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.     

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.     

Concepts in occupational therapy in relation to the ICF

Occupational therapists need an acceptable terminology to describe a client's clinical performance. The language or terminology must be in harmony with common language in the health care system but also reflect occupational therapists' professional responsibility. The aim of this paper is to help clarify similarities and differences between concepts in occupational therapy and the International Classification of Functioning, Disability and Health (ICF). Two studies were completed in which items in the International Classification of Impairments, Disabilities and Handicaps (ICIDH-2) were compared with concepts from the Swedish version of the assessment of Motor and Process Skills (AMPS) and the Assessment of Communication and Interaction Skills (ACIS-S). An expert panel of occupational therapists served as raters and 33 clients with learning disabilities and mental health problems were assessed. The result showed that 12 (60%) of the skills items from the ACIS-S were found to be equivalent to items in then ICIDH-2. In total, 41% (n = 23) of the items in the AMPS or ACIS-S have a correlation higher then 0.60 with the ICIDH-2. The classification can serve as a useful tool for occupational therapists and supports communication between professions, but is not sufficient as a professional language for occupational therapists. Further research is indicated to examine how the ICF can be applied in occupational therapy and its implications on clinical practice.     

Relevance and focal view point in occupational therapists' documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where "Activity" and "Health" are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on "activity" and holistic health notions.     

Relevance and focal view point in occupational therapists’ documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where “Activity” and “Health” are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on “activity” and holistic health notions.     

Icelandic occupational therapists' attitudes towards educational issues

The purpose of this study was to assess the readiness of occupational therapists in Iceland to accept a professional as opposed to a technical view of the profession. Most Icelandic occupational therapists were educated in other countries, with little emphasis on liberal arts, sciences and research. The first Icelandic occupational therapy programme, a university-level programme, was founded in 1997. All Icelandic occupational therapists were surveyed. Eighty-seven questionnaires were sent out and 80 (92%) were returned and used for statistical analysis. The results of the study showed that Icelandic occupational therapists valued academic skills over technical skills, emphasizing occupational therapy theory unique to the profession and research to validate practice. More recognition among other health professionals was considered the most needed change in the profession. The results of the study showed that the clinicians' attitudes confirmed in general what is emphasized in the curriculum and in students' fieldwork. Further research is needed to explore whether the Icelandic occupational therapy profession succeeds in promoting research and recognition by other health professions.     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.     

Ethics, occupational therapy and discharge planning: Four broken principles

Occupational therapists play a significant role in the discharge process and are often exposed to ethically challenging decision-making. This paper examines the moral basis of discharge planning, relating it to the four fundamental bio-ethical principles of respect for autonomy, beneficence, non-maleficence and justice. Using a case study design, data was collected from 10 occupational therapists and two elder care patients using the critical incident approach, as part of a wider study to determine their perceptions of discharge planning and multidisciplinary teamwork. Direct observation of interaction within multidisciplinary teams was also undertaken. The findings from the research suggest that occupational therapists are unintentionally breaching these four principles and therefore their code of ethics and professional conduct. It is suggested that further research is needed to determine how occupational therapists overcome these challenges. Furthermore, this research has important implications for education establishments regarding the teaching of ethics to occupational therapists.     

The structure of novice and expert occupational therapists' clinical reasoning before and after exposure to a domain-specific protocol

Background/aim:  The research aimed to determine the influence of a protocol designed for use in the domain of upper limb hypertonia due to brain injury on novice and expert occupational therapy clinical reasoning.
Method:  Individual, structured repertory grid interviews were completed with 13 novice and eight expert occupational therapists prior to, and following, exposure to a domain-specific clinical reasoning protocol. Data were subjected to quantitative analyses (Principal Components Analysis, Generalised Procrustes Analysis).
Results:  Novice participants demonstrated statistically significant change in the structure of their clinical reasoning following exposure to the protocol ( P  < 0.004). Prior to exposure, novices relied on therapy tasks, the problem-solving process, environmental factors and standard practice to structure their reasoning. Following exposure, novices' clinical reasoning changed to more closely reflect experts' reasoning. Thus, a 'structured approach' and (theoretical) practice perspectives became evident. Prior to exposure to the protocol, experts structured reasoning in terms of (personal and theoretical) practice perspectives, therapy tasks and the scope of such tasks (either 'general' or 'specific'). Following exposure, therapist/client collaboration and upper-limb-related constructs emerged as being used to structure experts' reasoning, although these changes were not statistically significant.
Conclusion:  A protocol designed for guiding clinical reasoning in the context of upper limb hypertonia was perceived to be conceptually useful by novice and expert occupational therapists.     

Continuing professional development for occupational therapy emergency department services

Aim: To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists. Method: Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity. Results: No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty‐one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists. Conclusion: Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.     

Occupational therapy in palliative care: Is it under‐utilised in Western Australia?

Aim: To explore potential barriers to occupational therapy in palliative care in Western Australia, as perceived by occupational therapists and other health professionals. Method: A qualitative research methodology was used. Semi‐structured interviews were conducted with 10 occupational therapists and 10 health professionals (including a physiotherapist, a social worker, medical registrars and clinical nurses). Interviews were transcribed verbatim and analysed using content analysis. Results: The four main themes identified were: inconsistent understanding of the contribution that occupational therapists can make to palliative care, insufficient promotion of the potential contribution of occupational therapy, insufficient funding, and limited research on the role of occupational therapy in palliative care. Conclusion: This study provides an understanding of the barriers that have limited occupational therapists’ involvement in providing palliative care in Western Australia.     

Clinical outcomes research from the occupational therapist's perspective

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.     

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.     

Hospice and palliative care: A Delphi survey of occupational therapists' roles and training needs

This paper describes the use of the Delphi survey method to identify the roles and training needs of occupational therapists working in the field of hospice and palliative care in Australia. The study was conducted in 1993 using a purposive sample of 47 occupational therapists. The survey consisted of three consecutive questionnaires and five in-depth interviews. The results indicated that there is a role for occupational therapy in this new and expanding field, and that occupational therapists need to promote a higher profile for their profession and their skills through research, education and presentations to maximize this role. The study also highlighted the importance of continuing education for occupational therapists working in this field.     

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.     

Occupational therapy and people with intellectual disability from culturally diverse backgrounds

The multicultural nature of Australian society creates a need for occupational therapists to become aware of the issues facing people from culturally diverse backgrounds. People with intellectual disability from culturally diverse backgrounds may experience a 'double disadvantage' due to issues of their culture and their disability. This research aimed to identify the experiences, issues and strategies used by occupational therapists working with people with intellectual disability from culturally diverse backgrounds. A semistructured group interview and three individual interviews were conducted with occupational therapists from both metropolitan and rural locations in Queensland. It was found that communication and residential services present some unique issues for people with intellectual disability from culturally diverse backgrounds. Strategies suggested by therapists to address a range of issues are listed. Implications for occupational therapy are discussed, and suggestions for future research are provided.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

An Investigation of Moral Distress Experienced by Occupational Therapists

This study used a quantitative survey design to investigate the existence of moral distress among occupational therapists. The Moral Distress Scale-Revised (MDS-R-OHPA) was distributed to a random sample of 600 members of the American Occupational Therapy Association (AOTA). The results of this explorative study found that occupational therapists reported moderate levels of moral distress with occupational therapists working in geriatric settings reporting higher levels of moral distress than occupational therapists who work in physical disability settings, although the difference was not statistically significant. However, occupational therapists who were considering leaving their current position reported the highest levels of moral distress. These initial findings are discussed as well as the need for further research.     

Male occupational therapists: A profile of job satisfaction and work environment variables

Occupational therapy is a female-dominated profession with only 4% of all clinicians in Canada being men. Traditionally, occupational therapy training programmes have had limited success recruiting men into their educational programmes and those men who do qualify as therapists tend to work only in the profession for short periods of time. The purpose of this study was to identify work-related factors that impact on male occupational therapists. Specifically, five job satisfaction factors (work, pay, co-workers, supervision and promotional opportunities), work environment traits and the demographic characteristics of male occupational therapists in Canada were examined. A mailed survey questionnaire was sent to all male therapists who were members of the Canadian Association of Occupational Therapists (n = 199) during the 1990–1991 membership year; 83% of the sample responded. In terms of job satisfaction, male occupational therapists indicated that they were relatively dissatisfied with their work, pay, promotional opportunities, supervision and co-workers as a group. However, they characterised their work environments as being above average in terms of supervisor support, autonomy and physical comfort, whereas they obtained a well below-average score for the control dimension. Further research is needed to explore the issue of job satisfaction among occupational therapy personnel and to identify what factors impact on the job retention of male occupational practitioners.