Canadian Journal of Occupational Therapy

In Canada, the guidelines for the practice of occupational therapy are named and framed as client-centred. Two in-depth interviews were conducted with clients of mental health services about their experiences with a hospital-based occupational therapy service. These occupational therapy clients described their experiences as prescriptive, and as less than client-centred. With the publication of Enabling occupation: A Canadian occupational therapy perspective (Canadian Association of Occupational Therapists [CAOT], 1997) and an increasingly refined focus on being client-centred, these interviews highlight the challenges of a client-centred practice within the current health care environment. These occupational therapy clients raise issues of importance for occupational therapy. The participants stated that the prescription of ‘activity’, a lack of choice, and a focus upon the illness as opposed to the individual, served to diminish any collaborative partnership with the client and eliminate the client from any decision-making process. This distancing from the client, in their opinion, served to greatly diminish any therapeutic value of occupation. The participants recommended a greater focus upon occupational choice, consideration of the individual within the client, providing accepting, supportive environments, and using professional expertise on occupation to guide the client towards participation in meaningful occupation. These recommendations are strikingly similar to the most recent guidelines for the client-centred practice of occupational therapy in Canada. A discussion of the implications of these findings for the client-centred practice of occupational therapy is offered.

This research sought to determine which therapist barriers prevent client-centred practice the most, and which methods are perceived as being most effective in resolving therapist barriers. A list of barriers that therapists bring to client-centred practice and methods to resolve these was identified from the literature and formed the basis of a questionnaire sent to 60 occupational therapists in the United Kingdom. The results showed that the therapist and client having different goals was the barrier which most prevented client-centred practice. The high ratings of other statements suggested that the values, beliefs and attitudes of therapists and of the employment culture make client-centred practice uncomfortable to use and hence prevent its implementation. Case examples showing how to practice in a client-centred fashion were rated as the most effective method of barrier removal.

This study addressed the validity and community utility of the Canadian Occupational Performance Measure (COPM) (Law et al., 1991; 1994; 1998): a measure that now represents a national standard in clinical practice and research in occupational therapy in Canada. The study employed a crosssectional design. Participants for the study were former consumers of occupational therapy services, recruited from the Queen's University catchment area (Kingston, North Bay, Oshawa, Perth, Peterborough). A sample of 61 disabled individuals living in the community were recruited. Each individual was sent a package of self-administered measures including the Satisfaction with Performance Scaled Questionnaire, the Reintegration to Normal Living Index, the Life Satisfaction Questionnaire, and the Perceived Problems List. An interview was also arranged with the project coordinator, which was based on the COPM and the Consumer Utility Questionnaire. Multivariate analyses showed that construct validity was supported; scores on the COPM were significantly related to theoretically related constructs: satisfaction with performance, reintegration to normal living and life satisfaction. In addition, criterion validity was supported. A majority of participants (53%), when asked about problems of daily living, spontaneously reported at least one of the problems raised on the COPM. Community utility was evaluated highly by participants, 75% of whom found the COPM useful in identifying and rating their problems, and 100% of whom reported no problems in understanding the COPM.

L'ergothérapeute est fréquemment impliqué dans le processus d'attribution de lève-personnes auprès des clients présentant des incapacités physiques sévères et vivant à domicile. Le but de cet article est de présenter un cadre conceptuel pour faciliter la recommandation d'un lève-personne incluant la toile. Premièrement, les facteurs qui influencent la décision d'octroyer cette aide technique sont analysés à partir des concepts du Modèle canadien de rendement occupationnel (Association canadienne des ergothérapeutes, 1997). Pour faciliter les transferts, l'ergothérapeute tiendra compte des caractéristiques du client, de son environnement, de l'équipement de même que du temps requis pour compléter l'activité. Deuxièmement, la notion de situation de travail proposée par une organisation spécialisée en santé et sécurité au travail est utilisée comme guide lors de l'évaluation des manœuvres de transferts. Dans cette veine, l'introduction du lève-personne est située dans un continuum de perte d'autonomie progressive en tenant compte des degrés d'autonomie physique, d'assistance humaine et d'assistance technique requis pour effectuer les transferts. Finalement, les avantages et les inconvénients inhérents à l'utilisation de cette aide technique à domicile sont présentés en guise de conclusion.

The ever-changing, dynamic practice environment coupled with increased consumer needs and awareness create an atmosphere that requires optimal professionalism from occupational therapists. Professionalism requires specific knowledge, attitudes, and values — all manifested by professional behaviours. The authors assume that professional behaviours mature through a natural developmental process; a process that requires careful nurturing on the part of educators and clinical supervisors. Based on this assumption, the authors propose this conceptual model based on Erikson's life cycle stages. The model implies that occupational therapy professional behaviours develop sequentially through stages that begin during the educational process of occupational therapists, and progress throughout their career. The purpose of this model is to provide a framework for educators and supervisors to nurture professional behaviours in students and novice clinicians, and to continue their own professional growth.

Clinical competence is generally defined as a combination of knowledge, skill and professional behaviour. It is typically assessed using written tests, direct observation, chart audit, client satisfaction surveys and supervisor ratings. This paper describes the development and evaluation of a chart-stimulated recall (CSR) measure that combines the methods of chart audit and clinician interview to assess the clinical competence of practicing occupational therapists. The CSR tool was developed using the Canadian Guidelines for Client-Centred Practice and taps global domains of competence: use of theory, assessment, program planning, intervention, discharge planning, follow-up, program evaluation, clinical reasoning and professional behaviours. This pilot study involved two independent raters/interviewers who assessed twelve occupational therapy clinicians on two occasions using a random sample of client cases/records on each occasion Results indicate that the CSR tool is not only reliable and valid, but also sufficiently generic to be used in a variety of practice settings as a global measure of on-the-job performance.

At the close of the 20th century, there is a renaissance of occupation in occupational therapy and occupational science. Kielhofner (1992) offers an intraprofessional explanation that the growing interest in occupation recaptures occupational therapy's lost identity. An extraprofessional explanation is that postmodern ideas and social practices have helped to create a societal context in which a renaissance of occupation is welcome. Postmodernism raises questions and awareness of power, diversity, temporality, and situatedness in which normative ideas of occupation as paid work can be challenged. Since occupation is of primary concern to occupational therapy and occupational science, the authors reflect on postmodernism and its influence on a renaissance of occupation in these two fields. These reflections consider what such a renaissance means for occupational therapists and occupational scientists in the 21st century.

This qualitative pilot study was completed as an exploratory study of the meaning of gardening using attention restoration theory. Three women with breast cancer who garden for leisure were recruited from a cancer support group. Each participant was interviewed at her home on two occasions. To complement the qualitative data, participants also completed the Perceived Restorativeness Scale (PRS) (Hartig, Korpela, Evans, & Garling, 1996). The interviews revealed six major themes some of which were concerned with the interactions between the gardener and the garden, and others which focused on gardening within the context of having cancer. The qualitative and quantitative outcomes supported the perspective of attention restoration theory. Spirituality was interwoven throughout the comments of two participants but was less important for one participant. The implications of this study for practice and future research are discussed.