The pan occupational paradigm: development and key concepts

Occupational therapy's oversight: How science veiled our humanity

BACKGROUND

Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.

AIMS/OBJECTIVES

This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured.

METHODS

This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.

CONCLUSION

Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.

SIGNIFICANCE

The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

Occupational Experiences of Medication Management Among Adults Living With Multiple Chronic Conditions

Adults with multiple chronic conditions (MCCs) often face difficulties with medication management, affecting their experiences of well-being and illness. The objective of this study was to identify and describe the occupational experiences of medication management and their impact on well-being and illness in adults living with MCCs. We used document analysis methods to analyze 134 illness narrative blog posts authored by 52 adults aged 18 and older with MCCs. Content and thematic analysis of their textual content was based on the Pan Occupational Paradigm. Medication management is enacted through the dimensions of doing, belonging, becoming, being, and knowing, in an interconnected, nonlinear manner, with a more notable impact on illness than well-being due to the complexities associated with medication management for MCCs. Occupational therapy practices for medication management should consider all occupational dimensions and their impact on health rather than focusing primarily on the performance of medication tasks and routines.

Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Beyond conventional healthcare for mental health problems: Experiences of existential group conversations

BACKGROUND

Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

AIMS

To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

MATERIALS AND METHODS

Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

RESULTS

The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

CONCLUSION

Existential conversations in group may contribute to a more reflected doing in accordance with one's own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual's own preferences.

SIGNIFICANCE

This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

Creative activities as intervention - Exploring occupational therapists' narrative reasoning

BACKGROUND

Creative activities as intervention (CaI) in mental health promotes recovery and is an important part of occupational therapy practice. Yet few studies have explored occupational therapists' reasoning about using CaI to trace tacit knowledge.

AIMS/OBJECTIVES

The aim of this study was to explore occupational therapists' reasoning on rationale and motives in co-creating a model (the CreActivity model) for CaI as a resource in mental health rehabilitation.

MATERIAL AND METHODS

Co-operative inquiry and narrative theory provided the methodology for exploring eight occupational therapists' narrative reasoning in the process of co-creating a model. Data were generated via ethnographic methods from seven co-operative inquiry group meetings and analysed through narrative analysis.

RESULTS

The occupational therapists' reasoning in using creative activities comprised building relationships and opportunity for activity. Motivating and engagement by finding 'cracks' and stories bridging action with the past and future using creative activities were used to create reflection, development, and empowerment.

CONCLUSIONS AND SIGNIFICANCE

Identifying the narrative layers of occupational therapists' reasoning on achieving core dimensions of occupational therapy may enable and support occupational therapists in the use of creative activities as intervention.

"Cured" but not "healed": The application of principles of palliative care to cancer survivorship

Application of principles of palliative care to the concept of survivorship may serve to establish an interdisciplinary approach to guide those treated for cancer through the experience of being "cured" but not "healed". Valuable lessons may be garnered from palliative care if its principles are considered within the context of survivorship. This work aims to define key terms including cured, healed, survivorship, and quality of life (QoL) and delineate the central tenets of palliative care and disease-modifying care. Since pursuit of a cure tends to dominate provision of oncological care, Western society's prevailing death denying attitudes often equate to the prioritization of advanced medial treatment to postpone death. Accordingly, the "modern paradox" of medicine (Cassell, 2004) is examined in consideration of the suffering that often results from advanced medical treatment that is intended to alleviate the cause of suffering and ultimately, "deny" death. However, owing to the profound consequences of advanced medical treatment and the associated losses of function concomitant with cancer, there is an apparent need for a framework of care that attends to these survivorship issues. When the experience of being cured but not healed is articulated through a theoretical discussion of liminality and the "remission society" (Frank, 1995), the applicability of palliative care to survivorship care becomes apparent. By embracing principles of palliative care, survivorship care may be guided by a theoretical foundation that provides cancer survivors with care that supports increased QoL, biopsychosocial symptom management, and a holistic perspective of the illness experience. Accordingly, application of palliative care to survivorship may establish congruence between notions of cured and healed.

Evaluating a multidimensional strategy to improve the professional self-care of occupational therapists working with people with life limiting illness

BACKGROUND

The term 'life limiting conditions' refers to premature death following decline from chronic conditions, which is a common circumstance in which occupational therapists work with people at the end of life. The challenges for clinicians of working with these patients have long been recognised, and may have a significant impact on their professional self-care. This study aimed to evaluate a multidimensional workplace strategy to improve the professional self-care of occupational therapists working with people living with a life limiting condition.

METHODS

A pre and post mixed methods survey approach were utilised, with baseline data collection prior to the implementation of a multidimensional workplace strategy. The strategy included professional resilience education, targeted supervision prompts, changes to departmental culture and the promotion of self-care services across multiple organisational levels. Follow up data collection was undertaken after the strategy had been in place for 2 years. Quantitative data were analysed descriptively, while qualitative data were subjected to thematic analysis.

RESULTS

One hundred three occupational therapists responded (n = 55 pre, n = 48 post) across multiple service settings. Complex emotional responses and lived experiences were identified by participants working with patients with life limiting conditions, which were not influenced by the workplace strategy. Working with these patients was acknowledged to challenge the traditional focus of occupational therapy on rehabilitation and recovery. Participants were confident about their ability to access self-care support, and supervision emerged as a key medium. While the strategy increased the proportion of occupational therapists undertaking targeted training, around half identified ongoing unmet need around professional self-care with this patient group. Demographic factors (e.g. practice setting, years of experience) also had a significant impact on the experience and needs of participants.

CONCLUSIONS

The multidimensional workplace strategy resulted in some improvements in professional self-care for occupational therapists, particularly around their use of supervision and awareness of available support resources. However, it did not impact upon their lived experience of working with people with life limiting conditions, and there remain significant gaps in our knowledge of support strategies for self-care of occupational therapist working with this patient group.

Development of the Translating Allied Health Knowledge (TAHK) Framework

BACKGROUND

While evidence-based practice is a familiar concept to allied health clinicians, knowledge translation (KT) is less well known and understood. The need for a framework that enables allied health clinicians to access and engage with KT was identified. The aim of this paper is to describe the development of the Translating Allied Health Knowledge (TAHK) Framework.

METHODS

An iterative and collaborative process involving clinician and academic knowledge partners was utilised to develop the TAHK Framework. Multiple methods were utilised during this process, including a systematic literature review, steering committee consultation, mixed methods survey, benchmarking and measurement property analysis.

RESULTS

The TAHK Framework has now been finalised, and is described in detail. The framework is structured around four domains - Doing Knowledge Translation, Social Capital for Knowledge Translation, Sustaining Knowledge Translation and Inclusive Knowledge Translation - under which 14 factors known to influence allied health KT are classified. The formulation of the framework to date has laid a rigorous foundation for further developments, including clinician support and outcome measurement.

CONCLUSION

The method of development adopted for the TAHK Framework has ensured it is both evidence and practice based, and further amendments and modifications are anticipated as new knowledge becomes available. The Framework will enable allied health clinicians to build on their existing capacities for KT, and approach this complex process in a rigorous and systematic manner. The TAHK Framework offers a unique focus on how knowledge is translated by allied health clinicians in multidisciplinary settings.

Meaningful occupation with iPads: Experiences of residents and staff in an older person’s mental health setting

Introduction

This study aimed to explore the experience of staff and residents of mental health residential care facilities, using iPads as a medium to engage in meaningful occupation.

Method

A mixed method was used, which combined descriptive quantitative and thematic qualitative analysis. The Pan Occupational Paradigm was used as a theoretical framework, to maintain an occupational perspective. Residents participated in semi-structured interviews, and staff completed surveys and participated in a focus group or individual interview. The responses were then coded and analysed for their description of ‘doing’, ‘being’, ‘becoming’ and ‘belonging’ experiences.

Findings

Analysis found that residents engaged in personally meaningful occupations with the iPads, often with staff facilitation. The study also found that staff and residents responded positively to the iPads, particularly regarding developing positive connections and opportunities for growth and mastery. However, barriers associated with resource availability (particularly hardware and infrastructure) were also identified.

Conclusion

The use of iPads in these facilities provided opportunities for residents to engage in meaningful occupation, and overcome the occupational limitations inherent in the service setting. iPad use also enabled residents to engage in the community outside the facility.