Judith Pettigrew

Political violence and mental health: a multi-disciplinary review of the literature on Nepal.

Implementation of current international consensus guidelines regarding mental health and psychosocial support in emergencies requires the consideration of findings from both the medical and social sciences. This paper presents a multi-disciplinary review of reported findings regarding the relations between political violence, mental health and psychosocial wellbeing in Nepal. A systematic search of six databases resulted in the identification of 572 studies, of which 44 were included in the review. These studies investigated the influence of political violence on contextual variables that shape mental health and psychosocial wellbeing, and examined psychological distress and mental disorders in the context of political violence. The majority of studies addressed the mental health of Bhutanese refugees in Nepal and the impact of the Maoist Peoples War. Based upon these results from Nepal, we discuss a number of issues of concern to international researchers and practitioners and present policy and research recommendations. Specifically, we consider (a) the need for longitudinal multi-disciplinary research into protective and risk factors, including agency, of psychological distress and mental disorders in situations of political violence, (b) the continuing controversy regarding the PTSD construct, and (c) the lack of robust findings regarding the effectiveness of mental health and psychosocial support.

An integrative review of social and occupational factors influencing health and wellbeing

Therapeutic approaches to health and wellbeing have traditionally assumed that meaningful activity or occupation contributes to health and quality of life. Within social psychology, everyday activities and practices that fill our lives are believed to be shaped by structural and systemic factors and in turn these practices can form the basis of social identities. In occupational therapy these everyday activities are called occupations. Occupations can be understood as a contextually bound synthesis of meaningful doing, being, belonging and becoming that influence health and wellbeing. We contend that an integrative review of occupational therapy and social psychology literature will enhance our ability to understand the relationship between social structures, identity and dimensions of occupation by elucidating how they inform one another, and how taken together they augment our understanding of health and wellbeing This review incorporates theoretical and empirical works purposively sampled from databases within EBSCO including CINAHL, psychINFO, psychArticles, and Web of Science. Search terms included: occupation, therapy, social psychology, occupational science, health, wellbeing, identity, structures and combinations of these terms. In presenting this review, we argue that doing, being and belonging may act as an important link to widely acknowledged relationships between social factors and health and wellbeing, and that interventions targeting individual change may be problematic.

Occupational choice of youth in a disadvantaged community

Introduction The ability to make daily autonomous occupational choices has been identified as a human right and positively linked to wellbeing. Those marginalized from choice are considered at risk of occupational injustice. Disadvantaged young people are one group who may be marginalized from making such choices. Occupational choice is largely assumed to be an internal, individual process based on abilities and motivation, within environmental boundaries. From an external, contextual standpoint, this process has been scantly explored. This research, underpinned by an occupational justice perspective, sought understanding of disadvantaged young peoples’ daily choices. Method Qualitative and participative methods were used. Nine young people, aged 11–14 participated in Photovoice and photo elicitation interviews. Data were analysed thematically. Findings Occupational choices are contextually informed and constrained, as illustrated by three themes: a limited perception of choices, choices informed by a need to stay connected to others and choices as a vehicle for social positioning. Conclusion Occupational choices do not appear to emanate from internal interests and abilities but rather from necessitated and mandated actions based on socio-cultural expectations. This suggests that occupational therapists must pay closer attention to the social context that informs choices to improve wellbeing of at-risk young people.

Major trends in the use of occupation as therapy in Ireland 1863-1963

Purpose Major gaps exist in the documented history of occupational therapy in Ireland. The purpose of this paper is to contribute to filling these gaps by providing an overview of three major transitions in Irish occupational therapy in the century preceding the opening of St. Joseph?s College of Occupational Therapy in 1963. Research on occupational therapy’s past is valuable not only for recording and commemorating key events and individuals but also for allowing reflection on and questioning of contemporary practice and assumptions. Design/methodology/approach This descriptive paper draws on multiple documentary sources to present an overview of the first 100 years of the use of occupation as therapy/occupational therapy in Ireland from 1863 to 1963. Findings Three major transitions in occupational therapy in Ireland are presented: from moral treatment and the use of occupation as therapy to medical patronage of occupational therapy, from medical patronage to the early/pre-professional era and finally from the pre-professional era to the era of professionally qualified occupational therapists. To illustrate these transitions, a small number of individuals and their contributions are discussed including Dr Eamon O’Sullivan, Dr Ada English, Donal Kelly, Olga Gale and Ann Beckett. Originality/value This paper charts the foundations upon which the currently thriving profession of occupational therapy are built. The Association of Occupational Therapists of Ireland recently celebrated their 50th anniversary (AOTI, 2015a), and in 2017, it is 100 years since occupational therapy was formalised in Clifton Springs, New York, USA. Occupational therapy is a relatively young profession, and great opportunities exist to research its history in Ireland to capture the memories and experiences of the pioneers who laid the foundation of the profession as well as to situate the development of the profession in the broader social, cultural and scientific contexts within which it developed.

Using historical documentary methods to explore the history of occupational therapy

Introduction Historical research can benefit health professions by providing a basis for understanding how current beliefs and practices developed over time. From an occupational therapy perspective, a need for deeper critical understandings of the profession has been identified; historical research can facilitate this process. Documentary research is a significant methodology in historical inquiry, but there is a dearth of guidance for occupational therapists wishing to employ this method. Method A conceptual literature review was conducted to describe how to use documentary sources to understand the development of the profession, drawing on literature from the disciplines of history and occupational therapy. Results The stages of historical documentary research are described: choosing a topic, sourcing and selecting evidence, and managing sources. How to consider the authenticity, credibility and representativeness of historical material is discussed. Various means to determine the meaning of historical evidence are considered, with chronological, thematic and theoretical approaches proposed. Conclusion Methodological transparency is central to the process of historical documentary research. To enhance understanding of the quality of historical source material, adoption of the guidelines outlined is recommended. Adopting a clearly defined questioning perspective promotes more substantial conclusions and professional understandings.

The Bluebirds: World War I Soldiers’ Experiences of Occupational Therapy

OBJECTIVE. More is known about the experience of occupational therapists than the experience of patients during the profession’s early years. We examined soldiers’ experiences of occupational therapy in American Base Hospital 9 in France during World War I through analysis of a 53-line poem by Corporal Frank Wren contained in the unpublished memoir of occupational therapy reconstruction aide Lena Hitchcock. METHOD. Historical documentary research methods and thematic analysis were used to analyze the poem, the memoir, and the hospital’s published history. RESULTS. The poem describes the activities engaged in during occupational therapy, equipment used, and the context of therapy. It articulates positive dimensions of the experience of engaging in activities, including emotional benefits, diversion, and orthopedic benefits. CONCLUSION. Previous historical research has identified core philosophical premises about the use of occupational therapy; in this article, the enactment of these principles is established through the analysis of a soldier’s account of receiving occupational therapy.

Vocational Rehabilitation and Occupational Therapy: Impact of a Knowledge Translation Initiative

In musculoskeletal disorders (MSDs) and chronic pain, work disability has been identified as pervasive and costly, from human, societal and economic perspectives (Gignac et al., 2008; Bevan et al., 2009a,2009b; Leon et al., 2009). Vocational rehabilitation (VR) has been defined as: ‘a process to overcome the barriers an individual faces when accessing, remaining or returning to work following injury, illness or impairment’ (Department for Work and Pensions, 2004). VR has the potential to reduce the risk, cost and the negative human effect of work disability (Franche et al., 2005; Briand et al., 2008; Waddell et al., 2008). The integration of VR into a standard healthcare role is reported as necessary but is challenged in many countries which fail to incentivize return to work or resource health-related employment services, or lack policy frameworks to promote work ability (Alsop, 2004; Adam et al., 2010; Szeto et al., 2011). Allied health professionals are encouraged to use an evidence-based model of care to improve the effectiveness of clinical interventions and influence a positive patient outcome in developing areas of practice (Bennett and Bennett, 2000, Law, 2002; McCluskey and Cusick, 2002). Yet, allied health professionals consistently report that they do not have training, time, support or resources tomaster evidence-based practice (EBP) skills (McCluskey and Cusick, 2002; Rappolt and Tassone, 2002; Bennett et al., 2003; Grol and Grimshaw, 2003; McCluskey, 2003; Haynes et al., 2012; Caldwell et al., 2008; Lin et al., 2010; Murphy and Robinson, 2010). This rings true for VR, with occupational therapists (OTs) feeling

Traumatic Brachial Plexus Injury: The Lived Experience

Introduction: It takes a long time for someone to come to terms with a traumatic brachial plexus injury. The loss of function is akin to physical amputation of the limb, with all the associated body image and psychological effects (Waldram 2003). Numerous studies have been carried out that report on the functional outcomes following traumatic brachial plexus injury, but there is a noticeable lack of qualitative evidence that explores the subjective experiences of people following such an injury. The purpose of this study was to give these people a voice and allow researchers and occupational therapists to learn from the ‘lived experiences’ of those who had incurred such a devastating injury. Method: The research (undertaken by the first author) utilized a qualitative approach informed by phenomenology. This approach permitted the researcher to examine the core concepts of the lived experiences of people with this injury (Strauss 1990). Ten male Irish participants diagnosed with a traumatic brachial plexus injury were interviewed. Thematic analysis and member checking were utilized. Findings: The lack of rehabilitative and counselling services in the health care system was evident. Participants also voiced issues such as unequal opportunities in gaining employment, gender roles, the challenges of pain control, and the devastating effect of depression. Conclusion: The findings from this study will be of direct relevance to further development of services for individuals diagnosed with a traumatic brachial plexus injury.

A case study of the development of occupational therapy at St. Patrick’s Hospital Dublin, 1935-1969

This paper aims to examine the relationship between psychiatry and occupational therapy in Ireland through a case study of the development of the occupational therapy department in St. Patrick’s Hospital, Dublin, from 1935 to 1969. Patronage by psychiatrists was an important factor in the professionalisation of occupational therapy internationally.,Documentary sources and oral history interviews were analysed to conduct an instrumental case study of occupational therapy at St. Patrick’s Hospital from 1935 to 1969.,The research identified key individuals associated with the development of occupational therapy at St. Patrick’s Hospital, including psychiatrist Norman Moore, occupational therapy worker Olga Gale, occupational therapist Margaret Sinclair, and social therapist Irene Violet Grey. Occupational therapy was considered by the hospital authorities to be “an important part in the treatment of all types of psychiatric illness” (Board Meeting Minutes, 1956). It aimed to develop patient’s self-esteem and facilitate social participation. To achieve these objectives, patients engaged in activities such as dances, arts and crafts, and social activities.,This study has highlighted the contributions of key individuals, identified the links between occupational therapy and psychiatry, and provided an insight into the development of the profession in Ireland prior to the establishment of occupational therapy education in 1963. Occupational therapy practice at St. Patrick’s Hospital from 1935 to 1969 was congruent with the prevailing philosophy of occupational therapy internationally, which involved treatment through activities to enhance participation in society.

Qualitative synthesis: A guide to conducting a meta-ethnography:

Introduction Qualitative meta-synthesis draws together data from multiple studies and can enrich understandings of client experiences and inform health policy. Meta-ethnography is the most commonly utilised qualitative synthesis approach in healthcare; however, there is variation in the conduct and quality of many published meta-ethnographies. This paper aims to guide occupational therapists on the process of completing a meta-ethnography. Method A systematic search of articles published from 1986–2016 was conducted. Studies which described an evaluation or critique of meta-ethnography as a research method, and consequently provided reflections or guidance on the method, were included. Two authors independently screened papers and nine relevant papers and one key text were identified. Two authors independently extracted data from identified sources. Results The seven stages of meta-ethnography described by Noblit and Hare (1988) are presented and integrated with key advancements from subsequent publications. Stages include starting the meta-synthesis, consideration of relevant studies, reading the studies and deciding on how they should be put together, translating the studies into one another, synthesising translations and expressing the synthesis. Conclusion Given the proliferation of qualitative methods in occupational therapy research, rigorous use of meta-ethnography has great potential to contribute to the research evidence base.