Occupational therapy students’ perceptions of occupational therapy

Background/aims: An understanding of students’ perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students’ perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Methods: Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose‐designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Results: Students’ responses were categorised as ‘what’ occupational therapists do; ‘how’ they do it; ‘why’ they do it; and ‘who’ they work with. In ‘what’ occupational therapists do students frequently described ‘helping’ people. Both undergraduate and graduate entry masters students used the term ‘rehabilitation’ to describe how occupational therapy is done, with graduate entry students occasionally responding with ‘through occupation’ and ‘modifying the environment’. Students perceived the ‘why’ of occupational therapy as getting back to ‘everyday activities’, with some students emphasising returning to ‘normal’ activities or life. Regarding the ‘who’ category, students also thought occupational therapists worked with people with an ‘injury’ or ‘disability’. Conclusions: Students entered their occupational therapy programmes with perceptions consistent with the general public’s views of occupational therapy. However, graduate entry students exposed to a pre‐reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.     

Indigenous health and community services employment in remote Northern Territory: a baseline examination of 2006 and 2001 Census data

Objective: To establish a baseline of levels of Indigenous professional engagement in the health and community services sector in remote Northern Territory. Design: Analysis of data from 2001 and 2006 Census. Setting: Northern Territory – Balance Statistical Division. Participants: Persons employed in health and community services sector in 2006. Main outcome measures: Indigenous status, level of education, current education status, occupation type and residential mobility. Results: Indigenous employment grew by 137% between 2001 and 2006. In 2006, 42% of Indigenous employees were labourers and 9% professionals, in contrast to non‐Indigenous workers of whom 41% were professionals and 5% labourers. Over 50% of workers who moved into the region between 2001 and 2006 were professionals, compared with 20% of those who had remained in the region. Indigenous in‐migrants were twice as likely as Indigenous people who had stayed in the region to be professionals. Indigenous workers were much less likely to have post‐school educational qualifications than non‐Indigenous workers. Indigenous workers were also less likely to be studying for a post‐school qualification. Indigenous in‐migrants were three times as likely to have post‐school qualifications than Indigenous people who had remained in the region and were also more likely to be enrolled in post‐school education. Conclusions: The baseline is low Indigenous engagement as professional labour, and low Indigenous engagement in formal education. Mobile Indigenous people have higher levels of engagement. The situation might be addressed by increased formal education in remote areas and increased mobility of Indigenous health labour.     

Occupational therapy students' perspectives regarding international cross-cultural experiences

Background: The purpose of this study was to investigate the perspectives of occupational therapy students who have engaged in international, cross‐cultural learning and service experiences. Methods: This study utilized a qualitative, phenomenological design. Nine semi‐structured interviews were conducted with students who engaged in international learning opportunities. The interviews were coded and analyzed using a constant comparative analysis approach. Results: Three central themes emerged from the data anlysis. Connectedness is the process of forming relationships with others while engaging in cross‐cultural experiences. Students formed relationships with faculty, other students, and people within the community. Cultural awareness is the recognition and understanding of a different culture and responding to those differences. Students attempted to understand the new culture in comparison to their own lived experiences. Complexity portrays cross‐cultural opportunities as dynamic, multi‐faceted and intricate. This was demonstrated as the students raised additional questions about the conflict between their own culture and the new culture they entered. Students also identified limited orientation, support and structure with such experiences and the conflicting roles between volunteer, student, and team member. Conclusions: The ability to connect with others when building relationships in diverse cultural contexts held meaning for the students; however, the students also expressed conflict in trying to make sense of the new culture as it often challenged personal beliefs and constructs. The complexity and challenges of engaging in these opportunities needs to be recognized and further explored to assess how curricula and faculty best supports culturally responsive care.     

Differentiating Fieldwork Settings: Matching Student Characteristics to Demands

Abstract

Academic fieldwork coordinators (AFWCs) face the challenge of matching students to Level II fieldwork (FW) sites. This study surveyed 301 fieldwork educators (FWEs) from 30 states to explore how important it was for students to possess 25 characteristics or abilities to enable success at the educators’ individual work sites. The top three characteristics and abilities overall were as follows: (1) time management, (2) ability to communicate with supervisor when help is needed, and (3) overall professional behavior. Using Mann–Whitney U-tests for ordinal data, statistically significant differences (p?≤?.01) were found between settings with acute care having the highest expectations of students. Overall results support the value of FW coordinators matching students’ abilities to demands of settings prior to Level II FW placements. Top ranking items may also guide schools on admissions criteria and skill development throughout curriculum.     

Occupational therapy entry‐level education in Australia: Which path(s) to take?

Background/aim: There has been an increase in the number of occupational therapy educational programmes offered in Australia over recent years. Although universities offer bachelor, masters and graduate‐entry masters programmes, there is a push to consider phasing out occupational therapy bachelor degrees. The aim of this study was to identify advantages and disadvantages associated with current and future credentials needed for entry into the profession. Methods: This article reviews current literature and other issues concerning entry‐level occupational therapy education Results: The underlying issues are complex and require great consideration as a profession. Conclusion: As a profession we need to take charge of our destiny before governments, universities and other stakeholders/professions determine the basic level of entry for our profession.     

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.     

Critical reflexivity in client-centred therapeutic relationships

Abstract

Aim/objectives. This paper explores how a particular form of reflection – critical reflexivity – can support clinicians in developing a more nuanced understanding of therapeutic relationships, and work to advance the goal of client-centred practice. Methods. A critical autobiographical narrative was written, and critical reflexivity adopted, as methods to critically examine the therapeutic relationship. Findings. Critically reflexive stories have the potential to advance client-centred therapeutic relationships by inspiring the (re-)consideration of practices, and by interrogating interpretive systems. Discussion. Understandings and practices that potentially limit the extent to which therapeutic relationships are client centred include (i) Dichotomous thinking, (ii) Objectification, (iii) The economic imperative, and (iv) Knowledge generation. Conclusion. The critical autobiographical account points to ways in which critical reflexivity on the therapeutic relationship has the potential to foster critical questioning, interrogate interpretive systems, attune to subjectivities, contribute to practice-based knowledge, resist violation, foster compassionate practice, and develop new understandings of relevance to client-centred practice. Significance. This critical examination of the therapeutic relationship supports occupational therapists in more fully realizing the profession’s core value of client-centred practice.     

Furthering the sceptical case against virtue ethics in nursing ethics

In a recent article in this journal I presented a sceptical argument about the current prominence of virtue ethics in nursing ethics. Daniel Putman has responded with a defence of the relevance of virtue in nursing. The present article continues this discussion by clarifying, defending, and expanding the sceptical argument. I start by emphasizing some features of the sceptical case, including assumptions about the nature of sceptical arguments, and about the character of both virtue ethics and nursing ethics. Then I respond to objections of Putman's such as that, according to virtue ethics, virtue is relevant to the whole of a human life, including one's behaviour in a professional context; and that eudaimonia should be central in explaining and motivating a nurse's decision to enter the profession. Having argued that these objections are not compelling, I go on to discuss an interesting recent attempt to reassert the role of virtue ethics in the ethics of professions, including nursing. This centres on whether role‐specific obligations – e.g. the obligations that arise for a moral agent qua lawyer or mother – can be accommodated in a virtue ethics approach. Sean Cordell has argued that the difficulty of accommodating role‐specific obligations results in an ‘institution‐shaped gap’ in virtue ethics. He suggests a way of meeting this difficulty that appeals to the ergon of institutions. I endorse the negative point that role‐specific obligations elude virtue ethics, but argue that the appeal to the ergon of institutions is unsuccessful. The upshot is further support for scepticism about the virtue ethics approach to nursing ethics. I end by gesturing to some of the advantages of a sceptical view of virtue ethics in nursing ethics.     

High job demands and lack of time: A future challenge in occupational therapy

Abstract

Objective: The aim of this study was to identify work-related stress factors that contributed to work-related stress among Swedish occupational therapists and to investigate the association between work-related stress, demographic factors, and perceived overall stress. Methods: A postal questionnaire and a letter of invitation were sent to 807 Swedish occupational therapists, selected at random and representing 10% of occupational therapists working in Sweden. The response rate was 59%. A stress index presenting 49 stress factors graded on a scale from 1 (indicating no source of stress) to 6 (definitely a source of stress) was included. In addition, the level of perceived overall stress during the last two weeks was scored on a rating scale with the end points 0 (no stress) and 10 (extreme stress). Results: The main findings indicated that lack of resources and lack of time were the main stressors. “Working at a superficial level due to lack of time” was the only variable associated with high overall stress when both work-related and personal factors were included. Professional identity and clarity concerning the role were graded low with regard to stress. Conclusions: Work-related stress is just one aspect of the overall stress experienced but knowledge about its consequences highlights the importance of further studies.     

Psychosocial work environment and burnout among emergency medical and nursing staff

Objectives: The prevalence of burnout syndrome is increasing among doctors and nurses. The aim of this study was to analyse the relationship between the psychosocial work environment and burnout syndrome among emergency medical and nursing staff in Spain. A secondary aim was to determine if the effect of this psychosocial work environment on burnout was different for doctors and nurses. Methods: A cross-sectional survey was carried out by means of a mail questionnaire among 945 emergency doctors and nursing staff of Spain. The outcome variable was three dimensions of burnout syndrome [emotional exhaustion (EE), personal accomplishment (PA), depersonalisation (DP)]. The explanatory variable was that psychosocial work environment evaluated according to Karasek and Johnson’s demand-control model. The adjusted odds ratios (OR) and their 95% confidence intervals were calculated by logistical regression. Results: The probability of high EE was greater among those exposed to high psychological demands, OR 4.66 (2.75–7.90), low job control, OR 1.65 (1.04–2.63), and low supervisors’ social support, OR 1.64 (1.01–2.59). Emotional exhaustion dimension was negatively influenced by low control only among doctors. Those exposed to low job control had a higher risk of low PA, OR 2.55 (1.66–3.94). There was no evidence of negative effect of psychosocial risk factors on the DP. Prevalence of EE and PA was higher among doctors and nurses. Conclusions: The presence of risk factors derived from work organisation within the work place (psychosocial risk factors) increases the probability of presenting burnout syndrome and, above all, EE.     

Workplace stressors experienced by physiotherapists working in regional public hospitals

Objective: To identify and measure the effects of workplace stressors experienced by Victorian regional physiotherapists. Design: Survey questionnaire. Setting and participants: A questionnaire was distributed to three Victorian regional public physiotherapy departments and data were collected from 80 physiotherapists. Main outcome measures: The type and frequency of workplace stressors, the nature and frequency of common signs and symptoms of stress and the amount of leave taken as a result of stress were measured. Results: Caseload quantity, complexity of patients, constant excessive workload, covering staff on leave and staff shortages, were reported as key workplace stressors. Physiotherapists aged between 20 and 29 years were significantly more likely to report a higher number of workplace stressors (F = 4.173, n = 80, P = 0.009). Inpatient rehabilitation physiotherapists were significantly more likely to report stress at a higher frequency than physiotherapists working in other areas (χ² = 14.359, n = 73, P = 0.002). Eleven per cent of all respondents reported taking leave from work as a result of stress with no significant difference identified between those who took leave and those who did not. There was, however, a trend identified with senior staff (Z = 1.792, n = 80, P = 0.073) and those who work in inpatient rehabilitation (χ² = 6.926, n = 80, P = 0.074) being more likely to take leave as a result of stress. Many of these physiotherapists did not make their employers aware of the reasons for the leave (77%, n = 9). Conclusions: High caseloads, periods of increased activity and staff shortages are some of the factors that contribute to stress in regional physiotherapists. Younger therapists were more likely to identify stressors with greater frequency. Strategies to monitor, prevent and manage stress should be implemented to minimise burnout in regional physiotherapists.     

The Shifting Sands for Applicants to Maternal and Child Health Training Programs

Objective: Anecdotal evidence suggests that fewer students today than in decades past are applying to maternal and child health (MCH) graduate training programs with previous clinical degrees. The purpose of this study was to determine the extent to which applicants accepted to an MCH training program demonstrated a shift away from the tradition of having a prior health professional degree and discuss options needed to provide responsive training. Methods: Twenty years of demographic face sheet data (1983 through 2002) for admitted applicants to the MCH training program at the University of South Florida College of Public Health were examined. Results: Quantitative analysis of admission records confirmed the anecdotal data. Today's applicants are more likely to possess undergraduate nonclinical backgrounds rather than clinical health professional training. Statistically significant differences were found between the students with clinical and without clinical degrees for ethnicity, GRE score, GPA, and the length of time needed to complete the MPH degree. Conclusion: Adjustments in MCH curricula may be necessary to be responsive to the shifting sands of clinical and public health work experience among program applicants. However, curriculum modifications need to be ones that maintain the zeal of the new generation of MCH students without diluting the rigor of traditional professional preparation. Some possible responses of training programs are suggested.     

Partnership in practice: what parents of a disabled child want from a generic health professional in Australia

Despite the love that exists between children with disabilities and their parents and the positive contribution that children with a disability make to families and communities, caring for a child with a disability can be difficult and demanding for parents, carers and the family. Their interaction with the many and varied health professionals they encounter can serve to either ameliorate or exacerbate these difficulties. In this paper we report on a qualitative needs analysis undertaken as part of a project to develop disability awareness resources for generic health professionals (GHP). Data were collected through focus groups (n = 5) and individual interviews (n = 7) with 34 parents/carers and was analysed using a process of thematic analysis. ‘Partnership’ was identified as the overarching theme that answers the question ‘What do parents/carers want from a GHP?’ Three further themes were identified that together tell the partnership ‘story’. These are: ‘The GHP–parent partnership’, ‘Qualities of a GHP’, and ‘The role of advocacy in the GHP‐parent partnership’. Implications are presented that highlight the importance of advocacy in GHP–parent partnerships and suggest improvements in GHP education and preparation.     

Analyzing the professional practice context using three lenses: An essential step for responding strategically

In the face of increased external controls on their practice and increased accountability obligations, health professionals such as occupational therapists must be able to act strategically with other stakeholders to reach consensus about service quality and the accompanying level of professional autonomy. Such strategic action requires certain competencies, including that of analyzing the context in which one’s practice take place. In this article, we argue that the following three approaches, or lenses, should be used in this analysis: (1) accountability, (2) ethics, and (3) professional-as-worker. Individually, each lens offers a useful perspective, however, using all three permits a comprehensive and conceptually clear analysis. We present both the distinctive characteristics and complementary elements of the three lenses.     

Book reviews

Books reviewed: Ham, C. Health Policy in Britain Peterson, M. (ed) Healthy Markets? The New Competition in Medical Care Hacking, I. Mad Travellers: Reflections on the Reality of Transient Mental Illnesses Samson, C. (ed) Health Studies – a Critical and Cross‐cultural Reader Bornat, J., Perks, R., Thompson, P. and Walmsley, J. (eds) Oral History, Health and Welfare Miller, D., Kitzinger, J., Williams, K. and Beharrell, P. (eds) The circuit of mass communication: Media strategies, representation and audience reception in the AIDS crisis Murray, M. and Chamberlain, K. (eds) Qualitative Health Psychology: Theories and Methods     

Development of Professional Identity among Social Work Students: Contributing Factors

Based on the person-in-environment theory, this article presents empirical findings on the contribution of organizational resources (satisfaction with supervision), personal resources (empathic concern, self-differentiation, and sense of coherence), and environmental resources (values) to the professional identity of social work students. The sample consists of 160 social work students who were about to complete their Bachelor of Social Work (BSW) degrees. The participants filled out a set of questionnaires which examined these resources. Two variables contributed directly to the development of professional identity: satisfaction with supervision and personal values. Social values, self-differentiation, and empathic concern contributed to the development of a professional identity only when they interacted with satisfaction with supervision. Practical recommendations are discussed.