When Clients are Dying: Occupational Therapists’ Perspectives

Occupational therapists working with people who are terminally ill potentially face a contradiction between the principles and assumptions of rehabilitation-oriented practice and the needs and experiences of clients who are dying. This research investigated experiences of occupational therapists working with clients who are terminally ill to examine if such a contradiction existed and, if so, how it was managed in daily practice. Ten occupational therapists working with people who are terminally ill shared their perspectives through in-depth interview and participant observation. Data analysis followed grounded theory procedures. Nine conceptual categories were generated from the data: Making a Difference, Referral to Occupational Therapy, Assessing the Situation, Goal Setting, Building Against Loss, “Normality Within a Changed Reality,” Client Control, Supported and Safe Care, and Closure. Analysis of relationships between categories resulted in the development of a conceptual framework of occupational therapy practice with people who are terminally ill. The core phenomenon of the framework emerged as Affirming Life: Preparing for Death. Results indicate that occupational therapists manage this contradiction between their rehabilitation training and their work with people who are dying by reframing the process and outcomes of practice to acknowledge clients’ dual states of living and dying.

Good Patients and Bad Patients: How Occupational Therapists View Their Patients/Clients

Many studies have highlighted how health professionals tend to categorise their patients in terms of moral evaluations, in particular perceiving patients as ‘good’ and ‘bad’. This article reports on a qualitative study which explored how occupational therapists experienced their patients/clients, investigating what social evaluations were made. Nine occupational therapists were interviewed using a relatively non-directive, phenomenological approach. Although the therapists were reluctant to stereotype their patients/clients, the use of moral and social evaluations was widespread. ‘Good’ patients were warmly responsive and made the therapists feel valued and effective. ‘Bad’ patients were manipulative, threatening and resisted change. An additional category of ‘difficult’ patients emerged which reflected the therapists' ambivalent responses to this patient/client group, who were experienced as positively challenging but hard work. The discussion emphasises how social evaluations are complex and involve multiple meanings which emerge in different contexts with different individuals.

Transition from Student to Practitioner: The Role of Expectations, Values and Personality

Research into occupational therapy job satisfaction has been driven largely by concerns regarding recruitment and retention. There is a need to develop more robust theoretically sound methodologies for the investigation of job satisfaction within the profession.

This article presents the initial findings of a national longitudinal study of Australian occupational therapists. The respondents (n=295) were investigated immediately prior to graduation with respect to their expectations about working as an occupational therapist, their work values and their work preferences. A personality profile was also administered.

The findings indicate that students hold inflated expectations about their first job and retain traditional occupational therapy work values. Demographic and personality profiles reflect those of the international student body and can assist in the prediction of student expectations.

Applying Phenomenology in Research: Problems, Principles and Practice

Interest in phenomenological research has been growing steadily over the last decade as researchers have sought to capture the richness of individual experience. However, the sheer complexity of ideas embedded within phenomenology is challenging. Confusions abound as to what phenomenology means, let alone how to apply it as a research method. Misconceptions and contradictions are apparent in the literature.

This paper starts with a broad review of some current phenomenological literature relevant to occupational therapy. The key principles of the phenomenological approach are then clarified, followed by an exploration of how these might be applied practically in research.

Connecting with Patients: The Personal Experience of Professional Helping

In this study, we examine the nature and meaning of therapist-patient interactions from the perspective of the therapist. Qualitative analysis of phenomenologic data from interviews with occupational therapists affirmed the importance of a sense of “connecting” in these relationships, and the predominance of “helping” and “working together” in forging those connections. The nature of helping, the nature of working together, and the personal nature of these experiences in occupational therapy are examined. Findings enhance our understanding of collaboration in occupational therapy and underscore the importance of considering the personal contexts of practice.

Is There Life after Categories? Reflexivity in Qualitative Research

This article encourages occupational therapists conducting qualitative research to use disciplined self-reflection to enrich their studies. Subjective reactions infield situations should not be eliminated or ignored, but examined systematically, leading to new insights and deeper understandings.