and most importantly how it informs and shapes our practice. Not only have we gained valuable knowledge from this article, but we have also played a part in bringing positive change to health service delivery, for best practice directly influenced by research evidence. The discussion between different clinical areas was highly beneficial and enabled different views and concepts to be heard. These shared ideas helped bring together a mutually beneficial and enjoyable discussion.
As student occupational therapists we felt valued and part of a professional team. To have the opportunity to facilitate this journal club felt like a great achievement.
Camden, C. & Silva, M. (2021) ‘Pediatric Telehealth: Opportunities Created by the COVID-19 and Suggestions to Sustain Its use to Support Families of Children with Disabilities’, Physical & Occupational Therapy in Pediatrics, 41(1), pp. 1-17.