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Why use literature reviews in health and social care?
Why use literature reviews in health and social care?

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4.3 Practice focus: Adele’s literature review

Earlier you learned that in her professional role Adele ‘wondered whether the benefits I had observed in my own attention processes [mindfulness] would also benefit people with cognitive impairment’, including people with dementia. Adele’s role involved helping people to restore their mental wellbeing, and one aspect of her work involved Mindfulness [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (NHS, 2018). If you want to find out more about mindfulness, Professor Mark Williams, former director of the Oxford Mindfulness Centre, has outlined its theoretical basis in the article ‘Mindfulness and psychological process’ (Williams, 2010) and some of its practical applications in the article ‘Mindfulness, depression and modes of mind’ (Williams, 2008). Adele was interested in applying what she knew about mindfulness in her practice setting for people in later life.

This illustration shows only the top of an information sheet produced by Adele Pacini, for service users and carers of people with dementia. At the top of the image the viewer sees a person’s hands, opened up to the viewer in a welcoming way, and placed between their hands is a yellow flower. To the right of the hands is a quote from a mindfulness practitioner. The quote says: ‘Why do we practice mindfulness? So that we can enjoy our old age’ The practitioner is said to be ‘Shunryu Suzuki Roshi’. Below the photograph the information sheet is titled ‘Mindfulness Therapy’. Below the title the viewer sees two columns of text. The title of the left-hand column is titled ’What is mindfulness?’ and the right-hand column is titled ‘What does the course involve?’ Below each of these titles is the beginning of the text that Adele created. The text on the left-hand column says: ‘The definition of mindfulness is paying attention to the present moment without judgment. The mindfulness for dementia course consists of a number of exercises that can be learned by listening’. It is implied that the column continues but this is unseen by the viewer of the image. The right-hand column text says: ‘As well as attending the classes, we will ask people to practise skills at home for 20 minutes each day.’ Following this text there is a bullet-pointed list beginning: ‘We will help you to: use helpful coping skills’, a lengthier bullet-pointed list is implied but is unseen by the viewer
Figure 1

The information sheet above (Figure 1) was created for illustrative purposes in that it was an outcome of Adele’s literature review, just as much as either Jean’s or Julie’s publications. The leaflet promotes the new service/practice that Adele’s literature review supported. While publication can be an outcome of doing a literature review, it doesn’t have to be. Adele wanted to develop a new service/practice within her work environment. Her literature review led to that but she still had the practical task of advertising the service and engaging with service users and carers.

Activity 3 Mindfulness and working with people with dementia

Listen to the following interview with Adele Pacini.

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Answer these questions:

  1. Would you describe Adele’s approach as ‘bottom-up’ or ‘top-down’?
  2. Ultimately, Adele was successful in changing practice. What steps did she take to enable her success?
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  1. Adele’s approach was definitely ‘bottom-up’. It didn’t depend on any particular overall policy. Neither a government department nor her employer wished to implement a policy on mindfulness practice. Adele’s concern was that existing forms of therapy and practice to help people with cognitive impairment and dementia were not sufficient. She thought a change of practice was required. However, she couldn’t simply introduce a practice on her own. She had to win over others, not least because the Clinical Commissioning Group (CCG) had to ‘buy’ services from her employer.
  2. Adele was successful for a number of reasons because she was aware of what her immediate audience needed to know. However, her success also involved understanding that she needed to network with potential allies outside her immediate work environment, for example, the local university and a local charity. Success in using secondary research to begin a change process requires that you understand which stakeholders in your audience will challenge your evidence, and which stakeholders will be your potential allies.