Margaret McGrath

Occupational therapists’ perspectives on addressing sexual concerns of older adults in the context of rehabilitation

Abstract Purpose: To explore occupational therapists’ perspectives on addressing sexuality in the context of rehabilitation services for older people. Method: A qualitative exploratory design was used. Data were collected using a series of focus groups (n = 5) among occupational therapists (n = 22) working with older people. Data were analysed using content analysis. Results: Occupational therapists in this study rarely addressed sexuality in the context of rehabilitation services for older people. Three major categories emerged in relation to barriers which influence therapists’ practice in this area: (i) the influence of culture on decisions regarding whether or not to address sexuality, (ii) perceived competence and confidence to address sexuality and (iii) the impact of resources regarding the inclusion or exclusion of sexuality from rehabilitation. Conclusions: Although sexuality is increasingly considered an important and relevant aspect of successful ageing the extent to which healthcare professionals are prepared to address sexual concerns identified by older people is less clear. If new expectations of healthy ageing are to be met, healthcare professionals must acknowledge the importance of sexuality and be prepared to be involved in sexual health management. Implications for Rehabilitation Healthcare professionals continue to be reluctant to respond to older peoples’ concerns relating to sexuality. Occupational therapists in Ireland identified socio-cultural norms relating to sexuality, perceived professional competence and confidence and prioritization of resources as key barriers. Education is needed to improve therapists’ perceived competence and confidence in addressing sexuality with older adults. Policy change is required to consider the underlying assumptions about sexuality, ageing and disability.

Occupational therapy and dementia care: A survey of practice in the Republic of Ireland

BACKGROUND/AIM There is a growing body of research to support the role of occupational therapy in dementia care. However, little is known about the extent to which this research is translated into occupational therapy practice. This study addresses this gap by considering current occupational therapy practice in the field of dementia care in Ireland. METHODS A cross-sectional online survey was used to gather data about current practice. Convenience sampling and snowball recruitment techniques were used to recruit occupational therapists. Data were analysed using a combination of descriptive statistics and content analysis. RESULTS Forty-seven therapists responded to the survey. The majority of respondents worked in primary care and provided services for people with early stage or mild dementia. Assessment practices were primarily focussed on cognitive screening and functional performance. Limited attention was paid to occupational participation. Interventions typically addressed environmental modification, assistive devices and compensatory strategies. The ability of therapists to apply research evidence to practice appears to be strongly constrained by practice and organisational demands. CONCLUSION There is a need for a global occupational therapy strategy to support knowledge translation in dementia care. At present although occupational therapists are aware of research evidence they face significant barriers in applying this evidence in practice.

Why has so little progress been made in the practice of occupational therapy in relation to sexuality

Despite recognition of the rights of disabled people to sexuality, occupational therapists continue to not address sexuality in practice. This failure can be understood as a consequence of social discourses relating to sexuality and disability and a professional discourse that values certain occupations over others. Given the importance of sexuality to the human experience and the evidence of the link between the opportunity for sexual expression and well-being, occupational therapists need to change their practice in relation to sexuality and disability. One method of achieving this change may be to adopt a rights-based approach to sexuality and disability. This article presents the possibilities offered by such an approach, discusses implications for occupational therapy practitioners, and proposes suggestions for future actions to ensure that the rights of disabled people to sexuality are embedded in occupational therapy practice.

Exploring ‘wicked problems’ from an occupational perspective: The case of turf cutting in rural Ireland

ABSTRACT Wicked problems are complex issues beyond the capacity of one individual or group to understand or respond to. While these problems have direct consequences for participation in occupation, occupational scientists have paid limited attention to wicked problems. This paper explores turf cutting (harvesting of turf from boglands for use as fuel), a traditional practice which has emerged as a wicked problem in contemporary Irish society, from an occupational perspective. Interviews were conducted with seven adults and data were analysed using interpretative phenomenological analysis. Findings suggest that rather than only being concerned with fuel, turf cutting was experienced as representing a particular way of life and as a meaningful occupation. The repetitive nature of the actions involved in the occupation enabled participants to experience ‘doing’ of turf cutting as a time of restoration. Learning how to gather turf from elders supported development of generational consciousness and transmission of cultural values. Turf cutting also appeared to support development and management of identities as members of rural communities. The findings offer new perspectives on turf cutting and highlight the value of an occupational perspective in illuminating the meaning behind everyday practices when seeking to understand and respond to wicked problems.

Dementia in prisons – enabling better care practices for those ageing in correctional facilities:

The number of older people with dementia who are ‘ageing in place’ in prisons across the world is rapidly increasing. Within the broader prison population these older people are particularly vulnerable to poorer outcomes as a result of inadequate access to appropriate health services. There is an urgent need for occupational therapists to collaborate with prison services to develop evidence-based care practices that provide viable, cost-effective options for prisoners who are ageing with dementia. We identify priorities for research and practice and set out a call for action for occupational therapists worldwide to address this growing need.

Community–university partnerships in occupational therapy education: a preliminary exploration of practice in a European context

Abstract Aim: To explore community–university partnerships in occupational therapy education in Europe. Method: Educators from Europe were invited to participate in the study. Data were collected using a questionnaire designed for the study. Eleven completed questionnaires were included. Descriptive statistics were generated from quantitative data while qualitative data were analyzed using inductive content analysis. Results: The majority of participants reported that community–university partnerships were part of the third year of undergraduate occupational therapy studies. Partners were from a broad range of sectors. The activities undertaken were typically focused on specific target groups within the community. Three main themes emerged from the qualitative analysis (i) instigating community–university partnerships, (ii) processes of creating and sustaining partnerships and (iii) perceived outcomes of community–university partnerships. Conclusions: This is the first study of community–university partnerships in Europe generating some useful findings. Clarification is needed regarding the use of the term community–university partnership. Educators are called upon to consider how partnerships are embedded into curricula and to address issues of sustainability. Implications for Rehabilitation Healthcare education should prepare rehabilitation professionals to collaborate with diverse communities. Community--university collaborations appear to offer opportunities to support students to develop competences for future community orientated practice. Key issues to be considered include choice of pedagogical approach, issues of reciprocity and sustainability.

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis

Abstract Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood. Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia. Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers. Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future. Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history. Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.

Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners:

The aim of this study is to systematically review practitioners’ practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis. Euphemistic terms such as ‘memory problems’ are more often used to describe dementia than medical terms. Practitioners’ decision to diagnose and communicate the diagnosis of dementia are influenced by (a) their own beliefs regarding dementia and treatment efficacy and their confidence in diagnosis and communication; (b) patient circumstances including level of awareness, level of severity and family support; (c) the health and social care system including access to specialist and diagnostic services, reimbursement for diagnosis/management and availability of services and (d) cultural norms in relation to dementia including stigma, labels, and common clinical practice. The diagnosis and communication of diagnosis of dementia are intertwined processes and should be concurrently addressed in interventions. Multicomponent approaches to address these practices could include guideline development, practitioner education, anti-stigma public health campaigns, offering post-diagnosis treatments and support and sufficient reimbursement for practitioners for time spent managing dementia.

How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies

Objective: To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors. Methods: MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team. Results: The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss. Conclusion: Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.