Kirk Reed

The interconnected meanings of occupation: The call, being‐with, possibilities

While a range of literature has explored the meaning of occupation, the lived experience of occupation has been relatively neglected. In this hermeneutic phenomenological study 12 New Zealand adults who had experienced a disruption to their occupations were interviewed, on the assumption that disruption reveals things that are usually overlooked. The data were analysed by identifying key themes and engaging in a hermeneutic process informed by the philosophies of Heidegger and Gadamer. The findings suggest that the meaning of occupation is complex and tends to remain hidden. Three facets of meaning that work in unison, each interconnected with the other, emerged from analysis; the Call, Being‐with and Possibilities. The findings of this study are considered in relation to selected literature, to build on current understandings of the meaning of the occupation. While the study is acknowledged to have limitations in terms of sampling, the findings do have implications for occupational science which include building on knowledge of the meaning of occupation and considering occupation from a context wider than that of the individual.

Exploring the Meaning of Occupation: The Case for Phenomenology

Background. Some authors are beginning to challenge current categorisations of occupation as self-care, productivity, and leisure in favour of categories that address meaning. However, the meaning of occupation receives relatively little attention in the literature. Purpose. To provide a synthesis of the contemporary literature that considers the meaning of occupation and to argue that phenomenological insights into the meaning of occupation might usefully inform occupational therapy research, theory, and practice. Key Issues. Meaning is a key aspect of occupation. Three phenomenological meanings of occupation uncovered by a study conducted in New Zealand—the call, Being-with and possibilities—provide a starting point for practice, research, and theory informed by understandings of the lived experience of occupation. Implications. Occupational therapys theories would benefit from an evidence base that includes meaning, which in turn would lead to authentic occupational therapy practice.

A pilot cluster randomized controlled trial of structured goal-setting following stroke

Objective: To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting. Design: A cluster randomized controlled trial. Setting: Inpatient rehabilitation facilities. Subjects: People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure. Interventions: Structured goal elicitation using the Canadian Occupational Performance Measure. Main measures: Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention. Results: Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design. Conclusions: A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.

Resituating the Meaning of Occupation: A Transactional Perspective

Like Dewey, Heidegger understood that people’s context shapes the meaning they give to their experiences and that the significance of meaning of the human world is not dependent on one-to-one connections. Rather, meaning depends on the “whole context”. In this chapter, we explore the transactional nature of the meaning of occupation and how that meaning is shaped—by others and by the constellation of occupations that make up peoples’ lives. We use the work of Heidegger, Dewey and others in relation to meaning to expand a phenomenological study of the meaning of occupation for 12 New Zealand adults who had experienced an occupational disruption. The findings show that the meaning of occupation should be considered from broad perspectives beyond that of the individual, in context and in the transactional relationships with other people and non-human things. The complex layers of meaning are not necessarily obvious and tend to remain hidden if not understood in that context. Implications for occupational therapy and occupational science are considered along with suggestions for further research to strengthen and expand the developing strand of evidence in relation to the meaning of occupation.

The Meaning of Occupation: A Hermeneutic (Re)view of Historical Understandings

This article reports the findings of an analysis of historical and contemporary literature which explored how the meaning of occupation has changed over time. A hermeneutic approach, based on the work of Gadamer, focuses on changes of meaning. The core idea of reviewing literature published over a very wide and ancient span of time was to bring the notion of occupation to the fore and shed light on how meanings of occupation are culturally embedded. This article focuses on Western sociology, history, philosophy and leisure texts that ranged from Ancient Greek and Roman times to the Industrial Revolution. The exploration showed that while the word ‘occupation’ did not exist until the 12th century, there were rich descriptions of what occupational scientists now understand as occupation. While the meaning of occupation per se may have been hidden during these early times, there were many influences that contributed to both the understanding and experience of occupation. Highlighting how historical factors have contributed to culturally embedded meanings provides occupational scientists with insights into the way what is called ‘occupation’ is shaped, which in turn has the potential to influence current and future scholarship.

Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

Aim: This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation. Method: Eight participants were interviewed in their own homes, in a town or city in New Zealand. Findings: Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources. Discussion: The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention. Conclusion: The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

Occupational Science Informing Occupational Therapy Interventions

Occupational therapists’ need for greater knowledge of occupation is described from two perspectives: as it was understood at the time the profession was established and as it is defined in the present day. Occupational science responds to that need. This new field of investigation is defined, and understandings about occupation that are shared by occupational therapists and scientists are reviewed. Three ways in which occupational science informs practice are identified. First, it supports a return to occupation-focused practice, where occupation is both the means of intervening and the goal of intervention, and understanding clients’ occupational history is essential. Second, occupational scientists are generating new intervention strategies, two of which are briefly outlined. Third, occupational science is opening up new practice areas with vulnerable populations, such as immigrants and refugees, using interventions that promote population health rather than providing rehabilitation. The need for ongoing research, particularly to support population-based interventions, is recognised.

Knowing the people planning: measuring change in mental health services

This article describes the underlying philosophy of knowing the people planning (KPP) and gives an example of a practical approach to measure peoples recovery in terms of consumer identified outcomes leading to the improvement in the effectiveness of mental health and addiction services in Hawkes Bay. KPP provided a valuable approach to planning service delivery by measuring key variables of service delivery based on consumer determined key features and a means to describe the quality improvements implemented in services in Hawkes Bay. Practitioners were directly involved; the key was to identify gaps and work with stakeholders to create solutions to facilitate better and improved recovery outcomes.

Focusing on employment in primary mental health care: A scoping review

BACKGROUND People with mental health issues usually access primary health care services but employment status and/or return to work is not typically an explicit focus of a general practice consultation. OBJECTIVE This scoping review aims to investigate the broad range of interventions used in primary health care to effectively support people with mental health issues to choose, get, or keep employment. METHODS A literature search was conducted using five electronic databases. Peer reviewed research articles published between 1996 and February 2016 were included in the review. RESULTS Twelve studies explored work related interventions for people with mental health issues in the primary health care context. The most commonly used intervention was sickness certification, other interventions that show promise were identified but there is limited empirical evidence to show their effectiveness in relation to improving employment outcomes. General practitioners identified a range of barriers in terms of focusing on employment outcomes for patients including knowledge and confidence in understanding the impact of work on symptoms and limited access to advice or services to refer patients to. CONCLUSIONS This review suggests that work focused interventions situated in primary health care settings appear to be a promising approach for people with mental health issues. However, various barriers impact the implementation of an employment approach, with limited comparisons between different effective interventions. In the context of increasing numbers of people presenting with mental health issues, future research should address the implementation and effectiveness of work-focused interventions based in primary health care.

Re-visioning practice through action research

BACKGROUND/AIM Ongoing knowledge development calls on health professionals to explore strategies to disseminate new or updated theoretical frameworks to practitioners. To date few researchers have explored effective means to do this or how the dissemination of professional ideas impacts on effective service delivery. The study described in this article aimed to identify strategies senior occupational therapists adopted to disseminate new concepts that have the potential to re-vision and transform practice. METHODS Six occupational therapists were recruited as co-researchers to become part of a collaborative community of practice. Over a 9-month period they engaged in a project based on action research cycles where they had access to a newly revised theoretical framework. During each cycle the co-researchers participated in a teleconference which was audio-recorded where they reflected on concepts in relation to their own practice. FINDINGS As understanding of the theoretical framework increased, they discussed which aspects of their practice could change, particularly in relation to processes they used to disseminate knowledge to the staff they supervised or managed. CONCLUSION/SIGNIFICANCE The co-researchers described a range of ideas for dissemination which included individual and group strategies. In addition, they became aware of the transformative potential of their new knowledge as a way to better understand and create change within their organisations. The co-researchers also described a sense of increased confidence, not only in terms of conceptualising practice but in terms of supervising staff and challenging service delivery.