Embracing Our Ethos, Reclaiming Our Heart

Healthcare Education: Can Literary Narratives Address Occupational Therapy's 'Incongruence' in Values?

Occupational therapy may be facing an incongruence in values. A growing body of literature, based on occupational therapy documentation and the perspectives of clients, suggests the profession is more focused on productivity and institutional demands than the individualized needs of clients. A proposed solution in occupational therapy education is the critical reading of literary narratives with qualities of complex characters, sensory evoking language, and the subjective truths of the individual experience. This is proposed because empathy has been shown to improve client outcomes and the reading of literary narratives has been shown to improve levels of empathy. Instruction through literary narratives, versus medicalized case studies or videos, may help occupational therapists practice with consilience, regain what is threatened, and provide more impactful and empathic-centered care.

How is resilience conceptualized and operationalized in occupational therapy and occupational science literature? Protocol for a scoping review

Abstract Introduction Resilience is a commonly discussed term describing the ability to overcome, adapt to, or cope with stressful/disruptive events. Although researchers and practitioners define resilience in diverse ways – e.g., psychological or disaster resilience – the concept fundamentally encompasses perseverance through adversity. As experts in the interplay between individuals, environments, and occupations, occupational therapists and occupational scientists have great potential to understand and enable resilience, with some similar concepts appearing in occupational theories (e.g., occupational adaptation). However, there are no published reviews of resilience in the occupation-focused literature. Objective We will explore how resilience is conceptualized and operationalized in the occupational therapy and occupational science research literature. Method Guided by the Joanna Briggs Institute scoping review methodology, we will search library databases and other sources for relevant records. Two team members will screen records for inclusion, with discrepancies settled by a third person. We will include English-language literature (including research papers, editorials, dissertations, etc.) published since 1990 which 1) contains the word root ‘resilien*’ and 2) is occupation focused, according to our criteria (occupational therapist/occupational scientist co-authors or research participants; and/or published in occupation-focused periodical). We will report key information of included literature, such as methodology and resilience theories discussed. Results Our study is ongoing at the time of publication; this manuscript reports its protocol without results. Conclusion Findings will be useful for clinicians and researchers looking for occupational conceptualizations of resilience. From a social justice perspective, our review may highlight evidence that occupational engagement can foster resilience among marginalized communities.

A Career in Inquiry

This article, based on the 52nd Eleanor Clarke Slagle lecture given at the 95th American Occupational Therapy Association Annual Conference & Expo, explores the concept of inquiry as the basis for a career and as an activity of daily living. Using the heliocentric theory and the space program at NASA as examples, the broad concept of inquiry is discussed, because it has led to important changes in society over the course of history. The article describes how a career as a clinician-scientist can be grounded in the concept of inquiry and explains how all occupational therapists and occupational therapy assistants can base their own careers in inquiry, using examples from the early history of the profession of occupational therapy and from work by current investigators. Practical suggestions applicable to every clinician are provided.

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.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

In the footsteps of Wilcock, Part one: The evolution of doing, being, becoming, and belonging

This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.

Population-centered life skills groups: perceptions of satisfaction and engagement

PURPOSE. We examined the satisfaction with and engagement in population-centered life skills groups of women in a residential facility for substance dependence. METHOD. This study was a retrospective, cross-sectional analysis of 561 surveys designed to elicit Likert scale client ratings. Descriptive statistics were used to examine client satisfaction. Differences in client engagement by content focus and activity process were also examined by analyzing the median scores of eight life skills development questions using the Kruskal-Wallis test of medians. RESULTS. Collectively, 96.8% of those who completed the surveys were satisfied with the living skills groups; 73.3% strongly agreed, and 23.4% agreed. No significant differences (p > .05) were found in the median scores of the engagement responses by either content focus or activity process. CONCLUSION. Population-centered life skills groups conceptualized within a holistic Person-Environment-Occupation model appear to be satisfactory and engaging interventions for women in recovery.

Self-development groups among women in recovery: client perceptions of satisfaction and engagement

PURPOSE

We examined engagement in and satisfaction with occupational therapy self-development groups among women in a residential facility for substance dependence.

METHOD

We performed a retrospective, cross-sectional analysis of 1,488 Likert-scale surveys completed anonymously between 2006 and 2010. Descriptive statistics were used to examine client satisfaction in self-development groups. Differences in engagement by content focus and activity process were also examined by analyzing the median scores of eight self-development questions using the Kruskal-Wallis test of medians.

RESULTS

Of those who completed surveys, 73.6% strongly agreed and 23.4% agreed (collectively, 97%) that they were satisfied with the group. No significant differences (p > .05) were found in the median scores of the questions by content focus or activity process.

CONCLUSION

Self-development activity groups with salient recovery themes conceptualized within a person-environment-occupation model appear to be a satisfactory and engaging intervention for women in recovery from substance abuse.

I looked to her as a guide: the therapeutic relationship in hand therapy

PURPOSE

To illustrate important dimensions of the therapeutic relationship in a hand therapy patient-therapist dyad.

METHOD

This instrumental case study utilised narrative analysis of semi-structured interviews of a patient-therapist dyad.

RESULTS

Four dimensions of the therapeutic relationship were identified. These were (1) humour to promote reciprocity, (2) ordinary conversation to build rapport, (3) social comparison to promote acceptance and (4) attention as caring.

CONCLUSIONS

The therapeutic relationship is not a one-way flow from therapist to patient but a mutual exchange between equals. However, it is the therapist who is responsible for establishing the environment for the therapeutic relationship to develop and flourish.

Practitioners' Use of Interpersonal Modes within the Therapeutic Relationship: Results from a Nationwide Study

Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.

Shortening the distance between the "i" and the "it": a transformative approach to improving teaching

"It" science focuses on the external and technical dimensions of action. "I" science focuses on the internal experiences and meaning particular actions hold for people. Elevating "It" science over "I" science can deform occupational therapy's body of knowledge and, consequently, stunt its practices. Similarly, elevating the technical or instrumental dimension of teaching over the internal experiences of educators can deform education and even do harm to students. A transformative learning approach to improving teaching foregrounds the inner lives of educators, thus balancing the instrumental with the deeply personal aspects of teaching. Such a balance is vital given the hopes that ride on occupational therapy education.