Occupational therapy student experiences of a university mental health course based on an integrated application of problem-based and team-based learning

Background: The goal of problem-based and team-based learning (PBL/TBL) is to maximize student engagement and encourage interactive learning. Combining these methods in course design is described as a win-win situation that optimizes student learning, professional development, and uses varied teaching approaches that fit well within health science. More research is needed in the effectiveness of such a hybrid approach.

Objectives: The aim of this study was to explore student experiences of a newly developed mental health course based on an integrated application of PBL and TBL in a university occupational therapy program in Sweden.

Methods: In this grounded theory study data were collected through logbooks (n?=?13) and supplemental open-ended interviews (n?=?7) at the end of the course.

Results: The analysis resulted in two core categories: 1) learning is facilitated by a course design based on the integrated application of PBL and TBL, a current topic, and teachers who are perceived as engaging, and 2) a perceived safe setting facilitates learning and creates a good study environment. There were six related sub-categories.

Conclusions: Combining elements of PBL and TBL may have a range of benefits in promoting student learning and professional development. Other aspects may also have a role to play.     

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.     

How to contribute occupationally to ecological sustainability: A literature review

Abstract

Objective: Climate change is of great concern today, and is an important health issue. The changes are related to human occupations and, therefore, an occupational perspective can make important contributions to ecological sustainability. The aim of this scoping literature review was to explore and describe what has recently been written about how occupational therapy/therapists/science can contribute to ecological sustainability and the prevention of more severe climate change. Methods: Publications were used as data. Searches were conducted in databases, journals, reference lists, and citations. Fourteen items, with content related to the contribution of occupational therapy/therapists/science to climate change and ecological sustainability; written in English; having an occupational therapist among the authors; and published between 2008 and 2013; were included. Results: The results revealed four different ways that occupational therapists/scientists can contribute: by adapting to prevent climate change and to existing changes; by cooperating with others; by exploring people's occupational choices and the relationship between occupation and ecology; and by warning of the consequences of the changes. Conclusion: These ways of contributing can be used as a point of departure for further research on this important topic.     

Examining Intraprofessional Competencies for Occupational Therapist and Occupational Therapy Assistant Collaboration

Abstract

This study examined competencies perceived by occupational therapists and occupational therapy assistants as important for intraprofessional collaboration. While interprofessional practice is well defined, less is known about collaboration within professions with varied levels of practice credentials. Occupational therapy practitioners (N?=?351) rated 20 competencies in four domains (Intraprofessional Teamwork, Roles/Responsibilities, Communication, and Values/Ethics) through an online survey. A high percentage of respondents perceived all competencies as important or very important. There were significant differences between occupational therapists and occupational therapy assistants in ratings of five competencies, including: seeking information/support from the team partner, flexibility for effective partnership, engagement in professional development for collaboration, communicating ideas, and providing feedback about performance. Outcomes contribute to understanding intraprofessional collaboration for occupational therapy practice. Competencies can serve as guidelines for education and professional development.     

How do Swedish day center attendees with psychiatric disabilities view their worker role? A structural equation modeling study

Abstract

Aim: To investigate how day center attendees with psychiatric disabilities perceived their worker role and the importance of current work situation and personal factors in that respect.

Methods: Two-hundred attendees completed the Worker Role Self-assessment and questionnaires addressing possible predictors of the worker role: current employment situation, satisfaction with that situation, and a personal factor (encompassing self-esteem, self-mastery and engagement). Structural equation modeling was used.

Results: A model indicated two worker role factors; belief in a future worker role (WR1) and current capacities and routines (WR2). WR1 was positively influenced by having a job, younger age and the personal factor. Satisfaction with current work situation (usually unemployment) was negatively associated with WR1. The personal factor was single predictor of WR2. The attendees rated WR2 more positively than WR1.

Conclusions: The personal factor was crucial for both WR1 and WR2. Work-related factors were only important for WR1. The more negative rating of belief in a future worker role may be interpreted as mistrust in the services. The attendees’ positive ratings of capacities indicate, however, that they had a rehabilitation potential to develop. Enhancing self-esteem, mastery and engagement may be an avenue for staff in efforts to support the attendee’s worker role.     

Do occupational therapists’ communication behaviours change with experience?

Background: An increasing amount of literature has studied changes in communication skills in medical and nursing undergraduate students. Aim: To evaluate whether occupational therapists’ communication behaviours change with experience. Material and methods: A total of 45 participants (second-year OT students, final-year OT students, professional OTs) were enrolled and met three simulated clients. The role plays were video-recorded and analysed through OT-RIAS (Occupational Therapy-Roter Interaction Analysis System). Chi-square tests were used to analyse the statistical differences between groups for the OT-RIAS categories. Results: Process represented 30.74% of communication for second-year students, 33.69% for final year students, and 35.58% for professional OTs; Occupational therapy ranged from 30.41% in the second-year students to 32.54% in the undergraduates and 37.04% in the professional OTs; Medical increased from 18.66% to 34.33% of the final-year students and 47.01% of the professional therapists. Personal and Psychosocial slightly decreased through experience. Emotional decreased gradually: 39.8% in the second-year students, 29.54% in final-year students, and 30.66% in professional OTs. Conclusion: During training in occupational therapy the communication skills changed, assuming a more technical shape, increasing control and content-related OT communication. Nevertheless, the therapists’ communication behaviours showed the endurance of attention to the client’s point of view.     

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.     

Independence: proposing an initial framework for occupational therapy

Background: The concept of independence is common in occupational therapy theory and practice but has rarely been clearly defined or conceptualized within in occupational therapy literature and there seems to be no standard definition. This can result in ambiguity, which potentially jeopardizes client-centred practice.

Aim: This paper proposes an occupational therapy independence framework (OTIF) that synthesizes the range of characterizations of independence in a practically useful and occupation-centred manner.

Methods: A review of literature, clinical experience, doctoral research and conversations with occupational therapists and disabled people, in particular those involved in a disability activism group and people with physical disabilities, has led to the development of the OTIF.

Results: Independence and interdependence, as characterized in the OTIF, occur when an individual exerts choice over occupational performance and can engage in occupations in a manner acceptable to the individual. Interdependence results when occupations are performed with another person whereas independence involves solitary occupational performance. Dependence typically results from inability to choose occupations or a mismatch between performance capacity and environmental factors.

Significance: The OTIF has the potential to clarify the conceptualization of independence within occupational therapy theory and practice. This initial proposal is presented to stimulate debate and discussion.     

Developing professional values: perceptions of francophone occupational therapists in Quebec,Canada

Objective Recent literature shows growing interest in the values displayed by occupational therapists. Yet, none of these writings has so far examined the factors that contribute to the development of occupational therapists’ professional values. These factors are important, since values play a pivotal role in forging professional identity, which in the case of some occupational therapists remains somewhat ambiguous. This article proposes possible answers to the following question: What do Quebec Francophone occupational therapists perceive as the building blocks of their professional values? Methods Using a phenomenological qualitative method, the subjective experience of occupational therapists in Quebec, Canada was examined. Twenty-six occupational therapists took part in the study. Results As intended, their professional experience was varied. According to the participants, four factors contributed significantly to their professional values: professional experience, university training, personal experience, and professional development. However, fewer than 50% of the participants cited six other factors (workplace, family upbringing, personal development, personality and abilities, professional normative framework, and sociocultural background). Conclusions Most of these results are consistent with those documented in existing works. They point to the relevance of discussing professional values during university training and continuing professional development, as well as encouraging occupational therapists to become exemplars for their colleagues and interns. This study constitutes an initial step in understanding how occupational therapists’ axiological identity is formed.     

Introducing the Occupational Balance Questionnaire (OBQ)

Abstract

Objective: The concept of occupational balance is frequently used in occupational therapy but the fact that it has been defined and measured differently is a limitation. This article introduces the Occupational Balance Questionnaire (OBQ), which focuses on satisfaction with the amount and variation of occupations. It consists of 13 items measured on six-step ordinal scales. It has shown good content validity in a sample of 21 occupational therapists but other psychometric properties have not been investigated. The aim was to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Methods: The OBQ was administered twice to a sample selected through convenience sampling. Internal consistency was investigated by Cronbach's alpha and test–retest reliability analysed with Spearman's Rho correlation for the total score and weighted kappa on each item. Potential floor/ceiling effects were explored by checking for the percentage of participants who scored lowest and highest. Results: The results demonstrated that the OBQ has good internal consistency (Cronbach's alpha 0.936) and sufficient test–retest reliability (Spearman's Rho for the total score was 0.926) and, thus, seems stable over time. No floor or ceiling effect was detected. Conclusions: The OBQ therefore showed promising reliability, although further instrument development studies to examine its construct validity are required.     

Intensive client-centred occupational therapy in the home improves older adults’ occupational performance. Results from a Danish randomized controlled trial

Background: There is growing interest in enabling older adults’ occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults.

Methods: An assessor-masked randomized controlled trial among adults 60?+?with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N?=?59) or to receive usual practice with a maximum three sessions of occupational therapy (N?=?60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM).

Results: No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p?=?0.001.

Conclusions: ICC-OT improved older adults’ occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.     

Muslim Middle Eastern clients' reflections on their relationship with their occupational therapists in mental health care

Abstract

Persons with a Middle Eastern background represent a minority in Sweden which has significantly increased in size over recent years. The purpose of the present study was to explore the elements that shape the experiences and perceptions of clients with a Middle Eastern background living by Muslim norms who received occupational therapy in mental health care at the time of participating in the study. The study included interviews with 11 clients who received occupational therapy in mental health care. Data collection and analysis were carried out in accordance with the grounded theory approach. One core category, desiring a union, described the clients' desire for an alliance with the therapists that encompassed the realities and truths embedded in their values, preferences, world-views, and belief systems, as well as a wish to reconstruct their abilities to function and perform daily life tasks within their cultural contexts. The core category included sub-categories: desiring relationship, desiring affiliation, and desiring affirmation as well as some related components. The overall findings showed a tentative model in which the notion of mahram affinity was embedded. The results demonstrated that the clients' views regarding desiring a union had their support in collectivistic world-views that often clash with those of the therapists.     

Mindfulness and human occupation: A scoping review

Background: Mindfulness is an emergent construct with implications for our understanding of approaches to engagement in human occupation. Little is known about how mindfulness is being applied and what its possibilities are in the occupation-based disciplines.

Objective: The purpose of this scoping review was to summarize, describe, and identify gaps in the existing literature on mindfulness in relation to human occupation.

Material and Method: A scoping review, guided by Arksey and O’Malley’s methodological framework was undertaken. The initial search yielded 929 articles; 20 articles met the criteria for inclusion. Articles included peer review and gray literature published in English between 2006-2016. Articles addressed mindfulness in OT or OS and included the terms ‘human occupation’, ‘occupational therapy’ and/or ‘occupational therapist’, and ‘mindfulness’ and/or ‘meditation’ or ‘yoga’.

Findings: The qualitative thematic analysis identified an overarching theme of mindful occupation, with 5 sub-themes including occupational presence; occupational awareness; occupational engagement; occupational well-being; and occupational fulfillment.

Conclusions and Significance: The findings have important implications for practice, education, theory and research. Future directions should focus on more depth and breadth of empirical research about mindful engagement in human occupation that can be used to implement and evaluate mindfulness in occupation-based theory and practice.     

Defying aches and revaluating daily doing: Occupational perspectives on adjusting to chronic pain

Abstract

The aim of this study was to investigate how people with chronic pain experience their daily doing, with a special focus on possible adjustment to pain and altered life conditions in order to cope with pain and maintain well-being. In-depth interviews were guided by themes concerning daily occupation, ways to maintain well-being, and future expectations. Using qualitative content analysis a core concept “Reappraising daily doing” was arrived at, containing the categories of altering doing processes and altering values, each in turn containing four subcategories. The findings showed that along with the grief of having to abandon jobs and former social networks, the participants coped with their everyday lives in ways that opened up the use of imagination and improvisation and the valuing of non-material and altruistic behaviour. An occupation was generally given up when aches (participants' term) became worse, except for when the occupations were so enjoyed that the pain was put out of focus. Using the concept of Occupational Value to enhance coping ability seems a reasonable strategy for occupational therapists when assisting clients in finding or maintaining meaningful daily doing and effective coping strategies for experiencing well-being. This could in turn limit the use of health care resources, which is extensive.     

Occupational performance and strategies for managing daily life among the elderly with heart failure

Abstract

Aim: The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF). Methods: Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis. Results: The first theme, “Redefining an active life, aware of one’s impaired body”, was based on four sub-themes: realizing one’s limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, “Planning activities and balancing the degree of effort”, was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today’s ability; and using technology and adapting the environment. Conclusions: Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.