Posted at 11.01.2018
My occupational remedy studies are actually in their third calendar year and I feel, this year, more than other year which i am starting to understand and appreciate the core values of the occupation. These beliefs include client-centeredness, use of evidence, social competence and occupation-based practices. Many of these values embody the fundamental ideas of occupational remedy practice (Regulation, 2004). Although I battled to comprehend the ideals of occupational remedy initially and was unsure of the true benefits associated with the profession I can now see our job is one that ought to be truly respected and respected. However Personally i think that our career can only be viewed in this way when its core ideals are upheld. However I feel that is not often the case anticipated to a number of different barriers that i will discuss further later in the task. Personally i think that unless these prices are employed by occupational therapists our job will continue steadily to have a problem with its definition and its own personal information with the professional medical world. This year I completed a ten week position within an acute physical setting. Personally i think that in this particular setting occupational therapists conformed more to the medical model sometimes and even though they upheld many of the core values, I think that it can be difficult to address occupation established practice in this setting, which is actually the key aspect of our vocation. I also feel that therapists found it difficult to use evidence established practice due to time constraints but also as there are extremely few occupational therapy related articles. Therefore I feel there is a sizable gap of literature within our profession. This was apparent when researching for this assignment.
I chose the above title because of this paper, as I am going to think about the core ideas of the occupational remedy job but also the obstacles to making use of them in practice. I am going to review the books and I will also draw by myself learning to day. I will than consider how effectively I applied these primary skills in my recent practice experience by reflecting on some key activities. I am going to identify gaps in my learning and also any challenges I experienced in applying these skills used. To summarize my paper, I will reflect on the implications that exist in making use of these main skills in current practice settings and I will explore ways of conquer these implications in future practice.
Before discussing client centred practice it is important that I have a clear classification of the approach. On overview of the literature, it would appear that there has been much controversy in building a definition for client-centred occupational therapy practice and I was unable to find one clear-cut classification of the term. The magnitude of the research in this area is largely based on the difficulty in defining the concept and making use of the approach used. However I did realise that there are lots of important elements underpinning the explanations. These are choice, relationship, empowerment, respect, joint goal setting and decision-making and autonomy (Sumsion, 2000, Legislations & Baptiste, 2002, Sumsion & Rules, 2006, ). The overall goal of this practice strategy is to "make a caring, dignified and empowering environment in which clients truly steer the span of their care and call upon their internal resources to speed up the healing process" (Laws & Baptiste, 2002).
Client centred practice has proved very effective however there look like lots of issues associated with its implementation used. For example as Nelligan et al (2002) reviewed - often it appears the budget, the current method of management or personnel shortages prevail and dictate how work is conducted. There may also be conflicts arising between your client's decision making and the prices of the professional and the patient. For example, often on placement there were times when I, as the OT student would recommend something that might be in the best interest of your client but still they could prefer never to agree to it. Clients could also not be able to be effective lovers in your client centred collaboration due to obstacles to communication, for example, or they could have cognitive deficits (Rosa, 2008). On discourse with others any difficulty. this can be considered a regular occurrence for professionals. I have identified two spaces throughout my research which is that there is a lack of recommendations in existence to aid occupational therapists in conquering the barriers to client-centred practice. Also there exists little research proof to aid how current occupational remedy practitioners are making use of this approach used.
In an attempt to handle the diversity of the health care system, the drive for health care professionals to realize cultural competence has become important (African american & Wells, 2007). This has been mentioned within occupational remedy where the terms culture and social competency are broadly discussed. Cultural competence has been defined as "having a knowledge of, awareness to and understanding of this is of culture" (Dillard et al. , as cited in Guiral, 2002 & Awaad, 2003). The AOTA, 1995 send ethnic competency to the process of actively growing and practicing appropriate, relevant, and very sensitive strategies and skills in interacting with culturally different persons. Why is ethnical competence of importance? As occupational therapists our consumer group is often made up of individuals with dissimilar cultural backgrounds but I appreciate now that this may well not necessarily mean that your client is of an alternative racial group. For instance, the interaction of clients and experts can embody a form of multiculturalism in which several ethnicities- medical care profession, organization, family, community, traditional culture, etc. -are all merged (Genao et al. , 2003). Therefore, from my research I realise that every healing interaction can be considered a cross-cultural relationship. This overlap and relationship of cultures and dialects can create honest conflicts and dilemmas in providing occupational remedy services. Therefore, Personally i think, ethnic competency is important within our profession. To be able to uphold the main values of the job and apply interventions that are occupation-based, client-centred and supported by evidence, we have to consider the client's culture. Usually our social incompetence will result in compromised quality of health care, noncompliance by your client, inability to recognize differences, concern with the new or unfamiliar, denial, and inability to look in-depth at the average person needs of the client and their family (Wells & Black color, 2000).
On reviewing the literature it appears that there can be an abundance of information on what this means to be culturally proficient. However, a number of people have commented on how attaining ethnic competence inside our practice has been known as one of the least developed areas of occupational therapy (Awaad, 2003, Guiral, 2002, Odawara, 2005). This, I feel, is because of having less clear rules or an information base about how to achieve cultural competence and apply it in practice with different ethnical groups. This reveals exercising therapists with a challenge.
Occupation-based practice has been noted in the occupational therapy literature since the basis of our vocation. During my literature review I noticed that the main target was in defining profession and what it means to be occupation-based inside our practice. Gray (1998) mentioned that occupation is meaningful and goal-directed, and that "occupation, when it is applied as activity with wholeness, goal, and signifying to the person, can also affect her or him psychologically, psychologically, and socially in ways that purposeful activity unrelated to the person cannot" (p. 356). I feel that it is precisely because job as intervention has the ability to create change throughout the individual's multiple systems that occupation-based practice is worth exploring. According to the AOTA (2005), the therapist's activity evaluation and environmental/activity changes skills are critical to the linkage process referred to above and are fundamental factors in using occupation in an included approach to treatment and I too feel that this is exactly what makes us unique as OT's. However within the books the obstacles to employing occupation-based practice are also mentioned. These barriers can be external or internal.
According to the AOTA (2005), the obstacles to implementing OBP are related to factors inside to the therapist and job as well as to issues in our external environments. Internally, two of the most noteworthy barriers relate to the interrelationship of the therapist's value system and habit structure. I've seen on both placements how easy it can to stick to a habit rather than explore other treatment possibilities that may hold more so this means for a client. Externally, you'll find so many environment and system conditions that hinder OBP. Included in these are factors such as reimbursement, limited time and resources, productivity expectations, population details such as amount of stay or acuity and treatment conditions that promote reductionism and are impoverished occupationally. Limited resources and time have been the most important external factors I have witnessed. These points are important to consider as they frequently affect every therapist and their capacity to handle occupation founded practice.
On overview of the books, it was obvious that there is no current research evidence into how many current practitioners such barriers affect and just how many practitioners are doing interventions that are occupation-based. A lot of the literature in this area appears to be predicated on the ideas of OPB and the benefits, rather than solid research evidence how practitioners are making use of this concept in practice.
Evidence-based practice has been defined as 'the conscientious, explicit, and judicious use of current best data to make decisions about the health care of specific patients' (Sackett, Rosenberg, Gray, Haynes & Richardson, 1996; p. 7). On review the books appears to be concerned with defining evidence-based practice and acknowledging it's importance. The purpose of evidence-based practice is to ensure that the interventions being provided to clients will be the most effective. External facts such as journal articles and research studies is only taking care of of the procedure and it must be combined with clinical reasoning of the occupational therapist and the client's decision (Taylor, 2007). The Canadian Connection of Occupational Remedy et al. (as cited in Taylor, 2007) support this by defining evidence-based occupational remedy as "client-centred enablement of job, based on customer information and a crucial overview of relevant research, expert consensus and past experience". Having an facts base is vital in our practice as occupational therapists. It supports and plainly articulates our scientific decision making to clients and also justifies our practice solutions to authority characters (Taylor, 2007). The books on evidence-based practice seems to get on the role of the occupational therapist in reflecting on their practice methods to improve their evidence-base (Stube & Jedlicka, 2007, Taylor, 2007, Bailey et al. , 2007). While we can recognize the sheer need for having an evidence-base to our practice, the books suggests that there may be insufficient research being carried out to determine the efficiency of particular interventions in every areas of practice. Melton et al. (2003) determined inadequate resources, time constraints and insufficient skills as the primary obstacles impacting on occupational therapists acquisition of evidence-based practice. Without a sound evidence-base to our practice it is difficult to justify our interventions and apply interventions that are client-centred, occupation-based and culturally competent.
I believe that being able to effectively find and critically appraise research can be an essential skill which all occupational therapist should be proficient in. As a relatively young job, with limited research, occupational remedy does not have an especially persuasive evidence platform compared with that of other health professions. When I was on placement the conversation therapist or physiotherapist or expert would, regularly in multi disciplinary conferences (MDT), talk about research articles they had read regarding to their profession. It shown the knowledge they had but also the evidence base because of their interventions. It helps to advocate for his or her profession. With this in mind I feel it's important that all training occupational therapists have the ability to validate their practice through facts based practice. With an increase of occupational therapists able to provide treatment, which is research based, occupational therapy will have significantly more credibility as a profession with both clients and other medical researchers (Taylor, 2007).
However one hurdle I noticed was that when on placement it can be very difficult to get the time to research, yet this could very well be the time it is most effective as ideas are fresh and can be applied to apply. On placement I had formed many patients who acquired acquired brain injuries (ABI) either from heart stroke or seizures and who required regular involvement. With little time to research before involvement I began to carry out intervention utilizing a bottom up strategy. However when I finally managed to have enough time to research I discovered a top down approach is more effective with people with ABI. This event made me appreciate how important it is to make time for research, as it could be more beneficial in the long term. I also realise that other professionals are just as busy but nonetheless they find time to research. In the future I am hoping to become more skilful in handling my time effectively so that I can carry out the study essential to support might work.
Prior to my literature review I always considered cultural competence as a skill to use with clients from other cultural groups. During my practice experience the majority of the client group I worked with were of Irish culture. Understanding of my own culture was essential in order to be culturally competent in my own interventions. I also needed to have a positive attitude to embracing different life styles and prices as occasionally I got offered clients whose beliefs and life styles deviated from my very own. Matching to Rosa (2008) occupational therapists need to be more open to exploring differences regarding remedy goals. Using one occasion I attained a gentleman who had just undergone bilateral leg replacement and had a transient ischemic strike. I felt he'd benefit from an extended completed reacher and sock aid scheduled to his poor capacity to bend. However he admitted that he was not a materialistic gentleman, enjoying a straightforward life, and would often even go without putting on socks and shoes inside your home and would put up with any slip on shoes he previously at home instead for when heading outdoors. It was problematic for me to understand initially so discussed the benefits associated with the equipment but I also recognized I had to simply accept his own values even though they were different to my very own. Although, I managed this obstacle well, I am unsure easily would identify myself as culturally qualified. Especially as I've limited experience and knowledge of working with other ethnic organizations. I hope to build up my knowledge in this area through future learning and practice opportunities.
Maitra and Erway (2006) state that the success of client centred practice can also often rely upon the client's potential and desire to activate in decision-making procedures. For example one of my clients had moderate combined aphasia and a moderate cognitive impairment. Therefore it was a concern to keep a collaborative customer centred partnership. But regarding to Rosa (2008, p. 288) "practitioners are called on to overcome the obstacles that can be found to the amount possible in order to understand the clients as completely as they can and discuss the energy and responsibility of decision making. " However I possibly could find no suggestions that could of helped me achieve this and in hindsight I really believe these would of been useful as I came across it difficult to be customer centred and rather than creating joint goals I proven my very own goals for the client. I do not feel that I ever before provided the ability for this customer to lead the course of his therapy. I understand that in the foreseeable future I'll have many clients who've cognitive or communication impairments and therefore I have to improve my communication and personal conversation skills which must offer with such obstacles matching to Rosa (2008). I also have to be knowledgeable as to what methods are being used by other occupational therapists to provide client centred health care with such clients as well as having a more good attitude to pondering more creatively about ways of connecting with my clients. It's important that I explore many areas with them so that I could gather a feeling of the path they would like therapy to have.
Being occupation based was something I really battled with on placement which kept me disheartened as Personally i think it's important that all OT's are occupation based as the fundamental principle in our profession and hallmark in our practice (Hersch et al, 2005). I got in an severe physical setting and frequently the main involvement was worried about providing equipment or making a community OT referral. However using one occasion I felt I was occupation based and the results was successful. A significant skill to be job based mostly it to know very well what people like to do in their lifestyle and to be familiar with what motivates them (Chisholm et al, 2004). I had formed a customer who enjoyed drawing and colouring on a regular basis. As she had fine motor challenges and visual understanding problems I thought that using her drawing and art work skills is a nice intervention plan as it was a significant activity for your client. It proved to be very successful and she appeared forward to your sessions together. I believe another skill to get when being profession based is to be creative and I personally struggled to think of ideas to keep carefully the sessions fun and interesting. I overcame this by researching alternative activities to do in my spare time but I understand that easily had had a larger caseload I would not have monitored as well as I did so. Only over a rare occurrence does I witness OT's interesting clients in significant occupations although it was evident all of them knew the value of meaningful occupation for clients they just never really had the time to transport it out. I feel that in order to be true to your vocation OT's need to use meaningful occupations more in practice. I think research about how other OT's are handling to carry out occupation-based practice in serious physical settings would be very helpful to guiding our practice.
Translating theory into practice is a task encountered by all occupational remedy experts. We endeavour to uphold the central values of the profession while simultaneously we have been impacted upon by lots of barriers inside our practice setting up. I experienced such obstacles in my environment. Reflecting on the year and my practice education I realise that it is our professional responsibility to type in a remedy situation with the aim of applying all of these concepts. Whenever we are confronted with a challenge, we need to draw on our own evidence-base in order to make sound scientific judgements. The literature provides us with an abundance of home elevators what this means to be client-centred, occupation-based, culturally skilled and evidence-based. I am aware of this is of all of these concepts, as will be the majority of rehearsing therapists. However, the particular literature fails to communicate, is how occupational therapists can effectively uphold these core ideas when offered a challenging situation in real practice. We are able to draw on our very own personal and clinical judgement, but where is the evidence-base to support our actions and define what's right?
Based on my practice experience, I would recommend that we stay up to date with the current literature to steer our daily practice and think about our own interventions and performance regularly. I am aware that is a skill I have to improve on and I need to begin regularly researching databases, publications and books to stay current but also to increase my knowledge as a young professional. I also claim that we take the possibility to participate in or perform research studies that will guide our practice. This allows us to set goals for our very own development and enhance our strategies so that we can engage in best practice. My practice experience provided me with an intensive insight in to the realities of occupational therapy practice. I know of the issues which exist in being client-centred, occupation-based, culturally capable and evidence based in real practice. However, moreover I know of what I can do to work in practice. By trying to be the occupational therapist at the primary of these four concepts, I am hoping to fulfil my quest in becoming a competent occupational therapist.