Physical and occupational therapists' learning needs and preferences for education on functional electrical stimulation: A qualitative descriptive study.

BACKGROUND: Functional electrical stimulation (FES) is an evidence-based intervention that is rarely used by Canadian physical therapists (PTs) and occupational therapists (OTs). A common barrier to FES implementation is a lack of knowledge and training. FES learning resources that meet therapists' learning needs and preferences may address this barrier. OBJECTIVE: To explore OTs' and PTs' perspectives on the utility of FES e-learning resources, including whether the resources met their learning needs and preferences. METHODS: Through this qualitative descriptive study, feedback on FES e-learning resources was solicited from 5 PTs and 18 OTs who work clinically, but do not use FES. Participants reviewed ≥3 prerecorded lectures on FES topics and then completed a semi-structured interview. Participants were asked about the lectures' content, delivery, ease of use and comprehensibility, and were asked to suggest modifications to facilitate self-directed learning about FES. Interviews were analyzed using conventional content analysis. RESULTS: Three themes were identified. (1) Feedback on FES e-learning: the content and delivery of the prerecorded lectures facilitated participants' learning, although opportunities to improve content and delivery were identified. (2) Factors influencing FES learning needs and preferences: Participants identified internal (i.e., baseline knowledge, learning style) and external (i.e., learning with colleagues, practice setting) factors that affected learning. Themes 1 and 2 impacted (3) the effects of FES e-learning: Participants described the outcomes of their FES e-learning, including increases in FES knowledge, confidence, and use in clinical practice. CONCLUSION: Therapists' perceived the FES e-learning resources to be useful and to address their learning needs and preferences.

Research-related knowledge, understanding and practice in public mental health: the voices of social workers and occupational therapists.

INTRODUCTION: Previous studies have explored facilitators and barriers to research conducted by allied health professionals in general medical settings. Since the mental health system is acknowledged to be significantly under-funded and more poorly functioning than general medical services, it is unclear whether the published facilitators and barriers also apply to mental health settings. This study sought to explore the research-related knowledge, understanding and practices of allied mental health clinicians based in a large public mental health service. METHODS: A mixed methods study recruited 59 occupational therapists and social workers working in a dedicated metropolitan public mental health service in Melbourne, Australia. Quantitative survey results are reported elsewhere. Semi-structured interviews were conducted with 16 survey responder volunteers. Thematic analysis was conducted on the qualitative survey and interview data. RESULTS: Four main themes were identified: research must connect with clinical practice; fragments of knowledge; research in practice; and research is not part of my professional identity. The third theme, research in practice, comprised four subthemes: no time for research in clinical roles, missing communication, lack of ownership, and what I need to do research. CONCLUSIONS: This study found that research and research-related activities were not considered part of the mental health social workers and occupational therapists' professional identities. Dealing with this issue may be instrumental to the realization of these clinicians' professional peak-body associations' code of practice and to government mandated practice standards. We provided several strategies to encourage both clinicians and services to view research-related activities as an everyday part of clinical roles. This is especially important if we think of allied health evidence-based practice requiring a reasonable level of research-related skills and/or competencies to appraise, practice, evaluate and adapt their evidence-based practice.

What are the experiences, preparation, and support needs of early career clinical educators within an Australian tertiary health service?: a qualitative study.

BACKGROUND: There is increasing demand for professional practice placement opportunities, supported by health professional educators, to enable future health workforce development. Early career health professionals performing the educator role is one strategy that can help meet this demand. However, there is a need to consider how best to prepare and support early career health professionals to become educators. This study aimed to explore the experiences and perspectives of early career occupational therapy clinical educators including their preparation and support needs. METHODS: Semi-structured interviews were completed with ten early career occupational therapists who had supervised their first or second student on a professional practice placement. The participants worked within an Australian tertiary hospital and health service in various clinical settings. Interviews were completed within six weeks of placement completion and lasted approximately one hour. They were recorded and transcribed verbatim and reflexive inductive thematic analysis was undertaken to identify key themes. RESULTS: Ten occupational therapists, who had been working for an average of two years and two months, consented to participate. Initially, participants expressed mixed emotions about taking on the clinical educator role. They then described their adjustment to the role responsibilities, challenges encountered, and the development of the educator-student relationship. Participants found that the experience of supervising a student enhanced their educator, clinical, and professional skills and confidence. The important support elements of tailored educator preparation, placement design, and timely access to relevant resources and experienced staff were identified. CONCLUSIONS: This study demonstrated how early career health professionals can possess desirable educator attributes, such as enthusiasm for taking on the role and cultivating collaborative learning relationships with their students. The experience of being an educator also presents a professional development opportunity for early career health professionals. Insights gained about the specific preparation and support needs of early career clinical educators warrant consideration by organisations and staff involved in the provision of student professional practice placements. Overall, this study's findings signify the importance of engaging and investing in early career health professionals to support student clinical education and to develop our current and future healthcare workforce.

Current and preferred services of specialized professionals in childcare settings in Quebec, Canada: A descriptive survey of childcare administrators' perspectives.

BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.

Collaboration in the midst of chaos: perspectives of inpatient occupational and physical therapists during the COVID-19 pandemic.

The COVID-19 pandemic has affected over 700 million people globally, straining healthcare systems and highlighting the need for interprofessional collaboration. The aim of this study was to describe interprofessional collaborative practice (IPCP) experiences from the perspectives of occupational therapists (OTs) and physical therapists (PTs) who were employed in a medical center both before and during the COVID-19 pandemic. This qualitative study, conducted from July 2020-November 2021, delved into the lived experiences of occupational and physical therapists in an inpatient setting during the pandemic through analysis of semi-structured interviews and journal entries. The pandemic prompted fear, uncertainty, and ethical dilemmas among therapists, affecting patient-centered care. Roles expanded, and teamwork challenges emerged in defining boundaries, while communication dynamics were transformed by virtual technologies. The pandemic affected therapists' values and ethics, and evolving roles brought expanded tasks. The crisis showcased both collaboration potential and the need to address team disparities. This study highlights the significance of values, roles, teams, and communication for occupational and physical therapists during the COVID-19 pandemic providing valuable insights into interprofessional collaboration's effect on healthcare delivery in times of crisis and beyond.

A Pilot Survey of Pediatric Occupational and Physical Therapy Providers' Confidence, Attitudes, Barriers, and Education Regarding Trauma-Informed Care.

AIM: Trauma-informed care (TIC) is a strengths-based organizational approach which recognizes the prevalence and impact of trauma on an individual's neurological, sensorimotor, and emotional responses and development. There is limited research on pediatric occupational therapy providers' (OTPs) and physical therapy providers' (PTPs) perceptions on incorporating TIC into their practice. This pilot study aims to describe the confidence, attitudes, barriers, and education of pediatric OTPs and PTPs regarding TIC. METHOD: OTPs and PTPs (n = 87) working in pediatric settings in the U.S. completed an electronic survey regarding their perceptions of TIC. RESULTS: OTPs reported higher confidence in TIC compared to PTPs. Most participants reported favorable attitudes toward TIC, yet no statistical significance was identified between the two professions' overall attitudes toward TIC. Collectively, participants reported lack of time and training as barriers. There was a statistically significant difference between how the two professions rated competency, training, and concern over clients' retraumatization. There was significant association between years of professional experience and TIC education. CONCLUSION: Preliminary findings indicate an overall agreement of OTPs and PTPs with principles of TIC and common barriers to TIC practice. There are implications to further integrate opportunities for TIC training into foundational education and professional practice.

Supporting self-determination in mental health recovery: Strategies employed by occupational therapists.

INTRODUCTION: Self-determination is a core component of mental health recovery and a predictor of positive outcomes. The literature calls for occupational therapists to lead practice change to greater recovery-orientation, including facilitating people's self-determination. However, systemic challenges thwart translation of policy into practice and therapists report a lack of confidence in implementing recovery-oriented principles. This study aimed to understand the strategies that mental health occupational therapists employ to support people's self-determination. METHODS: Data were collected through an international on-line questionnaire principally comprising two open-ended questions designed to elicit deep reflective personal accounts. Participants were asked about an experience in which they supported a person's self-determination and the factors that either facilitated or hindered this experience. Qualitative data were analysed using inductive thematic analysis, guided by constant comparative methods. FINDINGS: Thirty-four therapists, predominantly from Australia (n = 30), participated. Therapists described supporting self-determination as a multifaceted process that involved: (1) working on myself, (2) working with the person, and (3) working with others. They emphasised that the combined use of various strategies across these three areas of work was important to support people's self-determination. Further, awareness of and addressing issues of power in their practice was key. CONCLUSION: This study supports the translation of recovery-oriented principles into practice by revealing the nuanced strategies implemented by occupational therapists striving to support self-determination. Participants employed diverse strategies to empower people to take the 'driver's seat' in their mental health recovery journey. Insights from this study will support other occupational therapists to actualise recovery-oriented principles and better support self-determination in their practice. To effectively implement self-determination strategies, therapists must reflect on and address existing power differentials within mental health services, particularly between themselves and the people they support.

"Why is it not bringing me meaning and purpose?" Former occupational therapists' narratives of leaving the profession.

INTRODUCTION: The demand for occupational therapy services in Australia has experienced considerable growth in the last decade. Despite an increase in occupational therapy numbers, there remains a substantial workforce shortage. One reason for this shortage is difficulty with the retention of occupational therapists and subsequent workforce attrition. The literature attributes planning to leave as being influenced by high workloads, insufficient time, a negative workplace culture, and stress impacting well-being. However, much of this research is specific to a practice area, such as mental health, and does not explore the experiences of those who have already left. Knowing why people leave occupational therapy will inform our understanding of how to support and retain our occupational therapy workforce. METHODS: A qualitative study was undertaken using narrative inquiry in an Australian context. In 2022, stories were gathered from six former occupational therapists who left within the previous 5 years. Data were collected via semi-structured in-depth interviews using Zoom. Interviews were recorded and transcribed verbatim. The data were analysed using narrative and thematic analysis. FINDINGS: Four themes were developed: "I just want to help this person"; "there was no real understanding"; "Trying to find where occupational therapy fits for me"; and "I'm not able to continue … anymore." Participants experienced dissonance between enacting their occupational therapy values and the expectations of their management. They were challenged by unsupportive workplace cultures and leadership styles that undermined their autonomy. They responded with resilience, and trying new ways to continue being occupational therapists, but became increasingly uncomfortable and stressed until they reached a tipping point where they decided to leave. CONCLUSION: Increasing leadership development within the profession is essential, along with creative strategies for meeting funding requirements and fulfilling occupational therapy values. Workplaces that provide autonomy and respect the occupational therapy role are likely to support retention.

Occupational therapy with patients in forensic solitary confinement: A qualitative study.

INTRODUCTION: Occupational therapists work with forensic mental health patients in solitary confinement to counter impacts of mental illness and occupational deprivation, to promote well-being and support transition to less restricted environments. There is little literature describing occupational therapy in this context. This study aimed to explore and describe the work, context and professional reasoning of occupational therapists working in solitary confinement settings within a large forensic mental health service in Victoria, Australia. METHODS: A qualitative design used semi-structured interviews with 11 occupational therapists and reflexive thematic analysis. FINDINGS: Three central organising themes, it's all about risk, the work we do and why we do what we do, provided rich description of the context and work of occupational therapists in solitary confinement settings, including approaches used to engage patients in occupation and how the Model of Human Occupation and recovery principles informed their professional reasoning. Despite the setting restrictions, participants engaged in core elements of the occupational therapy practice process and described creative work that offered patients choice and meaningful occupation. They described occupational enrichment to address occupational deprivation and create opportunities for change within the highly restrictive and risk-focussed environment of solitary confinement. Assessment was mainly unstructured, and the need for better evaluation of therapy outcomes acknowledged. Goal setting often focussed on immediate needs. Working in a risk-focussed environment influenced participants' professional reasoning and work with patients, and while they advocated for occupational opportunities for patients, frustration was experienced in response to limits to occupational therapy involvement in risk assessment. CONCLUSION: The findings address a gap in the literature about the work of occupational therapists in forensic solitary confinement. Though participants' reasoning was informed by occupational and recovery principles, and they described working in occupation-based ways, they did not always articulate explicit connections between theory and practice.

The use of practice evidence by Australian occupational therapists: Perspectives and actions.

INTRODUCTION: Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. METHODS: A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. RESULTS: Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. CONCLUSION: Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

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.

Age-Related Cognitive Bias in the Assessment of Lateral Pinch Modulation by Occupational Therapists.

BACKGROUND: Cognitive bias may appear in occupational therapists' interpretation of physical examinations. Since different strategies for decision making have been shown to reduce bias, its quantification is an essential first step towards awareness and bias reduction. Our aims: (1) quantify cognitive bias by testing the differences in occupational therapists' assessment of lateral pinch force modulation between young and older adults, and between women and men; and (2) to test for a correlation between the tendency to bypass an intuitive response and the degree of cognitive bias. METHODS: Occupational therapists (n = 37; age 40.3 ± 11.4 years) used a visual analogue scale to rate pre-recorded simulations of the digital output of lateral pinch modulation videos of different levels of abilities coupled with videos of young/old men/woman pressing the force sensor. They filled out the Cognitive Reflection Test and the Rational-Experiential Inventory-40. RESULTS: Subjects showed higher bias towards old individuals compared to young ones (p < 0.001), but with no sex bias (p = 0.119). Rational ability correlated with cognitive bias of assessment of lateral pinch modulation in old individuals (r = 0.537, p < 0.001). DISCUSSION: Occupational therapists might underestimate the physical abilities of older adults. Biased evaluation might cause assignment of redundant exercises and therefore loss of time, effort, and resources.

Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting.

IMPORTANCE: Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice. OBJECTIVE: To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States. DESIGN: Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice. SETTING: Acute mental health service in a large teaching hospital system. PARTICIPANTS: Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study. DATA COLLECTION AND ANALYSIS: Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice. FINDINGS: The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change. CONCLUSIONS AND RELEVANCE: For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

Occupational therapists' understanding of supporting physical activity participation when working with children and adolescents: A national survey.

INTRODUCTION: Physical inactivity is a leading risk factor to disease and mortality. Despite the recognised benefits of physical activity, over half of the Australian population are not sufficiently active. For individuals with a disability, inactivity rates are further increased placing them at a higher risk of the negative effects of physical inactivity. Developing healthy lifestyle habits such as physical activity participation in early childhood has been found to be supportive of health behaviours being maintained into adulthood. Physical activity is an occupation said to involve the complex interaction between psychological, social, environmental, and physical factors placing it within the scope of occupation therapy. However, limited research is available exploring what this role looks like in practice. METHOD: An online, anonymous survey was developed to better understand how Australian occupational therapists understood physical activity participation, as well as their current and potential role in facilitating regular physical activity participation with their clients. All registered Australian occupational therapists were eligible to participate in this survey, which consisted of both closed and open answered questions. RESULTS: A total of 43 occupational therapists registered to practice within Australia completed the survey. All participants viewed physical activity as an important occupation for maintaining the health and well-being of their clients. Participants described the holistic role occupational therapists could play supporting physical activity participation outside of motor skill development. Therapists identified several ways in which a family-centred, occupation-based approach could be used to support sustained engagement in physical activity. CONCLUSION: The findings from this study contribute to our understanding of the role occupational therapy can play supporting physical activity participation for children and adolescents. This sparsely researched area requires more evaluation to ensure intervention is delivered in a way that is most effective.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study.

IMPORTANCE: Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions. OBJECTIVE: To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions. DESIGN: This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship. SETTING: Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom. PARTICIPANTS: In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated. OUTCOME AND MEASURES: A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions. RESULTS: Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done. CONCLUSIONS AND RELEVANCE: The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

Early career programs for mental health occupational therapists: A survey of current practice.

INTRODUCTION: Early in their career, occupational therapists may require a range of additional development for a successful transition to the profession. However, both the definition of 'early career' and the relevant development for this career stage vary between sources. In regard to occupational therapists transitioning to mental health professional practice, there is very little evidence to draw upon when designing the structure and content of development programs. This study aimed to review current practices in early career programs for mental health occupational therapists within the Australian state of Victoria. METHODS: Tertiary mental health services in Victoria were purposefully recruited, supplemented by snowball recruitment. The participants responded to a bespoke survey including open and closed questions, designed to benchmark practices against previous research and explore current practices with early career mental health occupational therapists. Thirteen services participated, with respondents including senior clinicians, allied health chiefs, allied health clinical educators and early career development program coordinators. RESULTS: The participants confirmed the perceived value of development programs for early career mental health occupational therapists; however, limited resources were available to develop, implement and sustain these supports. Program content, structure and terminology varied significantly, as did the identified competencies for participants to achieve. Some of this variability was related to program eligibility criteria and early career workforce structure within organisations. CONCLUSION: Early career mental health occupational therapist development should be responsive to their local service environments. A better understanding of the outcomes of these programs for early career occupational therapists, from both an individual and service perspective, could also provide a firmer rationale and foundation for sustained resourcing of this valuable approach to workforce development.

Occupational therapy in oncology palliative care for adolescents and young adults: Perspectives of Australian occupational therapists.

INTRODUCTION: Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis. METHODS: Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6 weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data. RESULTS: Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs. CONCLUSION: Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

Working with clients of higher weight in Australia: Findings from a national survey exploring occupational therapy practice.

INTRODUCTION: Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight. METHODS: A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis. RESULTS: Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma. CONCLUSION: Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.

Evaluating a multidimensional strategy to improve the professional self-care of occupational therapists working with people with life limiting illness.

BACKGROUND: The term 'life limiting conditions' refers to premature death following decline from chronic conditions, which is a common circumstance in which occupational therapists work with people at the end of life. The challenges for clinicians of working with these patients have long been recognised, and may have a significant impact on their professional self-care. This study aimed to evaluate a multidimensional workplace strategy to improve the professional self-care of occupational therapists working with people living with a life limiting condition. METHODS: A pre and post mixed methods survey approach were utilised, with baseline data collection prior to the implementation of a multidimensional workplace strategy. The strategy included professional resilience education, targeted supervision prompts, changes to departmental culture and the promotion of self-care services across multiple organisational levels. Follow up data collection was undertaken after the strategy had been in place for 2 years. Quantitative data were analysed descriptively, while qualitative data were subjected to thematic analysis. RESULTS: One hundred three occupational therapists responded (n = 55 pre, n = 48 post) across multiple service settings. Complex emotional responses and lived experiences were identified by participants working with patients with life limiting conditions, which were not influenced by the workplace strategy. Working with these patients was acknowledged to challenge the traditional focus of occupational therapy on rehabilitation and recovery. Participants were confident about their ability to access self-care support, and supervision emerged as a key medium. While the strategy increased the proportion of occupational therapists undertaking targeted training, around half identified ongoing unmet need around professional self-care with this patient group. Demographic factors (e.g. practice setting, years of experience) also had a significant impact on the experience and needs of participants. CONCLUSIONS: The multidimensional workplace strategy resulted in some improvements in professional self-care for occupational therapists, particularly around their use of supervision and awareness of available support resources. However, it did not impact upon their lived experience of working with people with life limiting conditions, and there remain significant gaps in our knowledge of support strategies for self-care of occupational therapist working with this patient group.

A Community of Practice of primary health care occupational therapists: Advancing practice-based knowledge.

INTRODUCTION: New contexts of practice demand that professionals engage in critical reflection to handle new situations and to create new knowledge that is responsive to professional practices situated in unique historical and social contexts. Community of Practice offers a framework for professions to reflect together on practice dilemmas and to generate practical solutions. METHODS: This paper presents a participatory action research project that traces the trajectory of a Community of Practice made up of seven occupational therapists working in primary health care and a researcher team, in Brazil. This study mapped the Community of Practice's trajectory between 2013 and 2017 through a group timeline analysis, which occurred gradually, in a collaborative mode. RESULTS: Three distinct phases in the trajectory of the development of the Community of Practice were identified: narrative perspectives were utilised as a means to identify dilemmas and difficulties in practice; the investigation of clients' needs and identification of issues was an ongoing process; and the generation of practice-based knowledge through the development of instruments to sustain clinical reasoning was a creative solution to practical dilemmas. CONCLUSION: Three main aspects were highlighted: the partnership between researchers and practitioners as a potential avenue for the production of knowledge relevant to professional practice; the negotiation of the dilemma of "putting practice into words" in the context of constantly changing local and global perspectives; and the investigation of situated practice as an important element that can strengthen, strain, resist or even modify hegemonic perspectives of knowledge production in our field.