Aims: This article presents some preliminary findings from an action research study into the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services. Methods and Findings: Narrative data gathered from 10 individual interviews were analysed through numerous iterative cycles to reveal salient themes. These include epistemological tensions associated with working in a hospital environment, antagonistic reasoning processes, overinclusive descriptions of practice, and communication challenges. Conclusions: The findings suggest that occupational therapists in acute settings may experience challenges in describing occupational therapy and engaging in occupation-based practice. This is because of a range of factors, including, but not limited to, the paradigmatic conflict that arises between a profession informed by occupation and a predominantly biomedical setting. However, through in-depth, reflective processes undertaken collectively within a supportive community of practice milieu, significant changes in everyday practices can be activated.