Karen Morris

Are we achieving occupation-focused practice?

In 2012, the National Institute for Health and Clinical Excellence (NICE) accredited the College of Occupational Therapists (COT) practice guideline, Occupational therapists’ use of occupation-focused practice in secure hospitals (COT 2012). This practice guideline evaluated the evidence base available to therapists working within secure (that is, locked) adult mental health settings. However, the guideline affirms that occupation-focused practice is pertinent to all of our work, whether based within secure settings or not. The themes identified have much to offer occupational therapists in all areas of practice and research, with realistic recommendations such as understanding and considering the impact of the environment and time, working with service users, and the need to increase our evidence base.

Developing a descriptive framework for “occupational engagement”

ABSTRACT “Occupational engagement” is a term often used within occupational science and occupational therapy literature. However, it has yet to be clearly and consistently described, resulting in a lack of clarity in the use and definition of this term. This paper is derived from a larger piece of research, which used social constructionism to explore occupational engagement for five men living in a secure mental health unit from an occupational perspective. This research required the development of a clear description of occupational engagement. Following an exploration and critical review of the literature, the process of developing a new description of occupational engagement is outlined. Occupational engagement cannot be considered in isolation, so within this paper it is positioned within a descriptive framework of values and consequences. The development of the framework returned to the etymology of relevant terms, considering both the value and consequences of occupational experiences. This is the first published holistic description of this term, as the framework fully acknowledges the negative as well as positive dimensions of occupation. The paper concludes with consideration of how this new framework could be useful to occupational science.

Challenges of teaching occupation: Introduction of an occupation focused teaching tool.

ABSTRACT Occupational science is of importance to multiple disciplines due to its potential to contribute to understandings of complex social issues. “Occupation”, as a key concept of occupational science, is recognised as being highly complex, making it challenging for students to develop a comprehensive understanding of the concept. Terminology of occupational science literature has been noted at times as using the terms occupation, purposeful activity and activity interchangeably, which further adds to the challenge of teaching the concept. This paper explores evolving definitions of occupation, challenges this evolution has created within education, and the potential use of occupation as a threshold concept. Consideration of a selection of pedagogic methods used in teaching the concept of occupation is briefly explored. The paper concludes with identification of a newly developed occupation-focused teaching tool as a proposed alternative approach to teaching the concept of occupation. The teaching tool was originally developed to teach occupation as a discrete concept, rather than the therapeutic use of occupation as taught in occupational therapy education. The tool is an analogy for occupation, and has utility in supporting the transformation of students’ understanding of the concept of occupation, commensurate to understandings of occupational science.

Exploring stories of occupational engagement in a regional secure unit

Abstract This paper focuses on the occupational experiences of five men living within a forensic mental health unit over a year. This study used a descriptive qualitative case study methodology to explore the meaning and value placed on daily life (activities, occupations and routines), and how this changed over time. The men’s stories showed a complex picture of their experiences of daily life. This study demonstrated the impact of the environment on the men and the ongoing challenge of the need to balance treatment/therapy with security demands and opportunities. Three interrelated themes were identified: (1) Power and Occupation; (2) Therapy or Punishment; (3) Occupational Opportunities within Restrictions. These findings serve as a reminder to clinical teams to reassess the value of occupations attributed by their patients and the impact of the secure environment, whilst also acknowledging the potential for occupations to have a negative impact on well-being.

Cross-dressing as a meaningful occupation: A single case study

Introduction The purpose of this qualitative study was to explore the lived experience of cross-dressing, to raise awareness of cross-dressing and investigate any possible implications for occupational therapy. Method A single design case study utilizing an unstructured interview was used with a male cross-dresser known to the first author. Following transcription, flexible and ongoing analysis was undertaken following an interpretative phenomenological analysis approach and emergent themes resulted in an ongoing literature review. Findings The themes that developed were ‘identity’, ‘dressing’ and ‘conflict’. A complexity of meanings related to cross-dressing also emerged: uncontrollable urge; erotic expression; sexual orientation; and a sense of completeness. Conclusion The findings suggest that cross-dressing is a meaningful occupation and as such influences identity formation and occupational choices. Occupational therapists have a duty of care to this vulnerable and alienated group within society.

A survey of research capacity and partnerships among mental health occupational therapists in the UK

Purpose Occupational therapists working in mental health services in the UK are under increasing scrutiny to provide both clinically and cost-effective services. The profession has indicated that a stronger evidence base would help promote the unique contribution of occupational therapy when influencing service managers and government bodies. The paper aims to discuss these issues. Design/methodology/approach The Royal College of Occupational Therapists (RCOT) and its Specialist Section – Mental Health carried out a survey to gauge recent research capacity among occupational therapists working in mental health services in the UK and to seek their views about how to further increase research capacity and partnerships. Findings Of the 145 participants approximately half had been involved in research in the past five years, and most had involved research partnerships. A number had successfully applied for funding and about half of the research carried out had been disseminated. The participants felt that methods to increase research capacity and partnerships should continue to include improving research leadership and networks; promoting research skills through formal studies and increasing research dissemination. Originality/value A variety of methods will continue to be required to expand the evidence base. RCOT and its Specialist Sections continue to have an important role developing research capacity and partnerships.

Dementia: sustaining self in the face of cognitive decline

It is argued that the way in which we view a person with dementia can have a significant effect on the level of disability and wellbeing of the person. There is a divergence between a belief that the self disintegrates, leaving a non-person, and a belief that the self remains but is misplaced and can be maintained with the appropriate approach from others. This article seeks to examine the differing approaches to self and personhood in dementia care, and establish ways of approaching care for the person with dementia which may limit the extent of disability in the face of cognitive decline.

Occupational therapy delivered by specialists versus non-specialists for people with schizophrenia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the effects of occupational therapy delivered by occupational therapists compared to occupational therapy delivered by any other person for people with schizophrenia. Our secondary objectives are to determine whether the response differs by specific type (e.g. hospital versus non-hosptial setting), intensity (e.g. more therapist contact time or more frequent task repetition), or duration of occupational therapy.