Muriel Westmorland

Disability Management Practices in Ontario Health Care Workplaces

Background: Workplace disability management programs are important in managing injury and disability. Methods: A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces. Results: A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence. Conclusion: Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.

Workplace organizational policies and practices in Ontario educational facilities.

Background: Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario’s education sector. Methods: OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated. Results: Mean subscale scores (potential range 1–5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%). Conclusions: Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.

Moral Development or Moral Decline? A Discussion of Ethics Education for the Health Care Professions.

Ethics education curricula in professional programmes are often confused and ineffective. They focus on traditional conceptions of professional ethics as rules supplementary to the law, and, it is claimed, contribute to tension and conflict in professional relationships, particularly with authority. This paper presents, first, a contemporary conception of the relationship between law and ethics that reinstates morality as a core component; it informs professional ethics and together they contribute to the law. Second, the paper describes the educational philosophy of two programmes in rehabilitation science where the ethics education component is being analyzed. Finally, research, that is currently under way, is described which will demonstrate the different effects of traditional and enhanced ethics education effort upon the moral reasoning processes that students use in reaching moral judgments.

The structured oral self-directed learning evaluation : one method of evaluating the clinical reasoning skills of occupational therapy and physiotherapy students

The Structured Oral Self-directed Learning Examination (SOSLE) is used to evaluate the clinical reasoning skills of occupational therapy (OT) and physiotherapy (PT) students. It is an oral examination which evaluates a students problem-solving ability, self-directed learning skills, knowledge level and self-assessment ability. The three parts of the examination are conducted over a 24-hour period. Validation of this instrument was carried out in two groups of OT and PT undergraduate students over two consecutive years (Year 1--n = 20) (Year 2--n = 18). Inter-rater reliability correlations varied from 0.61 to 0.78 the first year to 0.85 to 0.99 in the second year. The results obtained from the SOSLE were also compared to written and tutorial marks obtained in the same course. Pearson Correlation Coefficients (PCC) among mean SOSLE and two written paper scores ranged from 0.0-0.05 (Year 1) to 0.0-0.1 (Year 2). The PCC among the mean SOSLE and tutorial performance scores were 0.57 (Year 1) and 0.0 (Year 2). The results show that good agreement between raters can be reached using this evaluation method. However, the poor correlations between the SOSLE and the other methods of evaluation may show that different skills are being evaluated. Further validity testing needs to be carried out to confirm that this tool is measuring process oriented skills.

The Once and Future Programme: Educational Innovation in Occupational Therapy

During the late 1960s and early 1970s while the Canadian Association of Occupational Therapists was wrestling with issues of educational standards, Mohawk College in Hamilton, Ontario was developing two diploma programmes in occupational therapy and physiotherapy with input from McMaster University Faculty of Health Sciences. This article reviews the development of the Mohawk College Diploma Programme in Occupational Therapy and focuses on several unique features of the curriculum which proved to be the strengths of the programme. These features, problem-based small group learning, strong partnerships with the clinical community and non-traditional fieldwork placements, formed a strong base for the subsequent development of the degree completion programme at McMaster and the new second degree undergraduate (BHSc.OT.) programme in Occupational Therapy. The reference to “The Once and Future Programme” emphasizes the fact that the new undergraduate programme in Occupational Therapy at McMaster University has successfully built upon the strengths of the earlier Mohawk College Diploma Programme.

1999 Muriel Driver Lectureship. Risk taking: an antidote to diffidence.

Iam honoured to be the recipient of the Canadian Association of Occupational Therapists’ Muriel Driver Lecture Award. I have chosen to focus on the subject of risk taking as it reflects not only part of my personal and professional style, but much of what many occupational therapists are experiencing, as their practice shifts from the routine and controllable to the entrepreneurial and uncontrollable. The title also reflects the importance of risk taking as we continue to move away from our diffident roots that cast a shadow on the profession in Canada in the early seventies. These were the subject of a much publicised report Occupational Therapy: The Diffident Profession by Maxwell and Maxwell (1978). This report stated that “It would seem important that occupational therapists have a greater sense of partnership in the planning of these changes (preparing for an elderly population for example). The Canadian Association of Occupational Therapists (CAOT) and the provincial associations might well encourage their members to take a more active and visible interest in health care planning and administration ...than in the past.” (p. 40). We have come a long way since those days, particularly with the move by CAOT to Ottawa. The latter has enabled the profession to lobby more vigorously at the federal level. Occupational therapists have been provided with important position statements on Primary Health Care (CAOT, 1996) and Agreement on Internal Trade, (CAOT, 1996) to name a few. In addition there has been a noticeable strategic involvement with key health care initiatives that impact on occupational therapists (Bressler, 1997; von Zweck, 1999). However, I believe that if each occupational therapist examined how risk taking might put these words into action we might see even more accomplishments in these areas. This paper will review the theoretical underpinnings of risk taking as discussed in the literature and I will share some personal experiences and perspectives about risk taking that I have practised in my life and profession. These perspectives will be followed by why the notions of risk taking are relevant to occupational therapy as we face a number of challenges in the health and social services sectors across our vast country. Examples of risk taking will be provided and I will conclude with some guidelines for occupational therapists.

What prevents people with disabilities from obtaining employment? An examination of Canadian data from a national and regional perspective.

People with disabilities who are able to be employed have historically had to struggle with a number of barriers related to workplace activities. In recent years, more data has become available regarding employment in general and for people with disabilities in particular. As major stakeholder groups (people with disabilities, service provider agencies, funders and employers) move to a more integrated and equitable approach, it is essential that data related to employment for people with disabilities not be esoteric but utilitarian. This article will review a Canadian regional study that is being used to help shape vocational services for people with disabilities and will compare the findings to the Canadian national scene.