Occupational Therapy Process Research Articles

Functional assessment and intervention in occupational therapy.

Occupational therapists consider the person, the environment and the occupation (personally meaningful activities) in the assessment and intervention process with the ultimate goal being occupational performance. This paper describes functional assessment and intervention from the perspective of the occupational therapist with specific examples of assessment instruments and intervention approaches. A scenario of a person in recovery with a particular occupational performance goal is woven throughout the paper to apply the concepts of functional assessment and intervention to a specific situation. CINAHL and PubMed databases; Existing assessment manuals and research on these instruments. Occupational therapists are just one discipline of many within psychiatric rehabilitation. Multidisciplinary teams can be most effective when they work collaboratively and maximize the expertise of all contributors. By describing the occupational therapy process, providing a scenario, and offering suggestions for collaboration, it is hoped that this paper fosters dialogue among occupational therapists and others involved in psychiatric rehabilitation.

Occupational Therapy in Progressive Neurology: A Rehabilitative Approach

People diagnosed with a progressive neurological disorder represent a significant proportion of the population that lives with a neurological disease. Neurological impairment may vary between different conditions and the rates of progression differ. However, progressive impairment has a direct effect on activity, participation and wellbeing. The occupational therapy process attempts to alleviate and/or remedy the direct effects of impairment in order to maximise activity and participation. The basic premise of neurorehabilitation and the International Classification of Functioning, Disability and Health fit well with occupational therapy practice.

School-based Services: What does OT bring to the IFSP and IEP Table?

Occupational therapists working in early intervention and schools bring a unique perspective regarding child development and occupational performance to the table. The occupational therapy theories and frames of reference that guide pediatric practice are a key part of the occupational therapy domain and process. Occupational therapists need to carefully select appropriate theories and frames of reference to guide practice, given the unique needs of the children and students they serve.

Developing Occupational Therapy Best Practice Guidelines for Acute Medical Services

Occupational Therapists began exploring their role in Acute Medicine in the late 1990’s.1 A decade later the presence of Occupational Therapists in accident & emergency departments and acute medical units is seen as routine. The literature and evidence base to support this, however, has not progressed as rapidly. With few guidelines to support practice the authors produced a document locally to promote standardisation of good practice and equity of treatment within all relevant NHS Lothian and NHS Borders sites. A table illustrates the specialist skills necessary for Occupational Therapy in Acute Medicine and appendices outline components of various assessments. It is hoped that as therapists progress through the flow chart they can utilise further sections of the guidelines related to specific assessments. This article will introduce the reader to the occupational therapy process in acute medicine and describe the guidelines that are currently in use.

Team Focus: Occupational Therapist

Occupational therapists (OTs) have a unique and valued role in the health and functional recovery of individuals with multiple sclerosis (MS). To maximize the benefit of occupational therapy by both health care professionals who refer patients and the patients who use the services, an understanding of the scope of services that OTs offer is essential. This article describes the breadth of the OT evaluation and intervention specific to the treatment of individuals who have MS. As an overriding goal, the OT assists clients in processing the implications of physical, cognitive, and emotional changes and creatively developing strategies to cope with and, when appropriate, minimize the effects of these changes. The occupational therapy process is described, beginning with evaluation and providing guidelines and resources for appropriate client-centered goal setting. The OT and client then discuss intervention that ensures optimal functional outcome and includes symptomatic management, according to the specific functional difficulties and implications and the particular symptoms of each patient. Through discussion, the OT helps each client achieve health and well-being with remedial and compensatory techniques that enable participation in meaningful activities and roles in the home, work, and community. OT services are essential to the appropriate and optimal delivery of comprehensive care and support to individuals with MS.

Relevance and focal view point in occupational therapists’ documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where “Activity” and “Health” are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on “activity” and holistic health notions.

The guiding nature of the kawa (river) model in Ireland: creating both opportunities and challenges for occupational therapists

The kawa (kawa is Japanese for 'river') model of occupational therapy has recently emerged in response to the needs for culturally sensitive conceptual models of practice that adequately address clients' diverse cultures and belief systems (Iwama, 2006a). The present article reports two case studies in which the kawa model was used to guide occupational therapy intervention with two individuals with multiple sclerosis in Ireland, with the aim of exploring the effectiveness of the recently emerged kawa model. A qualitative grounded theory approach using case-study methodology was undertaken. Semi-structured interviews based on the kawa model were completed with two participants with multiple sclerosis before and after occupational therapy intervention. The authors also documented their experience of using the model in reflective diaries. Analysis revealed a core category of the guiding nature of the kawa model creating both opportunities and challenges. Opportunities afforded by the model included enablement of the occupational therapy process and facilitation of occupation-based practice. Challenges created by the use of the kawa model included participant uncertainty and the influence of therapist preconceptions. Limitations and recommendations for future research are discussed in terms of generalizability. Further research with greater numbers and more diversity of study participants is required to validate the tentative theory proposed.

Culture or cult? The mythological nature of occupational therapy

The willingness of occupational therapists to act on their shared beliefs and values has created knowledge and techniques that have been handed down from generation to generation, and, thus, have entered into what might be called the 'mythology' of occupational therapy. These myths arose from a set of shared philosophical assumptions that provided a sense of cultural identity. In the present article the authors compare the occupational therapy process to a mythical hero's journey in which the occupational therapist uses narrative reasoning to guide the client (the hero) through a rite of passage to a kind of rehabilitative rebirth. By structuring therapy as an unfolding story, the occupational therapist creates personal myths for his or her clients. Unfortunately, there is a darker side to this process in which cultural identity distorts into membership of a 'cult', wherein expert practitioners become 'priests' or 'monks' possessing secret knowledge that cannot be readily explained to others, especially those from different cultures. It is argued that, by reflecting on and interacting with other cultures through shared mythologies, occupational therapists can learn to amend their values and beliefs accordingly. Myths could bring a sense of cohesiveness to a culture in which 'truth' is seen through these shared mythologies.

The use of assessments in occupational therapy in Malta

Assessment forms an integral component in the occupational therapy process.

How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver?

Objective: To enhance insight into the process of occupational therapy (OT) and the changes after OT, in an older patient with mild dementia and his primary caregiver. Design and setting: Case study: content analysis of an OT patient record. Intervention: System-based OT at home using a guideline focusing on both patient's performance in daily activities and caregiver's cognition on patient behaviour and caregiver role and focusing on adaptation of the physical environment. Measures: Triangulation of results of qualitative content analysis and quantitative description using the following measures: Brief Cognitive Rating Scale (BCRS), Assessment of Motor and Process Skills (AMPS), Interview of Deterioration in Daily Activities in Dementia (IDDD), Canadian Occupational Performance Measurement (COPM), Dementia Quality of Life Instrument (DQOL), Sense of Competence Scale (SCQ) and the Mastery Scale. Results: The global categories derived from content analysis were: daily performance and communication. The specific categories were the patient with dementia, his or her caregiver and the occupational therapist. Important themes derived from content analysis were: patient's capacity for pleasure, autonomy and appreciation in performing daily activities and caregiver's competence. Patient's changes reported after OT: more initiative, autonomy and pleasure in performing daily activities, increase of quality of life; caregiver's changes reported after OT: improved communication and supervision skills, changed cognition on patient behaviour and caregiver role, improved sense of competence. The quantitative results showed an improved daily performance (e.g. initiative, motor and process skills, need for assistance) and quality of life of the patient and improved sense of competence, quality of life and mastery of the situation of the caregiver after OT intervention. Thus the results of the qualitative content analysis were supported by the quantitative results. Additionally, based on the results of the content analysis an exploratory and system-based model has been developed connecting OT diagnosis and OT treatment at home for patients with dementia and their primary caregivers. Conclusion: This case study provides information on how occupational therapy can improve the daily performance, communication, sense of competence and quality of life of an older patient with dementia and his or her primary caregiver. A combination of education, setting feasible goals, using adaptations in physical environment, training compensatory skills, training supervision skills, and changing dysfunctional cognitions on patient behaviour and caregiver role seemed to be successful. A randomized controlled trial must provide information on the effects of OT at home for older patients with dementia and their primary caregivers.

Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members

Background/Aim: The occupational therapy profession is in need of self‐examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment. Methods: Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process. Results: Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination. Conclusions: Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client‐centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists’ culture on the therapeutic process.

Occupational Therapy Practice Errors in Physical Rehabilitation and Geriatrics Settings: A National Survey Study

The purpose of this survey study was to investigate occupational therapy practice errors in physical rehabilitation and geriatric practice settings. Two hundred and forty-five (245) out of 994 surveyed occupational therapists who have practiced or currently practice in physical rehabilitation or geriatrics settings responded to a self-developed questionnaire. Descriptive statistical analysis was used to describe practice errors as to the types, causes, impact on, and responses of occupational therapists and work sites. Inferential statistical analysis was used to explore the relationships among different variables of interest including: the effect of the number of years of practice experience on the perceived impact of making errors on practice; the relationship between disclosure or nondisclosure of errors; and the types of coping strategies used by occupational therapists and work site administrators' responses to errors. The vast majority of practice errors occurred during the intervention phase of the occupational therapy process. Misjudgment, lack of preparation, and lack of experience were reported as the top three causes of practice errors. Various coping strategies-such as compensating for the errors by voluntarily devoting additional time for care of the patient, making and following a corrective plan, concentrating on the next step, or not letting errors interfere with daily work-were used by the occupational therapists when errors occurred. The types of coping strategies and work site responses appeared to be associated with the disclosure or nondisclosure of errors. Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.

Valuing Occupational Therapy as a Complex Intervention

This opinion piece introduces a framework for understanding and valuing occupational therapy as a complex intervention. The nature of complexity, particularly non-linearity and unpredictability, is summarised. The factors that characterise occupational therapy as a complex intervention are then presented. These include the visible actions that constitute the occupational therapy process; the centrality of activities and occupation in the therapist's thinking and actions; the shifts of perspectives in occupational therapy intervention; the client-centred nature of practice; and the importance of the therapist's thinking skills. All these factors elucidate why we should be proud of the complexity of occupational therapy and why a simple definition is unattainable.

Record Keeping in Occupational Therapy: Are We Meeting the Standards set by the College of Occupational Therapists?

Sixty-four occupational therapists from a range of specialisms in Tayside audited 320 client records against 61 standards from the College of Occupational Therapists' core standard on record keeping. The audit found that there were areas to be celebrated, such as the inclusion of relevant client history and the outcome of interventions. The challenges identified included documenting the views of clients, the recording of treatment goals and the use of abbreviations. The conclusions focused on client involvement, the occupational therapy process and the appropriateness of the College of Occupational Therapists' standards.

Quality of Life for People with Motor Neurone Disease: A Consideration for Occupational Therapists

Motor neurone disease (MND) is a rapidly progressive neurological disease of unknown cause, which results in relentless loss of function and, conversely, high levels of disability. There has been a significant increase in quality of life (QoL) literature in recent years and the philosophy of the occupational therapy process may be considered consistent with the QoL construct. However, little is documented in occupational therapy literature that promotes consideration of the QoL construct in practice. This may be explained by the profession's adherence to the medical model of health care intervention. Expectations and desires continually shift for people with MND and individual-perceived QoL is determined by a continuous process of adjustment to increasing disability. In order to promote wellbeing, occupational therapists must identify what people with MND consider important in their lives.

Cultural tensions in occupational therapy practice: considerations from a Japanese vantage point.

Culture not only assigns a name to occupation through its language, but it also shapes the form it takes and the meaning with which it is imbued. When an individual chooses an occupation, psychological and physical concerns as well as cultural practices, values, and beliefs come into play. Although occupational therapists are trained to be culturally competent, their grasp of the importance of cultural considerations can be enhanced through detailed accounts of the way in which such concerns affect clinical practice. In this paper, I describe in detail my observations of how differences between American and Japanese culture have created tensions in occupational therapy practice in Japan. Further, largely through a case presentation, I illustrate the necessity for incorporating in-depth cultural considerations as a central part of the occupational therapy process. I argue that the study of culture and the production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy.

Applying Sensory Integration Framework in Educationally Related Occupational Therapy Practice (2003 Statement)

Based on the educational team recommendations, occupational therapists and occupational therapy assistants working in educationally related settings provide services to students who are eligible for Section 504 or special education under IDEA and need occupational therapy to benefit from their education program. It is the occupational therapist's responsibility to develop an intervention plan based on the student's needs and the therapist's professional knowledge base. The occupational therapist chooses and applies any frame of reference within the domain and process of occupational therapy. Regardless of the frame of reference utilized, the desired outcome of occupational therapy services is always engagement in occupations that allows participation in a student's daily life. When students demonstrate deficits in sensory integration that contribute to a significant and documented discrepancy in their skills within their educational program, the use of a sensory integrative approach may be one frame of reference for, intervention chosen by the occupational therapist.

Recovery and Occupational Therapy in the Community Mental Health Setting

The purpose of this essay is to describe how occupational therapy operates in a community mental health setting focused on recovery and wellness, from the perspective of a first year occupational therapist. The philosophy of recovery and wellness coincides with a philosophy of intervention that is consumer centered and consumer driven. Occupational therapy began in this setting through a fieldwork relationship between the mental health center and an occupational therapy education program. As the first occupational therapist hired as staff, the author developed an occupational therapy program that corresponds to the principles of recovery. The relationship between occupational therapy and recovery and wellness is described by outlining the occupational therapy process. From referral to discontinuation, the unique aspects of practicing in a recovery and wellness setting are depicted. Finally, a case study illustrates one example of the relationship between recovery and occupational therapy in the community mental health setting.

Process Mapping Occupational Therapy Activity within a Medical Admissions Unit

There are increasing demands on professionals within health care to provide a service that meets the needs and expectations of patients. This requires the patient to be placed at the centre of the care pathway. Occupational therapy is well placed to contribute to this change in emphasis because of its fundamental client-centred philosophy. Experience has shown, however, that the realisation of these aims has been a challenge for all health care professionals. Increasingly, the National Health Service is drawing upon expertise from outside and, in particular, the quality improvement tools that are used within industry. This article explores the use of the traditional quality tool of process mapping in the evaluation and review of occupational therapy processes. The use of this tool is explained in relation to a clinical audit within a medical admissions unit. The results of the process mapping exercise, and the associated audit that was undertaken, demonstrated the value of the approach. In particular, process mapping enabled the occupational therapy service to evaluate systematically the service being provided and to visualise the optimum pathway of care.

Innovation in Fieldwork Education: Working with Members of the Homeless Population in Glasgow

Occupational therapists are increasingly likely to come into contact with clients who have special needs associated with homelessness through acute or community care services. Given the degree of role loss often linked with homelessness, it could also be argued that occupational therapy has a part to play in the development and maintenance of the functional status of the members of this population. Statutory or voluntary sector day shelters might offer a new point of contact for service delivery with homeless people, representing nontraditional sites for occupational therapy services. The models of fieldwork supervision adopted by the College of Occupational Therapists could allow students to experience new forms of service delivery as undergraduates in novel practice settings. This opportunity could serve an adaptive function as health and social care services meet the demands of the changing political and social environment. This paper describes the perceptions of a student who undertook an elective placement in a day centre for homeless men in Glasgow. Conclusion In terms of educational development, this model of placement has since been incorporated into the curriculum at Glasgow Caledonian University. On revalidation of the BSc(Hons)OT degree in 1995, there was a decrease in the number of fieldwork hours in the curriculum structure, from 1200 to 1080 hours, and the elective placement was removed. The programme philosophy, however, embraced the learning opportunities provided by placements, such as the one described in this paper. As such, all second-year students have since been required to undertake a placement in the non-statutory, social care sector. In particular, these placements are seen to offer students a chance to develop a deeper understanding of social care needs and issues, and a chance to explore the occupational therapy process in nontraditional settings and thus to think more widely. In addition, they offer an opportunity for students to take much more responsibility for their learning, within a model of supervision where they get professional input, direction and support while developing their own sense of professional identity and autonomy.