Enabling occupation in the 21st Century: Making good intentions a reality

Occupational therapists intend to collaborate with individuals, groups, agencies, and organizations in their search for meaningful occupations to promote health and justice. Since the 1997 publication of Enabling Occupation: An Occupational Therapy Perspective, Canada's latest guidelines on client-centred practice, the author has interwoven her ethnographic research in mental health services and client-centred practice to raise awareness of disjunctures between intentions and actual practice. Her 1999 Keynote Presentation at OT Australia's 20th National Conference in Canberra offers stories of George and Martha as allegories of the potential for enabling occupation in the 21st century. George presents a story of enabling occupation directly with people in need; Martha's story is about organizing services for enabling occupation. Through these stories, Dr Townsend calls occupational therapists to develop the language, organization and practice needed to make the profession's good intentions a reality in the 21st century.     

A review and critique of well-being in occupational therapy and occupational science

Abstract

Scholars in occupational therapy and occupational science often reference well-being when discussing treatment goals or occupational engagement, but the various meanings of this reference remain unexamined in current literature. This paper reports the results of a literature review of five journals and five monographs in the occupational therapy and occupational science literature. The purpose of this review was to understand and critique how scholars in the profession and the discipline conceptualize well-being, guided by broader philosophical perspectives on the subject. The review revealed inconsistent definitions and uses of “well-being” throughout the literature, illuminating the need to reconsider this concept's purpose within the profession and the discipline. Based on these results and building on current theoretical trends, the author advocates a more nuanced and considered use of well-being that acknowledges the uncertainty faced by occupational therapists, occupational scientists, and the people with whom they practice or research.     

Reflections on doing, being and becoming*

Occupation, and its relationship with health and well-being, is very complex. It can be described in many different ways by the profession within which it is so central that it provides its name. A simple way to talk about occupation that appears to appeal to a wide range of people is as a synthesis of doing, being and becoming. In the present paper I reflect on how a dynamic balance between doing and being is central to healthy living and wellness, and how becoming whatever a person, or a community, is best fitted to become is dependent on both. Doing is often used as a synonym for occupation within our profession and is so important that it is impossible to envisage the world of humans without it. Being encapsulates such notions as nature and essence, about being true to ourselves, to our individual capacities and in all that we do. Becoming adds to the idea of being a sense of future and holds the notions of transformation and self actualization. It is a concept that sits well with enabling occupation and with ideas about human development, growth and potential. Occupational therapists are in the business of helping people to transform their lives through enabling them to do and to be and through the process of becoming. In combination doing, being and becoming are integral to occupational therapy philosophy, process and outcomes, and some attention is given as to how we may best utilize these in self growth, professional practice, student teaching and learning, or towards social and global change for healthier lifestyles.     

Well-being and occupational rights: An imperative for critical occupational therapy

Abstract

Background: One of occupational therapy's core assumptions is that engagement in occupations influences well-being. Because occupational engagement is integral to human well-being, and because well-being is integral to human rights, this paper contends that the ability and opportunity to engage in occupations is an issue that concerns rights. Aims: To outline well-being and its centrality to human rights; to explore the relationships between well-being and occupation and between well-being and occupational rights; and to highlight the consequent imperative to engage in critical occupational therapy. Key issues: The World Federation of Occupational Therapists asserts that all people have the right to participate in a range of occupations that enable them to flourish, fulfil their potential, and experience satisfaction congruent with their culture and beliefs; and further asserts the human right to equitable access to participation in occupation. Conclusions: If occupational therapists are to take seriously their espoused commitment to enabling equitable access to participation in occupation, the inequitable conditions of people's lives will need to be addressed. Critical occupational therapy is a committed form of practice which acknowledges that well-being cannot be achieved solely by enhancing individuals' abilities, and that consequently endeavours also to address the conditions of people's lives.     

Stress Management as a Component of Occupational Therapy in Acute Care Settings

The recent explosion of stress literature in the medical community has created a new awareness of "stress" as a potentially destructive force in itself. Contributing the physical and psychological dysfunction, stress has now been linked with a wide range of diagnoses including cancer, cardiac disease and arthritis. The importance of incorporating stress management activities into daily life is increasingly apparent. Occupational therapists concerned with patients' ability to achieve health enhancing independent living skills are in a key position to help patients master stress management skills and incorporate them into activities of daily living. This article will explore the incorporation of stress management into occupational therapy programming for a variety of acute care patients. It will review the components of stress, the stress cycle, the relaxation response, the occupational therapy role based on a model of human occupation, and will review current programs through case study of four patients: one diagnosed with cancer (leukemia), one with anorexia nervosa, one with chronic pain and the fourth, a patient in medical intensive care.     

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.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

The Contribution of Occupational Therapy to Alcohol and Drug Rehabilitation: A Descriptive Review

Occupational therapists work as members of multidisciplinary teams in the assessment and treatment of people experiencing alcohol and drug related difficulties. In the context of “team” treatment, the role of the occupational therapist often appears unclear. Although there is a paucity of available literature regarding occupational therapy roles and functions in this field, the importance of activity based interventions to promote the development of living skills and for facilitating lifestyle changes is well documented. Occupational therapists employed at Pleasant View Centre, Victoria, aim to assist people with addiction problems in reducing or abstaining from drug use within a psychosocial framework. They assist clients in both the detoxification and rehabilitation phases of treatment and provide appropriate follow-up and support. Occupational therapists contribute both their group and individual counselling skills and, in addition, provide a unique focus on maximsising self-efficacy and competence to perform life skills. They provide activity based programmes which enhance existing skills and the acquisition of new skills. The complex nature of addiction requires a diverse range of orientations and skills to which the occupational therapist contributes a philosophy and practice of learning skills for living through “doing” and activity.     

The Nature of Emerging Practice in Occupational Therapy: A Pilot Study

The profession of occupational therapy is responding to changes in the health care system by expanding the contexts and models for service provision, typically referred to as emerging practice. As a pilot study, a survey was completed by 174 occupational therapists to gather information and opinions about emerging practice. Results indicated occupational therapists hold diverse perceptions about emerging practice settings and services as well as the role and significance of emerging practice within the profession. Occupational therapists engaged in emerging practice described numerous rewards and challenges inherent within the process of developing and delivering services. The findings indicate continued professional dialogue and research are needed to support the development and efficacy of occupational therapy services in emerging settings and roles.     

Work-related stress and occupational therapy

Occupational stress and burnout have been studied extensively in the human services. It has been suggested that healthcare professionals in particular are at risk of stress owing to the caring nature of their work. Articles related to occupational therapy and work-related stress were reviewed in regard to practice in Australia, Canada, the United Kingdom, the United States and Sweden. Although the empirical literature is relatively weak for occupational therapy, it has been argued that occupational therapists in health care share risk factors with other healthcare professionals. These risk factors include repeated exposure to distress and difficult behaviour, prolonged interventions and uncertain outcome. Issues such as professional status, staffing issues and the nature of the profession have been identified as additional risk factors for occupational therapists. However, empirical studies that enable burnout rates of occupational therapists to be compared with those of related occupational groups suggest that this may not be the case. Occupational therapists may in fact be protected from some stress and burnout factors. Further research is recommended to clarify the nature of stress experienced by occupational therapists and to identify both risk and protective factors characteristic of the profession.     

Henry B. Favill and the School of Occupations: Origins of Occupational Therapy Practice and Education

The Henry B. Favill School of Occupations, a pioneer program in the history of occupational therapy, was named for the visionary physician Henry Baird Favill, M.D. who practiced in Chicago, Illinois. The School had two types of classes or programs. One was a curative workshop for disabled clients in need of occupational training and the other was a teaching program designed to train people to work with clients. The curative workshop, called the Occupational Center, began in 1915 at the Illinois Society for Mental Hygiene under the guidance of Dr. Favill and the direction of Eleanor Clarke Slagle, a founder and leader in the profession of occupational therapy. The teaching program began in 1917 initially in cooperation with the American Red Cross, Chicago Chapter, and later with the Chicago School of Civics and Philanthropy and the Illinois Department of Public Welfare. This article traces the development and history of the workshop to treat clients and the training programs to educate teachers of occupation who would become known as occupational therapists.     

The illusion of client-centred practice

Abstract

Aim: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession’s philosophical basis and espoused commitment to client-centred practice. Findings: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession’s espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine’s expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession’s core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Conclusion: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.     

Sharing the agenda: pondering the politics and practices of occupational therapy research

AIMS: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. MAJOR FINDINGS: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. PRACTICE CONCLUSION: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

What do Swedish occupational therapists feel about research? A survey of perceptions, attitudes, intentions, and engagement

The aim of this study was to identify Swedish occupational therapists' perceptions and attitudes to research-related activities as well as the therapists' present engagement in future plans for research. A follow up design was used, and the study was undertaken between 1997 and 2003. A total of 425 and 442 Swedish occupational therapists responded to a postal questionnaire (response rate 74.4% and 70.4%). Questions regarding research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes towards research used a semantic differential scale. There were small differences between the two surveys. The result showed that occupational therapists considered research-related activities to be an important part of their development of the professional role and status. Reading research literature to update knowledge was the most important research activity and the second most important activity was applying research findings to improve occupational therapy practice. High workload and lack of time were the most commonly mentioned barriers to participation in research- related activities. Occupational therapists read a large variety of journals, preferably in Swedish. The barriers to participation in research-related activities did not change from 1997 to 2003. The fact that occupational therapists reported reading research as rating highly gives hope for the future development of the occupational therapy profession and practice.     

Translating knowledge to practice: an occupational therapy perspective

Background/Aim:  Translating knowledge to practice, also called ‘knowledge translation’, is increasingly recognised as a driving force to strengthen and improve the healthcare system. How knowledge translation fits with occupational therapy practice deserves examination. Methods:  This paper will explore how an action process model, the Knowledge‐To‐Action Process, may advance knowledge translation in occupational therapy. Occupational therapists typically view knowledge in a broad sense, encompassing research, tacit knowledge, expert opinion and client evidence. The Knowledge‐To‐Action Process facilitates application of client, therapist and research knowledge to occupational therapy practice. Results:  Examination of knowledge translation through the lens of the Knowledge‐To‐Action Process creates awareness of the value of client, therapist and research knowledge. It also highlights opportunities as practitioners to implement knowledge translation. Conclusions:  Models able to flexibly reflect an occupational therapy perspective of knowledge have a potentially vital role in successful knowledge translation. Furthermore, these models allow therapists and other stakeholders to analyse complex situations and identify targeted knowledge translation strategies.     

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.     

Contributing to an integrated profession: a model-based examination of the A-ONE

Yerxa’s [1] model of an integrated profession depicts a circular scholarly process whereby ideas formed in practice are subjected to research and then returned to practice through education. This knowledge-generating cycle supports occupational science and the development of our professional identity. The aim of this article is to demonstrate how Yerxa’s model was used to evaluate if three developmental cycles of the ADL-Focused Occupation-Based Neurobehavioral Evaluation (A-ONE) sufficiently represented all necessary model components required for implementation into practice. The three cycles were historical, educational and measurement. The necessary components included: (a) dilemmas in practice, (b) new ideas that emerged from those practice issues, (c) research to test those ideas and (d) education designed to integrate new knowledge into practice. The results of this analysis of the A-ONE supported adequate research related to ideas from practice being implemented back into practice. Through using the model of an integrated profession to reflect on ideas ignited within practice, and then implementing research to explore the potential contribution of those ideas to knowledge generation, we gain the power to influence the future development of occupational science and the profession.