The Management of Altered Body Image: A Role for Occupational Therapy

While historically a number of approaches and disciplines have proved to be effective in the management of altered body image, there is little evidence within the occupational therapy literature to suggest that this is an area actively pursued outside the realm of eating disorders. The concept of altered body image in relation to occupational therapy is explored, within the context of life-threatening disease. A review of multidisciplinary input in this area indicates that a number of factors contribute to the difficulty in identifying, assessing and treating this complex concept.

This article suggests that occupational therapists, with their unique perspective of activity as a facilitator of change in occupational performance, are well placed to address altered body image concerns. Education and training in this area are required if occupational therapists are to do so with confidence and competence, irrespective of clinical condition or setting, in order to contribute positively to the rehabilitation process and the individual's overall quality of life. Further research in the management of altered body image by occupational therapists is recommended.

Identity Issues for People Living with HIV/AIDS: Humans with Potential or Sexual Victims?

Sexuality issues are important to consider within the practice of occupational therapy. This is especially so when working with people with the human immunodeficiency virus and the acquired immune deficiency syndrome (HIV/AIDS), where issues related to sexuality are both relevant and present. Recent advances in HIV medications have improved the health and life expectancy for many people living with HIV/AIDS (PLWHA). This has been not only a medical and biological change, but also one that has had dramatic impact on the psychosocial issues, including those related to sexuality, relevant for PLWHA.

This shift in HIV context prompted the creation of a new occupational therapy service for PLWHA — Positive Employment Support (PES). This paper describes data from a focus group held with PES clients, conducted to evaluate the client responses to PES and to direct future service provision. While the focus group provided the expected data about client responses to PES, it also provided rich data about the impact of the shifting HIV/AIDS context on notions of sexuality and identity. This paper explores these ideas and the resulting implications for occupational therapists, especially those working within the field of HIV/AIDS.

Writing up Rigour: Representing and Evaluating Good Scholarship in Qualitative Research

Qualitative research is a mode of inquiry with which many occupational therapists engage and which some claim is particularly suited to researching the complexity and richness of occupational therapy practice.

This paper, written as part of a research series in this journal, has a dual purpose: first, to encourage qualitative researchers to identify their own ontology and use recognised strategies for ensuring high quality work which are consistent with their own world-view of research and, secondly, to consider how best to represent those strategies within their written accounts of their research.

Three researcher positions ranged along a continuum are proposed – realist, subtle realist and relativist – and alternative criteria for each of these positions are suggested. Occupational therapy and health examples are used to illuminate each of these traditions.

It is hoped that the paper will assist qualitative researchers both to clarify their own position along the research continuum and remain coherent within it and to identify the key features relating to quality and rigour that they should consider including in papers submitted for publication.

Sexual Issues within Occupational Therapy, Part 2: Implications for Education and Practice

Part 2 of this article considers the implications of a study which asked if a client's sexual expression was a legitimate domain of concern of the occupational therapist. The majority of practitioners interviewed believed that it was compatible with the values of the profession and should be part of practice, but views differed about the scope and limits of the role. In reality, only half the respondents included sexual expression of the client within their practice, either routinely or occasionally.

The results demonstrated disparity between ideology and practice. There was evidence of powerful emotive forces, encompassing cultural, contextual and personal issues, which explained why sexual activity was not regarded like other activities of daily living. The majority of participants did not feel adequately prepared to address this aspect of human function. Further research is required but the study has implications for both professional education and practice.

Sexual Aspects of Rehabilitation: The Client's Perspective

This paper outlines the findings of a small-scale study that explored disabled people's experiences of the sexual aspects of rehabilitation. It focuses on whether this should be the role of the occupational therapist or not. Sexuality is a complex area that encompasses many facets of the individual and is different to sexual functioning. The literature demonstrates that disability in any form may potentially result in problems with respect to sexuality as well as sexual functioning.

Seven in-depth interviews were carried out with disabled people aged between 30 and 50 years. Although the sexual functioning of six participants was affected, only two had received information on sexual aspects of rehabilitation. All believed that they should receive advice and information on the sexual aspects of their rehabilitation, but were uncertain as to who should take responsibility for this role.

The findings from this study suggest that any health professional would be appropriate for this responsibility, including occupational therapists, but that they would need specialist training. Undergraduate education and training for occupational therapists should address basic issues of sexuality and disability, and provide opportunities for individuals to explore their own values and beliefs so that they feel confident in discussing sexual issues with clients. Health professionals who work with clients with specific sexual needs are likely to require additional training in this sensitive area.

Sexual Expression and Occupational Therapy

Little is written in the occupational therapy literature about sexual expression and professional practice. This opinion piece presents two opposing opinions. One argues for its inclusion as part of an holistic approach. The other, developed from published emails, argues for its exclusion, because sexual expression is not seen as an occupational activity. These professional perspectives are set against the lived experiences of physically disabled people. From this consumer perspective, the omission of sexual expression from practice can be viewed as potentially damaging. A proposed way forward is to increase the awareness and skills of occupational therapists in this domain of practice.

Sexuality and Occupational Therapy: Exploring the Link

Holism is perceived to be one of the major tenets of occupational therapy. This article discusses the relevance of sexuality to holistic health care and contributes to the continuing discussion regarding the legitimacy of sexuality as an area of concern for occupational therapists. Sexuality is an important part of the human experience and is linked closely with spirituality. However, it is often neglected by occupational therapists.

The article explores the occupational nature of sexuality and demonstrates its connection with the core concept of occupation. Moreover, considering the importance of spirituality in holistic care, the article also presents an overview of the relationship between sexuality and spirituality and illustrates sexuality as a dynamic identity component. It is proposed that occupational therapists should recognise sexuality and its importance in the individual's life and incorporate it into therapy.

Why Has So Little Progress Been Made in the Practice of Occupational Therapy in Relation to Sexuality?

Despite recognition of the rights of disabled people to sexuality, occupational therapists continue to not address sexuality in practice. This failure can be understood as a consequence of social discourses relating to sexuality and disability and a professional discourse that values certain occupations over others. Given the importance of sexuality to the human experience and the evidence of the link between the opportunity for sexual expression and well-being, occupational therapists need to change their practice in relation to sexuality and disability. One method of achieving this change may be to adopt a rights-based approach to sexuality and disability. This article presents the possibilities offered by such an approach, discusses implications for occupational therapy practitioners, and proposes suggestions for future actions to ensure that the rights of disabled people to sexuality are embedded in occupational therapy practice.

Integrating sexuality into gynaecological consultations: gynaecologists' perspectives

There are currently few studies exploring doctors' personal perspectives on integrating sexuality into medical consultations. This study focuses on the views of gynaecologists on introducing, or not introducing, sexuality into their work. A total of 30 semi-structured interviews were conducted with gynaecologists in the French-speaking part of Switzerland. The thematic content analysis and computer-assisted lexical analysis (Alceste) on the interview transcripts highlighted four categories: perceptions and description of sexuality, patient's sexological history, training in sexology and perceived difficulties. It is observed that, above all, the 'medical dimension' characterises gynaecologists' perceptions. Of greater interest is our observation of disparities in gynaecologists' discussion of their practice, which is often the product of lay knowledge based on common sense and/or personal experience. Finally, the decision to integrate questions relating to sexuality seems to depend on non-medical factors such as the personal experience, interest or gender of the doctor.

Sexuality in patients undergoing haematopoietic stem cell transplantation

McKee and Schover have suggested that sexuality is an aspect of intimacy that is frequently compromised by cancer and its treatments. Cancer, both in terms of diagnosis and treatments, may have a dramatic impact on both intimacy and sexuality. There is a body of published research addressing sexual concerns among patients with prostatic, testicular, breast, and rectal cancers. This issue seems to be less well documented in patients who have undergone haematopoietic stem cell transplantation (HSCT). In this review, we seek to elaborate different points regarding sexuality and how it is affected in patients undergoing HSCT, with the aim of identifying optimum solutions for such patients in confronting such problems in the course of cancer treatment.

The Impact of Assistive Equipment on Intimacy and Sexual Expression

Introduction:

Sexuality is a holistic concept that involves more than the sexual act. Despite being a quality of life domain that promotes meaningful existence, it is an aspect of life that is often avoided by health care practitioners.

Method:

In this Heideggerian phenomenological study, conversational interviews were conducted with 13 people with motor neurone disease, and 10 of their partners, in order to understand their experiences of sexuality and intimacy.

Findings:

The findings provide evidence for the value of touch in people's lives and shed light upon the impact that assistive equipment has on intimacy, sexual expression and maintaining emotional and physical connection between couples. None of the people interviewed had previously been given the opportunity to discuss these issues with their occupational therapist.

Conclusion:

There is a place in occupational therapy practice for discussing the value of emotional and physical connection for individuals in the context of any equipment provided.

Survey of occupational therapy students' attitudes towards sexual issues in clinical practice

The purpose of this study was to examine the level of comfort of 340 occupational therapy students during clinical interactions that have sexual implications. Participants completed the Comfort Scale Questionnaire to indicate their anticipated level of comfort. More than half of the students anticipated that they would not feel comfortable in dealing with sexual issues. The three items that students indicated as being most uncomfortable with were 'Walking in on a patient/client who is masturbating' (91.7%), 'Dealing with a patient/client who makes an overt sexual remark' (82.1%) and 'Dealing with a patient/client who makes a covert sexual remark' (77.2%). The three items which students felt relatively comfortable with were 'Homosexual male' (26.4%), '14-year-old female seeking contraception' (26.4%) and 'Handicapped individual who is inquiring about sexual options' (33.5%). At least half the senior students believed that their educational programme had not dealt adequately with sexual issues. Further research investigating the nature and origin of discomfort in clinical settings is recommended as well as research examining the effectiveness of sexuality education in increasing comfort in dealing with sexual issues in clinical settings.