The Value Filter: A Novel Framework for Psychosocial Adjustment to Traumatic Upper Extremity Amputation.

Purpose Upper extremity traumatic amputation due to work injury is a devastating injury with poor outcomes. As it does not appear to follow existing theories of psychosocial adjustment to injuries and illness, we sought to understand this problem by asking those who have sustained the injury, how they try to adjust. Methods Qualitative methods were used to interview 11 participants within 3 years of their accident. Questions included "Tell me about the impact of the amputation on your life". Data were systematically gathered and analyzed using a grounded theory (constructivist) approach which led to a preliminary model of adjustment. Results The Value of the Hand, and the Value of Working and Doing, emerged as central phenomena and created a Value Filter through which our participants' new experiences were interpreted. Two interacting themes, Instability of the Core Identity, and Efforts to Stabilize the Self, describe the effects of the process which either interfered with or promoted the formation of new values that, in turn, could lead to adjustment. Conclusions The preliminary model helps explain psychosocial adjustment for individuals with a traumatic upper extremity amputation due to work injury. The model may also be useful with other acquired injuries where the lost body part was deemed highly valuable for the individual's sense of self.

Recognizing the Role of Research Assistants in the Protection of Participants in Vulnerable Circumstances.

Little is known about how research assistants (RAs) protect participants in vulnerable circumstances. Using a critical qualitative method informed by feminist ethics, we ran five focus groups with experienced RAs. We identified two themes: (a) expressing moral competencies (subthemes: recognizing power, privilege, and vulnerability; adapting processes and providing support; understanding the sources of moral competencies) and (b) negotiating and making transparent roles and responsibilities (subthemes: separating responsibilities as a clinician from those of an RA; critically reflecting on the shared responsibilities of principal investigators and RAs; and identifying the role of the Research Ethics Committee). Although RAs possess a variety of moral competencies and have an important role in protecting research participants in vulnerable circumstances, that role is largely unrecognized.

Illness intrusiveness and subjective well-being in schizophrenia.

This study evaluated the extent to which schizophrenia and its treatment interferes with participation in valued life activities and its impact on subjective well-being. The Illness Intrusiveness Ratings Scale was completed by 78 individuals with schizophrenia on 3 measurement occasions. Clinicians working with participants, plus a relative/friend of each participant also provided independent ratings of the person. The Illness Intrusiveness Ratings Scale displayed internal consistency (coefficient alpha = 0.82), and temporal stability across 1 day (r = 0.89), 1 week (r = 0.51), and 1 month (r = 0.78). Reported intrusiveness was high (M = 50.5) and was among the highest compared with populations with other serious medical and psychiatric illnesses. Ratings correlated with staff and family/friends' ratings of intrusiveness (r = 0.33 and r = 0.40), measures of symptomatology (average r = 0.25), and subjective well-being (average r = 0.41). Path analysis indicated that lifestyle disruption mediates the impact of symptoms and treatment on well-being. Implications for these findings and future directions for research are discussed.

Evolving identities: Thomas Bessell Kidner and occupational therapy in the United States.

A founder of the National Society for the Promotion of Occupational Therapy, Thomas Bessell Kidner (1866-1932) played a prominent role in the early development of occupational therapy in Canada and the United States. We describe Kidner's early life and how his work using occupations evolved. We then examine ideas and assumptions about occupations as treatment and trace Kidner's involvement through to his leadership role within the American Occupational Therapy Association. Through our analysis of primary and secondary source materials, we have extracted recurring themes and related them across and within the materials to discern Kidner's influence on the profession. From among his many contributions, three areas emerge as particularly relevant to current practice: occupational therapy's role in return to work, relationships with medicine, and the profession's image. Kidner's story gives us a window on our history and an opportunity to see how the profession has evolved.

From education to occupation: the story of Thomas Bessell Kidner.

BACKGROUND: Thomas Bessell Kidner is well-known in the United States as a great contributor to occupational therapy. He is not well-known in Canada despite the fact that his first contributions to the profession were made here between 1900 and 1918. PURPOSE: To tell the story of Thomas Bessell Kidner and his impact on occupational therapy. METHODS: Interpretive biography research methods using archival materials, published papers and family papers. RESULTS: Kidner's work as an organizer of manual training in elementary schools in Nova Scotia and New Brunswick and as Director of Technical Education for Calgary prepared him for his work as Vocational Secretary of the Military Hospitals Commission during World War I. Kidner developed, implemented and oversaw the reeducation program for injured soldiers across Canada. It included bedside occupations, off-ward and curative workshop activities provided by ward aides, as well as industrial training and apprenticeships in the workplace. PRACTICE IMPLICATIONS: Kidner's story stimulates us to revisit our profession's early emphasis on return-to-work. Knowing about our past helps occupational therapists to build a stronger identity.

Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"

Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.

Holding on and letting go: the perspectives of pre-seniors and seniors on driving self-regulation in later life.

Although decisions related to driving are vital to well-being in later life, little is known about how aging drivers who do not experience a medical condition that requires driving cessation regulate their driving. This exploratory, qualitative study used focus groups with 79 such community-dwelling individuals to examine driving self-regulation from the perspective of pre-senior (aged 55-64) drivers, senior (aged 65 years or over) drivers, and senior ex-drivers. Themes resulting from inductive analysis addressed the importance of driving, mechanisms of self-monitoring and self-regulation, people who influenced decision making, and opinions regarding licensing regulations. A preliminary model of the process of self-regulation that highlights intrapersonal, interpersonal, and environmental influences on why, how, and when aging drivers adapt or cease driving is presented. The model identifies areas for future research to enhance understanding of this process, including the effectiveness of self-regulation. Findings suggest that increased public awareness of issues related to driving and aging could assist aging drivers, their families, and their family physicians in optimizing driving safety for this population. Since a near accident or accident was seen as the only factor that would lead many informants to stop driving and few informants planned for driving cessation, there is a need for interventions that help aging drivers make the transition to ex-driver in a timely and personally acceptable way.

Helen Primrose LeVesconte: occupational therapy clinician, educator, and maker of history.

BACKGROUND: The Canadian history of our profession is not well known and our identity is thought to suffer as a result. Helen Primrose LeVesconte (7896-1982) is one pioneer in our development whose story has not been told. PURPOSE: Our purpose is to explore LeVesconte's life and work in order to expand knowledge of our roots and thereby strengthen our identity. METHOD: Using interpretive biography methods we draw on LeVesconte's own writings, articles written about her, and archival documents to describe turning point moments in her life and to display meaningful patterns in her work. RESULTS: LeVesconte's work as a clinician and her role and reputation as an educator, show her to have been a strong and visionary leader. Her views on the client's role, the importance of the therapist-client relationship, prevention, community-based programs, and vocational rehabilitation are of particular interest. PRACTICE IMPLICATIONS: Because LeVesconte educated over 1,850 students while director of the occupational therapy program at the University of Toronto, her influence has been felt throughout the country. Her perspective is compared to current practice; and questions are raised as to aspects of her legacy and philosophy that might now be reconsidered.

Experiences of university students living with mental health problems: Interrelations between the self, the social, and the school.

BACKGROUND: A university education is becoming ever-more important in preparing for employment in the knowledge-driven economy. Yet, many university students are not able to complete their degrees because they experience mental health problems during the course of their higher education. Despite the growing numbers of students seeking help, there is limited knowledge about the issues that these students face. OBJECTIVE: The purpose of this study was to understand the range of individual, interpersonal, and environmental factors that affect the lives of university students living with mental health problems. METHODS: The study was based at a large public university in Canada. Semi-structured interviews were conducted with 19 students with self-identified mental health problems. Their narratives were analyzed using grounded theory methods and a model was developed which drew upon social-ecological theory. RESULTS: Findings depict student experiences as a function of the self (individual factors), the social (interpersonal factors) and the school (environmental factors) and their interrelations. CONCLUSIONS: Interventions must be designed to address all three of these areas and their interrelations. The model can be used to guide universities in designing interventions; however, a fourth level that incorporates a university policy that values and supports student mental health, should be included.

Stroke survivors', caregivers', and health care professionals' perspectives on the weekend pass to facilitate transition home.

OBJECTIVE: To explore stroke survivors', caregivers', and health care professionals' perceptions of weekend passes offered during inpatient rehabilitation and its role in facilitating the transition home. DESIGN: Qualitative descriptive. SUBJECTS: Sixteen stroke survivors, 15 caregivers, and 20 health care professionals' from a rehabilitation hospital. METHODS: Participants discussed their perceptions of the purpose of the weekend pass, experiences with the weekend pass including supports needed, and weekend pass administration. Focus group and interview data were audio recorded, professionally transcribed, checked for accuracy, and analyzed using conventional content analysis. RESULTS: We identified 3 key themes: i) preparing for patients to be safe at home; ii) gaining insight through the weekend pass; and iii) the emotional context of the weekend pass. These themes varied by participant group. CONCLUSIONS: When offering weekend passes, stroke care systems should carefully consider patients' and caregivers' readiness, emotional state, and preparation for weekend passes. The weekend pass experience can inform in-patient therapy, provide patients and caregivers with insight into life after stroke, and help prepare patients and families for the ultimate transition home.