Professional competence for private practitioners in occupational therapy

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi-structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.     

Community mobility in the context of universal design: Inter‐professional collaboration and education

Background/aim: The design of built environments is a critical factor in facilitating participation for all community members. This study aimed to explore key stakeholders’ views on the role and collaboration of occupational therapists and architects in relation to universal design and the built environment. This study is currently the only research to focus on the needs and practices of both occupational therapy and architecture in universal design. The results have implications for both clinical practice and professional education, and highlight an area of developing interest in occupational therapy. Methods: Focus groups and semi‐structured telephone interviews were conducted with key stakeholders involved in the design of built environments. Data from these interviews were analysed qualitatively, using codes of interpreted meaning which were then organised into themes. Results: Three main themes emerged in relation to inter‐professional collaboration around universal design: ‘form vs. function’, ‘the earlier the better’ and ‘universal design as a specialist area’. Discussion/conclusions: Although there are areas of synergy between occupational therapy and architecture in universal design, each profession has its own strengths and skills to bring to the design process. Given the multidisciplinary nature of ensuring designs support participation in occupations and roles, both professions could benefit from opportunities to meaningfully collaborate during professional education and in the workplace.     

Transition of graduates of the Master of Occupational Therapy to practice

Background/aim: The transition from classroom to clinical practice is a necessary and challenging journey for occupational therapy students. In recent years, worldwide trends in occupational therapy education are moving towards graduate‐entry in professional preparation courses. Little is known about the journey experienced by these graduates when they enter practice. This qualitative study aimed to explore the lived experience of these graduates in their transition from student to practitioner within first six months of practice. Methods: A phenomenological approach was adopted for this study. Using purposive sampling, eight participants from a recent graduate cohort of the Master of Occupational Therapy from the University of Sydney were recruited. Data was collected via in‐depth, face‐to‐face interviews. The focus of inquiry was on the experience of transition. Interviews were audio‐taped, transcribed and analysed thematically. Member checking and consensus coding were conducted to increase trustworthiness of the study. Results: Four themes emerged from the interview data. The themes were (i) valuing maturity; (ii) being new; (iii) needing skills; and (iv) pursuing satisfaction. Participants described metaphors about their experience across and within these themes. Conclusions: Recognising the experience of transition from student to practitioner has the potential to assist university staff in the development of the educational curriculum. Understanding this transition can also help employers and therapists in providing adequate support and supervision for new graduates. Furthermore, awareness of the transition experience allows students to better prepare themselves for their own transition to practice.     

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.     

Caring and daily life: Occupational experiences of women living with sons diagnosed with schizophrenia

Occupational therapists need to appreciate carers' lived experiences to build and maintain effective partnerships with them in mental health practice. This study explored the caring experiences of six women living with sons diagnosed with schizophrenia from an occupational perspective, using the Occupational Performance History Interview-II. Thematic analysis identified five themes: 'It's a whole new thing' described carers' initial confusion and learning; 'the need to provide support' concerned the tasks involved in caring; and 'this situation just evolved' was about their adaptation to caring. 'Much of our life is focused on him' was about these women's home lives, while 'don't get too optimistic' concerned emotional aspects of their experiences. These themes illustrate how the women's life trajectories and occupations were altered to incorporate caring. The pursuit of their interests, in addition to care-related occupations, appears important for carers to sustain satisfying lives. Occupational history interviewing provided a useful method for learning about the life transitions and occupational issues faced by people in caring roles. Its use by occupational therapists in building partnerships with immediate family and friends of persons experiencing mental illness is recommended.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

What needs to be done? Occupational therapy responsibilities and challenges regarding human rights

Background: Addressing human rights issues brings forth ethical and political responsibilities for occupational therapists and requires new epistemological and educational approaches. The way occupational therapists have faced these challenges has depended upon historical, cultural and social contexts. Aim and method: By means of literature review and historical analysis, this paper reflects on how occupational therapists have dealt with human matters issues and on the contemporary changes within the profession. Results and discussion: The paper portrays how Latin American occupational therapists have engaged in social transformation by choosing not to transform ethical and political problems into technical matters. Taking into account experiences and views from South Africa, Brazil and Chile, the paper outlines the importance of developing political literacy and interdisciplinary professional/postprofessional education to prepare the new generation of occupational therapists to engage in social transformation. Addressing issues of invisibility and lack of access to human rights, the paper reflects on the need of developing conceptual tools and strategies for change, and discusses the transformations being produced in contemporary occupational therapy. Conclusion: Occupational therapists and scientists need to be attentive to human rights issues. They also need to answer the call for interconnectedness in the present‐day complex societies, and engage in networking and a cross‐bordering dialogue. Nevertheless, although necessary and welcome, international cooperation requires a permanent exercise of cultural sensitivity, political awareness and self‐awareness.     

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.     

Professional and organizational commitment in paediatric occupational therapists: the influence of practice setting

The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web‐based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty‐seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school‐based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web‐based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale. Copyright © 2010 John Wiley & Sons, Ltd.     

Utopian visions/dystopian realities: exploring practice and taking action to enable human rights and occupational justice in a hospital context

Aim: This article reports some preliminary findings of an Australian action research project that aimed to investigate, and affect, occupational therapists’ understanding of human rights theory and occupational justice philosophy in everyday occupational therapy practice. Method: Over the course of one year, nine therapists from a range of practice areas in a major metropolitan hospital participated in monthly discussion groups. Narrative data was collected through audio‐recording and transcribing the discussions. Data was qualitatively analysed using line‐by‐line coding and theme‐building. Results: Two preliminary themes are discussed herein: the invisibility of human rights issues in an Australian occupational therapy setting and the dissonance between the ideal and the reality of human rights practice in occupational therapy. Conclusion: The authors suggest that through discussion, and with the support of a community of practice dedicated to exploring human rights and occupational justice issues, occupational therapists can increase their awareness of human rights challenges. And, therapists can increase their actions to better enable occupational justice in their practice.     

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.     

Factors influencing job satisfaction among Jordanian occupational therapists: a qualitative study

Purpose: The main purpose of this study was to explore factors influencing job satisfaction and dissatisfaction among Jordanian occupational therapists. Methods: Ours was an explorative qualitative study involving the use of structured open‐ended written questions. Participants were asked to answer in narrative their perception about the factors behind their job satisfaction and dissatisfaction. In addition, they were asked to express their suggestions, ideas, or solutions for increasing job satisfaction. Results: Ninety‐three occupational therapists responded to the survey. For job satisfaction questions, four themes emerged: a humanistic profession; professional issues; work benefits; and work environment. Participant’s comments at the end of the survey revealed one general theme for improving job satisfaction, ‘a call for improvement’. Discussion: This qualitative study revealed that the humanistic nature of occupational therapist was counterbalanced by several dissatisfying factors for occupational therapy practitioners in Jordan. The need for better supported working conditions in terms of financial rewards, recognition, awareness and resources as well as public and professional recognition of occupational therapists are needed to enhance the occupational therapy profile in Jordan. A comprehensive collaboration is highly needed between the individual practitioners, representatives of the profession, government and hospital administrators.     

Occupational therapy practitioners’ perspectives regarding international cross‐cultural work

Aim: The purpose of this study was to investigate the perspectives of occupational therapy practitioners who have engaged in cross‐cultural work experiences. The research question was how do occupational therapy practitioners make meaning of their lived cross‐cultural experiences. Methods: This study utilised a qualitative, phenomenological design. Eleven open‐ended, semi‐structured interviews were conducted with occupational therapy practitioners educated in the United States and who engaged in international practice. The interviews were then coded and analysed using a constant comparative analysis approach. Results: Three central themes emerged from the completed interviews and data analysis, including connectedness, cultural awareness and complexity. Connectedness is the process of forming relationships with others while engaging in cross‐cultural experiences. Cultural awareness is the recognition and understanding of a different culture, comparing these insights with one’s own culture and then responding to those differences. Complexity is the idea that cross‐cultural experiences are dynamic, multi‐faceted and intricate. Conclusions: This study helps provide an understanding of cross‐cultural work experiences from the practitioners’ perspective. The demands of such work require practitioners to go beyond developing basic skills related to cultural sensitivity and cultural awareness. Instead, practitioners need to embrace and integrate the ability to incorporate layers of cultural awareness, complexity and connectedness into practice. Further research is needed to understand how this is actually developed and utilised within practice.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

Clinical outcomes research from the occupational therapist's perspective

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.     

International fieldwork placements and occupational therapy: lived experiences of the major stakeholders

Introduction: Occupational therapy students obtain a great deal of their professional preparation and experience through fieldwork placements. Although many occupational therapy students have taken part in international fieldwork placements, there is little research on this topic. As fieldwork placements are an integral part of the education of occupational therapy students, literature on the subject of international fieldwork placements is necessary. Accordingly, the aim of this study was to examine the personal and professional experiences of occupational therapy students, supervisors, and on‐site staff who have taken part in an international fieldwork placement. Methods: Qualitative interviews for this phenomenological study were administered with 14 participants who had taken part in an international fieldwork placement in Trinidad and Tobago. Data were analysed using thematic analysis. Findings: Three themes emerged: collaborative learning, cultural negotiations and thinking on my own. Discussion: Considering fieldwork is a critical component in the occupational therapy curriculum, it is reassuring to uncover that international placements can be of benefit to all stakeholders while achieving its primary goal of preparing students to become competent therapists. All participants developed a greater cultural awareness and appreciation, which is necessary as occupational therapists are increasingly working in diverse settings with diverse client groups. This information can also be used to enhance international fieldwork education as students continue to travel abroad to complete their mandatory fieldwork hours.