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.     

Ethics, occupational therapy and discharge planning: Four broken principles

Occupational therapists play a significant role in the discharge process and are often exposed to ethically challenging decision-making. This paper examines the moral basis of discharge planning, relating it to the four fundamental bio-ethical principles of respect for autonomy, beneficence, non-maleficence and justice. Using a case study design, data was collected from 10 occupational therapists and two elder care patients using the critical incident approach, as part of a wider study to determine their perceptions of discharge planning and multidisciplinary teamwork. Direct observation of interaction within multidisciplinary teams was also undertaken. The findings from the research suggest that occupational therapists are unintentionally breaching these four principles and therefore their code of ethics and professional conduct. It is suggested that further research is needed to determine how occupational therapists overcome these challenges. Furthermore, this research has important implications for education establishments regarding the teaching of ethics to occupational therapists.     

Enabling international communication among Brazilian occupational therapists: seeking consensus on occupational terminology

The purpose of this study was to examine how key occupational therapy terminologies are used by Brazilian occupational therapists. A nominal group approach combined with a Delphi technique involving 31 Brazilian occupational therapists was applied. A sociolinguistic approach was adopted since it broadens our understanding of the social and cultural determinants of terminology consolidation. Brazilian occupational therapists were found to adopt the term activity more often than human action or doing. Even less often were praxis and occupation applied. No consensus was reached regarding which of the terms is most preferred. While Brazilian occupational therapists have been developing their profession from international standards, it is still embedded in local demands and policies. Additionally, the political context must be considered when building an international dialogue between members of a professional body. Such a dialogue could engage professionals from different countries in meaningful exchanges about their practices. These exchanges may lead to the development of solid professional communities that can contribute meaningfully to social change. Copyright © 2010 John Wiley & Sons, Ltd.     

Occupation-based intervention in hand injury rehabilitation: Experiences of occupational therapists in Malaysia

Introduction: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists’ experiences of providing OBI in hand injury rehabilitation in Malaysia. Methods: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. Results: Definition of “Occupation as a means”, and “Occupation as an end” was broadened after data analysis of interviews to include two new themes: “Rewarding yet challenging” and “Making OBI a reality”. Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. Conclusion: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients’ maximum level of functioning both can be used for successful rehabilitation of hand injuries.     

Occupational Status as Documented in Records for Stroke Inpatients in Sweden

The Swedish literature shows shortcomings in the documentation of occupational therapy in patient records, especially goal setting and evaluation at discharge. Modern society has adopted the language of medicine as a framework for organizing all health service, and the law and regulations do not clearly define how to document goals, or how to record the evaluation of the interventions. Improvements are needed. Since "occupational performance" is a current concept in goal setting and evaluation of occupational therapy, the aim of this study was to obtain an understanding of how occupational performance is documented for stroke inpatients. Twenty occupational therapy records from stroke inpatients at a hospital in Sweden were analysed, using the method of constant comparison. "Occupational status" was found to be the core concept, which includes occupational performance "areas" and "aspects" assessed in pre-stroke, at admission, and at discharge. The "areas" were personal care, meal preparation, and transfer at home. The ''aspects" taken into consideration were independence, difficulty, problem related to impairment, patient contribution, safety, and physical environment. The study revealed that, as far as stroke inpatients are concerned, occupational therapists regularly documented occupational areas and assessed six aspects of occupational performance.     

Barriers to Occupational Therapy Practice in Wellness

Wellness programs are intended to increase the wellbeing of society and as a consequence reduce health care costs. Occupational therapy writers have urged therapists for the past two decades to move into wellness-related programming, yet current practice trends reflect only minimal involvement in wellness. The purpose of this study was to identify barriers to wellness practice, components of occupational therapy philosophy and practice that can promote wellness, and wellness concepts which can be incorporated into patient therapy sessions. Semi-structured interviews were conducted with three occupational therapists, two related health professionals and two former patients, all of whom have made contributions in wellness programming. A summary of the barriers to occupational therapists, entry into wellness is presented. Also, recommendations are provided on how occupational therapists can expand their holistic approach to include wellness concepts in all areas of practice.     

Influences of the social environment on engagement in occupations: the experience of persons with rheumatoid arthritis

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants' experiences of engaging in occupations in two ways, which formed the categories: "Constructive collaboration" and "Insufficient collaboration". These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants' possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the "Conditions for collaboration" varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.     

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.     

Influences of the social environment on engagement in occupations: The experience of persons with rheumatoid arthritis

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants’ experiences of engaging in occupations in two ways, which formed the categories: “Constructive collaboration” and “Insufficient collaboration”. These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants’ possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the “Conditions for collaboration” varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.     

Occupational science: a renaissance of service to humankind through knowledge

The context for the development of occupational science, the study of the human as an occupational being, included the worldwide increase in the population of people with chronic impairments, decreased resources for people with handicaps, growth in the complexity of daily life and the global maturation of the profession of occupational therapy. Occupational science promises that occupational therapists will define the knowledge base of the profession and its appropriate scope of practice through scholarly work. Occupational scientists need to develop a fresh synthesis of ideas from those scholarly disciplines that view the human as a complex being who interacts with the environment by using occupation over the three time spans of evolution, human development and learning; occupation as agency; and viewing the person served as Homo occupacio, a dynamic, open human system. The occupational human engages in daily life through development of a repertoire of skills which adheres to the rules of culture. Such study will need to include the contexts in which people carry out their rounds of occupation. The ‘detective work’ of occupational scientists, contributing to but not bound by the immediate demands of occupational therapy practice, will be guided by the values and traditions of the field to ensure its relevance and ethical foundation. The most important tool of the world community of occupational therapists will be the mind of the occupational therapist, who, through knowledge of occupation, will foster human capability and influence health. Copyright © 2000 Whurr Publishers Ltd.     

Relevance and focal view point in occupational therapists' documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where "Activity" and "Health" are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on "activity" and holistic health notions.     

Older people's experiences of acute hospitalisation: an investigation of how occupations are affected

Background/aim: Few qualitative studies have investigated older people’s experiences of hospital admission and none has done so from an occupational perspective. The purpose of this study was to examine older people’s experience of acute hospitalisation. Methods: In‐depth semi‐structured interviews were conducted with six participants recruited from the Alfred hospital, Melbourne, Victoria. Data were analysed using Colaizzi’s (1978) approach to phenomenological analysis. Results: Five themes describing older people’s experience of acute hospitalisation emerged from the analysis: (i) not part of ‘normal life’; (ii) undesirable, but for the good of my health; (iii) understanding my condition and abilities; (iv) subject to approval; and (v) getting back into life. The importance of the individual’s occupational narrative emerged as a central theme in understanding the older person’s experience of acute hospitalisation. Conclusions: Occupational therapists have a unique contribution to make in encouraging meaningful occupation on hospital wards. Identifying the manner by which occupational therapists can most effectively implement the assessment of occupational performance in the acute care setting should constitute a research priority for future investigations.     

Sharing the agenda: pondering the politics and practices of occupational therapy research

AIMS: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. MAJOR FINDINGS: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. PRACTICE CONCLUSION: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

Strategies for understanding. A case study of occupational therapists' communication behaviour

This study focuses on the communication strategies of occupational therapists. Many recent studies in occupational therapy emphasize the importance of having a client-oriented perspective; the needs and wishes of the patient should form the basis for treatment. Such a perspective brings to the fore the capacity of the therapist to enter into the life-world of the patient. Communication, dialogue between patient and therapist, is the basic source of such knowledge. In this paper, understanding verbal acts is seen as fundamentally problematic. The purpose is to analyse what strategies and tactics occupational therapists use to create a basis for their interpretation of patients' messages. What kinds of questions and other forms of verbal behaviour are utilized to check and verify these interpretations? A case-study of communication behaviour during five meetings between patients and therapists in the homes of the patients was undertaken. Seven types of tactics were observed and categorized as belonging to two different strategic dimensions: active-passive and abstract-concrete. Although active strategies were predominant, only one therapist consistently used a combination of ‘asking open questions’ and ‘verifying’ interpretations, the two most active tactics. Most therapists also asked the patients to concretely ‘show in action’ what they meant, but to a varying degree. A consistent use of active-concrete strategies is arguably an ideal way of seeking knowledge and understanding. Empirically, therapists differ in how closely they fit this ideal. This may be a result of training and experience, but also of degree of empathy. This study points to the importance of carefully developing communication strategies in order to fully understand the problems of the patients. Copyright © 1997 Whurr Publishers Ltd.     

Enabling occupation in the 21st Century: Making good intentions a reality

Occupational therapists intend to collaborate with individuals, groups, agencies, and organizations in their search for meaningful occupations to promote health and justice. Since the 1997 publication of Enabling Occupation: An Occupational Therapy Perspective, Canada's latest guidelines on client-centred practice, the author has interwoven her ethnographic research in mental health services and client-centred practice to raise awareness of disjunctures between intentions and actual practice. Her 1999 Keynote Presentation at OT Australia's 20th National Conference in Canberra offers stories of George and Martha as allegories of the potential for enabling occupation in the 21st century. George presents a story of enabling occupation directly with people in need; Martha's story is about organizing services for enabling occupation. Through these stories, Dr Townsend calls occupational therapists to develop the language, organization and practice needed to make the profession's good intentions a reality in the 21st century.     

Relevance and focal view point in occupational therapists’ documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where “Activity” and “Health” are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on “activity” and holistic health notions.     

Encounters between older adults and occupational therapists during the assistive technology application process

ABSTACT

Background: From the perspective of older adults, the assistive technology application process is complex and their perceived involvement varies. Occupational therapists find it challenging to satisfy their clients’ needs while complying with the eligibility criteria of the service provision system. Research has shown that, from the perspective of both clients and occupational therapists, the application process is perceived to be challenging. However, little is known about which specific actions and experiences during the application process give rise to this perceived complexity.

Aim: The aim of this study was to investigate older adults’ and occupational therapists’ actions and experiences of their encounters during the assistive technology application process.

Material and method: Data were generated using repeated participant observations and informal interviews. Ricoeur’s theory of interpretation was used to interpret and discuss the data generated.

Results: Two themes emerged: Expressing needs and translating needs.

Conclusion: Older adults express their needs in different ways. When the older adults’ expression of needs does not correspond with the service provision system’s conditions of eligibility, the occupational therapists act as mediators, by translating experienced needs so that they are expressed in a way that corresponds to the expression of the eligibility criteria.