Deborah Laliberte Rudman

Living in a restricted occupational world: The occupational experiences of stroke survivors who are wheelchair users and their caregivers

Background. In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. Purpose. This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n=16) who use wheelchairs and their primary caregivers (n=15). Results. Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers. Practice Implications. In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.

Positive aging and its implications for occupational possibilities in later life.

Background. There is a growing emphasis in academic, policy and popular literature within Western societies on positive discourses of aging. Although such discourses appear to be consistent with central beliefs of occupational therapy, particularly with respect to the health-promoting potential of occupation, critical social gerontologists are raising concerns about how such discourses are being shaped in relation to consumer culture and the rise of neoliberalism. Method and Purpose. Literature examining the emergence and evolution of positive aging discourses was reviewed and reflected upon using an occupational perspective. Results. Positive aging discourses are being shaped in ways that limit occupational possibilities and promote occupational injustices. Clinical Implications. Occupational therapists need to consider ways to enact discursive, practice and policy changes that enable aging persons with diverse abilities and resources to pursue occupations that fulfill needs and promote health.

Understanding Political Influences on Occupational Possibilities: An Analysis of Newspaper Constructions of Retirement

Abstract Occupational possibilities, that is, the occupations people view as ideal and possible and which are promoted and made available within specific sociohistorical contexts, are shaped by political, social and cultural influences. This paper examines the implications of the contemporary structural and discursive transformation of retirement for retirees’ occupational possibilities. Results of a critical discourse analysis of 138 recent Canadian newspaper articles addressing retirement that examined: i) the possibilities and constraints for ways of being (subjectivities) and doing (occupation) and, ii) if and how subjectivities shaped for retirees are linked with neoliberal political rationality, are presented. Four ideal subjectivities, falling along continua with ends points of producer and consumer, and age‐defiance and being prudential, were shaped within the texts analyzed. Drawing on the governmentality perspective, it is argued that contemporary discourses regarding retirement are bounded within neoliberal rationality and, as a result, shape occupational injustices. The findings highlight links between political factors and occupation, and challenge occupational scientists to contribute to the creation of alternative discourses about retirement.

Shaping knowledge regarding occupation: Examining the cultural underpinnings of the evolving concept of occupational identity

BACKGROUND/AIM Within occupational therapy and occupational science, knowledge regarding occupation-based concepts is in the process of being developed, disseminated and acted upon internationally. It is critical to reflect on the forces shaping the ways in which this knowledge is being constructed. METHOD In this paper, the ways in which cultural assumptions and values have influenced the evolving concept of occupational identity are examined through applying Kluckhohn and Strodtbecks framework of cultural variations in values to two contemporary conceptualisations of occupational identity. RESULTS The analysis demonstrates the ways in which values most consistent with Western culture are embedded within and dominate these contemporary conceptualisations of occupational identity, emphasising a future orientation, achievement-based doing, individual choice, and mastery of individuals over nature. CONCLUSIONS This paper points to conceptual boundaries within which occupational identity is currently being shaped and points to alternative possibilities in the hope of prompting dialogue and research that looks at this concept in more diverse ways. Heightened sensitivity to the influence of culture on the shaping of occupation-focussed knowledge will serve to strengthen and enrich the growth of the evolving body of knowledge pertaining to occupation, and foster culturally sensitive research and practice.

DESCRIPTION AND VALIDATION OF A MEASURE OF RECEIVED SUPPORT SPECIFIC TO HIV

Validation data are described for the Social Support Inventory for People who are HIV Positive or Have AIDS. This inventory was developed specifically for use with individuals who are HIV-positive to assess three types of received support (instrumental, informational, emotional) for each of four dimensions: whether support is received or wanted, satisfaction with support, and source of the support. It was validated in the context of a larger cross-sectional study of 120 adults with HIV who completed a set of questionnaires. Descriptive statistics, internal consistency coefficients, and evidence of construct validity for the original inventory are presented. An improved, revised version based on the validation data for the original one is also briefly described, but not tested.

Preliminary Investigation of the Content Validity and Clinical Utility of the Predischarge Assessment Tool

With the trend towards decreasing lengths of hospital stays, comprehensive discharge assessment is essential to facilitate continuity of care between hospital and community, minimize readmissions, and maximize client satisfaction. Predischarge assessment is often part of the occupational therapy role, especially in acute care. The Predischarge Assessment Tool (PAT) outlines a method of conducting comprehensive assessments in a manner consistent with the Occupational Therapy Guidelines for Client-Centred Practice. The tool is designed to inform decisions regarding: occupational readiness for discharge to the community from acute care; physical and social supports required to support occupational performance; and follow-up therapy. Two studies provide initial support for the content validity and clinical utility of the PAT and, at the same time, indicate that some modifications to the PAT are required.

The Evolution of a Quality Programme within a Changing Environment

Health care facilities have been forced to re-evaluate traditional methods of quality assurance and consider quality improvement techniques. The Toronto Hospital Occupational Therapy Department has developed a quality programme that incorporates a foundation and supporting structures that can be adapted to accommodate the shift from quality assurance to continuous quality improvement. The foundation consists of a philosophy and principal functions, while the supporting structures include mechanisms to monitor principal functions and for communication. With a shift to continuous quality improvement, the quality programme was expanded to include clinical indicators and greater involvement of front-line staff and consumers. The programme also incorporates a framework that directs the development and implementation of clinical indicators related to occupational performance outcomes. Issues pertaining to the implementation and adaptation of the quality programme are discussed. Although initially developed in an occupational therapy environment, the framework and processes of this quality programme are being applied to multidisciplinary quality programmes in which occupational therapists are taking on leadership roles.