Professor Lunn OT Final

occupational therapy

therapy based on engagement in meaningful activities of daily life (as self-care skills, education, work, or social interaction) especially to enable or encourage participation in such activities despite impairments or limitations in physical or mental functioning

occupational science

an academic discipline that offers support, reason, and scientific data that legitimizes the work that is done within that profession

form

direct, observable aspects of occupation
objects and tools used
steps involved
environmental factors

function

human development
health
quality of life
adaptation

meaning

looks at how people think, feel, and experience what they do
discovered through qualitative measures such as interview
encompasses the personal and cultural significance of occupations
looks at how it influences choice
through occupation we develop a sense of competence, self-esteem, and identity

occupation

the focus of occupation therapy and the unit of measure for occupational science

clinical reasoning

process used by practitioners to plan, direct, perform, and reflect on client care

William Rush Dunton

father of OT

Eleanor Clarke Slagle

mother of OT

George Edward Barton

leader of Arts and Crafts Movement

Susan cox Johnson

showed occupation can be positive for health

Thomas Bessel Kidner

established OT in Vocational Rehab.

Phillipe Pinel

conceived Moral Treatment Movement

Adolf Meyer

physch. who developed basis of OT

WWI

provided a motivation to the concept of OT (crafts, habit training)

WWII

provided more functional activities to enhance return of daily life; goal was rehab.

Biomechanical Frame of Reference (FOR)

emerged (Medical Model)

OT as a profession

seeks to improve the quality of life for individuals who are experiencing or are at risk for physical, cognitive mental, or psychosocial impairments

OT as art

it is different for every person - the therapist must learn to enter a client's life to understand

client-centered practice

the client determines what is meaningful and important for therapy

occupational-based practice

separates us from other allied health professionals; we use occupation as an end as well as a means

evidence-based practice

the use of research to guide clinical reasoning

thinking about the client

OT understanding their motivation, goals, developmental level, and personal expectations; OT needs to be realistic, ask Qs, and seek support

thinking about the family

the OT needs to perceive family members as listeners , supporters, motivators, and adaptable when necessary

OT role

respecting family values, beliefs, and routines
not judging
comm. with clean goals, expectations, and education to promote health, safety, and independence
listening and trying not to fix everything
being realistic
HIPAA
advocating for client/family
establishing a professional relationship
being human

thinking about the team

comm. with each other, the client, and the family
everyone needs to be on the same page
educate the family and client about outcomes, illness, disability, comm. resources, etc.
provide necessary intervention/services

philosophy

a set of basic principles/concepts underlying someone's practice or conduct

metaphysical

the Qs concerned with the nature of humankind

epistemology

related to nature, origin, and limits of human knowledge; provides a base for understanding motivation, change, and learning; investigates how we know things and how do we know that we know?

axiology

examines the value of a profession and what's considered just and right; OT this = client-centered care, quality of life, ethics; explores Qs of desirability and ethics

reductionistic approach

humankind is reduced to separately functioning parts; successful in producing cures and technological advancements; inefficient and costly

holistic approach

emphasized the organic and functional relationship between parts and the whole being; core concept to our profession - this means that evaluations and intervention plans should reflect the needs of the whole person

active beings

how OT views humans; actively involved in controlling and determining their own behavior and are capable of changing behavior as desired; viewed as open systems in which there is continuous interaction between the person and environment

occupation as a means

the use of a specific occupation to bring about a change in the client's performance

occupation as an end

the desired outcome or product of intervention

culture

a set of shared distinct beliefs, values, and behaviors that help individuals to recognize who belongs and who does not belong to the collective group

culture is...

learned - not inherited
real - influence can be felt
shared - be group individuals
dynamic - changes over time in response to politics and economics
invisible - taken for granted until a different culture makes our own visible
NOT race or ethnicity

cultural sensitivity

cultural differences impact OT assessment and intervention; if we are not addressing important occupations - why would the client continue participating in OT treatment?

spirituality

fundamental orientation in a persona's life; what inspires and motivates; may result in a connection with others; linked to hope, faith, coping, and self-transcendence; may imply religion

religion

an organized and culturally shaped avenue for spiritual expression

social position

the differences and inequalities among people or groups of people; can shape one's values, beliefs, and view of the world as they participate in it

social/material qualities

resources such as education, jobs, housing, food, sources, and health care

socioeconomic status

the occupational, educational, and income achievements by individuals or groups

poverty

lack of material resources that are necessary to live

working poor

people who work full time but still live within the poverty line

new poor

when an unplanned life change occurs and effects the resources required to meet basic needs

1960s

when medicare and medicaid are established

medicare

for people 65+, disabled of any age, and end-stage renal disease
part A:
inpatient hospitalization
SNFs
HHC
hospice
part B:
physician and outpatient services
HHC
DME

medicaid

insurance for all who are unable to afford health care (requirements)
federally and state funded
varies by state with coverage/usage

SCHIP (State Children's Health Insurance Program)

established in 1997 to provide health care to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for medicaid.

IDEA (Individuals with Disabilities Education Act)

a school-based program that focuses on care in school systems; highest % of OTs work in school-based programs; partnerships between state and federal gov. and school systems

workman's compensation

state-run; pays for healthcare related to a work injury; pays for medical services, salaries, vocational training, and for disability if determined by an MD; uninsured

JCAHO (Joint Commission on Accreditation of Healthcare Organizations)

evaluates an organization's compliance with the standards established; organization being evaluated must comply with essential standards in order to receive Medicare reimbursement; hospitals utilize this organization by choice

NCQA (National Committee for Quality Assurance)

assesses and reports on the quality of managed care plans; voluntary service for MCO's; standards relate to member satisfaction, quality of care, access., and services provided

CARF (Commission on Accreditation of Rehab Facilitates)

a voluntary organization for rehab providers

NBCOT (National Board for Certification in Occupational Therapy)

credentials OT's and COTA's to be able to work within the profession; and examination in taken after a master's education and 6 of fieldwork

State Regulatory Board

after passing the certification exam (NBCOT) an OT/COTA can apply for licensure within the state in which they want to practice; each state has specific criteria regarding the duties and responsibilities of the OT/COTA.

NHOTA ( )

advances the profession within the state; provides continuing education opportunities independent from AOTA, but they collaborate

CHT

certified hand therapist

CPE

certified professional ergonomist

SCLV

specialty certification in low vision

supervision

depends on skill, knowledge, and experience; promotes learning, autonomy, and professional growth; includes respect and trust; comm. needs and type of supervision

service competency

demonstration and verification of skills and knowledge of treatment; this can be done by:
- co-treatment
- observation
- individual education

collaboration

respect, understanding, clear expectations, dependability

interdisciplinary

team members have shared responsibility for providing services and support one another's goals for treatment. Separate assessments, then shared results to develop integrated and coordinated care

multidisciplinary

team members work side-by-side one another. Roles are clearly defined and team members are aware of each others' scope of practice

transdisciplinary

team members work together to develop goals, and carry out patient care. Family interacts with a primary provider, based on patient needs

ethics

clinical decisions based on professional judegment

dilemma

involves personal and social morals and values; not a right/wrong answer

OT code of ethics

(AOTA 2000) common set of values/principles that promote high standards of behavior and professional responsibility

beneficience

demonstrates concern and well-being for the recipients of services

nonmaleficence

do no harm to the recipients of service

autonomy and confidentiality

respect the right of the individual to self determination; collab with all, inform recipients of potential risks of intervention, respect decisions, HIPAA

social justice

providing service in a fair/equitable manner

procedural justice

compliance with laws/policies

veracity

the duty to tell the truth

fidelity

treating colleagues and others with fairness, discretion, and integrity

OT values

Altruism
Equality
Freedom
Justice
Dignity
Truth
Prudence

process of ethical reasoning

- identify the ethical dilemma
- gather relevant facts about the case
- apply ethical theories and guiding principles to analyze the case
- problem solve practical alternatives
- decide on an action
- act on that choice
- evaluate how to prevent or cope with the dilemma should you encounter it again

professional reasoning

used by practitioners to plan, direct, perform, and reflect on client care; complex' multifaceted; effected by the amount of experience one has

metacognitive

thinking about thinking

schemata

building up a representation of what to expect based on experience

scripts

rules to guide thinking (initial treatment to discharge)

scientific reasoning

focuses on the diagnosis of the illness or condition; guided by theory; considers evidence from research to guide practice; does not consider the patient on a personal level

narrative reasoning

personal; includes info from the patient and family; focuses on the patient's history and story; considers the patient's culture; helps the therapist make sense of the patient's circumstances

pragmatic reasoning

practical; considers scheduling options, payment, equipment needed/available, therapist's skills, organizational policies; not focused on the client's condition, but the realities of providing services

ethical reasoning

a systematic approach to a moral conflict; analyzes the dilemma; helps generate alternative solutions; determines actions needed

interactive reasoning

thinking that helps the therapist build a positive relationship with the patient; uses positive communicative skills; allows for collaboration in treatment; identify and solve problems

OT process

involves the interaction between the practitioner and the client; collaborative; dynamic process with the focus on

evaluation process

to find out what the client wants/needs; based on age, diagnosis, developmental level, education, socioeconomic status, cultural background, and abilities

referral

starts the OT process; a request for service for a particular client is made from a medical prof.

screening

OT practitioners gather prelim. info about the client and determine whether further evaluation and intervention are needed; involves interview, screen test, observation, discussion, and referral

occupational profile

gather basic demographics: age, gender, diagnosis, reason for referral, etc.; provides OT with a history of the client's background and functional performance with which is to design interventions

occupational performance analysis

uses the occupational profile to provide a direction to the practitioner to the areas that need further examination; involved analyzing all aspects of the occupation to determine the client factors, patterns, skills, and behaviors required to be successful

observation

the means of gathering info about a person or an environment by watch/notice; ex: posture, dress, social skills, voice, behavior, physical abilities, etc.

structured observation

watching the client perform a predetermined activity

intervention

working with the client through therapy to reach client goals

occupational justice

to develop an understanding of the political potential of OT to create situations in which all individuals, regardless of race, ethnicity, socioeconomics, class, or disability status, can engage in meaningful occupations by choice that support their participation in everyday life

occupational dysfunction

impaired or disordered occupations

occupational apartheid

segregation of groups of people through restriction or denial of participation in occupations if daily life; can be based on race, color, disability, sexual preference, political beliefs, etc.