Report on an interdisciplinary program for allied health.

CONTEXT: A central recommendation from the Pew Health Commission to educators has been to empower future care providers to function effectively as teams. Administrators and faculty members within a school of allied health sciences thus established an interdisciplinary program where students would learn to function as team members and demonstrate competencies required for practice in diverse, demanding, and continually changing health care environments. Students from five disciplines have participated in featured events, mentored activities and capstone projects, earning credit in an interdisciplinary course of study that complements offerings in their home disciplines. GOAL: This follow-up article reports on the progress and development since 2002 of an interdisciplinary program known as Team IDEAL. Formative evaluation measures used to assess satisfaction with the program are presented alongside a discussion of new directions. CONCLUSION: Team IDEAL will move forward in a streamlined form that reflects its central aim. IDEAL leadership will remain cognizant of the effects of discipline-specific curricular changes, complex programming, and student perspectives on the process interdisciplinary education.

Airway function in lifetime-nonsmoking older asbestos workers.

Previous studies of lung function in asbestos workers have documented airflow limitation in many of the workers, but the specific influence of asbestos exposure could not be clearly differentiated from the effects of the cigarette smoking habit. In this study, airway function was evaluated in lifetime-nonsmoking, long-term workers of the mines and mills of Québec. The 17 asbestos workers in this study had worked for an average of 28 years in the mines and mills of the local asbestos industry and did not have any other respiratory industrial dust exposure. They did not have a history of previous pulmonary disease and did not meet the usual diagnostic criteria for chronic bronchitis, emphysema, or asthma. Seven of the workers met the diagnostic criteria for asbestosis and 10 workers did not. The latter group of workers did not differ from a matched control group except in terms of a higher isoflow volume (p less than 0.05). The workers with asbestosis, however, had a restrictive pattern of lung function, increased isoflow volume, and increased upstream resistance at low lung volumes (p less than 0.01). Lung biopsy in three of the patients with the disease demonstrated peribronchiolar alveolitis and fibrosis with obliteration and narrowing of the small airways. These data on lifetime-nonsmoking, long-term asbestos workers provide further evidence of small airway obstruction associated with asbestos exposure and independent of the smoking habit. This airflow limitation was observed predominantly in workers with a restrictive pattern of lung function associated with peribronchiolar alveolitis. The lifetime-nonsmoking asbestos workers without restrictive patterns of lung function had minimal dysfunction of the peripheral airways.

Time as a commodity: reflections and implications.

American society's conceptualization of time as a commodity has supported occupational therapy practice since its inception. This article discusses numerous contemporary media messages about time both because they are pervasive and because their meaning often escapes us. Popular magazines, greeting cards, and cartoons weave themes about time into the fabric of other messages. There is remarkable coherence in the themes that cut across these three sources of time messages. Commercial images reveal the ideas that we are asked to accept about time; satirical images ask us to reflect about the ideas that we have accepted. A preponderance of images suggest that we control time and live in style. These suggestions constitute a cultural force that shapes personal values toward an end that we rarely consider. Occupational therapists need to recognize the presence and power of media images that radically challenge the meaning of living a satisfying life.

Occupational therapy service: individual and collective understandings of the founders, Part 1.

This inquiry aims to explore the understandings of patient, therapist, and occupation held by the founders of the National Society for the Promotion of Occupational Therapy. Influenced by contemporary historical events, the founders shared a common belief that the right occupation could help persons in need. Personal narratives found within the early occupational therapy literature illustrate each founder's unique understanding of how occupation might address contemporary problems. Each view contributed to the development of a multifaceted therapy. Exploration of the multiple interpretations that shaped a common idea may help current therapists to better understand their heritage of caring and to compare it with current practices. The first part of this inquiry considers the personal narratives of George Edward Barton, Susan Elizabeth Tracy, and William Rush Dunton, Jr. The second part, which will appear in a later issue, will further discuss Dunton's views, along with those of Eleanor Clarke Slagle, Herbert Hall, Susan Cox Johnson, and Thomas Bessell Kidner.

Moral treatment: contexts considered.

Many scholars associate the 19th-century practice of moral treatment with occupational therapy practice. A more thorough understanding of moral treatment is therefore relevant for occupational therapists. This article considers moral treatment within the contexts that shaped both its characteristics and the course of its practice--the medical community and 19th-century society. This consideration may provide therapists with a broader understanding of moral treatment and enable them to address the question of a relationship between the two practices.

Sustaining the art of practice in occupational therapy.

The art of practice in occupational therapy is intrinsically centered on relationships, on the qualities that make relationships meaningful, and on the meaning of occupation in a life. Demands from today's health care system make it increasingly difficult for practitioners to engage in meaningful relationships with their patients. The art of practice, jeopardized by the health care system, requires sustenance from other sources. A new field, literature and medicine, suggests a source of sustenance for the art of occupational therapy practice. The reading of fictional literature can provide occupational therapists with sustaining images that can reaffirm their commitment to the art of providing occupation as therapy.

The fullness of empathy: reflections and illustrations.

Seven core values are said to undergird the profession of occupational therapy, with empathy serving as a hallmark of one of those values-personal dignity. This inquiry explores the meaning of empathy within a practice that holds occupation at its center. The literature on empathy in both philosophy and the behavioral sciences yields cogent thoughts about the fullness of empathy and its characteristics actions. The Healing Heart, the biography of a pioneer therapist, Ora Ruggles, shows the manner in which occupational therapists can be empathic in their practice. These reflections and illustrations serve to sharpen the vision of occupational therapists as persons who reach for both the hands and the hearts of others.

AIDS: toward a compassionate response.

AIDS evokes powerful feelings, often manifestations of fear, among health care providers. To effectively treat patients with AIDS, occupational therapists must acknowledge and reconcile their personal feelings. One way to formulate a compassionate response to patients is to understand the meanings that we give to AIDS, meanings that shape our interpersonal behaviors. Restricted meanings--that the disease constitutes death, sin, crime, war, or community division--place the person with AIDS at risk for compromised care. Recognizing the limitations of these meanings can free therapists to find other meanings that inspire compassion.

The patient-therapist relationship in occupational therapy: understanding visions and images.

The patient-therapist relationship in occupational therapy has been a blend of competence and caring with the emphasis fluctuating over the years between these two features. When patients tell stories about their experiences, they reveal widely differing views of occupational therapists, partly because of the different ways therapists manifest competence and caring during patient-therapist interactions. Images from stories suggest that some therapists unwittingly disappoint their patients. This paper examines the patient-therapist relationship as envisioned by therapists and patients to help occupational therapists recommit to the patient as a vital partner in a collaborative relationship.

Moral treatment: how a caring practice lost its rationale.

The 19th-century practices of moral treatment and phrenology serve as historical examples of a narrowing focus in health care and reveal the manner in which theories can shape practice. The story of moral treatment, as it is told in connection with phrenology, emphasizes the push for success and right solutions. The push followed several shifts in the conceptualization of mental illness, the last of which proved moral therapy unreasonable. If practitioners in this century hope to ensure that the heart of moral treatment will withstand the effects of ever-changing theories, they must hold caring attitudes, words, and actions at the center of their practice.

Occupational therapy service: individual and collective understandings of the founders, Part 2.

This inquiry continues to explore the understandings of patient, therapist, and occupation held by the founders of the National Society for the Promotion of Occupational Therapy. The first part of this search, published in the April 1991 issue of AJOT, discussed personal narratives and anecdotes about George Edward Barton, Susan Elizabeth Tracy, and William Rush Dunton, Jr. This second part extends that discussion through an examination of the shaping influence of World War I on Dunton's beliefs and through consideration of the views held by Eleanor Clarke Slagle, Herbert J. Hall, Susan Cox Johnson, and Thomas Bessell Kidner. Influenced by contemporary historical forces as well as their personal experiences, the founders shared a common understanding that the right occupation could help persons in need. Personal narratives found within the early occupational therapy literature illustrate each founder's unique understanding of the manner in which occupation might address contemporary problems. Each view contributed to the development of a multifaceted therapy. Exploration of the multiple interpretations that shaped a common idea may help current therapists to better understand their heritage of caring and to compare it with current practices.

Art: an occupation with promise for developing empathy.

Empathy is central to the interactions of occupational therapists who value personal dignity. Persons from various sectors of the behavioral sciences and the medical humanities have proposed that engagement with the arts can develop empathy, an assumption that prompted this inquiry. The observations of artists and art philosophers suggest that the assumption that art may develop empathy is grounded in the kindred natures of the two practices and in the actions that occur when a person engages with a work of art. The assumption that art may develop empathy is grounded in the kinship of the actions common to both practices: response, emotion, and connection. Artists and art philosophers' observations of human practices have uncovered three rules of art that may dispose one toward empathy: reliance on bodily senses, use of metaphor, and occupation by virtual worlds. Analysis of art's potential suggests that a person who would derive empathy from art must (a) use the senses to grasp feeling, (b) stretch the imagination to see a new perspective, and (c) invite an occupation that enhances understanding. Persons who hope to develop empathy must pursue an experience that evokes the fellow feeling that inspires it. Art can offer this experience.

The depersonalization of patients: a profile gleaned from narratives.

Occupational therapists who would better understand and advocate against depersonalization in health care can find specific references in narratives to the attitudes and behaviors that seem problematic. Patients argue that helpers fail to recognize that illness and disability are events charged with personal meaning. Instead of communicating with patients, helpers establish a distance that diminishes them. They withhold information in a manner that precludes hope, they use brusque manners, and they misuse their powers. Each of these behaviors seems unreasonable and impersonal, and each discourages patients. Together these narratives might inspire therapists to value interactive reasoning as central to practice, to recommit to their consideration of persons, and to enact a climate of caring.

The patient-therapist relationship: beliefs that shape care.

The results of a previous inquiry suggest that three images of occupational therapists dominate patients' stories about them: the images of technician, parent, and collaborator or friend. These ways of being in practice can be said to reflect the various understandings that therapists have about how to enact the profession's commitment to both competence and caring. When therapists act as technicians or authoritarian parents, patients register their disappointment over a valuation of competence that excludes caring actions. In a more current inquiry into the climate of caring, patients and caregivers reflect about the current health care system and identify three societal constructs that shape a preference for competence over caring: (a) emphasis on the rational fixing of the health care problem, (b) overreliance on methods and protocols, and (c) a health care system driven by business, efficiency, and profit. Occupational therapists who are concerned about complaints that the health care system is increasingly uncaring might benefit from a consideration of the extent to which societal beliefs shape the manner in which they care.

The development of an occupational therapy interview/therapy set procedure.

Emphasis on returning patients quickly to the community requires staff in acute psychiatric settings to maximize therapeutic efforts within limited time frames. To satisfy standards for practice, therapists must constantly apply time management techniques to their therapeutic endeavors. Despite patient stays as brief as 10 days, practitioners continue to evaluate, treat, and plan for the discharge of each patient referred to their service. This led to a reassessment and restructuring of the initial occupational therapy interview in one psychiatric setting. The objectives of the interview, with particular emphasis on therapy set, are reviewed. These objectives were incorporated into a three-part procedure of interview/therapy set. The forms that structure the procedure are discussed as adaptable tools for use in similar settings.

Linking purpose to procedure during interactions with patients.

Occupational therapists' use of goal statements during interactions with patients can extend far beyond the care-planning session. Each treatment session provides an opportunity to match goals decided upon by the patient and therapist with a structured activity, thus endowing that activity with a therapeutic purpose. This article presents a rationale for discussing with patients the purpose and relevance of any procedure. The rationale for providing information and explanation is based on current health care trends, traditional occupational therapy assumptions, and the often ambiguous nature of activity, occupational therapy's primary modality.

Rethinking the use of the Hogan Empathy Scale: a critical psychometric analysis.

OBJECTIVE: The purpose of this research was to study the stability internal consistency factor structure, and convergent and discriminate validity of the Hogan Empathy Scale (EM) when used longitudinally with occupational therapy students. METHOD: More than 300 occupational therapy students completed the EM once; 192 completed it twice over a 12-month interval; and 56 completed a third administration at intervals ranging from 3 years to 6 years. The Fieldwork Performance Evaluation (FWPE) was rated twice for students after fieldwork rotations in the occupational therapy program. Data on grade-point average, gender, and age were collected. RESULTS: Stability was estimated at .41 over a 12-month interval and from .30 to .38 over longer intervals. Internal consistency was estimated at .57, and factor structures hypothesized previously were not replicable. Students' biographical variables explained only trivial amounts of variance in EM scores in regression equations (R = .08 and .21). Correlations between EM and FWPE scores did not support convergent validity (r = -. 01-.18). CONCLUSION: The reliability estimates for the EM as a measure of a trait-like construct are not encouraging and do not replicate previous estimates. Validity evidence was equally disappointing, raising questions about what the EM is measuring and cautioning against its continued, uncritical use as a measure of empathy.

Competence in scientific inquiry and research.

The survival and expansion of the profession of occupational therapy depends on its ability to respond to continually changing environments. One of the most current and critical factors in this adaptation is the capacity of therapists to achieve competence in scientific inquiry and research. Competence in the role of researcher is necessary because it contributes to the development of the individual therapist, the profession, and the organization within which the therapist functions. The aim of this article is to review and elaborate on the competencies associated with the role of researcher and to propose a reconceptualization of the knowledge, skills, and attitudes that shape competence in scientific inquiry.