Neurobiological narratives: experiences of mood disorder through the lens of neuroimaging

Many scientists, healthcare providers, policymakers and patients are awaiting in anticipation the application of biomedical technologies such as functional neuroimaging for the prediction, diagnosis and treatment of mental disorders. The potential efficacy of such applications is controversial, and functional neuroimaging is not yet routinely used in psychiatric clinics. However, commercial ventures and enthusiastic reporting indicate a pressing need to engage with the social and ethical issues raised by clinical translation. There has been little investigation of how individuals living with mental illness view functional neuroimaging, or of the potential psychological impacts of its clinical use. We conducted 12 semi‐structured interviews with adults diagnosed with major depression or bipolar disorder, probing their experiences with mental health care and their perspectives on the prospect of receiving neuroimaging for prediction, diagnosis and planning treatment. The participants discussed the potential role of neuroimages in (i) mitigating stigma; (ii) supporting morally loaded explanations of mental illness due to an imbalance of brain chemistry; (iii) legitimising psychiatric symptoms, which may have previously been de‐legitimised since they lacked objective representation, through objective representations of disorder; and (iv) reifying DSM‐IV‐TR disorder categories and links to identity. We discuss these anticipated outcomes in the context of participant lived experience and attitudes to biologisation of mental illness, and argue for bringing these voices into upstream ethics discussion.     

Novice occupational therapists' perceptions of readiness to undertake fieldwork supervision

Aim: This study investigated new graduate occupational therapists’ perceived readiness for the fieldwork supervisor role at a metropolitan Melbourne Hospital. Methods: Data from four in‐depth individual interviews and a focus group conducted with seven Grade 1 occupational therapists were analysed thematically. An iterative process was used to develop themes from the categories of data. Results: The new graduate occupational therapists’ perceived readiness for supervising students was strongly influenced by a sense of still learning themselves. High expectations were expressed of the supervisory role. Active support and supervision from the workplace and the university are seen as neccessary. Conclusions: A deeper understanding of the supervisory role and associated skills required for new graduate therapists is needed. Support from senior colleagues and workshops conducted by the university to up‐skill the therapists are recommended.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

Identifying occupational therapists' referral priorities in community health

Occupational therapists in British community mental health teams have been debating how the most effective services can be targeted at the most needy clients. This paper presents the results of a quantitative study that examined 40 British occupational therapists' referral prioritization policies. Results showed half of the participants felt their generic responsibilities, which involved having care co-ordination responsibilities, were too large. Only 25% of participants co-ordinated care for clients whose needs were related to occupational dysfunction. Judgement analysis, that involved regressing the 40 individuals' prioritization decisions onto the 90 respective referral scenarios, was used to statistically model how referral information had been weighted. Group agreement of prioritization was moderate with the reason for referral, history of violence and diagnosis being given the most weighting. Consistency in policy application, as measured by examining prioritization decisions on identical referrals, showed wide variability. Further research is required to identify the optimal and most stable policies within this group.     

An examination of the pairing between narrative and occupational science

Abstract

In this paper the author proposes a possible typology of the use of narrative in occupational science based on an analysis of journal articles from occupational therapy and occupational science literature. The resulting typology identifies usages of narrative that fall into three categories: (a) everyday life, (b) clinical reasoning, and (c) research methodology. The theoretical and methodological interrelations among these categories are explored. This typology contributes to a clearer conceptualization of the various uses of narrative, minimizes terminological confusion, and suggests new extensions through which narrative can be used to study occupation. Recommendations for how this typology can be used to diminish confusion and encourage dialogue are provided.     

Occupational therapists' assessments of adults with long-term pain: the Swedish experience

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.     

Discourses of risk in lay accounts of microbiological safety and BSE: a qualitative interview study

This paper reports on a qualitative study of lay understandings of food risks, focusing on discourses of risk in lay accounts of microbiological safety and BSE. The research was conducted using interpretive sociological methods. In-depth interviews were conducted with 32 lay participants from a range of social backgrounds and perspectives on food issues. The qualitative data were analysed thematically, drawing on principles and techniques derived from Grounded Theory approaches. Several key themes relating to risk emerged: these included, the role of experience in interpreting vulnerability to food risks, the time-scale of foods risks, the severity of the consequences of food risks, the incidence of food risks (and comparative risk), personal risk management strategies (and the ‘salience’ of food risks), risk and trusted food sources, responsibility for regulating food risks and the ‘politics’ of food risks. This paper presents an interpretive account of these themes and discusses the implications of the findings for a sociological analysis of food risks.     

Eclectic Application of Theoretical Models in Occupational Therapy: Impact on Therapeutic Reasoning

Abstract

We investigated the impact of an eclectic framework for combining theoretical conceptual practice models on occupational therapists’ theoretical reasoning using concurrent mixed methods with repeated measures and grounded theory designs. Study participants (n?=?9) attended two workshops to review select occupational therapy theoretical conceptual practice models and learn how to use the eclectic framework. We assessed skills in eclectic combination of theoretical conceptual practice models using the Theory Application Assessment Instrument. The skills improved significantly [χ²(2, 9) = 7.09, p = .02], a finding that was corroborated by the qualitative findings indicating that the eclectic framework may potentially help improve theoretical reasoning among occupational therapists.     

Occupational therapists' experiences in integrating a new intervention in collaboration with a researcher

Abstract

Objective: The aim of this study was to describe occupational therapists' expectations and experiences of integrating a new intervention programme within an RCT pilot study, in collaboration with a researcher. Methods: Six occupational therapists participated in a five-day training course (during a one-month period) including lectures, reading articles, and discussions. The data were collected through interviews and written reflections, analysed by a qualitative constant comparative approach. Results: The findings displayed a process of change, primarily in the participants' way of integrating research in their clinical practice. Three main categories were identified as: hope of taking part in a research project, confirmation of anchoring, and experience of scepticism. These categories constituted the core category “The occupational therapist's process of integrating research in a clinical context with the prerequisite being a dialogue and a sharing of responsibility and authority between researcher and occupational therapist”. A tentative model was formulated which described how the various categories were related to one another as well as how change occurred over time in the context in which the study was carried out. Conclusions: One conclusion is the importance of providing opportunities for creating dialogues among researcher and practitioners to narrowing the gap between research and “everyday practice of occupational therapy”.     

Barriers to Improving Patient Safety in India: Focus Groups with Providers in the Southern State of Kerala

Objective:To understand the perceptions of health care providers about barriers to improved patient safety in the Indian state of Kerala.Setting:One rural primary care clinic, one secondary care hospital and one tertiary care center in Kerala, India.Participants:16 doctors and 20 nurses participated in five focus groups.Results:Overall, there were 129 unique mentions of barriers to patient safety; these barriers were categorized into five major themes. ‘Limited resources’ was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness.Conclusions:Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.     

Occupational therapy and early intervention: a family-centred approach

The purpose of this study was to identify factors that encourage or inhibit family-centred practice in the occupational therapy intervention process. A qualitative paradigm using grounded theory methodology was utilized to gather and analyse data. Participants included six families and four occupational therapists. Data analysis from the family interviews identified six categories: education, communication, relationship, parental roles, follow through, and scheduling. With further analysis two central themes of time and support were extracted from these categories. Analysis of the occupational therapists' interviews revealed six categories: education, communication, relationship, sibling/family participation, follow through, and empowerment. The central themes emerging from these categories are time and natural routine. The themes obtained from the families and occupational therapists were then compared and family individuality was identified as the core concept. Viewing families as a unique entity is necessary to assist occupational therapists in providing the most effective family-centred occupational therapy.     

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.     

Occupational therapy and culture: a literature review

Abstract

Background: Occupational therapy has culture as a relevant phenomenon of interest. Culture appears increasingly often in occupational therapy research, from diverse approaches and foci. As culture is difficult to define, and has political and ethical implications, an investigation into its usage is warranted. Aim: To identify and describe how culture as a broad phenomenon is expressed in OT research published between 2006 and 2011, regarding knowledge development in the discipline and its impact on practice. Methods: A qualitative study was carried out, using an integrative literature review. Thirty-nine studies in English were included. Results: From the analysis, two dimensions concerning expressions of culture emerged: “culture is alive” and “occupational therapy as a culture”. Aside from these dimensions, a group of forces that have an impact on these dimensions is described. Conclusions: In its understanding of expressions of culture, occupational therapy stands at a crossroads between traditional and critical approaches. A lack of critical insight into professional knowledge increases the risk that occupational therapy will remain satisfied with the current understanding of culture, based on the dominant knowledge. The discipline could fail to address the political, ethical, and theoretical issues required to reach the targeted diversity in its practice.     

Barriers in addressing body image and eating issues in primary care: an overview of women’s narratives

ABSTRACT

Disordered eating and body image concerns continue to be rising problems for young women that come with significant mental and physical health risks. Primary care may be a potential avenue for early identification and intervention of eating and body image issues. However, few studies have explored this area in depth. Preliminary studies show that few women discuss these issues with their primary care providers (PCPs), and the barriers to these conversations remain unknown. This study used an open-ended survey to explore women’s narratives concerning their experiences and barriers to discussing eating and body image issues with their PCPs. A total sample of 102 female college students (aged 18–35 years) in the Boston area completed self-report questionnaires online (February 2015 through January 2016). Themes in both communication and relationship domain emerged. Communication themes for participants included: health information, prompting by the PCP, and other barriers. Relationship themes included: patient and provider characteristics, negative and positive emotions, and trust. According to these participants, many women experience negative interactions with their providers when discussing these sensitive topics. Strategies for improving these outcomes in primary care are discussed.