Exploring the role of palliative care occupational therapists in supporting compassionate communities in end-of-life care.

INTRODUCTION: The compassionate communities' movement is a public health approach to end-of-life care that emphasises the integral role of communities in supporting and caring for dying persons and their informal carers. Although occupational therapists have well-established roles in palliative care teams, little is known about their potential in assisting in the formation and maintenance of compassionate communities. METHOD: Data were gathered via semi-structured interviews with nine Australian occupational therapists with experience in specialist palliative care. Interview questions were based around the British Columbia Compassionate Community Ideal framework. Key themes were derived through qualitative descriptive analysis, blending deductive, and inductive reasoning. FINDINGS: Interviewees indicated that occupational therapists have a role in supporting compassionate communities that centres on the facilitation of networks and connections between palliative care professionals and in the promotion of informal care networks. The importance of education and awareness raising were also discussed as valuable to the development of community capacity. It was also suggested that occupational therapists have important skills to support dying persons and their caregivers to remain engaged and safe in their homes and communities, in a meaningful and sustainable way. However, many interviewees maintained a profession-centric view on control within compassionate communities, as opposed to approaches that are community led. CONCLUSION: Findings offer early insights into the promise and potential of occupational therapists in supporting the compassionate communities' movement. However, education regarding the ethos of the compassionate communities' movement so as to facilitate a shift away from professionally oriented modes of practice may be needed to maximise success.

Exploring the occupational experiences of livestock farmers during drought: A narrative inquiry.

INTRODUCTION: For much of the 21st century, Australia has endured the most prolonged and severe drought since records began. This drought has been found to have negative and long-lasting consequences upon both the physical and mental well-being of farmers and their families. To date, however, no research has examined the experience of drought from an occupational perspective. OBJECTIVE: This study aims to explore the way in which drought impacts upon the lived experience of the farming role and the way in which the occupational identity of farmers influences the meanings attributed, and response to, drought. METHODS: Narrative inquiry and thematic analysis were used to explore the experiences of drought among six farming men and four farming women from Northern Queensland. FINDINGS: Four inter-related themes were identified. These being: 'Becoming a farmer - Rites of passage on entry to the farming role'; 'Farmers as guardians over the land'; 'Drought as siege' and; 'Leisure occupations as temporary bridges to a world beyond drought'. Each of these themes offer insights into the way in which drought comes to be understood by farmers and, in turn, experienced and responded to. CONCLUSION: By better understanding the occupational experiences of farmers during drought, resources can be more effectively targeted towards promoting occupational balance and well-being. Interventions aimed at reframing the way in which the farming role is conceptualised from a young age and supporting occupations beyond farming as bridges to the outside world may be effective in achieving positive outcomes during drought.

Alignment and mismatch in role relations at end-of-life: A constructivist grounded theory study.

In this Australian, constructivist grounded theory study, we undertook in-depth interviews with 11 dying people and 8 caregivers to examine their perspectives on role relations at end-of-life. We found that situations of role alignment between dying people and their family and friends support positive relational and practical outcomes, whereas role mismatch can cause considerable distress. Factors contributing to role mismatch at end-of-life were: dying people and their caregivers' efforts to shield each other from emotional harm; fear of social exclusion; and unwanted focus on the dying identity. Our findings highlight a need for flexibility and adaptability in end-of-life role relations.

Examining the transitions between living and dying roles at end-of-life.

Improvements in the diagnosis and disclosure of dying mean that nowadays dying people typically live with an awareness of their status for longer than they have previously. However, little is known regarding how transitions between living and dying roles occur during this time. In this grounded theory study, we investigated role transitions at end-of-life. We found that dying people periodically foreground and background living and dying selfhoods, focus on living day-by-day and goal-by-goal and reframe dying roles with an orientation to living. We argue that with better understanding of role transitions at end-of-life more compassionate and responsive care becomes possible.

An exploration of the lived experience of professional grief among occupational therapists working in palliative care settings.

BACKGROUND/AIM: Occupational therapists who work in palliative care are frequently exposed to the experience of death and dying. Previous occupational therapy research has offered insight into factors that influence feelings relating to death and dying and associated coping strategies. However, existing literature is dated and has not specifically examined the concept of grief. This study addresses this gap in knowledge by exploring the lived experience of professional grief among occupational therapists working in palliative care settings. METHODS: Semi-structured interviews were conducted with six Australian palliative care occupational therapists. The data were collected and analysed using an interpretive phenomenological approach. RESULTS: Four interrelated themes were identified as core to the lived experience of professional grief among participants. These included; 'knowledge of self', 'giving permission for connections and feelings', 'filtering experience' and 'being present at work and at home'. CONCLUSION: Considered in combination, these themes offer a guide for therapists to explore their own experience of and responses to professional grief and, in doing so, foster the development of personalised management strategies.

Exploring the Contemporary Stage and Scripts for the Enactment of Dying Roles: A Narrative Review of the Literature.

This narrative review explores the literature regarding the drama of dying from several academic perspectives. Three key themes were identified including "The impact of blurred boundaries on roles and transitions," "The orchestration of death and dying through time," and "Contemporary dying and new machinery of control." This review reveals the manner in which tightly scripted dying roles serve the needs of the living to a greater extent than those of the dying, by ensuring the depiction of both dying and death as phenomena which have been brought under the control of the living, thereby countering death anxiety. An incongruence between the actual experience of dying and contemporary dying scripts is also highlighted. The authors argue that this incongruence is hidden from the broader societal audience through the maintenance of a dying role that demands serenity and acceptance, thus downplaying or even hiding the actual end-of-life experiences of the dying themselves.

Different meanings what we want in our lives a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service.

PURPOSE: Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland. MATERIALS AND METHODS: Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis. RESULTS: Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people's lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities. CONCLUSIONS: These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.

Listening to and following the needs and wishes of Aboriginal and Torres Strait Islander rehabilitation participants, promotes the delivery of a service that is culturally and personally meaningful.Promoting two-way learning between participants and the people delivering the service promotes engagement with the service, reduces traditional power dynamics and increases the importance and meaning of the service for participants.Elevating cultural respect as an essential element of a rehabilitation service promotes service delivery that supports cultural relevance and safety.

Occupational Experiences of Refugees and Asylum Seekers Resettling in Australia: A Narrative Review.

The contexts into which refugees and asylum seekers resettle, particularly the socio-political context as represented through various discourses, shape their occupational opportunities, health, and well-being. This article explores current literature in regard to the contemporary Australian discursive climate, particularly in relation to the way it may shape the occupational experiences of refugees and asylum seekers. In addition, a synthesis of current research regarding the occupational experiences of refugees and asylum seekers during their period of resettlement is presented. These two topics of research, drawn from 42 articles, were thematically analyzed. Identified themes include imagined possibilities prior to arrival, establishing occupational routines on entry to the Australian community, and pursuing a personally meaningful life. The authors argue that consideration of the way in which discourse shapes the lived world, and in turn, the occupational opportunities of refugees and asylum seekers, is of key importance for those working with these marginalized groups.