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.     

Integrating health literacy into occupational therapy: Findings from a scoping review

Abstract

This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) “health literacy” with (ii) “rehabilitation”, “occupational therapy”, or “health promotion”. Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

Building health promoting work settings: identifying the relationship between work characteristics and occupational stress in Australia

Occupational stress is a serious threat to the health of individual workers, their families and the community at large. The settings approach to health promotion offers valuable opportunities for developing comprehensive strategies to prevent and reduce job stress. However, there is evidence that many workplace health promotion programs adopt traditional, lifestyle-oriented strategies when dealing with occupational stress, and ignore the impact that the setting itself has on the health of employees. The aim of the present study was to address two of the barriers to adopting the settings approach; namely the lack of information on how psycho-social work characteristics can influence health, and not having the confidence or knowledge to identify or address organizational-level issues. A comprehensive occupational stress audit involving qualitative and quantitative research methods was undertaken in a small- to medium-sized public sector organization in Australia. The results revealed that the work characteristics 'social support' and 'job control' accounted for large proportions of explained variance in job satisfaction and psychological health. In addition to these generic variables, several job-specific stressors were found to be predictive of the strain experienced by employees. When coupled with the results of other studies, these findings suggest that work characteristics (particularly control and support) offer valuable avenues for creating work settings that can protect and enhance employee health. The implications of the methods used to develop and complete the stress audit are also discussed.     

Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence

Background: Clinical Practice Guidelines (CPGs) are prominent tools in evidence‐based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. Methods: This narrative review examines the health‐related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? Results: Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. Conclusions: By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided.     

Exploration of the occupations of people with schizophrenia

Background: Participation in occupations is a powerful determinant of wellbeing. This study focusses on obtaining a greater understanding of the occupational experiences of people with schizophrenia and the factors that facilitate or hinder occupational engagement. Sample: Six participants with schizophrenia living in an Australian urban community who were clients of an assertive outreach team formed the sample. Methods: Data gathered via semi‐structured interviews and observation were thematically analysed. Results: The findings are reported in three main themes: struggling to survive in the present, enabling and constraining factors in the living environment and the importance and value of work. Conclusions: These findings provide further evidence for occupational therapists working with consumers of mental health services to adopt practices that enable self‐determination of participation in occupations, increase supports and resources within the community environment and expand opportunities for work.     

A qualitative study of service user experiences of occupation in forensic mental health

Background/aim: This qualitative study explored occupational engagement of those detained in forensic units. Legal and institutional restrictions on occupation have implications for their health and wellbeing. Method: Twenty‐six current forensic mental health service users participated in five focus groups, which were audio‐recorded, transcribed verbatim and subjected to constant comparative analysis. Findings: The participants highlighted previous occupations, current occupations and hopes. Key aspects were control over decision‐making, motivation and support, generating suggestions alongside positive experiences of occupational therapy. Conclusions: Institutional barriers could be overcome with a dynamic balance between risk management and mental health promotion through occupation. This demands a sustained focus on occupation for everyone involved in providing care and treatment in these settings.     

The decriminalization of prostitution is associated with better coverage of health promotion programs for sex workers

Objective: In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, we compared health promotion programs in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalised if licensed, unlicensed brothels criminalised), Perth (criminalisation of all forms of sex work) and Sydney (sex work largely decriminalised, without licensing). Methods: We interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Results: Despite the different laws, each city had a thriving and diverse sex industry and a government‐funded sex worker health promotion program with shopfront, phone, online and outreach facilities. The Sydney program was the only one run by a community‐based organisation and the only program employing multi‐lingual staff with evening outreach to all brothels. The Melbourne program did not service the unlicensed sector, while the Perth program accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; p<0.001). Sex workers in Melbourne's licensed brothels were the most likely to have access to free condoms (Melbourne 88%, Sydney 39%, Perth 12%; p<0.001). Conclusions: The legal context appeared to affect the conduct of health promotion programs targeting the sex industry. Brothel licensing and police‐controlled illegal brothels can result in the unlicensed sector being isolated from peer‐education and support.     

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.     

Measuring rural allied health workforce turnover and retention: What are the patterns,determinants and costs?

Objectives: To measure variations in patterns of turnover and retention, determinants of turnover, and costs of recruitment of allied health professionals in rural areas. Design: Data were collected on health service characteristics, recruitment costs and de‐identified individual‐level employment entry and exit data for dietitians, occupational therapists, physiotherapists, podiatrists, psychologists, social workers and speech pathologists employed between 1 January 2004 and 31 December 2009. Setting: Health services providing allied health services within Western Victoria were stratified by geographical location and town size. Eighteen health services were sampled, 11 participated. Main outcome measures: Annual turnover rates, stability rates, median length of stay in current position, survival probabilities, turnover hazards and median costs of recruitment were calculated. Results: Analysis of commencement and exit data from 901 allied health professionals indicated that differences in crude workforce patterns according to geographical location emerge 12 to 24 months after commencement of employment, although the results were not statistically significant. Proportional hazards modelling indicated profession and employee age and grade upon commencement were significant determinants of turnover risk. Costs of replacing allied health workers are high. Conclusions: An opportunity for implementing comprehensive retention strategies exists in the first year of employment in rural and remote settings. Benchmarks to guide workforce retention strategies should take account of differences in patterns of allied health turnover and retention according to geographical location. Monitoring allied health workforce turnover and retention through analysis of routinely collected data to calculate selected indicators provides a stronger evidence base to underpin workforce planning by health services and regional authorities.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

Employment trends for occupational therapists: An analysis of employment advertisements in the Sydney Morning Herald 1984–90

Despite rapid growth in the number of occupational therapy graduates in Australia, almost no data are available concerning the demand and the expectations of employers. This study surveyed 6298 advertised positions available to occupational therapists, social workers, psychologists and counsellors in the state of New South Wales during the years 1984–90. Over this period the demand for occupational therapists grew by 53%, which exceeded the growth in demand for social workers and psychologists, but was less than that for community and mental health workers and counsellors. The employment base was found to be reasonably broad and 8% of jobs were in the private sector. The number of duties required of occupational therapists increased over time, and there was an increase in the demand for programme promotion, administration and supervision skills. The results are discussed in terms of the employment base and defining strengths of the profession, recommendations for strengthening the profession, and implications for the Australian Association of Occupational Therapists.     

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.     

Rehabilitation of Infant Oral Feeding Difficulties: A Survey of Occupational Therapists Practice Approaches

This study identifies the scope of occupational therapy practice for the rehabilitation of oral feeding difficulties in infants who are in the neonatal intensive care unit (NICU). A written survey was administered to 127 occupational therapists who work with infants in the NICU. All 68 (54%) respondents used a client-centered approach, taking into consideration the infant (intrinsic), caregiver, and environmental (extrinsic) factors. Family and health team education was the most commonly provided service with the majority of occupational therapists providing services only until feeding problems were resolved. Continuing education (n = 20, 30%) and own clinical experience (n = 22, 33%) were the two most common justifications to support their choice of practice. These results suggest a client-centered approach in the rehabilitation of oral feeding difficulties is commonly used, but services are not extended beyond hospitalization. Few occupational therapists used peer-reviewed journals as sources of evidence for their practice strategies.     

Occupational possibilities in a Brazilian mental health service: The perspective of users

Background: Psychosocial care centers (CAPS) are a type of service that redirects care to people with mental health problems in Brazil, de-emphasizing the asylum model and promoting the psychosocial model. Aim: To understand and analyze how CAPS contribute to the possibilities of occupational engagement of users. Methods: A qualitative research methodology was used and semi-structured interviews were conducted with 17 users of CAPS and 12 people from their social networks, totaling 29 interviews. Discourse analysis was used as a reference for data analysis. Results: CAPS provide opportunities, and, as users engage in the activities offered by CAPS, they can find the types of occupations that they want to perform and what they like to do, as their range of opportunities and access are expanded. However, promoting these occupational opportunities and choices in the community remains a challenge. Conclusions: CAPS have been able to help users improve their occupations in everyday life. Occupational therapists must build their clinical strategies in association with the opportunities offered by the health services and the community.     

National survey of Canadian occupational therapists’ assessment and treatment of cognitive impairment post‐stroke

Aim: This study examined variations in management of cognitive impairment post‐stroke among occupational therapists and factors associated with variations in practice. Methods: Canada‐wide cross‐sectional telephone survey. Clinicians’ practices were examined using standard patient cases (vignettes). Setting: Acute care, inpatient rehabilitation and community‐based sites providing stroke rehabilitation in all Canadian provinces. Participants: Occupational therapists (n = 663) working in stroke rehabilitation as identified through provincial licensing bodies. Main outcome measures: Type and frequency of cognition‐related problem identification, assessment and intervention use. Results: Respectively, 69%, 83% and 31% of occupational therapists responding to the acute care, inpatient rehabilitation and community‐based vignettes recognised cognition as a potential problem. Standardised assessment use was prevalent: 70% working in acute care, 77% in inpatient rehabilitation and 58% in community‐based settings indicated using standardised assessments: 81%, 83% and 50%, respectively, indicated using general cognitive interventions. Conclusion: The Mini‐Mental State Examination was often used incorrectly to monitor patient change. Executive function, a critical component of post‐stroke assessment, was rarely addressed. Interventions were most often general (e.g. incorporated in activities of daily living) rather than specific (e.g. cueing, memory aids, computer‐based retraining).     

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.