Stress among Pediatric Occupational Therapists: A Study of Prevalence, Work and Demographic Factors.

This study aimed to evaluate the self-reported stress levels of pediatric occupational therapists, examine specific work factors and determine if demographic factors predict occupational stress. A cross-sectional survey design study, using voluntary response sampling, was conducted. The survey included demographics, the Workplace Stress Scale, and the Stress Index. The sample included 289 pediatric occupational therapists. Using descriptive analysis, a one-sample t-test, and multiple linear regressions, results indicated that pediatric occupational therapists had significantly higher stress levels than the validating sample of the Workplace Stress Scale. Self-reported work factors included too much work to do in a limited time and lack of time to plan or evaluate treatments. No demographic factors predicted work stress, while several work factors did. Occupational stress exists in pediatric occupational therapy work settings, especially in settings where high productivity is self-reported.

"You've Got to Do Something": Developing Occupational Therapists' Role in End-of-Life Care.

Occupational therapists support the occupational participation of people who are dying yet remain underutilized in end-of-life care. The purpose of this article was to explore how occupational therapists develop their role in end-of-life care to provide strategies to address underutilization. Using a grounded-theory method, semi-structured interviews were conducted with 21 occupational therapists. Three themes emerged which demonstrate participants' role development process. Participants' experiences with dying (Close Experience of Loss) often instilled the importance of end-of-life care. Led by these convictions (Willing to Do It), participants developed skills for end-of-life care. Reflecting on their experiences and treatment outcomes (Making a Difference), participants self-validated their role. The Model of Occupational Therapists' Role Development in End-of-Life Care captured this process. Personal experiences and critical self-reflection may provide an adaptive means to drive role development and appropriately increase end-of-life care occupational therapy utilization.

Missed Opportunities to Ease Suffering: An Explanatory Model of Occupational Therapy Utilization in End-of-Life Care.

Background: With disease progression, a terminally ill person may experience loss of physical and cognitive skills required to perform everyday activities. Such functional loss can erode autonomy and cause existential suffering. Supported engagement in everyday activities may help terminally ill people stay involved in living and cope with dying. Occupational therapy enables people to engage in valued activities at the end of life, yet remains under-utilized. Objectives: To address the perceived under-utilization of end-of-life care occupational therapy, the authors investigated how utilization of occupational therapy in end-of-life care is determined from the perspective of decision-makers and occupational therapists and then developed a model of the process. Methods: Using a grounded theory method, authors conducted two semi-structured interviews with 20 decision-makers and 21 occupational therapists. Theoretical sampling followed by paradigm analysis, yielded a data-grounded model. Results: The authors developed The Model of Occupational Therapy Utilization in End-of-Life Care. Service utilization was primarily contingent upon the decision-makers' awareness of occupational therapy's role in end-of-life care and further influenced by place of care cost constraints and participants' ability to adjust focus of the occupational therapy to accommodate the patient's dying process. Conclusion: Limited awareness of occupational therapy's role in end-of-life care warrants research on whether modification of model constructs may increase awareness and utilization. Education is indicated to teach providers about suffering due to functional loss and how to adjust focus of occupational therapy to sustain occupational participation through decline, across different care settings, and along a range between rehabilitation-focused to participation-focused outcomes.

Pediatric Occupational Therapists and Occupational Stress: A Scoping Review.

The purpose of this scoping review was to provide further insight into the stress and the stressors experienced by pediatric occupational therapists in the work environment. Using the Arksey and O'Malley framework, the search was conducted in eight databases, nine electronic journals, and eight gray literature sources to identify articles related to stress and stressors of pediatric occupational therapists. Review selection and characterization were performed by two independent reviewers. Twelve articles published from 2011 to 2020 were identified and varied in terms of purpose, population, and results although the articles all shared similar methodologies and outcome measures. Only 25% of the articles (3/12) addressed pediatric occupational therapy stress and stressors directly while the remaining addressed occupational stress, but with varying levels of attention to pediatric occupational therapists. Stress and stressors experienced by pediatric occupational therapists have been studied to a limited extent. Occupational stress is associated with increased burnout, decreased health, and decreased job satisfaction and performance. Several knowledge gaps have been identified, as well as priorities for future research into pediatric occupational therapists and occupational stress.

Occupational therapy, cancer, and occupation-centred practice: impact of training in the model of human occupation.

INTRODUCTION: This study examined the influence of training in an occupation-centred model on the practice of occupational therapists working in a cancer hospital. There is an increased need for occupation-based rehabilitation services for individuals with and surviving cancer. Incorporating an occupation-centred model into practice has unique challenges for occupational therapists working in oncology settings. Utilizing an occupation-centred model of practice may influence the therapeutic reasoning of occupational therapists. METHODS: A generic qualitative inquiry (Patton, 2015) was used to examine therapeutic reasoning as related to post-professional training in a specific occupation-centred model, the Model of Human Occupation (MOHO). Initially, ten occupational therapists with various levels of experience, working across populations in a large cancer centre completed a training session about the MOHO. This was followed by participation in monthly focus groups with an emphasis on the use of MOHO in daily practice (Taylor, 2017). Focus group sessions were video recorded and transcribed. The transcripts were then analysed using open coding and theme generation (Patton, 2015). RESULTS: Three major themes were extracted from the data during the thematic analysis: understanding and using MOHO language; challenges in incorporating a conceptual model of occupation-centred practice in an oncology setting; and therapeutic reasoning implications. Patterns in the themes indicated a progression from learning the model, to applying the model, to reflection on practice. CONCLUSION: Post-professional training in an occupation-based model influenced the therapeutic reasoning and practice of occupational therapists in an oncology setting.

Battle weary/battle ready: A phenomenological study of parents' lived experiences caring for children with autism and their safety concerns.

AIM: The first aim of this study was to explore the lived experiences of parents caring for their autistic children and their experiences with safety for these children. The second aim was to elicit safety recommendations from the parents of autistic children. DESIGN: Hermeneutic phenomenology. METHODS: Fifteen participants who self-reported they were parents of children with autism were recruited via snowball sampling. Data were collected from September 2017-December 2018 in audiotaped interviews using semi-structured questions. Interviews were held with four participants to determine if the findings represented their experiences and concerns accurately. RESULTS: Two underlying structures which demonstrated the trajectory of the experience caring for autistic children were lost/finding our way and battle ready/battle weary. The phenomenological themes within battle weary included living with fear, living with uncertainty and living with disappointment. Resilience was a fourth phenomenological theme which supported the experience of being battle ready. The participants provided recommendations for other parents and healthcare professionals to help keep autistic children safe. CONCLUSION: This study illustrates the unique perspective of parents of autistic children concerning autism and safety. IMPACT: Most parents in this sample reported they faced substantial issues with safety for their child. Study results demonstrated that parents received little to no information about safety from healthcare professionals. Parents of autistic children and healthcare professionals need to be educated about safety issues to prevent injuries and death.

Long-Term Impact of Model of Human Occupation Training on Therapeutic Reasoning.

This general qualitative study explores occupational therapists' perspectives related to the long-term impact of Model of Human Occupation (MOHO) training on therapeutic reasoning in practice. MOHO is a widely used, occupation-focused theory that promotes participation and engagement in meaningful activities for occupational adaptation. One-on-one, semi-structured interviews were conducted with six occupational therapists at a cancer rehabilitation center who previously underwent systematic MOHO training. Therapists acquired or expanded MOHO knowledge as a result of training and retained that knowledge 9 months later. They also implemented training-related practice changes including the provision of more holistic, client-centered occupational therapy services and systematic use of the MOHO to reason in practice 9 months later. Specific results varied based on experience with the MOHO prior to study-related training. MOHO training promotes knowledge acquisition and positive practice changes long-term for occupational therapists in cancer rehabilitation. Similar trainings would meet therapists' desire to learn more about theory-driven practice and improve their clinical reasoning skills. Future research should explore how results transfer to other facilities and how therapeutic reasoning with the MOHO impacts quality of care.

A Study of the Amputee Experience of Viewing Self in the Mirror.

PURPOSE: To describe the trajectory of viewing self in a mirror after an ampu-tation and participants' perceptions of what health care professionals should know about mirrors. DESIGN: Hermeneutic phenomenologyMETHODS: Focus groups were conducted to collect the research data. FINDINGS: The mirror experience had three key moments: decision, seeing, and consent. The trajectory of viewing self in a mirror had four key themes: mirror shock, mirror anguish, recognizing self, and acceptance: a new normal. Participants' recommendations for introducing the mirror after an amputation and using a mirror to avoid skin breakdown and infection, and correct gait and balance are described. CONCLUSIONS: This study provides a unique viewpoint into the world of those who have suffered amputation of a limb. CLINICAL RELEVANCE: Rehabilitation nurses and other health care professionals are encouraged through these participants to consider the effect and value of mirrors when caring for those who have had an amputation.

Determining the Internal Validity of the Inventory of Reading Occupations: An Assessment Tool of Children's Reading Participation.

The Inventory of Reading Occupations (IRO) is an assessment tool of children's reading participation. In this study, we used Rasch methods to determine the internal validity of the IRO. Participants included 192 typical and struggling readers from kindergarten to third grade from five different states in the United States. We analyzed the fit of each of the items in the 17 reading categories, the test items in the three dimensions of reading participation, and the contexts of reading in the IRO. Analysis indicated that the IRO items support the Rasch model of unidimensionality. Analysis also indicated that 1 of the 30 test items can be revised to strengthen test validity. Moreover, the analysis also suggested that the IRO is more useful for first- to third-grade students. This study provides evidence of internal validity of a useful tool to assess children's reading participation.

Striving for shared understandings: therapists' perspectives of the benefits and dilemmas of using a child self-assessment.

Pediatric client-centered intervention planning is particularly complex because children, parents, and professionals must form a "tridactic" partnership and reach a shared understanding for therapy. Therapists may use child self-reports to facilitate children's involvement in this process. The purpose of this study was to understand how therapists used and interpreted a child self-report to achieve a shared understanding in the context of a tridactic relationship, using the Children's Occupational Self-Assessment (COSA) as an exemplar. Thirty-three pediatric therapists participated in five focus groups and qualitative analysis was conducted in four iterative phases. Therapists' decision to use the COSA led to either "good" responses or unexpected tensions between the therapist's, child's, and parent's perspectives. Therapists used demonstration, negotiation, or reflection to shift beliefs to achieve a shared understanding for therapy. Findings suggest that although therapists valued children's voices, professional knowledge usually took precedence over child and parent self-knowledge during intervention planning.

How interdisciplinary pediatric practitioners choose assessments.

BACKGROUND: The assessment process affects the direction and quality of the services children and youth with disabilities receive. However, little is known about how practitioners choose tools and strategies to assess clients. PURPOSE: To identify processes practitioners use to gather information and choose methods of assessment in pediatric practice. METHODS: Three focus groups were held with teams of interdisciplinary pediatric practitioners. Key themes were identified. FINDINGS: Two primary themes emerged: "Things practitioners want to know" and "Choosing what and how to assess." Practitioners began the assessment process wanting to gather information about children and their environment. Practitioners then used the initial information to decide what and how to further assess as described by three subthemes: "fitting" the child, balancing formal and informal information, and professional context. IMPLICATIONS: Practitioners generally made individualized assessment choices for each child based on the initial information they gathered and then used a balance of formal and informal assessments. However, they were more likely to formally assess children at the level of body structures and function rather than participation, and continued to rely upon such standardized assessments to meet reimbursement and policy requirements.

International efforts to disseminate and develop the model of human occupation.

This paper documents efforts in Canada, France, Finland, Germany, Hispanoamerica, Israel, Japan, The Netherlands, and Taiwan to disseminate the Model of Human Occupation (MOHO). We aim to characterize the challenges involved, the strategies used, and the impact of these efforts in diverse cultural and social conditions.

Measurement properties of the Short Child Occupational Profile (SCOPE).

The purpose of this study was to examine the reliability and validity of the Short Child Occupational Profile (SCOPE; version 2.0). The SCOPE is an occupation focused, client-centered, theory driven assessment developed out of a practice/academic partnership. In this study, twenty practitioners from occupational therapy, physical therapy, speech therapy, and social work completed thirty-five SCOPE assessments with clients' ages two years, four months to twenty-one years with both physical and intellectual disabilities. All therapists rated one common client. Rasch analysis using Facets was used to analyze the items. Results reveal that the SCOPE items coalesce to represent the construct of occupational participation in a valid manner and that most clients can be measured in a valid way by those items. Therapists used the SCOPE in a similar way and analysis demonstrated there was limited variability among therapists. The SCOPE discriminated between clients who had varying levels of occupational participation. The results indicate a need to do minor revisions to the assessment in order to maximize the psychometric properties and enhance clinicians' understanding of the items and rating scale terms.

Interdisciplinary staff perceptions of an occupational therapy return to work program for people living with AIDS.

The purpose of this qualitative study was to identify the perception of interdisciplinary staff members regarding the impact of a model work and independent living oriented program for residents in supportive living facilities. This study used focus groups and individual interviews to collect these perceptions. Staff members identified four areas of impact: utilization of a holistic and process-oriented approach, an ability to identify and work with the strengths of clients, emphasis on the learning of practical skills, and creating an intersection for all aspects of services. These findings point to the fact that staff members found the value that occupational therapy has to offer their overall programming by improving participation of clients with HIV in learning practical skills for use in their daily lives and in developing work related skills.