Glenys Carlson

Using a Matrix in Life Transition Research

Life transitions can be planned or can occur unexpectedly. They can cause a major change to a person’s life patterns and well-being. Older adulthood is a time for many life transitions as a result of changes in life roles and health status. In this exploratory study, the authors investigate the transition involved in driving cessation for older people. In analyzing and organizing the data, they develop a matrix that incorporated descriptive and temporal factors associated with the transition. This matrix is useful in organizing and communicating the findings as a whole and could be used in describing individual experiences. It might be of use for the organization of qualitative data about other life transitions such as illness, retirement, and the development and adoption of new behaviors.

The Needs and Experiences Related to Driving Cessation for Older People

Older people may cease driving owing to health concerns, discomfort while driving, cancellation of their licence or financial reasons. Because driving is fundamental to the freedom and independence of older people, driving cessation can lead to depression, loss of roles and unsafe use of alternative transport. Little consideration has been given to the development of approaches to improve outcomes for retiring drivers. This study aimed to understand the experiences of driving cessation for older people to inform the design of interventions for retiring drivers. Qualitative methodology was used to explore the experiences of driving cessation from the perspective of nine retired drivers, three family members and six service providers. The retired drivers experienced challenges during three phases of driving cessation, in addition to discussing their driving history. The challenges were (1) a predecision phase – a balancing act and achieving awareness; (2) a decision phase – making the decision and owning the decision; and (3) a post-cessation phase – finding new ways and coming to terms. Interventions to facilitate the process of driving cessation may need to be designed according to the phase of driving cessation and the challenges that the person is experiencing and to be underpinned by behaviour change and life transition theories.

Occupational therapy in multicultural contexts: Issues and strategies

The profession of occupational therapy aims to recognise and value cultural diversity. The purpose of this review is to examine occupational therapy in Western multicultural contexts. First, culturally competent practice is discussed. Secondly, concepts relating to culture in two occupational therapy models (the Model of Human Occupation and the Occupational Performance Model) and in occupational science are examined. Thirdly, occupational therapy in Western multicultural contexts is examined in relation to immigrant cultural groups and indigenous cultural groups: issues, cultural variations and strategies are identified. Fourthly, the implications for occupational therapy education are discussed. In conclusion, the implications for the profession of occupational therapy are identified.

MENSTRUAL MANAGEMENT AND WOMEN WHO HAVE INTELLECTUAL DISABILITIES: SERVICE PROVIDERS AND DECISION-MAKING

As part of a study about menstrual management decision-making for women who have an intellectual disability and high support needs, 63 service providers were interviewed using a semi-structured interview schedule. The interview participants included school staff, residential staff, ”resource” staff, managers, and medical practitioners. The interview schedule sought information about decision-making bases, such as relevant personal experiences and observations, attitudes to menstruation, knowledge of management approaches, and practical support networks accessed by the participants. In addition, participants were asked their opinions about decision-making processes such as what choices they perceive as practicable and preferable, who should be involved in decision-making processes and criteria upon which decisions should be made. Participants were also asked for their suggestions about how to access information and enhance practical support for the young women and their families. This paper summarises the ...

Sterilisation, drugs which suppress sexual drive, and young men who have intellectual disability

In 1992, the High Court of Australia ruled that all procedures involving the sterilisation of children (other than to treat some malfunction or disease) should be referred to the Family Court of Australia. There has been recent public debate about the sterilisation of young women who have intellectual disability. However, there appears to be very little known about the sterilisation of young men who have intellectual disability. Health Insurance Commission figures indicate that vasectomies and perhaps bilateral orchidectomies are occurring for some young Australian males under 19 years of age, some of whom are under nine years of age. In addition, the use of drugs to alter sexual behaviour in young men with intellectual disability remains controversial. Concerns include sexual behaviour, aggression and other aspects of human relationships of young men with intellectual disabilities. This paper reports on 51 responses to a request for information about sterilisation, drugs and young men who have intellectual disability in Australia. Several issues, including the influence of attitudes and the need for informed decision making are raised.

Factors influencing occupational therapists' clinical decision-making for clients with upper limb performance dysfunction following brain injury

Occupational therapists make clinical decisions to help clients with upper limb performance dysfunction following brain injury to achieve their goals. Although occupational therapy services have traditionally been separated for paediatric and adult populations, it has been proposed that a common process can be used to make clinical decisions for children and adults with upper limb performance dysfunction following brain injury. This study compared the factors that influenced the clinical decisions of experienced occupational therapists who worked with either children or adults with upper limb performance dysfunction after brain injury to determine if the clinical decision-making process was common for all clients with brain injury. Eleven occupational therapists with experience in working with clients with brain injury participated in two focus groups. Six had experience in working with children and five in working with adults. The discussions were audiotaped, transcribed and analysed using NUD*IST Version 4 data management software. The intrinsic or client-related factors identified as influencing clinical decision making were the clients condition, personal attributes and occupational performance needs. The extrinsic factors were related both to the therapist (knowledge of ‘feel’, experience, treatment preferences, confidence and personal convictions and beliefs) and to the environment (context of service provision and organisational culture and constraints). The consistency in the factors identified across different caseloads appeared to indicate that a common protocol would be suitable for guiding clinical decision making for both children and adults with varying patterns and intensity of upper limb performance dysfunction. Further research is needed to determine the clinical usefulness of such a protocol and the consistency of client outcomes following its use.

A model of substitute decision-making

Abstract Substitute decisions are those made on behalf of people who are not able to make decisions for themselves. From an ethical point of view it is important that substitute decision-making involving another persons health and well-being be approached methodically. The decision-making model outlined in this article was developed during a study which investigated substitute menstrual management decision-making for young women who had intellectual disabilities and high support needs. The decision-making literature provided relevant theoretical bases for structuring the components of the model. On the basis of the model, a definition of informed substitute decision-making is proposed. Although the model and definition were developed in relation to a specific area of substitute decision-making, they appear to be applicable to a range of decisions involving a persons health and well-being that are undertaken by substitute decision-makers.

The Legal Trends‐‐Implications for Menstruation/Fertility Management for Young Women who have an Intellectual Disability

Since 1988, there have been a number of Family Court of Australia cases where permission was sought for a hysterectomy (surgical removal of the uterus) to be performed on premenarchal women who have an intellectual disability. The case judgments refer to several cases from appellate overseas courts. While the judgments indicate a division of judicial opinion on the issue of the necessity of court consent for such surgery on this group of young women, all of the judges sanctioned a premenarchal hysterectomy. This paper will review the cases with specific reference to relevant Australian legislation, and the implications for women who have an intellectual disability which may have international applicability.

An Introduction to Menstrual Management for Women who have an Intellectual Disability and High Support Needs

Abstract This paper describes a project researching the management of menstruation for women who have severe or profound intellectual disability (high support needs). Its mandate was to develop materials, processes and resources to support menstrual management for women who have high support needs. Intervention processes are described via an illustrative case study. The impact of care providers’ attitudes on menstrual management for these women is considered. Partial participation in menstrual self‐care is discussed. Reference is made to a ruling by the High Court of Australia which requires the consent of the Family Court of Australia for surgeryresulting in sterilisation of young women under the age of 18 years.