Uses and misuses of psychiatric occupational therapy: occupational therapy as a haven.
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Deriving from the philosophical basis of the profession, occupation is the core concept of the profession of occupational therapy. However, in the occupational therapy literature, the term occupation is used in a variety of ways. Occupation, a collection of activities that people use to fill their time and give life meaning, is organized around roles or in terms of activities of daily living, work and productive activities, or pleasure, for survival, for necessity, and for their personal meaning. It is the individualized, unique combination of activities that comprises an individual's occupations. Purposeful activities have been described in many different ways: as something all people engage in; as tools or media that therapists use to enhance or facilitate performance; and vehicles for bringing about change. Purposeful activities are seen as part of the process of occupational therapy. Purposeful activities are subset of occupations in that they are goal directed and serve as a major tool in the process of occupational therapy. The term function, viewed as the ability to perform activities required in one's occupations has become increasingly important to society in describing the performance or change in individuals. This societal shift in ideas has prompted the concept of function, viewed as a product, to become more important than the process of bringing about change. Occupational therapy practitioners typically have viewed the process as being just as important as the product. When working to improve function, occupational therapy practitioners use purposeful activities that are meaningful to the person in relation to his or her occupational history, preferences, personal goals, and needs. Occupational therapy practitioners need to keep the individual's occupations in the forefront of their thoughts when using any purposeful activity and to plan interventions toward improving the individual's ability to function within his or her occupations. In the interest of the profession, it is important to concentrate on occupation. Furthermore, it is essential that we study our interventions' relationship to occupation and function, and how purposeful activities are used toward supporting the individual's ability to engage in occupation.
The purpose of this study was to determine whether physical therapy (PT), occupational therapy (OT), and speech-language therapy (SLP) students shared common perceptions of the practice roles of the three disciplines. The survey instrument used in this study contained 55 questions that addressed practice-role perceptions. The questions were based on a case study. A total of 172 undergraduate students (PT 71, OT 52, SLP 49) from a southeastern university participated. Chi-square test of association was used to analyze the data. Results showed that PT, OT, and SLP students shared common perceptions of administrative and educational practice roles but differed on their perceptions of assessment and physical/mental treatment roles. Practice-role confusion was particularly acute between OT and PT and between OT and SLP students in these areas.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Occupational therapy, formally organized in the United States in 1917, is considered an allied health field. Mapping occupational therapy literature is part of a bibliometric project of the Medical Library Association's Nursing and Allied Health Resources Section's project for mapping the literature of allied health. Three core journals were selected from the years 1995 and 1996 and a determination was made of the extent to which the cited journal references were covered by standard indexing sources. Using Bradford's Law of Scattering three zones were created, each containing approximately one-third of the cited journal references. The results showed that three journals made up the first zone, 117 journals the second, and 657 the third. The most cited journal was the American Journal of Occupational Therapy. In the second zone, journals from twelve disciplines were identified. While MEDLINE provided the best overall indexing, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) was the only database that indexed the three most cited journals plus nine of the currently active titles in occupational therapy. MEDLINE could improve its coverage of occupational therapy by indexing the journals of the British, Canadian, and Australian national associations.
Occupational therapy is facing some important decisions as it approaches a changing health care system. By understanding the prospective payment system it is possible to promote occupational therapy services to a changing marketplace while avoiding major problems. Specific opportunities and strategies are defined to promote occupational therapy to new markets.
Occupational therapists treating older people with Alzheimer disease know that they must also consider the others who are affected by the disease, the informal caregivers. Intervention is most effective when it enables both the impaired person and the primary caregiver to manage the secondary symptoms of dementia. Unfortunately, little is understood about how caregivers approach and carry out their tasks and about why male and female caregivers respond differently to their caregiving role in terms of depression, burden, stress, and substance abuse. This paper discusses the effects of gender on dementia management plans of spousal caregivers. Husbands and wives have different approaches to caregiving; each approach has consequences. Male caregivers adopt a task-oriented approach to their duties and carry out their activities in a linear fashion; female caregivers use a parent-child approach and nest activities inside one another in a constant stream of work. Two cases are presented to illustrate gender differences in dementia management plans. Implications for occupational therapy include suggestions for supporting men and women in their caregiving role, modulating the negative consequences of caregiving, and conducting research to demonstrate the efficacy of an occupational therapy approach.
Occupational therapy practice has bridged two contradictory value systems for more than 100 years. This article describes the origins of practice ideas in both the United States and Britain and demonstrates that founding members of the occupational therapy profession all shared a core of humanistic beliefs while embracing the emerging paradigm of scientific medicine. The result has been an intellectual tension between the biological and the psychosocial aspects of practice. For more than 75 years, occupational therapists struggled to balance the art and science of patient care; recent debates on modalities, practice domains, and research priorities indicate that the unifying core of the profession is occupation that considers a person's mind and body.
Occupational therapists have begun to recognize the importance of considering how the environment influences occupational performance. Models of person-environment fit provide a theoretical context within which occupational therapists can consider the influence of the environment on function. The challenge for occupational therapists is to select assessments that incorporate concepts of person-environment fit. However, limited awareness of appropriate environmental assessments that have undergone psychometric testing has limited their introduction into clinical practice. This paper reviews 41 environmental assessments and considers each in terms of its purpose, environmental attribute, environmental application, clinical utility, instrument development, and psychometric testing. A case example illustrates the applicability to the practice of occupational therapy.
Occupational therapists use many forms of measurement tools to assess the existing and potential functions of their clients. Too often the principles of measurement theory have not been applied in the development of such instruments and the resulting assessments have no established validity or reliability. This article presents basic measurement theory and appropriate procedures for estimating validity and reliability within an occupational therapy framework. Special considerations with regard to measurement of motor behavior are emphasized. An understanding of these assesment principles can enable a therapist to construct measurement scales that are valid, reliable, and yield data of scientific value.
Occupational therapy departments of tertiary care hospitals can provide staff with opportunities to gain diverse clinical experience if they rotate through the various services such as surgery, medicine, geriatrics, plastic surgery and orthopaedics. The system of rotation offers both advantages and disadvantages for the staff and the institution. The Royal Victoria Hospital in Montreal, a large university teaching hospital, had traditionally offered staff the opportunity to rotate. Changes in staffing and their needs however, resulted in rotation becoming an important issue within the department. This article presents the pros and the cons of rotation and non-rotation systems as identified by therapists and administrators across Canada. Staff rotation was found to have an effect on job satisfaction and a therapist's career orientation. Given these findings, administrators may want to reconsider the role of the generalist and specialist in their facilities.
A joint appointment is a position agreed to by a health service facility and an educational institution where the appointee holds a position in each affiliated institution and carries out defined responsibilities in each. In light of the growing costs of higher education, financial cut backs, the need to respond to manpower shortages and the expanding need for clinical research, the benefits of joint university-clinical appointments should be considered by academic and clinical institutions in physical therapy (PT) and occupational therapy (OT). To obtain data on existing joint university-clinical positions in Canadian PT and OT schools, mailed survey questionnaires were conducted. The purpose of the survey was to gain information on these appointments so that future faculty-clinical roles in PT and OT could be developed. An initial questionnaire was mailed to the 25 directors of the Canadian PT and OT education programs to obtain information on existing joint appointments and the names of joint appointees holding these positions. A second questionnaire was sent to 104 joint appointees to gather information on their perceptions of these positions. The results of this survey suggest that with continuing manpower shortages, demand for clinical research, increase in student enrollment and insufficient number of faculty members, there is a need to develop these roles further.
Reflex sympathetic dystrophy (RSD) is a disorder that can potentially result in permanent impairment. Because there are no adequate comparative studies regarding the additional value of physical therapy (PT) or occupational therapy (OT) for reducing the severity of permanent impairment in RSD, we prospectively investigated their effectiveness. At two university hospitals, we randomly assigned 135 patients with RSD of one upper limb, existing for <1 yr, to PT, OT, or control therapy (CT). One year after inclusion, impairment percentages were calculated according to the general method of the American Medical Association's Guides to the Evaluation of Permanent Impairment. For statistical evaluation, the Wilcoxon's signed-rank test (two-sided; alpha = 0.05) was used. The mean whole body impairments were as follows: PT, 21.6% and 19.1%; OT, 22.8% and 22.1%; CT, 22.0% and 22.1% (intention-to-treat and per protocol analysis, respectively). There were no significant differences between the groups. We conclude that impairment percentages in RSD patients treated with PT or OT did not differ significantly from those treated with CT at 12 months after inclusion.