Exploring Theory in Practice: A Conceptualisation of Three Inter-related Influences on Practice Transformation

Occupational therapy has a well documented gap between theory and practice. As a result, occupational therapy has struggled to reconcile its occupational roots as the central construct for the profession in practice. This has, in part, been due to the historical origins of the profession that direct the focus of contemporary professional practice but fail to be aligned with contemporary theoretical debates. To date literature, both within and out with the profession of occupational therapy, has focused on developing skills and knowledge of practitioners to bridge the theory-practice gap. This has largely been at the exclusion of understanding the influence and complexity of practice situations when implementing evidence informed theory to facilitate practice transformation.

This thesis aims to explore and understand the implementation of evidence informed theory in practice with occupational therapists working within physical disability services across health and social work organisations. The Model of Human Occupation was selected as the evidence informed theory to be implemented within this research as it reflected the professional principles of evidence informed, occupation focused and person centred practice (Kielhofner 2008). Ontologically this research is positioned within a social constructionist standpoint and draws on a number of sociological theories to inform analysis and understanding. An action research approach was adopted to explore the aims of this research. A co-operative inquiry group methodology was utilised and eight action reflection cycles were completed with seven practitioners over a two year period. A thematic approach to analysis was adopted to track inquiries within and across the action research.

A multifaceted approach to practice transformation is presented that focuses on understanding the nature of professional practice within and across health and social work organisations. The research presents the inter-relationship between professional learning, social and organisational situations of practice as the unique conceptualisation emergent from this research. This conceptualisation is presented to provide a framework for understanding future practice transformation initiatives. This research indicates that occupational therapy practice within physical disability settings is defined by historical organisational and social constructs that determines values within practice rather than professional values being defined by professional principles of the profession. Potential considerations regarding the future development of occupational therapy services within physical disability settings are outlined to reconcile practice and theoretical values to deliver evidence informed, occupation focused and person centred services for service users.