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.

Gaming the system: using transactional analysis to explore dysfunctional processes in clinical supervision

OBJECTIVE

This paper discusses the ongoing relevance of concepts derived from transactional analysis to understanding the challenges that can emerge in clinical supervision under the Competency Based Fellowship Program.

CONCLUSIONS

Defensive game playing has face validity as a framework for understanding dysfunctional processes in clinical supervision. Being aware of these concepts may aid trainees and supervisors in promoting effective clinical supervision practice.

Supervision in Occupational Therapy, Part 2: The Supervisee's Dilemma

The first paper (Sweeney et al 2001) in this series of three on supervision in occupational therapy reported the views and experiences of occupational therapy supervisors. In contrast to the supervisor experience, where there remains a paucity of evidence in the general literature, the clinician as supervisee has been relatively well explored. However, the literature on the experiences of the occupational therapy supervisee is virtually nonexistent.

This paper, the second in the series, describes a grounded theory study which set out to explore the process of first-line supervision from the perspective of the novice occupational therapy supervisee (those employed at basic grade and senior II levels). Data collection took the form of semi-structured, one-to-one interviews with 30 female supervisees, who were drawn from a wide range of clinical specialties within the National Health Service in the South West of England.

The findings suggested that there existed a large gap between what many of the supervisees expected from supervision and what they actually received. In addition, there was evidence that the typical supervisee entered the supervision process with the aim of presenting a professional face to her supervisor and to the wider health care team and that she did this to protect her fragile sense of competence. Many supervisees employed a range of covert strategies within the supervision setting in order to facilitate the presentation of a professional face. The use of this approach carried with it a number of risks and benefits for the supervisee.

The final paper in the series will discuss the implications of these two studies of supervisor and supervisee experience in order to distil recommendations for the future practice of supervision within the profession.

Grounded Theory: Exploiting the Potential for Occupational Therapy

Occupational therapy possesses few mid-range substantive theories, particularly those that have been derived empirically or generated within the profession. Grounded theory offers a systematic and well recognised approach to study the richness and diversity of human experience, in order to generate relevant theory. This paper describes grounded theory, its theoretical orientation and its elements, and offers a critique of the approach. A selection of grounded theory studies related to occupational therapy and occupational science are reviewed to demonstrate the contribution that the approach has begun to make to, and the potential that the approach offers for, developing empirically derived occupational therapy theories.

Supervision in Occupational Therapy, Part 3: Accommodating the Supervisor and the Supervisee

This paper, the final one in a series of three, aims to draw together the findings of the two reported studies on the experiences of supervisors and supervisees in the discipline of occupational therapy (Sweeney et al 2001a,b) and to distil recommendations for the future practice of supervision within the profession.

A paucity of empirical research on the process of supervision within the health care professions has resulted in a confusion concerning the purpose of supervision, its distinctiveness from other activities and the role and function of both supervisors and supervisees, and a lack of clarity regarding the tasks and techniques to be employed within supervision. In keeping with concerns about supervision expressed in the general literature, the findings of these studies (Sweeney et al 2001a,b) suggest that supervision as it is currently practised within occupational therapy is not a comfortable experience for either the supervisor or the supervisee.

This paper recommends steps that can be adopted by both supervisors and supervisees to facilitate the development of a more productive relationship within supervision; for example, the use of training, exposure to theories and models of supervision, and the use of agendas, contracts and feedback. Supervisor and supervisee recommendations are discussed within the wider framework of professional, cultural and organisational implications.

Before Preceptorship: New Occupational Therapists' Expectations of Practice and Experience of Supervision

Newly qualified health care practitioners generally have high expectations of practice. Stress, value conflict and role uncertainty (‘reality shock’) can result where such expectations remain unmet. Good quality professional supervision can mitigate the deleterious effects of such change. Agenda for Change initiatives have the potential to improve the new practitioners' lot in this area by mandating a year-long period of ‘preceptorship’ support. Such support pairs newly qualified individuals (preceptees) with senior colleagues as role models and resources (preceptors).

This article reports a questionnaire-based survey conducted with 45/74 (61%) newly qualified occupational therapists based in London. The respondents reported high initial expectations of their first posts, particularly with regard to professional supervision and client care, which varied according to their age and education. Most (76%) received weekly professional supervision, focused on primarily clinical issues, although this did not always reflect the respondents' desired time use. Although varied development opportunities were cited, the respondents spent little time with their senior colleagues.

This study showed that the respondents' expectations and experience of supervisory practice varied. A structured approach to the respondents' personal and professional development, and/or supervision, was not always apparent. Given this, preceptorship seemingly has much to offer newly qualified occupational therapists in the United Kingdom.

Quality and Effectiveness of Clinical Supervision: Evaluation of An Occupational Therapy Service

Occupational therapy was a comparatively early adopter of clinical supervision, the value of which has been publicly endorsed by the College of Occupational Therapists. This practice analysis explores the quality and effectiveness of the clinical supervision received by occupational therapists working for the West London Mental Health Trust through the use of a descriptive qualitative survey using the Manchester Clinical Supervision Scale. Results indicate that the range for all the sub-sets were consistently high. The total Manchester Clinical Supervision Scale score was 142.9, which indicates demonstrable efficacy of clinical supervision had been achieved.

The Individual Practice Development Theory: an individually focused practice development theory that helps target practice development resources

BACKGROUND

Research indicates that multifaceted practice development (PD) interventions are more effective than single strategies. However, models of education in health care need to consider cost-effectiveness.

OBJECTIVES

This paper presents a research-based, PD theory called the Individual Practice Development Theory. It argues that programmes that use the Individual Practice Development Theory to tailor PD support to the learning needs of practitioners will result in more engagement in PD and will target PD resources efficiently.

METHODS

The in-depth qualitative, multi-method realistic evaluation was of a multifaceted, organization-wide PD programme in one National Health Service Mental Health and Learning Disabilities Trust. Semi-structured interviews, practice observation and documentation audit were used to gather data from occupational therapists.

FINDINGS

Results indicated that environmental contexts, particularly the support of the immediate team, and the participant's personal circumstances affected PD behaviour change. Six mechanisms acted as catalysts. These were: Building Confidence, Finding Flow, Accumulating Reward, Conferring with Others, Constructing Knowledge Know-how and Channelling Time. Four stages of PD characterized as: 'In the Hangar', 'On the Runway', 'Take-off' and 'In the Air' were identified. The research also illustrated the interconnectivity between outcome levels, contextual circumstances and activating mechanisms.

DISCUSSION

The findings suggested that PD interventions need to be more individually tailored to achieve optimum learning outcomes. The identification of four discernable stages permits rapid understanding of PD support needs in order to focus PD support.

CONCLUSION

With a systematic and individualized approach to PD in health care, more target PD supports can be put in place.

Quality allied health clinical supervision policy in Australia: a literature review

Clinical supervision is presented as a complex set of skills that may broadly apply to any and all allied health professions. However, it is also noted that a clear understanding of clinical supervision and how to implement it in allied health is currently lacking. It is argued that there is a need to reflect upon current approaches to clinical supervision amongst allied health professionals and to gain a shared understanding about what supervision involves, what effective supervision is, and what effective implementation of clinical supervision might look like. By gaining an understanding of what high quality clinical supervision is and how it is best put into practice, it is anticipated that this will form the first step in developing an understandable and useful universal supervision policy for all allied health professionals. What is known about the topic? Clinical supervision is important because it improves quality of care for clients and it may also improve staff satisfaction and retention rates and clinical governance for organisations. There is a clear need for a well-articulated supervision policy in allied health as there is currently no comprehensive and universally accepted supervision policy for this group of health professionals. What does this paper add? This literature review argues that if there is no clear supervision policy that is endorsed at a whole of health level there is a risk that disparate, haphazard, and poorly coordinated approaches to supervision may result in poor quality of supervision provision. Much of the recent literature is profession-specific; however, this paper contends that there are many possible reasons for collaboration in establishing clinical supervision in allied health. The possible barriers to implementing a universal policy are also examined. What are the implications for practitioners? This literature review will help practitioners understand the complex issues that inform the clinical supervision process and particularly those factors that affect the delivery of an excellent quality of supervision. This knowledge will help them to assess the quality of supervision they receive and provide, and may also contribute to motivation to work with colleagues to develop meritorious supervision skill.

Developing an Observed Practice Programme for Occupational Therapists and Physiotherapists: Reporting the First Phase of an Action Research Study

Occupational therapists working in higher education have acknowledged the benefits of peer observation to their professional development and there has been discussion of its potential benefits in clinical settings. However, there is limited literature and no practical guidance on the implementation of observed practice within clinical practice.

This action research study sought to develop a work-based observed practice programme for occupational therapists and physiotherapists in a United Kingdom mental health trust. Action research was chosen to enable the positive engagement of practitioners in order to co-create knowledge and to improve practice. Occupational therapists and physiotherapists with expertise of local practice and personal experience of staff development and clinical supervision formed a working group to develop and implement the programme.

The group considered examples of similar programmes from higher education and addressed issues relating to the purpose, status and process of the programme. It also explored its relationship to existing preceptorship programmes and clinical supervision. This paper summarises the key steps of the observed practice process and the development of supporting documentation created by the working group. The observed practice programme was implemented at workshops in the autumn of 2009 to be followed by a formal evaluation.

An Evaluation of a Preceptorship Programme for Newly Qualified Occupational Therapists

Following the introduction of preceptorship as a requirement for most newly qualified practitioners in the National Health Service in the United Kingdom, a preceptorship programme for occupational therapists was designed. This was the first of its kind within occupational therapy and was endorsed by the College of Occupational Therapists. Participation in preceptorship was intended to ease the transition of newly qualified occupational therapists.

This paper offers a definition of preceptorship for the profession in the United Kingdom and reports on a small qualitative study that evaluated the extent to which the interventions of the preceptorship programme ameliorated the challenges of transition. The evaluation was conducted within a realist framework. Data were collected by semi-structured interviews from four pairs of newly qualified occupational therapists and preceptors during the pilot year. The findings suggest that the preceptorship programme was successful in supporting the development of new practitioners and that implementation was optimised through strong leadership, a learning culture and positive supervision.

This paper contributes to the body of knowledge relating to the transitional experience of occupational therapists and recommends changes to the programme to optimise its effectiveness for practice.

Supervision in occupational therapy regarding rehabilitation of elderly people in Sweden

The aim of this study was to investigate occupational therapists' supervision of healthcare workers regarding rehabilitation of elderly people in Swedish municipal elderly care. Data were collected through a self-report questionnaire developed for this study. In total, 238 occupational therapists working with supervision of healthcare workers in the field of municipal elderly care participated in the study. Data were analysed using descriptive statistics. For supervising healthcare workers, the participants rated highly the importance of cooperation and communication. Many of the participants considered both the time available for one supervision session and the number of supervision sessions to be insufficient. The result also demonstrated that the participants supervised healthcare workers more frequently in P-ADL than in I-ADL. A majority of the participants supervised other groups of people in addition to healthcare workers. The lack of research work in supervision specific to occupational therapy indicates a need for more studies in this area.

Supervision in Occupational Therapy: How are We Doing?

Occupational therapy has endorsed the practice of clinical supervision to promote high quality services and professional accountability, in line with the Government's governance agenda (Department of Health 1998, 2000). This opinion piece was prompted by a survey of London-based occupational therapists in autumn 2005, which highlighted inconsistencies in the practice and theory of supervision and in the provision of training. The authors argue that managers in health and social care settings should adopt a theoretical framework for supervision; make their expectations explicit; and build an infrastructure, including training and audit, to demonstrate the effectiveness of supervision in improving patient care as well as supporting staff growth.

The Integration of Clinical and Managerial Supervision: A Critical Literature Review

The introduction of a new development review process, the Knowledge and Skills Framework (KSF), has placed a greater demand on occupational therapists within the health service to be more accountable for practice. It has been proposed that the KSF may provide a useful structure for supervision in order to ensure continual development. Therefore, this literature review looked at the appropriateness of addressing both clinical and managerial issues within the supervisory process.

The results indicate that despite many professions being unsure of how best to deliver supervision, there is a common understanding that a structure combining clinical and managerial supervision, such as the KSF, may be useful. It is, however, recommended that the roles of appraiser and supervisor remain separate, because many researchers found conflict within this duality of role as having an impact upon the effectiveness of supervision. It is also recommended that further research be undertaken in order to evaluate formally the effectiveness of integrating the KSF into supervision.

Changing practice speciality in occupational therapy: Exploring the experience. Part two

Despite an ongoing shortage of occupational therapists in the UK, the career behaviours of senior occupational therapists are under-researched. This article explores Senior occupational therapists' experience of changing practice specialities as a potential retention strategy. The background to this area was considered in part one of this article.

In the second part of this article, the authors detail an interview-based qualitative study conducted with 10 Senior I/II occupational therapists who had changed practice specialities within the previous decade. Thematic analysis of the study data led to the emergence of five inter-related study categories. These reflected participants' reasons for changing practice speciality, the practical steps taken, the elements that made changing easier or more difficult and the resulting effects. A model of the process of changing practice speciality was derived from these data. This saw participants as influenced by a range of personal, professional and organizational elements. These, in turn, influenced the practical steps taken to effect change.

Reported outcomes included increased job satisfaction and retention within the profession. These findings suggest that changing practice speciality can improve recruitment and retention among Senior occupational therapists, to the benefit of all concerned.