Occupational science and its application to occupational therapy practice

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A presentation by Annie Turner – Emeritus professor of occupational therapy, University of Northampton
and Emma Royal – Clinical specialist occupational therapist, Aylesbury, Bucks.

These slides explore how occupational science provides the evidence base for the practice of occupational therapy and introduce some tools for practice, such as OT process models, rehabilitation frameworks and goal setting.

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  • OS is a concept, therefore impossible to teach within such a short space of time. 
    Leave the session questioning whether your day to day work focuses upon occupation that is meaningful and relevant to your clients/patients.
  • OT –reasoned use of occupation to enhance health and well being.
    Use meaningful occupations as means and outcomes of intervention
    Unique - occupation
    That is ALL we have that is unique
  • Occupations dictated by service user so can be SEEN doing anything at all!
    This can cause problems in peoples understanding of what we do
    If not confident in our core professional drive it can give us problems too
  • Our roots don’t lie in medicine but in humanism
    BUT we have long worked in medical settings and medical model
    Without caste iron core beliefs of what we do this medicalisation of our profession can harm practice
  • Has this happened to us?
    Is this part of the reason we maintain services in places that don’t suit our needs?
    Trouble is this is where we can currently access many ‘sick’ people who benefit from our help – but take care
  • Isaac Stern, on a tour of China where free development of musical skill had been quashed, made this statement.
    It’s the same for us
    Doesn’t matter where we practice (the context is the instrument). That shouldn’t be the driver of our practice
    Our MUSIC lies in the beliefs we hold about occupation and its impact on health and how we ‘play’ that with out service users
  • Occupation – the study of occupation is occupational science – explores human occupation, its performance, meaning and relationship to health and ill health
  • Yerxa 2013 – humans have an innate yearning to engage with their environment
    Each individual has a drive to engage in occupations that are meaningful to them – portfolio is unique set of skills and interests
    Meaningful occupation is self initiated, directed, organised, skilful, productive and adaptive.
    It contributes to well being
    It builds into flexible routines
    If meaningful occupations are ignored or suppressed then the human spirit fails to flourish
    Occupations are embedded in culture
    We strive for mastery and our ability to exercise control and develop skills confirms our self efficacy.
    Interests are magnetic motives that sustain us through the early stages of learning. We have limited understanding of the ‘why’ of interests
    Culturally shaped routines are the glue that link us to our context. If roles are lost then link to society is loosened
    People search for spiritual meaning and identity through occupations and so performance of meaningful occ helps spirit grow. Reilly quote
    We live in a world (in the West) where scientific proof of efficacy is vital for status and acceptance. So need evidence. OS building this.
  • Occupational Science is a discipline first envisaged at the university of southern California and named by Elizabeth yerxa
  • So how can you nurture the human spirit for occupation? What does OS tell us
    Learn about the individual – what are there interests, skills, beliefs, roles and sense of self?
    Create belief in success and efficacy
    Create ‘just right’ challenges that work towards meaningful occupation. Interests are our secret weapon – use them (student and lady going to church)
    Help person set and prioritise goals
    Nurture autonomy – not the same as independence
    Acceptance of new state grounded in the development of satisfaction and efficacy in new way of undertaking occupations based on interests and meaning.
  • Introduce concepts. Link to what’s been said
  • Remember interests and meaning?
    Don’t confuse with frequency
  • Medical model perspective can limit OT vision and direction
  • Occupational science and its application to occupational therapy practice

    1. 1. MS Trust Annual Conference 3/5th November 2013 Occupational science workshop programme Annie Turner – Emeritus professor of occupational therapy, University of Northampton Emma Royal – Clinical specialist occupational therapist, Aylesbury, Bucks Intro - Emma/Annie 5 mins Your thoughts on case study – Emma 10 mins OS presentation – Annie 20 mins Application of OS to practice presentation – Emma 15 mins Your new thoughts on the case study – Annie 10 mins Presentation of case study based on CMOP-E – Emma 15 mins Discussion/questions - Annie/Emma 15 mins
    2. 2. Referral for Mrs S What do you think this lady’s main problems are? What further information would you want to gather?
    3. 3. What is unique about occupational therapy?
    4. 4. So our core driver is the concept about occupation and its impact on health Skill based profession Concept based profession • Core ideas lack visibility • Impact demonstrated through outcomes which may be qualitative and long term • • Techniques/skills often not unique Practitioner needs a strong professional identity • Core ideas are more tangible • Impact demonstrated through outcomes which may be quantifiable and short term • Techniques/skills often unique • Practitioner less likely to have issues with identity
    5. 5. This is unchanging and forms the basis of all practice These skills are unchanging though tools may vary Splinting Communication Core skills in occupational therapy Analysing & Evaluating prioritising occupational occupational outcomes needs Identifying and assessing Enabling occupational occupational needs performance Group work Wheelchair assessment Reflection Cognitive behavioural skills Leadership Vocational rehab Housing adaptations Business skills Creative skills Leisure skills Mobility Management Core professional reasoning skills Home visits Research Teaching ADL Central philosophy Professional belief in the impact of occupation on health and well-being Context dependent practice skills Supervision skills Social skills Etc. These skills are driven and changed by fashion, research, legislation, context and technological development
    6. 6. The paradigm of healing the sick gave rise to the medical model So where do we sit? The paradigm of promoting health through human doing gave rise to the humanistic model
    7. 7. How did this thinking affect the growth of the profession? Throughout the 20th century 1950s Crisis Growth of reductionism in medicine, in conflict to concepts of moral treatment, influences occupational therapy Criticism by medicine of OT’s failure to produce scientific evidence 1960s Paradigm of inner mechanisms Early 20th century Paradigm of occupation Concepts of moral treatment drive early occupational therapists who believed in the occupational nature of humans and its influence on health but had no evidence 18th and 19th centuries Conflict between moral treatment and scientific schools of thought in the treatment of the mentally ill Modified from Creek J 1985 Occupational therapy and Mental Health Churchill Livingstone Emergence of modifying internal functions of body and mind based on medicine’s dominant reductionist perspective 1970s Crisis Widespread professional dissatisfaction. Identity loss and inadequacy of reductionism in addressing long term disability. 1990s Re-emergence of paradigm of occupation Occupational science verifies occupational therapy and OTs’ identity
    8. 8. The iron rice bowl “…….an organisation, in return for security, expects its employees to toe the party line for the good of the organisation. …….Could we argue that our expectations of being ‘cared for’ by employment in statutory services has taken away the edge of a feisty journey into unchartered territory…..?” Annie Turner 2008 A rose by any other name would smell as sweet Occupational Therapy News February 2008
    9. 9. “What is music all about? The instrument is not that important. It is only a means to an end, in other words, you don’t use music to play the violin, you use the violin to play music”. Isaac Stern – ‘From Mao to Mozart’ (1981)
    10. 10. OK, so what is occupation? You practice as an occupational therapist, what is this occupation thing?
    11. 11. What is occupation? “All that people need, want or are obliged to do; what it means to them; and its…potential as an agent of change” Wilcock A 2006 An occupational perspective of Health Ed 2 Slack Inc., New Jersey “A group of activities that has personal and socio-cultural meaning, is named within a culture and supports participation within society. Occupations can be categorised as self care, productivity and/or leisure/rest” TUNING document 2009
    12. 12. The nature of occupation Occupation as active engagement: Occupation is manifest in doing It occupies time and space, requires energy, interest and attention It includes physical activity and/or mental doing (when do you ‘do’ nothing?) Occupation as purposeful: All human endeavour has reason or purpose It meets survival needs, develops skills, rewards use of capacity and binds communities Occupation as meaningful: It has meaning to the person performing it This meaning is self defined and unique People make meaning of their existence through their occupations Meaning motivates occupational performance
    13. 13. So what is occupational science? “The study of the human as an occupational being including the need for and capacity to engage in and orchestrate daily occupations in the environment over the life span” Yerxa et al 1989 Occupational science provides the evidence base for the practice of occupational therapy.
    14. 14. Occupational identity “To do is to be” Socrates “To be is to do” Satre “A composite sense of who one is and wishes to become which is generated from one’s history of occupational participation. It includes one’s sense of capacity and effectiveness for doing” (Forsyth and Kielhofner, 2006:78)
    15. 15. How do we access occupational science? STUDY DAYS BJOT TEXT BOOKS OT models of practice Other journals available through COT STUDENTS AND NEW GRADS!
    16. 16. A Hierarchy of Concepts related to Occupation Expectations ROLE Motivation Life stage ROLE ROLE Occupational balance Activity Etc.. ROLE OCCUPATION “mothering” Activity Task Clean Lunch box Environment ROLE(mother) OCCUPATIONAL PERFORM (Occupational form and Activity Culture Activity (packing school lunchbox) Task Prepare drink ANCE function) Activity Task Make sandwiches Activity Skills Grip flask Grip lid Unscrew lid Occupational Alienation Etc… Performance components Etc.. Occupational deprivation Having ingredients ready Judging amount of concentrate Etc.. Occupation as a “means” and as an “end”
    17. 17. Human beings orchestrate their lives through their occupations Humans need to DO in a way that is true to their unique BEING in order to BECOME who they wish to be
    18. 18. Potency of occupations Potent but infrequent Non potent but frequent
    19. 19. Who are you? Mr Brian A M: Aged 78 year. Smoker for 40 years, gave up 8 years ago. 2004 CCF monitored by GP. FH – brother died of heart attack aged 56 yrs 2009 Prostate cancer. 2012 Radiotherapy arranged but cancelled on reconsideration. 2013 D and V leading to dehydration and some confusion. Appears recovered but complains of persisting fatigue. Recent ® Colles♯
    20. 20. Who are you? Tony M Occupational identity: A retired office manager. Husband, grandfather, friend, cousin Occupational performance: Routines- He has created a daily routine where he gets the paper and then does what he calls his work – cutting the grass, getting household bills paid, washing his car etc. He routinely visits his ill cousin and friends in hospital and once a month meets his former work colleagues for lunch Roles and responsibilities- Most weeks he collects his grandchildren from school on Thursdays and occasionally he will take them to their football training or music lessons. He prepares breakfast for himself and his wife every day and occasionally cooks the evening meal. Occupational issues: Perceived inability to fulfill roles & responsibilities
    21. 21. A need to reflect What is our profession all about? What is our USP? Do my professional actions (treatment, reports, use of language etc) portray my belief in the power of occupation?
    22. 22. The application of Occupational Science to practice
    23. 23. What are we interested in? The patient journey BECOMING BEING DOING Who do we want to be? What do we want to do now to reflect who we are? What help do we need to do what we want to do? Being true to ourselves. Who are we now? What are we doing? What do we hold dear? Our image of ourselves as promoted through our ‘doing’ Who were we? What did we do? Where have we been? FUTURE PRESENT PAST
    24. 24. DOING • Doing is vital because it reflects who we are. We spend our lives doing stuff by choice or obligation . • Doing is a survival mechanism of the body and soul. We all do different stuff in different ways and patterns • Health and well-being are promoted by balanced, purposeful and meaningful ‘doings’.
    25. 25. Doing – Past and Present What were past activities, occupations, roles and responsibilities? Which were most potent? How big is the What are current activities, occupations, roles and responsibilities? Do they reflect a sense of self? gap? What is the impact of the illness on occupational performance? What is the change in the quality of the performance? What are the barriers to performing occupations, roles and responsibilities? What is the satisfaction with the quality and content of performance?
    26. 26. Being - our past and present sense of self is influenced by: Choices & opportunities in life Life experiences Impact of illness on current participation and aspirations Interactions with others and how we think they see us Our performance of activities, occupations, roles & responsibilities Understanding, acceptance and adaptation to illness
    27. 27. Becoming - Future What do they want & need to do? What are their priorities & goals? What are their roles, activities, responsibilities & occupations? What is the impact of illness on occupational performance? How do future activities reflect sense of self? What is the potential for improved performance quality? What is the level of adaptation for redefining hopes & aspirations for the future? What is the performance of future activities/occ upations?
    28. 28. Intervention ng Be co mi ca tio Ed u ing Do io n rat sto Re n CLINICAL REASONING Being Compensation The interplay between the individual’s Doing, Being and Becoming will determine your therapeutic approach to intervention.
    29. 29. Tools for Practice Rehabilitation frameworks OT Models of Practice OT Process Models Functional/occupational performance assessments Goal setting Outcome measures (activities/occupations/performance/s atisfaction)
    30. 30. Now think of Mrs S in terms of Doing, Being & Becoming What strikes you about this lady’s issues now? What additional information would you collect?
    31. 31. Doing : her occupational performance What were her past activities, occupations, roles and responsibilities? Which were most potent? What are current activities, occupations, roles and responsibilities? What impact has her illness had on her occupational performance? How satisfied is she with what she can do? What are the barriers to her performance? Being: her sense of self. What is the impact of illness on how she sees herself and on her aspirations? How did/does she Interact with others? How does she think they see her? How well does she understand, accept and adapt to where she is now? What choices & opportunities does she have? Becoming: her future activities reflecting her sense of self What are her roles, activities, responsibilities & occupations? What are her interests, goals and priorities? What is the level of adaptation for redefining future hopes & aspirations? What is the potential for improved performance quality?

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