Professional autonomy of occupational health nurses in the United States

Autonomy, the freedom to practice independently and to exercise professional judgment in practice activities, is a central element for professional practice. Numerous articles and studies have reported on professional autonomy in general nursing practice; however, professional autonomy for occupational health nurses has not been explored in depth. This article advances the development of a body of knowledge relative to professional autonomy in the practice of occupational health nursing. This article also provides an overview of professional autonomy in nursing practice; discusses the nature and importance of professional autonomy in the occupational health practice setting; reports findings from a seminal study of occupational health nurse autonomy; and addresses professional autonomy in the context of collaborative practice.     

What,Why, How – Creative Activities in Occupational Therapy Practice in Sweden

Creative activities have historically been used in occupational therapy, and although their usage has declined in recent decades, they are still used in Swedish practice. The aim of this study was to better understand how occupational therapists use creative activities in practice. A web‐based survey was sent to 520 occupational therapists, of which 304 (58.5%) responded. The main reason identified for using creative activities was to strengthen the client's occupational performance, well‐being and self‐esteem. The expected outcomes of applying creative activities were to support the client in self‐expression and experiencing joy and desire. More than half of the occupational therapist respondents did not use creative activities to the extent they desired. Creative activities in occupational therapy are still used as a vital treatment to strengthen the clients' occupational performance abilities. The survey has looked at only a professional perspective on effectiveness of applying creative activities in occupational therapy. More research is needed to evaluate how occupational therapists internationally apply creative activities. There is also a need to gain information from the client's perspective on the therapeutic value of creative activities. Copyright © 2016 John Wiley & Sons, Ltd.     

Occupation-based intervention in hand injury rehabilitation: Experiences of occupational therapists in Malaysia

Introduction: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists’ experiences of providing OBI in hand injury rehabilitation in Malaysia. Methods: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. Results: Definition of “Occupation as a means”, and “Occupation as an end” was broadened after data analysis of interviews to include two new themes: “Rewarding yet challenging” and “Making OBI a reality”. Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. Conclusion: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients’ maximum level of functioning both can be used for successful rehabilitation of hand injuries.     

Online learning: the potential for occupational therapy education

Online learning continues to have a significant impact on higher education. Increasingly students seek a combination of online learning and face-to-face instruction at undergraduate and graduate levels and occupational therapists ask for online continuing professional development opportunities. However, occupational therapy educators have been slow to adopt web-based instructional technology. This paper presents background information on the use of web-based learning in the general sphere of higher education and outlines the current range of usage in occupational therapy education. Research findings are presented to stimulate discussion regarding online learning and occupational therapy professional socialisation, student satisfaction and outcomes. There is a fine line between full and partial online course delivery, so research on technology-enhanced campus-based delivery is also included in the review. Evidence suggests that blending combinations of technologies with computer mediated learning enhances interaction and could address the higher order learning needs of professional programmes such as occupational therapy.     

Use of creative activities in occupational therapy practice in sweden

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web‐mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web‐mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in‐depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy. Copyright © 2012 John Wiley & Sons, Ltd.     

Time use and importance of instrumental activities of daily living

This study investigated time use and the importance of instrumental activities of daily living (IADL) tasks to an older community-dwelling population. In addition, the study compared occupational therapists' and older people's perception of importance of IADL tasks for maintaining community living. Thirty-three subjects completed a time diary and an interview-based questionnaire to ascertain their time use and the importance of IADL tasks. It was found that older people living in the community spent most of their time at home and alone, with nearly half the day being spent on IADL tasks. The subjects indicated that the three most important tasks were use of the telephone, use of transportation (including driving) and reading. Differences were found when the results from an earlier study of occupational therapists were compared with results from the present study of older people. The occupational therapists also considered use of the telephone as most important but then rated medication management and snack preparation as the most necessary activities for continued community living. These results emphasize the differences in the perception of 'important' between the two groups studied. The results from this research confirm the importance of IADL to both the occupational therapy profession and older people living at home in the community. Further, these results confirm the need for client-centred practice and collaborative intervention planning for occupational therapy.     

Allied health student and faculty attitudes regarding faculty evaluation

Faculty and students of undergraduate programs in medical technology, nursing, occupational therapy, physical therapy, and social work were surveyed to determine the perceived importance of faculty participation in 24 teaching, professional service, and scholarly and administrative activities. Results indicate that both groups view teaching activities as most important, faculty tended to assign more importance to scholarly and administrative activities than did students, and students tended to assign more importance to professional service than did faculty. An overall tendency toward similarity was found.     

Occupational Therapy as Part of a Pulmonary Rehabilitation Program

In the City of Hope Medical Respiratory Care (MRC) program occupational therapy is a dynamic, integral part of the rehabilitation process. Three broad and varying aspects of occupational therapy are covered. These consist of upper extremity exercises using both an arm argometer and gravity resistive exercises, relaxation and stress management training, and a multifaceted approach to activities of daily living (ADL) training. The ADL training is carried out in both individual and group sessions and includes techniques or work efficiency and motion economy, proper body mechanics, and proper breathing techniques during daily activities. The occupational therapist is a member of the MRC treatment team and would be unable to function effectively with these patients without the support and assistance of other members. The studies referred to in this paper validate this use of occupational therapy in a Pulmonary Rehabilitation Program.     

Clinical Management of Scar Tissue

This paper will review the physiology of scar formation including the properties of wound healing and scar remodeling. A clinical scar management program that includes evaluation of scar adhesions and use of a variety of therapy interventions to minimize the formation of scar will be described. Use of compression, massage, splints and functional activities is included in this program. The information is applicable for the general occupational therapist who sees patients with hand dysfunction as well as a therapist specializing in hand rehabilitation. Every therapist who treats hand trauma must be familiar with the sequence and the properties of scar formation in order to reestablish tendon gliding and facilitate early remodeling of scar tissue. Many treatment techniques can be directed toward scar adhesions and no one method is totally effective when used alone; used together, these techniques can positively influence scar formation and restore maximal hand function.     

Occupational Therapy and Low Vision Rehabilitation

This article addresses low vision rehabilitation programs and the certified occupational therapy assistant's role in a low vision, outpatient, ambulatory-care service. An individual who acquires low vision secondary to eye or brain pathology may have some useful vision but not enough to facilitate ease in performing activities of dail living. Visual tasks, such as reading, writing, homemaking and leisure activities become quite difficult without medical and therapeutic intervention. In these instances, the efforts of eye care professionals and occupational therapists can be coordinated to provide a holistic approach to patient treatment. The primary objective in utilizing a low vision rehabilitation program is to provide instruction to patients with low vision problems in activities of daily living through the use of optical/nonoptical aids to achieve functional independence.     

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.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Sharing Stories: Using Narratives to Illustrate the Role of Critical Reflection in Practice with First Australians

This paper aims to fill a gap in existing literature by using examples of reflective practice and how these informed service delivery and development with First Australians within a population health paradigm. Population‐based approaches have been proposed as useful for providing services that reach beyond the individual. They may be particularly helpful in providing a framework for occupational therapists working with First Australians, when modified appropriately. “Healthy Ears” is a statewide ear health programme for First Australians. It is an example of a health promotion programme working to partner with First Australian communities using a community‐driven and strengths‐based approach. The occupational therapy role within this service has been recently established. Collaborative autoethnography was used to produce narrative reflection and discussion between the first and second authors in order to illustrate the role of critical reflection in developing this new occupational therapy service. The narratives presented are based on three main themes, which emerged as important guiding principles; these are core occupational therapy knowledge and skills, partnerships with communities and organizations and cultural safety. Each theme comprises narrative excerpts followed by interpretations based on the literature. The findings from these narratives, whilst limited to a particular context, suggest there is a need for greater professional preparation and support for occupational therapists working cross‐culturally through undergraduate training and professional development opportunities. This paper highlights the usefulness of reflective practice as a tool for developing culturally safe occupational therapy services and emphasizes the importance of relationships with key First Australians as a platform for culturally safe practice. Copyright © 2013 John Wiley & Sons, Ltd.     

Cultural differences: The experience of establishing an occupational therapy service in a developing community

Aim:  This paper documents the subjective experience of a Western trained occupational therapist as she establishes a service in a community that is developing its health-care services. The community is located in the Dominican Republic.
Method and Results:  Ethnographic interviewing was used to document the tasks and events that occurred during this 6 month project. Challenges arose related to the region's developing health, education and community services, training the local workers and the reaction of the recipients of occupational therapy service. The contrast in beliefs, values and cultural customs between the therapist and the local people contributed to the challenge.
Conclusion:  This study indicates that exporting Western occupational therapy services without any changes causes significant conflict for the professional and the clients. Furthermore, this study demonstrates the importance of understanding cultural differences between the therapist and client, as well as the need for occupational therapy services in communities that seek to improve the health and abilities of the local people requiring rehabilitation services.     

New Scandinavian Doctorate:Verifying and Measuring the Ability to Perform Activities of Daily Living (ADL). A Critical Examination of ADL Instruments and the Practice of Occupational Therapy

The aim of the present thesis was to study how the ability to perform activities can be verified and measured.

The analyses have been performed point of view of occupational therapy. One view that occupational therapists often put forward is that the ability to perform activities consists in the relation between what the individual desires/wants to do and what he/she can do, and that the demand on capacity varies from situation to situation. It is emphasized that the activities vary in importance according to how the individual chooses to form his her life. This means that the ability to perform activities is regarded as a multidimensional and relative concept.

Occupational therapists make assessments of ADL ability in two different ways, one non-formalized, the other formalized. The latter involves the use of a standardized instrument. The ADL instruments have mainly been developed outside the practice of occupational therapy and for research purposes. Both these forms of assessment have been studied in an attempt to answer the question whether the introduction of standardized ADL instruments in occupational therapy may facilitate clinical decisions about the rehabilitation needs and about continued care and evaluation.

The survey of the traditional measuring instruments used has shown that no uniform method of measuring ADL exists. The instruments have mainly been constructed on the basis of a concept applied in practice. Consequently, ADL ability is defined by what the instrument measures. Most instruments focus on what the individual does or can do without help from anyone else. It is clearly evident that efforts are also made to measure the activity as a single, uniform ability that can be summarized as a value, i.e. one-dimensionally. The traditional instruments primarily measure the level of care that the individual needs, on the basis of his/her mobility level, but it is difficult to attain one-dimensionality even if one investigates basal and equivalent activities. The various activities appear to differ in their essentials and demand different abilities.

In a study of occupational therapists in their everyday practice, it was found that they did use a number of dimensions when making decisions about the patients' ability. It was also shown that assessments were made for different purposes, no precise language existed for describing the patients' ability.

The most important conclusion must be that it is a myth that occupational therapists should be able to use a uniform instrument for all ADL assessment. Formalized instruments can be useful when making decisions about future care requirements on the grounds of functional impediments. As guides in the direct contact with an individual patient, the scale constructions are inadequate, being far too abstract. In order to obtain as reliable measurements as possible, one should avoid index constructions and measure each activity separately. The thesis was concluded with various attempts to construct linguistic expressions to describe the ability to perform activities with greater exactness and in more detail than is possible with the traditional instruments and in current practice.     

Use of time in childhood and adolescence: A literature review on the nature of activity participation and depression

Despite a philosophical belief in the health benefits of balanced participation in everyday activities, occupational therapists have devoted scant research attention to the relationship between mental health and activity participation in childhood and adolescence. Time use studies offer valuable insights into this relationship. In this literature review the methodologies employed in time use studies are described, and empirical findings linking depression to the distribution of time to leisure, productive and self-care activities, and sleep are then outlined. The relevance of findings to occupational therapy assessment and intervention is discussed. Therapists are challenged to further research the area, as gaining thorough knowledge of young people's time use has implications for both professional practice and broader public health policy.     

A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: an occupational therapy perspective

In response to the need for effective non-pharmacological approaches for individuals with mild to moderate dementia, cognitive stimulation therapy (CST) interventions aim to optimize cognitive function. The present literature review explored the effectiveness of CST and the congruence of this approach with occupational therapy. Twenty-four databases and 13 "grey" sources were searched. Relevant papers were analysed using the McMaster Critical Literature Review Guidelines, the Modified Jadad Quality Scale and the Oxford Centre for Evidence-based Medicine Levels of Evidence Scale. To establish the congruence of CST with occupational therapy, themes were identified using the International Classification of Functioning and professional values outlined by the Canadian Association of Occupational Therapists. Twelve studies demonstrated a trend towards delayed cognitive decline following CST. This intervention strategy is congruent with occupational therapy values and may provide a useful structural framework to build rehabilitation programmes for this population. Psychometric properties of the McMaster Guidelines have not yet been established, and there is no standardized way to extract quantitative data from this measure. There is a need for further research exploring outcomes of CST interventions within the context of everyday function in individuals experiencing cognitive decline.