A qualitative meta-synthesis about challenges experienced in occupational therapy practice

Introduction

Information about challenges for occupational therapists is typically provided in small-scale studies from different perspectives. The purpose of this meta-synthesis was to synthesise and report about challenges in occupational therapy practice that appear to penetrate across the profession.

Method

Databases searched were Ovid Medline, EMBASE, AMED and CINAHL. Search terms were selected after gaining understanding of the topic: occupational therap* AND Exp burnout / OR Exp morals / OR retention OR clinical reasoning OR new graduate OR novice OR transition-to-practice. Studies were critically appraised using the criteria of credibility, transferability, confirmability and dependability. Findings, along with direct quotes, were extracted and data compared and contrasted through first, second and third order analysis.

Findings

Twenty-four studies were included in the meta-synthesis and three constructs were identified: ‘challenges in context’; ‘personal challenges’ and ‘social and cultural challenges’. These findings inform knowledge about constraining factors on clinical reasoning and the alignment of practice with the occupational therapy philosophy, and give insight into satisfaction with practice, ethical and professional behaviours.

Conclusion

These findings could inform provision of professional support, education for students and enhance agency to reform practice. More research is needed about professional socialisation, clinical reasoning and ethical issues.

Critical reflexivity in client-centred therapeutic relationships

AIM/OBJECTIVES

This paper explores how a particular form of reflection--critical reflexivity--can support clinicians in developing a more nuanced understanding of therapeutic relationships, and work to advance the goal of client-centred practice.

METHODS

A critical autobiographical narrative was written, and critical reflexivity adopted, as methods to critically examine the therapeutic relationship.

FINDINGS

Critically reflexive stories have the potential to advance client-centred therapeutic relationships by inspiring the (re-)consideration of practices, and by interrogating interpretive systems.

DISCUSSION

Understandings and practices that potentially limit the extent to which therapeutic relationships are client centred include (i) Dichotomous thinking, (ii) Objectification, (iii) The economic imperative, and (iv) Knowledge generation.

CONCLUSION

The critical autobiographical account points to ways in which critical reflexivity on the therapeutic relationship has the potential to foster critical questioning, interrogate interpretive systems, attune to subjectivities, contribute to practice-based knowledge, resist violation, foster compassionate practice, and develop new understandings of relevance to client-centred practice.

SIGNIFICANCE

This critical examination of the therapeutic relationship supports occupational therapists in more fully realizing the profession's core value of client-centred practice.

Governing the Majority World? Critical reflections on the role of occupation technology in international contexts

BACKGROUND

Within occupational therapy, increasing attention has been focussed on international development work. However, many have critiqued the focus of knowledge development within occupational therapy and occupational science, arguing that it is focussed on Western values. Questions arise about how occupational therapy and occupational science, and the knowledge and therapeutic technologies that are associated with these communities, will affect the 'developing' world, which, recently, some have described as the Majority World.

AIM AND METHOD

Using Foucauldian analytical tools, this paper reflects on specific discourses that are foundational for development work. Specifically, this paper attempts to better understand how concepts like 'occupational justice' and the 'occupational being' are presented in the literature and relate to practices in international contexts. Within this analysis, attention is focussed on how practices associated with occupational development work might also be enmeshed in power dynamics.

RESULTS

  This paper outlines how occupational discourses may shape and order life in particular ways and challenges researchers and practitioners to develop a better understanding of how power can operate through occupational discourses and occupational therapy practices. This paper also adds to the literature through the interpretation and explication of various theories that may underpin work in international contexts.

CONCLUSIONS/FUTURE DIRECTIONS

Suggestions for future directions that will enable the development of more politically and culturally sensitive knowledge and practices are also explored. It is crucial that as a community we become more aware of how our theoretical frameworks may impact and shape practice.

A qualitative study of Iranian nurses' understanding and experiences of professional power

BACKGROUND: Nurses are expected to empower their clients, but they cannot do so if they themselves feel powerless. They must become empowered before they can empower others. Some researchers have emphasized that understanding the concept of power is an important prerequisite of any empowerment program. While many authors have tried to define the concept of power, there is no comprehensive definition. This paper is an attempt to clarify the concept of power in nursing. It also would present a model describing the factors affecting nurse empowerment. METHODS: We chose the grounded-theory approach for analysis of the participants' experiences and their viewpoints regarding the concept of professional power in nursing. Semi-structured interviews and participant observation methods were used to gather the data. Forty-four participants were interviewed and 12 sessions of observation were carried out. The constant comparative analysis method was used. RESULTS: Six main themes emerged from the data: "Application of knowledge and skills", "Having authority", "Being self-confident", "Unification and solidarity", "Being supported" and "Organizational culture and structure". According to the participants, nurses' power is influenced by these six variables. A theoretical model was designed to represent the interrelationships between these six variables. CONCLUSIONS: Nurses' power depends on gaining and applying professional knowledge and skills. Delegating authority and enhancing self-confidence of the nurses also help them to apply their knowledge in practice. Unification of the nurses and their mutual support play the key roles in development of their collective power and provide a base for better working conditions, professional independence and self-regulation.