Betty R. Hasselkus

Connecting with Patients: The Personal Experience of Professional Helping.

In this study, we examine the nature and meaning of therapist-patient interactions from the perspective of the therapist. Qualitative analysis of phenomenologic data from interviews with occupational therapists affirmed the importance of a sense of “connecting” in these relationships, and the predominance of “helping” and “working together” in forging those connections. The nature of helping, the nature of working together, and the personal nature of these experiences in occupational therapy are examined. Findings enhance our understanding of collaboration in occupational therapy and underscore the importance of considering the personal contexts of practice.

Physician and family caregiver in the medical setting: Negotiation of care?

Abstract Forty clinic visits with physician, older patient, and family caregiver were audio-taped and analyzed for topical themes and exchanges of meaning. The extent to which the caregivers contributed to traditional physician domains of care during the visits [diagnosis, interpretation of symptoms, treatment recommendations) was unexpected. This presentation of self as a practitioner by the caregiver differed from the physicians view of the caregiver as a patient-substitute. In addition to Health Care, the problem situations most often discussed were Eating, Moving Around and Risk. In general, the participants in the clinic visit-physician, caregiver and patient-brought very little of the social context of the illness and care into the medical visit.

Themes of Meaning: Occupational Therapists' Perspectives on Practice

As part of the broad effort in occupational therapy to define directions for future education and practice, a pilot study was conducted that focused on the meanings therapists find within their practice. Using a phenomenological approach, therapists were asked to describe their most satisfying practice experience. Five primary themes of meaning in occupational therapy were derived from the pilot data: Making a Difference, Being Valued by Others, Sense of Initiative, Sense of Inventiveness, and Agreeableness. These preliminary findings are discussed as they relate to previous research of job satisfaction in occupational therapy. Implications for occupational therapy and questions to be addressed in an expanded study are presented.

BARTHEL SELF-CARE INDEX AND GERIATRIC HOME CARE PATIENTS

Barthel Self-care Index scores were recorded at 6-month intervals for patients in a geriatric home care program by an occupational therapist in cooperation with an interdisciplinary health care team. Scores ranged from 10 to 100 with an overall mean score of 83.9. Lowest score for a patient living alone was 75 and that patient required extensive social services to remain in the community. The data suggest that the Barthel Index may be useful in helping to define the personal care needs of the frail community elderly and in identifying the need to consider institutional placement.

Post-occupancy evaluation: an environment-behaviour technique for assessing the built environment.

This paper reviews the development, structure and process of post-occupancy evaluation (POE) as an environment-behaviour approach to assessing built environments of all sizes and types. It illustrates the use of POEs with three examples from the Health Care sector: The Canadian Hospital Evaluation Program, the Weiss Institute, and 18 independent-living apartment units. A comparison is made between POEs and the approach currently used by occupational therapy (OT) for environmental assessments. Recommendations suggest that OTs approach could be extended and strengthened through 1) incorporating POE methods and existing data from environment-behaviour studies; 2) the use of standard assessment procedures and well-validated measures; and 3) the development of a data bank on OT environmental assessments.

Staff helping behaviors: Alzheimer day care

Helping behaviors of staff members at an Alzheimer day care center were examined through participant observation and ethnographic interviewing. Analysis of the field notes and interview data revealed a primary theme of prevention of harm in the helping patterns and secondary themes of enhancing client function and providing social connectedness. Comparisons with relational and dependency models of helping are made and implications for dementia care are discussed.

Patient Education and the Elderly

The past decade has witnessed a rise in the concept of consumer health care and an increasing commitment of health professionals to patient education. A new awareness of the complexities of health behavior has led health providers to focus on the need to guide patients in understanding their illnesses, in developing strategies to continue daily life in spite of chronic conditions, and in acquiring adaptive skills for mastery and competency in living. An understanding of the basic principles of adult education will enhance the health professionals skills in carrying out patient education with adults. In particular, the concept of life span development in education provides a framework for planning patient education interventions for elderly clients.L

Ethical dilemmas: The organization of family caregiving for the elderly

Abstract Analysis of sixty ethnographic interviews on the meaning of activity in family caregiving for frail community elderly generated a model of caregiving as a daily round of ethical dilemmas. Five ethical themes were derived from the data. The ethical maxim “above all do no harm” led to prominent patterns of tension within the principle of beneficence and between the principles of autonomy and beneficence. Justice was the principle most often perceived to be violated. The data suggest that professionals who work with family caregivers should seek to understand the caregivers ethical framework in order to bring about an optimum therapeutic relationship in long term care.

Keeping body and soul together.

When I was an undergraduate student in occupational therapy, one of the required courses in the curriculum was a six-credit course in gross anatomy offered by the medical school. During the lab sessions across the semester, we gradually worked our way into the interior of the human body, going deeper and deeper into the anatomical structures. I vividly remember the labor-intensive process of dissection and identification of the complex neuromuscular structures of the upper extremity and, in particular, those of the hand. For me, the symbiotic arrangement of the deep tendons of the palmar surface of the hand, with the flexor digitorum profundi neatly tunneling through the sheaths of the flexor digitorum superficialis, was both elegant and amazing. But, as Margaret Atwood said, “The living bird is not its labeled bones” (2000, p. 395). The physiological processes and the anatomical structures of the human body may be wondrous, but the living person is much more than a biological fleshly being. For us in occupational therapy, the heart of the matter lies not in the structures and processes themselves, but in the way they contribute to the engagement of human beings in everyday occupation. Yet we know intuitively as well as conceptually that occupation does not and cannot exist without the body; disembodied occupation is a contradiction in terms. The question arises: What is the place of the body in the study of occupation and in the practice of occupational therapy? In the third edition of Uniform Terminology for Occupational Therapy (American Occupational Therapy Association [AOTA], 1994), muscles and tendons and other bodily structures and processes were imbedded within the category Performance Components; this category was one of three broad categories that included Performance Components, Performance Areas, and Performance Contexts. In the new Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), the category of Performance Components is replaced with two new categories—Performance Skills and Client Factors. Performance Skills is defined partly as “what one does, not what one has” ( p. 38). This definition seems to mean that at the skill level, we in occupational therapy do not focus on the body itself but, rather, on what the body does (i.e., the “observable elements of action that have implicit functional purposes” [p. 38]). Alternatively, Client Factors includes the body structures and functions represented by the anatomical and physiological aspects of the corporeal body. Body structures and functions reside “within” the client and influence the client’s occupational skills and performance. These factors are what one has. The Framework is an Official Document that strives to present our official professional gaze. The document encompasses the physical body as well as the occupational performance of the body. Yet I believe that as a profession, we continue to struggle with just where and how the body fits into our occupational framework. Client Factors is the last subheading within the large section of the document devoted to the domain of occupational therapy. It seems likely that the final placement of the “body” in the Framework was the end result of considerable discussion. In occupational therapy, our ongoing conversation about how the corporeal body fits into our profession’s philosophy, values, and principles of practice is not dissimilar to conversations present in other fields, such as disability studies. As a quasi-resolution to “the contested nature of the body” (Williams, 1999, p. 797), we have elected to embrace the new World Health Organization (WHO, 2001) International Classification of Functioning, Disability Keeping Body and Soul Together

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