Article review: “Articulating an Occupational Perspective” by Njelesani et al (2014)

Article review: “Articulating an Occupational Perspective” by Njelesani et al (2014)

This article investigated uses of the term “occupational perspective” in order to clarify a standard definition for use in occupational science. This should make it easier to apply occupational science research findings in practice, the authors argue. In the end they came up with

“a way of looking at or thinking about human doing”

What is an occupational perspective then? According to the authors it’s not an occupational therapy perspective, since this term was one of the exclusion criteria in the Method section. The authors describe in the Findings the term as being used in relation to employment until the 90s when it became associated with Occupational Therapy and Occupational Science.  Research investigating it is mainly qualitative suggesting it is something abstract perhaps also explaining why there were so many different interpretations of the term in the articles Njelesani et al (2014) shortlisted. The research on occupational perspective covered a wide variety of client populations indicating it’s a concept that applies to all people with disabilities/illness.

detective-otter

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Just what IS occupation?

Just what IS occupation?

No, it’s not your job.

computer otter

Although in a way that can be part of one!  It’s any activity or task carried out which has an end goal and provides meaning to you. There are many definitions put forwards, all slightly different, which does make it hard to compare different articles or pieces of research effectively.  However it is generally agreed there are certain aspects of any occupation:

  • Form  the observable aspects of the occupation: what how & when
  • Function the way the occupation influences health, and its purpose or intended outcome
  • Meaning -the entire subjective experience of an individual who is engaging in the occupation

Considering occupations broken down in this way helps practitioners to understand why people choose to participate in certain occupations.

Analysing someone’s ability to carry out an occupational activity in order to assess where problem areas lie is the cornerstone of occupational therapy. The American Occupational Therapy Association (AOTA) has created a useful guide to the standardised terminology that should be used when documenting activity assessments (it can be found here for BAOT members).

Occupational science seeks to answer questions about the nature of occupation, such as:

  • WHO engages in occupations?
  • WHAT occupations are there?
  • WHEN do people engage in occupations?
  • WHERE do people engage in occupations?
  • HOW are occupations performed?
  • WHY do people engage in occupations?

 

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Sources:

American Journal of Occupational Therapy, March/April 2014, Vol. 68, S1-S48. [Access at: http://ajot.aota.org/article.aspx?articleid=1860439 for BAOT members]

Article review: “Occupational science: Adding value to occupational therapy” by Hocking & Wright-St.Clair (2011)

Article review: “Occupational science: Adding value to occupational therapy” by Hocking & Wright-St.Clair (2011)

Hocking and Wright-St.Clair outline the benefits that occupational science can bring to occupational therapy in practice.

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Source:

Hocking C and Wright-St. Clair V (2011) ‘Occupational science: Adding value to occupational therapy’ New Zealand Journal of Occupational Therapy 58(1): 29-35

Abstract:

We chart the scope, origin and purpose of occupational science, illustrating its relevance to occupational therapy with four case examples:

  1. using cooking to establish relationships with community leaders,
  2. applying theoretical understandings of the relationship between objects and identity to promote recovery,
  3. applying Lifestyle Redesign™ principles to practice with adults with arthritis
  4. addressing occupational deprivation in a secure dementia unit.

We argue that occupational science will expand the boundaries of occupational therapy, as graduates familiar with that knowledge enter the profession. To conclude, we outline how therapists can access occupational science knowledge to inform their practice.

Article review: “The Challenge of Occupation: Describing the Things People Do” – Clare Hocking (2009)

Article review: “The Challenge of Occupation: Describing the Things People Do” – Clare Hocking (2009)

Hocking says that occupational science must seek to provide in-depth information about what occupation is, rather than just how people engage with it or what they experience as a result of doing it. She outlines her idea of what the definition of occupation is and how it is context-dependent on the culture it occurs within.

otter reviewing paper
Story checks out.

As a result of increased knowledge she argues it would help OT practitioners to see people as ‘occupational beings’ and provide improved appreciation of the meaning occupation has to people’s lives, together with the demands required to carry them out. Using this knowledge would eclipse personal experience alone, for example you may know from personal experience that cooking a large meal is tiring and time-consuming and so may direct an Asian patient recovering from stroke to withdraw from the seemingly burdensome occupation of preparing dinner for her husband. But armed with research knowledge that meal preparation is seen as a gift to family, you could instead consider ways to adapt the occupation to allow the patient to continue since it holds meaning across this culture. Read more

Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Chronic conditions (such as COPD or diabetes) are increasing in Western countries like England and Holland. These long-term conditions need the patient to be active in managing their condition in order to achieve reduced financial healthcare burden and better quality of life for the patient.

In this way, evidence shows that a biopsychosocial model would benefit patient well-being and produce these financial improvements. However provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system.

So the biopsychosocial model is a great idea – how to implement it? Read more

Article review: “The role of mental health professionals in multidisciplinary pain rehabilitation programs” by Townsend et al (2006)

Article review: “The role of mental health professionals in multidisciplinary pain rehabilitation programs” by Townsend et al (2006)

Townsend et al (2006) write that traditional roles of psychologists are being challenged by the Multi-Disciplinary Team (MDT) treatment now required in order to treat patients with chronic pain according to the biopsychosocial model.

MDT of otters
MDT: Team Otter

Treatment of chronic pain was traditionally carried out according to a biomedical model- a patient after a car accident was treated for chronic pain syndrome but not assessed for PTSD, for example. Research has shown the efficacy of a biopsychosocial model in treating  pain, where social and psychological factors as well as biological are taken into account. Turk (2002) reported patient benefits of the biopsychosocial approach (with regards to chronic pain) as increase in functional ability, fewer disability claims, and less illness caused as side effects of medical treatment or examination. Where treatment ie pain reduction is not possible, the MDT will aim to maximise the patient’s functioning.

Townsend et al describe a case study about a patient Ann who underwent intensive 3 week programme with a MDT to cope with her lower leg pain and end dependency on pain medication. In the case study, the OT’s role in the MDT was to incorporate the various pain control strategies into activities of daily living (ADLs), using for example pacing techniques and appropriate body mechanics. They could possibly have been involved with the functional assessment and assisted with outcome measurement.

Read more

Article review: “An On-Site Job Evaluation Performed Via Activity Analysis” by Canelón et al (1997)

Article review: “An On-Site Job Evaluation Performed Via Activity Analysis” by Canelón et al (1997)

Activity analysis is used to evaluate the motor, sensory, cognitive,emotional, behavioural, cultural and social areas of the tasks being carried out in order to complete an activity. In this example, the Biopsychosocial approach is being used to guide the assessment of the patient.

Canelón et al analysed a patient who was experiencing pain in her right wrist following an injury in the workplace and subsequent hand surgery. The patient’s job involved processing insurance paperwork based at a desk workstation, and she was experiencing continued pain despite having an operation and prescribed medication to help with the pain.

Otter co-worker
I can has RSI?

They carried out an on-site job evaluation and  analysed each motor movement she carried out in great detail at her workplace. They also evaluated her communication style and social interaction with colleagues, concentration and organisation, emotional areas such as her need for gratification, and cultural influences. Read more

Article review: “Community Dwelling Elderly Women and Meal Preparation” by Eckel (2012)

Article review: “Community Dwelling Elderly Women and Meal Preparation” by Eckel (2012)

The researchers sought to identify which tasks in meal preparation were the most demanding for elderly women, and how they overcame these to continue preparing meals as they aged. Meal preparation was meaningful to the women as it was an important part of their self-identity.

prepping dinner of sea urchins.jpg

The COMP model was used to identify which tasks were important to the women. The PEOP model was then used by the researchers to carry out activity analyses for the chosen tasks.

They found that the difficulty in completing tasks as the women aged was not just due to biomedical functioning decreasing, but also environmental barriers. Often the women had carried out tasks habitually for a long time and when their physical functioning declined slightly it id not occur to them to change the environment to facilitate easier task completion. In this way the environment had become disabling since if it was altered the women would be able to carry out the tasks even with their decreased functioning.

This shows an example of the biopsychosocial (BSP) model in practice as it highlights the social/environmental factors affecting individuals (and influencing their physical functioning) as well as the traditional physical/medical factors according to the biomedical model, and highlights how other factors can influence or cause biomedical problems rather than them be the starting point.

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Sources:

Eckel E (2012) ‘Community Dwelling Elderly Women and Meal Preparation’ Physical & Occupational Therapy In Geriatrics 30(4) pp 344-360

Article review: “Occupare, to seize: expanding the potential of occupation in contemporary practice” by Robert Pereira (2015)

Article review: “Occupare, to seize: expanding the potential of occupation in contemporary practice” by Robert Pereira (2015)

There is an increasing paradigm shift towards including occupation (and defining it) within the wider professional OT theories, research and philosophies. Pereira looks at how we understand the term occupation in our professional language.

The etymology (origin of the word) is occupatio Latin noun for occupation. However when we talk about occupation it isn’t as a noun, it is as a verb where we describe to occupy, to possess, to take control of, etc. Therefore the Latin verb occupare (to occupy) is more representative of our use of the word occupation, he argues. When we think of occupation as something ‘doing’ rather than a ‘description’, it can influence how we think about it in everyday life; rather than focusing on what is being done in an isolated occupation task, we can think of the purpose of the goals achieved through occupation.

OTs may be unintentionally limiting their practice by misunderstanding the term occupation to mean occupatio and not occupare.

otter dictionary

Basically, try thinking of the term occupation as a verb rather than a noun, and see how it changes your perception of situations for example when applying OT models to practice.

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Source:

Robert Pereira (2015). Occupare, to seize: expanding the potential of occupation in contemporary practice. Australian Occupational Therapy Journal (2015) 62, 208–209

Article review: “Having and using objects in the western world” by Clare Hocking (2000)

Article review: “Having and using objects in the western world” by Clare Hocking (2000)

According to Riley (2012),  this article uses occupational science to illustrate the meaning of ‘ identity’ in the CMOP-E.

It describes how a sense of self and social identity are represented by the objects someone makes or uses. Using objects in this context includes making, wearing, maintaining or restoring, displaying, collecting and consuming objects, operating or using objects as tools, as well as purchasing things (the focus of consumer research). Hocking used information from sources of psychology, consumer research, sociology, anthropology, disability studies and popular literature to make her conclusion. This aligns with the view that occupational science draws from many different disciplines to create its understanding of occupation.

Western people use objects to create and express a sense of self and an identity, and that the way they use objects to achieve this is placed in a cultural and historical context.

The self is how we view ourselves internally, and our memories/knowledge of experiences that have shaped us.

Identity is how society views us, and assigns us a social identity.

otter seeing mirror of self

Objects are used as mirrors of self, reflecting attitudes, values, relationships & achievements. People selecting objects for themselves choose those that represent their ideal self and not actual self. Objects are used as mirrors of identity, especially clothing, and offer the chance claim or to buy into a desired social identity. They reflect desired social position, status identity, gender identity.

People use objects to transform or develop their identity, to become more successful, exciting, attractive, or socially statused. Westerner culture assumes that that people have an individual rather than collective identity. In other cultures eg India people’s preferred objects are those relating to family or communal prestige, rather than ones with individual meaning.

The more insecure Western people become in relation to the identity they want, the more they want the material symbols of that identity.

For Westerners using objects is on a continuum between Stoicism (practical, puritan,rational decisions about need, spiritual, simple, long term gain over short term reward) and at the other end of the scale, Romanticism (emotional expression, beauty for sake of it, self-expression, freedom of desire, complexity, conspicuous consumption, hedonistic (note; not the same as happy).

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Source:

Riley J (2012) Occupational science and occupational therapy: a contemporary relationship. Chapter 14 in Boniface G, Seymour A (eds) Using occupational therapy theory in practice. Oxford: Wiley Blackwell.

Hocking, Clare (2000) Having and using objects in the western world. Journal of Occupational Science vol 7 (issue 3), pp148-157.

Abstract: This interpretive study explores how Western people construct self and express identity though the objects they acquire, make and use in their day-to-day occupation. Drawing on literature from psychology, consumer research,sociology, anthropology, disability studies and popular literature, it proposes that people use objects to reflect self and identity, and to transform self and others. Using a history of ideas methodology, the author argues that Western people take for granted that the objects they have and use reflect an individual rather than collective identity, and suggests that the ways people use objects to construct self and identity are informed by the philosophies of both Stoicism, which emphasises self discipline and rational decision making, and romanticism which celebrates people’s emotional depth, creativity and self expression.