Cultural tensions in occupational therapy practice: considerations from a Japanese vantage point.

Culture not only assigns a name to occupation through its language, but it also shapes the form it takes and the meaning with which it is imbued. When an individual chooses an occupation, psychological and physical concerns as well as cultural practices, values, and beliefs come into play. Although occupational therapists are trained to be culturally competent, their grasp of the importance of cultural considerations can be enhanced through detailed accounts of the way in which such concerns affect clinical practice. In this paper, I describe in detail my observations of how differences between American and Japanese culture have created tensions in occupational therapy practice in Japan. Further, largely through a case presentation, I illustrate the necessity for incorporating in-depth cultural considerations as a central part of the occupational therapy process. I argue that the study of culture and the production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy.     

Application of the Person-Environment-Occupation Model: a practical tool.

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.     

The patient-therapist relationship in occupational therapy: understanding visions and images

The patient-therapist relationship in occupational therapy has been a blend of competence and caring with the emphasis fluctuating over the years between these two features. When patients tell stories about their experiences, they reveal widely differing views of occupational therapists, partly because of the different ways therapists manifest competence and caring during patient-therapist interactions. Images from stories suggest that some therapists unwittingly disappoint their patients. This paper examines the patient-therapist relationship as envisioned by therapists and patients to help occupational therapists recommit to the patient as a vital partner in a collaborative relationship.     

A prevention model for occupational therapy

The role of occupational therapy in prevention has received much discussion but relatively little empirical testing and model building. Because of the evidence linking stress and illness, the life stress process has become a popular area of investigation. More importantly, a role strain model can provide a theoretical guide to occupational therapy practice due to the central importance of adaptive behavior and social competence. To illustrate, the maternal stress study is presented as an example of prevention research that examines the relationship between maternal stress and child psychopathology. Risk factors are identified as the first step in reliable case finding and the design of preventive interventions. Such model building can help occupational therapists develop prevention services for vulnerable populations.     

Tools of practice: heritage or baggage? 1986 Eleanor Clarke Slagle lecture

Occupational therapists have used many media and methods over the years to achieve the therapeutic potential of occupational therapy. Yet the reasons for selecting a specific medium or method frequently have been lost or changed without consideration of the result to the therapeutic situation. When neither therapist nor patient understands fully the rationale for a medium or method, the therapeutic potential of that medium or method may be compromised. The author suggests there are eight factors that influence the selection and discarding of media and methods in the practice of occupational therapy. The effects of the eight factors can be summarized in 14 assumptions. Three examples--arts and crafts, sanding blocks, and work-related programs--are used to illustrate the factors and assumptions. It is suggested that improved analysis of occupations based on values and interests could reduce the separation of meaning and purpose in the selection and discarding of media and methods used in occupational therapy practice.     

Personal-professional connections in palliative care occupational therapy.

This qualitative study examined the experiences of occupational therapists working in palliative care. Multiple qualitative interviews were conducted with each of eight occupational therapists working with people who are terminally ill. The interviews were transcribed verbatim and analyzed for recurring and unique themes. Five themes emerged: satisfaction, hardship, coping, spirituality, and growth. Common themes, while resonating through all participants' stories, were experienced in a uniquely personal way by each participant. The result was the discovery of an individualized "personal-professional connection" for each participant. The exploration of personal-professional connections can contribute to the understanding of occupational therapy practice in palliative care. Furthermore, these individual stories may resonate for other occupational therapists and inspire personal and professional reflection; validation of feelings and issues can arise from parallel comparisons. Therapists may in tum gain insight into the relationship between their own personal and professional experiences.     

Perceived control: how is it related to daily occupation in patients with mental illness living in the community?

Perceived control is of significance in occupational therapy, as revealed in empirical research and suggested in practice models. This study investigated the relationship between perceived control and occupational performance in persons with long-term mental illness. The 177 participants were assessed regarding perceived control (locus of control and self-mastery) and occupational performance (activity level and satisfaction with daily occupations). Subgroups with respect to diagnosis and having gainful employment or not were also explored concerning the targeted association. The results indicated relationships between perceived control and occupational performance in the sample as a whole and in all subgroups except that representing people engaged in gainful employment or education. The latter was a surprising result, considering that the importance of perceived control was originally identified in the work science area. The results strongly supported that perceived control should be included in the clinical reasoning of occupational therapists working in mental health care.     

Spirituality as experienced by occupational therapists in practice.

Despite considerable literature describing the potential place of spirituality in occupational therapy, surveys repeatedly demonstrate that therapists are uncomfortable with this concept in practice. To gain a better understanding of how spirituality might inform practice, we interviewed eight occupational therapists who stated that they considered spirituality while working with patients. Participants defined spirituality as one's beliefs about the world and one's place in it and how one lives out these beliefs, through reflection and conscious actions. Four themes of consideration of spirituality in practice emerged. In the first, addressing religious concerns, therapists dealt with patients' religious questions and issues. In the second, addressing suffering, therapists assisted patients to deal with their feelings related to loss and pain, attempted to relieve patients' distress and helped patients move towards increased functioning. In the third, encouraging the self, therapists worked to assist patients to acknowledge their own worth and to use their unique gifts and interests. In the fourth, growing as a person, therapists themselves were transformed as a result of the therapeutic encounter. This study represents an early attempt to determine what occupational therapists who consider spirituality actually do in practice. Future research should go deeper into the experience of such therapists, to gain a richer understanding of the phenomenon.     

Relationships between occupational factors and health and well-being in individuals with persistent mental illness living in the community

PURPOSE: This study identified relationships between occupational factors and health and well-being among individuals with persistent mental illness. METHODS: There were 103 subjects assessed in regards to time spent in different occupations, activity level, satisfaction with daily occupations, and experienced occupational value. The health-related variables were self-rated health, quality of life, self-esteem, sense of coherence, self-mastery, psychosocial functioning, and psychiatric symptoms. RESULTS: Subjective perceptions of occupational performance were consistently related to both self-rated and interviewer-rated aspects of health and functioning. While variables pertaining to actual doing showed weak or no associations with self-rated health-related variables, they exhibited moderate relationships to interviewer-rated health and functioning. IMPLICATIONS: The health-promoting ingredients in occupations were determined by the way occupations were perceived, rather than the doing per se. The findings indicate that perceived meaning and satisfaction ought to be prioritized when setting goals in occupational therapy practice, and, besides, that existing occupational therapy theory needs to be updated.     

Applying sensory integration framework in educationally related occupational therapy practice (2003 statement).

Based on the educational team recommendations, occupational therapists and occupational therapy assistants working in educationally related settings provide services to students who are eligible for Section 504 or special education under IDEA and need occupational therapy to benefit from their education program. It is the occupational therapist's responsibility to develop an intervention plan based on the student's needs and the therapist's professional knowledge base. The occupational therapist chooses and applies any frame of reference within the domain and process of occupational therapy. Regardless of the frame of reference utilized, the desired outcome of occupational therapy services is always engagement in occupations that allows participation in a student's daily life. When students demonstrate deficits in sensory integration that contribute to a significant and documented discrepancy in their skills within their educational program, the use of a sensory integrative approach may be one frame of reference for, intervention chosen by the occupational therapist.     

Culture, theory, and the practice of occupational therapy in New Zealand/Aotearoa.

In the context of contemporary New Zealand, this paper discusses the need for occupational therapy to substantiate its claims of being a holistic profession with particular reference to the Maori, the indigenous people of New Zealand (referred to by the Maori as Aotearoa). In this era of accountability and consumer choice, occupational therapists need to more effectively meet the cultural needs of their clients through an understanding of both the material and nonmaterial aspects of their cultures. However, for New Zealand occupational therapists, cultural sensitivity is not enough to contribute to changing the diminished life chances of the Maori. It is proposed in this paper that the Model of Human Occupation (Kielhofner, 1985; Kielhofner & Burke, 1980), when combined with the work of radical community educators such as Freire (1972), could provide the sociopolitical dimension to New Zealand practice. The Model of Human Occupation is examined in light of current occupational therapy practice in New Zealand. It is argued that this model, when accompanied by a broader understanding of the sociopolitical processes informing monoculturalism, could be seen as a suitable framework for understanding cultural differences in New Zealand and could assist in the move toward providing culturally appropriate occupational therapy for indigenous peoples such as the Maori.     

Occupational Therapy Interventions and Outcomes Measured in Residential Care: A Scoping Review

Abstract

Aims: This scoping review identified the interventions and outcome measures used by occupational therapists working with older adults in residential care facilities.

Methods: A five-step approach was used to retrieve and screen studies from five databases. Included studies described an occupational therapy intervention with older adults living in residential care facilities, were published in English, between 1990 and 2019 in a peer-reviewed publication. Data were mapped using domains of the Canadian Model of Occupational Performance and Engagement.

Results: Findings from 51 studies revealed that occupational therapists most commonly implemented occupations as the intervention with little focus on aspects of the environment. Outcomes predominantly measured person factors and less commonly occupational performance and engagement.

Conclusion: The exploration of the past foci of practice and measurement of therapeutic impact enables occupational therapists to consider how their practice can enhance future occupational performance and engagement of residential care facility residents.     

Using Literature to Create Cultural Competence

Purpose: To describe how literature can be used to promote cultural competence. Cultural competence is essential for nurses who practice in diverse societies like the United States.
Organizing Framework: Cultural competence is viewed as a dynamic process of framing assumptions, knowledge, and meanings from a culture other than one's own. Selected excerpts from "The Color Purple" by Alice Walker are used to illustrate the method. Isler' s readers' response theory serves as a guide for imaginative engagement and reflective discussion of the concept of health.
Conclusions: Literature helps to dispel the false notion of a monolithic culture. Reflecting on reputable literature helps us hear the stories of those we hope to help and heal.     

Cross-cultural occupational therapy: a critical reflection.

In the Netherlands, Dutch health care professionals, including occupational therapists, are confronted with a growing number of patients whose cultural backgrounds differ from theirs. Acknowledging this influx, the Dutch government allocated a grant for educating occupational therapy students on cross-cultural care. This paper summarizes the information we collected from a survey of Dutch occupational therapists on treatment of immigrants and briefly describes the eight educational tools we developed for the two occupational therapy curricula. Two of these tools are described fully--first, a critical essay on the white middle-class values and norms that underlie occupational therapy theory and practice, and second, the guidelines for developmental policies to use in the treatment of immigrant patients. Case studies illustrate how the values of our profession create obstacles to cross-cultural care.     

Experiences of social class: learning from occupational therapy students

BACKGROUND AND PURPOSE: Despite the potential in occupational therapy models, there has been little investigation of the ways social class may affect occupations or occupational therapy. This paper explores the occupational impacts of poverty. METHODS: Essays by 17 occupational therapy students, who identify as lower class, were coded and analyzed inductively. RESULTS: Class-based shame and stigma led to attempts to "pass" as middle class-an occupation consuming time and energy. Exclusion from middle-class leisure occupations left students with gaps in their adult knowledge. Family was a site of both shame and safety, as well as pressure to succeed. Educational occupations embody marginalization. PRACTICE IMPLICATIONS: Class is not only about money, but also having the right norms, values, and experiences to fit easily in middle-class society. Educational and health care institutions epitomize middle-class assumptions. The experiences of these students may help therapists to examine where they unwittingly enact middle-class norms in practice.     

Portrait of occupational therapy

The profession of occupational therapy promotes individuals to achieve health and wellness through engagement in meaningful occupations of daily living. This occupation-focused profession plays a critical role in health care in a multitude of settings with a wide range of clients. The paper highlights a global overview of the philosophies of occupational therapy, the current international practices in occupational therapy, the education of therapists, and the roles of law and professional societies that govern the practice of occupational therapy.     

Here to be seen: ten practical lessons in cultural consciousness in primary health care

Providing health care for culturally diverse individuals and members of underserved groups can be challenging but also rewarding if a few simple yet important lessons are followed. Taking time to get to know patients; using preferred names; looking at patients' photographs; learning patients' languages; showing respect; being open to messages in the media; listening to patients' stories; prescribing culturally appropriate and practical regimens; and remaining aware of the interrelationship of culture, illness, and health care are steps toward cultural consciousness and competence in primary care. This article is based on a keynote address at the 11th Annual Primary Care for the Underserved Conference held May 2003 in Boston, Massachusetts.