This document discusses a study that investigated how occupational therapists find meaning in their work. The researchers discovered that some therapists found meaning in their occupation, while others experienced a "meaning gap." Through participatory action research with occupational therapists at a hospital, the study aimed to identify strategies to address this meaning gap. The background section reviews how occupation has historically been a core concept in occupational therapy practice, but how the field has also experienced a shift toward more medical models of care. The method section describes how the participatory action research study was conducted in three phases with occupational therapists from the hospital.
Images are personal or stock except for...
6,7 http://static2.businessinsider.com/image/4f9ab672ecad041602000000-480/lost-in-space-danger-will-robinson.jpg
11 http://www.vinylrecords.ch/B/BR/Bronski_Beat/Why_si/bronski-beat-why-1185.jpg
15 World Federation of Occupational Therapists
39 Canadian Association of Occupational Therapists
Images are personal or stock except for...
6,7 http://static2.businessinsider.com/image/4f9ab672ecad041602000000-480/lost-in-space-danger-will-robinson.jpg
11 http://www.vinylrecords.ch/B/BR/Bronski_Beat/Why_si/bronski-beat-why-1185.jpg
15 World Federation of Occupational Therapists
39 Canadian Association of Occupational Therapists
Examining "Borrowed Theory" in Original vs. New Disciplines via Text MiningStephen Downing
Examines the differences in borrowed theories from their parent to their appropriated disciplines, specifically related to qualitative vs. quantitative use and changes in their applications over time, via text mining of peer-reviewed journal articles.
Examining "Borrowed Theory" in Original vs. New Disciplines via Text MiningStephen Downing
Examines the differences in borrowed theories from their parent to their appropriated disciplines, specifically related to qualitative vs. quantitative use and changes in their applications over time, via text mining of peer-reviewed journal articles.
Name: Carolyn Sithong
Position: Occupational Therapist and Certified Aging in Place Specialist
Company: Home for Life, Consulting and Design
Personal Bio (1 paragraph for introduction): Carolyn has a Master\'s degree in occupational therapy and provides environmental modification solutions through her company, Home for Life, Consulting and Design. She is nationally certified as an Aging in Place Specialist by the National Association of Home Builders and is founder of the Central Florida Aging in Place Chapter, a grass roots organization created to increase Aging in Place awareness and promote a multi-disciplinary approach to healthy senior home and community living.
Topic Title: Occupational Therapy and Aging in Place: Ensuring Quality of Life in the Home
Topic Description (1-2 sentences): Occupational therapists play a key role in making sure an environment where someone lives is one that supports an ability to engage in life practices as opposed to one that inhibits. This presentation will invite you to see an environment through the eyes of an occupational therapist and describe how acess to all areas of the home leads to participation in activities of daily living and provides the opportunity to enjoy the world around them.
A comparison of two occupational therapy modelsJou Yin Teoh
How do occupational therapy clients' lives look like through a clinician's lenses? This presentation aims to compare how clients' lives look like via two different occupational therapy tools - the Kawa Model and the Canadian Model of Occupational Therapy. We discuss the pros and cons and also the possibility of using both models in combination, not very well known but encouraged by renowned occupational therapy theorists and industry leaders.
Task detailDescribe a clinical practice issue. Critically analys.docxssuserf9c51d
Task detail
Describe a clinical practice issue. Critically analyse material (including relevant research articles) to support an argument for how an understanding of adult learning theory may assist the facilitation of practice development within a clinical context. How might the role of facilitation assist when approaching this practice issue?
Essay word length 2000
N U R S I N G T H E O R Y A N D C O N C E P T D E V E L O P M E N T O R A N A L Y S I S
Getting evidence into practice: the role and function of facilitation
Gill Harvey BNurs PhD RHV RGN DN
Director, Quality Improvement Programme, RCN Institute, Oxford, UK
Alison Loftus-Hills BA MSc BSW
Senior Research and Development Fellow, RCN Institute, Oxford, UK
Jo Rycroft-Malone BSc MSc RGN
Research and Development Fellow, RCN Institute, Oxford, UK
Angie Titchen MSc DPhil MCSP
Senior Research and Development Fellow, RCN Institute, Oxford, UK
Alison Kitson BSc DPhil RN FRCN
Professor and Director, RCN Institute, Oxford, UK
Brendan McCormack BSc DPhil RGN RMN
Professor of Nursing Research, University of Ulster and Royal Hospitals Trust, Belfast, UK
and Kate Seers BSc PhD RGN
Head of Research, RCN Institute, Oxford, UK
Submitted for publication 14 February 2001
Accepted for publication 11 December 2001
Ó 2002 Blackwell Science Ltd 577
Correspondence:
Jo Rycroft-Malone,
Quality Improvement Programme,
RCN Institute,
Radcliffe Infirmary,
Woodstock Road,
Oxford OX2 6HE,
UK.
E-mail: [email protected]
H A R V E Y G L O F T U S H I L L S A R Y C R O F T M A L O N E J T I T C H E N AH A R V E Y G ., L O F T U S -H I L L S A ., R Y C R O F T -M A L O N E J ., T I T C H E N A .,
K I T S O N A M C O R M A C K B & S E E R S K . ( 2 0 0 2 )K I T S O N A ., M c C O R M A C K B . & S E E R S K . ( 2 0 0 2 ) Journal of Advanced Nursing
37(6), 577–588
Getting evidence into practice: the role and function of facilitation
Aim of paper. This paper presents the findings of a concept analysis of facilitation in
relation to successful implementation of evidence into practice.
Background. In 1998, we presented a conceptual framework that represented the
interplay and interdependence of the many factors influencing the uptake of
evidence into practice. One of the three elements of the framework was facilitation,
alongside the nature of evidence and context. It was proposed that facilitators had a
key role in helping individuals and teams understand what they needed to change
and how they needed to change it. As part of the on-going development and
refinement of the framework, the elements within it have undergone a concept
analysis in order to provide theoretical and conceptual clarity.
Methods. The concept analysis approach was used as a framework to review
critically the research literature and seminal texts in order to establish the
conceptual clarity and maturity of facilitation in relation to its role in the
implementation of evidence-based practice.
Findings. T ...
The role of theory in bridging interdisciplinary research with evidence-based...Patrick Connolly
The role of theory in shaping and translating research into practice is neglected in the field of psychology at present. Internationally, there has been a growing call for development of an integrative theoretical framework within which research results can be understood as well as applied. A recent article in Nature Human Behaviour (Muthukrishna & Henrich, 2019), has proposed that the replication crisis currently facing the psychological sciences is the result of the lack of development of such integrative theoretical frameworks. Those authors propose that researchers should confine the questions that they ask, and the analyses that they do, to the predictions made within a particular theoretical framework. This is an important suggestion, because without a coherent theory, research results can only ever be applied to practical questions as a heuristic (or problem-solving strategy). It is suggested here that this state of affairs is the reason for the most common critical challenge made of research for evidence-based practice, which is the problem of knowing which intervention to apply, in which way, to which person, at what time, by which professional, and so on. Only a coherent theoretical framework can address these problems in applying research to practice. Finally, following Tretter and Loeffler-Statska (2018), it is proposed that systems theory (including information theory) is the best candidate for a integrative clinical theory framework that not only has potential of successfully bridging different disciplines, but also integrating the key assumptions and propositions of most dominant theories of psychology today.
Counselling Psychology QuarterlyVol. 24, No. 1, March 2011, .docxvoversbyobersby
Counselling Psychology Quarterly
Vol. 24, No. 1, March 2011, 43–53
How special are the specialties? Workplace settings in counseling
and clinical psychology in the United States
Greg J. Neimeyer
a*, Jennifer M. Taylor
a
, Douglas M. Wear
b
and
Aysenur Buyukgoze-Kavas
c
a
Department of Psychology, University of Florida, P.O. Box 112250, Gainesville, FL
32611, USA;
b
Psychology and Community Counseling Clinic, Antioch University Seattle,
Seattle, WA 98121, USA;
c
Department of Educational Sciences, Division of Psychological
Counseling and Guidance, Middle East Technical University, Ankara, Turkey
(Received 1 February 2010; final version received 18 February 2011)
How special are the specialties? Although clinical and counseling psychol-
ogy each have distinctive origins, past research suggests their potential
convergence across time. In a survey of 5666 clinical and counseling
psychologists, the similarities and differences between their workplace
settings were examined during early-, mid-, and late-career phases to
explore the distinctiveness of the two specialties. Overall, clinical and
counseling psychologists reported markedly similar workplace settings.
However, some significant differences remained; a greater proportion of
counseling psychologists reported working in counseling centers, while a
greater proportion of clinical psychologists reported working in medical
settings. In addition, during late-career, substantially more counseling and
clinical psychologists worked in independent practice contexts than in
community mental health centers, medical settings, academia, or university
counseling centers. Findings are discussed in relation to the ongoing
distinctiveness of the two specialties and the implications of this for training
and service in the field of professional psychology.
Keywords: clinical psychology; counseling psychology; workplace settings
Introduction
Recognized as distinct specialties by the American Psychological Association,
clinical and counseling psychology each have distinct histories, intersecting appli-
cations, and longstanding concerns regarding their continuing, or diminishing,
differences. This article explores these issues and examines the contemporary
similarities and differences between these two specialties as reflected in their
workplace settings. Workplace settings are examined at early, mid, and late career
in order to determine whether differences vary by cohort in a way that might reflect
either on their enduring or diminishing differences over time.
Enduring or diminishing differences?
Historically, the specialties of clinical and counseling psychology have developed
from different origins and formed distinctly different trajectories as a result
*Corresponding author. Email: [email protected]
ISSN 0951–5070 print/ISSN 1469–3674 online
� 2011 Taylor & Francis
DOI: 10.1080/09515070.2011.558343
http://www.informaworld.com
(Munley, Duncan, McDonnell, & Sauer, 2004). Clinical psych.
1
Annotated Bibliography: Topic (Chosen from the list provided)
[Name]
South University Online
[Template instructions: Replace the information in red with your work-then delete this line]
2
Annotated Bibliography: Topic (Chosen from the list provided)
[APA formatted reference for source (list in alphabetical order) using a hanging indent]
[Underneath the reference, give a summary of the article then an analysis:
Summary of article: 1-2 paragraphs that describe the following information in your own words
in paragraph format (not bullet points).
• Why the article was written?
• What are the major points of the article?
• If the article was a study, describe:
o The methods used in the research: Include the participants, how the research question(s)
was tested or measured (e.g. survey, interview, formal testing…)
o The results of the study: What did the researchers find out?
o The conclusions: What did the researchers conclude from the study? What were the
limitations of the research?
NOTE: The article doesn’t need to be cited in the body of the annotated bibliography
because it is referenced in the beginning of the review. For any other sources used
(e.g. the text) you would cite as you normally do and list them in the reference section.
[Analysis of the article: 1-2 paragraphs describing the following: Whether or not the
points made by the author are logical and supported by evidence and whether the author
demonstrates any bias in presenting the arguments. Were other arguments or possibilities
considered? Are the author’s conclusions supported? Do they fit with your understanding
of the topic and your textbook's description (cite the textbook and any other sources you
use for analyzing your article – include any additional sources you cite as part of your
analysis in your reference list)? Why or why not (provide support for your opinion)?]
3
Example of formatting:
Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by
physicians from systematic review to taxonomy and interventions. BMC Health Services
Research, 10(1), 231-248. doi:10.1186/1472-6963-10-231
Authors conducted a systematic review of research papers between 1998 and 2009 that
examined physician perceptions of barriers to implementation of electronic medical
records. An examination of 1671 articles….
DeVore, S. D., & Figlioli, K. (2010). Lessons Premier hospitals learned about implementing electronic
health records. Health Affairs, 29(4), 664-667. doi:10.1377/hlthaff.2010.0250
Premier healthcare alliance is a network of 2300 non-profit hospitals and 63,000
outpatient facilities in the United States, This paper summarized lessons learned from
reviewing implementation practices within their system….
4
References
List any references you cited in your analyses of your chosen sources. DO NOT list the references ...
Training Therapists in Evidence-Based Practice A Critical.docxjuliennehar
Training Therapists in Evidence-Based Practice: A Critical
Review of Studies From a Systems-Contextual Perspective
Rinad S. Beidas and Philip C. Kendall, Department of Psychology, Temple University
Evidence-based practice (EBP), a preferred psychologi-
cal treatment approach, requires training of community
providers. The systems-contextual (SC) perspective, a
model for dissemination and implementation efforts,
underscores the importance of the therapist, client, and
organizational variables that influence training and con-
sequent therapist uptake and adoption of EBP. This
review critiques the extant research on training in EBP
from an SC perspective. Findings suggest that therapist
knowledge improves and attitudinal change occurs fol-
lowing training. However, change in therapist behaviors
(e.g., adherence, competence, and skill) and client out-
comes only occurs when training interventions address
each level of the SC model and include active learning.
Limitations as well as areas for future research are
discussed.
Key words: dissemination and implementation, evi-
dence-based practice, systems-contextual perspective,
therapist training. [Clin Psychol Sci Prac 17: 1–30, 2010]
The American Psychological Association (APA) and the
American Academy of Child and Adolescent Psychiatry
(AACAP) support the provision of evidence-based prac-
tice (EBP; American Academy of Child and Adolescent
Psychiatry, 2006; American Psychological Association,
2005). However, a report by the United States Surgeon
General (1999) suggests that the majority of clients with
mental illness do not receive EBP. There are obstacles in
the dissemination and implementation (DI) of EBP into
clinical practice (e.g., criticism of treatment manuals,
inadequate training, and unsupportive organizational
climates). Understanding how to best disseminate EBP is
paramount to reducing the gap between research and
practice (Addis & Krasnow, 2000; Hayes, 2002;
Herschell, McNeil, & McNeil, 2004).
Multiple terms have been used interchangeably, and
at times inaccurately, in this area (Kendall & Beidas,
2007). EBP1 as defined by the American Psychological
Association (2005) is ‘‘the integration of the best avail-
able research with clinical expertise.’’ ESTs refer to
psychological interventions that have been evaluated
scientifically (e.g., a randomized controlled trial, RCT)
and satisfy the criteria outlined in Chambless and
Hollon (1998). DI research includes the purposeful
distribution of relevant information and materials to
therapists (i.e., dissemination) and the adoption and
integration of EPB into practice (i.e., implementation;
Lomas, 1993). Our focus is on training as it relates to
DI research: How does training influence therapist
knowledge and behavior (adherence, competence, and
skill), and how does the therapist’s context (organiza-
tional support and client population) influence adop-
tion and implementation of interventions ...
Getting Your Feet Wet Becoming a PublicHealth Nurse, Part 1.docxgilbertkpeters11344
Getting Your Feet Wet: Becoming a Public
Health Nurse, Part 1
Lee SmithBattle, R.N., D.N.Sc.,
Margaret Diekemper, R.N., M.S.N., C.S.,
and Sheila Leander, R.N., M.S.N.
Abstract While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described, much
less attention has been given to the knowledge derived from
practice (clinical know-how) and the development of PHN
expertise. A study was designed to address this gap by recruiting
nurses with varied levels of experience and from various practice
sites. A convenience sample of 28 public health nurses and seven
administrators/supervisors were interviewed. A subsample, com-
prised of less-experienced public health nurses, were followed
longitudinally over an 18-month period. Data included more
than 130 clinical episodes and approximately 900 pages of tran-
scripts and field notes. A series of interpretive sessions focused
on identifying salient aspects of the text and comparing and
contrasting what showed up as compelling, puzzling, and mean-
ingful in public health nurses’ descriptions. This interpretive
analysis revealed changes in understanding of practice and cap-
tured the development of clinical know-how. In Part 1, we
describe the sample, study design, and two aspects of clinical
knowledge development—grappling with the unfamiliar and
learning relational skills—that surfaced in nurses’ descriptions of
early clinical practice. In Part 2, which is to be published in the
next issue of Public Health Nursing (SmithBattle, Diekemper, &
Leander, 2004), we explore gradual shifts in public health nurses’
understanding of practice that led to their engagement in
upstream, population-focused activities. Implications of these
findings for supporting the clinical learning of public health
nurses and the development of expertise are described.
Key words: clinical knowledge, community health nursing,
home visiting, public health nursing.
While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described
(Kenyon et al., 1990; Bramadat, Chalmers, & Andrusyszyn,
1996; Block et al., 2001), much less attention has been
given to the knowledge derived from practice (clinical
know-how) and the development of PHN expertise. This
study was designed to address this gap and to draw
on scholarship regarding the role of experience, percep-
tion, embodiment, and engaged reasoning in the develop-
ment of expertise (Schon, 1983/1994; Dunne, 1993;
Benner, Tanner, & Chesla, 1996; Dreyfus & Dreyfus,
1996; Benner, 1999, 2000a; Benner, Hooper-Kyriakidis,
& Stannard, 1999). In describing the experiential gains,
ethical discernment, and perceptual acuity central to clin-
ical expertise in acute care settings, Benner and her col-
leagues (1984, 1996, 1999, 2000b) have articulated crucial
distinctions between theoretical, applied knowledge
(knowing-that) and the practical, engaged reasoning
(knowing-how) that responds to.
Occupation Based Intervention or Occupation Centered Practice is a modern tool especially used by Occupational Therapist where assessments, interventions and evaluations are based and focused on occupation. It is based upon client centered practice grounded by Clinical Reasoning of how Occupation can enhance the therapy.
I've made all the changes discussed - I took out about 5 slides - got the sunnybrook stuff down from 7 to 2
hope you are all OK with it I alos took out one of my two imagine ifs - one is fine for me
note I have created two options -the et-hp is essentilly as it was with content for me. the option2 has heading changes ans transition slides - and may work better - see what you think!
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
BÀI TẬP BỔ TRỢ TIẾNG ANH GLOBAL SUCCESS LỚP 3 - CẢ NĂM (CÓ FILE NGHE VÀ ĐÁP Á...
July13 2010 meaning gap
1. Finding Meaning in our Occupation: Filling the Meaning Gap
July 13, 2010 draft (4852 words)
Introduction
The practice vision for Occupational Therapy is client-centred enablement through occupation
(Townsend & Polatajko, 2007), internationally espoused by leaders of our profession (AOTA, 2002; CAOT,
1997, 2007; Christiansen & Baum, 1997; Christiansen & Townsend, 2004; Kielhoffner, 2002, 2004; Law,
Polatajko, Baptiste & Townsend, 1997; Law, Baum & Baptiste, 2002; Townsend & Polatajko, 2007; Wilcock,
1999), and Every ooccupational therapist clinicians useknows that occupation ias the basis of our practice. Or
do theywe?
Since graduating (I, first author, Fran) have increasingly experienced witnessed first-hand the move to
increasingly disease-oriented health care and experienced and found that even occupational therapy colleagues
devalueding activity-oriented interventions. There wasappeared to be a fear of being seen as keeping people
busy, spending time on elemental menial activities, and not being understood acknowledged as a ‘legitimate
scholarly’ profession. While Occupational Therapy theory continually championed the use and application of
occupation as therapeutic means, the lived experience of occupational therapists’ practice did not always appear
to be congruent. An opportunity to investigate the personal experiences of infusing occupation into everyday
practice arose when an organizational change occurred in the teaching hospital in which I worked.
In the year 2000 three urban Ontario hospitals with distinct and different organizational structures, client
populations and occupational therapy departments, merged through a legislated amalgamation. A new program
management organizational structure was developed and oOne occupational therapy service was created for the
three campuses, with (Fran, first author) as the professional leader. Fran took the opportunity to focused on
occupation and occupation-based practice as a unifying concept for the new service. A variety ofVaried, on-
going strategies were incorporated within the service are used to foster a culture and process that which
promotes reflective practice amongst occupational therapy practitioners, including. Some of these include:
dissemination of articles related to occupation-based practice, with structured opportunities for discussion; an
annual, individually written opportunity for reflection on practice moment/s, with opportunity to share through
sharing with peers and written commentary; and professional development retreats with occupation foci such as
occupational science and enabling occupational engagement. A central occupational therapy education council
was developed with members drawn from across the three campuses.
One of the Another key strategiesy was the development and implementation of the research study
described in this paperarticle. Fran and Anne and Fran (the first and second authors) had previously formed a
professional relationship, through their common roles and interest in clinical education, mental healthpractice
issues, and occupation-based practice, and interprofessional collaborative practice. Anne joined the education
council and Fran, aAware of Anne’s shared professional vision, Fran approached her to be a co-PIprincipal
investigator for the study. Fran also coordinated a central occupational therapy education council, with an
additional five members representing practice areas across the campuses. These representatives were also
invited to participate in the study as co-investigators and participants in the participatory action research
study.The study participants, occupational therapists in the new centre, provided their perspectives on the
incorporation of occupation within their particular clinical practices.
Through extensive iterative analysis of the data, the authors (we) discovered that therapists search for
meaning in their own occupation of providing occupational therapy. For some therapists the meaning is
realized, and for other therapists finding personal meaning in their occupation is elusive. When therapists
struggle to find personal meaning and value in their occupation of being an occupational therapist, the a
meaning gap is experienced by occupational therapists. More importantly, we identified and will describe
herein possible solutions and strategies to address the meaning gap.
Background
Occupation has been a core concept since the inception of the Occupational Therapy profession (Meyer,
1922), but the role and significance of occupation has shifted over the decades from use as a therapeutic
2. Finding Meaning in our Occupation: Filling the Meaning Gap
medium to enablement (Polatajko, 2001). In Enabling Occupation II, occupational therapy practice is viewed to
be driven by theory and process instead of method, and Townsend and Polatajko (2007) envision a future for
our profession to be “occupation-based” and “focused on enablement,” so that all people may be “engaged” in
“meaningful occupation.” That is, our practice is not defined by tasks and procedures, but by the systematic
series of enabling actions that are grounded in occupational theory.
Over the years however, occupational therapy practice has been described as narrowed to a component
approach of “assessing, fixing, adapting, remediating” specific medical problems (Wilcock, 1991), which is
most obvious in teaching hospitals with clinically defined programmatic areas (Baum, Berg, Seaton, & White,
2002; Crabtree, 1998; Jongbloed & Wendland, 2002). Further, research into occupation-based practice has
primarily focused on service delivery of specific treatment modalities and its application to particular client
populations. Such medical and illness focused models of care and research (Bryen & McColl, 2003; Whiteford,
Townsend & Hocking, 2000) lead therapists to translate broad occupational experiences into basic medically
measurable components which do not encompass the full scope of enabling occupation (Mattingly & Fleming,
1994; Cockerill, Scott & Wright, 1996), and which may be disconnected from the meaningful occupations that
our profession values and endorses. As Hasselkkus (2002) summarized, “occupational therapists are caught up
in a balancing act as they strive to function both within the dominant health care paradigm of the human body as
machine and within the newly emerging paradigm of the human body as lived experience” (p.92).
The current Canadian framework and model for Occupational Therapy practice endorses that partnering
with clients to enable meaningful occupation optimizes clients’ enagagement and performance (Townsend and
Polatajko, 2007). This assumption may be extended to the occupation of occupational therapists; that is, when
we as occupational therapists find our occupation meaningful, we will be engaged and performing optimally at
enabling client’s occupation. Meaning in Occupational Therapy literature has been discussed as a broad concept
as it is related to understanding the experiences of our clients (Hammell, 2004; Hasselkus, 2002; Wilcock,
1998), and may be understood as a sense of value, purpose and fulfillment in what we do, and how we exist,
interact, contribute and envision possibilities.
However, there is little research into the meaning that occupational therapists find within their own
occupation-based practice experiences. Two recent studies which did examine the meaning of practice in
paediatric practice (Trenc Smith & Kinsella, 2009) and in acute physical settings (Robertson & Finlay, 2007)
identified that occupational therapists found meaning through making a difference in clients’ lives and working
within a supportive, multidisciplinary team. Trenc Smith and Kinsella additionally categorized that meaning
was found through relating to clients as human beings, permission to have fun, congruency of values, and an
artistry of practice, and participants from Robertson and Finlay’s study also described coping strategies to deal
with frustrations and demands of their work. In both studies, participants described examples from typical
practice experiences which they reflected to have contributed to meaningful work and interpretation of the
participants’ interviews did not explicitly identify gaps in meaning. The premise of this paper is that filling a
meaning gap in our occupation as occupational therapists is key to assisting occupational therapists find
meaning in their occupation.
Method
The research method chosen was a modified participatory action research strategy. Participatory action
research strategies involve participants in the design and implementation of the research project (Whyte, 1998).
The research group consisted of the two co-principal investigators of the research project who were two senior
occupational therapists employed at the institution and five staff occupational therapists who were members of
the OT educational committee. The five staff occupational therapists were both members of the initial research
team and research subjects.
There were three phases to the research project. During Phase one ethical approval was received from
The Sunnybrook and Women’s College Health Sciences Centre Research Ethics committee (approval #?). The
semi-structured interview format was developed by the research group and the first external interviewer (a
recently graduated occupational therapist who was not known to the facility) piloted it with an occupational
3. Finding Meaning in our Occupation: Filling the Meaning Gap
therapist from another facility who was not part of the research cohort. The interview format was revised for
increased clarity. The interview guide is available from the authors upon request.
Participant Recruitment
All occupational therapists from the institution were invited to a departmental inservice/retreat on
Occupational Therapy and Occupational Science where the research project was launched. Therapists indicated
their willingness to be contacted by the external interviewers for a semi-structured interview. Participation was
voluntary and anonymous as the research team was not aware of the identities of those who chose to participate
or not. Two external interviewers who were recently graduated occupational therapists, who were not
employees of the hospital, conducted the semi-structured interviews.
Research participants were recruited from all the occupational therapists practicing at the institution
during the data collection period following the launch in 2003? until 2005????. 13 subjects consented to be
interviewed and audio taped but one individual withdrew consent subsequently and that data was not included
in the analysis.12 out of how many possible? Twelve subjects were interviewed. 25% of the sample had
worked for less than two years, 25% had worked between 2 and 5 years, 17% had worked between 5 & 10years
and 33 % had worked for over 10 years. Subjects identified their area of practice as mental health 33%,
ambulatory 17%, long term care 8% acute medical care 42%. The sample size is typical of small scale
exploratory qualitative studies.
The recruitment period was prolonged by the disruption of normal functioning in the institution caused
by SARS. The majority of the interviews were conducted by the second external interviewer because of delays
in recruitment due to SARS. All individual interviews were audio taped and transcribed verbatim.
Data analysis
Data analysis was an iterative process conducted in Phase 1 by the entire research team. Initially open
coding of the data broken down into units of meaning followed by synthesis using the Person Environment and
Occupation framework to structure the analysis and develop themes. Detailed fieldnotes of the data analysis
process and the investigators reflections were kept.
As this was an iterative process, in Phase Two, the themes that emerged from the data analysis were shared
with the occupational therapists at a second retreat in October 2006. All members of the occupational therapy
who attended a half day Occupational Therapy retreat and gave consent participated in focus groups. The
normal turnover in the department meant that some of the individuals participating in the focus groups had not
been employed at the facility during the initial launch of the project. Three focus groups were held
simultaneously. In these focus groups, the research team’s initial thematic analysis was presented and discussed
by staff occupational therapists. Focus groups were facilitated by clinicians from other health profession
disciplines who were experienced facilitators. The focus groups were audio taped and transcribed verbatim.
The focus groups were seen as part of the research strategy to deepen the thematic analysis. .The focus
groups provided an opportunity for all participants to learn about the research analysis to date and continue to
reflect on their own practice. It also provided an opportunity for member checking to enhance trustworthiness.
Member checking is a method of going back to the participants in a qualitative research study and collecting
feedback about the resonance of the themes in capturing the participants’ experiences.
In addition to participating as an interview subject, the therapists who were researchers/participants were
involved in most aspects of the research project including: the project design; the development of the semi
structured interview tool; planning and implementing the initial occupational therapy departmental in-service
where the research project was launched; participation in initial data analysis and participation in presenting the
data at conferences. As this was an iterative process, therapists also participated in planning and implementing
of the second retreat during which the focus groups of occupational therapists were held.
4. Finding Meaning in our Occupation: Filling the Meaning Gap
In Phase 3, post focus group, authors continued to analyze the initial transcripts and reflect while the other
members of the research team discontinued their participation. There was a decision to reanalyze the initial data
as the PEO framework did not fully capture all elements of the transcripts. An additional investigator was
invited to join the team the first 3 authors/investigators continued to immerse themselves in the data, reflect and
reanalyze the initial transcripts. The fourth author did not do primary re- coding but participated in thematic
development.
Results
One over arching meta theme of the meaning gap emerged through our analysis of the data. This refers
to the gap that can occur between how therapists believe occupational therapy should be practiced in an ideal
world and how they do practice in the real world. Florence clearly articulates this meaning gap as a struggle
between her expectations of herself and the demands and structure of her work on a daily basis. She contrasts
her area of focus with a broader understanding of occupation. She also talks about how she “tries to make
herself feel better as an OT” by bridging that meaning gap “outside of the regular part of the job” She continues
“So we are focused on the occupation of work, you know, or paid employment, whereas as an occupational
therapist you want to look at occupation much more broadly.”
This meaning gap also emerged when another therapist, Brooklyn, reflected on the relationship/gap
between occupation and her role as an occupational therapist in the following way: “I think I facilitate people
to become independent but maybe not necessarily in occupations that are significant or important to them.”
Other therapists appeared to have found a way to bridge the meaning gap for themselves. They
experienced themselves as finding personal meaning and satisfaction within their own occupation despite
challenges in their work environment, In Gabrielle’s words, “And so seeing the confidence that’s built from
engaging in occupation, seeing that his self-esteem and overall quality of life was improved from engaging in
occupation, that’s really—that’s the point to being an OT”. Chloe adds, “If someone is engaged in an
occupation that they find personally meaningful and whatever is meaningful to them . . . then that all impacts
their health in a positive way”.
Four themes emerged from our meta theme of the meaning gap, all of which elaborate different aspects related
to the meaning gap. These are as follows:
• The Job versus Real OT
• Co-creating occupational meaning
• Meaning transforms doing
• Finding occupational meaning is personal
The job” versus “Real OT”
The first theme that emerged was “The job” versus “Real OT.” Therapists discussed a clash of expectations
between being able to fully realize scope of practice in enabling occupation, and negotiating the expectations of
other staff, constraints of the work environment and hospital policies.
Ava described the struggle with programmatic demands:
We always struggle with being true to our profession and yet being true to the programme that we work in.
And very often I think it's hard to say that I've been able to balance both in my clinical practice.
Lily spoke of challenges to maintain a focus on occupation within the dominant medical model paradigm:
5. Finding Meaning in our Occupation: Filling the Meaning Gap
So in acute care, especially when it's a very medically focused injury-related type of arena, this type of
activity isn't first, not even second, sometimes not even in the whole scope of the day. So that makes it
always a battle, sort of, 'well what are you doing? Why are you making this harder for us' all around.
Therapists identified various aspects of the meaning gap dilemma, including programmatic demands, time
constraints imposed in acute care environments, a medical model focus as opposed to an occupational
paradigm, and team members’ limited understanding of their role. Therapists’ strategies to address the dilemma
are described under the sub themes of negotiating the team environment and enhancing the understanding of
the OT role.
Negotiating the team environment
Many therapists identified the team environment as an important factor in how they were able to enable
occupation with clients. Their perception of support, value and understanding of an occupational focus from the
team varied.
Gabrielle, felt there was buy in and support from other team members:
We have a really strong cohesive, trusting community that I can rely on without a doubt. So, I can trust on
anyone on my team that if I'm not there that day, and I wanted to explore something that came out of the
COPM, for example,…that someone else on the team will follow through with that.
Ava, on the other hand, felt her team members did not understand her focus on occupation. “I think their [the
teams] understanding is very much [safe] and independent in function, but that's not what occupation is all
about.”
Not being understood by the team impacted professional identity and how therapists see themselves. Megan
reflected, “with OT’s, some of our things that we do are very common sense things. So it's almost like you
have to validate yourself, you have to validate your profession.”
Enhancing understanding of the OT role
Therapists spoke of challenges they encountered and strategies they developed to enable their own
occupation within their teams, including articulating their role through words and actions.
Whereas Ava developed and “documented” her “non-traditional,” “unique” “role for this program,” Lily
preferred to “educate one-on-one”:
We…corral some of the nurses, 'oh yeah, he's got a great nurse today, let's get this pattern going', and then
somehow it's harder to change a pattern back if the pattern's existing. So we'll post things behind beds ‘up
daily, up and out of the room to see OT, likes to be by the lounge’, so we'll push a lot of that. And usually
when the pattern is rolling, then it's hard then for one nurse who has them for three days to suddenly say,
'well they don't really get up on my shift'. Because then everybody says, 'well they do on mine, and they
have been for the last two weeks, what do you mean they're not getting up on your shift?' So we try to do it
that way, more of a one-to-one.
6. Finding Meaning in our Occupation: Filling the Meaning Gap
In some teams, therapists felt they were “pigeon-holed” into a limited scope. Hanna said, “I think I've tried to
really expand my role. I didn't want to just do wheelchairs, and I felt that I could do more.” She continued:
When I first started I was getting a lot of referrals for wheelchairs, wheelchairs and more wheelchairs, and…
I really worked on, you know, other areas, like going in, like even on the dementia unit, you know, ‘if you
guys are having difficulty I can come in and maybe see if there are some strategies that we can try, or you
know, adapting to the environment, like different things that have to do with occupation’. And so now I'm
actually getting a lot more referrals that are very--there's quite a big variety to them.
Co-creating Occupational Meaning
The second theme of co-creating occupational meaning refers to the process of interacting with the client to
find occupational meaning and enable occupational engagement. For some therapists it represented those
moments when they were living most fully their ideal of enabling occupation. In these moments therapists
describe experiences of personal occupational fulfillment and meaning as they work with clients. When
therapists do not see meaning in the activities or tasks they engage in with clients or when clients do not appear
motivated or engaged, the therapists may experience a form of the meaning gap.
Lily describes the difficulties when there are challenges in co-creating meaning with a client in the following
way:
And if the client isn't totally engaged in that as well, that's what I mean about if the motivation isn't there,
then I'm the only one who seems to be trying to engage somebody in an occupation. So I find that
difficult
Jessica gives an example of the process of co-creating meaning with a client:
He wanted to live more independently, have his own room, have more privacy, live in a smaller house, and
so we supported him through that and it's amazing how just being involved in these self-care occupations
how it had a huge impact, not only on his health, his well being, but his quality of life…. And his quality of
life, I have to say, has tripled.
Power of occupation to make a difference
Therapists described the power of occupation to make a difference as an important impact of co-creating
occupational meaning. Passion and creativity emerged as an important part of the OT’s experience as they co-
create occupational meaning with their clients. This leads the occupational therapists to find more meaning in
their own occupation as an OT. Curiosity about the clients’ experiences, and a sense of mutual engagement and
reciprocity between the OT and the client were important aspects of co-creating occupational meaning.
Florence describes her thoughts with one client where she was wondering about the client returning to a
physically demanding job
even for me as an occupational therapist I was going, 'I don't know that I want to send this guy back to a
heavy job', I was questioning it. But this guy was so motivated and it really challenged me in my thinking
of what can a person do… So it was kind of neat, that one, in sort of challenging even me that I was
questioning should we be doing this, and yet a highly motivated client can transform your thoughts on
occupation.
7. Finding Meaning in our Occupation: Filling the Meaning Gap
Meaning Transforms Doing
The theme Meaning Transforms Doing emerged as we recognized that therapists ascribe different meanings to
the same intervention, for example self-care. Therapists who view the intervention as meaningful in its potential
impact on client occupational engagement, also highly value their identity as occupational therapists.
Kiera’s perspective:
If patients in this unit don't get a basis of stretching right way…they're not going to be able in the long run to
do any other functional activities…it's not necessarily the traditional round of OT, allows us to bridge that
gap, and we're able to get into their occupational goals… people that have great outcomes can often go back
to work, can lead a normal life, and patients with more complicated outcomes, they tend to not want to get
out in public and they tend to not be able to go back to their job, and often times they'll even need more help
at home, along with the scarring can also limit the function of that joint.”
The following are sub-themes of meaning transforms doing:
Meaning is ascribed
It is the therapist who invests an intervention with occupational meaning.
Gabrielle shares this example:
Even if I'm just attending Court with someone because there was some charge related to their mental illness,
I know that when Court is through and with whatever consequences they hear from the judge and the lawyers
and etc., that eventually that will lead back to them being more able to engage in occupations that are
meaningful to them because they'll have a better understanding about consequences of behaviours and what
they choose to do and not do…I don't think that there is one day in my practice that I fail to remind myself
about occupation.
Meaning has to be made visible
Therapists who locate their interventions within the context of meaningful occupation can diminish or eliminate
the experience of a meaning gap, viewing their practice as occupation-based.
Hanna describes a teachable moment:
Say Mr. Smith [pseudonym], I'm getting him a wheelchair, and she [the student] sees for Mr. Whoever, that
I'm getting him a wheelchair and then another resident I'm getting them a wheelchair, she's thinking 'my god,
all this woman does is wheelchairs'. But then I had to like kind of take her aside and say, ‘this person, how
are we helping her occupations? What are the things that they are wanting to do?’
Focus on the occupational narrative
Exploration of the client’s story, occupational goals, realities, and possibilities helps the therapist understand the
meaning of occupation for the individual.
Lily speaks of one of her clients:
I have a lady right now who's had quite a traumatic injury and it's a spinal cord injury, but she lives
independently in the community, she's got lots of clubs and social activities…and suddenly interrupted [by
this] event that she isn't sure will allow her to do any of these things again...which really brings me back to
that initial rapport building . . .to really see what drives people, what their passions are, why they do those
things that they do, how well those things are integrated and why they--did they love it? Was it something
that time passed and they just engaged in it?
Finding occupational meaning is personal
The process of finding occupational meaning appeared to affect and be affected by personal values and
therapists frequently used leading words such as “personal bent,” “personal perspective,” “individual sense,”
“different view,” and “my experience.” Meaning is personal, so it follows that finding meaning is also a
personal process. Megan described that her “individual sense of occupation is very different,” stating, “We learn
the same stuff, the same theory, but within each person is what your view of occupation is …So I think it's your
individual sense of occupation that sort of guides you where you want to go.” Lily discussed the influence of
8. Finding Meaning in our Occupation: Filling the Meaning Gap
personal “value systems which are kind of cultural”:
But that's sort of a personal bias I kind of see because I sometimes hold some value systems which are
kind of cultural in some ways, and then I see how that would motivate me to do certain activities that
others might question, or to my satisfaction I'm happy doing those in such a way but others might see no
reason behind why I would even engage in those things. So that's just personal beliefs, and if I never
was to voice them, they would have no idea why my occupations are chosen in such a way.
The following three sub-themes emerged within finding occupational meaning is personal.
Personal sense of occupation
Therapists offered personal definitions of occupation which revealed unique thinking, and which in turn
informed how they reflected about practice interactions. Brooklyn viewed occupation as “anything that we do as
human beings. It can be self-care, productivity or leisure.” Chloe agreed that occupation is “anything that
people do throughout the day, throughout their lives,...it can be very broad,” continuing that “If someone is
engaged in an occupation that they find personally meaningful and whatever is meaningful to them and it's
something productive, then that all impacts their health in a positive way.” and Wwhen asked if there is
anything in her daily work which is not related to occupation, she replied, “Not really. I'm trying to think. It all
eventually ties back.” Florence introduced another perspective, that occupation “can also be more passive
reflection, although we tend to think of occupation as doing, I think there's also those passive things like
reflecting on life. Just even that sense of spirituality could be considered an occupation although I'd say more
typically if I think of occupation it is more how we spend our time and engage in activity.”
Building Ooccupational perspective is evolving and internally motivated
In addition to differing understandings of occupation, therapists’ experiences with developing an
occupational perspective also differed. Gabrielle described that her "own understanding of occupation has
evolved over time to the point that now I feel very comfortable with it” and through a personal desire to “learn
more about occupation” because of “interest and motivation and initiative” that “exists from within.” Therapists
employed different strategies to develop an occupational perspective in practice, including formal “monthly
reflective practice sessions” and “informal networking” (Daphne), applying for and receiving a Canadian
Occupational Therapy Foundation grant to research how her work “is actually making a difference to these
individuals” (Ava); attending “rounds,” “in-services,” and “reading on my own time” (Chloe); “spend[ing]
more time with therapists just talking through why we are doing what we are doing and not going with the
status quo” (Florence); and dedicating a concerted effort to “translate [occupation]…and incorporate it… as a
team effort” as well as educate her clinical team about other roles she could fulfil, which resulted in her “getting
a lot more referrals” (Hanna).
Language creates meaning
Some therapists found using occupational language an ongoing process and opportunity for others and
selves to learn about occupation-based practice. Ava spoke about the need to “take advantage of opportunities,”
through “
Like for instance,…I'd really like to incorporate some other things into my clinical practice based on this
whole concept of occupation…I just think,...educating colleagues and sort of sliding that term ‘occupation’ and
9. Finding Meaning in our Occupation: Filling the Meaning Gap
you know, now and then,… if you use the lingo often enough, then they kind of become accustomed to it and
know that that's something that's fundamental or part of your practice.” And, Chloe identified the “systemic”
role of language “even [in] the assessment form” because “when I'm assessing, I'll like think of like what's the
next thing on the form and kind of ask based on that, and if the assessment form used those terms more or
reflected that a little more,… like just using the terminology …like what's hindering occupational
performance… then I think it influences the way I would kind of like think on a daily basis because it's hard to
really in your daily practice to like infuse that into it.”
Several therapists identified the role of language in creating meaning for their practice. Therapists
experienced different levels of ability and comfort in using occupational language into practice. Gabrielle, who
used terms such as “occupational deprivation,” and “occupational motivation” during her interview stated, “I
see a lot more exposure to the idea of occupation even in everyday language, replacing a word like functioning
with occupational performance. Say what you mean, and if you don't mean occupation and you mean activity
or task, say what you mean,” adding, “We don't use, as occupational therapists across the board, consistent
language. We don't use occupation when we mean occupation. We say ‘OT’ when we should be saying
‘occupational therapist’ to describe who we are to people.” Similarly, Brooklyn discussed the challenge in
incorporating occupational language, stating, “the terminology and the lingo of all that is not really there, you
know, we don't talk about that. Occupation is more like the performance [components] and…I don't necessarily
see this occupational view in health because it's not really established.” All these therapists inferred that use
ofing occupational language hadwas significancet to their everyday practice and the meaning they find in their
practice. Lily summarized, :
And if we are to engage in it and really be meaningful in it, then our research base should be
increasingly embracing...all that new language and terminology. My personal bent is “until there's a language
and terminology that's commonly used, there isn't going to be an understanding within the OT field...It's hard to
have that language sitting at the bedside trying to make it up.”
Gabrielle explains her personal processes of finding meaning, “We all come with different theories and I think
that guides us to how we see the world and how we interact with clients…So our theory is different, so I think
inherently occupation is central to what I do on a daily basis. But consciously on a different level as well, I
think that my thoughts are always on occupation for a client. When I see a client I ask them what their day has
been like. When I see a client for the first time I ask them what their routine is like in terms of what they do,
how they occupy their time, and when I talk to clients about their treatment time or their goals, that's my focus
as well, is on occupation.”