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Volume 76, Number 4
Table of Contents
From the Editor
Enabling scientific writing: Recent strategies implemented through CJOT
Muriel Driver Memorial Lecture 2009
Occupational therapy: A thread that weaves a lifetime
Barriers and facilitators to participation in work among Canadian women living with HIV/AIDS
Valerie Barkey , Elisa Watanabe, Patty Solomon, Seanne Wilkins
Background. The impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on the participation of women in paid/unpaid work is a little understood phenomenon. Purpose. A research study exploring the lived experiences of Canadian women’s engagement in paid/unpaid work and the barriers and facilitators mediating this phenomenon. Method. Study design employed a phenomenological approach using data subanalysis of transcripts, double coded for agreement and to ensure saturation of themes. Results. Analysis of the data revealed an overarching theme of engagement mediated by interacting forces with eight subthemes: active management, agency constrained by structure, the nature of supports, HIV/AIDS sequelae, work as a galvanizing force, the presence of children, the element of fear, and negotiation of self. Implications. Insights gained indicate a need for further education, resources, supports, and policy changes at the systems level. Occupational therapy is positioned to broaden the role of rehabilitation in the context of HIV/AIDS, episodic disability, and work participation.
Human immunodeficiency virus, Acquired immunodeficiency syndrome, Occupational therapy, Work, Women
Evaluating work readiness following acquired brain injury: Building a shared understanding
Mary Stergiou-Kita, Susan Rappolt, Bonnie Kirsh, Lynn Shaw
Background. Despite occupational therapists’ role in work-related evaluations, there are no guidelines for evaluating clients’ work readiness. Purpose. This study explored how occupational therapists evaluate work readiness following acquired brain injury in order to develop an integrated model of the factors, processes, stakeholders, and contextual elements relevant to this evaluation. Methods. Ten occupational therapists with expertise in vocational and brain injury rehabilitation were interviewed. Data were analyzed using grounded theory methods to develop the work readiness evaluation model. Findings. This model describes five processes formative to therapists’ evaluation: (1) drawing upon diverse sources of information and perspectives; (2) assessing occupational capacity; (3) contextualizing occupational potential; (4) building a shared understanding of work readiness among stakeholders, including, clients, employers, insurers, and rehabilitation teams; and (5) transforming the work readiness question. Implications. The model highlights the importance of building a shared understanding amongst stakeholders and provides a provisional framework to guide practice.
Rehabilitation, vocational, Work capacity evaluation, Occupational therapy assessment, Brain injuries, Qualitative studies
The impact of everyday racism on the occupations of African Canadian women
Brenda L. Beagan, Josephine Etowa
Background. Occupational therapy has increasingly explored the impact of cultural differences on occupations but has not yet begun to explore the impact of racism on human occupation. Purpose. This study with 50 African Canadian women used mixed methods to explore the effects of racism on their occupational experiences. Methods. Women aged 40–65 were interviewed in-depth about everyday experiences with racism and overall well-being. Three standardized instruments assessed frequency and stressfulness of race-related experiences. Findings. Everyday racism had subtle, almost intangible, impacts, shaping women’s engagement with and the meaning of leisure, productive, and caring occupations. Implications. As occupational therapy increasingly attends to issues of cultural difference, it is critical to also attend to racism. This means learning to ask thoughtful questions about how racism may shape clients’ occupations. Attention to this aspect of the social environment will enhance practice with African-heritage clients and clients from other racial minority groups.
Racism, Blacks, Minority groups, Race factors, Cultural diversity, Cultural competence
Uses of the National Rehabilitation Reporting System: Perspectives of geriatric rehabilitation clinicians
Jennie L. Wells, Mary Egan, Kerry Byrne, Susan Jaglal, Andrea C. Dumbrell, Paul Stolee
Background. The National Rehabilitation Reporting System (NRS) is a minimum data set for inpatient rehabilitation units. The system was designed to support administrative decision making from the facility to the national level. Purpose. To conduct a pilot study to explore current and potential clinician uses of NRS data, particularly for hip-fractured clients. Methods. Focus groups with rehabilitation teams from two urban academic geriatric rehabilitation units in Ontario. Findings. Few current uses were identified; barriers to use included timeliness of data reports and perceived lack of sensitivity to clinically significant changes in functional status. Strategies for resolving these barriers were identified, including customization of data reports. Implications. Clinicians will need to work collaboratively with managers, information technology specialists, and software vendors to explore opportunities to maximize potential usefulness of NRS data.
Health resource utilization, Health informatics, Rehabilitation, Geriatrics, Hip fractures
Paediatric occupational therapists' reflections on meaning in professional practice: A phenomenological study
Kirsten Trenc Smith, Elizabeth Anne Kinsella
Background. The construct of meaning plays an important role in the theories and models that inform occupational therapy; yet little research has examined the construct of meaning within the professional practices of occupational therapists. Purpose. The purpose of this research is to gain a deeper understanding of the meanings occupational therapists identify within their professional practice occupations. Methods. A phenomenological methodology was adopted for this study. Eight paediatric occupational therapists participated in in-depth, semi-structured interviews, which were tape-recorded, transcribed, and analyzed. Findings. Seven major themes were identified: Relating to clients as human beings, making a positive difference, working as a team, permission to have fun, congruency of values, support in the workplace, and artistry of practice. Implications. The study contributes to knowledge about accounts of meaning in the working lives of paediatric occupational therapists and highlights potential implications for therapists, clients, teams, organizations, and for the profession.
Professional practice, Paediatric occupational therapy, Phenomenology
Lessons in living and dying from my first patient: An autoethnography
Katie E. Warne, Steve Hoppes
Background. This study examines the challenges and rewards of a fieldwork student’s first encounter with death in a clinical setting and describes occupational interventions that affirm the life of a client preparing for death. Purpose. To explore meanings, challenges, and lessons of end-of-life care for an occupational therapy fieldwork student. Methods. A qualitative format, autoethnography, was used to develop a narrative that reveals the lived experience of a fieldwork student. Findings. Findings include a description of what a fieldwork student was and was not able to accomplish in end-of-life care. The paper describes using self-care activities to normalize and cede control of end-of-life care to the client and developing a vision of how to help clients find closure. Implications. The study carries implications for students and therapists working in end-of-life care. Therapists and educators can draw from this study to better understand and support new therapists when patients die.
Death, Palliative care, Education