Occupational therapists’ reflection on practice within psychiatric care: A Delphi study

Aim: The aim of this study was to describe the reflections on practice in a group of Swedish occupational therapists in psychiatric care in order to illuminate the present practice and ideas about the future using a Delphi survey of three rounds. Material and method: The sample consisted of 14 occupational therapists in psychiatric care. The answers from the first and second rounds illustrate the wide variation in their practice. The third round points out consensus and disagreements in the domains: professional role, theories in practice, domain of concern, occupational therapy assessment, goal setting/treatment, outcome/evaluation and thoughts about the future. A consensus was reached in all domains, but not regarding competence to treat functional reduction and symptoms, or on the importance of theories for documentation, the choice of a theoretical foundation, and the importance of an evidence-based treatment model, although the theories were seen as supporting practice. Disagreements were found as to the effectiveness of repeated assessments as a means of evaluation. The future for OTs within psychiatric care was looked upon as positive. Discussion: The results developed from providing a relatively unclear and shallow perspective on OT practice to indicating a depth that shows what occupational therapy within psychiatry can be. During the process it became more and more clear how OTs think and act.     

A survey of Israeli occupational therapists' definitions of the profession

The broad definition of occupational therapy, its holistic basis and its unifying characteristics enable occupational therapists to treat their clients as whole human beings. Yet, the holistic basis of occupational therapy and the divergence of its specialty areas seem to be polarised. This study explores Israeli occupational therapists' perceptions of their professional role and boundaries, and how it is affected by professional background; 265 Israeli occupational therapists participated in the study. A two-part questionnaire was constructed: (1) an attitudinal questionnaire including statements on issues that concern occupational therapists regarding the definition of the profession and its role; (2) nine items representing the main unifying characteristics of occupational therapy. Results indicate seven factors underlying the main issues concerning occupational therapists in Israel. From the seven factors two main sources of tension were revealed: strong sense of self-value as compared to lack of recognition by others and the advantages and the pitfalls of the holistic definition of occupational therapy. The most unifying characteristic of occupational therapy was the holistic definition, and the least important was the use of arts and crafts. In addition, occupational therapists from developmental disabilities area of specialty were distinct from others in their perceptions of the profession.     

Sex Education and Schizophrenia: Should Occupational Therapists Offer Sex Education to People with Schizophrenia?

Adult sexuality contributes significantly to an individual's identity, self-esteem and relationships. Since occupational therapy is practised from the perspective of holistic care, sexual behaviour can be a legitimate area for therapists to consider when working with clients. For people with schizophrenia there are particular issues that may need to be addressed by the therapist. This paper summarizes the results of a study examining whether occupational therapists regard sex education as a valid topic to teach, as part of a treatment package, to people with schizophrenia. Forty-nine therapists responded to a questionnaire. The results suggest that the majority of occupational therapists believe sex education to be within the domain of their profession. They are not, however, providing sex education for their clients. The factors that influence this decision include length of time qualified, theories of practice and the expectations of employers.     

Choice,Knowledge, and Utilization of a Practice Theory: A National Study of Occupational Therapists Who Use the Model of Human Occupation

Objective. To identify how therapists choose and use the Model of Human Occupation (MOHO). Method. A systematic random sample of 1,000 occupational therapists was surveyed as to whether they used MOHO in their practice. Those who were using MOHO were then sent a detailed questionnaire; 259 therapists responded to the survey questionnaire, forming a response rate of 60.2 percent. Results. A total of 80.7% of therapists indicated that they had used MOHO in their practice. A number of factors influenced therapists' choice to use MOHO. The most frequently cited factors were therapists' judgment that MOHO fit their own practice philosophy and their clients' needs. Most therapists used multiple means of learning about MOHO, and the number of means they used was related to both self-reported levels of knowledge and utilization of this model. Many therapists are also actively engaged in sharing their knowledge and utilization of this model. Conclusion. Multiple factors contribute to therapists' choice and use of MOHO. Therapists actively make a decision to use MOHO in practice and put forth substantial efforts to learn and share their knowledge of MOHO.     

The Gardia Experience: Implications for Occupational Therapists Working with Australia's Indigenous People in the Kimberley Region

Working with Australia's indigenous people as an occupational therapist requires an understanding of Aboriginal culture. Non-Aboriginal (gardia) therapists, in the Kimberley region of Western Australia, have been challenged to revise their use of conventional therapy to work effectively with their traditional Aboriginal clients. Some of the cultural aspects which impact on the therapists' work include language differences, explanations of illness and death, complex laws governing family relationships, and attitudes to ageing and disabilities.     

Use of creative activities in occupational therapy practice in sweden

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web‐mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web‐mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in‐depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy. Copyright © 2012 John Wiley & Sons, Ltd.     

Shoulder Pain in the Patient with Hemiplegia

Shoulder pain in the affected upper extremity of patients with hemiplegia is of fundamental concern to occupational therapists who are working for increased independence of patients. The author interviewed several other occupational therapists, reviewed recent literature and completed a survey of charts of 30 patients. The literature and the therapists' responses indicated a higher frequency of pain than the author anticipated. The chart review was completed (1) to determine objectively the frequency of shoulder pain or subluxation in patients with hemiplegia, and (2) to ascertain the use of the upper extremity and the performance of functional activities of those patients who had shoulder pain or subluxation. Although the number in the sample of charts was too small to yield more than an indication of problems, 3 group patterns emerged based on the differences in functional use of the upper extremity. These 3 patterns of function were compared with findings in the literature. Further study is suggested to assess pain and its responses to occupational therapy, during both the acute and chronic phases of care. The goal of research would be to better predict which patients would develop shoulder pain, thereby helping to prevent long-term complications.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Occupational Therapy Intervention for Residents in a Skilled Nursing Facility: A Focus on Atypical Patients

The 1990 implementation of the Omnibus Budget Reconciliation Act (OBRA) has expanded opportunities for occupational therapists to treat individuals with non-traditional illnesses. Therapists working in skilled nursing and long term care can benefit from gaining an understanding of the OBRA guidelines and patient's rights, especially regarding restraint reduction. Occupational therapists possess the necessary skills to assess and treat these individuals to help maximize their functioning as well as improve their quality of life (Moon-Sperling & Pinson, 1991). The premise of this article is to inform therapists about various types of ethical and legal intervention with atypical patients in skilled nursing facilities and to introduce therapists to the laws supporting provision of these services. [Article copies available for a fee from The Haworth Document Delivery Service: 1–800–342–9678. E-mail address: getinfo@haworth.com]     

Working Relationship,Participation and Outcome in a Psychiatric Day Care Unit Based on Occupational Therapy

A process-outcome study was conducted in a psychiatric day care unit based on occupational therapy for long-term patients with severe mental illness. The development of the working relationship was explored. Most of the patients and staff rated the quality of the working relationship as good. The study also investigated whether working relationship and participation factors were related to outcome concerning psychiatric symptoms, global mental health, and occupational functioning. A group of patients with a positive development in working relationships from their own perspective showed greater improvement in global mental health and the habituation aspects of occupational functioning than another group with a less positive development. Patients' assessment of a better working relationship vis-à-vis the main therapist compared to the other occupational therapists was reflected in a greater improvement in global mental health and occupational functioning. There were no clear-cut linear relationships between specific levels of the working relationship and outcome. Patient participation, especially in a psychological sense, was positively related to occupational functioning. It was concluded that further investigations are needed before any general statements can be made regarding which treatment processes play a role in and have an influence on the outcome of occupational therapy.     

Clinical reasoning and the occupational therapy curriculum

Several reasoning styles are used by occupational therapists when they evaluate clients' problems. This study investigated the influence of the occupational therapy curriculum in Hong Kong on therapists' clinical reasoning styles. Two groups of therapists with different clinical experience were recruited. Through interviews with the therapists after identifying clients' problems using the Canadian Occupational Performance Measure, their clinical reasoning styles were explored. The local occupational therapy curriculum was analysed to isolate the components that influence clinical reasoning. Results showed that more experienced therapists use conditional reasoning that considers clients' needs in their future lives whereas junior therapists use procedural reasoning that focuses on clients' disabilities. The analysis of the occupational therapy curriculum indicated that it prepared the students with an equal emphasis on theoretical and clinical subjects and fieldwork practice. The present curriculum was useful in providing educational preparation for novice therapists. However, the period of fieldwork practice can be lengthened to allow adequate maturation of clinical reasoning skills. Problem‐based learning can be incorporated to facilitate students' problem‐solving and self‐directed learning skills. Copyright © 2000 Whurr Publishers Ltd.     

Occupational Therapy Assessment of Potential Hazards in the Homes of Elderly People: an Inter-Rater Reliability Study

Falls and fractured hips in the elderly have often been attributed to home environmental factors. There is a lack of research evaluating occupational therapists' reliability in assessing the home environment for potential safety hazards. Twenty home visits were conducted by seven therapists with two occupational therapy raters present at each home visit. The kappa statistic was used to determine inter-rater reliability. Generally, therapists were able to reliably rate potential hazards in the home, however, some areas, such as the toilet area and shower rails had poor reliability. It is recommended that more objective criteria be developed for assessing potential hazards in the home.     

Occupational therapists as object users: A critique of Australian practice 1954–1995

This research sought to identify the conventions and expectations that guide Australian occupational therapists' use of objects, and to critique these against professional beliefs and values. A history of ideas methodology was used to analyse the content of a sample of issues of the Australian Occupational Therapy Journal, spanning 42 years. This revealed that therapists have been strongly influenced by mechanistic thinking, with a resultant focus on biomechanical, neurological and functional aspects of object use, which has excluded consideration of the client's subjective experience of using objects and the symbolic meaning of the objects used. The centrality of assistive devices, splints and formal assessments to occupational therapists' identity and professional development is also identified. Current practices are critiqued as inconsistent with respecting clients' dignity and worth.     

Agreement Between Occupational Therapists and Clients with Stroke on Three Outcome Measures

In recent years, the occupational therapy profession has been under increased pressure to document the outcomes of interventions in order 10 improve the quality of client care and to provide evidence of the effectiveness and efficiency of services to recipients and sponsors. The literature to date has focused primarily on establishing therapy outcomes from a therapist perspective. However, attention must also be paid to the views of our consumers regarding the outcomes of therapy. The purpose of this study was to determine whether clients and therapists agree regarding client scores on three outcome measures. The study included 4 occupational therapists and 20 clients with stroke who rated clients' status in terms of personal activities of daily living, instrumental activities of daily living and quality of life, at admission of clients as well as discharge from rehabilitation. The results indicated that there was generally only moderate agreement between therapists' and clients' ratings at both admission and discharge. These findings suggest that therapists should continue to spend time exploring client status with their clients so that both parties have the best possible understanding of the clients' capabilities, and the outcome of therapy. The findings also suggest the need to administer client outcome assessments as well as to utilize client self-reports.     

Old Values versus New Developments: How will Occupational Therapists adapt to Technological Change?

The authors have demonstrated in recent research that occupational therapists strongly endorse patient-oriented values. While they may be highly respected within the profession, the priority that these values are given in undergraduate education may be detrimental to the development of occupational therapy as an applied science. This paper presents an analysis of the values that Canadian therapists endorse and the roles that they currently consider to be most important. Research findings comparing the values endorsed by occupational therapists and other professional research/managerial women are presented, providing interesting contrasts which should be of benefit to clinicians and educators in planning for a future which will definitely require increasing therapists' interface with technology.     

Occupational therapists' experience of working with immigrant clients in mental health care

Abstract

Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, “the challenges of the multicultural therapeutic journey—a journey on a winding road” was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice.     

Comparing and Using Occupation-Focused Models

ABSTRACT

As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.