Rosalind Bye

When Clients are Dying: Occupational Therapists’ Perspectives:

Occupational therapists working with people who are terminally ill potentially face a contradiction between the principles and assumptions of rehabilitation-oriented practice and the needs and experiences of clients who are dying. This research investigated experiences of occupational therapists working with clients who are terminally ill to examine if such a contradiction existed and, if so, how it was managed in daily practice. Ten occupational therapists working with people who are terminally ill shared their perspectives through in-depth interview and participant observation. Data analysis followed grounded theory procedures. Nine conceptual categories were generated from the data: Making a Difference, Referral to Occupational Therapy, Assessing the Situation, Goal Setting, Building Against Loss, “Normality Within a Changed Reality,” Client Control, Supported and Safe Care, and Closure. Analysis of relationships between categories resulted in the development of a conceptual framework of occupational therapy practice with people who are terminally ill. The core phenomenon of the framework emerged as Affirming Life: Preparing for Death. Results indicate that occupational therapists manage this contradiction between their rehabilitation training and their work with people who are dying by reframing the process and outcomes of practice to acknowledge clients’ dual states of living and dying.

Occupational Therapy for People Living with a Life-Limiting Illness: A Thematic Review:

Introduction: Little is known about occupational therapy practice for people with a life-limiting illness. This paper aims to review the available occupational therapy literature in order to develop a greater understanding of the role and practice trends of occupational therapists working in this area. Methods: A systematic search of literature published from 1975–2013 was conducted. Three hundred and fifty-five pieces of literature were located and screened for inclusion using a three-stage process. All literature that met the inclusion criteria was then analysed thematically. Findings: An in-depth review of 52 articles, three position statements, two key occupational texts, and one clinical guideline identified three themes in the literature. These themes comprised: (i) reframing practice: defining a palliative approach in occupational therapy; (ii) continuing occupational engagement despite loss; and (iii) preparing for practice when your client is dying: educational requirements of occupational therapists. Conclusion: Occupational therapy has an important role to play in the care of people with a life-limiting illness. However, knowledge gaps remain concerning the scope of the role and how best to engage clients in meaningful occupations at the end of life. Further education is required at the undergraduate level and for clinicians working in this area.

Building a strong academic workforce: Challenges for the profession

Over the last 20 years Australia has seen a huge growth in new occupational therapy programs. Each new program is an historic event that changes occupational therapy’s national profile. Each new course raises expectations. Governments fund universities expecting a civic and economic return on public investment through teaching, community engagement and research. Universities expect occupational therapy academic staff to fulfil this institutional obligation and bring a return on staffing and infrastructure costs. Students expect their employability, life and career opportunities will be enhanced. The profession expects the program will be high quality and will add to occupational therapy’s esteem. Clients and the community expect ethical, safe and competent graduates will help them.

Day surgery for older people (70+): selection versus outcome effects

As length of Australian hospital stays decreased, concerns were raised about benefits of shorter stays for older people. We investigated personal characteristics, perceived health outcomes (SF-36) and service use of day-only and other patients aged 70+, at one and 12 weeks after hospital discharge. Day-only patients were younger, had better self-reported health, were selected for orthopaedic, gastrointestinal and ophthalmic procedures and used similar levels of formal and informal services after discharge as people with longer stays. There was no evidence of ill effects of day surgery for older people, but improved selection and information giving procedures can improve outcomes.

Effectiveness of interventions for co-residing family caregivers of people with dementia: Systematic review and meta-analysis

BACKGROUND/AIM Occupational therapists and health practitioners commonly provide interventions to family caregivers of people with dementia with the aim of relieving burden, depression, and disruptions in health and social support. To date, the effects of multicomponent interventions specifically targeting these four important outcomes has not been established. The aim of this study was to evaluate the effectiveness of multicomponent interventions on four outcomes for co-residing family caregivers of people with dementia. METHODS A comprehensive database search of the literature was performed using CINAHL, MEDLINE, PubMed, PsycINFO, OTseeker, EMBASE and the Cochrane library. Randomised control trials (RCTs) that included multicomponent interventions for co-residing family caregivers addressing burden, depression, health and social support were selected. Relevant articles were critically reviewed and study results were synthesised. Meta-analysis was conducted separately. RESULTS Twenty-two of 358 retrieved studies were selected, with 15 studies being included in the meta-analyses. The multicomponent interventions identified were comprised of a range of different individual strategies. Significant effective results were found for all four specified outcomes. CONCLUSIONS Many types of multicomponent interventions appear beneficial on all of the four specified outcomes. The literature presents a trend that multicomponent interventions consisting of a combination of counselling, support groups, education, stress and mood management or telephone support are important strategies within an effective multicomponent intervention.

Occupational Therapists in Action: Local and Global

The World Federation of Occupational Therapists (WFOT) brings a global perspective to local activity and local concerns to global professional decisions. Many local education programs are accredited by the WFOT, and many local professional associations are affiliated with the world body. The WFOT also provides opportunities through committees and the international congress for local entry points to the global “community of colleagues.” The sometimes slow and bureaucratic processes of the WFOT can and do facilitate change on a global scale for an entire profession. It is rare to find a profession where local activity and membership can relate to global strategy and belonging. Consequently, the theme chosen for the 2006 Congress of the World Federation of Occupational Therapists—”OTs in action: local and global”—is a good one. It is the central challenge facing occupational therapists of the 21st century. It provokes the question of how we might build a unified global profession in the context of local diversity. Although Cusick (2001) has previously explored this in relation to national priorities for Australian occupational therapists, it is worth considering the unity–diversity paradox in relation to the WFOT congress challenge of local and global action. Tension between local and global issues is probably greater now than it ever has been in the history of the profession. In part, this is because of the success of the profession: it is now active in more countries across the globe and serves an ever-increasing population base. Local concerns and contexts affect the nature, process, and outcomes of many aspects of our profession (e.g., student recruitment and retention, accreditation and registration, professional development, and consumer access). At the same time, global priorities influence local activity. Recent global issues that have challenged local activity include the nature and accreditation of occupational therapy education programs and the emergence of evidence-based practice. Other international trends with local effects include use of institutionalized research performance assessment; effects of chronic and infectious disease; commercialization, regulation of health services, or both; burgeoning economic rationalism in university and health sectors; global effects of poverty and marginalization of communities; consumer rights and activism; recognition of individual and cultural diversity; and an increased emphasis on ethics and litigation in education and practice. The local–global dichotomy presents “OTs in action” with questions that are both exciting and uncomfortable. One “old chestnut” is fieldwork quality assurance in WFOT program accreditation. There are also new and more complex questions emerging. For example, how does the profession respond to cultural diversity in occupation norms and values while maintaining unifying core assumptions regarding occupation (Hocking & Whiteford, 1995)? How should we understand and manage differing contexts of occupational therapy (Whiteford & Wright-St. Clair, 2005)? How can the profession apply evidence in ways that do not undermine the occupation focus of our practice (Polatajko & Craik, 2006)? Should we adopt a universal language for communicating aspects of occupation, participation, and health (Craik, 2005; Polatajko, 2005)? Should we consider professional epistemologies in relation to the “modern” world and, if so, what does this mean for a global context (Hooper, 2006)? Do we need agreement on research priorities (Ottenbacher & Christiansen, 2005)? These and other questions are tasks facing “OTs in action: local and global” who work in a profession where the tension between unity and diversity is daily reality. Journals such as OTJR: Occupation, Participation and Health will provide a means for continued debate, scholarly research, and thoughtful reflection on these issues long after the WFOT congress is over.

Practice preferences of pre-graduation allied health professionals: do graduates want to work where the workforce is needed?

Background Occupational therapists form a significant proportion of the allied health workforce in developed countries. Demand for occupational therapists in Australia is growing due to the rapidly expanding population of people living with chronic and complex conditions. Recent Australian government initiatives conducted through Health Workforce Australia have been implemented to enhance training opportunities to increase workforce supply. But increasing graduate numbers is only one part of a solution to matching workforce supply and demand. Another part that has had considerable attention in medicine but little in allied health, is where they want to work their practice preferences.

Techniques to tell the real story: narrative inquiry in health services research

Background Fifteen years ago in Health Services Research (1999) qualitative research methods were argued to be useful and valid. Since that time qualitative research methods have gained increasing legitimacy however qualitative research papers remain underrepresented in high impact health journals [1]. The rigour of qualitative methods and their relevance in policy evaluation and development is, however, a continuing debate. On the one hand, qualitative inquiry methods bring the complexity of health service policy impacts to the fore; they provide policy makers with perspectives from the people services aim to support. On the other hand, the variability of qualitative approaches can lead to questions around validity and utility of findings. Narrative inquiry is one qualitative approach which, like others, has no prescribed method. Yet it is a method gaining increasing popularity in social science, clinical and health services research. This paper makes the methodological case for narrative inquiry in health services research and recommends techniques.

A comparison of social attitudes, professional and institutional identities and acculturative stress between podiatry and other health professional students

Methods Thirty-three out of forty-six enrolled first-year podiatry students completed surveys at a large, culturally diverse university in Sydney, Australia. Demographic data and standardised measures of English language acculturation, acculturative stress, universe diverse orientation and professional and institutional identities were collected. Surveys were also administered to first-year physiotherapy, occupational therapy, nursing and medical students at the same university. Data were entered into and analysed in SPSS version 18. Descriptive statistics and Kruskal-Wallis tests were used to describe and compare the student cohorts. Results Seventy-three percent of first-year podiatry students were born in Australia although 36% of these students speak a language other than English at home. Podiatry was the first course preference for 73% of students, and 34% of the cohort reported having a close friend in the same course. 64% were in paid employment at the time of the study, and of these 71% worked in a non-healthrelated area. Conclusions Trends were identified which differentiated the health professions. When compared with other health professional students, podiatry students had relatively low levels of acculturative stress and moderate levels of professional and institutional identity. This suggests that first-year podiatry students (after 12 weeks of study) have appropriate attitudes that will facilitate the development of cultural competence with further study. The data to date has shown similar trends for physiotherapy and occupational therapy students in the School of Biomedical and Health Sciences.

Ageing & Society: Australian aged care & the new international paradigm

Australia has more than a century of history of investment i n institutional care for older people, generally providing long term care for increasing frailty, dependency and illness i n purpose built, often large, residential environments. This began at the turn of the century with Asylums and changed to nursing homes after World War I I . Over the last 20 years there has been a major attempt to shift the balance of care from more intensive to less intensive residential care and from residential to communitybased care. Nursing homes were the dominant form of residential care in the late 1970s but since the mid-1980s the less intensive hostel accommodation has grown at the expense of nursing homes. These boundaries, while still common in public discussion, have been officially removed by the creation of a single category of residential care with h igh intensity to low intensity levels. While expenditure on nursing homes has grown mostly because of high uni t costs, the number of places in hostels and the availability of community-based care services such as CACPs (which provide hostel level care i n the community) have grown at a greater rate than nursing homes (Figure 1). A continuation of the current downward trend for residential care raises the interesting question: will residential options continue to decline, flatten out around some ‘natural’ level or re-emerge as modified forms of community-based care?