Monthly Archives: July 2007

Doing occupational therapy differently – have we considered it?

Frost

I was watching TV last night and they were talking about the Accident & Emergency department crisis in New Zealand where people have to wait for hours and don’t always get the service they need. They showed an A&E department in Australia – who had taken some learning from the toyota motor cars assembly facility – the ‘lean’ method/technique (or some similar word) as a way to address the waiting issue and to avoid getting into traps that prioritising patients though a triage system often brings. They were focusing on seeing the person and getting the intervention right by the right people at the right time, seeing the whole and not just the parts, focusing on the best outcome.

 

I’m not in the heart of practice any more but can remember going to one job where it felt that the people in the job before me had spent most of their time assessing and putting people on the waiting list and not therefore having time to treat the clients. The TV programme and my experience made me wonder whether it was time for us to also think about how we prioritise our clients and whether prioritising is the most effective way to go. I also know that the pressure of waiting lists often gets to therapists. Seeing people who have beenwaiting for a time is also frustrating as it often means intervention has become harder and the client and the family are incredible frustrated about having had to wait.

Interesting on the same night there was a segment on a new stroke initiative to give rehab to stroke clients who have received little since they returned home. It’s a sad fact that rehabilitation seems to be a dying art – so great to see someone pushing for it’s return. I guess what it reiterated for me is that some services that were previously provided by hospital facilities are going to need to be championed by non-government organisations if they are to survive – and as occupational therapists we need to be advocating hard ensure clients have the possibility to receive services such as rehabilitation.

Food for thought

Advertisements

Occupational Therapy Communities of Interest

 

I have been doing a bit of reading about communities of interest and thinking about how belonging to such communities contributes to and enhances the experiences we have.

The literature describes communities of interest as being people with a collective perspective, a common; identity, purpose, and concerns. And importantly they are about sharing and social interaction between the people in them. How well the community works is seen to have an effect on the well being of the people.

Working in an occupational therapy school (you could probably substitute any type of school) the role we have to establish, maintain and grow the community of staff and students is a complex one. Ensuring everyone from the newest of students, to staff who have been within education for some time all feel apart of this same community.

The curriculum we have plays a large part in enabling students and staff to develop a collective perspective, an occupational therapy identity etc. But perhaps of equal importance is the other things that happen within the school e.g the events, the structures and of course the environment which contribute to ensuring we have a strong community of interest. A community that assists students and staff through the hard times, which celebrates the good times, and has a positive effect on everyone’s sense of well being.

My reading would indicate that communities work best when the people in the community feel that their; views are heard, where they are a part of the decision making, where they have a sense of belonging, unity, affinity and compatibility.

I see our challenge as one of ensuring we have not only the best curriculum we can, but ensuring the environment and the other activities within the school also work to develop a positive community of interest inclusive of both students and staff.

This isn’t rocket science and isn’t new, however sometimes it’s good to stop refocus, and reset priorities.

I believe the same thinking applies to teams of occupational therapists in practice.

These URL’s helped shape the thinking in this blog:

http://crawford.osu.edu/cd/cd/myweb2/concept_of_communities_of_interest.htm

http://www.dlg.nsw.gov.au/Files/CommissionsTribunals/bconcept.pdf

Island off St Clair


Occupational therapy is it boring??

Blog statistics are interesting things. I was intrigued to see someone had done a search on “occupational therapy boring” and some how they had got to my site !!. It made me stop and think is occupational therapy boring?, have I been bored being an occupational therapist?, are students bored?  What is boring about? is boredom internally or externally driven? 

When I look at the dictionary the following phrases are associated with bored, boring, or boredom: A dull and uninteresting activity, tedious, feeling weary and impatient because one is not well occupied.  

Occupational therapists should know about being well occupied, but do we apply our knowledge to ourselves? 

And the opposite of bored  = excitement.

Strong, R., Silver, H., Perini, M., & Tuculescu, G., (2003). Boredom and its opposite. Educational  Leadership, 61(1), 24-29. 

Have this to say about boredom in the classroom: “Adam Phillips (1993) describes boredom as both: 

A form of depression—a kind of anger turned inward;

and A longing for that which will transform the self, making life and learning meaningful. 

This double aspect of boredom—its negative brooding and its positive yearning—makes it difficult to deal with in the life of classrooms… Instead of [teachers] asking, Am I boring?, we can ask, when are students most likely to be interested enough to overcome the boredom that occasionally haunts almost any sustained act of learning? In other words, When and under what conditions do students care enough to work hard? This question shifts attention away from an obsession with boredom and toward a more productive fascination with ordinary human interest.”

And “student achievement is more highly correlated with student interests than with cognitive ability, then we should make curriculum design based on human interests a primary focus for professional development” 

for more you will find the article on http://www.ascd.org/authors/ed_lead/el200309_strong.html  

And so clearly there are ways to help students be less bored  but is occupational therapy boring? I look forward to hearing from others….

Blogging duldrums

Harry

I seem to have the Blogging duldrums. I have a few things that I could blog about but it seems like a bit of effort at the moment. And so a post that doesn’t require too much thought is in order….

I was doing a little procrastination at the end of the day yesterday when a survey on using technology for professional development popped up in my emails – and so it got my attention. It made me realise just how dependent I am now on the web and yet 10 years ago it was not a feature of my work life at all, I started to wonder how I coped without the instant information I now have at my finger tips.

Did it mean I relied more on my own analysis and interpretation?…. was it easier to be confident in my own abilities and reasoning i.e. no checking it out on the net …. does the web mean we individually now know less or more? …. does it help us articulate ideas more easily or less? …. what do we do better as a result of the web and what do we do less well?

I think this post is turning out to require more thinking power than is available tonight as I multitask watching TV (as I was going to have an evening blobbing out) blogging, and trying to fit the cat and the lap top on my lap at once. So if anyone else has any thoughts they would be appreciated.

Supervision as professional development

Frozen Cabbage     It’s still rather cold here in the far south.

I have been interested in supervision for some time and was involved in doing a small qualitative study that looked at supervision of occupational therapists in New Zealand. There were two parts to the study firstly participants in the study were asked what supervision is.

In defining supervision participants spoke of the activities of supervision, the nature of the supervisory relationship and identified three key concepts that described the purpose of supervision. The activities of supervision were raising issues and talking through problems: generating solutions. Raising issues gave a starting point from which supervision could begin. The issues raised were seen as emerging from a wide variety of contexts; those that relate to one’s professional and personal self, those that highlight one’s interactions and interventions with clients, and lastly those that relate to the wider context in which the person worked, for example the team or the organisation. Supervisees were clear that the activity of talking through problems: generating solutions was not about being given answers but rather enabling supervisees to work through their own solutions with guidance and support from a supervisor.

The quality and nature of the supervisory relationship was seen as critical to the effectiveness of these activities. In defining supervision participants described the nature of the supervisory relationship as one of mentoring which suggests as important the notion of nurturing within the relationship. All of the participants saw that the supervisory relationship must be supportive and trusting. These concepts provided a picture of a relationship that should be non-judgemental, respectful, encouraging, and that felt caring. It excluded the elements of oversight, checking and evaluation indicated in much of the literature. Interestingly mentoring was a term that was less frequently used as the interviews progressed and the characteristics of a supervisor became clearer.

For participants the purpose of supervision related to three key concepts; keeping safe, the opportunity for reflecting on practice and the provision of knowledge by the supervisor. Participants were concerned that their role and practice as an occupational therapist put them at risk. They felt at risk firstly by, being in situations where they might find their competence questioned. Secondly, due to the nature of working with people who were under stress or thirdly where they themselves felt physically or psychologically unsafe. Having a means to explore ways of keeping safe was therefore essential. Supporting this by looking at what they were doing in practice and how they were doing it, through reflection on practice and the feedback they received when involved in reflection were important purposes of supervision. Not all therapists have sufficient experience or resources for the variety of challenges that arise within their work place, particularly those new to occupational therapy or those settling into a new role. For these people the provision of knowledge is important. More skilled therapists likewise acknowledged that the knowledge supervisors impart as a part of offering different perspectives or suggesting resources is beneficial.

What really struck me about how the participants defined supervision is that they were showing that they saw that this was a process that could work for them. They clearly wanted to be able to lead in the supervision by having a system that enabled them to work through their own challenges, and at the end to feel that they had come to their own solutions. I think the other thing that strikes you is the committment the therapists were wanting to make to ensure that they were continuing to grow as therapists. In looking at the ability technology now gives us we clearly need to ask if there is a role for web 2 and the internet in this process.

Asia Pacific Occupational Therapy Congress June 21-27th

Asia Pacific Lion dance

I have just been to the Asia Pacific Occupational Therapy Congress held in Hong Kong where it is definitely warmer than Dunedin at this time of year. In fact I understand there was snow at my house when I was enjoying 29-32 degrees in Hong Kong. It certainly rates a blog or two so here is the first.

Part One: Finding out about therapists and therapy in the region:

I was interested to hear that China has approx 60 schools where they run programmes based on occupational therapy / physiotherapy – creating what they term rehabilitation therapists. It appears likely that in the future these will become physiotherapy and occupational therapy programmes, which it is hoped will then meet the World Federation of Occupational Therapy (WFOT) minimum standards for training for occupational therapists. So hopefully soon occupational therapy will be flourishing in China! The hard part will be getting enough educators in occupational therapy to do the training. As I understood it there are perhaps only 40 graduates of WFOT schools in China currently.

There appeared to be some interesting similarities with Canada as when it was running courses (up until the mid 80’s) where students were dual trained in both occupational therapy and physiotherapy most students came out taking jobs that were more physio based. Occupational therapy only flourished in Canada when they moved to separate schools, hopefully the same will occur in China. Going by the growth of occupational therapists in Canada there must have been a huge growth in, and an acknowledgement of the need for our skills by clients and the health care system.

Thinking about this it renewed an old ‘wondering’ for me – mind the link might only be visible to me (but maybe you can figure out the jump in logic). I started to redebate whether the same kind of issues might be true of the move to use more case managers that we seeing in New Zealand and wonder whether clients miss out if they only receive the core skills associated with this role and not receive specific occupational therapy, social work etc. I guess the question is do they know what they might be missing – if they have never seen the alternative. anyway back to the congress.

We heard most from therapists from Hong Kong I was fascinated by the amount of quantitative research being done. Here in New Zealand when research is done in occupational therapy it is more likely to be qualitative research. Asia Pacific wide the pressure for educators to produce research is inescapable, and the frustration about the poor impact score our research is given was universal (funding received for research depends on the perceived impact of the research).

There were a number of wonderful examples of therapists doing innovative therapy in some very under resourced areas, and of regions helping other regions.

There seemed to be an increasing awareness from different countries in the Asia Pacific region of the need for occupational therapy to be culturally appropriate. Which has resulted in some questioning of occupational therapy models based on Western values. It seems that whilst there is an awareness of a need to acknowledge and do something to acknowledge the different cultures, and the peoples of these cultures needs, that the direction is still not clear, although the Kawa Model is giving everyones thinking a bit of a push. This confusion/rebellion to me is all a part of the process of articulating an identity and for me is not is not unexpected as we only have to consider how long it took for the profession (which started in the West) to develop its first profession specific models. I hope that the debate continues. Perhaps it would be worth thinking/discussing the differences and similarities that exist in occupational therapy whereever they might be in the world. could always utilise appreciative inquiry (see below)