Continuité et discontinuité dans les trajectoires de soins de personnes ayant une problématique complexe de santé : perceptions d’ergothérapeutes – une étude exploratoire

Depuis la mise sur pied d’un système de santé financé par des fonds publics et dirigé par un ministère de la santé, le réseau de la santé du Québec a connu plusieurs changements. Par exemple, des changements ont été réalisés au début des années 2000, visant en outre à améliorer l’accessibilité et la continuité des soins de santé disponibles à la population québécoise. En dépit du souci du Ministère d’améliorer la continuité des soins, des problèmes persistent pour les personnes présentant une problématique complexe de santé. En effet, les individus aux prises avec une comorbidité, c’est-à-dire avec un problème de santé physique et une autre de santé mentale, sont plus susceptibles de vivre des discontinuités dans leurs trajectoires de soins de santé (autrement dit une discontinuité dans leur accès aux soins), constituant une réponse peu adéquate à leurs besoins. Pour comprendre ce que vivent des ergothérapeutes qui desservent de tels clients, une étude exploratoire a été réalisée. Le but de cette recherche était d’explorer les perceptions d’ergothérapeutes à propos de la continuité et de la discontinuité dans les trajectoires de soins de ces clients. Les ergothérapeutes identifient des raisons qui, à leur avis, expliquent les discontinuités dans les trajectoires de soins des individus présentant une problématique complexe de santé, nomment plusieurs conséquences négatives de ces discontinuités et mentionnent des façons pouvant contribuer à améliorer la continuité des soins prodigués à ces personnes. La prise en compte des perceptions des ergothérapeutes s’avère pertinente afin d’améliorer les soins offerts à ces personnes.

The axiological ontology of occupational therapy: a philosophical analysis

OBJECTIVE

This article describes the results of a study analyzing several discourses on the values of occupational therapy and some philosophical assumptions upon which these values are based.

METHOD

A qualitative study of several values statements using the hermeneutical method--a conventional analytical approach in philosophy--was conducted.

RESULTS

The literature review reveals that opinions on the values of occupational therapy differ greatly--no one value is shared among all the values statements examined. However, the majority of the texts mention occupational participation. A philosophical analysis of the literature shows that this value is based on a conception of human beings that can be traced back to the philosophical anthropologies of thinkers like Marx, Rousseau, Sartre, and Kant. The philosophical analysis also brought to light a certain conceptual confusion about what a value is.

CONCLUSIONS

This article therefore offers some conceptual clarifications to help distinguish between values, beliefs, attitudes, principles, and non-evaluative concepts. It also presents the implications for practice of this philosophical analysis of values statements of the profession.

The Professionalisation of Occupational Therapy: A Continuing Challenge

Professions are socially constructed phenomena. Accordingly, an understanding of what is meant by a profession, with its associated social positioning and how that is interpreted, is governed by historical, temporal, cultural and ideological influences. For occupational therapy, such an understanding can be a real challenge. This is because of a dichotomy between its ontological, person-centred approach and the medically dominated constructs prevalent in the professionalisation of all caring professions and still inherent in health care arenas today (Etzioni 1969, Fairhurst 1981, Rivett 1997, Freidson 2001).

As a consequence of this traditionally accepted dominance and the roles ascribed to or enabled by this positioning, the professional identity of occupational therapy can be limited by the politics of power at the organisational level. This can shape how occupational therapy is understood, not only by significant others but also by the profession itself. Professional consistency and cohesion, both inside and outside the profession, could therefore be challenged, unless individual actors, organisational attitudes and social constructs change. There is a need both to confront and to accept the ever-changing nature of professionalism and the meaning of occupation in the postmodern world.

Cultural influences on occupational therapy practice in Singapore: a pilot study

Over the past decades, numerous occupational therapy frameworks have been published and adopted in the West but there is little discussion of their applicability to Singapore. The purpose of this study was to examine the relevance and applicability of occupational therapy frameworks in Singapore. Data were gathered from nine highly experienced occupational therapists. Audio-taped semi-structured interviews were used to collect data. Qualitative methods were used in identifying five themes--independence, applicability of client-centred practice, concepts of occupation/activity, client's areas of concern, and application of occupational therapy models to practice. The themes were discussed in the context of three broad areas: (1) the potential discrepancy between occupational therapy's philosophical base and clients' values, (2) mismatch between the occupational therapists' prescription of activity and the meaning of activities to clients, and (3) the potential conflict between the occupational therapy approach and the corporate culture in Singapore. One of the important results from the study was that in Singapore culture, clients generally did not believe that achieving independence was important and they expected to be taken care of by their families. Further research with a larger sample is necessary to explore how culture and societal values impact on occupational therapy practice in Singapore.