The contribution of occupational therapy to the fabric of Australian rural and remote communities

Social justice has provided a basis for the underlying values of occupational therapy in Australia. In the 1990s, changes in health issues and delivery of services are causing occupational therapists to reconsider their values and the ways they deliver their services. By any measure, the health status of individuals in rural and remote communities of Australia is poorer that their urban counterparts. The issues associated with the poor health status of these communities will best be addressed through a combined strategic approach by governments, organizations and professional groups, including occupational therapy. Identification of some of the key issues affecting the supply of occupational therapists in rural and remote communities and how they might be addressed are discussed. It is proposed that the development of cohesive national strategies and actions aimed at enhancing the contribution of occupational therapy to rural and remote communities ought to include, among other things, adoption of the primary health care approach, fundamental changes in the education and preparation of practitioners for practice, and identification of competencies and standards for effective rural and remote practice.     

Practical strategies for working with indigenous people living in Queensland,Australia

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.     

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.     

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.     

Occupational therapy in palliative care: Is it under‐utilised in Western Australia?

Aim: To explore potential barriers to occupational therapy in palliative care in Western Australia, as perceived by occupational therapists and other health professionals. Method: A qualitative research methodology was used. Semi‐structured interviews were conducted with 10 occupational therapists and 10 health professionals (including a physiotherapist, a social worker, medical registrars and clinical nurses). Interviews were transcribed verbatim and analysed using content analysis. Results: The four main themes identified were: inconsistent understanding of the contribution that occupational therapists can make to palliative care, insufficient promotion of the potential contribution of occupational therapy, insufficient funding, and limited research on the role of occupational therapy in palliative care. Conclusion: This study provides an understanding of the barriers that have limited occupational therapists’ involvement in providing palliative care in Western Australia.     

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.     

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.     

Burnout among Occupational Therapists in Portugal: A Study of Specific Factors

Abstract

This pilot study was conducted using a sample of 374 Portuguese occupational therapists to evaluate burnout levels and prevalence among occupational therapists as well as to relate those levels to practitioner age, gender, client age, years of professional activity, and area of practice. The Copenhagen Burnout Inventory questionnaire (Portuguese version) and a sociodemographic questionnaire was used. Results showed that ～23%, 44%, and 45% of occupational therapists presented with client-related burnout, personal burnout (PB), and work-related burnout, respectively. Higher rates of burnout were observed across all dimensions as the age of the professionals increased, with more years of working increased the client-rated rate, and client age increased the PB rate. Outcomes suggest a need to implement intervention programs to promote personal and organizational strategies to prevent burnout.     

Levels of occupational stress in the remote area nursing workforce

Objective: To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. Methods: The study used a cross‐sectional design, utilising a structured questionnaire. Setting: Health centres in very remote Australia. Results: Nurses working in very remote Australia experience significantly higher levels of psychological distress and emotional exhaustion, compared with other professional populations. Paradoxically, results also highlight higher than average levels of work engagement. Nurses working in very remote regions in Australia further report moderate levels of job satisfaction. Most significant job demands identified were emotional demands, staffing issues, workload, responsibilities and expectations, and social issues. Key job resources included supervision, opportunities for professional development, and skill development and application. Conclusion: In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long‐term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover.     

A quantitative approach to measure occupational therapist–client interactions: a pilot study

Abstract

Aims: The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist–client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience. A modified version of the Roter Interaction Analysis System (RIAS), OT-RIAS, was used to analyse data. Major findings: Occupational therapists considered the role play experience to be “highly realistic” (mean score 5.4 on a 1–6 Likert scale). The actors' comfort role playing clients was also high (mean = 4.0; range 1–5). Inter-coder reliability for the OT-RIAS was highly significant (r = 0.919; p = 0.000). The modified version of this system fits well in an occupational therapy context. Principal conclusion: The quantitative approach used in this study to explore the therapist–client relationship appears to be effective. The role plays and RIAS may be useful in research exploring correlation between the OT communication style and outcome measures such as client satisfaction or comprehension, or in order to assess and offer feedback in teaching communication skills programmes.     

Occupational therapists as expert witnesses on work capacity

Aim: The aim of this study was to explore the particular challenges for occupational therapists during their cross‐examination as an expert witness on work capacity. Methods: Grounded theory methodology was used to collect and analyse data. Interviews were conducted with 31 participants with direct experience of occupational therapy work capacity assessments. Of these, 19 were occupational therapists, six were medical specialists and six were lawyers. Results: All participant groups perceived that maintaining one’s credibility in the witness box was of paramount importance. The occupational therapists identified 11 strategies that barristers may use to challenge their credibility as an expert witness. Conclusions: The three professional groups proposed practices that maintain occupational therapists’ credibility as expert witnesses on the work capacity of personal injury claimants.     

Client-centred occupational therapy with children: A critical perspective

Abstract

Background: Client-centredness is a central theme within occupational therapy; however, its application within clinical practice has not been thoroughly examined within the literature. Aim: The aim of this practice reflection is to provide a critical perspective on client-centredness in occupational therapy practice with children. Methods: Two action points of the Canadian Practice Process Framework (CPPF): Set the Stage and Agree on Objectives and Plan are applied to examine the concept of client-centred practice using a common practice example. Results: There are multiple benefits to using a client-centred approach to goal setting and developing a therapy plan. Practical challenges to client-centred practice include a lack of time, organizational support, and professional autonomy. Therapists may exert power over clients by enforcing institutional policies that prioritize the client diagnosis and organizational processes. Conclusion: The authors support a client-centred approach to occupational therapy practice with children but suggest that therapists may feel conflicted in trying to apply these principles within the current context of rehabilitation for children. Occupational therapists are encouraged to identify opportunities where they can advocate for a client-centred approach to services.     

Measuring rural allied health workforce turnover and retention: What are the patterns,determinants and costs?

Objectives: To measure variations in patterns of turnover and retention, determinants of turnover, and costs of recruitment of allied health professionals in rural areas. Design: Data were collected on health service characteristics, recruitment costs and de‐identified individual‐level employment entry and exit data for dietitians, occupational therapists, physiotherapists, podiatrists, psychologists, social workers and speech pathologists employed between 1 January 2004 and 31 December 2009. Setting: Health services providing allied health services within Western Victoria were stratified by geographical location and town size. Eighteen health services were sampled, 11 participated. Main outcome measures: Annual turnover rates, stability rates, median length of stay in current position, survival probabilities, turnover hazards and median costs of recruitment were calculated. Results: Analysis of commencement and exit data from 901 allied health professionals indicated that differences in crude workforce patterns according to geographical location emerge 12 to 24 months after commencement of employment, although the results were not statistically significant. Proportional hazards modelling indicated profession and employee age and grade upon commencement were significant determinants of turnover risk. Costs of replacing allied health workers are high. Conclusions: An opportunity for implementing comprehensive retention strategies exists in the first year of employment in rural and remote settings. Benchmarks to guide workforce retention strategies should take account of differences in patterns of allied health turnover and retention according to geographical location. Monitoring allied health workforce turnover and retention through analysis of routinely collected data to calculate selected indicators provides a stronger evidence base to underpin workforce planning by health services and regional authorities.     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.