Marie Gage

Re-engineering of health care: opportunity or threat for occupational therapists?

The health care system is responding to a paradigm shift from the industrial era to the knowledge society. The rapidly changing administrative structures of some hospitals and increasing numbers of proposals for new models of care are disconcerting for therapists who are used to working in traditional organizational structures and models of care. However, with a broader understanding of the shift that is occurring, it becomes apparent that this paradigm shift is pushing the system toward care practices that are more consistent with occupational therapy practices than those of the traditional medical model. This paper describes the factors influencing the direction of the paradigm shift, the major emerging models of care and organizational structures associated with the paradigm shift, and then discusses the issue of whether the paradigm shift presents a threat or a challenge to occupational therapists.

Expanding the boundaries of occupational therapy practice through student fieldwork experiences: description of a provincially-funded community development project.

The numbers of occupational therapists in community practice are not yet large enough to provide fieldwork placements to accommodate all students. This article describes a project designed to educate community agencies that do not employ occupational therapists, about our service while at the same time securing new fieldwork placements. We used on-site different discipline and offsite same discipline supervision to provide students to selected agencies without cost. Funding for one year from the Ontario Ministry of Health to the Ontario University Programs in Rehabilitation Science enabled us to initiate and evaluate the project. Students in the project developed their ability to work independently and to see their potential role in health promotion and prevention. Despite the lack of ongoing government funding, four years later, community sites are not only being maintained, but the number of sites has increased from 28 to 39, providing a total of 75 student placements. By educating a growing number of community agencies about the work of occupational therapists, the project has also expanded the boundaries of practice.

Strategic planning: positioning occupational therapy to be proactive in the new health care paradigm.

Strategic planning can be a powerful tool for occupational therapists seeking to position themselves to be leaders in the rapidly changing health care environment. The philosophical base and values of occupational therapy are consistent with those embraced by the emerging health care paradigm. However, occupational therapy staff at Victoria Hospital, an acute care university-affiliated health care institution, identified obstacles to seizing the opportunities offered by this shift in health care. In reviewing the literature, it was discovered that these obstacles were not unique to one particular facility, but were in fact common issues faced by the profession. The strategic planning process described in this paper provided a framework for addressing the identified barriers and positioning occupational therapists to play a proactive role in the evolving health care paradigm.

Retention Strategy: A Clinical Ladder for Occupational Therapists

This article explores the issue of retention of occupational therapists and its impact on the facility, client, department and the profession. It also describes the use of a clinical ladder as a retention tool and presents the experience of one clinical facility in developing a clinical ladder. The literature, in association with the experience of the aforementioned clinical facility in the development of a clinical ladder in an occupational therapy department, does not provide conclusive evidence of the efficacy of a clinical ladder as a retention tool. However, it does lend enough support for the concept to encourage its further use in occupational therapy departments. There is a need to be creative in the design of retention methodologies which will decrease turn over and attrition from the profession in order to provide a stable pool of personnel to agencies that employ occupational therapists.

Book Review: Beyond Burnout: How Teachers, Nurses, Therapists, and Lawyers Recover from Stress and DisillusionmentBeyond Burnout: How Teachers, Nurses, Therapists, and Lawyers Recover from Stress and Disillusionment (1995) ChernissCaryRoutledge Publishing, 29 West 35th Street, New York, NY 10001 234 pages,

Barbara VV Posthuma, Allyn and Bacon, Needham Heights, /V\A 02194 261 pages,

17.95 US (paperback)

42 95 Canadian The content of this second edition of Posthumas book has been broadened to appeal to both occupational therapists and other health-care workers without losing the essence of occupational therapy groups. The order of the content has been reorganized, a chapter on self-help groups added and some revisions made to the appendices which provide outlines of several sessions on the themes of assertiveness and awareness. The text begins with the history of groups and a discussion of their benefits, and proceeds to present the stages of groups development including the structure of groups and how groups are conceptualized, group climate and productivity. Many factors that a group leader must consider such as group, individual and leader goals, hidden agendas, membership size, composition and roles, and the factors to consider when choosing a group activity are all clearly presented. Issues of leadership including theories and theoretical approaches, impact on group members, techniques, advantages and disadvantages of co-leaderhsip and what to do in a variety of challenging situations, help the reader to reflect on the responsibilities that are inherent in leadership. This text provides a good overview of all aspects of group counselling, including key components related to both leaders and group members, that must be considered for effective groups. The text is easy to read and provides a clear integration of theory and practical information. There is good interplay between chapters and the reader is told where many topics that are introduced in one section will be discussed more fully in a later section. A complete summary is provided with each chapter and many figures and graphs illustrate the key points. An extensive bibliography allows the reader to pursue any topic in more detail. Posthuma has presented a carefully revised text that integrates her own opinions and examples from her own experience with the work of many other authors. This is a good refresher text for experienced group leaders and an excellent resource for those who have recently accepted the challenge of group leadership. Thelma Sumsion

Book Review: Through the Patient's Eyes: Understanding and Promoting Patient-Centred Care (1993)Through the patient's eyes: Understanding and promoting patient-centred care (1993)GerteisM., Edgman-LevitanS., DaleyJ., DelbancoT. (Eds) Jossey-Bass, 350 Sansome Street San Francisco, CA 94104317 pages,

head-injury. It is well laid out in three sections: the first is an explanation of the concepts upon which the workbook is based, the second is an assessment to evaluate the clients cognitive level thereby establishing a basis for treatment, and the third is a workbook. Before deciding to use this tool; one _must observe the population for which it is geared. Many exercises are suited for persons who have good reading and writing skills, and who have reached a grade five level in mathematics. The workbook has three levels of difficulty, red, white and blue, in order of increasing complexity. A good aspect of this book is that it emphasizes ability to function in everyday activities such as grocery shopping, reading maps, writing cheques, and organizing time. It is based on the concept that self-awareness is fundamental in the process of enhancing cognitive abilities. This is why the client, throughout the workbook, must always evaluate his or her performance using the answer key. The clinician is made aware of the importance of both extrinsic and intrinsic performance variables, and how these can be manipulated to maximize each clients performance. Further activities which will enhance the skills learned in each section of the workbook, are summarized at the end of each section. For this reason, the awareness of a clients performance ceiling is crucial to ensure an appropriate challenge, giving adequate stimulation and positive reinforcement. Overall, the book will be a useful tool for clinicians working in the area of head injury rehabilitation. However, as a word of caution, this reviewer noted that there are several errors in the answer keys to the exercises. This can become a source of frustration to both client and therapist. Perhaps a letter to the author or publisher, requesting revised answer keys, should be written. Cisela Thorén