Using Occupational Therapy Theory in Practice

Gail Boniface, Alison Seymour, Gail Boniface, Alison Seymour

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781444355680
• Edition: 1
• Topic: Medizin
• Subtopic: Beschäftigungstherapie

Competence in any profession depends upon an understanding of the theory that underlies it. This concise and practical text for students and practitioners bridges the gap between occupational therapy theory and clinical practice, offering highly practical advice on using theory in practice in a wide range of settings. It considers the nature of professional practice and the need for a sound theoretical basis from which to plan, implement and justify interventions, and investigates the practical use of occupational therapy theory and the issues such use raises in health and social care settings from a European perspective.

Every occupational therapy student worldwide needs to know about the underlying theory of their profession and its application to practice. The book particularly debates the nature of the theory of occupational therapy via the introduction of the concept of models of the profession as an umbrella for practice, all of which is brought to life via case studies incorporating expert advice, reflection exercises and assessment and evaluation forms.

Chapter 1

Introduction

Gail Boniface and Alison Seymour

In this book (divided into three sections), we invite you to participate in a discussion and debate with us on the use of theory by occupational therapists in relation to today's health and social care settings. A key message throughout the book is our belief that, in order to be able to use theory in practice, it is first necessary to get to grips with that theory and understand it. This would appear obvious; but in our experience, we have sometimes found that, for many reasons, when using their theory, practitioners have jumped straight to the use of assessments associated with occupational therapy practice models rather than really understanding the underpinning theory first of all. When this has happened (see Chapters 6, 8 and 12), the model itself has been left behind, a superficial understanding of the use of theory has resulted and the model has eventually been abandoned.

As the preceding paragraph has indicated, this book is both theoretical and practical in nature. It offers definitions of such concepts as professional terminology and occupational therapy professional models, whilst narrating individual practitioners’ and services’ experiences of using occupational therapy specific theory in practice. More specifically, it aims to:

• consider the nature of professions and professional practice;
• debate the nature of the theory of occupational therapy via the introduction of the concept of models of the profession as an umbrella for practice – this also relates occupational theory to its use in the current evidence-based world of contemporary occupational therapy practice;
• discuss the different ways in which occupational therapists, their support staff and other professionals use theory;
• investigate the practical use of occupational therapy theory and the issues such use raises in health and social care settings from a European perspective;
• investigate the ways in which occupational therapists and their students learn how to use occupational therapy theory in practice;
• relate the use of theory to the nature of the individual therapist as a person; and
• consider the place of reflection as a concept to help the occupational therapist get to grips with their understanding of their own theory base.

The nature of professions and professional practice

In Chapter 2, a critical lens is offered through which we can begin to reconceptualise both professional practice and identity. We are invited to do this, by reconsidering what it is that makes a professional, a distinct professional working within the organisation, rather than an organisational worker. In the same chapter, we are asked to consider the difference between behaving professionally and being a member of a profession, with loyalty to our professional theories as well as to our employing organisations being viewed as holding equal importance. Here (and in Chapter 5), we are asked to consider what type of occupational therapist we are and relate this to our use of our own personality and our moral stance on our practice. In both chapters, we are asked to determine what we feel counts as professional practice.

The theory of occupational therapy and its place in an evidence-based practice world

Chapter 3 offers us an overview of the current models of occupational therapy and puts these in the context of (potentially contentious) definitions of terms associated with professional practice, such as paradigm, philosophy, model and approach. Thus, it takes the theory associated with professions by the horns and provides some clear and usable definitions of terms, which are often discussed and described in an interchangeable and consequently confusing manner elsewhere in occupational therapy literature. The chapter, by so doing, discusses the interrelationship between the concepts the terms represent and provides the context for the chapters in Section 2, wherein practitioners narrate their experiences of using occupational therapy professional models in practice. This definition of the interrelationship of the concepts encourages us to view occupational therapy professional models within the analogy of an umbrella. Chapter 3 should be read in conjunction with Chapter 2, which advocates we take a critical, rather than an unthinking, approach to models of our profession and their use in practice. We should also note here that all of the chapters, wherein practitioners describe their journeys in using occupational therapy professional models, demonstrate the extent to which they have obviously been influenced by the theory, but equally, have altered and tweaked it to fit into their specific working environments. Thus, occupational therapy professional models, clearly having begun in practice, continue to be influenced by that practice.

One of the more recent influences on practice has been the rise of the concept of evidence-based practice, and Chapter 13 relates the theory of the profession to the concept of evidence-based practice more overtly, whilst at the same time asks us to consider what it is that we mean by evidence-based practice. Finally, under this heading of the theory of occupational therapy, we draw attention to the discussion of occupational science in Chapter 14, where its historical and contemporary relationship to occupational therapy is investigated.

Discussion of the different ways in which occupational therapists, their support staff and other professionals use theory

Throughout the book, the models viewed as those of the profession of occupational therapy are discussed as theories that offer a definition of the profession and a process through which the clinical reasoning of the occupational therapist can be demonstrated. Therefore, it is our belief that if a theory of occupational therapy is truly a model of the profession, it should be shared with others; however, this should be done by the occupational therapist using it to explain their reasoning rather than giving it away to others to use. Our reasoning behind this is that if we give our professional models away to other professions, they will not have the occupation theory base that occupational therapists have spent some years both developing and learning about, and which is thus central to our models for our profession. Equally, we feel that the occupational therapy profession needs to think long and hard about how much of its unique occupational theory it puts under the control of its support staff. Chapter 9 deals with these aspects in more depth and also suggests a delegation and allocation framework for use with support staff when the occupational therapy service as a whole uses an occupational therapy professional model (in this instance, the Canadian Model of Occupational Performance (Townsend et al 2002), now CMOP-E (Townsend and Polatajko 2007).

Investigation into the practical use of occupational therapy theory and the issues such use raises in health and social care settings from a European perspective

The whole of Section 2 of this book is dedicated to the practical use of occupational therapy professional models in service settings. The narratives of the services and the staff implementing the models have been described by the practitioners in detail and should serve as a guide to any individual occupational therapist, or service, considering how to go about using the occupational therapy professional theory in practice. Although each service describes their own implementation of a specific model, the models chosen just happen to be the ones the practitioners felt were appropriate to their settings and it must be emphasised here that we feel that, if any theory is truly an occupational therapy professional model, then it is possible to use that theory in any setting, not just the types of settings described in this book. Thus, Chapters 6 discusses the move towards using the Model of Human Occupation (Kielhofner 1985, 1995, 2002, 2008) in a mental health setting, Chapter 7 discusses the Model of Adaptation through Occupation (Reed and Sanderson 1983, 1992, 1999) in a physical setting and Chapters 8 and 9 discuss the implementation of the Canadian Model of Occupational Performance (Townsend et al 2002), now CMOP-E (Townsend and Polatajko 2007) in a mixed, integrated community and hospital physical setting. However, this is not to say that these are the only settings in which each model can be used.

Chapters 10 and 11 offer a different and wider slant on the use of the theory of occupational therapy in countries where it has been viewed as an emerging profession (both happen to be ex soviet bloc countries) – that is, Chapter 10 asks us to consider the situation of Poland, whilst Chapter 11 discusses the use of theory in occupational therapy in Croatia.

Investigation into the ways in which occupational therapists and their students learn how to use occupational therapy theory in practice

All of the chapters that narrate the ways in which the professionals have used their theory contain some element of description of the ways in which individual therapists (and by default perhaps students) have learnt how to understand the theory of occupational therapy. However, it is Chapter 2 that reminds us to use our theories and models with caution, that is not as rote learning or lists of instructions for action, but rather as models for the profession that offer us guidelines for action, which we must see as needing to be tempered by our own professional judgement. Chapter 4 extends this concept and reminds us to use models of reflection when critiquing our professional practice wisely and to use reflection itself as a way of enhancing our learning about our theory.

Relationship of the use of theory to the nature of the individual therapist as a person

There are a number of chapters in this book that discuss the factors that influence the individual therapist's use of self in relation to practice and consequently in relation to theory use. However, Chapters 5 and 12 seek to do this most overtly. Finally, Chapter 15 seeks to ask us as individuals to consider our answers to some of the most frequently asked questions related to the use of models. It asks us to determine for ourselves our own view of the place of occupational therapy theory within our own practice.

Consideration of the place of reflection as a concept to help the occupational therapist get to grips with their understanding of their own theory base

In this book, we are delighted to include a chapter by Della Fish, wherein she takes the opportunity to revisit her 1989 model of reflection – Strands of Reflection (Fish et al 1989) and offers us a new take on the nature of professional thinking and our ways of consequentially reflecting on our theory and ourselves in relation to that theory.

Conclusion

In this conclusion, we would like to draw the reader's attention to the fact that each chapter begins with a text box of key points that should draw the reader's attention to the chapter's aims and ends (where appropriate) with a list of recommended further reading.

Finally, we would like to acknowledge that the ideas for this book have come from a number of sources. These include our own experiences in practice, our experiences in teaching and using the theory of occupational therapy and, most recently, our experiences of working closely with practitioners in the implementation of models as theory bases for professional action in service settings. The confidence we observed, which many of the practitioners, with whom we worked, gained from using occupational therapy professional models in practice, led us to want to share our thoughts with others; hence, this book was created.

We recognise, of course, that not all members of the profession will necessarily agree with our interpretation of the use of occupational therapy theory in practice, but we hope that this book will be viewed, in the way it is meant, as a serious contribution to the debate.

References

Fish, D., Twinn, S. and Purr, B. (1989) How to Enable Learning through Professional Practice: A Cross Profession Investigation of Pre-service Practice. London: West London Institute.

Kielhofner, G. (1985) A Model of Human Occupation. Baltimore: Lippincott, Williams and Wilkins.

Kielhofner, G. (1995) A Model of Human Occupation, 2nd edn. Baltimore: Lippincott, Williams and Wilkins.

Kielhofner, G. (2002) A Model of Human Occupation, 3rd edn. Baltimore: Lippincott, Williams and Wilkins.

Kielhofner, G. (2008) A Model of Human Occupation, 4th edn. Baltimore: Lippincott, Williams and Wilkins.

Reed, K.L. and Sanderson, S.N. (1983) Concepts of Occupational Therapy, 2nd edn. Baltimore: Lippincott, Williams and Wilkins.

Reed...