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

Professional identity and workplace motivation: A case study of health information managers

BACKGROUND

The professional identity and motivation of qualified health information managers (HIMs) is largely unexplored.

OBJECTIVES

A larger study has investigated the motivators of HIMs in the construction of their professional identity and associated relationships to job satisfaction and engagement with their profession. The aims of this component of the study were to: (i) identify and analyse the characteristics of members of the profession who have different motivation profiles; (ii) obtain HIMs' perspectives on their professional identity; and (iii) measure correlation between HIMs' professional identity and different motivating factors. Method: A cross-sectional study design, with a convergent mixed-methods approach to data collection was employed. An online survey was administered to the 1985, 1995, 2005 and 2015 Australian health information management and medical record administration graduate cohorts from one university in Victoria.

RESULTS

Response rate: 72.7% (n = 72). There were no statistically significant correlations between the HIMs' motivation profile and professional identity. The HIMs were largely motivated by a need for achievement (striving for excellence) and continuous improvement; maintained high standards of work quality (95.8%); valued their work (94.4%) and work collaborations (84.7%); satisfactorily applied skills-knowledge (94%); demonstrated a very strong professional association (92% were proud to belong to the profession). Key factors in motivation that were consistently reported by members of all cohorts in the open-ended questions were as follows: intrinsic motivation; colleagues and teamwork; the variety of work performed; and contribution to the bigger picture. Overall, and notwithstanding between-cohort differences: 65.3% confidently directed others, 45.8% aspired to leadership and 38% actively networked. They related difficulty in explaining the profession to outsiders.

CONCLUSION

There was no correlation between motivation profile and professional identity. Significantly, the HIMs demonstrated exceptionally strong positive professional identity, reflected particularly in pride in membership of the profession and their belief in the importance of their professional work.

An Investigation of the Professional Resilience Strategies Used by Experienced Occupational Therapists

There is a paucity of research into the strategies occupational therapists use to maintain career longevity professional resilience. The objective of the study was to identify the strategies used by occupational therapists to maintain their professional resilience. Descriptive statistics were used to analyze data from a cross-sectional survey that investigated the professional resilience strategies used by experienced occupational therapists. Valid responses were received from 489 occupational therapists from 29 countries. The most used professional resilience strategies were maintaining a belief in the value of occupational therapy, taking time for reflection on positive outcomes, using personal time management strategies, and engagement in informal and formal professional support networks. A range of professional resilience strategies are used by experienced occupational therapists in health and social care settings. The findings can be used by managers and workplace organizations to support their occupational therapy workforce.

Occupation-centred practice and supervision: Exploring senior occupational therapists' perspectives

INTRODUCTION

Occupation-centred practice is core to contemporary occupational therapy; however, knowledge and implementation of occupation in practice vary. New graduate occupational therapists find implementing occupation-centred practice challenging, partly due to the influence of senior occupational therapists. However, little is known about senior therapists' views, knowledge, and use of occupation-centred practice and the impact this has on new graduates. The aims of this study were to explore senior occupational therapists' perspectives on and use of occupation-centred practice and the extent to which they influence the occupation-centred practice of the new graduates they supervise.

METHODS

Interpretative phenomenology was used as the research design. Ten senior occupational therapists in Australia were purposively recruited to participate in semi-structured interviews, which we transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse the data and develop themes.

FINDINGS

Five themes were discovered from the data: together, but apart; a link between knowledge and identity; navigating different cultures; making up for what is missing; and good supervisors. The themes revealed participants' varied knowledge and use of occupation-centred practice, the influence of practice context, and the way supervision impacted on the practice of new graduates.

CONCLUSION

Senior occupational therapists valued occupation-centred practice, but their understanding and implementation of it varied. Participants acknowledged that they held great power to influence new graduates' use of occupation-centred practice through supervision. Consequently, if occupation is not central to supervision, this could perpetuate the ongoing challenges of delivering contemporary practice.

Experiences with continuous quality improvement work based on the Occupational Therapy Intervention Process Model

BACKGROUND

Sustainability is an important issue in implementation processes in health care, and more knowledge is needed to facilitate improvement work in occupational therapy practice.

AIM

The aim of this study was to explore how occupational therapists experienced continuous quality improvement work based on the Occupational Therapy Intervention Process Model after 17 years.

METHOD

Two focus group interviews were conducted with a total of 12 occupational therapists. The data were analysed using qualitative content analysis.

RESULTS

The analysis resulted in three themes with related subthemes describing the occupational therapists' experiences of their model-based long-term improvement work. The themes were labelled as follows: 'sharing a safe and well-known professional reasoning', 'reaching normality and empowerment' and 'questioning and reshaping the too safe and too well-known normality'. The model functioned as a sustainable framework both for ordinary clinical practice and for continuous improvement work.

CONCLUSION

By using the model, the occupational therapists had established a safe and well-known professional reasoning in which continual quality improvement work had become sustainable.

Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions

BACKGROUND

While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach.

AIM

To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice.

MATERIALS AND METHODS

A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression.

RESULTS

The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice.

CONCLUSIONS

The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice.

SIGNIFICANCE

The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.

Understanding occupation in Canada: Recent graduates' perspectives

BACKGROUND

A robust occupational perspective can fortify an occupational therapist's professional identity, which is especially important as occupational therapists can struggle with professional identity. Occupational therapy curricula are critical to the development of an occupational perspective. Recent graduates can offer valuable insights on an occupational perspective, having transitioned from occupation-centred curricula into often medicalised practice settings.

AIMS

This study explored how recent graduates from Canadian entry-level occupational therapy master's programs understand the concept of occupation.

MATERIALS AND METHODS

Using an interpretive descriptive approach, rooted in constructivism, 13 English-speaking graduates (2017, 2018, 2019) from Canadian entry-level occupational therapy master's programs were purposively recruited to participate in semi-structured interviews. Reflexive thematic analysis was used to analyse data, informed by reflexivity and member-checking.

RESULTS

Four themes were described: (1) occupation: more than doing, (2) occupation is broad, abstract, and context-dependent, (3) occupation is not well understood: the fall out, and (4) navigating the challenge of describing occupation.

CONCLUSION

Participants' experiences aligned with much of the previous literature, including the challenges of describing occupation and frustrations with navigating this in practice. Yet, participants described how flexible and critical understandings of occupation facilitate the use of an occupational perspective across practice settings, supporting professional resilience.

Identifying Suitable Cognitive Assessments for Children and Adolescents with Acquired Brain Injury for use by Occupational Therapists in Acute and Subacute Hospital Contexts: A Scoping Review

AIM

To appraise the literature evaluating psychometric properties and clinical utility of cognitive assessments available for use by occupational therapists in acute and subacute hospital contexts with children aged 4-18 years diagnosed with an acquired brain injury.

METHODS

Scoping review. Assessments and associated studies were evaluated for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy.

RESULTS

Forty-one studies evaluated 49 different assessments and reported on assessment psychometrics (n = 40), clinical utility (n = 1) and five reported on both. Fourteen assessments with the strongest psychometric properties and clinical utility were shortlisted.

CONCLUSION

A gold standard assessment was not identified. Instead, a shortlist of functional, performance-based, technology-based, and self-report assessments were identified as relevant for the setting and population, but requiring further investigation. Future development of a cognitive assessment in partnership with therapists working in tertiary pediatric settings will ensure optimal clinical utility and validity.

The use of the term ‘occupational profile’ in occupational therapy and occupational science literature: A scoping review

Introduction

The term ‘occupational profile’ is widely used within the occupational therapy profession; however, its use and application appear inconsistent in the literature. Understanding how occupational profile is described in existing literature can reduce ambiguity and strengthen consistent use of terminology across practice and research.

Methods

A scoping review was conducted to examine how occupational profile has been described in occupational therapy and occupational science literature.

Results

Seventy-six journal papers were included. A lack of consistent definitions, conceptualisation and measurements was identified. Key concepts relating to the conceptualisation of occupational profile included occupational history, motivation and performance. Only one measurement was used consistently with paediatric clients to identify individuals’ occupational profiles. Occupational profiles of populations and communities were not identified.

Conclusion

The lack of consistency in definitions, conceptualisation and measurement of the term ‘occupational profile’ presents significant issues for occupational therapy practice, including an inability to compare populations. Researchers should articulate their conceptualisation of occupational profile in the absence of a universally agreed-upon definition. More comprehensive measures seeking to explore the occupational profile of a variety of clients need to be developed. Occupational profiles of communities and populations should be explored to understand occupational patterns and identify potential occupational issues.

Occupational therapists’ experiences of implementing occupation-based practice in neurology, and its impact on professional identity

Introduction

Facilitating engagement in meaningful occupations underpins occupational therapy intervention. Occupation-based practice, while linked to improved professional identity and job satisfaction for occupational therapists, is challenging to implement, particularly in hospital settings. This study aimed to explore occupational therapists’ perceptions of their role, and facilitators and challenges to implementing occupation-based practice in neurology.

Method

This qualitative descriptive study included semi-structured interviews with seven occupational therapists working in Australian acute/sub-acute neurology settings.

Findings

Three themes identified: Conceptualisation versus implementation of occupation-based practice; Use of occupation-based practice impacts role satisfaction; Promoting the profession. Participants described using occupations in their practice as important, however, reported that the challenges of the neurology environment hindered their ability to carry out occupation-based practice.

Conclusion

This study provides insights into occupational therapist’s perceptions regarding occupation-based practice in neurology settings, finding there is a need for occupational therapists to promote their role and use of occupations in neurology settings, and that occupation-based practice impacts job satisfaction. The study highlights occupational therapists working in neurology settings would benefit from a number of approaches including student interprofessional activities, potential buddy system for new graduates and experienced clinicians, and increased support by the profession to maintain their identity as occupation-based specialists.

Terapia ocupacional e Paulo Freire: uma revisão de escopo

Resumo Introdução O referencial teórico e o aporte metodológico trazidos pelas obras de Paulo Freire vêm se espraiando por distintas áreas, inclusive na terapia ocupacional. Objetivo Apreender como o referencial freireano vem sendo utilizado em publicações acadêmicas da terapia ocupacional, reunindo e analisando essa literatura, para identificar eixos temáticos e lacunas presentes. Método Revisão de escopo, com levantamento de publicações nas bases de dados CINAHL, Scopus e Web of Science, focalizando artigos acadêmicos que referenciam explicitamente Paulo Freire, num período que, sem recorte inicial, foi até abril de 2020, tendo sido incluídos todos os artigos que referenciavam pelo menos uma obra do autor. Uma planilha desenvolvida no programa Microsoft Excel® reuniu os dados gerais dos artigos, cujos conteúdos foram agrupados, sintetizados e analisados a partir de conjuntos temáticos significativos. Resultados Foram identificados 56 artigos, publicados entre 1993 e abril de 2020. A obra de Freire vem sendo utilizada em publicações acadêmicas da terapia ocupacional, destacando-se o livro “Pedagogia do Oprimido” e as categorias Diálogo/Dialógica e Conscientização/Consciência crítica/política. Foram definidos e discutidos três conjuntos temáticos: 33 (58,9%) artigos que utilizam o referencial freireano para o pensar/fazer da terapia ocupacional; 10 (17,8%) em que ele parametriza a pesquisa na área; 13 (23,2%) cujas análises e proposições envolvendo a formação de terapeutas ocupacionais tomam-no como aporte. Conclusão Paulo Freire informa de diversas maneiras a terapia ocupacional, em prol de uma práxis para a transformação social, embora, em boa parte das vezes, as formulações freireanas não sejam o centro dos esforços de elaboração reflexiva.

Growing occupation-centred therapists for the future: Understanding student experiences of learning about occupation and its place in occupational therapy practice

INTRODUCTION

Occupational therapy entry-level education is integral to how students obtain deep understanding of occupational therapy's core philosophy of occupation and its place in practice. However, there is a lack of research that explores occupation-centred education from the perspectives of students. Therefore, this study aimed to identify Australian entry-level occupational therapy students' experiences of learning about occupation, and its place in practice.

METHODS

A qualitative descriptive design was adopted. Overall, 20 students participated in four focus groups lasting between 45 and 75 min. Data were audio-recorded and transcribed verbatim. Transcripts were analysed in two phases, using reflexive thematic analysis.

FINDINGS

There were three themes that encapsulated what helped students to better understand occupation and its place in practice: (1) making occupation real; (2) relating occupation to me; and (3) theory as a focussing lens. There was also a range of pedagogical strategies that helped students to better understand occupation: using active and interactive teaching and learning strategies. One additional theme indicated a challenge to helping the students understand occupation and its place practice: when practice education settings were not centred on occupation.

CONCLUSION

Learning about occupation and occupation-centred practice may be facilitated by using practice examples, encouraging students to think about occupation in their own lives, teaching and applying occupation-centred theory, and employing interactive learning and teaching strategies. Student learning in practice settings where occupational therapy is centred on occupation is imperative. Further exploration of students' perspectives of learning about occupation across multiple occupational therapy programmes is warranted.

Understanding professional identity in occupational therapy: A scoping review

INTRODUCTION

A strong professional identity helps occupational therapists maintain professional values and thrive when facing work-related challenges and opportunities including generic, blurred or emerging roles, funding pressures and a push for outcome evidence. A scoping review will build understanding of professional identity and how to maintain it in such circumstances.

OBJECTIVES

To scope what is currently understood of professional identity in occupational therapy and factors which influence ability to maintain this and adapt in challenging work environments.

METHODS

Using Arksey and O'Malley's scoping review framework three databases were searched using the terms 'occupational therap*' and 'professional identity'. Data extraction and thematic analysis highlighted the extent and nature of current literature and mapped key concepts.

RESULTS

89 papers were included. Professional identity was revealed as a multidimensional construction. Four themes emerged: developing a shared ontology, embracing the culture, enacting occupational therapy, and believing in occupational therapy. Factors which influenced development and maintenance of professional identity included occupation-centred practice, ontological reflexivity, linking theory to practice and professional socialization.

CONCLUSIONS AND SIGNIFICANCE

The enhanced understanding of professional identity and factors which preserve or enhance it can help the profession identify how to position itself to remain resilient and adaptive in an ever-changing environment.

Identifying the characteristics of occupation-centred practice: A Delphi study

INTRODUCTION

Occupation-centred practice is key to aligning with the contemporary paradigm. Benefits of this approach for clients and the profession are well documented, yet how to identify occupation-centred practice is not yet understood. Therefore, this study aimed to uncover the characteristics of occupation-centred practice and how they can be identified in practice.

METHODS

A three round Delphi survey was conducted to gain consensus on the defining characteristics of occupation-centred practice. Purposive, convenience, and snowball sampling were used to distribute three survey rounds to occupational therapists internationally. Content analysis was used to create characteristics, descriptions, and examples of occupation-centred practice. Percentage agreement between occupational therapists were calculated to determine consensus.

RESULTS

Responses were received from 100 participants in round one, 89 in round two, and 70 in round three. Round one generated 12 characteristics that were refined and finalised into four defining characteristics, one of which had three subcharacteristics. The four characteristics are as follows: guided by theory and philosophy grounded in occupation, language and documentation promotes occupation among stakeholders, understanding and incorporating the person's context, and occupation as core to practice, which includes occupation in goal setting, assessment, and intervention. Descriptions and examples were generated for each characteristic.

CONCLUSION

This study presents valuable information for occupational therapists wanting to practise in an occupation-centred manner. The characteristics, descriptions, and examples provide a foundation upon which occupational therapists can understand and identify occupation-centred practice. Examples provided were highly influenced by factors including practice settings and preferred terminology. Future research will explore the creation of a tool for occupational therapists to evaluate their own practice against the characteristics to demonstrate areas of strength and for development.

Describing the occupational nature of practice: A scoping review

BACKGROUND

Describing how occupation is used in practice can be challenging for occupational therapists. Occupation-centred, occupation-based, and occupation-focussed terminology are frequently used interchangeably and ambiguously to describe practice. However, ambiguous language creates confusion and inadequately demonstrates the value of occupation.

AIMS/OBJECTIVES

This scoping review aimed to identify how occupation-centred, occupation-based, and occupation-focussed terminology are defined and represented in occupational therapy literature.

MATERIALS AND METHODS

A five-step scoping review included papers published between 2014 and 2019 from four databases. Extracted data were summarised to outline how the terms were being used within the literature.

RESULTS

Initial searching yielded 819 articles and 35 papers met inclusion/exclusion criteria. Within current literature, occupation-focussed and occupation-based terminology were inconsistently described. A limited number of articles used occupation-centred and occupation-focussed terminology to describe practice, whilst occupation-based was more prominent. Occupation-based terminology was represented in numerous ways to describe assessments, practice tools, interventions, research, and theory. Discrepancies between the description and implementation of occupation-based practice were most prominent within interventions.

CONCLUSION AND SIGNIFICANCE

Findings demonstrated that occupation-based and occupation-focussed terminology were used interchangeably and inconsistently in literature. It is timely to consider how this is problematic for our professional identity and perceptions of occupation in practice.

Evolution of professional identity in Iranian occupational therapy students and new graduates: A comparative study

Introduction

The development of professional attitude evolves over time and contributes to the formation of professional identity. This study tracked formation of professional identity by comparing professional attitudes of three cohorts: new graduates, final-year, and first-year students of occupational therapy.

Method

The online survey, including a 5-point Likert scale 17-item questionnaire and one qualitative inquiry using an incomplete statement, revealed the perception and future career prospects of 144 novice practitioners and students of occupational therapy. Written statements were compared to each other to provide insight about the participants’ perspectives during the three time periods.

Findings

One-way ANOVA indicated that there were significant differences in professional attitudes among the three cohorts (F (2, 141) = 14.32, p < 0.0001), demonstrating a downward trend in professional identity formation. The comparison analysis of statements confirmed the quantitative results and highlighted an issue of negative professional identity through indicating great concerns over the future career prospects.

Conclusion

Despite increased awareness of occupational therapy over time, these participants seemed to have had trouble developing a sound sense of professional identity. Possible sources and solutions for this issue were discussed, to better facilitate a clear sense of professional identity in occupational therapy students and practitioners.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach – a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond “knowing that” occupation centred practice is important, to “knowing how” to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

El poder del diagnóstico clínico en las prácticas de terapeutas ocupacionales que trabajan en contextos educativos

Resumen La Terapia Ocupacional es una disciplina emergente dentro de los equipos educativos multidisciplinarios, por lo que, resulta relevante indagar sobre su rol dentro del contexto educativo chileno. Este artículo presenta una investigación cualitativa cuyo objetivo es analizar desde una perspectiva crítica, cómo influye el diagnóstico clínico en las prácticas de terapeutas ocupacionales que trabajan en contextos educativos, considerando como ejes principales para la investigación, el marco normativo inclusivo vigente en Chile, el discurso de terapeutas ocupacionales a cerca de sus prácticas y las relaciones que se establecen con el diagnóstico clínico en este contexto. La muestra corresponde a diez terapeutas ocupacionales que se desempeñan en establecimientos educativos del sur de Chile, a quienes se les aplicaron entrevistas semi-estructuradas. Los resultados permiten visualizar que las políticas educativas influyen significativamente en las prácticas de terapeutas ocupacionales, aún cuando la normativa no especifica el rol disciplinar. Además, el diagnóstico circula fuertemente en el discurso de terapeutas ocupacionales, funcionando como un dispositivo de poder al interior de las prácticas profesionales, especialmente con el fin de validar el rol profesional dentro del contexto educativo. Se discute el uso del diagnóstico en relación a la identidad profesional y los efectos que tiene sobre los sujetos de intervención. El artículo concluye con la propuesta de adoptar una visión crítica del propio quehacer de la disciplina, basándose en la acción transformadora que ésta busca generar a través de la práctica.

Exploring stroke survivors' experiences and understandings of occupational therapy

BACKGROUND

Occupational therapists view people with stroke as occupational beings who may experience occupational issues. Concurrently, occupational therapy practice is guided by research evidence that supports predominantly impairment-based practices. There has been limited exploration of how people with stroke experience and understand occupational therapy in the context of the potential tension between the professional philosophy and the research-based evidence.

AIMS/OBJECTIVE

To explore the experience and understanding of occupational therapy with stroke survivors.

MATERIAL AND METHODS

Interpretative phenomenology guided semi-structured interviews with nine participants from five states across Australia.

RESULTS

Three themes emerged: Understanding of occupational therapy grows by 'doing' outlines how participants understood occupational therapy based on their individual experiences over time; Personal factors influence the experience highlights how participants had diverse expectations for recovery that influenced their occupational therapy experience. Context shapes occupational therapy experience identified that the therapeutic relationship and context of occupational therapy were important factors in shaping experiences.

CONCLUSION

Both impairment-based and occupation-based therapy were considered valuable aspects of occupational therapy, representing the proposed tension between the professional philosophy and research-based evidence. Occupation-based and client-centred practice was more often experienced in the outpatient setting, with challenges described for both within the inpatient setting.

Contemporary occupational therapy philosophy and practice in hospital settings

BACKGROUND

Occupational therapists have sought to reconnect with the foundations of the profession for many years, and a key focus has been the place of occupation in practice. Existing literature suggests that therapists working in acute settings experience difficulties practicing in ways that centralise occupation.

AIM/OBJECTIVE

This scoping review aimed to explore the existing literature on contemporary occupational therapy philosophy and practice in acute hospital settings.

METHODS

A five step scoping review process was implemented. Four electronic databases were searched using a combination of search terms. Searching reference lists of papers was also completed. Results were summarised using numeric and thematic analysis.

RESULTS

Twenty four publications were included. Four themes were identified; attitudes towards occupation-based practice, benefits of occupation-based approaches, challenges implementing occupation-based practice, and strategies to overcome challenges.

CONCLUSION AND SIGNIFICANCE

Findings highlighted therapists value occupation as an important aspect of practice, however they experience many environmental and personal challenges in acute settings. Strategies to overcome these challenges related to individual's changing their practice to be more occupation-focussed and changes within the practice context including adapting environments, documentation and intervention protocols to focus on occupation. These strategies may support therapists to align practice with their professional values.

Contemporary factors shaping the professional identity of occupational therapy lecturers

Introduction

The contemporary factors of neoliberalism and evidence-based practice have implications for professional autonomy and values, education and training, ways of working and construction of knowledge. Occupational therapy lecturers are at the interface between student education and professional practice and therefore have unique insights into the way in which these factors are shaping their professional identity and that of the profession.

Method

Nine narrative inquiry focused interviews of occupational therapy lecturers from two universities were carried out. Data was interpreted through a Bourdieusian lens of professional habitus, and analysed thematically.

Findings

The main factors influencing occupational therapy lecturer identity were noted to be relationships between professional identity and artistry; the professional body of knowledge and language; evidencing practice, neoliberalism and changes to teaching and learning.

Conclusion

The structural factors of neoliberalism, evidence-based practice and associated policies are influencing the occupational therapy professional habitus and, in turn, occupational therapy lecturers’ professional identity. An effective critique of these structural factors is required to maintain the profession’s values and artistry and the knowledge upon which occupational therapy lecturers’ identity is formed and their approaches to teaching and learning are based.

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective

BACKGROUND/AIM

Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective.

METHOD

This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes.

RESULTS

The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity.

CONCLUSION

Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

An occupational perspective in hand therapy: A scoping review

Introduction

There have been calls for the occupational therapy profession to realign with its values around occupation. However, the profession faces challenges in practice areas that have historically been underpinned by a biomechanical approach, such as hand therapy. The aim of this scoping review was to describe what is known about an occupational perspective in the hand therapy literature.

Method

This scoping review utilised a recognised five-step approach. A search was conducted in four databases for papers published between 2005 and 2016. Numerical and thematic analyses were employed, using the Canadian Practice Process Framework as a theoretical framework.

Results

Fifty papers were included in the scoping review. Six themes were identified: the centrality of occupation; inconsistencies in terminology; where in the occupational therapy process?; informal discussion as a key occupational strategy; occupational therapists’ expectations of patients; and a bottom-up approach focusing on biomechanical strategies to implementing the plan.

Conclusion

Whilst there has been some integration of an occupational perspective into hand therapy literature, there are still challenges. Inconsistent terminology, the lack of an occupational perspective throughout the occupational therapy process and a bottom-up approach to interventions all demonstrate the continuing tensions between the biomechanical approach and an occupational perspective.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning

BACKGROUND

Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge.

AIM

To construct a conceptual representation of how occupational therapists make clinical decisions for such program.

METHOD

Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection.

RESULTS

Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed.

CONCLUSIONS

The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.

Novice therapists in a developing context: Extending the reach of hand rehabilitation

Introduction

Hand rehabilitation needs in some parts of the world extend beyond the impact of specialised hand therapists. This study aimed to establish what hand rehabilitation services novice occupational therapists in South Africa were providing; the supports and barriers for such services; and, therapists’ perceptions of being equipped for hand rehabilitation.

Methods

A descriptive cross-sectional study was conducted, and an online questionnaire was sent to all occupational therapists in their first year of practice (n = 240). Data were analysed with Stata 12 and IBM SPSS Statistics, version 21.0. Responses to open ended questions were post-coded.

Results

A 43.3% response rate was obtained. Participants (n = 104) treated an average of 20 clients requiring hand rehabilitation per month often without adequate equipment (73%). Central nervous system (91.3%), bone and joint (72.8%) and arthritic conditions (72.4%) were treated most frequently. Most participants felt confident (64%) and competent (79%) in hand rehabilitation.

Conclusion

Participants were undertaking hand rehabilitation that in other contexts is considered to require specialised skills. To ensure quality rehabilitation, supervision and mentoring of novice therapists and appropriate professional development opportunities are required.

An exploratory international study into occupational therapy students' perceptions of professional identity

BACKGROUND/AIM

The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity.

METHODS

An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed.

RESULTS

The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results.

CONCLUSION

When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes.

Unique core skills: Exploring occupational therapists' hidden assets

Introduction

Early literature considered occupational therapists' unique core skills in terms of visible activities. Suggestions of what these may be have often confused skills with techniques and personal attributes and thus arguably have had some negative consequences for the profession.

Method

An electronic and hand-searched review of past and present professional and adjunctive literature led to the inductive development of five themes: an historical perspective of core skills; defining occupational therapy; the occupational therapy process; practice skills and defining unique core skills.

Discussion

Literature has indicated that occupational therapists' unique core skills are those common non-visible skills based around unique reasoning processes that translate occupational therapy theory and knowledge into visible professional practice. Visible skills are context dependent and should not be seen as core.

Conclusion

The unique core skills of occupational therapists are largely hidden. They are the reasoning skills used to apply the understanding of occupation and its impact on health to the meaningful activities and occupations of service users. Visible practice skills are diverse and some may be shared with other professions. While some activities can appear mundane, forming the rationale for their use is the unique core skill of occupational therapists.

A debate on the professional identity of occupational therapists

Introduction

The issue of occupational therapy’s professional identity has been debated for many years and continues today. Lack of clarity has resulted in occupational therapists’ perceptions of holding a low status and of colleague and public misunderstanding.

Method

A range of international literature was reviewed. Inductive analysis elicited two major themes – reasons for issues with identity and the consequences of issues with identity. The development of communities of practice is discussed.

Results

The analysis of the causes and consequences of issues with professional identity was used to suggest how the profession might become a mature community of practice. Lack of deep knowledge of the profession’s unique beliefs was shown to cause inconsistent messages about its identity. Consequently, practitioners believed they were undervalued. Understanding, owning and reinforcing an occupational paradigm were seen as vital elements for creating professional communities of practice.

Conclusion

To function as a community of practice requires occupational therapists to use a range of strategies that reinforce their unique occupation-based practice. Where all members commit to a single set of values and beliefs this can afford a unique identity, reinforced by the ability to demonstrate and articulate this through a clear, single message.

Use of occupation-focused language by occupational therapists in physical health care settings when considering older people and alcohol use

Statement of context

There is ongoing debate about therapists’ use of occupation-focused language in practice. Through practice language analysis we explored how conceptual models influence therapists’ word choice by re-analysing qualitative data from a survey of occupational therapists’ knowledge and beliefs about alcohol use amongst older people.

Critical reflection on practice

We used word clouds to analyse practitioners’ responses about whether they used conceptual models in practice. We reflect on three themes: theories that mirror the realities of practice; shaping theories in action; and ‘considered’ practice.

Implications for practice

Conceptual models shape, and are shaped by, the language of practice. This provides insight into the relationship between models, language and professional identity.

Exploring emerging occupational therapy identity and the development of graduate attributes among occupational therapy students

Introduction

Strong professional identity allows for appropriate representation and promotion of occupational therapy. Academic education assists in the development of occupational therapy identity. This study aims to explore the development of occupational therapy identity and graduate attributes in occupational therapy students after the first year of a revised curriculum.

Method

Occupational therapy students ( n = 58) were surveyed at the commencement of the second year. Data analysis used descriptive statistics and inferential statistics (χ2 for trend).

Results

A total of 54 students (93.1%) completed the survey. Students progressively developed occupational therapy identity over time. There were no significant associations between main factors influencing the original decision to study occupational therapy and when occupational therapy identity developed. However, there were significant associations between main factors influencing students' decision to continue studying and when identity developed. Most students agreed the curriculum equipped them to develop graduate attributes, although this was not significantly associated with factors that either influenced students to study, or continue studying, occupational therapy. There was significant association between development of graduate attributes and occupational therapy identity over time.

Conclusion

This study showed an emergence of occupational therapy identity and graduate attributes in students, demonstrating the importance of first year curriculum in the development of these factors.

Evaluating the Impact of Audits and Feedback as Methods for Implementation of Evidence in Stroke Rehabilitation

Introduction:

This paper evaluates audits and feedback as methods to increase implementation of evidence in stroke rehabilitation.

Method:

The study used an action research approach and theories of knowledge translation. A sample of 22 occupational therapists participated from two Danish hospitals that admitted stroke patients. Data collection methods included audits of occupational therapy medical records, documentations of daily practice, and collaborative discussions. Active feedback and discussions of the findings took place, at a group level in four local clinical audits. Data analysis of daily self-reported recordings and audits was descriptive. Audit data were analysed using descriptive statistics. A phenomenological hermeneutical interpretive methodology was used for analysing qualitative data.

Findings:

Audits and feedback were based on clear standards and contextual developing action plans. Daily practice in both settings adapted to the clinical guidelines. Implementations of the standardized assessment tools seemed to be the most successful.

Conclusion:

The effects of audit and feedback profited from the active participation of the therapists, as well as local gatekeepers having formal responsibilities for implementing change. The process was strengthened by providing the audits and feedback more than once. The effect of audits and feedback was positively influenced by being in line with current conceptual frameworks, local policies, and values.

The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting

Background:

Limited evidence is available to illustrate the use of theory to underpin occupational therapy practice in acute physical health care settings in the United Kingdom.

Method:

A generic qualitative method investigated the views, knowledge and perceptions of seven Scottish occupational therapists about the potential usefulness of the Person-Environment-Occupation Model (PEO Model) in acute care. This convenience sample participated in two focus groups: the first to examine and understand the PEO Model and the second to explore further reflections of the strengths and limitations of its use in practice.

Findings:

The PEO Model has the potential to provide a meaningful framework in which to conceptualise patients in an acute physical health care setting.

Conclusion:

The PEO Model offers flexibility regarding the extent to which occupational performance is addressed, in a setting characterised by short hospital admission stays. Also, a range of occupation-focused models was valued to practise effectively in this setting.

Occupational therapy students' perceptions of occupational therapy

BACKGROUND/AIMS

An understanding of students' perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students' perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia.

METHODS

Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose-designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed.

RESULTS

Students' responses were categorised as 'what' occupational therapists do; 'how' they do it; 'why' they do it; and 'who' they work with. In 'what' occupational therapists do students frequently described 'helping' people. Both undergraduate and graduate entry masters students used the term 'rehabilitation' to describe how occupational therapy is done, with graduate entry students occasionally responding with 'through occupation' and 'modifying the environment'. Students perceived the 'why' of occupational therapy as getting back to 'everyday activities', with some students emphasising returning to 'normal' activities or life. Regarding the 'who' category, students also thought occupational therapists worked with people with an 'injury' or 'disability'.

CONCLUSIONS

Students entered their occupational therapy programmes with perceptions consistent with the general public's views of occupational therapy. However, graduate entry students exposed to a pre-reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.

The Meaning Gap in Occupational Therapy: Finding Meaning in our Own Occupation

Background. Occupation is a core concept of our profession, yet little is understood about how therapists use occupation in clinical practice. Purpose. This study explores frontline clinicians' experience with occupation-based practice in a large academic health sciences centre. Methods. A qualitative constructivist study was conducted using thematic analysis, following in-depth interviews with 12 occupational therapists. Findings. Participants described the existence of two realities: Occupational therapy as they felt it should be practiced and as it actually is practiced. When the two were incongruent, participants experienced a meaning gap, which was expressed through four themes to reveal that a personal sense of occupation guides practice and transforms the meaning of the job. Implications. The exploration of personal occupational meaning through conscious self-reflection and co-creation of meaning with clients and their health care teams may serve to bridge the meaning gap.