Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

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.     

Clinical reasoning and the occupational therapy curriculum

Several reasoning styles are used by occupational therapists when they evaluate clients' problems. This study investigated the influence of the occupational therapy curriculum in Hong Kong on therapists' clinical reasoning styles. Two groups of therapists with different clinical experience were recruited. Through interviews with the therapists after identifying clients' problems using the Canadian Occupational Performance Measure, their clinical reasoning styles were explored. The local occupational therapy curriculum was analysed to isolate the components that influence clinical reasoning. Results showed that more experienced therapists use conditional reasoning that considers clients' needs in their future lives whereas junior therapists use procedural reasoning that focuses on clients' disabilities. The analysis of the occupational therapy curriculum indicated that it prepared the students with an equal emphasis on theoretical and clinical subjects and fieldwork practice. The present curriculum was useful in providing educational preparation for novice therapists. However, the period of fieldwork practice can be lengthened to allow adequate maturation of clinical reasoning skills. Problem‐based learning can be incorporated to facilitate students' problem‐solving and self‐directed learning skills. Copyright © 2000 Whurr Publishers Ltd.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Evidence-based practice in everyday clinical practice: strategies for change in a tertiary occupational therapy department

Evidence-based practice is an approach that has gained recognition for facilitating the transfer of evidence into quality clinical practice. While occupational therapy clinicians have a professional responsibility to ensure that their practice is effective, managers also have a responsibility to implement structures and systems that will support therapists in doing so. A review of the literature demonstrated limited evidence of specific organisational models of practice to facilitate the transfer of knowledge into occupational therapy practice. This paper outlines the steps undertaken by occupational therapists in a large tertiary teaching hospital to develop and implement a model of research utilisation. The resulting Research and Evidence in Practice model and the enabling strategies for its implementation are presented. A challenge for the future is to conduct a formal evaluation of the model.     

Becoming “At Home” in Home Modifications: Professional Reasoning Across the Expertise Continuum

ABSTRACT

Professional reasoning used by occupational therapists in home modifications as they develop from novice to expert was explored in this grounded theory study. Eight occupational therapists participated in multiple interviews and member checks about home modifications training and practice. Formal academic and experiential learning provided the foundation for reasoning systems and habits of practice. As therapists gained expertise, they were able to shift their primary focus from systematic reasoning steps to focus on the comprehensive, client-centered, and contextual picture. Creative educational strategies support confidence in engaging in home modifications practice.     

The process of evidence-based practice in occupational therapy: Informing clinical decisions

As we move into the 21st century, there are increasing demands placed on occupational therapists to ensure their practice is based on sound evidence. Evidence-based practice is an approach to clinical decision making that has gained considerable interest and influence during the last decade. This article describes and explains the process of evidence-based practice and its application to clinical occupational therapy practice. Directions for resources that may assist therapists' self-directed learning are also provided. As health care becomes more evidence-based, awareness of the principles, skills, and resources for evidence-based practice is of relevance to all occupational therapists.     

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.     

Hospice and palliative care: A Delphi survey of occupational therapists' roles and training needs

This paper describes the use of the Delphi survey method to identify the roles and training needs of occupational therapists working in the field of hospice and palliative care in Australia. The study was conducted in 1993 using a purposive sample of 47 occupational therapists. The survey consisted of three consecutive questionnaires and five in-depth interviews. The results indicated that there is a role for occupational therapy in this new and expanding field, and that occupational therapists need to promote a higher profile for their profession and their skills through research, education and presentations to maximize this role. The study also highlighted the importance of continuing education for occupational therapists working in this field.     

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.     

Icelandic occupational therapists' attitudes towards educational issues

The purpose of this study was to assess the readiness of occupational therapists in Iceland to accept a professional as opposed to a technical view of the profession. Most Icelandic occupational therapists were educated in other countries, with little emphasis on liberal arts, sciences and research. The first Icelandic occupational therapy programme, a university-level programme, was founded in 1997. All Icelandic occupational therapists were surveyed. Eighty-seven questionnaires were sent out and 80 (92%) were returned and used for statistical analysis. The results of the study showed that Icelandic occupational therapists valued academic skills over technical skills, emphasizing occupational therapy theory unique to the profession and research to validate practice. More recognition among other health professionals was considered the most needed change in the profession. The results of the study showed that the clinicians' attitudes confirmed in general what is emphasized in the curriculum and in students' fieldwork. Further research is needed to explore whether the Icelandic occupational therapy profession succeeds in promoting research and recognition by other health professions.     

Occupational therapists' skills and attitudes regarding use of computers and assistive technology

The purpose of this study was to examine the skills and attitudes of a sample of practicing occupational therapists regarding the use of computers, and to explore their agreement with the Foundation Level Technology Competencies proposed for adoption in the United States of America (American Occupational Therapy Association, 1991; reported in Hammel and Smith, 1993). Out of a sample of 250 subjects, 89 occupational therapists in the USA completed a questionnaire regarding their experiences with, and attitudes towards computers, and their agreement with the proposed Competencies. The results indicated that while the majority of therapists had had some exposure to computers, they wanted to learn more—particularly how a computer could aid management tasks. While 50% or more of the therapists ‘Agreed’ or ‘Strongly Agreed’ with 19 of the 21 Competencies, the level of therapist ‘Indecision’ or ‘Disagreement’ with several of the Competencies suggests that either these Competencies require revision, or that if the Competencies are nationally adopted, many therapists may require intensive continuing education programmes to bring their skills to a competent standard. Adoption of these Competencies has many implications for international standards of occupational therapy practice and levels of computer education. Copyright © 1997 Whurr Publishers Ltd.     

Occupational therapists' experience of working with immigrant clients in mental health care

Abstract

Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, “the challenges of the multicultural therapeutic journey—a journey on a winding road” was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice.     

Radical changes or traditional approaches in a different guise? An analysis of the Norwegian mother-child service.

In recent years practitioners within the Norwegian mother and child health service have been advised to change their approach to parents, and in particular to play down their traditional "expert" role. On matters concerning their own child, parents have come to be regarded as the "experts," and scientific knowledge is no longer considered superior to skills gained through practical experience. However, current recommendations for practice are inconsistent, and rather than being reduced, professional authority and control have entered a new mode. Instead of being articulated and made explicit these aspects of the mother-child service are disguised. The language employed by the service might act to mask attempts to maintain the traditional relationship between professionals and parents. This article does not direct a one-sided critique toward the exercise of professional authority within this field of practice, but instead seeks to initiate a discussion on legitimate and illegitimate forms of authority and control. The analysis draws on two sources of data: documentary materials and interviews with public health nurses.     

Occupational therapists and the concept of power: A review of the literature

The concept of power is discussed in the broader health literature and the occupational therapy literature from three perspectives. These are the trait approaches to professionalization, the medical dominance perspective and the view of health care work places as organizations. The results of the review suggest that the power of the profession of occupational therapy is linked to a number of factors. These include its status as an occupation, the fact that the majority of its members are women and the extent to which therapists have knowledge and skills related to working with other disciplines in a changing political climate. While the review enables the type of knowledge and skills which would assist therapists to develop and exercise their power within the health sector to be suggested, the extent to which therapists actually possess the knowledge and skills is unknown due to a lack of research in the area.     

Becoming an evidence-based practitioner through professional development

Occupational therapy practitioners need to incorporate evidence-based practice into their professional role to remain competent, relevant and clinically effective. However, therapists may feel uncomfortable with the emphasis on evidence, may not know how to use it in practice and may not know where to start to develop the necessary skills. This paper explores these issues and proposes six strategies for continuing professional development which individual therapists can consider using or promoting to become evidence-based practitioners. These strategies are: (i) changing individual practitioner behaviours; (ii) changing consumer behaviours and expectations; (iii) using evidence about how best to get evidence into practice; (iv) developing institutional requirements for evidence-based practice; (v) supporting professional association initiatives; and (vi) using or developing local clinical guidelines. Each of these strategies is described in detail.     

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.