[AU: please check on spelling of ipsative (or ippsative ... · while whilst nearly 40% practice in...

[AU: please check on spelling of ipsative (or ippsative); don’t know if it’s Word or the

British spelling mechanism playing games here; cannot steady and make consistent.]

Chapter 5

Discussion

By integrating the results of this study with those of previous studies as found in the

literature review, thisThe present study discussesion here presents the implications as found

infrom the current study results by chapter of the research project performs the function of

drawing implications from the results of the study (Sim & Wright, 2000; Rudestam 2001;

Polgar & Thomas, 2000) ). A discussion will now be presented which integratinges the

results of this study with those of previous studies as previo foundusly outlined in the

literature review. Recommendations will placeput the current studyies findings within the

practice context of the research field andwhich is not only the field where the research was

conducted, butalso in the application of those findings in practice where the benefits of its

findings will be utilised (Racey, 2002).

5.1 Characteristics of the sample

Formatted: No underline, Font color: Red


Formatted: Font: Bold


Copyright WordPronk 2016. All Rights Reserved.

Respondents claimed to work as a full- time, OT practitioners. However, as OTsthey

specializsed more with PWLTI, more of these OTs shifted into part-time employment. The

average work experience with PWLTI was 4 years for OTs, less time than what the general

OT practitioner spent before specializsing with PWLTI. This suggests means that OT is

perhaps in an emergent stagejust on its adolescence stage among PWLTI as compared to

the more mature, established, and mainstreamed general OT practice. Many of the

respondents were Senior I OTs. N and no respondents were basic grade OTs nor OTs

higher than Head III III.responded. M More than 60%sixty perc [AU: 60% of the

respondents, correct?] of respondents workent ar practicee working in the community,

while whilst nearly 40% practice in anthe acute setting.

The findings of this study, culled from experts in the field, demonstrate and verify a

consensus among OTs who practice within PWLTI of the core skills required.nature of the

characteristics of the sample can verify the findings where OTs’ consensus towards their

core skills among PWLTI is reliable because experts in the field were consulted as describe

above. Additionally, core skills could be further identified by the higher frequency with

which they were used by OTsthe therapists participating in the study (Blenkiron, 1995).

This is, indeed, the case, asand this was, indeed the case where skills were identified at ≥

80% of the occasion [AU: difficult passage here; what do you mean by occasion?].


As a greater proportion of OTs working with PWLTI are employed part-time, and with this,

less time isare spent with the clients and targets as establishedset out by the national

directives (NICE, 2004). are compromised. Employers, therefore,Therefore, employers

should address recruitment and retention of OTs in this speciality (Caines, 2000).

Interestingly, OTs in this speciality should seek alsoalso look at how to increase and

encourage staff to join them team. . Knowing thatOwing to the nature of respondents thatof

the respondents no junior OT staff lower than Senior II worksare working with PWLTI,

how can Senior and Head OTs increase their staffing in this speciality if they are hesitant to

train basic grade OTs?

5.2 OT core skills among PWLTI

SevenThere were seven identified key practice areas of importance are identified by OTs,

among them: where OTs believed to be important in their practice. Among these were: the

skill to use the OT model of practice and its assessment tools; the skill to assess and

provide interventions; supervisory skills; educational/teaching skills, and updated

attendance with CPD [AU: please identify CPD: Continuing Professional

Development?].


5.2.1 OT models of practice

Study results reveal thatThe results of the study had shown that although 67% of the

respondents employ uses OT practice models generally, of practice in general, still, a

significant proportion (33%) of OTs do not use any OT models at all to guide their practice.

Many OTs employ theuses Canadian Occupational Performance Model (COPM) compared

with Model of Human Occupation (MOHO) and Reed & Sanderson’s model. In addition to

these three specific OT practice modelsOn top of these,, other such practice models were

identified as there were other identified ‘models’ that have been used such as problem

solving and goal setting approaches; and still others employuses an eclectic approach,

typically a hybrid as a result of the combination of all models as identified here.other

models identified and specified.

A lLarge proportion of OTs find that their practice among PWLTI is best carried out when

it is guided by certain frameworks, such as COPM. This contradictsis in contrary to the

findings of Norris (1999) whoseere the study concluded that “COPM appears to be of

limited value in the palliative care setting…( (p.44)[AU: page number goes with

reference list at end]." Additionally, Norris (1999) acknowledges that COPM does not


address the area of psychological difficulties and emotional factors that

influenceinfluencing functional ability in palliative care.

The Norris study does not fully recognize, however,However, what the author did not

recognise is the extent to which a study’s representation and applicability can be severely

limited by the small scale of its conduct and how little it may represent and reflect at the

study’s generalisability can be limited to the day centre where the study was conducted

because of the fact that it was not a large scale study and its sample is not representative of

the actual palliative care client’s population. The unproven effectiveness of COPM as an

outcome measure for OT intervention in palliative care is contrary to the valued consensus

of OTs in this study.

5.2.2 Assessment tools

Despite the fact that most OTs employwere using OT models to guide their practice, it is

apparent that significant proportions of OTs do not use any (standardizsed) assessment

tools. Surprisingly, the Canadian Measure of Occupational Performance (CMOP) is

employed, marginally (6.4%) used compared to OTs who claimed to have employedused

COPM (27%) as an OT model to guide their practice. Likewise, HOPE’s (2000) published

document regarding outcome measures did not prove helpful as respondents did not


acknowledge the use of Reintegration to Normal Life Index (RNLI) as a vital tool for their

practice with PWLTI.

Huang’s study (2001),On the study made by Huang, et.al., (2001) regarding the sensitivity

of assessment tools in measuring functional outcomes and quality of life, it findsyields

findings that the specifically Functional Independence Measure (FIM) (together with

Disability Rating Scale – DRS) are highly sensitive in detecting changes in functional

status of patients with brain tumourstumours. This study provides many us, have

implications for OTs who treattreating PWLTI. Nevertheless, Huang’sthis finding

contradictsis in contrary to what OTs believe regarding the use of Quality of Life Measures

(QoLM), including FIM-FAM (which is adapted from FIM). Less than 10% of OTs find

FIM-FAM valuable to their practice.

5.2.3 Areas of assessment

It is interesting to note that most of the findings in the literature literatures’ (Engquist et. al.,

1996; Rose, 1999; Udell & Chandler, 2000; Collins, 2001) remainfindings can be decisive,

specifically in terms of spirituality. Oddly enough, sSpirituality is identified as one of the

least important areas to the OT respondents identified in this study, which remainsis

contrary to what the literature (Rose, 1999). says. Five years on, OTs do not have ‘time’ to


address spirituality with PWLTI. [AU: not certain of expression “5 years on”: do you

mean “after 5 years working or practicing”?] NJust nearly half (47.9%) of OTs

claimed that spirituality is a core area that needs assessment.o assess. It can be argued,

however,However, it can be argued (Rose, 1999) that respondents’’s views are necessarily

affected by their very definition ofcan be affected by the way they define s spirituality

(Rose, 1999). Spirituality, it should be argued, canIt can be related to faith or religion or

“‘the experience of meaning in everyday life”’ (Rose, 1999). As defined thus, spirituality

which maywould more likely to yield more interesting and definitive results. if the latter

meaning is included on the study.

The mMajority of areas the identified areas for assessment reflect are similar to what much

of current OT skills forin general rehabilitation (Cheville, 2001). are. The 10 most

important areas in assessment among PWLTI include:Emphasis on the assessment of

PADL, DADL, fatigue/weakness, transfers, indoor mobility, risk assessment and& minimal

handling, access to home/school/work, cognitive deficits, coping strategies, and physical

and& physiological symptoms are the ten most important areas to assess among PWLTI

(Cooper, 1998; Armitage & Crowther, 1999; Cheville, 2001; and Ewer-Smith & Patterson,

2002).


This suggests that the Therefore, the philosophiesy and practices ofshared both by

palliative medicine and general rehabilitation are shared equally (Cheville, 2001were

proven right (Cheville, 2001). The important areas for OT assessment among PWLTI are

not different from what OT skills in general rehabilitation are assessing for.). Additionally,

as individual respondents perceive assessment and definition differently, any assessmentthe

degree andof its implied importance attributedremain can dependent upon that “‘the

‘inclusiinclusivityely ofon of d definition”’ s’ for each of each areas of assessment as

individual respondent may perceive each area differently, affecting the important areas of

OT assessment.

5.2.4 Types of intervention

The relationship between assessmentof areas of assessment and intervention types of

interventions as expressed remainsprovided is very intriguing. TheIt is apparent that the

order of importance in as to theassessment areas and intervention types types of

interventions and areas of assessment do not correlate. StudyThe r results revealed that the

10 most significant types of intervention provideded for PWLTI include functional

mobility, liaising with other agencies, advice and& education, fatigue management, PADL,

access/home visit, patient support, home environmental adaptations, family/carer support

and transfers. are the top ten significant types of intervention provided for PWLTI. It is


interesting to note that DADL is not among these10 most significant intervention types.part

of the ten most important types of interventions to be provided. On the contrary, sexual

counselling, work/employment acquisition, spirituality, counselling, body image and

community re-integration were found, consistently, least important or “‘never”’ been

usedemployed in OT practice among PWLTI.

IIn different perspective, it is interesting to note, too, that despite OTs having claimed s

claims to have used the COPM practice model more often than the MOHO and Reed &

Sanderson OT practice models, OTs they did not realise that veryvery few address

spirituality (which is part of COPM framework) in assessment and marginal in intervention.

(though marginal here).

TheIn the Cooper study (1998) of Cooper (1998), it was stressed that in providing daily

domestic activities, such activities not do not only administercover coping strategies

forwith physical disability but will also assist the client in coming to terms with their

disability and altered body image. However, in this study, DADL was not at the top agenda

for most of the respondents. Nevertheless, Cooper (1998) added that MDT may include a

specialist nurse who can address specifically altered body image. Despite evolution of OTs

involvement with PWLTI, skills core to their practice remain debatable. Is addressing


altered body image, then, the role of the an OTs or nurses’ nurse?role? Bearing in

mindConsidering the expressed consensus regardingabout body image, OTs do not believe

that they have enough time to cater to clients’ altered body image.

5.2.5 Supervision

Most of OTs responded that they were supervised by Head OTs (55%), while a significant

number of OTs claimed and there were significant numbers who claimed t to have no

supervision (15%). from anyone. Additionally, 18% of OTsLikewise, some OTs were

supervised by other employees (18%) who were not OTs. SuchThese findings

providehave implications for OT practice with PWLTI. If those OTs are not supervisedcl

at all,aimed to have no supervision at all, how can the best interest, safety and efficacy of

care for the client be assured?can they make sure that what they were doing was to the best

interest of their clients or they were not doing anything that could potentially harm the

client? Caution in interpreting these values prevails also: those unsupervised OTs may, in

fact, be supervisors themselves, who, presumably may not need (or receive)

supervision.However, caution should be treated in interpreting this value as those OTs who

do not receive supervision from others may actually be the OTs who provides supervision

themselves and not recipients at all. In this very demanding and sensitive speciality,


ongoing and regular supervision is required required.(?) [AU: not certain what you mean

to express here by requirement for supervision.]

OTs supervised by non-OTsThose OTs who received supervision from other colleagues

who were not OTs at least had some measure of support in their practice, if nothing

else.were lucky in some respect that someone could support them in their practice.

However, such input from other professionals could impact OTs practice with PWLTI.

Divergent philosophies between professionals, for example,They may have different

philosophy not common shared by the profession and could potentially affect working

conditions and, particularly, caseload management. in particular. OTs should balance the

input and feedback fromgiven to them by their colleagues.

On the other hand, frequency of supervision is primarily on a monthly basis. hugely on

monthly basis. Surprisingly, a small but important number of OTs have never been

supervised at all.never had While an argument can be made that the number of never-

supervised OTs is small,any form of supervision at all. Although, others may argue that it is

just marginal numbers of OTs whom do not receive supervision, with current NICE (2004)

guidelines regardingabout increasing OTs involvement with cancer patients, in particular,

supervision should be made available to all junior staff.


Nearly two- thirds of OTs have, at maximum, of one supervisoere. This may contradict the

expressed claim thatcomments they claimed OTs do not haveabout lack of time to develop

and use their skills due to supervisory duties and its imposed constraints.if mostly have

only one OT student/junior staff to be added on top of their existing responsibilities . This

could may also account forreflect the reasons why there are still the marginal numbers of

OTs who do not receive any supervision. from anyone as large proportion claimed to have

no supervision responsibility for or have only 1 for the most. It can should also be noted

thatalso be noted that only 2% of OTs supervisehave supervision responsibility between 9

and- 16 OT staff. A staff ratio of 4:1 is perhaps poor, and provides other considerations and

ramifications.This means that supervisor – staff ratio (1:4) is perhaps poor.

5.2.6 Education

Respondents were asked if they educate/teach about OT in their work place. Only slightly

more than Only more than two-thirds (79%) claimed to have taught OT. students. This

This figure may becan be attributed to the fact that with just nearly two-thirds (71%) of

OTs who previously claimed to have supervision responsibility for 0 to- 1 OTs,

respondents may bewhich can either be a junior OT staff or an OT students on placement.

However, this figurethis may also suggest thatcould also mean that not all students receive


professional education, about the profession as not all respondents reported to have

completed any professional education. done.

Despite mostmajority of OTs providinged information regarding the dissemination

ofabout OT, there are few (10%) but important numbers of OTs who claimed not to haveto

have not educated/taught any of the identified individuals [AU: not certain who

“identified individuals” are or represent]. Further The e evolution of OTs involvement

with PWLTI maycould highly depend highly on existing OTs to educateing and enlisting

spread the professionals to other members of the PWLTI team.

Interestingly, while a largewith greater number of OTs spends time with OT students and

junior staff, very few OTs spendspends time with other professionals (53%) and

physiciansdoctors (14%) fromor whom where most of the client referrals may came from. It

remains incumbent upon OTs should realise to strike the sources of referral, to educate

them and to teach others of them of OTs involvement with PWLTI, and the importance

ofwhy OT. is vital in the team. T OTs must disseminate the value of OT involvement with

he professions flourishing evolution can depend on how other professionals, especially

consultants who might not be all aware of what OT is for, value OTs involvement with

PWLTI PWLTI (Soderback, et. al., Reid, 2000).


5.2.7 CPD Attendance for past 12 months

Ninety-eight out of 118 respondents declared their participation inses collated proved to

have an updated continuing professional development (CPD). Only 17% (20) reported noto

have not been with any CPD courses/training overfor the past 12 months. This suggests

means that respondents are attending updated CPD. Interestingly, HOPE conferences were

indicated as major sources of CPD, as were were reported to be HOPE conferences, local

symposiaums, in-service trainings, and formal, post- graduate education. Cancer and

palliative care remain the most attended CDP.The major topics reported to have been

widely attended are cancer and palliative care . Implications for this findings may

inducecould target CDP moderators to address other issues/topics such as fatigue

management and legal issues with PWLTI with in whichwhere OTs may not be familiar

but commandremain importancet to their practice.are not familiar of but important to

practice, such as fatigue management and legal issues with PWLTI. CPDHowever, this do

not tell CPD moderators to may wish to supplement theirstop cancer and palliative cancer

and palliative care topics but to further develop its depth and widened its scope into

targeted OTs across different practice settings and experience levels.level of experiences.

5.3 Variation among variables


Anticipation of conducting a chi-square test to determine variation among OT core skills

and OTs work environment and levels experience levels of experience proved unhelpful.

The treated data did notOwing to the fact that the treated data did not fu fullylly satisfy the

following assumption:

“for an r x c (cross-tabulations, either r or c or both being greater than 2) when no

more than 20% of the cells have expected counts of less than 5, and no cell has an expected

count of less than 1.” (Sim & Wirght, 2000) (p. 215)

Particularly, anticipated data countsthe data have expected counts of less than 1 were

expected in many of the cross-tab cells. Because many of the data types provided two

options for answers (at least “yes” or “no”), This is mainly because of the types of provided

options in answering the question itself such as ‘yes’ and ‘no’ could potentially

disqualifiesy variable counts should oneif one option beis much greater than the

other.hugely greater than the other. Should, for example,For example, if the majority

answered “yes,”‘yes’, this wouldill leave the remaining option (“‘no”’) to potentially

produce a count of < 1, – making the data unfit for the statistical test.

Furthermore, there were attributes existed that correspond to multiple-response questions

(ipsative scales), such as in questions regarding interventiont types, in which of


interventions, where r respondents would rated the degree of frequency, as either in either

“‘frequently,”’, “‘occasionally,”’ or “‘never.”’. Statistically, scores on ippsative scales are

not independent, meaning, for example,. This means that for example, that the choice of

“‘frequently”’ used for one intervention maywould determine the frequenciesy that remain

available for other types of interventions, can either be ‘occasionally’ or ‘never’ for

instance, making the scores dependent, which again, could produce a count of < 1.

These answer options allAll these things have an impacted performance of an anticipated

on performing chi-square test. that was anticipated. Such an experience will helpLearning

from this scenario would help thise researcher in future studies to develop better-

designedwell designed questionnaires, in which answers to the questions would meet

“all”‘a ll’ the assumptions for an anticipated statistical test. AHaving a visual picture of

presentable results, in whichhow the results could be presented and w working backwards

would enablebe able th thise researcher to better design the questions with answers suitable

for the anticipated statistical test,. is much desirable. Such a visual picture is predicated

This depends on a good study framework at the design stage. Thus, instead of statistical

calculations, Nevertheless, the degree of variation was described tabularly and

graphically.through tables and graphs instead of statistical calculations.


5.3.1 Variation between areas of assessment and work environment

A singleThere was a single distinction existed between areas of OT assessment and various

work environments. Apart from social services, OTs who placeuts less emphasis (40%)

on assessing fatigue/weakness. The remainderst of the findings in this section are

congruent with ≥80% of the choice [AU: uncertain with term “the choice”]. Social

services OTs’ claim they are consistent because they provide less emphasis on assessment;,

thus, on intervention as well. Overall, the consensus onas to the areas of OT assessment is

uniform across various practice settings among PWLTI (Cooper 1999; Cheville, 2001;

Huang et al., 2001).

5.3.2 Variation between types of intervention and work environment

Fatigue management and PADL remain the two mostwere the two controversial

intervention types of intervention indicated most ‘frequently’ in relation to the work

environment. Apart from SSOTs (3 out of 5), OTs in charitable institutions’ also

expressprovide less importance (11 out of 17) to fatigue management. This is in

contrastcontrary to the findings that fatigue managementmanaging fatigue is a remit of OT

in charitable institutions among cancer patients (Scullion & Henry, 1998; Leedham & Platt,

1998).


Surprisingly, PADL, which is at the top of the list on areas of assessment, was ranked

came down to the fifth, rank, where only 83% of the consensus vouched for its

importance. This remains is very contradictory to the 99% of OTs who claimed that

“PADL is indeed the top most important area to assess” (Cooper, 1998; Armitage &

Crowther, 1999; Frost, 2001) but not ans an important intervention type of intervention

across various work environments. Specifically, findings in this of this study expressstate

that OTs working in the hospices (50%) and charitable institutions (68%) shared this

philosophy. This finding maycan be attributed to the reason that OTs whothat remitremit i

in the hospices (and charitable institutions) provideare to provide less PADL intervention

andbut more to address a more another meaningful occupation – spirituality (Rahman,

2000; Unruh et al., 2000; Vrklijan & Miller-Polgar, 2001; Ewer-Smith & Patterson, 2002;

Lyons et al., 2002).

Among other types of work environments, OTs working in the hospices emphasize

theprovides more emphasis on spiritual needs of PWLTI (Rahman, 2000; Unruh et al.,

2000; Lyons et al., 2002), as compared towith the remainderst of the OTs infrom other

settings. Nevertheless, OTs from other work environments should put up with [AU: do you

mean listen, follow, other?] the recommendations of addressing spirituality (Ewer-Smith


& Patterson, 2002; Unruh et al., 2000) with clients through open- ended discussions, and

active listening habits (Rose, 1999) and engagementingement in meaningful occupation

such as gardening (Vrklijan & Miller-Polgar, 2001).

Conversely,On the other hand, the pattern of differences amongbetween intervention types

of intervention indicated as ‘“never”’ remain inconsistent. used and work environment is

erratic. Majority of SSOTs (≥ 4 out of 5) claimed to provide sexual counselling,

work/employment acquisition, and body image adjustments for PWLTI. This contradicts

the view of OTs in theis in contrary to community Macmillan who OTs view that they do

not provide any of the “‘never”’ used interventions. at all. Unfortunately, there were no

previous studies exist made that describes SSOTs involvement with PWLTI that which

could verify the findings. Nevertheless, should this reflectif this is what SSOTs beliefved,

then SSOTthey are the ones who practices andlive up to addresses physical,

psychological, social and emotional components of care (Cooper, 1998; Armitage &

Crowther, 1999; Rahman, 2000) more than do the OTs in the community Macmillan. OTs.

5.3.2 Variation between areas of assessment and level of experience

No studies have been identified that describes the important areas of assessment in relation

to OTs level of experience. AThere was a single distinction exists amongbetween areas of


OT assessment and various experience levels. of experience. Apart from Head IV OTs,

who express provides less importance (67%) in assessing DADL, the remainderst of the

findings in this section are congruent with ≥ 80%, concession wise [AU: uncertain of term

“concession wise”]. Overall, the consensus as to the areas of OT assessment remainsis

steady across various practice settings among PWLTI. This suggests, perhaps, thatcould

mean that there exists is no difference inas to what is assessment importancet for an OT

to assess even as their experience level increases (y increase their level of experience (from

Senior I to Clinical Specialist), as because they entirely consider the top most areas of

assessment vital to their practice.

5.3.3 Variation between types of intervention and level of experience

As OTs experience levels increase, climb up the level of experience, less emphasis isare

given to the skills core to their practice. Such skills were deemedThey became m more

critical in the consuming skills taught by first few years of professional experience. This

view can be observed where in which Senior II OTs (93%) hugely value these skills

(liaisingliasing with other agencies, functional mobility, advice and& education, fatigue

management and PADL) more than withdo clinical- specialist OTs (85%). Likewise,

discrepancy on Head IV OTs’ identified views about the identified intervention types of

Formatted: Font: Bold, Font color: Red


intervention ‘“ffrequently” used ’ andused where there are ≤ 80% of Head IV OTsthem

claimed that liaisingliasing with other agencies and PADL wereare less vital to their

practice.

Surprisingly, liaisingliasing with other agencies supersededcame in first against functional

mobility when variation across work environment was compared, suggesting thatin

comparison to the variation across work environment. This means that OTs with various

experience levelsacross various level of experience valued the skill to liaiseliase with other

agencies (93%) more than did they with addressing functional mobility (88%).

AThere is a consistent trend towards PADL emerges, aswhere it has been said that among

the top “‘frequently”’ used intervention, it is also the least among the five to be given such

importance across experience levels level of experience (and work environment). Likewise,

less than the majority of Senior II OTs (67%) and Head IV OTs (50%) shared this

view.philosophy. T This trend can perhaps bebe attributed to the fact that people who

might have less than 6six months to live may actually value self-care activities less than

other meaningful occupations (Rahman, 2000; Unruh et al., 2000; Lyons et al., 2002)

However, this is not thewhat majority of Senior I (88%) orand Clinical Specialist OTs

(87%) views.believed.


On the other hand, those types of intervention ‘“never”’ used by the practitioners followed

a general trend across experience levels, in whichlevel of experience where more OTs

provided less intervention towards sexual counselling than did they community re-

integration. Also, as the level of experience increases, consumption towards community re-

integration increases, as more Clinical Specialist OTs valued it, compared with to other

OTs across experience levels.level of experience. The rest remainder of the ‘“never”’ used

intervention offers has an erratic trend trend, and greater variation across experience levels

of experience is noted. This suggests, perhaps, could mean that OTs across experience

levels possesslevel of experience has varying awareness in providing such interventions,

which has and has implications for the practitioners to review and to update their

knowledge and skills in this regardaspect (NCHSPCS, 2000; WHO, 2002; COT, 2003,

HOPE, 2004, NICE, 2004).

5.4 Factors influencing the development and use of OT core skills with patientserson

who have life threatening illnesses

ForIn order for the OTs to develop and use their core skills, they must necessarilyhave to

overcome the barriers, settle the contrasting beliefs, and promote enablers in practice. The

culture of the OTs work environment was seen to influence the integration of their skills in


the work place. Most of themOTs find that the OT models and assessment tools are not

unsuitable in environments witha a very rapid pace, acute setting, or environments in

which the skills themselvesitself are limited or shared by other colleagues, thus, requiring

further input from external agencies.

Furthermore, lack of resources and funding increases the pressure onof OTs to useusing

less of their skills than they their skills less than they believe they should. Should time

constraints and lack of staff to cover existing caseloads prevent the employment ofIf there

is lack of time to use standardizsed assessment tools because of time consumption and lack

of staff to cover existing caseloads, therefore , then OTs cannot be held solely responsible

for not fully employing their core skills.ould not be blame of why they develop and use

their core skills less. Stakeholders mustshould address this issue if they value the

importance of their staff as “managements who do not look after their staff have no right to

expect them to look after their clients (Caines, 2000 p.2).”

On the other end, Ddivided beliefs exist amongof OTs as to whether the nature of their

skills, practice models and tools, as well as the status and prognosis of their clients, have a

benefit in developing and using OT core skills with PWLTI. Some respondents believe that


models and tools in particular are ‘“unethical, unsuitable, ineffective and not user-

friendly”’ in this setting. However, other OTs argued thatthere are those who argue that the

models and tools identified werehere “‘flexible, adaptable, familiar and easy to use.”’.

DNot issention among OTs with regard unless these contrasting views about to the use of

models and skills must be resolved should any agreement among OTs with regard to core

skills withto PWLTI be found.

in particular will be resolved, OTs perception remains divided towards the development

and use of their skills core to PWLTI.

In this case, OTs should promote the development and use of their core skills through the

use of a client-centred approach, and the therapeutic use of one’s self and in a well-defined

role in the work setting. Client-centred approaches primarily uphold the assumptions:

“To value personal experience…..that the person must be considered as a whole in

the context of their physical and social reality; That a person has the right to personal

choice; That the goal of the individual is to function as a free, self-directing, honest

person whose life is meaningful and satisfying; That a person should direct his own

learning or therapy as far as possible and that a person is innately capable of positive

development” (Hagedorn, 2000 p. 93).


Such an assumptionThis is supported by the literature in which where they stressed that

OTs are placed as part of the multi-professional team, where a should use client-centred,

problem-solving approach to enables clients to optimise optimise their functional

independence (Cooper 1998; Armitage & Crowther, 1999) despite limitations in their

longevitytime to live (Bye, 1998; Lyons, 2002).

Therapeutic use of self is sometimes viewed as ansaid to use intuitive judgements about

people and situations (Hagedorn, 2000) in order to alleviate fear or anxiety, provide

assurance, provide and obtain necessary information, give advice, assist to gain more

appreciation of, expression of, and functional use of one’s resources (Mosey in Hagedorn,

2000). However, powerful personal experiences may also impede the use of one’s core

skill, particularly when one assumes experience will be similar to one’s ownjust like one’s

own (Willard & Spackman, 1998). Nevertheless, this could be balanced with reflective

practice in whichwhere “reflection about practice is done through identification of what

worked well and what did not and being open to alternative conceptions are necessary to

support the learning associated with advancing expertise (Willard & Spackman, 1998 p.

98).


Despite the adage that no the truth about the adage that no single profession canould

monopolise the needs of the patient, there remainare concerns thatwhich OTs should be

made aware of. OTs should work closely within a in the multi-professional team

environment work ( (Penfold, 1996; Cooper, 1999, COT, 2003, NICE, 2004). Despite the

collaborative effort, consequences of employingbringing overlapping roles and functions

(Frost, 2001), OTs can address this dilemma if they knowew what skills constitute their

practice with PWLTI. Consensus as to the OT core skills In in areas of assessment and

intervention should focus on: PADL, DADL, fatigue/weakness (management), transfers,

functional mobility, Liaisingliasing with other agencies, advice and & education,

access/home visit, patient and family/carer support, and home/environmental adaptations

(Penfold, 1996; Armitage, 1999; Cheville, 2001). Likewise, OTs should reflect on whether

the following should be addressed: community re-integration, body image, spirituality,

work/employment acquisition and sexual counselling (Cooper, 1999; Rose, 1999; Rahman,

2000; Unruh et al., 2000; Vrklijan & Miller-Polgar, 2001; Lyons et al., 2002).


[AU: please check on spelling of ipsative (or ippsative ... · while whilst nearly 40% practice in...

Documents

Transcript of [AU: please check on spelling of ipsative (or ippsative ... · while whilst nearly 40% practice in...