Active Participation in Fieldwork Level I: Fieldwork Educator and Student Perceptions

ABSTRACT

Fieldwork experiences bridge the gap between a student's education and entry-level practice. Academic programs, faculty members, and fieldwork educators are challenged to prepare occupational therapy students for entry-level practice. The Accreditation Council for Occupational Therapy Education (ACOTE) standards advocate for both active participation and guided observation in Level I fieldwork experience (. Students report their most meaningful learning experiences, which include performance of clinical skills and participation in clinical reasoning. However, many students enrolled in the author's entry-level master's program and the other schools within a regional consortium report their Level I fieldwork experience is primarily observation. This article describes the results of a survey administered to fieldwork educators and occupational therapy students eliciting their perceptions of active participation in Level I fieldwork. Results indicate that perceptions of the groups are dissimilar. Recommendations and implications for increased active participation in Level I fieldwork are discussed.     

Service Learning: The Process of Doing and Becoming an Occupational Therapist

ABSTRACT

The purpose of this phenomenological study was to explore the perceptions and experiences of entry-level occupational therapy students participating in a service-learning experience designed to provide preventive occupation-based social skills groups to low-income urban youth attending after-school care. Reflective journals and focus groups were used to study how the students made sense of their experience. Qualitative data analysis resulted in six major themes revealing the process of professional growth over the eight-weeks. Professional reasoning progressed from mechanical procedural reasoning to flexible forms of conditioning reasoning. Findings emphasize the critical role of active participation in real-life contexts on learning how to become an occupational therapist. Study findings provide a discussion about the possibilities of preparing future occupational therapy practitioners to address society's occupational needs in emerging practice areas.     

Student Reflections as Evidence of Interactive Clinical Reasoning Skills

A graduate level occupational therapy course in the experience of chronic illness is described for its unique method in helping students to broaden clinical reasoning skills. When students are faced with having to participate in a difficult situation with patients, they have the opportunity to discuss their own reactions, to understand better their own stressful experiences, and to more easily formulate questions for those who are chronically ill. Learning is facilitated through reading autopathographies; viewing videos of people dealing with illness, both sudden and gradual; participating in small group discussions, and writing reflective journals about the challenging community experience that is required of the course. The combination of methods serves to promote interactive clinical reasoning skills.     

Using Service-Learning to Teach Mental Health and Research Skills

ABSTRACT

This paper describes how an occupational therapy program used service-learning to integrate the learning objectives for mental health and research curriculum content. The service-learning program assisted participants diagnosed with mental illness to achieve success in higher education and/or related goals and served as a clinical program within a research curriculum for entry-level graduate occupational therapy students. The occupational therapy students served as mentors for the participants. The purpose of the program for the occupational therapy students was to teach research skills, clinical skills, and increase comfort in working with the mental health population. Seventy-eight occupational therapy students participated in the program over four academic years. A case example of a student/participant mentoring relationship is provided. Results indicated that the occupational therapy students gained comfort with the population and competence in their clinical and research skills.     

Teaching Evidence-Based Practice in a Distance Education Occupational Therapy Doctoral Program: Strategies for Professional Growth and Advancing the Profession

ABSTRACT

The Centennial Vision of the American Occupational Therapy Association (AOTA) projects that by 2017 all occupational therapy (OT) practice areas will be supported by evidence. Achieving this goal requires preparing clinicians with the skills to assimilate, analyze, and apply research to their areas of practice and communicate the value of OT services to consumers and payers. These skills are at the heart of evidence-based practice (EBP). Educators must be prepared to teach EBP skills in both entry-level and postprofessional programs. This article outlines how EBP can be taught to postprofessional occupational therapy clinical doctoral students using a distance education format. Key features of a successful EBP course include having access to full-text electronic articles, opportunities for students to explore the literature in their own areas of interest, consistent and timely feedback on written work and discussion topics, and opportunities to collaborate with peers.     

Occupational Therapy Master-Level Students' Evidence-Based Practice Knowledge and Skills Before and After Fieldwork

ABSTRACT

Evidence-based practice (EBP) has become a universal standard for practice among healthcare professions, but due to barriers to EBP, the most effective ways of teaching EBP are not well understood. The purpose of this study was to report students’ EBP knowledge and skill gained from an entry-level Master's of Science in Occupational Therapy course in EBP. The Adapted Fresno Test of EBP was administered at the beginning and end of the course and after fieldwork experience. Results indicated that EBP knowledge and skills increased between the precourse and postcourse measurements (t = ?7.98; p < 0.001), but declined between postcourse and postfieldwork measurements (t = 6.65; p < 0.001) indicating that the course improved basic EBP skills and knowledge, but was ineffective in giving the students the strategies to retain and use those skills beyond the classroom. Suggestions are made to strengthen the student retention and use of EBP skills and knowledge after graduation.     

Personal journal writing in a communication skills course for first-year medical students

Summary. Student journals are used at all levels of education to facilitate academic and personal learning. This paper describes the experience of journal writing from both a student and teacher perspective, in a communication skills course for first-year medical students at Queen's University, Kingston, Ontario, Canada. As one of the requirements of the course, students described their individual reactions to each weekly session in a journal. Teachers responded to each journal entry. Guidelines for journal usage in this course are described. The content of the journals includes topic-related information, comments concerning the student's individual experience of the course, and personal thoughts related to life experiences and becoming a doctor. A summary of evaluations of journal writing by teachers and students is presented. We have observed that journal writing facilitates a personal and reflective perspective to the first-year medical curriculum for both students and teachers. Journal writing appears to initiate and encourage self-awareness by providing a safe place for students to describe their experiences and relationships and to question their own values and beliefs. In the journal, through a mutual sharing of thoughts and feelings, barriers between students and teachers are diminished, leading to enhanced rapport and communication.     

Evaluating Cultural Competence in an Occupational Therapy Pediatric Course

Abstract

This study examined the impact on student cultural competence of using specific guided activities in a pediatric occupational therapy course. A combined two-group pre-posttest design was used with a convenience sample of 41 entry-level occupational therapy doctoral students. Using a measure of cultural competence change, results indicated significant increase in scores from pre to post course testing suggesting cultural competence structured activities in course work were associated with an increase in student cultural competence. Implications for occupational therapy education are discussed.     

Physicians’ comprehension of the German Patients’ Rights Act: A cross-sectional study

ObjectiveThe German Patients' Rights Act (PRA), promulgated on February 25, 2013, was created to enhance transparency of patients' rights. This prospective study aimed to objectively measure physicians' comprehension of the PRA.MethodsWe generated a controlled study design, developing a questionnaire consisting of six case scenarios with 4–7 dichotomous items each. The survey concluded with seven 5-point-Likert scale questions, dealing with the PRA’s effects. Physicians teaching at the Westfälische Wilhelms-Universität (WWU) Münster served as the intervention group, and medical students from WWU Münster at the beginning of their clinical education formed the control group. Physicians were surveyed in November 2015; students were surveyed in February 2016.ResultsA total 56 completed surveys of physicians and 134 of students were analyzed. Of a total 33 points, on average physicians answered 21.04 (95% confidence interval (CI) 20.43–21.64) items correctly, a significantly higher result than students' 19.74 (95% CI 19.31–20.17) points (p < 0.001; Hedges' g = 0.53). Estimations of the PRA’s effects were ambiguous. Students agreed with the PRA’s supporting effect more often than physicians (p < 0.001) whereas physicians felt increased uncertainty arising from the PRA.ConclusionComprehension of the PRA increases significantly over the course of medical work experience; however, this comprehension is limited among medical experts. The PRA leads to ambiguity and uncertainty in the medical decision-making process.     

Preparing Occupational Therapy Students to Make Moral Decisions

ABSTRACT

There is growing awareness that moral distress has negative consequences for health care practitioners. The preparedness of future occupational therapists to make moral decisions needs to be addressed. The purpose of this exploratory study was to examine how moral reasoning changes during occupational therapy education. A repeated cross-sectional design was used to collect data from students enrolled in a 5-year entry-level professional program. For students in this study, a type of moral reasoning based on rules and social order was preferred over a type of moral reasoning based on abstract ideals. The consequences for moral distress and implications for occupational therapy education were discussed.     

The Provider’s Body in the Therapeutic Relationship: How Complementary and Alternative Medicine Providers Describe Their Work as Healers

ABSTRACT

Although the body is central to health outcomes, the provider’s body has been largely absent in the provider–patient relationship. Drawing upon semi-structured interviews with complementary and alternative medicine (CAM) providers (N = 17), this study examines how CAM providers use their body to characterize their work as healers. The findings suggest the provider’s self-reflexive awareness of their own body’s illness and faith experiences informs their understanding of the patients’ experience of health and disease. The study foregrounds the intersubjective nature of the provider–patient relationship as an embodied interaction in the mutual construction of therapeutic goals. Provider reflection on their own bodies to make sense of their patients’ experiences emphasizes provider–patient coproduction of meaning and suggests ways for including the provider’s self-reflexive awareness of their own body in a patient-centered healthcare relationship in ways that benefit both the patient and the provider.     

Illness Representation and Associated Factors among Hypertensive Patients in Central Ethiopia

BackgroundIllness representation is an implicit belief system about an illness constructed by an individual to give meaning to their illness. An individual''s belief about his/her illness, treatment, and own control are known to influence an individual''s ability to cope with the illness and sustain the health-related quality of life. However, how Ethiopians perceive hypertension has not been studied well. This study aimed to assess illness representation and associated factors among hypertensive patients in Central Ethiopia.MethodA facility-based cross-sectional study was conducted in four public hospitals in Central Ethiopia. A total of 989 patients participated in the study. The revised Illness Representation Questionnaire was used to collect relevant data. Data were analyzed using the Generalized Estimating Equation with an ordinal logistic regression model and exchangeable working correlation matrix. A P-Value of less than 0.05 was indicated statistical significance.ResultsOverall, 64.3% (95% CI: 61.3, 67.4) of the respondents reported low to moderate Illness representation about their hypertension. Respondents who were housewife [AOR: 1.48, 95% CI= 1.05, 2.08], in older age category 50–64 years [AOR: 1.92, 95% CI= 1.19, 3.09] and ≥ 65 years [AOR: 2.38, 95% CI= 1.43, 3.96], and had no family support [AOR: 1.98, 95% CI= 1.44, 2.73] showed a significant association with Illness Representation.ConclusionThis study revealed that about two-thirds of hypertensive patients in Central Ethiopia perceived hypertension as a low to moderately threatening illness. Such low illness representation undermines initiation of treatment and effective control of blood pressure. Health care providers need to strengthen strategies that increase their patient''s illness representation.     

The Prevalence of Chronic Health Conditions Impacting on Daily Functioning and the Association With Emotional Well-Being Among a National Sample of High School Students

PurposeThis study aims to describe the prevalence of self-reported chronic health conditions among high school students in New Zealand, the extent to which the condition impacts on their activities and socialization, and to explore the association between the level of impact of the illness or disability and the emotional well-being of students with chronic health conditions.MethodsA two-stage cluster sample of 9,107 students (Years 9–13) from 96 New Zealand high schools participated in a 2007 health survey using internet tablets. Students were asked about any chronic illness or disabilities lasting more than 6 months, the impact of the illness or disabilities on their daily activities and socialization, and their depressive symptoms (RADS-SF) and emotional well-being (WHO-5).ResultsAlmost one in five students (18%) reported a chronic health condition. Among them, 28% reported an impact of their illness or disability on their activities, and 8% reported an impact on their ability to socialize. High levels of depressive symptoms were found among students with chronic health conditions reporting that their illness or disability impacts their activities (18%) or their ability to socialize (40%), and this was significantly higher than among students without chronic health conditions (10%).ConclusionsOur findings suggest that there is a large group of adolescents with chronic health conditions for whom their illness or disability has an impact on their daily activities and ability to socialize with their peers. These students are more likely to experience emotional distress and require support and opportunities for healthy youth development.     

HIV/AIDS Stories on the World Wide Web and Transformation Perspective

ABSTRACT

Survivor stories have been an important part of therapy and social support for persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome AIDS (PLWHAs), and the World Wide Web has made these stories accessible to a vast audience. These stories are examined in the light of the concept of “transformation perspective” defined as a self-communicative experience that changes an individual's life so that priorities and self-identity are refocused. The trigger event that alters the individual's life might be a diagnosis with cancer, HIV, diabetes, or some other serious illness; divorce; financial tragedy; unemployment; or retirement. The “disorienting dilemma,” according to Mezirow, leads to self-examination, and thus to changes in the individual's frame of reference. The present study found that PLWHA's stories with more details were more likely to reflect transformation perspective.     

Group Co-Leadership by Occupational Therapy Students in Community Centers: Learning Transitional Roles

SUMMARY

The experience of contact with community populations and settings at the beginning of fieldwork is essential in expanding the dimensions of non-traditional skills and roles for occupational therapy students. This article describes an initial fieldwork experience which builds on an occupational therapy group process course to enable students to supplement a community-based program with activities designed to meet a need of their group at the appropriate level of group interaction. Pairs of students select a receptive community site prior to the beginning of fieldwork to open dialog with the center's coordinator regarding performance areas, components, or contexts needed by the group. Working to assess the current programmatic offerings and desires of the participants for new activities and planning activities in collaboration with local staff, the students propose to conduct a series of five sessions addressing a theme desired or needed by the group. Upon immersion in the site's program, students are able to provide an in-depth assessment of the community group's psychosocial skill needs using the Group Level of Function Profile (Donohue, 2000).     

Pedagogical tools to develop clinical reasoning: physical therapy students' perspective

Physical therapy students' perspective about the development of clinical decision making ability was solicited to determine: 1) if actual clinical and academic learning experiences are consistent with student preferences; and 2) if actual academic learning experiences differ according to subject matter. Program representatives contacted physical therapy students via email with an embedded link to an on-line survey during their final clinical education experiences. Open-ended and forced-choice items addressed reactions to learning experiences to develop clinical reasoning in academic and final clinical education experiences. Data were analyzed with frequency analysis, chi-square and correlations of survey items. Ninety-one respondents completed the survey, yielding a 13% response rate. The frequency of use of pedagogical tools was lower than the preferred use of the tools. Perceptions about clinical reasoning learning tools varied with course content. Course content corresponded to the type of pedagogical tool that students deemed essential for learning clinical reasoning. Participants appeared to experience and prefer more independence at the final clinical experience although they preferred considerable involvement by the clinical instructor.     

How Goal Orientation Match Between Social Workers and Their Supervisors Impacts Social Workers' Job Satisfaction

Abstract

Social workers' perceptions of their supervisors' dispositional goal orientations towards learning and performing act as powerful situational influences—in interaction with their own goal orientations— to affect social workers' job satisfaction. Social workers perceiving their supervisors' goal orientation to align with their own will experience greater job satisfaction. Supervisors cognizant of supervisees' goal orientations are more able to provide individually motivating tasks, support, and rewards. Such inquiry offers a promising direction for improving the work conditions of social workers. An increase in job satisfaction should be correlated with an increase in improved client outcomes and reduction in social worker turnover.