Long-term cognitive impairment and delirium in intensive care: A prospective cohort study

Background

Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported.

Occupational performance: a case for self‐determination

The term, ‘self‐determination’, implies that individuals have choice and control over aspects of their lives. Individual/family preferences and choices are now core aspects of Australia's National Disability Insurance Scheme, underpinning the importance attributed to these concepts in relation to the fostering of wellbeing. As occupational therapists, in collaboration with our clients, we facilitate and enable occupational performance goals which are personally meaningful and self‐endorsed. As such, our professional practice provides us with a powerful motivational tool by which we can harness individuals’ energies in the pursuit of their goals – occupation. Self‐Determination Theory (SDT) is an influential theory of human motivation and is presented as a way of understanding the elements of our occupational therapy transactions, and the way in which we enact them so as to enhance client outcomes. In SDT, it is proposed that individuals engage in, pursue and persist with certain behaviours when three psychological needs are being met. These needs are for autonomy (engaging in behaviour that is self‐endorsed), relatedness (feeling cared for and connected to others) and competence (feeling effective in one's environment). A focus on supporting satisfaction of these basic psychological needs, it will be argued, engenders therapeutic alliance and internalisation of goal pursuits, thus optimising therapy engagement and outcomes. Examples of practice approaches that attend to the psychological needs for autonomy, relatedness and competence will be presented. A case will be made for embedding SDT into our models of practice as a sound way of articulating how we practise.