Maintaining or returning to work has been identified as having a predominantly positive impact on people experiencing neurological conditions. This review of qualitative research literature was con...
Bariatric surgery is increasingly used to manage severe obesity, which is becoming more prevalent globally. Most funding sources mandate pre-operative lifestyle interventions to optimize weight management success in the long term. Occupational therapists can help clients seeking bariatric surgery to adopt a healthier lifestyle, improve quality of life, and increase participation in desired occupation. This review aims to highlight the distinct value of occupational therapy in lifestyle interventions and identify current evidence available to support interventions that occupational therapists can use with individual who are morbidly obese to facilitate long-term weight management pre-operatively.
Stress is a primal physiological response to danger eventuating in a fight, flee or freeze response (Lazarus, 1984). This is a natural survival mechanism, however if we continually experience repeated stressful situations, this can endanger our physiological and psychological systems (Ganesh et al., 2018; Lazarus, 1984). In the workplace we may interpret events as stressful, even though our life is not in imminent danger. When we interpret a situation or conversation as life threatening, we stimulate the body's stress response to release additional chemicals (Lipton, 2011). If we continually interpret events as stressful, this can lead to high levels of sustained or chronic stress and culminate in mental and physical ill-health, relationship breakdown, and poor job performance (Diener, 2009; Seligman, 2012). Chronic stress can also impede decision-making abilities, decrease focus, and decline output and achievements (Achor, 2018).
This viewpoint article critiques tensions between the medical and social approaches to occupational therapy practice in mental health settings. Problem identification is contextualised to the recovery approach as it emerged through the service user movement in the 1980s and in its contemporary profile as co-opted into Aotearoa New Zealand guidelines to practice. Inadvertently, occupational therapy in mental health settings, through greater alignment with bio-medicine, risks marginalising those persons we aim to support. Our view is that increased awareness of social determinants of health and advocacy to address inequities are two strategies an occupational therapist can draw on to reduce marginalisation.
The occupational disruption caused by the public health response to Covid-19 has changed our sense of ourselves as human beings, the sense of belonging we derive from shared occupations, and impacted what we will become, as individuals and as a nation. This invited commentary considers whether Wilcock\u0027s ideas of doing, being, belonging and becoming can be applied to groups, communities, and populations. It concludes that as a profession, occupational therapists can both demonstrate their relevance to the well-being of all New Zealanders at this time and support positive shifts in the society we will become.
This is a decolonising story about my people, (de)colonisation and occupational therapy. I am a Kamilaroi woman, who speaks from my heart and therefore, the heart of my family and community. A fundamental component of the Kamilaroi Nation is the Barwon River. This perennial river forms a part of the larger Murray-Darling basin, in the continent called Australia. The Barwon River's water level is at an unprecedented low. Drought is one contributing factor but more significant are the domineering and biased river management principles. These management principles reflect the legacy of colonisation, including Western infrastructures, like legislation, health and education. Western infrastructures inform, and in many instances, dictate the occupations of societies, communities and individuals. Indigenous peoples, across the globe, not only resist oppressive Western ideologies, but continue to maintain, develop and/or restore their culture via cultural occupations. Decolonising practices are one of many approaches that can support non-Indigenous people's understandings of occupations and occupational therapy. Decolonising practices include honouring indigenous peoples' voices, recognising the ongoing legacy of colonisation, and taking affirmative actions to remove imbalanced social relations and reverse social inequities. Celebrating success is just as important as remaining cognisant of how previous actions can easily come undone and launching the next set of actions. Decolonising practices provide a platform to participate in difficult conversations, to do the hard work and to process the resulting discomfort. These conversations, work and discomfort are important for healing ourselves, our profession and our societies. Like the Barwon River, healing will take a long time. Right now, the occupational therapy profession needs to make conscious decisions about its collective leadership. This involves critically reflecting on the leadership it has built with Indigenous people and/or will build with Indigenous people. This leadership should stand on the shoulders of Indigenous ancestors and be sturdy enough to shoulder future generations.
Purpose: To explore equipment use by New Zealand Maori post-stroke. Procedures: Transcripts of interviews with four Maori participants and focus groups with 30 allied health professionals involved in equipment provision, drawn from a larger mixed methods study, were analysed using Te Whare Tapa Wha as an interpretive lens. Results: Te Tahi Tinana (physical), Te Hinengaro (psychological), Te Wairua (spiritual) and Te Whanau (family-related) health matters were all affected by, and influenced use of, equipment. Conclusion: The findings suggest Te Whare Tapa Wha is a culturally appropriate lens that occupational therapists can use to explore issues arising during equipment provision for Maori people.
This paper reports the process and evaluation of conducting a quality improvement activity framed in an evidencebased practice context. The quality improvement activity focused on the selection of occupational therapy assessments with strong psychometric properties for a paediatric tertiary health care facility. An online opinion survey determined perceived facilitators and barriers of the process. Participants were seven occupational therapists, and two occupational therapy managers. Participants indicated a lack of designated time and perceived lack of research skills as barriers. However, the majority identified managerial leadership, collaborative appraisal and consensus, and the discipline specific research coordinator as key quality improvement facilitators.
Inclusion is an emerging concept in occupational therapy. While it was not discussed in traditional curricula, occupational therapists, like other professions, will increasingly be called on to facilitate inclusion. That will include continuing the work we have done for decades, removing barriers that exclude people with disabilities from valued and health-giving occupations. It will also entail working to remove environmental and attitudinal obstacles encountered by groups who have not been the traditional recipients of occupational therapy; people who are homeless, street children, refugees and asylum seekers, people made vulnerable by poverty, and other minority groups. This work might also involve promoting inclusive attitudes towards people who do things perceived as \u0027foreign\u0027 or threatening; occupations that are not recognised as \u0027the New Zealand way of life\u0027. Taking up this valuable role will require all of us to understand the negative health impacts of occupational deprivation and other occupational injustices.
The aim of this paper was to investigate the experiences of qualified mental health practitioners in using a shared decision making approach. Data for this qualitative descriptive study were gathered from four participants using semi-structured interviews, the data were analysed using a six-phase method of thematic analysis. Three overall themes were identified: knowing the client; awareness of the practitioner; and the therapeutic relationship. The study promotes understanding of how shared decision making is used in practice. There is potential for the broader use of this approach in recovery-orientated settings. Further research is needed to establish the long-term benefits of the approach.
Community based occupational therapists are concerned about the impact of delayed intervention for clients waiting for services. This article considers the socio-political context, the subjectivity of prioritising referrals, and the effect of waiting on clients and therapists. A literature search was conducted, followed by a review of New Zealand policy documents, and consultation with New Zealand occupational therapists. Therapists described the 'pressure' of high caseloads and altered practice in time-poor practice contexts. Therapists expressed concerns about functional, emotional and financial implications for clients, while the literature showed that waiting contributes to poorer health outcomes, physical functioning and quality of life.
Occupational therapists require mandatory professional supervision that aligns with both the OTBNZ Code of Ethics and the Competencies for Registration and Continuing Practice (OTBNZ 2016). This article considers the systemic and clinical challenges experienced by both new graduates and experienced practitioners employed in non-government organisations in New Zealand. In the belief that there is limited support to meet these challenges and ensure new graduates safety, the author discusses practical models, organisational contracts and approaches to advocacy within supervision, based on personal experiences of providing supervision in practice.
Despite recognition of spirituality as a core value of occupation, it is not routinely nor consciously addressed by occupational therapists. This viewpoint article introduces the concept of reflective photography as an innovative intervention that can be used to explore spirituality in occupational therapy practice. Photo-elicitation, which informs reflective photography, is described before the process of reflective photography is discussed. The authors advocate that clinical supervision could help to facilitate occupational therapists' mastery of this interview method. Furthermore, they recommend reflective photography as an intervention that will support occupational therapists' clinical engagement with service users' spirituality.
This case report describes an intervention developed by a senior occupational therapist, working to improve the functional performance of a patient experiencing Guillain-Barre Syndrome. A combination of isometric and resistance exercises and static stretch were used in rehabilitation to increase muscle power. The combination of exercises and static stretch improved function to the extent that the patient was able to participate in a range of daily activities and to mobilise with stick. The outcome of the treatment was verified by the results of Barthel Index pre- and post-intervention. Ultimately, the patient's quality of life was greatly enhanced.
Where a limited body of evidence exists the traditional mechanisms of a literature or systematic review, which are often used to establish research gaps and priorities, can be problematic. This is especially the case in occupational therapy where evidence to guide future research directions can be sparse. A gap analysis of existing literature is one way to inform future research planning. This paper aims to describe a modified version of gap analysis specifically designed to identify research priorities in occupational therapy. This is illustrated using a small, disparate body of pre-existing, published work that explored practitioner knowledge of the effects of drinking alcohol in later life.
The clinical utility of the Canadian Occupational Performance Measure from the perspective of clients who completed it and therapists who administered it within a sub-acute rehabilitation setting was investigated. Semi-structured interviews explored ten clientsu0027 and six occupational therapistsu0027 perspectives. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The emergent themes from the participantsu0027 interviews included: (i) features clients like about the Canadian Occupational Performance Measure; (ii) influence of the Canadian Occupational Performance Measure on therapistsu0027 practice; and (iii) Canadian Occupational Performance Measureu0027s utility: clients and therapists. The Canadian Occupational Performance Measure increases clientsu0027 participation, satisfaction and awareness of occupational therapy.
The self-awareness of unilateral spatial neglect was investigated using meaningful occupation as an intervention. Six patients in the chronic stage following neurological lesions were recruited to engage in a customized intervention, based on an occupation that was meaningful to each patient. A self-awareness score, batteries for unilateral spatial neglect, Behavioral Inattention Test, Trail Making Test, and the Catherine Bergego Scale were applied before and after the intervention. Self-awareness scores were significantly improved after the intervention (p<0.05, t-test) clearly indicating that meaningful occupations could be a useful rehabilitation tool for interventions focusing on self-awareness in patients with unilateral spatial neglect.
This small scale study explored person-centred care for people with a dual diagnosis of intellectual disability and dementia. The goal was to identify areas of improvement in relation to personalised care, interactions with staff, and the environment. The Person, Interaction, Environment programme was used in staff training. Data was gathered using a cyclical process of observation, feedback and goal setting. The findings revealed ongoing improvement in the quality of residents' communication and care. The study outcomes suggest that the Person, Interaction and Environment programme is a practical tool that can make a positive difference to the experience of intellectually disabled people living with dementia.
This paper reports on a quality improvement initiative that aimed to review the provision of services and establish more effective utilisation of community occupational therapy resources to ensure a sustainable service, better outcomes for clients and the well-being of the occupational therapists. A business process re-engineering model was used to centralise systems and thereby release clinical occupational therapy time in the community to client care. Direct time with clients increased, longest wait decreased, and both average and median wait times were reduced. The initiative has surpassed expectations with services improved across the region and a more equitable service provided.
