The definition of occupational therapy as gradually metamorphosis from its genesis till date, yet it has gradually evolved from its first definition in 1914 by George Barton who stated that ‘if there is an occupational disease, why not an occupational therapy’. While in 1919, he further postulated that ‘occupational therapy is the science of instructing and encouraging the sick in such labours as will involve those energies and activities producing a beneficial therapeutic effect. Over the years, the definition of occupational therapy had transited and in 1923, Herbert J. Hall define occupational therapy as that which provide light work under medical; supervision for the benefit of patients convalescing in hospital and homes, using handicraft not with the aim of making craftsmen of the patients but for the purpose of developing physics and mental effectiveness. American occupational therapy Association (AOTA) proposed the definition that occupational therapy is the ‘art and science of directing man’s involvement in selected task to reinstate, reinforce and enhance performance, to facilitate learning of the skills and functions essential for adaptation and productivity, diminish or correct pathology and to promote and maintain health. In 1994 AOTA mmrevised the definition and stated that occupational therapy is the use of purposeful activity or interventions to promote health and achieve functional out come to develop, improve or restore the highest possible level of independence with person who is limited by a physical injury or illness.
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The goal of occupational therapy is to assist the individual in achieving an independent, productive and satisfying life style. Occupational therapist use adaptive activities to increase the individual’s functioning and productivity in view of achieving independence and satisfaction.
Occupational therapy is a health discipline concerned with enabling function and well-being (Baum, 1997)
Occupation in Occupational Therapy
(Polatakjo 2007, Wilcock 2000), states that the ultimate impact of occupational therapy in multidisciplinary health care service must be a profound understanding of enabling occupation (Pollock and McColl 2003) also stresses that the knowledge of occupation is employed as a means to enhance the development of health in people. Occupational therapists also aspire to the goal of facilitating occupational engagement and performance as the end or outcome of therapy. Occupation is “the purposeful or meaningful activities in which human beings engage as part of their normal daily livesâ€¦â€¦ all aspects of daily living that contribute to health and fulfilment for an individual”(McColl 2003 p1)
Schwammle (1996) encourage occupational therapists to focus on enabling clients achieve a sense of well being via occupation.
In contrast, (Wilcock 2006) de-emphasises occupation in favour of established concepts that are more consistent with a medical model. He also stressed that medical focus, rather than an occupational focused may have resulted in therapists looking at remedying performance components rather than addressing occupation itself, but (Molineux, 2004) said it will be highly problematic as it will lead to issues of role blurring, role overlap and role ambiguity.
A different dimension to core philosophy of occupational therapy is functional independence or activity of daily living as the ultimate goal of occupational therapy (Thornton and Rennie 1998). Chavalier (1997) concurred that occupational therapists experience difficulty agreeing on what occupational therapy is, and also that the diverse opinion is a strength to the occupational therapy profession.
There seems to be an overall conclusion by occupational therapy experts that occupational therapy as a profession should mainly focus and emphasis on occupation as the core centre of the profession.
(Baum and Baptiste 2007, Law et al 2002, Wilcock 2000, Asmundsottir and Kaplan 2001) all stress that occupation should be central in occupational practices. Various authors also gave reasons why occupation should be the epicentre of occupational therapy:
It will provide an exclusive perspective that will ensure the professional survival of OT in health service (Pierce 2001)
It will unite OT and ensure its continued survival (Nelson 1996).
It will enable OT to achieve its full potential (Crabtree 2000)
Occupation-focused practice may result in more satisfying practice for individual occupational therapists (Molineux 2004, Wilding 2008)
Occupation focused may assist therapists’ intervention s to be more meaningful when dealing with complex issues (Persson et al 2001)
It makes OT to be a true, self-defining profession.
Metamorphosis Of Occupational Therapy
Right from the inception of occupational therapy. the concepts of occupation is the foundation upon which the profession is built. The founders of occupational therapy the likes of George Barton, Fleanor Clarke Slage, Adolph Meyer etc based the new profession on their own personal experiences of the health enhancing effects of engagement in purposeful and meaningful activities (Peloquin, 1991a), Kielhofner (1992) noted for the early part of twentieth century how occupation is seen to play an essential role in human life and lack of it could result in poor health and dysfunction, occupation is also seen as the link between the mind and soul. Occupational therapy
There was a shift of focus to mechanistic paradigm in the (1960s). These emphases the ability to perform depend on the integrity of body systems, and functional performance can be restored by improving or compensating for system limitations.
KIELHOFNER (1992) saw a growing dissatisfaction among occupational therapist with the mechanistic approach whiled Reilly (1992) called for therapist in the early 1960s to focus on occupational nature of humans and also the ability of the profession to emphasize on the occupation needs of people contemporary paradigm (1980- present day).(Molineux 2009)
Relationship between professional philosophy and occupational therapy
A professional philosophy helps set values, beliefs truths and focuses the therapist on the principles that governs his actions. It gives credence to the profession existence and substantiates reasons for practitioner’s therapeutics processes.
In studying the philosophical basis of a profession, it is essential to look at it from its three components as it relates to occupational therapy
Metaphysical component. This bothers on what the nature of humankind is. -active being, occupation performance, Reductive approach and Holistic approach.
Epistemology component. This relates to the development of a professional philosophy. It analyse the nature, origin and limits of human knowledge.(Adaptation, Thinking, feeling and doing)
Axiology component. It concerns with the values of the profession. Quality of life, client catered approach, code of ethics
Man is an active being whose development is influenced by the use of purposeful activities, using their capacity for intrinsic motivation; human beings are able to influence the physical and mental health and their physical environments through purposeful activity. Adaptation is a change in function that promotes survival and self-actualisation, it is also described as the satisfactory adjustment of individual s within their environment over time. . Dysfunction may occur when adaptation is impaired, while purposeful activity enhances the adaptive process.
Health care system has been developed from a reductionistic approach where man is viewed as separate body function and each part treated separately and focuses on specific problem for greater efficiency. However, medicine has metamorphosis into addressing all the bodily functions of the client, this is a holistic approach by occupational therapy traced to Adolf Meyer. He sees the human body as a live organism acting. The holistic approach emphasises organic and fundamental relationship between the parts and the whole being, an interaction of biological, psychological, socio-cultural and spiritual elements. Occupational therapy trend is shifting away from holistic practice to specialised (reductionistic) approach again. For example, occupational therapy practitioners working in hand rehabilitation refers to themselves as hand therapists or those in psychiatry call themselves psychiatric therapists.
Critical analysis of model and frame of reference
MODEL AND FOR
In advancing the theoretical foundation of occupational therapy, a model is defined as a theoretical simplification of a complex reality (Frolitch, 1993) and consists of several explicitly defined concepts. Conceptual models are schematic or graphic representation of concepts and assumptions that act as a guide for theory development.
The frame of reference is based on philosophy or a paradigm and attempts to describe or explain what we believe or value. Models are developed within a frame of reference. Hence, FOR are viewpoints, beliefs or values. FOR are connected sets of ideas that form the basis for action. (Duncan, 2006)
Reed and Sanderson (1999) states that no perfect or ideal model for health, functioning and disability exists for occupational therapists. Rather, they suggest that occupational therapists should select the aspects from those health models that most closely fit the belief and values of occupational therapy.
According to Townsend (2002), Occupational performance is defined as the result of the dynamic relationship between the person, the environment and the occupation. It refers to the ability to choose and satisfactorily perform meaningful occupations that are culturally defined and appropriate for looking after one’s self, enjoying life and contributing to the social and economic fabric in the community. Occupations are groups of activities and tasks of everyday life.
Activities of Daily Living (ADL)
The initial process of occupational therapy assessment involves interviews with the patient and the carer to establish previously held life roles and the tasks and activities that were completed within these roles. Observational assessment is undertaken of personal self-care tasks, including showering, dressing, toileting, grooming, and eating, and domestic or instrumental tasks, including meal preparation, shopping, cleaning, laundry, and management of finances and medications. Standardized measures may include the Functional Independence Measure (FIM), [6
Model of human occupation (MOHO)
The model emphasis that occupational behaviour is a result of the human system, the
subsystem, the habitation subsystem and the environment.
MOHO is a behavioural model. He defines occupational performance from a behavioural perspective. The model sees occupational performance as a result of mind-brain-body performance subsystem.
Haglund and Kjellberg (1999) argue that the MOHO lacks the influence of the environment on human behaviour. Though it includes the environmental factor, he does not explain the interaction and relationship between the person and the environment.
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Canadian Model of Occupational Performance (CMOP).
See in occupational performance terms of dynamic relation between occupation, environment and a person, the key elements of environment are cultural, institutional, physical and social. While the purpose of occupation can be leisure, productivity or self-care. The CMOP presents the person as an integrated whole, incorporates spiritual, affective, cognitive and physical need (Townsend, 2002) The CMOP defines occupational performance as the result of dynamic relationship between the person, the environment and the occupation.
OCCUPATIONAL PERFORMANCE MODEL (Australia)
In contrast to the ICF where ‘rest’ is a body function, ‘rest’ has an activity perspective in the OPM.
CORE PROCESS (HAGEDORN 2006)
The first extensive presentation of occupational therapy core competencies was produced by Mosey (1986) she based her domains of concern of the profession as performance components, occupational performances, the life cycle and the environment. While (Neistadt and Crepeau 1998) give a list at entry level to be development of skills, socialization in the expectation related to organisation, peers and the profession, acceptance of responsibility and accountability in relevant active-ties. In 1994,the college of occupational therapist published a position on ‘core skills and conceptual framework for practice’. Core skill is defined as the ‘expert knowledge at the hearth of the Professional’.
The unique core skills of occupational therapy are
Engage in purposeful activity and meaningful occupation as therapeutic tools to enhance health and wellbeing.
Enable people to explore, achieve and maintain balance in their daily living tasks.
Evaluate the effects of manipulate, physical and psycho-social environments, maximise function and social integration.
Ability to analyse, select and apply occupation to focused therapeutic media to enable dysfunction in daily living tasks and occupational roles.
For a therapist to be able to display core professionalism via the above listed core skills. The therapist needs to use four core processes.
Therapeutic Use of Self
In the heart of therapeutic intervention is the ability of the therapist to communicate with the client and establish a therapeutic relationship or alliance. Mosey (1986) described ‘conscience use of self’ as one of the legitimate tools of practice.
ASSESSMENT OF INDIVIDUAL POTENTIAL, ABILITY AND NEEDS
For an effective therapeutic intervention, there must be a clear and accurate evaluation of the potential and abilities of the clients in view of the client’s needs and goals. This is achieved through the array of tests, checklists and other assessment tools. Assessment may require detailed observation, measurement and repeated testing in relation to ADL which the individual engages.
OT is concerned with the whole spectrum of human skills through all ages: past, present and future. Possibilities and probabilities need careful evaluation which requires experience and indepth clinical reasoning.
ANALYSIS AND ADAPTATION OF OCCUPATION
A fundamental assumption of occupational therapy is that engagement in occupation promotes health and well being. Hence, occupational analysis seeks to break down the tasks into smallest units of which performance is composed. The client skill components can be identified and the therapist can map how this can be built into competence. To achieve this, the therapist must observe, record and analyse elements of performance via work, leisure and self care activities. The therapist also employs analytical methods to determine client interaction between occupational role and social life relationships.
ANALYSIS AND ADAPTATION OF ENVIRONMENT
Therapists acknowledge that the environment has an effect on behaviour. It facilitates interaction, reduce stress and promote engagement. Hence, adapting to the environment can enhance occupational performance or impede engagement in task. The analysis of the environment should be at an holistic level and not limited to the physical aspects alone, but also socio-cultural aspects, emotional and financier environment.
CODE OF ETHICS AND PROFESSIONAL CONDUCT COT 2010
On a daily basis, occupational therapists are confronted with situations that requires decisions. Moral and ethics have the potential to affect the clinician’s decision making practice. Ethics are philosophical stands on the rightness or appropriateness of various voluntary actions. The adoption of ethical principles is one characteristic often used to distinguish professions from other occupations (Vollmer & Mills, 1966).
The code of ethics and professional conduct produced by the college of occupational therapists (COT) and NPC are formulated to guide O. T in their professional conduct in terms of competent combination of knowledge, skills and behavior’s.
The code of ethics and professional conduct are sub – divided into major sections:
Service user welfare and autonomy, this includes: Duty of care, welfare, mental capacity and informed consent and confidentiality.
Service provision: Equality, Resourses, the occupational process, risk management and record keeping.
Personal professional integrity: Personal integrity relationships with service users, professional integrity, fitness to practice, substance misuse, personal profit or gain, and information representation.
Professional competence and lifelong learning: professional competence, delegation, collaborative working, combining professional development, and occupational therapy practice education.
Developing and using the profession’s evidence base.
The code of ethics and professional conduct enacted various laws upon which an occupational therapist base his/her practice, these include:
Health Act 1999 ‘Occupational therapist’ is protected by law and can only be used by persons who are registered with the health professions council (HPC)
O.T personnel must respect the right of all people under the Human Right Act 1998.
Mental Capacity Act 2005 code of practice states that: A person must be assumed to have capacity unless it is established otherwise.
Data protection Act 1998: gives individual the right to know what information is held about them and that personal information is handled properly.
Roles of COT and HPC (Code of ethics and professional conduct.COT,2010)
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