Swedish Occupational Therapists Research Articles

Occupation as described by academically skilled occupational therapists in Sweden: a Delphi study

The aim of this study was to continue the process of exploring and understanding the concept of occupation in a Swedish occupational therapy context and from an expert perspective. Thirteen eligible occupational therapists active in Sweden, all academically skilled and who had published articles concerning the concept of occupation or activity, were invited to take part in the study. Eight were willing to participate representing different parts of Sweden. A three-round Delphi study was conducted in which the participants reflected on 46 statements derived from a core category and five categories concerning the concept of occupation, extracted from previous studies in this project. The participants gave 124 comments on 44 of the 46 statements. Results revealed new statements, mainly concerning the intentional aspect of occupation and occupation in a structural hierarchy. Comments also contributed with rephrased statements promoting clarity. A total of 54 statements were then ranked on a four-point Likert scale of which 47 reached consensus among participants. Seven statements were not supported to a level of consensus. Four of them dealt with how and if values and individual judgements influence what are viewed as occupations. To continue the developing process, studies in occupational therapy praxis have to be performed.

Occupational therapists’ descriptions of their work with persons suffering from cognitive impairment following acquired brain injury

The aim of the present study was to investigate how Swedish occupational therapists describe their work with persons suffering from cognitive impairment following acquired brain injury. A qualitative descriptive approach was used and interviews were conducted with 12 occupational therapists working in community and county council care. Qualitative content analysis was used and revealed three main themes: (1) “To make the invisible visible”, (2) “To collaborate—a prerequisite for success”, and (3) “Dilemmas to handle”. The findings showed a complex scenario where the occupational therapists worked to make the cognitive impairments visible to themselves, the clients, and persons close to the client. Collaboration was perceived as a key factor. The dilemmas concerned different aspects in the rehabilitation process, which affected the occupational therapists’ work with the clients. Identified areas in need of improvement are prioritizations and additional education regarding both intervention methods and theory. A reluctance to use standardized assessments was expressed and research that identifies and overcomes those hindrances in clinical practice is needed. Therapeutic use of self was described as important. To understand and illuminate the occupational therapists’ comprehension of the concept further research is required.

Experiences of ethical dilemmas in rehabilitation: Swedish occupational therapists’ perspectives

The aim of this study was to describe Swedish occupational therapists’ experiences of encountering ethical dilemmas in rehabilitation and strategies they used to handle the situations. Twelve occupational therapists who work with adults with developmental disabilities were interviewed using a semi-structured interview design. Data were analysed using qualitative content analysis. The results showed that ethical dilemmas were common in the occupational therapists’ daily work within rehabilitation. Many situations that created ethical dilemmas were related to occupational therapists who worked with clients and their relatives, and other healthcare providers. The results showed further that occupational therapists found it difficult to make decisions and to optimize clients’ participation in decision-making, to set limits and act professionally, and to best handle the situation for the client and avoid ethical dilemmas. This study indicates the importance of illustrating experiences of ethical dilemmas within occupational therapy praxis and the meaning of discussing ethical dilemmas with different healthcare providers to reach a divided view of the client in order to develop successful and healthy strategies that will optimize the rehabilitation of clients with developmental disabilities.

What do Swedish occupational therapists feel about research? A survey of perceptions, attitudes, intentions, and engagement

The aim of this study was to identify Swedish occupational therapists’ perceptions and attitudes to research-related activities as well as the therapists’ present engagement in future plans for research. A follow up design was used, and the study was undertaken between 1997 and 2003. A total of 425 and 442 Swedish occupational therapists responded to a postal questionnaire (response rate 74.4% and 70.4%). Questions regarding research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes towards research used a semantic differential scale. There were small differences between the two surveys. The result showed that occupational therapists considered research-related activities to be an important part of their development of the professional role and status. Reading research literature to update knowledge was the most important research activity and the second most important activity was applying research findings to improve occupational therapy practice. High workload and lack of time were the most commonly mentioned barriers to participation in research- related activities. Occupational therapists read a large variety of journals, preferably in Swedish. The barriers to participation in research-related activities did not change from 1997 to 2003. The fact that occupational therapists reported reading research as rating highly gives hope for the future development of the occupational therapy profession and practice.

A Swedish survey of occupational therapists’ involvement and performance in driving assessments

The purpose of this study was to examine the extent to which occupational therapists (OTs) are involved in driving assessments in Sweden and how these assessments are performed. A questionnaire was sent to 154 geriatric, rehabilitation, and neurological clinics, and additionally directly to 19 OTs who had purchased a test battery specifically used for driving assessments. The response rate was 60%. Of those responding, 57% reported being involved in fitness-to-drive assessments. However, such assessments were carried out in various manners and diverse methods were used, ranging from unstandardized activity assessments to a test developed specifically for driving assessments. Only 19% used on-road driving tests as a complement to the clinical assessments. Apart from the lack of appropriate methods, the respondents said that they did not have sufficient knowledge to perform driving assessments and expressed a need for further education. In the future it seems necessary for OTs in Sweden to undergo specialized training and perform the assessments on a regular basis to maintain a high level of competence as driving assessors.

Holistic and biomedical concepts of health: A study of health notions among Swedish occupational therapists and a suggestion for developing an instrument for comparative studies

The objectives of this study were to inquire into notions of health among a group of 439 Swedish occupational therapists and to test a model derived from a qualitative study by Björklund & Svensson with a representative sample of occupational therapists in Sweden. The data were collected through a questionnaire and were analyzed using descriptive statistics, cluster analysis, and confirmatory factor analysis. The means and ranking of the health notions showed that Swedish occupational therapists most frequently hold holistic notions of health, and to a lesser extent biostatistical ones. Most Swedish occupational therapists indicate that being clearly conscious of one's health notions is important both to themselves and to their profession. The test of the model provides a step towards developing an instrument for measuring notions of health that clearly distinguishes between holistic and biomedical ones and that could possibly be used for comparative studies.

Occupational therapists’ reflection on practice within psychiatric care: A Delphi study

Aim: The aim of this study was to describe the reflections on practice in a group of Swedish occupational therapists in psychiatric care in order to illuminate the present practice and ideas about the future using a Delphi survey of three rounds. Material and method: The sample consisted of 14 occupational therapists in psychiatric care. The answers from the first and second rounds illustrate the wide variation in their practice. The third round points out consensus and disagreements in the domains: professional role, theories in practice, domain of concern, occupational therapy assessment, goal setting/treatment, outcome/evaluation and thoughts about the future. A consensus was reached in all domains, but not regarding competence to treat functional reduction and symptoms, or on the importance of theories for documentation, the choice of a theoretical foundation, and the importance of an evidence-based treatment model, although the theories were seen as supporting practice. Disagreements were found as to the effectiveness of repeated assessments as a means of evaluation. The future for OTs within psychiatric care was looked upon as positive. Discussion: The results developed from providing a relatively unclear and shallow perspective on OT practice to indicating a depth that shows what occupational therapy within psychiatry can be. During the process it became more and more clear how OTs think and act.

Welfare state and women's work: the professional projects of nurses and occupational therapists in Sweden

In this article we explore how Swedish welfare politics within health-care and rehabilitation has opened up a space for nurses' and occupational therapists' professional projects. Using historical data, an analysis of the policy-making process behind welfare programs central to the professionalization of nursing and occupational therapy is presented. The time period covered is, in the case of nurses, the larger part of the twentieth century, while the modern history of occupational therapists first began in the 1940s. Special emphasis is placed on the corporative nature of the Swedish welfare state and the professional strategies utilized by nurses and occupational therapists in their struggle for jurisdiction. In the article, politicization is identified as a core strategy by which female-dominated welfare state occupations in Sweden have tried to gain influence over the welfare policy-making process and their occupations' jurisdiction.

Barriers and bridges to client-centred occupational therapy in Sweden

This study investigates barriers to client-centred practice and solutions to overcome these barriers as experienced by Swedish occupational therapists. A British questionnaire was translated into Swedish and completed by 97 occupational therapists. The questionnaire consists of three sections: background information; a list of barriers identified in a literature review; and a list of methods to resolve barriers. The results show that the highest ranked barrier was “the therapist does not know enough about client-centred practice”. The highest ranked method to resolve barriers was “management and peer support for use of client-centred practice”. Introducing client-centred practice takes time, commitment, education, training, interview skills, discussions with colleagues, and reflection on the therapists’ own attitudes.

Making international connections

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.

The Domain of Concern of Swedish Occupational Therapists Working in Psychiatric Care

As a consequence of the development of psychiatric care in Sweden, occupational therapists have adapted their roles to changing practice settings. The aim of this study was to investigate the domain of concern of occupational therapists in psychiatric care, operationalized as perceived responsibilities. Furthermore, the relationships of the domain of concern to underlying theories and models, clinical supervision, intervention strategies, and organization of the care were investigated. Data were collected by a mail questionnaire to occupational therapists working in psychiatric care with a response rate of 67%, in all 334 occupational therapists. A factor analysis revealed six domain-of-concern areas. The three most prominent factors were ADL, housing and leisure, Psychosocial dysfunction, and Work and studies, which confirmed that occupational therapists' focus is on the patient's occupational performance skills as well as the environment that supports or hinders the patient's performance. The occupational therapists were using a broad range of underlying theories and models as well as intervention strategies and several relationships to domain-of-concern factors were found. This study gave an overall view of the occupational therapists' domain of concern, but there is also need for a more detailed and thorough understanding of how occupational therapists define their domain of concern, which calls for more qualitatively oriented in-depth studies.

Factors Influencing Job Satisfaction Among Swedish Occupational Therapists in Psychiatric Care

Factors Influencing Job Satisfaction Among Swedish Occupational Therapists in Psychiatric Care

Factors Influencing Job Satisfaction Among Swedish Occupational Therapists in Psychiatric Care

This study examined job satisfaction among occupational therapists in Swedish psychiatric care, and investigated how clinical supervision, organizational aspects and demographic characteristics contributed to job satisfaction. We received 332 returned questionnaires, corresponding to a response rate of 66.9%. Job satisfaction factors that emerged were: general satisfaction with work, communication and co-operation among team members, managerial feedback, the patients' influence on care and the relatives' influence on care. The respondents rated their general satisfaction, co-operation and communication as high. They were least satisfied with the relatives' influence on care. We found few relationships between other factors and job satisfaction, but, for example, satisfaction with the patients' influence on care was higher among occupational therapists working in outpatient care than among those working in hospital wards. Furthermore, having supervision was positively associated with co-operation and communication. This study revealed a fairly satisfactory situation, possibly thanks to social support, advantageous care-planning strategies and supervision. However, managerial staff must be aware that measures need to be taken continuously to counteract detrimental forces. The study pointed to a need for further research that relates occupational therapists' job satisfaction with issues such as support, control and individual need for growth.

Practice Models in Swedish Psychiatric Occupational Therapy

In clinical settings, occupational therapists need models both from their own field, occupational therapy, and from other fields in order to offer the clients adequate treatment. It is unknown which theoretical approaches and practice models influence Swedish occupational therapists' daily work. In this study a questionnaire (n=334) was used to investigate approaches and models used in Swedish psychiatric care service and in psychiatric occupational therapy service. The results showed that the psychosocial approach influenced both psychiatric care and psychiatric occupational therapy most. The most frequently used practice model was the Model of Human Occupation. However, 75% of the respondents did not identify theoretical thinking based on models from their own field behind their actions. Many practitioners seemed to use knowledge developed by other disciplines more often. Years of clinical experience in the profession or education did not seem to have any impact on the ability to identify the practice models that were used. The results indicate that education in occupational therapy must emphasize knowledge in its own field more than has been done up to now.

Work Situation of Psychiatric Occupational Therapists in Sweden: Differences Between County Council and Municipality Employees

Since a psychiatric reform came into effect in Sweden in January 1995, municipalities have been responsible for the care of people with psychiatric illness who are no longer supposed to be in need of continuous medical care. In particular, the responsibility for assistance in independent or supported living and meaningful daily occupations was assigned to the municipalities. This reform implied that, among other professionals, occupational therapists were employed by the municipalities to meet the needs of these individuals. This study compared the view among Swedish psychiatric occupational therapists employed in county councils and municipalities regarding how the care was planned and organized, duties and work tasks, theories and models used, co-operation partners, availability of clinical supervision, quality assurance work and job satisfaction. Most differences found in this study between county council-employed and municipality-employed occupational therapists indicated that the municipalities used their occupational therapists to meet the assignment given by the psychiatric reform, or they were logical consequences of the distinct organizations. However, there was no difference in favour of the municipality group as to use of methods related to housing or vocational occupations. These results indicated that the municipalities did not fully use the qualifications of their occupational therapists to meet the clients' needs for assistance in independent or supported living and meaningful daily occupations.

What Occupational Therapists Consider to be Worth Knowing: An Analysis of Swedish Occupational Therapists' Examination Papers 1984-96

The aim of this study was to analyse the 1984-96 examination papers of a group of experienced occupational therapists with regard to their research interests, and especially to ontological and strategic matters. The title pages, summaries and discussions of results of 84 papers were analysed qualitatively and quantitatively, with the starting point of two of the components from Törnebohm's structure of paradigms: the world view and the field of action view components. The occupational therapists' interest in research subjects related to the field of action view component of paradigms and applied research on strategic matters dominated the material. The interest in research subjects related to the world view component of paradigms and basic research on ontological matters increased over the last 5-year period. The increasing interest in more ontological matters seems to be natural and necessary progress for a profession that is deeply involved in knowledge acquired by experience. Only by the development of a ?double-edged? knowledge will it be possible for the profession to develop and adapt to future demands.

Work-Related Stress among Occupational Therapists in Sweden

The purpose of this study was to describe work-related stress among occupational therapists and to identify the specific stress factors that contributed to work-related stress and their influence on the individual. Two hundred active occupational therapists in Sweden, selected at random from the membership registry of the Swedish Association of Occupational Therapists, received a postal questionnaire. One hundred and sixty-two responses were included in the study. An instrument introduced by Sweeney was used, which included 49 stressors, and a secondary aim was to conduct a factor analysis on the Swedish population of occupational therapists. In addition to this instrument there were questions about emotional and physical symptoms and discomfort, feelings about work and perceived satisfaction.The results showed that only two of the 49 stressors were graded as high in affecting stress levels, both concerning lack of resources and lack of time. The factor analysis indicated 15 dimensions of stress relevant to the sample, and a second-order analysis gave four factors with high reliability both for the whole stress instrument and for each of the four factors. The factors were named ‘Resources and demands’, ‘Professional value’, ‘Rewards' and ‘Interaction with patients and colleagues’.The Swedish study showed that lack of resources and lack of time were graded high as stress factors while the English population was concerned about patient contact to a greater extent than the Swedish. The most commonly reported symptoms were headache, poor concentration and feeling restless. There were significant correlations showing that high work satisfaction was correlated with low frequency of emotional and physical symptoms (r = 0.47–0.61). Work satisfaction was not correlated with discomfort from musculoskeletal disorders. Positive feelings about the job correlated with rare occurrence of symptoms (r = 0.17–0.51), and there were also relationships between positive feelings about work and fewer musculoskeletal problems like pain and headache.It was concluded that a low level of stress existed among the Swedish occupational therapists. They felt that they had a strong professional role and identity but that financial conditions had not kept pace with the status of the profession. The feeling of high work satisfaction was related primarily to fewer emotional or physical discomforts or symptoms. The factor analysis indicated that the work situation in Sweden was different from the situation in England.

Professionalization and Rehabilitation: The Case of Swedish Occupational and Physical Therapists.

Professionalization and Rehabilitation : The case of Swedish occupational and physical therapists

Working Conditions Influencing Professionalization of Occupational and Physical Therapists—Part 1: A Quantitative Perspective

The aim of this study was to survey the perception occupational and physical therapists had of their working conditions in the context of ongoing professionalization. Seven hundred Swedish occupational and physical therapists, equally represented and surveyed nationwide, met the criteria established for inclusion in the study. The findings revealed that most of the therapists experienced a strong feeling of job satisfaction and professional self-concept and that physical therapists are a significant step ahead of occupational therapists in their answers. A final multiple regression equation was completed on the working conditions variables, theoretically connected with professionalization. The findings showed that most of them turned out to be significant predictors of overall job satisfaction. Surprisingly, only half of the therapists experienced a reasonable possibility of developing and learning new things at work, and a minority admitted autonomy concerning identification of the patients' treatment needs. A tentative conclusion is that most of the therapists are extenders of functions performed by the physician. They neither seem to have a fair chance, nor do they seem to care to take on full responsibility for their professional development and field of competence, and to make their expert knowledge explicit. This might constitute an important barrier to full professional status.

Ability to solve problems, professionalism, management, empathy, and working capacity in occupational therapy--the professional self description form.

The majority of occupational therapists in Sweden previously worked on large occupational therapy wards. Health care policy has changed over the years and the system has been reorganized accordingly. The employment situation for occupational therapists has also changed. This paper focuses on the perception of professional self among occupational therapists. The objective was to explore the professional self and to suggest components important to the occupational therapist profession. The Professional Self Description Form (PSDF) was used for the exploration of self. The 19 items in the PSDF cover areas relevant to professional functioning and activity. Sixty-eight employed occupational therapists participated. The results of the PSDF were subjected to factor analysis and five factors were obtained; Ability to solve problems, Professionalism, Management, Empathy, and Working capacity. We believe that these five factors can function as improving domains of the role of the professional occupational therapist in Sweden.