"I can't be the nurse I want to be": Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving.

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.

Humor in rehabilitation professions: a scoping review.

PURPOSE: Studying humor in the rehabilitation professions is important given its positive effects on health and well-being. We conducted a scoping review to understand how the use of humor has been explored in the existing literature in four rehabilitation professions. The rehabilitation professions included audiology, speech-language pathology, physical therapy, and occupational therapy. MATERIALS AND METHODS: The five-stage method identified by Arksey and O'Malley was used to conduct this review. Six databases were searched. We included 57 articles in our final review, summarized in a narrative synthesis. RESULTS: We generated seven themes in our analysis: (1) humour as a management strategy in therapy; (2) humour as a power establisher vs. equalizer; (3) humour as a coping mechanism in rehabilitation; (4) conceptualizations of non-verbal humor cues in therapy; (5) Is humour trainable? (6) Humor used to foster group cohesion; and (7) Attitudes and beliefs surrounding humor practice. CONCLUSIONS: Our findings emphasize the importance of using humor in the rehabilitation professions, and the ways in which humor is conceptualized in a multitude of ways for both clinician and client. Future work is needed to further understand the presence and use of humor in rehabilitation professions.IMPLICATIONS FOR REHABILITATIONIn a scoping review of the literature, this study showed that humor was used mainly positively in rehabilitation by the included professions of audiology, speech-language pathology, physical therapy, and occupational therapy and contributed to a sense of belonging.Humor may be an effective way to improve management of client/clinician relations as well as improving group cohesion in rehabilitation settings.In the rehabilitation professions of audiology, speech-language pathology, physical therapy, and occupational therapy, non-verbal humor cues were used in instances where communication was difficult or impaired for clients.

Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis.

PURPOSE: To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. MATERIALS AND METHOD: We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. RESULTS: Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. CONCLUSION: Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care.IMPLICATIONS FOR REHABILITATIONThe provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice.Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system.Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions.

Assistive Technology Use among Older Adults with Vision Loss: A Critical Discourse Analysis of Canadian Newspapers.

Low vision assistive devices are often positioned as enabling continued social participation and engagement by older adults in everyday activities; however, previous research suggests that the use of such technologies is restricted by various environmental factors. With little attention previously paid to the discursive environment, this critical discourse analysis critically examined how aging persons with vision loss and assistive technology (AT) were constructed and the occupational possibilities promoted and marginalized through technology use in six Canadian newspapers. In total, 7,289 articles were screened, 1,867 articles underwent a full-text review, and 51 articles were selected for data analysis. Results highlight four key discursive threads related to the framing of disability and AT, positioning of seniors with vision loss, and the ideals and occupations to be attained through AT, and point to the importance of re-configuring discourses addressing AT for seniors with vision loss to expand occupational possibilities and embrace collaborative design approaches.

Mobilizing Occupation for Social Transformation: Radical Resistance, Disruption, and Re-Configuration: Mobiliser l'occupation pour une transformation sociale : résistance radicale, perturbation et reconfiguration.

BACKGROUND.: Given the sociopolitical roots of widening occupational, social, and health inequities, it is imperative that occupational therapy move forward in mobilizing occupation for social transformation. PURPOSE.: Three key aims are addressed: articulating the imperative to mobilize occupation for social transformation; highlighting the political nature of occupation and occupational therapy; and providing guideposts for embracing a radical sensibility to inform moving forward in mobilizing occupation for social transformation. KEY ISSUES.: Conditions of possibility within occupational therapy leave the profession ill equipped to enact social transformation. Enacting calls to mobilize occupation for social transformation requires radically reconfiguring these conditions of possibility to inform practices that resist, disrupt, and re-configure sociopolitical conditions perpetuating occupational inequities. IMPLICATIONS.: Mobilizing occupation for social transformation holds much potential to contribute toward creating more equitable, humane societies. Realizing this potential involves committing to transforming our profession, as well as societal discourses, structures, systems, relations, and practices.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice.

BACKGROUND.: As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as "street-level bureaucrats" ( Lipsky, 1980/2010 ) who effect and are affected by policy. PURPOSE.: Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being. KEY ISSUES.: By highlighting practitioners' everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice. IMPLICATIONS.: Framing occupational therapists as street-level bureaucrats reinforces practitioners' situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists' exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Initiating Participatory Action Research with Older Adults: Lessons Learned through Reflexivity.

La recherche-action participative (RAP) apporte une perspective intéressante pour la recherche abordant l'exclusion et l'inclusion sociale des personnes âgées. Les exemples et réflexions sur la RAP impliquant des personnes âgées sont rares, en particulier à l'étape de l'initiation de la recherche, lorsque l'action participative cyclique est mise en place. Dans cet article, nous décrivons le démarrage d'un projet de recherche-action participative avec des personnes âgées et analysons la concordance entre ce processus et les principes clés de la participation, ainsi que son arrimage aux structures de recherche typiques. Les résultats soulignent les tensions entre le développement de relations de plus long terme et les demandes de financement préparées dans de courts délais. Cette étude montre comment les conceptions traditionnelles de la recherche peuvent influer sur la création de partenariats équitables et met en évidence la nécessité d'élaborer des lignes directrices en matière d'éthique et de publications qui traitent explicitement des approches participatives. Ces observations clés pourront être appliquées pour utiliser les potentialités de la recherche-action participative, qui consiste à aborder les enjeux importants à travers un travail collaboratif et une approche équitable intégrant les personnes les plus affectées.Participatory action research (PAR) is well suited to research that aims to address social exclusion and inclusion in older age. Illustrations of and reflections on PAR with older adults are scarce, particularly the initiation stage, which sets the stage for the cyclical participatory action that follows. In this article, we describe the initiation of a PAR project with older adults and reflect on the alignment of this process with key participatory principles and fit within typical research structures. Findings point to the tensions between developing relationships over time and time-sensitive calls for funding, how traditional conceptions of research can influence creating equitable partnerships, and the need for development of ethical and publishing guidelines that address participatory approaches. These key insights can be applied to help achieve the potential of PAR: to address issues of concern by collaboratively and equitably working with the people most affected.

Challenges in enacting occupation-based social transformative practices: A critical dialogical study.

BACKGROUND.: Globally, occupational therapists are taking up the transformative potential of occupation to mobilize the profession's commitment to social change. PURPOSE.: This study examined ideal constructions of occupation-based social transformative practices and challenges that may arise when enacting these practices. METHOD.: Five participants with experiences developing practices aligned with social transformative goals in diverse locations were recruited. In this critical dialogical study, three dialogical interviews were conducted with each participant. Critical reflexivity was enacted through the exchange of transcripts and critical reflections with participants. A critical discourse analysis was conducted to examine how such practices are shaped within discourses and other contextual features. FINDINGS.: The findings address constructions of ideal practice and three threads that provide critical insights into ways discourses shape possibilities to enact social transformation through occupation. IMPLICATIONS.: This study brings together experiential and theoretical knowledge to advance social transformative practices by problematizing underexamined discourses in occupational therapy.

Occupational therapy and occupational science: building critical and transformative alliances / Terapia ocupacional e ciência ocupacional: construindo alianças críticas e transformadoras

[{"text": "Occupational therapy and science are facing calls for social transformation based on the growing\r\nawareness and concern with widening occupational inequities and growing occupational injustices apparent at\r\nlocal and global scales. This paper addresses the potential for occupational therapy and science to form productive,\r\ncritically-informed alliances that support occupation-based socially transformative work. Although acknowledging\r\nthe critical turn in occupational science, which has raised awareness of problematics within the discipline and moved\r\nscholarship in directions that align with transformative work, there is a need for further radical configuration of\r\nthe conditions that shape and bound occupational science to optimize its potential as a critical ally. The following\r\nfive key directions should be considered as means to expand the possibilities in occupational science: deeper\r\nengagement with critical and transformative paradigms; challenging dualistic thinking; critically situating and\r\npoliticizing occupation; addressing the moral and political values energizing scholarship; and questioning the status\r\nquo within and outside the discipline.", "_i": "en"}, {"text": "A terapia e a ciência ocupacional estão enfrentando pedidos de transformação social baseados na crescente\r\nconscientização e preocupação com o aumento das desigualdades ocupacionais e as crescentes injustiças ocupacionais\r\naparentes às escalas locais e globais. Este artigo aborda o potencial da terapia ocupacional e da ciência ocupacional\r\npara construir alianças produtivas e criticamente informadas que apoiem o trabalho socialmente transformador baseado\r\nna ocupação. Embora reconhecendo que a reviravolta crítica na ciência ocupacional aumentou a conscientização\r\nsobre as problemáticas dentro da disciplina e movimentou a produção intelectual em direções que se alinham com o\r\ntrabalho transformador, argumenta-se que existe uma necessidade de configuração radical adicional das condições de\r\npossibilidade que moldam e vinculam a ciência ocupacional, para otimizar seu potencial como aliado crítico. Cinco\r\ndireções-chave são consideradas como meio para expandir as condições de possibilidade na ciência ocupacional,\r\nincluindo: envolvimento mais profundo com paradigmas críticos e transformadores; desafio ao pensamento dualista;\r\nsituar e politizar criticamente a ocupação; abordar os valores morais e políticos que estimulam a produção intelectual;\r\ne questionar o status quo dentro e fora da disciplina.", "_i": "pt"}]

Toward Understanding Person-Place Transactions in Neighborhoods: A Qualitative-Participatory Geospatial Approach.

Background and Objectives: Emerging research regarding aging in neighborhoods emphasizes the importance of this context for well-being; however, in-depth information about the nature of person-place relationships is lacking. The interwoven and complex nature of person and place points to methods that can examine these relationships in situ and explore meanings attached to places. Participatory geospatial methods can capture situated details about place that are not verbalized during interviews or otherwise discerned, and qualitative methods can explore interpretations, both helping to generate deep understandings of the relationships between person and place. This article describes a combined qualitative-geospatial approach for studying of older adults in neighborhoods and investigates the qualitative-geospatial approach developed, including its utility and feasibility in exploring person-place transactions in neighborhoods. Research Design and Methods: We developed and implemented a qualitative-geospatial approach to explore how neighborhood and person transact to shape sense of social connectedness in older adults. Methods included narrative interviews, go-along interviews, and global positioning system tracking with activity/travel diary completion followed by map-based interviews. We used a variety of data analysis methods with attention to fully utilizing diverse forms of data and integrating data during analysis. We reflected on and examined the utility and feasibility of the approach through a variety of methods. Results: Findings indicate the unique understandings that each method contributes, the strengths of the overall approach, and the feasibility of implementing the approach. Discussion and Implications: The developed approach has strong potential to generate knowledge about person-place transactions that can inform practice, planning, policy, and research to promote older adults' well-being.

A critical interpretive synthesis: Use of the occupational justice framework in research.

BACKGROUND: The occupational justice framework was established in the late 1990s with an agenda to spur occupational therapists to take action against injustices pertaining to occupation. METHODS: A critical interpretive synthesis of 23 texts was undertaken to examine how the occupational justice framework has been utilised in research, with a particular focus on how such research is located on a knowledge to action continuum and the extent to which it enacts the call to remediate occupational injustices. RESULTS: Within the texts reviewed, the occupational justice framework was predominantly used to interpret research findings, and only four studies explicitly used an action research approach. There was also a dominant tendency to individualise situations of occupational justice, but with some examples attending to the social and political production of injustices. Absences and silences related to the locations of the research in developed regions and a focus on conceptualisations of justice commensurate with a Western worldview were evident. CONCLUSIONS: Full realisation of the potential contributions of the occupational justice framework requires challenging traditional modes of research that focus primarily on knowledge generation, and expanding into modes of research that embrace a knowledge to action continuum. This expansion, which will enable occupational justice research to more fully embrace action-oriented work, requires practicing epistemological reflexivity, adopting a critical stance, incorporating a participatory action research approach and collaborating with scholars from different disciplines.

Precarity in the Nonprofit Employment Services Sector.

Drawing on interview and focus group data, this article explores research undertaken as part of a larger research project exploring precarity in the nonprofit employment services sector in a mid-sized Canadian city. We critically survey major legislative changes to Canadian employment and income security policies and programs, including the restructuring of work and labor relations, growth of performance-based contracting-out, erosion of intergovernmental transfers, worker stress, and emotional tolls. Our study's results demonstrate how employment precarity in the nonprofit employment services sector is amplified by top-down and centralized relationships with funding partners and policymaking divorced from the employment experiences of frontline staff. We make the case that it is important to work against rising workplace precarity to strengthen organizational and workplace conditions, as well as build environments more supportive of optimal employment support services. En se fondant sur des entretiens et des données découlant de groupes témoins, cet article présente des explorations entreprises dans une recherche plus large étudiant la précarité dans le secteur des emplois de service dans une ville canadienne de taille moyenne. Nous faisons une revue critique de changements importants intervenus dans la législation portant sur l'emploi au Canada et les politiques et programmes de la sécurité du revenu, incluant la restructuration du travail et des relations de travail, l'augmentation de la privatisation se fondant sur la performance, la diminution des transferts intergouvernementaux, le stress au travail et les conséquences émotionnelles. Les résultats de notre recherche démontrent comment la précarité de l'emploi dans les secteurs des services à but non lucratif est amplifiée par des relations allant du haut vers le bas et centralisée avec des partenaires et des politiques séparés de l'expérience des travailleurs sur le terrain. Nous démontrons qu'il est important de travailler contre la précarisation en renforçant les conditions organisationnelles et de travail, tout en construisant des environnements favorisant une offre de services de l'emploi optimaux.

Reshaping understandings of disability associated with age-related vision loss (ARVL): incorporating critical disability perspectives into research and practice.

PURPOSE: In this paper, we have sought to stimulate a critical dialog regarding the ways in which disability has been largely conceptualized and studied in literature addressing age-related vision loss (ARVL). We suggest an expansion of this largely biomedically informed research area to include alternative frameworks, namely critical disability perspectives. METHOD: To demonstrate the potential contributions of adopting a critical disability approach to enhance understandings of ARVL, this article outlined the primary tenets of the biomedical and social models of disability; the key aims, emphases, and assumptions of critical disability perspectives; and provided examples of how such an approach would lead to new research foci in the study of ARVL. RESULTS: The paper highlighted four qualities of critical disability perspectives that future ARVL research should ascribe to, including (a) a focus on interdependence over traditional notions of independence; (b) a broader conceptualization of 'normalcy'; (c) the influence of language as a means of describing or labeling disabled persons; and (d) the influence of the socio-political environment in the creation and sustainment of disability. CONCLUSIONS: This paper encouraged the incorporation of critical disability perspectives to provide new ways of conceptualizing, researching, writing about, and practicing in relation to ARVL. Implications for Rehabilitation The application of critical disability perspectives to expand the boundaries of low vision research can broaden low vision rehabilitation services (LVRS) in ways that more effectively attend to environmental features shaping and perpetuating disability for clients with age-related vision loss (ARVL). Low vision research, informed by critical disability perspectives, would inform a shift away from the exclusive focus on independence towards an acknowledgment of interdependence. The integration of participatory research approaches in ARVL research could generate new insights to inform rehabilitation by enhancing space and respect for the stories and knowledge of older adults aging with vision loss. Greater attention in low vision rehabilitation should be paid to how older adults' experiences of disability are tied to both the environmental context in which they exist and by the limitations caused by their impairment.

Extending Beyond Qualitative Interviewing to Illuminate the Tacit Nature of Everyday Occupation: Occupational Mapping and Participatory Occupation Methods.

The study of human occupation requires a variety of methods to fully elucidate its complex, multifaceted nature. Although qualitative approaches have commonly been used within occupational therapy and occupational science, we contend that such qualitative research must extend beyond the sole use of interviews. Drawing on qualitative methodological literature, we discuss the limits of interview methods and outline other methods, particularly visual methods, as productive means to enhance qualitative research. We then provide an overview of our critical ethnographic study that used narrative, visual, and observational methods to explore the occupational transitions experienced by immigrants to Canada. We describe our use of occupational mapping and participatory occupation methods and the contributions of these combined methods. We conclude that adopting a variety of methods can enable a deeper understanding of the tacit nature of everyday occupation, and is key to advancing knowledge regarding occupation and to informing occupational therapy practice.

Examining the construct validity of the Cognitive Competency Test for occupational therapy practice.

BACKGROUND: Enhancing occupational therapy practice requires critical examination of assessment tools and the conclusions being drawn from their use. When working with cognitively impaired older individuals, judgments about occupational competence are often informed by an assessment of cognitive competence. PURPOSE: The Cognitive Competency Test (CCT) is a frequently used measure in Canada to inform predictions of occupational competence. However, there is an absence of published evidence that addresses its validity. METHODS: To appraise validity of the CCT, a retrospective chart review (n = 107) of CCT reports for inpatient and outpatient clients with cognitive impairment was conducted. Data were subjected to exploratory factor analyses to examine the factor structure, and the measure was compared with commonly used clinical variables reflecting cognitive and occupational competence. FINDINGS: Results suggest that the CCT measures a unitary construct and provide some support for its predictive capacity. IMPLICATIONS: CCT scores can add incremental validity to cognitive screens, such as the Mini Mental State Exam, when evaluating occupational competence.

Components of cognitive competence predictive of occupational competence in persons with dementia: a Delphi study.

BACKGROUND: Within the area of dementia care, occupational therapists are asked to predict occupational competence in everyday living and often do so by assessing cognitive competence. Considering the cognitive changes that occur with dementia over time, the construct of cognitive competence is a key consideration. Still, a gap exists in the literature examining the relationship between cognitive competence and occupational competence. PURPOSE: This study developed a consensus among participating Canadian occupational therapists regarding the components of cognitive competence they considered essential to predict occupational competence in people with dementia. METHOD: A three-round Delphi study was completed with English- and French-speaking occupational therapists (n = 127; 116; 125) experienced in dementia care. FINDINGS: Ten cognitive components were identified as essential to predict occupational competence in individuals with dementia. IMPLICATIONS: The 10 identified components provide direction for assessment practices and education in dementia care and for development of measurement tools.

Moving Beyond 'Aging In Place' to Understand Migration and Aging: Place Making and the Centrality Of Occupation.

'Aging in place' has become a key conceptual framework for understanding and addressing place within the aging process. However, aging in place has been critiqued for not sufficiently providing tools to understand relations or transactions between aging and place, and for not matching the diversity of contemporary society in which people are moving between and across nations more than ever before. In this article, the authors draw from concepts of place and migration that are becoming increasingly visible in occupational science. The concept of 'aging in place' is critically examined as an example of an ideal where the understanding of place is insufficiently dynamic in a context of migration. The authors suggest that the concept of place making can instead be a useful tool to understand how occupation can be drawn upon to negotiate relationships that connect people to different places around the world, how the negotiated relations are embedded within the occupations that fill daily lives, and how this process is contextualized and enacted in relation to resources and capabilities.