Occupational Therapistsmust ensure that at they always consider philosophy, theory and core skills toensure they are providing the best treatment possible. It is important theyunderstand occupations in occupational therapy “refer to the everydayactivities that people do as individuals, in families and with communities tooccupy time and bring meaning and purpose to life. Occupations include thingspeople need to, want to and are expected to do.” (WFOT, 2010). This means thatoccupational therapists must focus on important features of a patient’s lifeand use these in an effective way to help recovery. Occupational therapy didnot really begin until the first world war where occupations where used to helpex-service men recover from spinal injuries (Floyd et al, 1966). However, it can be seen as early as the 17thand 18th century where occupations were used to treat those withmental illnesses.
Basic beliefs ofoccupational therapy include that treatment must be clientcentred and that the clientshould have a choice over their life and decisions. A keyphilosophical assumption in Occupational Therapy is that each person is anindividual and that it is up to a person to take responsibility for their livesand their actions (Kelly and McFarlane, 2007). In terms of occupation therapythis means that an individual must decide what they must and want to do torecover and to fulfil their lives. Philosophicalassumptions and beliefs of Occupational TherapyPhilosophical assumptions are statements which arefundamental and act as framework that underpins reasoning, they are consideredobvious and not needed to be explained or demonstrated (Schwartz, 1994 inDuncan, 2011). They are used as a base for reasoning allowing arguments andtheories to be formed.
Philosophical assumptions are shared and providecohesiveness and allow for a sense of cultural identity. However, views on illnesses where not always as they aretoday. In the dark ages and Medieval times, it was believed that mental andphysical illnesses where due to a sin being committed and was linked withpossession and witchcraft (Neugebauer, 1979). This meant that recovery was notencouraged.
During the 17th and 18th century both aphilosopher Philippe Pinel and William Tuke contributed to the moral movement.Tuke established more humane methods treating mental health by focussing onoccupations instead of restraint. During the 19th century belief inthe individual was born with the help of Willliam Ellis and FlorenceNightingale.
During the 20th century adaption and occupations wereused to treat ex-service men with spinal cord injuries and Sir Ludwig Guttmanfounded the Stoke Mandeville Hospital in 1944 for that purpose (Floyd et al,1966). Influencers like these, and many others allowed for modern views to beaccepted meaning that patients are now seen as individuals who can controltheir own lives and it is essential that they are involved in decisions withtheir treatment. Elizabeth Kanny (1993) highlighted 7 core concepts ofoccupational therapy: altruism,equality, freedom, justice, dignity, truth, prudence. These are all essentialinto allowing a patient to get fair treatment in which the patient feels arewhat they want and in which is a decision in that they have been fully informedin. It is important that a professional bares in mind that occupations anindividual participates in will change over time and that their priorities maychange (Yerxa, 1979). In Occupational Therapy, it is believed that alltreatment should be client centred, that the client should be involved in all decisionsand that they are an expert in what they do. It is also believed that clientsshould always be treated with respect and dignity all the time (Gillen, 2014).
It is also important to remember that everyone is unique and have differentviews of what healthy is (Health People, 2010). Occupational ScienceIt is also essentialthat occupational therapists consider the science behind the treatment they areproviding. Occupational science can be defined as “The study of the human as an occupational beingincluding the need for and capacity to engage in and orchestrate dailyoccupations in the environment over the lifespan” (Yerxa et al, 1989) and was made to fulfil the needs of Occupational Therapy,formed from the beliefs and values from the founders of occupational therapy.Mary Reilly’s (1962, 1974) occupational behavior theory helped create a focuson the science as well as Elizabeth Yerxa who was concerned that occupationaltherapy did not yet have a knowledge base which focused on occupation. Shebelieved that a knowledge base was essential to allow Occupational Therapy tobecome authentic, self-directed and autonomous (Peirce, 2004). In the 1980s, Yerxa and her faculty members designed a PhD program so that they could train their scientistswhich began in 1989.
In 1996 the first Occupational Science book was published,Occupation Science: The Evolving Discipline, and edited by Zemke and Clarke. Thegrowth of occupational science can still be seen by the increasing number ofarticles and books being published. The growth ofOccupational Science is essential as it provides therapists with support andhelps improve and develop therapies, in and out of health and social caresettings. It also shows us the link between occupations and health, as well ashelping distinguish Occupational Therapy from other professions (Duncan, 2012).Fish (1995) stated that an Occupational Therapist’s “role is to apply knownfacts and procedures to well- defined situations”. This means that OccupationalScience is essential to ensure that patients get the best and most effectivecare possible backed up by scientific knowledge and allows evidence basedpractice to occur. This is because it clarifies and tests knowledge in reallife (Christiansenand Townsend, 2011). However,Occupational Science can easily become complex as it can be difficult toexplain casual relationships at different levels, i.
e. individual, family, communityand overall population (Duncan, 2012). Links betweenoccupation and health and wellbeingResearch suggests that there is a link between occupationand health and wellbeing. Those aged 45-59 showed the lowest levels of lifesatisfaction and it is suggested that this is because they may have manyresponsibilities, e.g. caring for parents and/or children as well as balancingwork and other commitments. This may show that those with too many occupationsmay have lower satisfaction of life. However, those who are married have thehighest levels of happiness, averaging to 7.
67 out of 10 as opposed to thosewho are single, widowed or divorced. This can suggest that if you have theright occupations it can be beneficial to happiness. Researchers also discoveredthat those who say they have poor health are much more likely to have muchlower average life satisfaction than those who said their health was very good (Officeof National Statistics, 2016). It is shown that occupations can have a positive effect onhealth and wellbeing.
For example, exercise decreases the risk of type 2diabetes (Department of health, 2004) as well as creative occupations can leadto an alternative identity to illness, heling improve self-image (Reynolds,2003). However, occupations can also have a negative effect on health. This canbe seen though a positive correlation between amount of involvement incompetitive sports and likelihood of injury (Department of health, 2004) andattention problems at age 7 can be linked with how many hours of TV watcheddaily between ages 1 and 3 (Christakis et al, 2004).
As the role of an Occupational Therapist is to support anindividual in an occupation that is important to them, it means they can helpempower the individual, restore confidence, improve quality of life and toenable the individual to live a fulfilled life. Wilcocks (1999) focuses on thisvia the balance for wellbeing suggesting that doing promotes self-worth. The OccupationalTherapy processThe Occupational therapy process is a sequence of actionsthat a therapist undertakes to allow them to provide a service. This iscompleted by gathering and recording information.
Creek (2003) standardisedthis process into 11 key steps as shown below.Different organisations may have different slightlydifferent protocols meaning the steps Occupational Therapists take may vary. Whencompleting these steps, it is essential that the patient is involved in all decisionsmade and that they choose their own goals to ensure that the treatment they arereceiving is client centred and based to their own needs. Core SkillsThe College of Occupational Therapists (2016) outlined 7core skills, the first being collaboration with the client meaning that allgoals are personal to the client and they have choices over their interventionas it is essential to a person’s wellbeing (Aristotle, 1980). The next isassessment for example the model of human occupation (MOHO) or observations.After that its enablement meaning you identify the patient’s strengths to givethe patient as much independence as possible.
Another core skill is problemsolving which addresses any physical and cognitive restrictions and allows youto consider adaptions. Environmental adaptions must also be considered whererelevant for the client (Bridge et al, 2007), which can cause barriers for manyreasons, this may be because lack of support or money or down to things such asaesthetics and desirability concerns. Group work is also a core skill as it isimportant that you can communicate well with both the patient as well as otherhealth professionals to ensure that the patient gets the best treatment planpossible which can be integrated into daily life. and that ideas from thepatient can be expressed in a safe non-judgement environment.
The final coreskill is using occupation as a therapeutic tool. The Canadian Model ofOccupational Performance and Engagement and MOHO both use meaningfuloccupations as a way of self-identity allowing it to be used as anintervention. It is important to consider the individuals physical and mentalcapabilities, environment and the individuals views for optimal occupationalengagement. This allows the individual to take an active role in theirtreatment promoting anonymity and participation.
Ethics and professionalpractiseEthics is underpinned by the notion of reasonable andwell-founded principles of what is right and wrong, also it relates to what ourown ethical standards are (Velasquez et al, 2010).Medical ethics can be seen as early as 400BC in theHippocratic oath (The World Medical Association, 2015) and Thomas Percival was the firstto bring out a book on medical ethics in 1803. Later, the UN declaration ofhuman rights (1948) promoted the right to self-determination and this conceptis now proliferating and becoming more important within medical ethics. Thereare 4 key principles of medical ethics which are autonomy, non-maleficence,beneficence and justice (Beauchamp and Childress, 2013). This means that Healthprofessionals must respect the patient, their decisions and views, treat themfairly whilst only doing good without intentionally causing harm. Duty ethicsmust also be considered. This strand is a deontological approach (Beauchamp andChildress, 2013) meaning that you focus on the intent behind the action ratherthan the consequence of the action.
However, it can be hard to base behaviouron good intentions alone as it could override the ethical obligations of anorganisation (Williams and Chadwick, 2012). Inmedical ethics, it is important to consider conduct. One significant issue thatcomes up in medical ethics is the tension between autonomy and paternalism.This is because people want to provide as much care as possible however theymust always try to ensure that the patient is as independent as possible. Aspatients have grown to be more autonomous the issue of consent has becomeincreasingly important (The World Medical Association, 2015).
Practise mustalso be considered in medical ethics. This is because medical capabilities canchange very fast meaning that it’s a professional’s duty to keep updated toensure they can give the best care possible. Ethical decisions can involveserious consequences for those involved and often each of the choices availablefor care will have negative results. Also, individual principles are often inconflict, this may be because decisions often involve balancing the rights ofdifferent individuals against each other, or as society as a whole (Boyd,2005). Evidence Based PracticeOccupationaltherapists must always consider evidence based practise to ensure they providethe best care possible. Evidence based practice means ensuring that topics arewell researched, discussed in collaboration and related to evidence withincontext. It is important to consider the validity and usefulness of the data collected.
Evidence based practise is essential as when applying it to theory allows us tonot only know that an intervention is working but also how it worked. It alsoallows us to have clear reasons for practise decisions (Aveyard and Sharp,2009).Theterm “evidence based medicine” was first used in the 1980s by McMasterUniversity Medical School and meant collecting and evaluating evidence for usein a medical setting and problem based teaching and learning. Evidence basedpractise emerged u the 1990s and is now known worldwide to meet the needs ofpublic concerns about inequalities and effectiveness in health care (WorldHealth Organisation,2004).
Thompson et al (2005) created a stagedapproach to evidence based practice which ensures that the professionalidentifies the question and finds relevant information and incorporates thatinto their strategy for action effecting any decisions made. In Occupational Therapy decisions must beinformed but not dominated by evidence based practice. This allows for thepatient to have well informed treatment, but still ultimately have treatmentthat is personal and allows the client to be at the centreof their care with their opinions still being valued (Canadian Association ofOccupational Therapists et al, 1999).
It also means that ineffective treatmentcan be identified and no longer used. As some aspects in Occupational Therapyare not as easy to measure than in medicine the results of some studies may notbe as accurate and this must be considered when choosing a treatment. To summarise, philosophicalassumptions and beliefs underlie the theory used in occupational therapy andact as framework. Individuals are responsible for their own lives, theirpriorities are essential and may change over time, and that all treatment mustbe clientcentred.
This means that occupations can be used toimprove health and wellbeing by focusing on occupations important to theindividual. The occupational therapist must have core skills such ascollaboration and enablement to ensure the treatment provided is important tothe client and effective. Occupational therapists must also follow key stepssuch as assessments, information gathering and goal setting to ensure that theyconsider the client’s needs as well as occupational science to ensure that theyhave reasoning behind their actions and that evidence based practice is used.This means that the occupational therapist would be well educated and enablesthem to provide to practice relevant treatments. This is essential to ensurethat ethical guidelines are considered and that the patient can be providedwith clear information to ensure they are at the centreof their treatment.
