Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

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.     

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.     

Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.     

Fine motor difficulties: The need for advocating for the role of occupational therapy in schools

Background:  Fine motor difficulties can impact on the academic, social and emotional development of a student.
Aim:  The aims of this paper are to: (i) investigate the need for support to students experiencing fine motor difficulties from the perspective of their classroom teachers, and (ii) report on the level of knowledge teachers have in regard to the role of occupational therapists in supporting students with fine motor difficulties.
Methods:  Fifteen teachers from a stratified random sample of public schools within two regions of Victoria, Australia, were interviewed in this qualitative, grounded theory investigation.
Results:  Results showed that the current level of support for students with fine motor difficulties is inadequate.
Conclusion:  Occupational therapists in Victoria need to advocate their role in developing the fine motor skills of students at both an organisational and an individual level in order to increase the access of students with fine motor difficulties to occupational therapy services.     

Job satisfaction in occupational therapy: a qualitative investigation in urban Australia

Background:  Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting.
Methods:  Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported.
Results:  Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession.
Conclusions:  Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.     

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.     

Cultural awareness among Queensland undergraduate occupational therapy students

Aim:  Australia's cultural diversity generates substantial challenges and implications for students and health-care professionals. This study investigated the cultural perceptions and self-rated level of cultural competence of undergraduate occupational therapy students in Queensland, Australia.
Results:  Two hundred and ninety-three students completed the Cultural Awareness Questionnaire. The findings indicated that the majority of students have a positive attitude towards cultural differences and influences on occupational therapy services. Students also recognised the importance of cultural awareness and highlighted the need for increased incorporation of cultural information and experience throughout the undergraduate course.
Conclusion:  The implications of this study are discussed with reference to the future academic planning of culturally sensitive occupational therapy course and fieldwork experiences.     

Occupational therapists' perception of usage of information and communication technology (ICT) in Western Australia and the association of availability of ICT on recruitment and retention of therapists working in rural areas

Objective:  The purpose of this study was to investigate occupational therapists' usage of information and communication technology (ICT) in Western Australia and the association of availability of ICT on recruitment and retention of rural therapists.
Methods:  One thousand, one hundred and thirty-eight surveys were sent to all occupational therapists registered with the Western Australian Occupational Therapy Registration Board in January 2003. The survey was used to identify ICT access, support and literacy. The attitude of therapists towards using ICT as a communication tool and therapists' usage patterns of ICT in metropolitan and rural localities were analysed by using the Chi-squared test.
Results:  Email and the personal computer were used most frequently. On ICT global competency, 58% of therapists rated their competency level as good or better. Competence was rated lower for web searching (48.5%) and searching for electronic articles (29.8%). Approximately one-third of respondents were dissatisfied with the level of technical support available and only 38.4% of therapists had participated in basic computer training provided by their current employer. Rural therapists had less access to a computer in their work environments in comparison to their metropolitan peers (P  <  0.05). Nevertheless, rural therapists were using email, teleconferencing and videoconferencing more frequently than their metropolitan counterparts.
A proportion of rural therapists (45.5%) felt that ICT influenced their decision to continue working in rural areas.
Discussion and Conclusion:  Professional isolation has been cited as an inhibitor to recruit and retain health-care workers in rural areas. The higher ICT usage by rural therapists may represent the utility of ICT as a means of circumventing professional isolation that is inherent in rural and remote areas.     

Older people: The enigma of satisfaction surveys

Background and Aims:  Health and social care reforms have emphasised the need for health and social care professionals to monitor user satisfaction. Obtaining the opinions of clients is an important mechanism for improving quality in health and social care. This paper discusses methodological issues in measuring satisfaction among older service clients.
Methods and Results:  Examples will be used from the authors' own experiences of conducting research with older people to ascertain opinions and levels of satisfaction. The strengths and weakness of methods used to collect the opinions of older clients using interview and non-standardised questionnaires are critically considered. The authors suggest that occupational therapists need to understand the methodological issues that can impact upon older clients' responses to satisfaction questions.
Conclusion:  If occupational therapists are committed to the ethos of client-centred practice, then clients must not only be consulted and involved in service delivery, but also in the design and implementation of satisfaction surveys.     

Stress and help-seeking for drought-stricken citrus growers in the Riverland of South Australia

Objective:  To explore the psychological impact of a problematic industrial climate for citrus growers, their help-seeking behaviour and perspectives on ways to encourage better use of rural mental health services.
Design:  Thematic analysis of in-depth interviews.
Setting:  The Riverland of South Australia.
Participants:  Sixteen citrus growers (12 male, 4 female) from eight Riverland towns.
Main outcome measures:  Citrus growers' perceived factors relating to psychological stress, coping behaviours, impact of stress on well-being, help-seeking behaviours, barriers to help-seeking and ways to encourage better use of rural mental health services.
Results:  Work-related stresses grouped under broad themes, including 'Uncontrollable events', 'Financial hardship' and 'Pressure', had negative effects on participants' well-being. Furthermore, it was found that significant difficulties arise because many of the stresses which growers endure are not controllable, and that the alleviation of strain with the help of mental health professionals is uncommon because of barriers preventing help-seeking. Five broad themes of barriers to help-seeking were extracted from the data: 'Self-reliance', 'Social image', 'Lack of knowledge', 'Negative perceptions of health professionals' efficacy' and 'Restrictive lifestyle factors'. A specialised model of occupational health for citrus growers was proposed.
Conclusions:  These results highlight the practical need to address the identified issues in delivery and promotion of health services when facilitating help-seeking within this group. The findings also add to our knowledge of occupational health psychology broadly.     

Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

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.     

Oral health workforce in rural and remote Western Australia: practice perceptions

OBJECTIVE: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. DESIGN: A postal survey was undertaken among all registered oral health professionals in Western Australia. SETTING: Rural and remote Western Australia. PARTICIPANTS: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. RESULTS: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. CONCLUSIONS: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.     

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.     

Issues affecting Australia's rural occupational therapy workforce

ABSTRACT: The unequal distribution of health workers across Australia in favour of urban areas affects the provision of effective health services to rural and remote communities. Additional pressures on the current and future supply of occupational therapists may arise from a restructuring of the health labour force and demographic changes in the age structure of the population. Projections made on the basis of these data indicate that employment growth for occupational therapists will create a demand for 9600 therapists in 2005, or 79.9% more than the number of occupational therapists employed in 1994. Factors such as reductions in the level of immigration and the number of people of working age, and a diminishing population of school leavers to fill student places in universities will make it difficult to meet the projected demand for occupational therapists. Occupational therapy labour force planning suffers from a lack of detailed data on under-serviced areas. Such data are critical for clarifying the magnitude of the projected discrepancy between future demand and supply needs for occupational therapists in rural and urban areas in Australia.     

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.     

Canada's health human resource challenges: what is the fate of our healthcare heroes?

Each year, the Canadian health education system graduates thousands of health professionals who have the best intentions of practising to their full scope of knowledge and skills to help improve the patient care experience in this country. However, a recent research study points to the fact that members of the healthcare team may be practising in a challenging environment in which only a limited number of their skills are actually being used. The Michener Institute for Applied Health Sciences believes that these issues, which include increased role specialization, limited scopes of practice, rapidly advancing technology, and challenges transitioning from hospital to community settings, have broader health education and health system implications that need to be addressed by policy makers, educators, and healthcare system leaders in order to enhance health professional education as well as patient care.