Goal‐setting in paediatric rehabilitation: perceptions of parents and professional

Background In paediatric rehabilitation, there is a belief in goal‐setting as a fundamental component of decision‐making that encourages collaboration and motivation, and improves outcomes. This study aimed to explore parents' and professionals' perceptions of setting and implementing goals within a family centred rehabilitation programme for preschoolers with cerebral palsy (CP). Methods Parents and service providers of 13 preschoolers with CP, classified in Gross Motor Function Classification System level I‐III, participated in two‐step focus group interviews. Results Three major themes emerged, each with two subthemes: (1) ‘Goals enhance competence’ with the subthemes ‘parents as drivers’, and ‘awareness through observation’; (2) ‘Goals direct attention’ with the subthemes ‘goals as valuable means’ and ‘collaboration through participation’, and (3) ‘Goals enter everyday life’ with the subthemes ‘goals as activities’ and ‘training vs. everyday practise’. A fourth theme ‘child perspective’ with the subthemes ‘follow‐up initiative’, ‘capture mastery’, and ‘create learning opportunities’ was both an exclusive theme and integrated in the other three main themes. Conclusions Active involvement of parents throughout the process of setting and implementing goals seemed to increase their feeling of competency and partnership with professionals. Concrete goals based on families' preferences and concerns, participatory observation, and discussions with professionals, came out as valuable means for practice of functional tasks within home environments.     

Health professional partnerships and their impact on Aboriginal health: an occupational therapist's and Aboriginal health worker's perspective

OBJECTIVE: To describe the extent and nature of demonstrated professional partnerships between occupational therapists and Aboriginal health workers in rural and remote communities of North Queensland. The study identifies ways in which professional partnerships improve client services and enhance occupational therapy outcomes through exploring the aspects of communication, collaboration and bridging cultural boundaries. DESIGN: Data collected via in-depth, semistructured telephone interviews. SETTING: Aboriginal and mainstream health and human service organisations in rural and remote North Queensland. Rural and remote areas were identified using the Accessibility and Remoteness Index of Australia codes. PARTICIPANTS: Seven participants working in rural and remote areas of North Queensland, comprising four occupational therapists and three Aboriginal health workers. All participants were female. RESULTS: Participants identified five core themes when describing the extent and nature of professional partnerships between occupational therapists and Aboriginal health workers. Themes include: professional interaction; perception of professional roles; benefits to the client; professional interdependence; and significance of Aboriginal culture. According to participants, when partnerships between occupational therapists and Aboriginal health workers were formed, clients received a more culturally appropriate service, were more comfortable in the presence of the occupational therapist, obtained a greater understanding of occupational therapy assessment and intervention, and felt valued in the health care process. CONCLUSIONS: This study substantiates the necessity for the formation of professional partnerships between occupational therapists and Aboriginal health workers. The findings suggest that participation in professional partnerships has positive implications for occupational therapists working with Aboriginal clients and Aboriginal health workers in rural and remote regions of North Queensland.     

International fieldwork placements and occupational therapy: lived experiences of the major stakeholders

Introduction: Occupational therapy students obtain a great deal of their professional preparation and experience through fieldwork placements. Although many occupational therapy students have taken part in international fieldwork placements, there is little research on this topic. As fieldwork placements are an integral part of the education of occupational therapy students, literature on the subject of international fieldwork placements is necessary. Accordingly, the aim of this study was to examine the personal and professional experiences of occupational therapy students, supervisors, and on‐site staff who have taken part in an international fieldwork placement. Methods: Qualitative interviews for this phenomenological study were administered with 14 participants who had taken part in an international fieldwork placement in Trinidad and Tobago. Data were analysed using thematic analysis. Findings: Three themes emerged: collaborative learning, cultural negotiations and thinking on my own. Discussion: Considering fieldwork is a critical component in the occupational therapy curriculum, it is reassuring to uncover that international placements can be of benefit to all stakeholders while achieving its primary goal of preparing students to become competent therapists. All participants developed a greater cultural awareness and appreciation, which is necessary as occupational therapists are increasingly working in diverse settings with diverse client groups. This information can also be used to enhance international fieldwork education as students continue to travel abroad to complete their mandatory fieldwork hours.     

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 therapy and early intervention: a family-centred approach

The purpose of this study was to identify factors that encourage or inhibit family-centred practice in the occupational therapy intervention process. A qualitative paradigm using grounded theory methodology was utilized to gather and analyse data. Participants included six families and four occupational therapists. Data analysis from the family interviews identified six categories: education, communication, relationship, parental roles, follow through, and scheduling. With further analysis two central themes of time and support were extracted from these categories. Analysis of the occupational therapists' interviews revealed six categories: education, communication, relationship, sibling/family participation, follow through, and empowerment. The central themes emerging from these categories are time and natural routine. The themes obtained from the families and occupational therapists were then compared and family individuality was identified as the core concept. Viewing families as a unique entity is necessary to assist occupational therapists in providing the most effective family-centred occupational therapy.     

Development and evaluation of an occupational therapy program for refugee high school students

Background: Adolescents from refugee backgrounds experience challenges participating in their new school environments. This study aimed to describe and discuss the development of an occupational therapy program to facilitate school participation of high school students from refugee backgrounds. Methods: Three cycles of action research were used to develop a program over 18 months in collaboration with two high schools. Data were collected from four occupational therapists, seven school staff members and two school principals using in‐depth interviews, questionnaires and review of documents. Results: The program changed significantly over the three cycles from a focus on individual task mastery in the classroom environment to development of social competence through an activity‐based group program. Conclusions: Building capacity for social competence helped create better alignment between the roles of occupational therapist and teacher within the school context and was perceived to contribute to refugee students’ overall availability for learning in their new environments. Action research is useful in collaboratively developing programs in emerging areas of practice.     

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.     

Art intervention among Finnish older people and their caregivers: Experiences of art pedagogies

The benefits of art therapies on older people's health have been well documented. However, studies into the perspectives of pedagogues on conducting arts interventions are scarce and no empirical evidence of the views of professional pedagogues views have been published to date. In this study, seven professional art pedagogues were interviewed using a thematic interview approach focusing on the pedagogues’ experiences of conducting arts interventions with a family caregiver and care recipient dyads. The interviews were analysed inductively using thematic content analysis. According to the analysis, three intersecting themes were found that both steered the pedagogical process and emerged from the process: holistic pedagogy, professional development and witnessing. The themes revealed a further understanding of approaches to the interviewees’ teaching and the value of participatory community arts in practice. The pedagogues’ experiences encourage art pedagogy to be acknowledged in a wider context within communities and healthcare environments. Further studies on interdisciplinary projects in collaboration with art pedagogues and healthcare professionals are encouraged.     

Collaboration and involvement of persons with lived experience in planning Canada's At Home/Chez Soi project

Planning the implementation of evidence‐based mental health services entails commitment to both rigour and community relevance, which entails navigating the challenges of collaboration between professionals and community members in a planning environment which is neither ‘top‐down’ nor ‘bottom‐up’. This research focused on collaboration among different stakeholders (e.g. researchers, service‐providers, persons with lived experience [PWLE]) at five project sites across Canada in the planning of At Home/Chez Soi, a Housing First initiative for homeless people with mental health problems. The research addressed the question of what strategies worked well or less well in achieving successful collaboration, given the opportunities and challenges within this complex ‘hybrid’ planning environment. Using qualitative methods, 131 local stakeholders participated in key informant or focus group interviews between October 2009 and February 2010. Site researchers identified themes in the data, using the constant comparative method. Strategies that enhanced collaboration included the development of a common vision, values and purpose around the Housing First approach, developing a sense of belonging and commitment among stakeholders, bridging strategies employed by Site Co‐ordinators and multiple strategies to engage PWLE. At the same time, a tight timeline, initial tensions, questions and resistance regarding project and research parameters, and lack of experience in engaging PWLE challenged collaboration. In a hybrid planning environment, clear communication and specific strategies are required that flow from an understanding that the process is neither fully participatory nor expert‐driven, but rather a hybrid of both.     

Culture in medical education: comparing a Thai and a Canadian residency programme

Medical Education 2011: 45 : 1209–1219 Context Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. Methods Using a mixed‐methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub‐themes. The integration of quantitative and qualitative data for each case was followed by a cross‐case analysis. Results The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty–resident relationship as ‘familial’ and focused on ‘teaching methods’. Canadian faculty members emphasised clinical abilities, described the faculty–resident relationship as ‘collegial’ and focused on ‘learning environments’. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. Conclusions This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical education must be tempered by recognition of these considerations.     

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.     

Examining Intraprofessional Competencies for Occupational Therapist and Occupational Therapy Assistant Collaboration

Abstract

This study examined competencies perceived by occupational therapists and occupational therapy assistants as important for intraprofessional collaboration. While interprofessional practice is well defined, less is known about collaboration within professions with varied levels of practice credentials. Occupational therapy practitioners (N?=?351) rated 20 competencies in four domains (Intraprofessional Teamwork, Roles/Responsibilities, Communication, and Values/Ethics) through an online survey. A high percentage of respondents perceived all competencies as important or very important. There were significant differences between occupational therapists and occupational therapy assistants in ratings of five competencies, including: seeking information/support from the team partner, flexibility for effective partnership, engagement in professional development for collaboration, communicating ideas, and providing feedback about performance. Outcomes contribute to understanding intraprofessional collaboration for occupational therapy practice. Competencies can serve as guidelines for education and professional development.     

The bargaining of professionalism in emergency care practice: NHS paramedics and higher education

Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals’ education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal–political circumstances affecting its provision and demand. Based on interviews with front-line paramedics, paramedic educators and paramedic science students in the South of England, this article examines how the reforms to paramedic education have impacted the professionalization of paramedics and their discourse of professionalism. Framed within to the ‘new’ sociology of professions, the case of British paramedics demonstrates the complex nature of the relationship between the university and professional practice. It appears that universities, the providers of paramedic education, are caught between two opposing discourses of professionalism: on the one hand, that of providing a platform for students’ socialization and engagement with professionalism ‘from within’ practice which is based on students’ common goals and mutual experiences, and, on the other hand, serving as a conduit for managerial/organizational strategies of professionalism which appear to undermine the role of university socialization.     

Experts’ views regarding Australian school‐leavers’ knowledge of nutrition and food systems

Objective: To explore Australian experts’ views regarding strengths and gaps in school‐leavers’ knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge. Method: Semi‐structured interviews were conducted with 21 highly experienced food‐related experts in Australia. Qualitative data were analysed thematically using Attride‐Stirling's thematic network framework. Results: Two global themes and several organising themes were identified. The first global theme, ‘structural curriculum‐based problems’, emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food‐related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, ‘insufficient levels of school‐leavers knowledge of N&FS ’, was generated from four organising themes, which together described Australian school‐leavers’ poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices. Conclusion: Study findings identified key problems relating to current school‐based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school‐leavers. Implications: These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly‐based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools.     

Is occupation missing from occupational therapy in palliative care?

Background/aim: The role of occupational therapists in palliative care is largely undocumented in Western Australia (WA). Little is known about the services occupational therapists provide or the needs of people who are dying and their carers in relation to these services. The aims of this study were as follows. First, to determine the number of occupational therapists employed and the range of services they provide in palliative care in WA. Second, with particular reference to self care, leisure, productive roles and occupations, to explore the daily experiences of people who were dying as well as their primary carers to determine the services that might be offered by occupational therapy to this population. Methods: Semi‐structured interviews were used to gather information from carers (n = 10 metro, n = 4 rural) and occupational therapists (n = 13 metro, n = 5 rural). Data were analysed qualitatively using grounded theory to develop categories. Themes were defined using the constant comparison method. Results: Four themes emerged that impacted people who were dying and their carers. These were; ongoing disengagement from usual activities with resultant occupational deprivation; disempowerment of both people who are dying and their carers within palliative care services; ‘occupation’ not being addressed adequately in palliative care and occupational therapists experience frustration with limited opportunities to contribute to the care of people who are dying. Conclusions: This paper highlights gaps in service provision in WA to people who are dying and their carers. It provides direction for occupational therapists to offer an occupation‐focussed approach to the care of this vulnerable group.