Reflections of occupational therapists working as members of a research team

Aim:  This qualitative study explored the effects of clinician participation in a randomised clinical trial on subsequent practice.
Method:  Eight occupational therapists responded to open-ended questions delivered by email about their reflections on participating in clinical research and its impact on their practice. Qualitative analysis uncovered therapists' motivation to participate in research, what they felt that they gained, and if and how research participation influenced practice.
Results:  Clinicians learned about research, practice, and their own clinical biases through their participation in clinical research.
Conclusion:  Our findings suggest that participation in research may contribute to shrinking the research-practice gap.     

Towards facilitating change in service delivery: An illustrative example

Background:  The management of change in organisations is a challenge facing many occupational therapists in practice today. This article presents an example of a program implemented to facilitate the process of change in paediatric service delivery. It presents the principles and design of the program, as well as the program's implementation and resultant findings.
Methods:  The principles and process of organisational change laid the foundation of the program and were utilised as measurement of changes occurring in the perceptions of participants. Interviews and online focus groups were utilised as data-gathering methods.
Results:  The findings of the study illustrate the process of change that participants were undergoing.
Conclusions:  The article provides an example of how managers can facilitate change in service delivery by using the principles of organisational change and adult learning. Recommendations are made for application of similar change management processes in other organisations and the future use of the online discussion medium as research tool and in 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.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.     

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.     

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.     

Employer-sponsored occupational therapy professional development in a multicampus facility: A quality project

Aim:  To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.
Method:  Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.
Results:  The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.
Recommendations:  Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the 'clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD.     

The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

Conducting case study research in occupational therapy

Background:  Case study research has been used increasingly in psychology and sociology in recent years. It provides researchers with an opportunity to explore a situation involving one individual or several individuals over time from multiple points of view.
Methods:  This literature review explains case study research as a method and summerises its scientific merit, also providing an example of its use.
Results:  Case study research offers occupational therapists a scientific methodology that can be used to understand and develop occupational therapy practice.
Conclusion:  This paper argues that case study research should be used more extensively by occupational therapists as the method respects the basic principles of occupational therapy.     

Inpatients' perspectives of occupational therapy in acute mental health

Background:  Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study by the South West London and St George's Mental Health NHS Trust and the Brunel University (UK) obtained inpatients' perspectives of occupational therapy.
Methods:  Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results:  Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of the intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as the most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving the inpatients' daily functioning and quality of their admission.
Conclusions:  Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual interventions in acute wards is warranted.     

Informing fieldwork design: Key elements to quality in fieldwork education for undergraduate occupational therapy students

Aim:  In this current climate of escalating student fees, students as paying consumers expect a quality fieldwork experience. However, the ability of universities to deliver quality fieldwork programs is compromised by the increasing pressure experienced by fieldwork educators to meet productivity targets in the face of diminishing resources. This paper details how one university, Monash University, sought input from stakeholders to design a fieldwork program.
Methods:  This qualitative study utilised focus groups to inform the researchers of stakeholders' perceptions of what constitutes quality fieldwork education. A total of five focus groups were held, involving 47 occupational therapists practising in Victoria.
Results:  The major findings include the need to provide ongoing professional development for fieldwork educators, the need to develop tangible strategies in recognition of their contribution towards fieldwork education, and the imperative for closer collaboration between universities and fieldwork educators.
Conclusions:  Based on literature and in response to the focus group discussions, Monash University has implemented a number of measures to ensure the successful implementation of quality fieldwork education. These include providing ongoing professional development for fieldwork educators to enhance their role, addressing fieldwork educators' concerns about project placements and supporting students with fieldwork relocation. Most importantly, this study demonstrates the need for educational institutions to take the lead in dialogue with the profession to enhance a collaborative response to constant changes in health-care directions. The importance of ongoing research to inform quality fieldwork education is critical to moving the profession forward.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

A national evaluation of the Australian Occupational Therapy Competency Standards (1994): A multistakeholder perspective

This paper summarises results from an evaluation of the adequacy and utility of the Australian Competency Standards for Entry-Level Occupational Therapists © (OT AUSTRALIA, 1994a). It comprised a two-part study, incorporating an online survey of key national stakeholders ( n  = 26), and 13 focus groups ( n  = 152) conducted throughout Australia with occupational therapy clinicians, academics, OT AUSTRALIA association and Occupational Therapy Registration Board representatives, as well as university program accreditors. The key recommendations were that: (i) urgent revision to reflect contemporary practice, paradigms, approaches and frameworks is required; (ii) the standards should exemplify basic competence at graduation (not within two years following); (iii) a revision cycle of five years is required; (iv) the Australian Qualifications Framework should be retained, preceded by an introduction describing the scope and nature of occupational therapy practice in the national context; (v) access to the standards should be free and unrestricted to occupational therapists, students and the public via the OT AUSTRALIA (national) website; (vi) the standards should incorporate a succinct executive summary and additional tools or templates formatted to enable occupational therapists to develop professional portfolios and create working documents specific to their workplace; and (vii) language must accommodate contextual variation while striking an appropriate balance between providing instruction and encouraging innovation in practice.     

A survey of recruitment and retention issues for occupational therapists working clinically in mental health

Background:  Mental health services Australia-wide have difficulty recruiting and retaining clinical occupational therapists.
Methods:  A survey of occupational therapists to identify factors that could influence their retention or loss from clinical mental health practice was undertaken.
Results:  Typically, respondents were female, aged 30 years or younger, working full-time at a grade 2 or 3 level, and had worked entirely in mental health. The main positive aspects that respondents identified about their positions were the 'social/emotional environment', 'aspects/nature of their roles', and 'using occupational therapy skills'. The main position constraints were 'insufficient time/workload' and 'insufficient use of occupational therapy skills/generic nature of work'.
Conclusions:  Recruitment and retention strategies are required to retain occupational therapists in clinical mental health positions.     

Job satisfaction in occupational therapy: a qualitative investigation in urban Australia

Background:  Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting.
Methods:  Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported.
Results:  Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession.
Conclusions:  Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.     

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.     

Occupational performance modification and personal change among clients receiving rehabilitation services for rheumatoid arthritis

Background:  A client's personal process of change is recognised as an important element in the rehabilitation process that may affect the acceptance and outcome of recommended occupational therapy self-management interventions. Recent research has examined the transformative process of changing underlying values, beliefs, feelings and knowledge, collectively known as meaning perspectives, in clients receiving rehabilitation for various chronic conditions.
Aim/methods:  This article presents the findings of a Grounded Theory Qualitative retrospective study of 10 adults diagnosed with rheumatoid arthritis receiving occupational therapy to modify their daily living environment and activities to maximise the quality of life and occupational performance. They were interviewed twice in a semidirected manner.
Results:  Two personal change processes were identified for two different courses of the illness: progressive adaptation during a course of gradual steady development of symptoms without remission, and complex adaptation that led to transformation during a course of acute development of symptoms with periods of remission.
Conclusion:  Implications for more effective and efficient occupational therapy interventions are suggested.