Práticas de terapeutas ocupacionais no âmbito das dissidências de gênero e sexualidade: um panorama da atuação no Brasil

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Workplace violence is a common experience for many health professionals. However, little is known about the experience of occupational therapists, specifically those that visit people in their own homes, and experience violence in that context. Home visiting is a fundamental component of practice for many occupational therapists and often takes place with the occupational therapist being alone. This study aimed to explore the experience of this group of occupational therapists, their responses to workplace violence such as reporting, and the impact of their experience on their wellbeing. A cross-sectional online survey was distributed among occupational therapists via NSW Health services and Occupational Therapy Australia with snowball sampling and links on Twitter, LinkedIn, and Facebook. The survey gathered information on demographics, work organisation, exposure to workplace violence, and strategies used to respond to this. Wellbeing was measured using the Abbreviated Maslach Burnout Inventory and the Kessler Psychological Distress Scale. A total of 101 surveys were returned: 97% (n = 97) were female, the mean age was 39 years, 52% (n = 52) were located in capital cities, and most worked in disability care (47%, n = 47) or aged care (46%, n = 46) and worked full time (60%, n = 60). Only 5% (n = 5) identified that they never worked alone. Of those who experienced violence at least occasionally, 74% (n = 74) reported verbal aggression, 27% (n = 27) physical aggression from clients or family members, 20% (n = 20) physical aggression using objects, 43% (n = 43) verbal sexual aggression, 46% (n = 46) unwanted sexual attention, and 3.2% (n = 3) sexual assault. Moderate to very high distress was exhibited by 26% (n = 26) of respondents, and 71% (n = 71) exhibited moderate to high emotional exhaustion. As the target participants were occupational therapists, consumer and community involvement was not sought. This study has demonstrated the exposure of occupational therapists to risks when visiting clients in their homes and identifies the need for risk management, training, and support for occupational therapists working in this environment. Occupational therapists often visit people in their own homes to assess their needs and provide interventions. The home is an important environment as this is where functional activities take place. However, occupational therapists can be at risk of workplace violence from clients and their families, especially if they visit clients alone. Clients may be upset and frustrated by their situations and could strike out. We know very little about workplace violence experienced by occupational therapists, and this study used an online survey to explore how commonly this occurs, the type of incidents experienced, the actions that occupational therapists took following the incident, and how these experiences affected their well-being. We found that workplace violence included verbal attacks and physical and sexual violence. Overall, 76.2% of participants reported any kind of violence. The most frequent type of violence was verbal abuse followed by unwanted sexual attention, verbal sexual abuse, and physical violence with and without objects. Three participants reported a sexual assault. However, fewer participants took actions following the incidents such as reporting it informally or formally. This means that workplace violence is likely to be underreported by occupational therapists. We also found that occupational therapists who were exposed to workplace violence reported higher distress, higher cynicism, and lower professional accomplishment, suggesting a risk of burnout. As employers are required to protect the health and safety of their employees, these findings are very important, and the occupational therapy profession should also address them.

Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

Background: Occupational therapists (OTs) practice on both a first contact and a referral basis. Medical practitioners are often the primary referral source for OTs. To make timely and appropriate referrals to OT, it is imperative that the referral sources demonstrate a broader level of understanding of the OT profession. Objectives: The objective was to determine the level of awareness about OT among medical practitioners in South India. Study Design: Survey research design was used to conduct this study. Methods: An electronic survey was developed for this study and sent via E-mail and social media to medical practitioners in South India who were identified through convenience and snowball sampling. Data were collected from June 15, to July 31, 2019. Results: The number of responses received was 116. Eighty-two percent of the respondents reported either being familiar with or having heard about OT. Respondents who are specialists, work in the private sector, and practice their profession in a foreign country were more familiar with the OT profession and referred patients to OT. Gender and years of medical practice did not influence the familiarity level. Conclusions: Although many respondents have heard about OT and recognize it as a profession aligned with the rehabilitation of individuals with disabilities, their responses indicate that they have a limited understanding of the profession's scope of practice, OTs' role in some practice areas, and practice settings in which OT services are delivered. The consequence of this could be missed referrals.

Healthcare transition (HCT), the process of transitioning an adolescent from paediatric- to adult-oriented care, is vital for improving the long-term health of adolescents with chronic conditions. The role of occupational therapy in HCT has not been well-researched. Effective HCT practices are necessary to ensure that adolescents have access to coordinated, optimal and uninterrupted occupational therapy services throughout this period of development. This study describes occupational therapists' self-perceived knowledge of HCT within the context of South African public health facilities, the HCT practices used, and the factors that promote or hinder the success of HCT within this context. The study utilised a quantitative, non-experimental and descriptive cross-sectional design. Simple convenience and snowball sampling were used to recruit participants via professional databases and social media forums. An online survey was used to collect data. Descriptive statistics and simple content analysis were used to analyse the information. This study identifies limitations in the knowledge and practical implementation of HCT within South African occupational therapy practice. Healthcare transition is characterised by inadequate use of policies, insufficient transition preparation and poor outcome measurements. There is a need for the development of training programmes and practice guidelines to optimise and support HCT implementation within South African occupational therapy practice. This study provides novel data on HCT practices utilised by occupational therapists in South African public health facilities. This study has potential use for the development of effective HCT programmes that can improve the functional outcomes of South African adolescents.

Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.

Knowledge translation in the context of the Asia Pacific region.

Commemorative Editorial: The Legacy of Franklin Stein, PhD, OTR/L, FAOTA.

Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis. Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data. Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs. Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

Occupational therapy is underpinned by the belief that occupation facilitates health and wellbeing. However, evidence suggests that occupational therapists encounter challenges to implementing occupation-centred practice. The aim of this study was to investigate the uptake, acceptability and impact of a workplace intervention designed to enhance occupation-centred practice of occupational therapists in an acute adult physical context. A concurrent mixed methods study using a pre-post design was employed. The setting was a regional and rural health service in Queensland. Data were collected using an online survey of occupational therapists' knowledge, attitude and confidence regarding occupational therapy models, an audit of medical charts and focus group discussion and in-depth interviews. Quantitative data were presented using descriptive statistics, and discussions were thematically analysed. No involvement. Survey results revealed minimal difference between pre- (n= 8) and post- (n= 8) interventions. The medical chart audit (pre = 40, post = 28) revealed an increase in occupational language over medically based language. Four themes were identified from the qualitative data (pre =5, post =6): change in theoretical awareness and acceptance of occupational therapy models; facilitators for adoption of occupational therapy models in the acute setting; what it takes: the qualities and efforts required of individuals; and enhanced professional identity. The themes revealed that participants varied in their knowledge and implementation of occupation-centred practice pre-intervention and could feel constrained by the workplace context. Post-participants recognised that actively practising occupation centredness impacted positively on their practice. Participation in an initiative to increase occupation-centred practice resulted in changed behaviours and beliefs for occupational therapists in this study. Participants recognised that their individual contribution and the concerted efforts of their occupational therapy peers led to increased professional identity and understanding of occupational therapy contribution in the acute adult physical setting. Occupational therapists promote health and wellbeing by working with people of all abilities to participate in the everyday occupations of life. However, within some hospital settings, occupational therapists face a number of challenges to implementing their desired approach due to time restrictions and dominance of other professions. Because of this, consumers and health colleagues in hospitals are unclear on the role or value of occupational therapists, and occupational therapists feel misunderstood. This may impact on job satisfaction, retention of staff in this setting and missed opportunities for identifying needs for consumers. In a regional and rural setting, this may be further complicated by occupational therapists working in isolation from direct professional support. In this project, occupational therapists in a regional and rural health service participated in an activity aimed to enhance their communication and confidence in their unique approach. The activity involved developing and using tools and resources for a hospital context that were 'occupation-centred' or were based on 'occupational therapy models'. Despite occupational therapists reporting that making this change required effort, they recognised that with persistence and collaboration, there was an improved understanding of occupational therapy contribution in the setting and better job satisfaction for occupational therapists. The tools and resources that were developed can be easily adopted by other organisations. These findings show that occupational therapists working in hospitals can alter their behaviours and beliefs to be more true to the profession. And that this benefits occupational therapists, consumers and the broader health-care team.

Having returned from the 13th World Congress of Occupational Therapists in Sweden, we reflect on the development of our international connections and collaborations in our profession. In the past, Australia was isolated by distance. This was highlighted during the celebrations of 50 years of the World Federation of Occupational Therapists at the Congress, when it was pointed out that in its beginning sea mail was the main form of communication! Since then, technological advances have greatly expanded our opportunities to travel, meet and share our ideas with international colleagues. Growth in electronic communication is enabling us to develop and maintain international professional contacts on a daily basis. It is also facilitating the accessibility of our Journal to international colleagues and their publications to us. Consequently, the readership of the Australian Occupational Therapy Journal, like other occupational therapy journals, now includes occupational therapists around the globe, as well as to Australian occupational therapists. To build international collaboration between occupational therapy journals, 11 occupational therapy journal editors met at the Congress. One outcome from this meeting was to establish a discussion database for international editors to enable exchange of ideas and to maintain contact. Our Journal is currently one of the few occupational therapy journals internationally with electronic publication, and the only journal to have established processes for publication of critically appraised papers. In addition, a report from Blackwell Publishing (UK) indicated that the Australian Occupational Therapy Journal was one of the most popular on the Wisepress stand at the Congress. To foster a more international outlook, the Editorial Board has made the decision to expand the Editorial Advisory Board to include recognised international occupational therapists, as well as Australian experts. Their roles will include promotion of the Australian Occupational Therapy Journal internationally, as well as advice to the Board, preparation of guest editorials and refereeing of manuscripts. Our first two international Advisory Board members are Dr Doris Pierce and Dr Michael Iwama. Doris is the Endowed Chair in Occupational Therapy at Eastern Kentucky University, USA, where her role includes facilitating faculty scholarship and research in infant and toddler development and disability. Michael has recently been appointed as an associate professor at Dalhousie University, Halifax, Nova Scotia, Canada, after seven years at Kibi International University, Okayama, Japan. Michael's research focuses on occupational therapy in Asia, particularly issues of culture and constructions of occupational therapy theory and knowledge. We believe both will offer us a wide range of expertise, and we welcome them to our Editorial Advisory Board. We also welcome our first international Editorial Board member, Dr M. Clare Taylor, who has been appointed the inaugural editor for Critically Appraised Papers. Clare is an international expert in the area of evidence-based practice. She is currently a lecturer in occupational therapy at Coventry University in the United Kingdom and author of Evidence-based practice for occupational therapists[ Taylor, M. C. (2000). Evidence-based practice for occupational therapists. London: Blackwell Science]. We thank Annie McCluskey (University of Western Sydney), Sally Bennett (University of Queensland), and Margaret Wallen (current Journal Editorial Advisory Board member) for their valuable contribution in preparing the guidelines for this new department. We believe these are exciting developments and enhance the Journal's capacity to bring you, the readers, clinically important research and practice knowledge of a high quality, and to enable you to share your work within the global occupational therapy community.

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

Editorial: How many courses for how many jobs? Enduring questions in need of research-based answers.

IntroductionAs the majority of occupational therapy philosophy has Western origins, occupational therapists working with palliative care clients in Singapore can provide invaluable insight into the practice of occupational therapy within a non‐Western, family‐centric population. This study aimed to describe occupational therapists' perceptions of the occupations of terminally ill Chinese older adults and their caregivers and explore occupational therapy practice with terminally ill Chinese older adults in Singapore.MethodsEleven occupational therapists were recruited via convenience and snowball sampling. Inclusion criteria were being fully registered with the Allied Health Professionals Council (Singapore) with at least 2 years of working experience and currently working with/had experience working with terminally ill patients within the past 2 years. Interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis.FindingsFive themes were constructed from the data: (1) Independence may not be for everyone, (2) it is a family unit, (3) contributing to others' lives is important, (4) what respecting clients means, and (5) a different way of engaging. These themes describe how occupational therapists adapted their practice to better meet the needs of clients and families in Singapore.DiscussionIn family‐centric societies, it may be more relevant for occupational therapists to facilitate interdependence instead of independence in activities of daily living. In addition, activities that contribute to others' lives tangibly/intangibly may be more meaningful and relevant. Finally, occupational therapists could engage clients through the ‘being’ instead of ‘doing’ dimension of occupation.ConclusionWhile occupational therapists in Singapore faced some challenges working with terminally ill clients and families due to differences between occupational therapy philosophy and practice context, by reframing their thinking, they were able to adapt their practices to meet the needs of a family‐centric population.