Anita M. Unruh

Reflections on: “So… What Do You Do?” Occupation and the Construction of Identity

Background. What we do has always played a leading part in social conversations about who we are. In part, these social questions are about occupational identity. Purpose and method. Occupational identity is an emerging concept in the occupational therapy literature. In this paper, the concept of occupational identity is examined through the observations of a former research participant in a previous study on the meaning of gardens and gardening in daily life, and the recent work of researchers in occupational therapy and occupational science. Results. Three themes are examined in these reflections. They are occupation and continuity of occupational identity, the contributions of productivity, leisure and self-care to occupational identity and, the public and private aspects of occupational identity. Practice Implications. Exploration with a client about what occupations are most meaningful in her or his life may be a means to understanding the persons construction of an occupational identity. Understanding the nature of the clients occupational identity may be a necessary beginning to developing a collaborative approach to what is needed in occupational therapy intervention.

The Occupation of Gardening in Life-Threatening Illness: A Qualitative Pilot Project:

This qualitative pilot study was completed as an exploratory study of the meaning of gardening using attention restoration theory. Three women with breast cancer who garden for leisure were recruited from a cancer support group. Each participant was interviewed at her home on two occasions. To complement the qualitative data, participants also completed the Perceived Restorativeness Scale (PRS) (Hartig, Korpela, Evans, & Garling, 1996). The interviews revealed six major themes some of which were concerned with the interactions between the gardener and the garden, and others which focused on gardening within the context of having cancer. The qualitative and quantitative outcomes supported the perspective of attention restoration theory. Spirituality was interwoven throughout the comments of two participants but was less important for one participant. The implications of this study for practice and future research are discussed.

In the eye of the dragon: : Women's experience of breast cancer and the occupation of dragon boat racing

Background. Women with breast cancer are at risk of developing lymphedema following surgical and/or medical treatment of the disease. Recently, women have challenged traditional advice about limiting upper extremity activity to prevent lymphedema by participation in dragon boat racing. Purpose. In this qualitative pilot study, three women were interviewed about the meaningfulness of dragon boat racing in their lives. Methods. The women were interviewed twice and their interviews analyzed using thematic analysis. Results. Seven themes are discussed: attraction of dragon boat racing; physical and emotional well-being; competition; social support; transcendence/connectedness/oneness; re-occurrence of cancer; and, public awareness. Competition enabled the participants to rebuild self-confidence and to regain control over their physical health and emotional well-being. Balancing support and competition was key to finding satisfaction in this occupation. The women did not believe that dragon boat racing affected their risk for developing lymphedema. Practice Implications. People who engage in the occupation of dragon boat racing find it meaningful and develop new coping strategies. Participating in dragon boat racing can decrease stress and shift the meaning of having breast cancer to a more positive view of the experience.

Knowledge about pain among newly graduated occupational therapists: relevance for curriculum development.

In recent years there has been a growing awareness amongst health professionals of the need to prepare undergraduate students more adequately for practice with clients who have pain. Occupational therapists have a central role in enabling such clients to have productive lives despite pain. In this study, an examination was made of the adequacy of preparation for pain practice in graduates from one Australian occupational therapy curriculum. Recent occupational therapy graduates from the University of Queensland, Australia, who responded to a postal survey, obtained an overall 53% correct response rate to a 69-item pain knowledge and attitudes questionnaire. Results indicated the need for further education in this area, especially in the areas of pharmacological management, and pain assessment and measurement. These results were comparable to those obtained from final year occupational therapy students at Dalhousie University in Halifax, Nova Scotia prior to undertaking an elective course about pain. Follow-up interviews with a number of new graduates supported the inclusion of an elective pain course in the undergraduate occupational therapy curriculum at the University of Queensland in Australia.

Teaching student occupational therapists about pain: A course evaluation

Occupational therapists frequently work with people who have difficulties in their occupational performance due to pain. Very little is known about the educational needs of occupational therapists in preparation for this client population. The objective of this course evaluation was to assess knowledge about pain in fourth year student occupational therapists and the impact of a pain elective on their subsequent learning. Twenty-nine students were given a pain questionnaire on entry to the pain elective and again on completion. On course entry, students scored highest on items addressing the physiological basis of pain with more limited understanding of psychosocial components, lifespan issues, assessment and measurement strategies, cognitive-behavioral applications, and principles of pharmacological management. Substantial change in all areas occurred following participation in this pain elective (t=17.61, df=28, p<0.001), Implications for occupational therapy education are briefly discussed.

Spirituality and Occupation: Garden Musings and the Himalayan Blue Poppy:

Spirituality is a key dimension in occupational therapy models of practice, but definitions of spirituality and its relationship to occupation have eluded us. Nevertheless, if the writings of people who are deeply involved in their occupations are examined, we discover that spirituality can be expressed through our engagement in occupations with personal meaning in our lives. In these reflections, the author examines spirituality as it is expressed by gardeners in their garden musings, and suggests that this occupation has the capacity to enrich spirituality in everyday life. Further study of the relationship between specific occupations and spirituality may illuminate the construct of spirituality and demonstrate the ways in which occupation can be used to facilitate a richer spiritual life for individuals and communities.

Reflections on …: Spirituality and Occupation: Garden Musings and the Himalayan Blue Poppy

Spirituality is a key dimension in occupational therapy models of practice, but definitions of spirituality and its relationship to occupation have eluded us. Nevertheless, if the writings of people who are deeply involved in their occupations are examined, we discover that spirituality can be expressed through our engagement in occupations with personal meaning in our lives. In these reflections, the author examines spirituality as it is expressed by gardeners in their garden musings, and suggests that this occupation has the capacity to enrich spirituality in everyday life. Further study of the relationship between specific occupations and spirituality may illuminate the construct of spirituality and demonstrate the ways in which occupation can be used to facilitate a richer spiritual life for individuals and communities.

Siblings of children with special needs.

Siblings of children with special needs have received little attention in the occupational therapy literature. However, siblings play an important role in the development of children with special needs. Siblings are also at risk for problems of emotional adjustment that have an impact on their own well-being as well as the well-being of the family. The research on siblings of special needs children is reviewed and followed by a description of the Ottawa Childrens Treatment Centre sibling programme.

Book Review: The sibling survival guide: Indispensible information for brothers and sisters of adults with disabilities

tion. Retrieved from http://www.who.int/healthpromotion/confer ences/previous/ottawa/en/ Wynn, K., Stewart, D., Law, M., Burke-Gaffney, J., & Moning, T. (2006). Creating connections: A community capacity-building project with parents and youth with disabilities in transition to adulthood. Physical & Occupational Therapy in Pediatrics, 26(4), 89–103. doi:101080/j006v26n04_0 Zacharakis, J. (2006). Conflict as a form of capital in controversial community development projects. Journal of Extension, 44(5). Retrieved from http://www.joe.org/joe/2006october/a2.php

The Importance of Expressive Play for Children

As an occupational therapist whose most rewarding area of clinical practice concerned childrens play, I was very pleased to see a detailed discussion on occupational therapy and childrens play in the Practice Paper published in the June 1996 issue of the Canadian Journal of Occupational Therapy. This paper will provide a useful format for further discussions about play as occupation and its meaning in childrens lives and in our own. There is an aspect of play that does not come forward in this paper or in most other occupational therapy papers about play. Some play is not primarily manipulative, imaginative, constructional or sensorimotor; it may have some of these elements but the primary focus of the play is expressive. Expressive play is a story-telling process that expresses the childs inner world and her or his place in it. Expressive play may be an aspect of imaginative play but imagination suggests pleasurable engagement in fantasy and role-playing, whereas expressive play is typically based on real and current, often troubling issues. When a child is involved in expressive play there may be an almost palpable state of flow within the child, however the play itself may not be pleasurable. The play may be infused with hope and wish-fulfilment but it often involves considerable conflict, tension and anxiety. For the observant occupational therapist, peaks in tension that occur during the childs play may be important cues to grasp the nature of the childs dilemma. Expressive play may also be spiritually mediated in that this play concerns the childs personal beliefs about who she or he is in relationship with the surrounding environment. As an example of expressive play, some years ago I saw a 4 yearold, withdrawn child, who exhibited development delays in learning and in social skills. In a play session, the child used a dolls house to tell a story about a family Christmas dinner. Following the play about Christmas, the story shifted to a play about an upstairs mother and a new downstairs mother, and a child who went from one to the other. The childs story was based on real events, a Christmas dinner that was a last memory of a mother who had recently died, and the fathers early remarriage. It reflected the childs unresolved grief and ambivalence towards her step-mother; issues which were both very difficult for the child to express in words, and had been shut out by her father and step-mother. For children who have experienced neglect, abuse, social isolation, traumatic injuries, significant health difficulties or unresolved grief, competence in play may or may not be a problem. However, many of these children may have difficulties with occupations that concern family and social relationships. Understanding the full spectrum of the meaning of play as occupation, and creating and facilitating expressive play may enable children to communicate the nature of their inner world and experience to others. The occupation of play can be used therapeutically for the meaning that the child derives from the play, and as a medium for change. In this way, one occupation (play) is used as a tool or strategy, along with other intervention efforts, towards meeting important goals such as understanding, resolving, and/or restoring occupations associated with family and social life, or managing occupational needs or changes associated with a chronic illness. Skilled therapeutic use of play relies on a comprehensive understanding of play as an occupation that may have complex manipulative, imaginative, constructional, sensorimotor and sometimes expressive components. We need to know more about the nature of expressive play and how it can be used by occupational therapists to meet the occupational needs of children. Anita Unruh, Ph.D., 0.T (C) Department of Occupational Therapy, Dalhousie University, Halifax, NS B3H 3J5