Occupational therapists' perception of their practice: A phenomenological study

Background:  International literature seems consistent in reporting that occupational therapists value their methods. However, little empirical evidence has been generated supporting the basic system of belief for occupational therapy. Few studies have explored the nature of the occupational therapists' experiences and thoughts about their use of occupation as means and ends, and which strategies they use to implement their tools in their current practice. Accordingly, the aim of this study was to explore how occupational therapists understood and presented their practice and interventions.
Methods:  A sample of six occupational therapists graduated in different decades, from diverse client populations and health-care settings was selected to participate in a semistructured interview.
Results:  Three main themes were developed: 'To make the client's potentials visible', 'reaching a position one values' and 'looking with other eyes'. Whatever their specialities, the participants were unanimous in the way they described their role. Their common focus was 'activities of daily living'. However, they had problems describing their therapeutic tools, and were not able to clearly articulate the 'common sense aspects' of their own methods. The participants were engaged in constructing their professional identities, and stressed the need to construct professional boundaries relevant to their particular work.
Conclusion:  The occupational therapists perceived their practice and interventions as distinctly different from other team members, thus, they provided a 'counterpoint'. The participants used various ways of marketing their perspectives. While the novices tended to go along with the team, the experienced therapists tended to assert their own special contribution.     

Patients' experience of groups in outpatient mental health services and its significance for daily occupations

The prevalence of mental health problems such as depression and anxiety in the Swedish population is increasing and individuals’ daily occupations are seriously affected. Occupational therapy groups have long been used in mental health services. Now, with the increase in the number of outpatients and the current principle of patients' participation there is a need for further knowledge of this group of patients' perspective on the method. The aim of this study was thus to explore how outpatients in mental health services experience treatment in occupational therapy groups and what significance the treatment has for daily occupations. The focus group method was used. Four groups, with a total of 14 participants, were formed and met on one occasion. A number of factors for positive change in occupational therapy groups were found, i.e. “timing”, “belonging”, “involvement”, “challenge”, “meaningful occupation”, and “balanced focus on disease”. The participants’ active use of the treatment and the transfer of experiences and knowledge from treatment to daily life were important for success. The abilities “to manage” and “to dare” developed in occupational therapy groups helped participants in the process of making changes in daily occupations. The findings show how a traditional method in occupational therapy in mental health services can be used to meet current needs and principles.     

Patients' experience of groups in outpatient mental health services and its significance for daily occupations

The prevalence of mental health problems such as depression and anxiety in the Swedish population is increasing and individuals' daily occupations are seriously affected. Occupational therapy groups have long been used in mental health services. Now, with the increase in the number of outpatients and the current principle of patients' participation there is a need for further knowledge of this group of patients' perspective on the method. The aim of this study was thus to explore how outpatients in mental health services experience treatment in occupational therapy groups and what significance the treatment has for daily occupations. The focus group method was used. Four groups, with a total of 14 participants, were formed and met on one occasion. A number of factors for positive change in occupational therapy groups were found, i.e. "timing", "belonging", "involvement", "challenge", "meaningful occupation", and "balanced focus on disease". The participants' active use of the treatment and the transfer of experiences and knowledge from treatment to daily life were important for success. The abilities "to manage" and "to dare" developed in occupational therapy groups helped participants in the process of making changes in daily occupations. The findings show how a traditional method in occupational therapy in mental health services can be used to meet current needs and principles.     

Cultural Safety and professional practice in occupational therapy: A New Zealand perspective

This research examined occupational therapists' attitudes to Cultural Safety for Maori clients. The main research tool was a semi-structured qualitative research interview. A cross-case analysis method was used to determine the major recurring themes. Thirteen participants with varied occupational therapy training backgrounds were interviewed. Current Cultural Safety education is designed to challenge health professionals' attitudes towards those culturally different from themselves. Results suggest that maturity and personal experiences had significant bearing on these attitudes. Implications for occupational therapy include implementing a policy that stipulates compulsory Cultural Safety education as part of professional development. Findings may have relevance for other countries where significant ethnic differentials in health service success exist, such as Australia.     

Effects of a hand training programme in five patients with myotonic dystrophy type 1

The aim of this study was to evaluate hand function and self-rated occupational performance before and after specific hand training in five participants with myotonic dystrophy (MD) type 1. MD is the commonest of the muscular dystrophies with adult onset and is associated with muscle weakness, wasting and myotonia. Compensatory techniques and strategies are mostly offered as the only intervention therapy. In the present study, the participants were their own controls using pre- and post-test measures. Each participant was tested at intervals a total of nine times before and nine times after hand training. A hand-held myometer (Microfet2), Grippit, Purdue Pegboard and self-rated myotonia were used as outcome measures. Occupational performance was assessed pre- and post-test using the Canadian Occupational Performance Measurement (COPM) in which the participants rated their own performance and satisfaction in five self-chosen occupational performance areas. The participants performed hand training for a total of three months, three times per week using a specific resistance training programme including Theraputty, a silicone-based putty. Hand function was significantly increased and a positive change in self-rated occupational performance was noted after the training period. This study indicates that hand training has a positive effect on hand function, i.e. motor function and occupational performance. The present results need to be replicated in a controlled study including a larger number of patients and over a longer period of time.     

Web-based training in occupational medicine

OBJECTIVES: The aim of our project was to develop and evaluate an interactive computer-based approach to teach medical students in occupational medicine. To enhance interest in occupational medicine the major focus was on clinical and practical aspects of occupational medicine. METHODS: The computer program was designed in HTML and JavaScript. It presents a guided tour of the patient's case history followed by information on practice and theory of occupational medicine. The program was integrated into the curriculum during the summer term of 1999 and the following winter term. To assess the effectiveness and acceptability of the program we asked students to rate the program on an 18-item questionnaire. RESULTS: Overall, 287 students participated in the evaluation of the program. The participants highly recommended the program structure and had no difficulties in handling the program. This was independent of the computer experience of the students. The evaluation showed that it was possible to enhance interest in occupational medicine by using "virtual patients". CONCLUSION: The program represents a student-orientated learning tool that points out clinical and practical aspects of occupational medicine. The availability via the Internet allows the application as a self-learning tool as well as a teaching tool for the medical curriculum.     

Incoordination of a sequential motor task in Parkinson's disease

The quality of life in persons with Parkinson's disease (PD) has increased significantly with improved medicines. However, as the disease progresses difficulty in performing activities of daily life occur and occupational therapy intervention is sought (Deane et al., 2001). Reviews describing the efficacy of occupational therapy intervention in PD are inconclusive (Murphy and Tickle-Degnen, 2001; Gaudet, 2002). The purpose of this study is to establish an occupational therapy protocol for PD based upon research on motor control, sensory feedback and bradykinesia. As a first stage, the present study investigated the contribution of sensory feedback in generating the most prevalent symptoms of PD, that is, bradykinesia. Fast reach-to-grasp movement without kinesthetic or visual dependence in PD patients under on-drug and off-drug conditions were investigated. Seven normal participants and 11 patients with PD voluntarily participated in the study. Movements of the upper arm as a measure of reach, and movements of the index finger as a measure of grasp were recorded using magnetic trackers. Compared to the normal participants, this index to upper arm movement relationship was severely disturbed in the patients with PD and was improved following medications. Inter-onset latency (IOL), that is, the time lag between the initiation of upper arm movement and index movement, was significantly longer in PD patients compared to normal subjects. Medications reduced IOL which lead to improvement of the relationship of upper arm and index. The results suggest that bradykinesia is due to the breakdown of co-ordination between joint movements as a result of presumably slow executive processing of motor programmes. Individual joint movements are initiated out of sequence resulting in uncoordinated movements even with antiparkinsonian drugs. It is suggested that occupational therapy intervention in PD patients should be directed to occupations that require co-ordination of joint movements essential for successful completion of various activities of daily living tasks.     

Struggling to be part of Swedish society: Strategies used by immigrants with late effects of polio

Objective: To explore and describe strategies in daily occupations among immigrants with late effects of polio. Method. The strategies were explored by interviews with 12 immigrants from Eastern Africa with late effects of polio. Sampling and data analysis was carried out according to grounded theory. Results: The participants struggled for occupational participation and normality in an effort to participate in, and be part of, society. The study identified 14 strategies used by the immigrants in their daily occupations. The strategies can be presented in the following four categories: managing physical capacity; promoting occupational performance; strategies for gaining respect; and preparing the ground for one’s existence. The participants struggled to find a balance between physical capacity and meaningful occupations, conception of their own and others’ norms and values, and living conditions in Swedish society. The strategies were related to the participants’ will to manage daily occupations, maintain social relationships, and be part of society. Conclusions: The strategies revealed that the participants strive to participate in occupations and society. This study reinforces the importance of occupation for immigrants with disability. The results highlight the need for adequate health care and rehabilitation but should also alert other social institutions.     

A pilot study on attitudes toward making reasonable accommodations for occupational therapists with disabilities

The Americans with Disabilities Act (ADA) ensures that persons with disabilities in the United States are entitled to reasonable accommodations in five areas including employment. This pilot study (1) tested the reliability and validity of a questionnaire, which (2) explored how much training American occupational therapists had in the ADA and (3) investigated the attitudes of occupational therapist supervisors toward occupational therapist employees with disabilities. A questionnaire consisting of 20 statements was designed by the researcher. The questionnaire was mailed to 18 occupational therapy administrators. Ten participants who completed the mailed questionnaire were included in the results. Participants with ADA training had a more positive attitude towards making reasonable accommodations than those without training. Only participants working in psychosocial settings claimed to have occupational therapy employees with disabilities. Six of the administrators made reasonable accommodations for employees who had disabilities. Further study of a larger sample of occupational therapy administrators is recommended to determine the attitude towards reasonable accommodations for employees with disabilities. Copyright © 1996 Whurr Publishers Ltd.     

Leading from Intermediary Positions: First-line Administrators' Experiences of their Occupational Role and Situation

The aim of this study was to illuminate how first-line administrators in healthcare organizations perceive their occupational role and situation. Interviews were conducted with eight first-line administrators in healthcare environments (five women and three men). Five were registered nurses, one was an occupational therapist, one a physiotherapist and one had a degree in logopaedics. A semi-structured formula with broad open-ended questions was used for the personal interviews. A qualitative interpretive method was used in the analysis. The analysis resulted in three categories describing the perceived role and situation of being a first-line administrator, namely, "developing strategies to manage the leadership role", "being part of an organizational culture characterized by traditional values", and "treading a fine line and striving to manage the balancing act". The results from this study indicate that there is a need to support this group of leaders with training adjusted to the role and situation of leading from intermediary positions in organizations.     

Post‐stroke fatigue: qualitative study of three focus groups

Fatigue affects many persons after cerebrovascular accident, particularly those with mild stroke. A qualitative methodology using focus groups with 19 community‐living post‐stroke survivors was utilized to explore the occupational impact of fatigue as communicated by the participants. Although self‐report of a small sample of the United States' post‐stroke population will have limitations in generalizability, this study identifies specific health‐related quality of life issues that can occur with post‐stroke fatigue. The participants felt unprepared for the fatigue phenomenon and struggled to adapt, with fatigue having a debilitating influence upon daily occupational performance and roles, including social participation, return to work, driving, reading and sleeping. The participants indicated that exercise (such as walking and water aerobics) and use of assistive technology were helpful strategies in reducing fatigue. The occupational performance and role impact identified by participants in this study can inform the design of effective occupational therapy interventions and further quantitative study of persons with post‐stroke fatigue. Copyright © 2009 John Wiley & Sons, Ltd.     

Experiences of daily occupations at 99 years of age

The aim was to explore experiences of daily occupations among the oldest old. Ten 99-year-old persons were interviewed in their living environment about an ordinary day. The interviews were analysed according to the phenomenographic approach. The result showed that participants regarded themselves as competent and that they felt proud because they were involved in daily occupations. Being challenged was experienced as a way of performing difficult tasks, thus being confirmed as a capable person who performs and learns new things. The participants' occupational patterns preserve occupational ability and continuity in life in that they have a rhythm and allow the individuals to predict and handle interruptions. Participants experienced being incapable and being restricted as a result of personal, environmental, and social hindrances. The participants adapted to and reshaped their sense of self, which has been disrupted due to the discrepancy between self, the person's ability, and the real world "outside". Experience of daily occupation is unique, supports the sense of self, builds identities, and describes engagement and creative processes. Individual experience must be recognized as it can mean the difference between success and failure in maintaining meaningful daily occupation.     

Using the Apple IIe Computer as an Administrative Tool in an Occupational Therapy Department

The microcomputer can be an extremely effective tool in an occupational therapy department for accomplishing administrative tasks in a more efficient and accurate manner when compared to traditional methods. This paper is directed to the occupational therapy manager who would like to streamline secretarial and administrative record-keeping. The mystery is removed from the computer terms of data base, spreadsheet, and word processing. Hardware and software requirements are identified. The process of creating patient files, attendance records and monthly reports is described so that the reader can gain an understanding of how occupational therapists can actually use a computer program to carry out these tasks. Additional applications including budgeting, creating home programs, and calculating productivity are also discussed. The reader is encouraged to consider the computer as a useful tool and approach it in an organized fashion, rather than let a lack of experience cause hesitation in initiating a project that can lead to enormous savings in time and improved accuracy for an occupational therapy department.     

Utilization of the iPad application: Aid for Decision-making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.     

The experience sampling method: its potential use in occupational therapy research

Occupational therapists rely on being able to understand which occupations are of value to clients and also appropriate to their needs. The Experience Sampling Method (ESM) was developed as a tool to study the experience of engaging in activities in everyday life. The purpose of this paper is to report on the findings of an ESM study of a group of final year occupational therapy students and to examine the strengths and limitations of this methodology. A modified version of an Experience Sampling Form (ESF) was used to measure flow. Of the 508 ESFs completed by the 11 participants over a one week period, 177 (31%) were found to be in flow, 51 (10%) anxiety, 104 (20%) boredom and 176 (35%) apathy. Many high flow experiences occurred while studying, usually alone and while reading and/or writing. The results indicate that ESM has the potential to be useful for describing in minutiae the patterns of an individual's daily experience. The major advantage of ESM is that it allows one to study the dynamics of emotions and other subjective states while a person engages in their normal daily occupations. The methodology has potential for use in clinical research as participants have the opportunity to describe their emotions while engaging in occupation. Copyright © 1996 Whurr Publishers Ltd.     

Developing professional values: perceptions of francophone occupational therapists in Quebec,Canada

Objective Recent literature shows growing interest in the values displayed by occupational therapists. Yet, none of these writings has so far examined the factors that contribute to the development of occupational therapists’ professional values. These factors are important, since values play a pivotal role in forging professional identity, which in the case of some occupational therapists remains somewhat ambiguous. This article proposes possible answers to the following question: What do Quebec Francophone occupational therapists perceive as the building blocks of their professional values? Methods Using a phenomenological qualitative method, the subjective experience of occupational therapists in Quebec, Canada was examined. Twenty-six occupational therapists took part in the study. Results As intended, their professional experience was varied. According to the participants, four factors contributed significantly to their professional values: professional experience, university training, personal experience, and professional development. However, fewer than 50% of the participants cited six other factors (workplace, family upbringing, personal development, personality and abilities, professional normative framework, and sociocultural background). Conclusions Most of these results are consistent with those documented in existing works. They point to the relevance of discussing professional values during university training and continuing professional development, as well as encouraging occupational therapists to become exemplars for their colleagues and interns. This study constitutes an initial step in understanding how occupational therapists’ axiological identity is formed.     

The use of craft activities as an occupational therapy treatment modality in Norway during 1952-1960

The purpose of the present study was to explore the use of craft activities as occupational therapy treatment modalities in Norway during the period 1952-1960. Data were obtained through in-depth interviews with six retired occupational therapists on their experiences in using crafts. Data were analysed through textual analysis and this resulted in four themes: craft activities identified as a therapeutic tool; ambivalence in how to frame the intervention; practice relative to power relationships; and occupational therapists and patients as equals. A limitation of the present study was that participants drew on their screened memories in the context of contemporary practice, which may omit or distort the historical truth. Further research is needed to document the effect of contemporary therapeutic use of craft activities, and to bring forward how occupational therapists and clients value the craft activities of today in the context of their lives.     

Experiences of daily occupations at 99 years of age

The aim was to explore experiences of daily occupations among the oldest old. Ten 99-year-old persons were interviewed in their living environment about an ordinary day. The interviews were analysed according to the phenomenographic approach. The result showed that participants regarded themselves as competent and that they felt proud because they were involved in daily occupations. Being challenged was experienced as a way of performing difficult tasks, thus being confirmed as a capable person who performs and learns new things. The participants’ occupational patterns preserve occupational ability and continuity in life in that they have a rhythm and allow the individuals to predict and handle interruptions. Participants experienced being incapable and being restricted as a result of personal, environmental, and social hindrances. The participants adapted to and reshaped their sense of self, which has been disrupted due to the discrepancy between self, the person's ability, and the real world “outside”. Experience of daily occupation is unique, supports the sense of self, builds identities, and describes engagement and creative processes. Individual experience must be recognized as it can mean the difference between success and failure in maintaining meaningful daily occupation.     

Client-Centred Occupational Therapy for Persons with Mental Retardation: Implementation of an Intervention Programme in Activities of Daily Living Tasks

The aim of this study was to implement a single-case design to evaluate the outcomes of a specified occupational therapy intervention programme. The intervention programme was based on a client-centred top-down approach and followed the Occupational Therapy Intervention Process Model. The interventions included both restorative and adaptive strategies to improve performance of the activities of daily living (ADL) tasks the participants defined as relevant and meaningful. Three women with moderate mental retardation living alone in apartments with support from professionals were included in the study. The Assessment of Motor and Process Skills was used to evaluate for changes in ADL motor and ADL process ability. The Assessment of Awareness of Disability was used to evaluate changes in the client's awareness of disability. The results showed improvements for all participants but patterns of changes were different between the participants and the outcome variables. ADL process ability was the only outcome variable that improved in all participants. The results are discussed in relation to the design used for evaluating intervention efficacy. Future improvements in the process of evaluating occupational therapy interventions are suggested.