Purpose - In Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statutory framework to adults who are experiencing difficulties with decision-making. This legislation has ...significant implications for all who work in health and social care. Increasing age and life expectancy, alongside the rising incidence of chronic health conditions and dementia-related diseases, indicates that more individuals are likely to experience challenges regarding decision-making capacity. Therefore, the need for more consistent, best-practice processes to assess decision-making capacity is likely to increase. To ensure occupational therapists are responsible in their contributions, and to ensure those with disabilities are supported, clinicians must be well-informed of the principles underscoring the Act. The purpose of this paper is to provide an overview of this multidisciplinary issue, including recent legislation, and consider how occupational therapy can contribute. Design/methodology/approach - The authors reviewed current literature and considered occupational therapy’s role in decision-making capacity assessment. Findings - Occupational therapists have potential to play a key role in multi-disciplinary assessments of decision-making capacity for clients. Further research is required to explore professional issues, identify clinical best practices and determine training and resource needs. Originality/value - This paper seeks to provoke consideration of how occupational therapists can contribute to capacity assessment from a client-centred, occupation-based perspective that is mindful of ethical and legislative considerations.
Background/aim
Demand for occupational therapy graduates able to work in complex and diverse workplaces is increasing. The threshold concepts framework has emerged as one pathway to assist in the ...development of work‐ready graduates. A previous Australian study identified 10 threshold concepts for occupational therapy; the aim of this study was to explore the acquisition of these.
Method
A mixed‐methods study using observational, cross sectional design and a triangulation design convergence model was undertaken. A survey using Likert scales and open response questions was developed by the authors. Seventy‐three surveys were completed by 13 first and 20 final year Victorian occupational therapy students. Twenty recent graduates and 20 experienced clinicians from across Australia also participated. Seven first and 10 final year occupational therapy students, 10 recent graduates and 10 experienced clinicians also took part in in‐depth interviews. Likert scales were used by participants to rate confidence that they had acquired the threshold concepts, they also answered open‐response questions (via survey or interview) asking them to provide examples of how they would use threshold concepts in practice.
Results
Fourth year students were statistically significantly less confident than experienced clinicians for the threshold concepts Understanding the models and theories of occupational therapy and Applying clinical reasoning (P < 0.05). When whole group data were analysed, participants were most confident for Occupation and Client centred practice (P < 0.05). These results resonated with the qualitative findings which demonstrated a shift from surface to deep knowledge with increased experience. Fourth year students reported responses that suggested some threshold concepts were still in development, while experienced clinicians used a web of threshold concepts.
Conclusion
This exploratory study provides provisional data to suggest that students appear to still be acquiring some threshold concepts at graduation and experienced clinicians make use of a web of threshold concepts in their clinical practice.
Using a case example, this article demonstrates the role of occupational therapy in the field of low assistive technology for children with disabilities in Romania. When making decisions about ...assistitive devices for a particular person in a particular situation, the occupational therapist needs to be aware of the family's socioeconomic backgound as well as the sociopolitical and cultural climate for practice. The article describes a client-centred approach with an emphasis on function and wellbeing in the provision of long-term services for children and their families. Future research should be conducted on strategies to improve occupational therapy practice using assistive technologies in relation to the health and wellbeing of children with disabilities.
The Canadian Occupational Performance Measure (COPM) is intended to help clients identify and evaluate their occupational performance issues. As it enhances client-centred practice (CCP), more ...frequent use of the COPM might fulfill the political agenda of patient involvement in Denmark. However, in a study translating the COPM into Danish, challenges were found highlighting the need to study its clinical utility.
To examine the clinical utility of the Danish version of the COPM (COPM-DK) and help determine whether to recommend a more routinely use.
Data gathered during qualitative interviews with 16 occupational therapists (OTs) from various settings were subjected to a qualitative content analysis.
The COPM-DK appeared to have clinical utility, especially regarding the meaning and relevance of the information obtained, and seemed to facilitate an occupational lens and CCP. The OTs' difficulties and concerns when using the COPM and their personal and environmental commitment to the COPM seemed associated with how they performed the COPM. Thus, training was recommended to facilitate a valid and reliable use.
Given the benefits and the perceived utility of the COPM-DK, a more routinely use, to place OTs and CCP in the center of Danish healthcare system, is recommended.
Key Messages
The utility of the Danish version of the Canadian Occupational Performance Measure is supported, according to Danish occupational therapists in various rehabilitation settings and hospitals.
Using the Canadian Occupational Performance Measure seems to enhance a client-centred practice with collaborative goals and helps to establish partnership, being of value to the interdisciplinary team, too.
The utility and acceptability of the Canadian Occupational Performance Measure seemed to be linked to the occupational therapists' experience and understanding of the Canadian Occupational Performance Measure's content and form, thus an introduction course is recommended to avoid a use that affects the assessment's validity and reliability.
Introduction
Client-centred practice was theorised by occupational therapists in Canada and subsequently introduced into the Tanzanian occupational therapy curriculum. There has been no critique of ...its relevance for African countries, nor research into occupational therapists’ perspectives of applying client-centred practice in African world contexts. This study aimed to determine the understanding and use of client-centred practice by occupational therapists in Tanzania.
Method
A descriptive cross-sectional design was used. Working Tanzanian occupational therapists (n=64) completed a questionnaire based on two existing instruments. Data were analysed using SSPS (version 20.0) and qualitative coding.
Results
Barriers were shortage of time (79.7%), client-centred practice is too demanding for the client (78.1%) and the therapist and client have different goals (76.6%). Enablers included education about client-centred practice as a student (98.4%), client involvement in planning services (96.9%) and staff and service provider training (96.9%). Three themes were identified: client-centred practice enriches relationships, is difficult to implement, and needs to be supported by increasing human resources, further training and client education.
Conclusion
The implementation of client-centred practice in Tanzania is compromised by the resource-constrained and hospi-centric health service context. Alternative practice approaches that are aligned with collectivist cultural attitudes could be considered.
Abstract
Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the ...student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students' attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students' knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.
Purpose To explore the perspectives of male clients in a neurological rehabilitation setting with regard to the occupational therapy they have received and the client-centred approach. Method This ...study involved a qualitative research design based on the grounded theory tradition. Individual in-depth interviews were used to collect data. Data were analysed using a constant comparative method. Seven male participants from an inpatient neurological setting were included using a theoretical sampling technique. Results Three themes emerged to describe the approach of the therapists to client-centred practice: (a) a shared biomedical focus as the start of the rehabilitation process, (b) the un-simultaneous shift from a biomedical towards a psycho-social focus and (c) formal versus informal nature of gathering client information. Conclusion A client-centred approach entails a shift from the therapist focussing on recovery from the short-term neurological issues towards the long-term consequences of the disease. According to the client, this shift in reasoning must occur at a specific and highly subjective moment during the rehabilitation process. Identifying this moment could strengthen the client-centred approach.
Implications for Rehabilitation
Client-centred practice entails a shift from recovering the short-term neurological issues towards the long-term psycho-social consequences of the disease.
To be effective in client-centred practice, the clients expect from the professional to be an authority with regard to biomedical issues and to be partner with regard to psycho-social issues.
Client-centred practice is most likely to be successful when client is susceptible to discuss his psycho-social issues and finding this moment is a challenge for the professional.
Using formal methods for goal setting do not necessarily cover all the information needed for a client-centred therapy programme. Rather, using informal methods could lead to a more valid image of the client.
Introduction
Annually, approximately five million people worldwide are left with a permanent disability following a stroke, often with ongoing occupational issues. A deeper understanding of the ...emerging picture of occupational disruption and identity reconstruction after stroke is needed to inform client-centred practice.
Method
In-depth interviews using constructivist grounded theory methodology were conducted with six Queensland (Australia) adult stroke survivors. Data analysis identified themes which were woven into an overarching theory about the process of reintegration back into the community and living a meaningful life.
Findings
The central process of adjustment for all participants was reconstruction of an occupational identity, facilitated through connections within and across three domains – self, others and reality. Connecting with self involved emotional management; motivation; confidence; occupational engagement; and seizing control. Connecting with others included being understood; belonging; receiving help; and interactions. Connecting with reality meant confronting the impact on daily life and one's unfolding life story according to three realities: past reality, the reality of the stroke and future reality.
Conclusion
Exploring how stroke survivors form and maintain connections across the domains of self, reality and others provides a framework to ground occupational therapy services in the reality of individual needs from an occupational perspective.
Objective: To study the convergent and divergent validity of the Canadian Occupational Performance Measure (COPM).
Design: Cross-sectional study.
Setting: The occupational therapy departments of two ...university hospitals in Amsterdam.
Subjects: One hundred and five consecutive outpatients.
Outcome measures: The COPM is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. Outcome measures of the COPM are: the client's most important problems in occupational performance and a total score for performance and a total score for satisfaction for these problems. Problems reported in the COPM were compared with the Sickness Impact Profile (SIP68), the Disability and Impact Profile (DIP) and an open-ended question.
Results: Complete data were obtained for 99 clients. The identification of occupational performance problems with the COPM surpassed the items reported in the SIP68, the DIP and the open-ended question, which confirms the surplus value of the COPM. Divergent validity was further demonstrated by the low correlation coefficients between the total SIP68 scores and the COPM. Seventy-four per cent of the occupational performance problems reported in the COPM had a corresponding item in the DIP and 49% had a corresponding item in the SIP68. Convergent validity was supported by the fact that 63% of the corresponding problems in the DIP were reported to be a disruption of quality of life and 74% of the corresponding problems in the SIP68 were identified as a disability.
Conclusion: The results of this study provide supportive evidence for the convergent and divergent validity of the COPM. The data support the assumption that the COPM provides information that cannot be obtained with current standardized instruments to measure health.
Abstract
Purpose: To explore the relationship between client-centredness (CC) and work in teams in inpatient rehabilitation. Methods: Case study, mixed-method design, with strong qualitative ...component. Methods include ethnographic observations of team and clinical encounters for 6 months; healthcare professional (HCP) interviews. HCP n=45; Observations = 40 encounters & meetings. Results: Based on HCP perceptions, intra-team and organizational factors were identified that influence client-centred practice in rehabilitation. Team factors included relational and communication dimensions affecting work that can hinder or facilitate CC. These dimensions are presented in detail. HCP perceived organizational factors such as workload, schedules and hospital culture to influence their work on teams and with clients. Conclusion: CC is not a "one size fits all". It is affected by similar factors that affect work in teams such as organizational policies, team characteristics and culture. CC can be seen as an outcome of team performance.Implications for RehabilitationClient-centred practice (CCP) is influenced by client, provider and organizational factors. CCP is not just about client-provider communication. How inter-professional teams work together is an important aspect of CCP.Shared knowledge, shared goals and mutual respect characterize the relationships among members in a team. These three dimensions influence, and are influenced by, the nature of team members' communication and the organizational structures and culture in which they take place.Effective teamwork does not automatically lead to enhanced client-centredness. Strategies are needed that ensure teamwork does not merely perpetuate the health professionals' control of the patient or that decisions are the "right" decisions from the health care professionals' perspectives.
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