OTalk

#OTalk – 11th May 2021 – “Resilience” – helpful or a hindrance?

This weeks chat will be hosted by Rachael Daniels @RachaelD_OT .

“We work in a world of traumas and triumphs. Most of the persons we serve come to us out of necessity, struggling with the sequelae of disease and illness or the aftermath of natural or manmade disasters.” (Fine, 1991). 

The term “resilience” is used when referring to how individuals overcome adversity (Bonanno, 2004). The term seems to be everywhere, but what does it really mean? Is referring to somebody as resilient a compliment? Or could it be considered insulting? 

In recent decades, there has been an influx of research on resilience (Bonanno, 2004; Leipold & Greve, 2009; Becvar, 2012) and yet a collective notion on its value is yet to be reached. Such interest in resilience is not surprising, as many industries and professions continue to move from a deficit-based approach to a strength-based approach. It is likely through the influx of this traction that the buzzword ‘resilience’ has taken off. 

In terms of defining resilience, there is controversy in the literature as to whether resilience is a personal trait, a process, or an outcome (Ahern, Ark, & Byers, 2008). In the field of psychology, resilience is considered to be a biopsychosocial and spiritual phenomenon. It is often defined as ‘the developable capacity to rebound or bounce back from adversity, conflict, and failure or even positive events, progress, and increased responsibility’ (Luthans, 2002, p. 702). 

When considering individuals and their perceived resilience,  Becvar (2012) surmised that one of the most accepted beliefs is that resilience refers to the capacity of those who, even in incredibly stressful situations, are able to cope, to rebound, and to eventually go on and thrive (Becvar, 2012). Lopez (2011) stated that Occupational Therapy practitioners should be cognizant of a patient’s resilient and adaptive capacity when providing services to a patient that has endured a traumatic event. With that in mind, is there a role for Occupational Therapists in assisting individuals to increase their resilience? Or indeed, is it even possible for one to improve their resilience? 

Newman (2005); Padesky & Mooney (2012) and Peters (2020), argue that we can all learn techniques to help build resilience. These are said to include: cognitive reframing techniques, character-building, stress management, viewing crises as challenges, learning to accept things you can’t change; sharing feelings, and keeping things in perspective (Peters, 2020). Is this something that we, as Occupational Therapists, are already addressing? If not, should we be?

  1. What does resilience mean to you?
  2. Would you be happy to be referred to as resilient? Please explain your answer. 
  3. Have you ever referred to somebody as resilient? If so, what was their response?
  4. Do you feel that the term resilient could demean the conscious efforts of individuals to overcome adversity?

References

Ahern, N. R., Ark, P., & Byers, J. (2008) ‘Resilience and coping strategies in adolescents’, Paediatric Nursing, 20, pp.32-36.

Becvar, D.S. ed., (2012) Handbook of family resilience. New York: Springer Science & Business Media.

Bonanno, G.A (2004) ‘Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?’ American Psychologist, 59(1), pp.20–28. DOI: https://doi.org/10.1037/0003-066X.59.1.20

Fine, S.B. (1991) ‘Resilience and human adaptability: Who rises above adversity?’, American Journal of Occupational Therapy45(6), pp.493-503.

Leipold, B. & Greve, W. (2009) ‘Resilience: A conceptual bridge between coping and development’, European Psychologist14(1), pp.40-50.

Lopez, A. (2011) ‘Posttraumatic stress disorder and occupational performance: building resilience and fostering occupational adaptation’, Work38(1), pp.33-38.

Luthans, F. (2002) ‘The need for and meaning of positive organizational behavior’, Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior23(6), pp.695-706.

Newman, R. (2005) ‘APA’s resilience initiative’, Professional psychology: research and practice36(3), p.227.

Padesky, C.A. & Mooney, K.A. (2012) ‘Strengths‐based cognitive–behavioural therapy: A four‐step model to build resilience’, Clinical psychology & psychotherapy19(4), pp.283-290.Peters, M.A. (2020) ‘The Plague: Human resilience and the collective response to catastrophe’, Educational Philosophy and Theory, DOI: 10.1080/00131857.2020.1745921

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OTalk

#OTalk Research 4th May 2021 – Autoethnography and Occupational Therapy

This weeks research focus chat will be hosted by Dr Gemma Wells @GemmaOTPhD. I am a Senior Lecturer and the Professional Lead in Occupational Therapy at Canterbury Christ Church University.  I am a qualitative researcher with a particular interest in using research methods that require an element of creativity, as illustrated by my use of photo-elicitation in my PhD.

As an Occupational Therapist I am inspired by the occupational narratives of people and communities.  The insight that these narratives provide is beyond anything that can be observed as they represent the personally attributed meaning and lived experience of the individual.  This personal experience is set within the context that surrounds the individual, a context that is shaped by a range of personal, local, and global factors.  My interest in the personal narratives of others has recently steered me to consider my own experiences as an occupational being, a process that has led me to the research method of autoethnography.

Autoethnography is a qualitative research method concerned with exploring the interplay between personal experience, and the social and cultural worlds in which this personal experience exists (Denshire and Lee 2013). Starting with their individual narrative, autoethnography requires the researcher to engage in a process of moving between existing theory and their described lived experience to enable the individual to make sense of their narrative.

We are all occupational beings that engage in personally meaningful activities (occupations), with our own occupational narratives to be told and explored. Embracing autoethnography as a research method could enable us all to make a positive a contribution to the body of research that informs Occupational Therapy practice.

This #OTalk aims to explore the potential of autoethnography as a means of contributing to the evidence base and theory informing Occupational Therapy practice.  The questions that will be considered are:

  1. What do you consider to be the benefits of taking an autoethnographic approach in Occupational Therapy research?
  2. How could you use autoethnography to inform your practice of Occupational Therapy?
  3. What are the potential challenges of using autoethnography within Occupational Therapy research?
  4. What might prevent you from personally engaging with autoethnography?
  5. If you were to complete one piece of autoethnographic work, what would be the main theme that you would be interested in exploring?

Denshire S, Lee A (2013) Conceptualising Autoethnography as Assemblage: Accounts of Occupational Therapy.  International Journal of Qualitative Methods 12(1):221-236

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OTalk

#OTalk – 27th April 2021 – Perinatal Mental Health – an Occupational Approach in Journeys to Recovery

This chat will be hosted by Rachael Coates (@rachaelOTUK) and Sarah Maris-Shaw (@sarahmarisshaw)

Following the recognition of significant inequality in access to perinatal mental health care across the UK, the Government committed to 3 waves of funding to increase access to services. Since 2015, a vast investment has been made, and there are now 21 mother and baby inpatient units and 80% of England has access to some form of perinatal mental health service. This service expansion has produced a rapid increase in occupational therapy posts and has required occupational therapists to upskill quickly, considering both the mother, baby and their relationship in their day to day practice. An occupational approach to supporting those in the perinatal period is very relevant and reflected in the rate at which the specialism is growing. Significant changes in daily routines, responsibilities, associated roles, and relationship are commonplace in the journey to motherhood, with associated occupational imbalance and deprivation being common.

Working with Health Education England, RCOT have addressed some of the training needs of those who are new into post and those wanting support and direction in their role through the development of an E-Learning training programme. In addition, the RCOT Specialist Section for Mental Health launched the Perinatal clinical forum in 2019. The long term plan 2019 also pledged to align provision with the 1001 day campaign to provide support to those with mental health issues from pre-conception until baby’s second birthday and recognising the support needs of partners within the family unit.

A few years on it is interesting to reflect on the diversity of our work, how the pandemic has influenced practice and what have we learnt from working with families in their journey. We are also keen to support the UK maternal mental health awareness week 3-9 May are interested in exploring the theme ‘Journeys to Recovery’. UK Maternal Mental Health Awareness Week 2021 – Perinatal Mental Health Partnership (perinatalmhpartnership.com)

  1. What is your priority as an occupational therapist when working with women during the perinatal period?
  2. What skills do you bring that others in team are not trained or aware of?
  3. What barriers do you face and how have you overcome them?
  4. What have you learnt that might help another OT working in perinatal mental health?
  5. Please share an example of a Journey to Recovery – what did occupational therapy add to this journey to recovery?

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OTalk

#OTalk 20th April 2021 – Advocacy in Occupational Therapy

This weeks chat will be host by Toks Odutayo @tokunbotweetz

As one who was once described as a ‘mouthy martyr’ (a label I proudly bear), I can confess that I typically do not shy away from offering my tuppence worth on matters that I consider to be unjust, unfair or discriminatory. As an occupational therapist working in the youth justice sector, I have observed issues with occupational deprivation, alienation, imbalance and dysfunction in children and young people within the justice system. Identifying such health, social and educational needs within this marginalised group has highlighted the inextricable link between justice and advocacy in occupational therapy practice (Stover 2016).

The more exposure I have to such issues, the more the subject of advocacy in occupational therapy has been stirring within, quite like a musical earworm. It is worth stating at this point that I by no means approach this subject as an expert. Rather, I come to it as an absolute novice, looking to facilitate conversations and shared learning that would further shape, strengthen and develop our approach to advocacy in practice. 

As occupational therapists, we acknowledge that occupation is a fundamental human right (World Federation of Occupational Therapists 2019), and therefore naturally find ourselves advocating for the clients we serve when their rights are compromised. One reason for this could be related to the fact that we primarily view health from the lens of the social model of disability, as opposed to the medical model (Dhillon et al. 2010). Although advocacy may not be an essential component to our training curriculum, it is inherent to what we do as occupational therapists (Kirsh 2015) and is also identified as one of the six core intervention types of occupational therapy (American Occupational Therapy Association 2020). 

My newly curated curiosity into this subject has also led to the consideration of advocacy in occupational therapy in relation to recent social issues. The past 12 months has seen instrumental campaigns such as Black Lives Matter and women’s public safety, which many of us have been affected by, had a particular interest in, and involvement with. But what have these issues got to do with our occupational therapy practice? Do we simply use our professional platform to lobby for matters that hold meaning and value to us? Or could it be that we acknowledge how these matters impact our practice by not only setting up barriers to us as clinicians, but also account for the lived experiences of our clients (as well as ourselves), and therefore impede on their ability to perform their desired occupations; and/or act as secondary barriers to their engagement with therapeutic interventions and subsequent functioning?

I firmly believe in the latter as experience has shown the significant detriment to our client’s health, wellbeing and quality of life, when their needs are not acknowledged, understood or catered to in our practice. However, I hope this OTalk would open up more conversation that affirms, challenges, and proposes additional considerations to my thinking.

With inclusion and participation being integral to occupational therapy practice, as well as the assumed promise of equality and diversity being core to our practice (Royal College of Occupational Therapists [no date]), I would like to think together about the ways in which we currently engage in advocacy from a professional perspective. I would also like to explore how we could further develop our efforts to ensure that it remains a core facet of our practice to enable our client’s engagement in occupation.  How we do this can vary from voicing individualised matters, all the way to contributing to larger political, legislative and policy changes (Kirsh 2015).  

Having recently re-engaged with my twitter account (for the umpteenth time), I have observed how advocacy is imperative to all areas of occupational therapy practice. There are numerous health, social, cultural, physical, and institutional issues that can impact on the participation of our clients. These can include, but not limited to:

  • Raising awareness about specific and poorly understood conditions, e.g. neurodevelopmental conditions.
  • Outlining the need of specific equipment and/or technologies in practice.
  • Promoting equality and inclusion for marginalised groups, e.g. displaced individuals.
  • Writing business plans for occupational therapy roles in services.
  • Educating on the severity and impact of Long Covid on health, wellbeing and occupational engagement.
  • Highlighting accessibility issues in public and private settings.

In addition to advocating for our clients and enabling their ability to advocate for themselves, we also advocate for ourselves. As an evolving, and continually developing profession, we also find ourselves championing and fending for the specialist skill set within our discipline and advocating for the necessity of our roles within multidisciplinary teams.

All of this leaves me with a million questions about the subject of advocacy in occupational therapy, but I have managed to whittle them down to the following:

Questions

  1. What is your understanding of the meaning of advocacy in occupational therapy? Is it a core function of what we do as occupational therapists? 
  2. Can you share any specific matters related to your current practice that you feel would benefit from advocacy (eg. client groups, condition awareness, practice areas)?
  3. In what ways do we currently engage in advocacy as occupational therapists? Do we have the adequate tools to support us in effectively advocating for matters related to occupational justice?
  4. What are the challenges or barriers faced when advocating for others or ourselves? How might we overcome them?
  5. Can you share any past or present experiences of successfully, or unsuccessfully, advocating for a matter? Or experiences of a current advocacy journey?

References

American Occupational Therapy Association. 2020. Occupational Therapy Practice Framework: Domain and Process- Fourth Edition. The American Journal of Occupational Therapy 74(s2), pp. 1-87.

Dhillon, S.K. et al. 2010. Advocacy in occupational therapy: Exploring clinicians’ reasons and experiences of advocacy. Canadian Journal of Occupational Therapy 77(4), pp.241-248.

Kirsh, B.H. 2015. Transforming values into action: Advocacy as a professional imperative. Canadian Journal of Occupational Therapy 82(4), pp.212-223.

Royal College of Occupational Therapists. [No date]. Available at: https://www.rcot.co.uk/equality-diversity-and-inclusion [Accessed: 11th April 2021].

Stover, A.D. 2016. Client-centered advocacy: Every occupational therapy practitioner’s responsibility to understand medical necessity. American Journal of Occupational Therapy 70(5), pp.1-6.

World Federation of Occupational Therapists. 2019. Occupational therapy and human rights. Available at: https://wfot.org/resources/occupational-therapy-and-human-rights [Accessed: 11th April 2021].

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OTalk

13th April 2021 – Let’s #OTalk about Falls

This week #OTalk will be hosted by Mangar @MangarInt

The chat will also be supported by Paul Watts @apaulwatts, Clare Birt @ClareBirt, Andrew Macphail @andrrewmacphail and Dan Colclough @ColcloughDaniel. having a wealth of experience in different markets segments, allowing any questions to be answered promptly and effectively. Note these are for support and input into the chat and the main chat questions will be via the Mangar account @MangarInt

If you search ‘falls in the elderly’ on the internet, most of the information you will find is associated with identifying intrinsic and extrinsic causes and methods of fall prevention.  In reality, however much we concentrate of investigating causes and putting the associated fall prevention methods in place, people will still fall.

More than 10% of all ambulance call outs are to the elderly who have fallen and around 50% (Welsh Ambulance Service Trust) need conveying to hospital.  But 50% just need moving back to a seat or helping to their feet.

So why are there not more conversations around post fall care?  We all know how vital it is to get someone up again after a fall.  A ‘long lie’ (usually described as an hour or more), can have a greater impact on the health of the fallen person than the fall itself.

The psychology around the ‘fear of falling’ is also interesting to track.  We know people become less active because they are scared of falling again, leading to an ever decreasing circle of activity, resulting in significant muscle weakness.

We also know it’s often the carers that suffer the greatest impact, picking up musculoskeletal injuries as they try and help their loved one back to their feet.

It is great to see some pilot projects where OTs and Paramedics have joined forces to properly examine the right way to treat a very common problem. Specialist teams working together to find patient centred solutions, must be the right way for both improved patient care and efficient spending of NHS budgets.

Questions

  1. Is calling an ambulance always the right thing to do after a fall?
  2. How reliant are we on carers or loved ones to lift the people they care for after a fall? 
  3. Is there enough emphasis on post fall care?
  4. What falls service collaborations are we aware of and are partnerships between paramedics and OTs the way forward?
  5. What tools/technology can be used to give Cares confidence in their decision to perform a lift?

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