Occupational therapists’ perceptions of gender – A focus group study

Background/aim: Women and men are shaped over the courses of their lives by culture, society and human interaction according to the gender system. Cultural influences on individuals’ social roles and environment are described in occupational therapy literature, but not specifically from a gender perspective. The purpose of this qualitative study was to explore how a sample of occupational therapists perceives the ‘gender’ concept. Method: Four focus group interviews with 17 occupational therapists were conducted. The opening question was: ‘How do you reflect on the encounter with a client depending on whether it is a man or a woman?’ The transcribed interviews were analysed and two main themes emerged: ‘the concept of gender is tacit in occupational therapy’ and ‘client encounters’. Results: The occupational therapists expressed limited theoretical knowledge of ‘gender’. Furthermore, the occupational therapists seemed to be ‘doing gender’ in their encounters with the clients. For example, in their assessment of the client, they focussed their questions on different spheres: with female clients, on the household and family; with male clients, on their paid work. Conclusions: This study demonstrated that occupational therapists were unaware of the possibility that they were ‘doing gender’ in their encounters with clients. There is a need to increase occupational therapists’ awareness of their own behaviour of ‘doing gender’. Furthermore, there is a need to investigate whether gendered perceptions will shorten or lengthen a rehabilitation period and affect the chosen interventions, and in the end, the outcome for the clients.     

Home Assessment of Person-Environment Interaction (HoPE): Content Validation Process

ABSTRACT

The purpose of this paper is to present the content validation, including a pilot test, of the Home Assessment of the Person–Environment Interaction (HoPE). The HoPE fills a gap for evaluating issues related to home adaptation. Using qualitative methods, a two-phase study was conducted: an expert consultation and a pilot test. The expert consultation was conducted via focus groups with occupational therapists (n = 20), and individual interviews with adults who had undergone home adaptation (n = 5). The pilot test was undertaken using a multiple case study design of four adults awaiting home adaptation. Data were audio-recorded, transcribed, and analyzed using NUD.IST software. In phase 1, experts agreed with the content of HoPE and suggested minor changes. In phase 2, HoPE enabled occupational therapists to identify handicap-creating situations. After both phases, the final version of HoPE is more comprehensive than other current tools and addresses the complex experiences of clients with whom occupational therapists work which suggests a new approach for practice regarding home adaptation.     

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 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.     

Development and content validity of the Norwegian Self-Assessment of Modes Questionnaire (N-SAMQ)

Background: The Intentional Relationship Model (IRM) introduced six therapeutic modes as ways of relating to clients. By increasing occupational therapists’ awareness of modes, and by increasing their skills in using them, therapists may improve their interactions with clients. The Self-Assessment of Modes Questionnaire may assist in increasing awareness of modes. Aim: To describe the process of developing a Norwegian version of the Self-Assessment of Modes Questionnaire (N-SAMQ) and to evaluate its content validity. Materials and methods: A 10-step translation and adaptation procedure was followed. Occupational therapists working in diverse practice areas completed the preliminary N-SAMQ version. Individual cognitive interviews were performed with these therapists in order to examine the comprehensibility and cultural appropriateness of the N-SAMQ. Results: Initially, one item was omitted. Following the pilot study (n?=?7), two of the remaining items were modified with a view to increasing their cultural relevance. Otherwise, modifications were made mostly in terms of words and phrasing. Conclusion: The N-SAMQ appears to have good face and content validity. Significance: With the N-SAMQ, Norwegian occupational therapists can assess their preferred therapeutic modes.     

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

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

Differences and similarities in therapeutic mode use between occupational therapists and occupational therapy students in Norway

Background: The Intentional Relationship Model (IRM) is a new model of the therapeutic relationship in occupational therapy practice. Two previous studies have focused on therapist communication style, or ‘mode’ use, but to date no group comparisons have been reported.

Aim: To explore differences between occupational therapists and occupational therapy students with regard to their therapeutic mode use.

Methods: The study had a cross-sectional design, and convenience samples consisting of occupational therapists (n?=?109) and of second-year occupational therapy students (n?=?96) were recruited. The Self-Assessment of Modes Questionnaire was the main data collection tool. Group differences were analysed with independent t-tests.

Results: The occupational therapists responded more within the collaborative and empathizing modes than the students did. The students responded more within the advocating and instructing modes than the occupational therapists did.

Conclusion and significance: There may be systematic differences between occupational therapists and students concerning their therapeutic mode use. Some modes, such as the collaborating and empathizing modes, may be viewed as requiring more experience, whereas other modes, such as the advocating mode may be related to more recent rehabilitation ideologies. These factors may contribute to explaining several of the group differences observed.     

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.     

Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push

Background/aim: Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method: Thirty‐eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results: Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ‘bored’ or ‘stale’, organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions: The results supported the development of a ‘push and pull’ conceptualisation of recruitment and retention issues, including job‐related (intrinsic) and non‐job‐related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.     

Novice occupational therapists' perceptions of readiness to undertake fieldwork supervision

Aim: This study investigated new graduate occupational therapists’ perceived readiness for the fieldwork supervisor role at a metropolitan Melbourne Hospital. Methods: Data from four in‐depth individual interviews and a focus group conducted with seven Grade 1 occupational therapists were analysed thematically. An iterative process was used to develop themes from the categories of data. Results: The new graduate occupational therapists’ perceived readiness for supervising students was strongly influenced by a sense of still learning themselves. High expectations were expressed of the supervisory role. Active support and supervision from the workplace and the university are seen as neccessary. Conclusions: A deeper understanding of the supervisory role and associated skills required for new graduate therapists is needed. Support from senior colleagues and workshops conducted by the university to up‐skill the therapists are recommended.     

Communicating with Employers: Experiences of Occupational Therapists Treating People with Musculoskeletal Conditions

Purpose Many employed people with musculoskeletal conditions rely on healthcare practitioners, including occupational therapists, for work-related advice and support. Good communication between healthcare practitioners and employers is considered vital in facilitating work retention and return to work. The purpose of this study was to explore the experiences of occupational therapists in communicating with patients’ employers. Methods Qualitative data were collected from the responses of occupational therapists to ten statements/open questions in a questionnaire survey of UK occupational therapists. Data were copied verbatim into word documents and analysed thematically. Results A total of 649 comments were made by 143 respondents. Five themes were identified that were associated with communicating with employers: patient-dependent; employer-dependent; therapist-dependent; extrinsic factors; methods of communication. Conclusion This study has identified that communication between occupational therapists and employers is influenced by a number of factors, including those which are outside the therapists’ control. These need to be acknowledged and addressed by therapists, their professional organisation, employers, commissioners, therapy service managers, educators and employees in order to support return-to-work and work retention of people with musculoskeletal conditions.     

Occupational therapists report a low level of knowledge,skill and involvement in evidence‐based practice

This study was conducted to collect information about Australian occupational therapists’ involvement in evidence‐based practice. The study aimed to document: (i) respondents’ level of knowledge and skills; (ii) their level of participation in continuing education; and (iii) perceived barriers to evidence‐based practice. A purposive sample of 85 occupational therapists was invited to complete a questionnaire prior to attending an introductory workshop on evidence‐based practice. Sixty‐seven questionnaires were returned and analysed (78.8% response rate). Half of the respondents rated their level of knowledge and skills required for evidence‐based practice as low (conducting database searches = 50.7%; critically appraising literature = 53.0%). The majority of respondents (79.1%) reported a low level of knowledge about electronic databases. Few respondents had attended education sessions on evidence‐based practice (15.0%). The six most commonly reported barriers to adopting evidence‐based practice were lack of time, a large caseload, limited searching skills, limited appraisal skills, difficulty accessing journals and a perceived lack of evidence to support occupational therapy intervention. The majority of occupational therapists in this sample were entering the first phase of continuing professional development in relation to evidence‐based practice.     

The values of occupational therapy: Perceptions of occupational therapists in Quebec

Objective: Recently, there has been increasing interest in the values of occupational therapy and the values held by occupational therapists. A wide range of values has been reported in the literature. Furthermore, despite the fact that values are an important part of professional identity, empirical studies have demonstrated that several occupational therapists possess an ambiguous professional identity. This study was undertaken to explore the values of Canadian occupational therapists, specifically French-speaking occupational therapists in Quebec. Methods: Semi-structured interviews were conducted with 26 occupational therapists. Their narratives were subject to hermeneutic analysis, a method of textual analysis common in philosophical research. Results: A total of 16 values were identified in the discourses of the occupational therapists interviewed: autonomy; human dignity; occupational participation; social justice and equity; professionalism; holism; partnership, environment, or ecological approach; quality of life; solicitude; honesty; integrity; health; creativity; professional autonomy; effectiveness; and spirituality. Conclusions: The results of this study are, in general, consistent with those reported in the few other empirical studies that have documented the values perceptions of occupational therapists. Finally, the explanation of the values of occupational therapists may reinforce their professional identity and favour best, or at least desirable, professional practices related to ethics and culture.     

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

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

Exploring Arising Moments and Mindfulness in Occupational Therapists Working in Diverse Clinical Practice Areas

ABSTRACT

An online survey was conducted with 72 Canadian occupational therapists to (1) explore if and how occupational therapists were aware of “arising moments” in clinical practice, which are moments that give rise to emotions, sensations, and thoughts, and (2) to examine therapists’ responses to questions related to mindfulness. Participants described arising moments through an open-ended survey question. Framework analysis was used to develop key themes and subthemes. A modified Philadelphia Mindfulness Awareness (PHLMS) subscale with two additional survey questions “understanding of living in the moment and being present, and awareness of mindfulness” (sum = PAM) were used as indicators of mindfulness. There were significant differences in the means of PHLMS mindfulness among therapists working in diverse practice areas (F = 3.63, p = .009). Posthoc analysis revealed that therapists working in mental health had higher mean PHLMS-mindfulness scores than in all other groups. There were no significant differences in PAM mindfulness among the practice areas (ANOVA, F = 2.15, p = .08). However, posthoc tests showed that the participants in the mental health practice area had a significant difference with one group, general physical health. Findings have implications for practice in occupational therapy and education about mindfulness in occupational therapy.     

The development of expertise in paediatric rehabilitation therapists: the roles of motivation, openness to experience, and types of caseload experience

Background/aim:  A transdisciplinary approach was taken to study the nature of variables associated with the development of expertise in 71 paediatric rehabilitation therapists (i.e. physical, occupational, speech, behavioural, and recreational therapists).
Methods:  Six groups of practising therapists were identified based on expertise status (novice, intermediate, and expert, as determined by a multifaceted assessment battery), and their level of clinical experience (10 years or less, more than 10 years). Scores for these six therapist groups were examined on three variables generally considered to be associated with the development of expertise — motivation, openness to experience (as defined by the critical-thinking dispositions of truth-seeking, open-mindedness, and cognitive maturity), and features of their clinical caseload experience (i.e. breadth of experience as measured by number of different client age groups worked with, the complexity of clients' needs, and experience in delivering services to adolescents, school-age children, preschoolers, and infants).
Results:  Low-experience experts ('young stars') had the highest motivation, truth-seeking, and open-mindedness scores of all groups, the highest percentage of clients with complex service needs, and were more likely to work with adolescents.
Conclusions:  The major differences between therapists who attain expertise quickly versus those who remain novices after many years of experience appear to be motivation and complexity of work experiences. Implications for supporting the development of expertise in practising therapists are discussed.