Understanding professional identity in occupational therapy: A scoping review.

INTRODUCTION: A strong professional identity helps occupational therapists maintain professional values and thrive when facing work-related challenges and opportunities including generic, blurred or emerging roles, funding pressures and a push for outcome evidence. A scoping review will build understanding of professional identity and how to maintain it in such circumstances. OBJECTIVES: To scope what is currently understood of professional identity in occupational therapy and factors which influence ability to maintain this and adapt in challenging work environments. METHODS: Using Arksey and O'Malley's scoping review framework three databases were searched using the terms 'occupational therap*' and 'professional identity'. Data extraction and thematic analysis highlighted the extent and nature of current literature and mapped key concepts. RESULTS: 89 papers were included. Professional identity was revealed as a multidimensional construction. Four themes emerged: developing a shared ontology, embracing the culture, enacting occupational therapy, and believing in occupational therapy. Factors which influenced development and maintenance of professional identity included occupation-centred practice, ontological reflexivity, linking theory to practice and professional socialization. CONCLUSIONS AND SIGNIFICANCE: The enhanced understanding of professional identity and factors which preserve or enhance it can help the profession identify how to position itself to remain resilient and adaptive in an ever-changing environment.

Engaging New Parents in the Development of a Peer Nutrition Education Model Using Participatory Action Research.

This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.

Transcending the individual: The promise and potential of collectivist approaches in occupational therapy.

BACKGROUND: In a globalised world, with injustices and inequities, occupational therapists have a moral and ethical obligation to use their knowledge and skills to work at a collective level with groups, communities, and populations rather than focus solely on individualistic approaches. OBJECTIVES: To review the literature exploring the question: What do occupational therapists do in their everyday practice that could be characterised as having a collectivist orientation? METHOD: A scoping review with searches on Web of Science, Scopus and CINAHL databases with the keywords 'occupational therapy' AND collectiv*. RESULTS: 161 articles were found and after screening of abstracts and/or full text, 19 were included. Articles were published in English (13) and Portuguese (6), in 12 different journals and one book, from 1988 to 2018. They were categorised as focussing on: social welfare - collectivism (n = 2); collective occupations (n = 11); and collective oriented practices (n = 6). CONCLUSION: A clear definition of collectivist approaches in occupational therapy practice was not found. What was evident, however, was a focus on experiential accounts of working with groups of people and the methods and processes utilised. It is argued that occupational therapy needs to further develop knowledge and practices aimed at injustices grounded in a collectivist epistemology.

Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis.

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards / Ser e fazer centrado na ocupação em ambientes desafiadores: reflexões sobre estratégias de implementação e recompensas profissionais

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards / Ser e fazer centrado na ocupação em ambientes desafiadores: reflexões sobre estratégias de implementação e recompensas profissionais

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.

Capabilities, Opportunities, Resources and Environments (CORE): Using the CORE approach for inclusive, occupation-centred practice.

BACKGROUND/AIM: Occupational participation is often claimed as a human right and determinant of health by occupational science and therapy scholars. Yet, maintaining occupation at the centre of practice is a challenge. The Capabilities, Opportunities, Resources and Environments (CORE) approach provides a mechanism for occupational therapists to address this challenge by viewing their practice through an inclusive lens, and enacting inclusive, occupation-centred occupational therapy. This paper presents applications of the CORE approach via three case narratives. The aim is to increase occupational therapists' understanding of how to apply the CORE approach and to facilitate research-to-practice knowledge translation. METHODS: The CORE approach is introduced and applied through three case narratives, each highlighting one of the CORE elements within the context of the broader approach. FINDINGS: The narratives contain critical reflective case narratives on the application of the CORE approach in the context of three different practice settings in Australia based on the authors' experiences. Practice settings include working within the National Disability Insurance Scheme, in a secure forensic mental health facility, and in rural community health. The forensic health case narrative documents findings from the authors' research which applied the CORE approach as an analytical tool, providing an additional layer of analysis of the identified themes from the original study. CONCLUSION: This paper provides occupational therapists with a practical understanding of how to apply the CORE approach through diverse case narrative examples. The practical "how to" questions that guided the development of the case narratives can be used by occupational therapists and occupational therapy students in individual or group critical reflection to support development and application of socially inclusive and occupation-centred praxis. If occupational therapists are to claim expertise in enabling occupation and social inclusion, then using the CORE approach is vital to designing and implementing inclusive, occupation-centred interventions.

Study Protocol of the Parents in Child Nutrition Informing Community (PICNIC) Peer Education Cohort Study to Improve Child Feeding and Dietary Intake of Children Aged Six Months to Three Years Old.

One in five Australian pre-schoolers are overweight or obese, meaning the first years of life are vital for obesity primary prevention. Parent child feeding practices impact on children's dietary intake, which in turn impacts on their weight status. Parents' child feeding beliefs are heavily influenced by parenting peers. The aim of this cohort study is to evaluate the impact of the Parents in Child Nutrition Informing Community (PICNIC) study on parents feeding practices and diet quality. The secondary outcomes are the perceptions of trained peer educators and education recipients based on their involvement in PICNIC. One hundred parents with a child aged 0-2 years at time of recruitment will participate in peer educator training, then disseminate nutrition and child feeding content to other parents over an intervention period of 12 months, supported by project-specific, evidence-based social media pages and website. An additional 100 new parents, recruited by peer educators, will participate in the study as nutrition education recipients. Both peer educators and education recipients will complete quantitative child feeding surveys before and during the 12 month intervention and a dietary intake survey at a time point 12 months post intervention. Following the intervention, 30 education recipients will be asked to participate in semi-structured phone interviews about their experiences with PICNIC. Peer educators will contribute as co-researchers and active participants in the evolution of the PICNIC model. This study will contribute to enhanced understanding of contemporary health literacy strategies for communicating nutrition and feeding messages to new parents and the impact of these strategies on parents feeding practices and children's dietary intake in a community setting.

Sylvia docker memorial lecture: Together we go further-Service co-design, knowledge co-production and radical solidarity.

BACKGROUND/AIM: Occupational therapy can be essentially described as enabling social inclusion through occupational participation. How does this best happen? The answer is through working in deeply collaborative, power and knowledge sharing partnerships with individuals, families, communities and populations of people across contextual boundaries. METHODS: In this lecture, critical consideration is given to first, ways of working with communities of interest in service co-design, knowledge co-production and as co-researchers and how the philosophical underpinnings of the profession are consistent with such approaches. The second part of the lecture examines epistemic and hegemonic 'blind-spots' of the profession which can act as barriers to such person centred interactions, further reproducing dynamics of exclusion and marginalisation of already vulnerable persons and communities. Finally, the lecture considers the 'next era' in occupational therapy in which, in response to entrenched situations of occupational injustice globally, we may work with people in what has been termed 'radical solidarity' using de-colonising and occupation-centred approaches such as the Participatory Occupational Justice Framework and the Capabilities, Opportunities, Resources and Environments approach. RESULTS: Using approaches that represent authentic partnerships between occupational therapists and the people they serve can result in powerful and potentially transformative outcomes. This is because working with people as co-designers of services and as co-researchers in evaluating service effectiveness, means that knowledge is co-produced within specific contexts. This in turn means the traditional evidence/practice gap is closed. CONCLUSIONS: Working in authentic, power sharing partnerships with diverse people in diverse settings using diverse approaches, will be the way in which occupational therapy can make its strongest societal contribution. Aligning occupational justice with epistemic and hermeneutic justice is fundamental to this vision, providing a platform in which members of the profession can work collaboratively with people and go further together towards societal change.

Enhancing occupational therapists' confidence and professional development through a community of practice scholars.

INTRODUCTION: An important professional issue for occupational therapy is the need to develop and maintain high-quality occupational therapy services. Clearly, a strong educational foundation is necessary, but not sufficient, for meeting this goal. Occupational therapists need to engage in ongoing education, professional development and critique of their theory and practice to ensure they meet best practice standards. One way that practitioners can do this, is to form practitioner communities with a focus on scholarship: a 'community of practice scholars'. METHODS: Using the framework of action research, three occupational therapy academics worked collaboratively with 25 occupational therapy practitioners over a period of 12 months. During monthly teleconference meetings, the research group discussed, critiqued and reflected upon their practice. Transcripts of the final month's teleconferences, which focussed on evaluation of the community of practice scholars, were qualitatively analysed. FINDINGS: Two major themes are presented. The first theme, promotion of scholarship, describes that involvement in the community of practice scholars assisted participants to think more critically about their practice and to consider ways in which their practice might be improved. The second theme, promoting professional confidence, passion and cohesion, articulates that the support offered by the group helped the participants to feel an increased sense of confidence in their practice. CONCLUSION: It is proposed that communities of practice scholars have considerable potential for providing professional development opportunities for occupational therapists. In addition, such communities may lead to occupational therapists feeling more supported and experiencing increased satisfaction in their work.

Utopian visions/dystopian realities: exploring practice and taking action to enable human rights and occupational justice in a hospital context.

AIM: This article reports some preliminary findings of an Australian action research project that aimed to investigate, and affect, occupational therapists' understanding of human rights theory and occupational justice philosophy in everyday occupational therapy practice. METHOD: Over the course of one year, nine therapists from a range of practice areas in a major metropolitan hospital participated in monthly discussion groups. Narrative data was collected through audio-recording and transcribing the discussions. Data was qualitatively analysed using line-by-line coding and theme-building. RESULTS: Two preliminary themes are discussed herein: the invisibility of human rights issues in an Australian occupational therapy setting and the dissonance between the ideal and the reality of human rights practice in occupational therapy. CONCLUSION: The authors suggest that through discussion, and with the support of a community of practice dedicated to exploring human rights and occupational justice issues, occupational therapists can increase their awareness of human rights challenges. And, therapists can increase their actions to better enable occupational justice in their practice.

Living and doing with chronic pain: narratives of pain program participants.

PURPOSE: This study aimed to explore factors which predicated successful long-term pain management for people who had attended a cognitive-behavioural-based pain management program (PMP) in regional Australia. METHOD: This study used qualitative methods based on analysis of narratives. Fifteen people (11 women and four men), who attended the PMP in 2002 and 2003, agreed to participate in two in-depth interviews with a narrative focus in 2005. Their ages ranged from 30-65 years. Interview transcripts were analysed thematically. FINDINGS: Themes that emerged from the interviews were the meanings and beliefs participants had attributed to their pain at the time of the program and after program completion (i.e. being ready to do the program and acceptance or non-acceptance of the long term nature of their pain). It also identified the strategies that some participants used and continued to apply in their daily lives (i.e. using pacing strategies and re-engaging in valued routines and tasks). CONCLUSION: The findings suggested that the ability to adopt positive meaning attributes and use a variety of strategies was related to those participants who were successful in their ongoing pain management. The importance of these factors should be considered for those attending chronic pain programs.

Knowledge generation and utilisation in occupational therapy: towards epistemic reflexivity.

AIM: The purpose of this article is to consider the ways in which theory generation, and hence knowledge generation, in occupational therapy is a complex social process, and therefore carries (often hidden) responsibilities for those who are part of our epistemic community. An epistemic community is a knowledge-producing community, who apply their standards of credibility, and epistemic values, to theory choice. In occupational therapy this community is comprised of a worldwide group of scholars and practitioners. METHODS: We propose that epistemic reflexivity can be used to critique and contribute to our disciplinary knowledge and to critically consider 'who' makes epistemological choices in our profession, and the consequent implications for the theories we adopt. The purpose of this article is to make these relations explicit so that scholars and therapists can become increasingly conscious and empowered with respect to their contributions to occupational therapy's epistemic community. To demonstrate an application of epistemic reflexivity, we critically consider a theoretical construction that has been widely adopted by the international occupational therapy community: evidence-based practice. RESULTS: As authors, we engage in epistemic reflexivity to critically consider the challenge posed by evidence-based practice. We propose a conception of practice knowledge that is informed by evidence yet based on a conception of wise practice. CONCLUSION: Our intention is to stimulate discussion and debate in occupational therapy's epistemic community, a number of approaches for fostering epistemic reflexivity in occupational therapy are suggested.

Language, identity and representation: occupation and occupational therapy in acute settings.

AIM: This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia. METHODS AND FINDINGS: Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation. CONCLUSIONS: The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.

Conceptual and practical issues in qualitative research: reflections on a life-history study.

Although qualitative research is becoming increasingly popular as a means of understanding not only occupation but also a range of other human health-related phenomena, the complex conceptual underpinnings of the paradigm remain relatively unexplored in the literature. This article addresses such a perceived gap. Context specificity, emic perspectives, its iterative nature, and power relations are four distinct conceptual dimensions of qualitative research that are discussed. The article also includes reflections on conceptual dimensions and practical issues in relation to a qualitative study that adopted a life history approach. These reflections highlight how the conceptual dimensions underpinning qualitative research guide the process in life-history research and shape the experience of life-history researchers. The practical considerations, which focus on participant qualities, effects on the researcher and the participant-researcher relationship, are particularly relevant for potential life-history researchers. The article concludes with a discussion on the value of life-history as a qualitative research approach for occupational therapy and occupational science.

Understanding the occupational deprivation of refugees: a case study from Kosovo.

BACKGROUND: Occupational deprivation as a concept has been presented and discussed in the occupational therapy and occupational science literature for the past several years. The discussion to date, however, has been largely exploratory and theoretical in nature. PURPOSE: This article represents the author's attempt to further understandings of occupational deprivation as a lived experience through research undertaken with Kosovar refugees living in Australia. METHOD AND RESULT: The article focuses on the story of one of the participants of the study which is presented as a case study to illuminate aspects of occupational deprivation as a process occurring over time. The case study is interwoven with interpretive commentary, which serves to highlight key issues as to how occupational deprivation may be experienced by groups of people in different cultural, historic and societal contexts and how it may therefore be addressed by occupational therapists. PRACTICE IMPLICATIONS: The article concludes with reflections on future directions with respect to both further research and professional action. In particular, the focus of professional action is oriented to a population-based approach.

Role of multi-purpose service programs providing residential aged care in rural Australia: a discussion paper.

OBJECTIVE: To determine if multi-purpose service (MPS) Programs deliver improved residential aged care as opposed to traditional rural hospitals. DESIGN: A variation on comparative-experimentalist: type 4. In this design 2 groups providing different service models of rural health services are compared. SETTING: Six MPS Programs and three traditional hospitals in rural New South Wales. SUBJECTS: Key stakeholders--area representatives, health service managers, MPS managers, doctors, staff, MPS or hospital committee members and consumer groups including residents. MAIN OUTCOME MEASURE: To analyse the ability of MPS Programs to deliver quality residential aged care as opposed to using traditional hospitals for such services. RESULTS: Multi-purpose service programs provided better residential environments and greater flexibility of service provision. There were few apparent differences between the two service models in regard to organisational culture and training. CONCLUSIONS: The findings of this evaluation suggest that in the provision of residential aged care in rural communities, MPS Programs demonstrated better standards of care than traditional hospital based services.