Occupational therapists’ perceptions of gender – A focus group study

Background/aim: Women and men are shaped over the courses of their lives by culture, society and human interaction according to the gender system. Cultural influences on individuals’ social roles and environment are described in occupational therapy literature, but not specifically from a gender perspective. The purpose of this qualitative study was to explore how a sample of occupational therapists perceives the ‘gender’ concept. Method: Four focus group interviews with 17 occupational therapists were conducted. The opening question was: ‘How do you reflect on the encounter with a client depending on whether it is a man or a woman?’ The transcribed interviews were analysed and two main themes emerged: ‘the concept of gender is tacit in occupational therapy’ and ‘client encounters’. Results: The occupational therapists expressed limited theoretical knowledge of ‘gender’. Furthermore, the occupational therapists seemed to be ‘doing gender’ in their encounters with the clients. For example, in their assessment of the client, they focussed their questions on different spheres: with female clients, on the household and family; with male clients, on their paid work. Conclusions: This study demonstrated that occupational therapists were unaware of the possibility that they were ‘doing gender’ in their encounters with clients. There is a need to increase occupational therapists’ awareness of their own behaviour of ‘doing gender’. Furthermore, there is a need to investigate whether gendered perceptions will shorten or lengthen a rehabilitation period and affect the chosen interventions, and in the end, the outcome for the clients.     

Patient–expert partnerships in research: how to stimulate inclusion of patient perspectives

Objective To gain more insight into exclusion mechanisms and inclusion strategies in patient–expert partnerships. Background Patient participation in health research, on the level of ‘partnerships with experts’ is a growing phenomenon. However, little research is conducted whether exclusion mechanisms take place and to what extent patients’ perspectives are included in the final outcomes of these partnerships. Case study A dialogue meeting attended by experts, patients and patient representatives to develop a joint research agenda. Different inclusion strategies were applied during the dialogue meeting to avoid possible exclusion. Method Data were collected by the means of audio and video recordings, observations, document analysis and evaluative interviews. The data are clustered using a framework that divides exclusion mechanisms in three categories: circumstances, behaviour and verbal communication. The data are analysed focusing on the experiences of participants, observation of occurrence of exclusion and difference between input and outcome of the dialogue meeting. Results The circumstances of the dialogue and the behaviour of the participants were experienced as mainly inclusive. Some exclusion was observed particularly with respect to verbal communication. The input of the patients was less visible in the outcome of the dialogue meeting compared to the input of the experts. Conclusion This case study reveals that exclusion of patients’ perspective occurred during a dialogue meeting with experts, despite the fact that inclusion strategies were used and patients experienced the dialogue meeting as inclusive. To realize a more effective patient–expert partnership, more attention should be paid to the application of some additional inclusion strategies.     

Translating knowledge to practice: an occupational therapy perspective

Background/Aim:  Translating knowledge to practice, also called ‘knowledge translation’, is increasingly recognised as a driving force to strengthen and improve the healthcare system. How knowledge translation fits with occupational therapy practice deserves examination. Methods:  This paper will explore how an action process model, the Knowledge‐To‐Action Process, may advance knowledge translation in occupational therapy. Occupational therapists typically view knowledge in a broad sense, encompassing research, tacit knowledge, expert opinion and client evidence. The Knowledge‐To‐Action Process facilitates application of client, therapist and research knowledge to occupational therapy practice. Results:  Examination of knowledge translation through the lens of the Knowledge‐To‐Action Process creates awareness of the value of client, therapist and research knowledge. It also highlights opportunities as practitioners to implement knowledge translation. Conclusions:  Models able to flexibly reflect an occupational therapy perspective of knowledge have a potentially vital role in successful knowledge translation. Furthermore, these models allow therapists and other stakeholders to analyse complex situations and identify targeted knowledge translation strategies.     

Factors influencing job satisfaction among Jordanian occupational therapists: a qualitative study

Purpose: The main purpose of this study was to explore factors influencing job satisfaction and dissatisfaction among Jordanian occupational therapists. Methods: Ours was an explorative qualitative study involving the use of structured open‐ended written questions. Participants were asked to answer in narrative their perception about the factors behind their job satisfaction and dissatisfaction. In addition, they were asked to express their suggestions, ideas, or solutions for increasing job satisfaction. Results: Ninety‐three occupational therapists responded to the survey. For job satisfaction questions, four themes emerged: a humanistic profession; professional issues; work benefits; and work environment. Participant’s comments at the end of the survey revealed one general theme for improving job satisfaction, ‘a call for improvement’. Discussion: This qualitative study revealed that the humanistic nature of occupational therapist was counterbalanced by several dissatisfying factors for occupational therapy practitioners in Jordan. The need for better supported working conditions in terms of financial rewards, recognition, awareness and resources as well as public and professional recognition of occupational therapists are needed to enhance the occupational therapy profile in Jordan. A comprehensive collaboration is highly needed between the individual practitioners, representatives of the profession, government and hospital administrators.     

Occupational therapists' skills and attitudes regarding use of computers and assistive technology

The purpose of this study was to examine the skills and attitudes of a sample of practicing occupational therapists regarding the use of computers, and to explore their agreement with the Foundation Level Technology Competencies proposed for adoption in the United States of America (American Occupational Therapy Association, 1991; reported in Hammel and Smith, 1993). Out of a sample of 250 subjects, 89 occupational therapists in the USA completed a questionnaire regarding their experiences with, and attitudes towards computers, and their agreement with the proposed Competencies. The results indicated that while the majority of therapists had had some exposure to computers, they wanted to learn more—particularly how a computer could aid management tasks. While 50% or more of the therapists ‘Agreed’ or ‘Strongly Agreed’ with 19 of the 21 Competencies, the level of therapist ‘Indecision’ or ‘Disagreement’ with several of the Competencies suggests that either these Competencies require revision, or that if the Competencies are nationally adopted, many therapists may require intensive continuing education programmes to bring their skills to a competent standard. Adoption of these Competencies has many implications for international standards of occupational therapy practice and levels of computer education. Copyright © 1997 Whurr Publishers Ltd.     

Occupational therapy students’ perceptions of occupational therapy

Background/aims: An understanding of students’ perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students’ perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Methods: Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose‐designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Results: Students’ responses were categorised as ‘what’ occupational therapists do; ‘how’ they do it; ‘why’ they do it; and ‘who’ they work with. In ‘what’ occupational therapists do students frequently described ‘helping’ people. Both undergraduate and graduate entry masters students used the term ‘rehabilitation’ to describe how occupational therapy is done, with graduate entry students occasionally responding with ‘through occupation’ and ‘modifying the environment’. Students perceived the ‘why’ of occupational therapy as getting back to ‘everyday activities’, with some students emphasising returning to ‘normal’ activities or life. Regarding the ‘who’ category, students also thought occupational therapists worked with people with an ‘injury’ or ‘disability’. Conclusions: Students entered their occupational therapy programmes with perceptions consistent with the general public’s views of occupational therapy. However, graduate entry students exposed to a pre‐reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.     

Sex Education and Schizophrenia: Should Occupational Therapists Offer Sex Education to People with Schizophrenia?

Adult sexuality contributes significantly to an individual's identity, self-esteem and relationships. Since occupational therapy is practised from the perspective of holistic care, sexual behaviour can be a legitimate area for therapists to consider when working with clients. For people with schizophrenia there are particular issues that may need to be addressed by the therapist. This paper summarizes the results of a study examining whether occupational therapists regard sex education as a valid topic to teach, as part of a treatment package, to people with schizophrenia. Forty-nine therapists responded to a questionnaire. The results suggest that the majority of occupational therapists believe sex education to be within the domain of their profession. They are not, however, providing sex education for their clients. The factors that influence this decision include length of time qualified, theories of practice and the expectations of employers.     

Actions of Competence in Occupational Therapy Practice: A phenomenological study of practice in narrative form

This study examined the phenomenon ?what are occupational therapists doing when they feel competent?. Data were provided by eleven occupational therapists who narrated clinical cases in which they had felt themselves to be competent. The empirical phenomenological psychological (EPP) method was used to analyse and interpret the data. The result revealed that on a general level the experience of feeling competent as an occupational therapist derived from achieving results in the rehabilitation project that were satisfying for both participants (the therapist and the client). The strategies for accomplishing this were related to the empathic competence of the therapists. This competence involved interpreting clinical situations as well as understanding the relationship between motive, meaning, decision and time. Further it involved bringing objects, in the form of adaptations, technical aids, structures, simplifications or compensations, into the clinical situation. These abilities together had a great impact on the therapeutic outcome by shaping the clients' lifeworld to make it richer and more active.     

Communicating with Employers: Experiences of Occupational Therapists Treating People with Musculoskeletal Conditions

Purpose Many employed people with musculoskeletal conditions rely on healthcare practitioners, including occupational therapists, for work-related advice and support. Good communication between healthcare practitioners and employers is considered vital in facilitating work retention and return to work. The purpose of this study was to explore the experiences of occupational therapists in communicating with patients’ employers. Methods Qualitative data were collected from the responses of occupational therapists to ten statements/open questions in a questionnaire survey of UK occupational therapists. Data were copied verbatim into word documents and analysed thematically. Results A total of 649 comments were made by 143 respondents. Five themes were identified that were associated with communicating with employers: patient-dependent; employer-dependent; therapist-dependent; extrinsic factors; methods of communication. Conclusion This study has identified that communication between occupational therapists and employers is influenced by a number of factors, including those which are outside the therapists’ control. These need to be acknowledged and addressed by therapists, their professional organisation, employers, commissioners, therapy service managers, educators and employees in order to support return-to-work and work retention of people with musculoskeletal conditions.     

The impact on occupational therapists of the reorganisation of psychiatric care in Sweden

The present study focuses on the on-going reorganisation of psychiatric care in a major county council in Sweden. The aim of this study is to describe the impact of these changes from the perspective of one group of occupational therapists. Data were collected by a mailed questionnaire. Results showed an acceptance of the current policies towards restructuring psychiatric care, especially on the focus on alternative living and work/occupational facilities. Strong criticism was raised concerning the lack of trans-institutional facilities. Loneliness and isohtion were seen as a main problem of the patients. Strong doubts were raised concerning independent living as the best alternative for most of the patients. The new professional role in community psychiatric care has brought the occupational therapist closer to die individual patient. Feelings of shortcomings and frustration in this group of occupational therapists regarding the reorganisation of psychiatric care were linked to the insufficiency of community support facilities designed to meet these new challenges.     

Differences and similarities in therapeutic mode use between occupational therapists and occupational therapy students in Norway

Background: The Intentional Relationship Model (IRM) is a new model of the therapeutic relationship in occupational therapy practice. Two previous studies have focused on therapist communication style, or ‘mode’ use, but to date no group comparisons have been reported.

Aim: To explore differences between occupational therapists and occupational therapy students with regard to their therapeutic mode use.

Methods: The study had a cross-sectional design, and convenience samples consisting of occupational therapists (n?=?109) and of second-year occupational therapy students (n?=?96) were recruited. The Self-Assessment of Modes Questionnaire was the main data collection tool. Group differences were analysed with independent t-tests.

Results: The occupational therapists responded more within the collaborative and empathizing modes than the students did. The students responded more within the advocating and instructing modes than the occupational therapists did.

Conclusion and significance: There may be systematic differences between occupational therapists and students concerning their therapeutic mode use. Some modes, such as the collaborating and empathizing modes, may be viewed as requiring more experience, whereas other modes, such as the advocating mode may be related to more recent rehabilitation ideologies. These factors may contribute to explaining several of the group differences observed.     

The lived experience of occupational adaptation following acquired brain injury for people living in a rural area

Aim: This phenomenological study aimed to explore the experience of occupational adaptation from the perspective of persons with acquired brain injury living in a rural area. Method: Two male participants aged 30 and 45 years were interviewed using a semistructured interview format. Colaizzi's approach was used for analysis. Results: Data analysis revealed three main themes: ‘Things are different now’, ‘Acceptance’ and ‘Just another chapter’. Conclusions: After initially coming to terms with having a brain injury and accepting the new person the self had become, adaptation through engaging in occupation was experienced by the participants. An understanding of strategies that participants used in the adaptation process is of use to occupational therapists in order to design meaningful occupational interventions.     

Medicinal relationships: caring conversation

Context Good social relationships are crucial to well‐being and to health in particular. The perception of having supportive social relationships has effects on reducing morbidity and mortality comparable with those of a good diet, regular exercise and cessation of moderate smoking. This suggests that supportive, trusting relationships with doctors could have a substantial direct biomedical effect on patients’ health. Methods A critical review of the patient–doctor relationship (PDR) literature is presented, along with a review of relevant interactional studies that examine doctor–patient interactions from the perspective of conversation analysis (CA). This literature shows how patients respond to doctors’ verbal and non‐verbal behaviours in systematic ways that affect how they disclose and how they relate to doctors. Results Findings from the CA literature suggest that clinicians might consider several important interactional features to improve the PDR and perhaps also patient health outcomes: (i) the use of open‐ended questions (e.g. ‘What brought you in today?’) and positive polarity items (e.g. ‘Is there something else you wanted to talk about today?’) elicits patient concerns and addresses unmet concerns more effectively than the use of closed questions and negative polarity items, respectively; (ii) eye gaze suggests availability and an attending recipient, and patients indicate that doctor attentiveness at crucial parts of their problem presentation is important, and (iii) verbal dysfluencies are one practice speakers employ to gain the attention of a non‐attending recipient. Doctors may want to pay attention to patients’ dysfluencies to better understand when their attention is valued. Conclusions Constructing supportive relationships with patients often does not require a great investment of time, but it does require commitment to ‘being there for patients’. This review suggests that when doctors attune to language and social practices during medical consultations, the relationships they develop with patients may substantially improve patients’ health and be intrinsically rewarding for both doctors and patients.     

Older people's experiences of acute hospitalisation: an investigation of how occupations are affected

Background/aim: Few qualitative studies have investigated older people’s experiences of hospital admission and none has done so from an occupational perspective. The purpose of this study was to examine older people’s experience of acute hospitalisation. Methods: In‐depth semi‐structured interviews were conducted with six participants recruited from the Alfred hospital, Melbourne, Victoria. Data were analysed using Colaizzi’s (1978) approach to phenomenological analysis. Results: Five themes describing older people’s experience of acute hospitalisation emerged from the analysis: (i) not part of ‘normal life’; (ii) undesirable, but for the good of my health; (iii) understanding my condition and abilities; (iv) subject to approval; and (v) getting back into life. The importance of the individual’s occupational narrative emerged as a central theme in understanding the older person’s experience of acute hospitalisation. Conclusions: Occupational therapists have a unique contribution to make in encouraging meaningful occupation on hospital wards. Identifying the manner by which occupational therapists can most effectively implement the assessment of occupational performance in the acute care setting should constitute a research priority for future investigations.     

IMPROVING COMMUNICATION SKILLS OF PSYCHIATRIC PATIENTS: A GROUP IN OCCUPATIONAL THERAPY

This paper reports on a group conducted by two occupational therapists at Brentwood VA Psychiatric Hospital. This group met weekly in the occupational therapy clinic after patients had pursued individual activities during regular clinic hours. The goal of this group was to discuss feelings and interactions which had occurred in the clinic. Thus, this group was a verbal interaction group aimed at improving communication skills of patients. It is our feeling that discussion groups of this type are of definite value for psychiatric patients. At one point during this group, the two occupational therapists requested supervision. Occupational therapists may need some additional education in group dynamics and the process of individual supervision of group facilitators can be beneficial.     

Assessment

The role of the occupational therapist in today's health care system is discussed in relation to the large numbers of patients with treatment problems and the relatively small numbers in the profession. The importance of good, efficient assessment procedures is emphasized in order to maximize the profession's helpfulness. Review of current practices among occupational therapists in carrying out the assessment function is presented along with data from a survey of therapists in physical disabilities practice. The article concludes with a plea for the increased use of standardized evaluation tools by occupational therapists to both make their efforts more effective and to build credibility for the services of the profession.