Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Starting out in rural New South Wales: the experiences of new graduate occupational therapists

ABSTRACT: The current shortage of health personnel in rural Australia is compounded by the difficulty in recruiting and retaining new graduate health professionals in rural practice. This qualitative study aimed to explore the experiences of five new graduate occupational therapists who began their careers in rural New South Wales (NSW). Data were collected via semi-structured, individual interviews. Results indicated that new graduates were attracted to their rural positions by multiple factors, especially their previous rural experience. Participants experienced low self-confidence during their transition from student to therapist. Rewarding and challenging aspects of rural practice were identified. New graduates valued challenging aspects of rural practice as opportunities for skill development. Results suggest that increasing the number of occupational therapy graduates with rural experience may attract more graduates to rural practice. Furthermore, enhancing the support available to new graduates in rural positions may help retain graduates in rural practice.     

From student to therapist: Follow up of a first cohort of Bachelor of Occupational Therapy students

Aim:  This study aimed to investigate the perception of graduate students on their preparation for practice, at 7 months post graduation.
Method:  Using an anonymous postal questionnaire, 18 respondents (58% response rate) provided data on the nature of current employment, the experience as a graduate therapist, and perceptions of their undergraduate experience in preparing them for practice.
Results:  Fifty percent of the respondents were practising in a rural environment. There was a significant positive relationship between respondents perception of their curriculum and fieldwork experiences and their preparation for practice ( rho = 0.52, p  < 0.05, and rho = 0.55, p  < 0.05, respectively). Of the fieldwork experiences, respondents rated block placements as more beneficial to practice than non-traditional placements. However, a correlational analysis showed the non-traditional placement was significantly related to preparation for practice ( rho = 0.54, p  < 0.05). On a seven-point Likert scale, respondents rated themselves from 5.2 to 5.7 for perceived self-competence as a newly graduated practitioner with community-based graduates having the higher rating. Confidence in clinical decision-making was rated 5.0 to 5.6 with community-based graduates having higher rating. Respondents reported a positive perception that the undergraduate program prepared them to enter the workforce and practise as an occupational therapist (mean ratings 5.5 to 6.2).
Conclusion:  Respondents felt adequately prepared to enter the occupational therapy profession and workforce. Strengths and weaknesses in their preparation are discussed as well as the need for further research.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

Occupational therapists' perception of their practice: A phenomenological study

Background:  International literature seems consistent in reporting that occupational therapists value their methods. However, little empirical evidence has been generated supporting the basic system of belief for occupational therapy. Few studies have explored the nature of the occupational therapists' experiences and thoughts about their use of occupation as means and ends, and which strategies they use to implement their tools in their current practice. Accordingly, the aim of this study was to explore how occupational therapists understood and presented their practice and interventions.
Methods:  A sample of six occupational therapists graduated in different decades, from diverse client populations and health-care settings was selected to participate in a semistructured interview.
Results:  Three main themes were developed: 'To make the client's potentials visible', 'reaching a position one values' and 'looking with other eyes'. Whatever their specialities, the participants were unanimous in the way they described their role. Their common focus was 'activities of daily living'. However, they had problems describing their therapeutic tools, and were not able to clearly articulate the 'common sense aspects' of their own methods. The participants were engaged in constructing their professional identities, and stressed the need to construct professional boundaries relevant to their particular work.
Conclusion:  The occupational therapists perceived their practice and interventions as distinctly different from other team members, thus, they provided a 'counterpoint'. The participants used various ways of marketing their perspectives. While the novices tended to go along with the team, the experienced therapists tended to assert their own special contribution.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

The meaning of leisure for well-elderly Italians in an Australian community: implications for occupational therapy

Aim:  This paper documents a study that aimed to discover the meaning of leisure experiences for an ageing Italian community in a large regional centre in Victoria, Australia.
Methods:  This qualitative investigation used a phenomenological study design, and data were collected through semistructured interviews with 10 well-elderly Australian Italians.
Results:  Participants engaged in numerous leisure occupations that were meaningful to them and directly impacted on positive subjective experiences and health outcomes.
Conclusion:  This paper adds to an understanding of how leisure impacts on the health of well-elderly Australians and how occupational therapists can use leisure effectively in interventions for successful ageing.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

Employer-sponsored occupational therapy professional development in a multicampus facility: A quality project

Aim:  To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.
Method:  Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.
Results:  The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.
Recommendations:  Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the 'clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD.     

A survey of recruitment and retention issues for occupational therapists working clinically in mental health

Background:  Mental health services Australia-wide have difficulty recruiting and retaining clinical occupational therapists.
Methods:  A survey of occupational therapists to identify factors that could influence their retention or loss from clinical mental health practice was undertaken.
Results:  Typically, respondents were female, aged 30 years or younger, working full-time at a grade 2 or 3 level, and had worked entirely in mental health. The main positive aspects that respondents identified about their positions were the 'social/emotional environment', 'aspects/nature of their roles', and 'using occupational therapy skills'. The main position constraints were 'insufficient time/workload' and 'insufficient use of occupational therapy skills/generic nature of work'.
Conclusions:  Recruitment and retention strategies are required to retain occupational therapists in clinical mental health positions.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

Occupational therapy and people with intellectual disability from culturally diverse backgrounds

The multicultural nature of Australian society creates a need for occupational therapists to become aware of the issues facing people from culturally diverse backgrounds. People with intellectual disability from culturally diverse backgrounds may experience a 'double disadvantage' due to issues of their culture and their disability. This research aimed to identify the experiences, issues and strategies used by occupational therapists working with people with intellectual disability from culturally diverse backgrounds. A semistructured group interview and three individual interviews were conducted with occupational therapists from both metropolitan and rural locations in Queensland. It was found that communication and residential services present some unique issues for people with intellectual disability from culturally diverse backgrounds. Strategies suggested by therapists to address a range of issues are listed. Implications for occupational therapy are discussed, and suggestions for future research are provided.     

The meanings of craft to an occupational therapist

Aim:   Craft was the first therapeutic occupation of occupational therapy. Since the early days of the profession, the value of craft in practice is a topic that has been discussed with fluctuating interest. Recent discussions by occupational therapists have reinforced that although craft is relevant to occupational therapy, there are uncertainties about its place in contemporary practice. Presently, scholars have identified that occupation is both the center of human experience and the core of our profession. Therefore, this study aimed to begin to clarify the meaning of craft to practice today by gaining a deep understanding of the meanings that one occupational therapist attributes to craft.
Methods:   Using narrative inquiry, data were gathered through a conversation held between the research participant and myself. A reflexive journal was also kept to support this data gathering process. Narrative analysis enabled intimate engagement with the data and the emergence of themes and sub-themes.
Results:   The findings, in the form of an interpretive story, suggest first, that craft-making has therapeutic value; second, that reasoning about the therapeutic use of craft is similar to reasoning about other therapeutic activities; and third, that personal experience with craft-making can influence the selection of craft as therapeutic media.
Conclusions:   From this study, further research into the impact personal and professional experiences can have on choice of therapeutic media and an analysis of the sociopolitical context of the meanings that occupational therapists attribute to craft-making is suggested.