Chapter 1 Introduction
‘Skills for Practice in Occupational Therapy’ introduces the reader to the wide range of skills that occupational therapists require to have in order to practice effectively in contemporary health and social care environments. Each chapter is written with a practice skills focus in mind, but wherever possible this is directly linked to theory and existing evidence. The book is clearly targeted at and relevant for occupational therapy students who are developing these skills. But the direct practice relevance of the chapters also makes it a resource that should not be left on the student shelf, never to be opened after graduation, but become used as a resource for new and experienced practitioners alike.
Whilst this chapter provides a useful orientation to the book’s purpose and contents as a whole, ‘Skills for Practice in Occupational Therapy’ is not intended to be read from cover to cover in chronological order. Readers will access different chapters at different stages depending on what they wish to know. However chapters have been extensively cross referenced, so the reader opening this book at one chapter may find themselves journeying through each section as they build up a bigger picture of what is required to deliver effective skills for practice.
The structure of each chapter, in the main sections of the book, is consistent. Chapters begin with a brief overview of the subject and chapter content, a highlight box is located at the front of each chapter to provide an even briefer and punchier synopsis. The body of the chapter then follows. Wherever possible, case vignettes are included to illuminate and illustrate the points being made. Each chapter concludes with a summary to bring together the key issues that have been presented and discussed.
The venue may differ (for example at a student house party; a family get-together, a meeting with a professional colleague, an interdisciplinary conference, or in a multidisciplinary team meeting…) but invariably the question is asked: ‘What do you do?’ or ‘What is occupational therapy anyway?’ One way of responding could be to recite a definition of the profession; telling the interested inquirer that occupational therapy,
Such an approach, however, is not recommended: It would likely lead to bemused stares, a polite thanks, and a quick exit by the person concerned! So how can one appropriately respond to such questions? And why can such a straightforward question be so challenging to answer?
Often when asked, ‘What do you do?’, it is tempting to respond by saying what you are, rather than what you ‘do’. And even when occupational therapists do respond by saying what they ‘do’, their description can belie the true depth and breadth of practice. Hagedorn (2000) discussed the challenges associated with being seen to do ‘simple’ things. Occupational therapy she stated is, by and large, a ‘low tech’ intervention in a ‘high tech’ modern healthcare environment. And when compared to ‘high tech’ interventions, such as three-dimensional imaging or steroid injections, may be viewed as merely ‘common sense’. So, describing the depth and breadth of what occupational therapists ‘do’ is challenging. Part of the reason for this is that the ‘visible’ portion of practice is only a small percentage of what actually goes on. Hagedorn (2000) presented two differing images to illustrate this. First occupational therapy was compared to an iceberg, where only the tip of the vast mass is visible to the eye; but she felt this was an unattractive analogy as icebergs appear clumsy. Secondly, and more favourably, Hagedorn compared occupational therapy to a computer; each has an easy-to-use interface but is highly complex beneath the surface interface. However this image too could be criticized as being excessively mechanistic. Of course the appeals of imagistic analogies are subjective and different people will find them more or less helpful. But they can be useful strategies to convey that the message that the totality of what occupational therapists ‘do’ is not immediately apparent. (As an aside, I quite like the analogy of the common garden mint plant: highly useful and very adaptable, deeply rooted, fast spreading and very difficult to remove once embedded!)
This book is about what occupational therapists actually do: the skills they bring to practice. Skills are, ‘the aptitudes and competencies appropriate for a particular job’ (Chambers Dictionary 1994: 1617). Occupational therapists are now required to have and use a complex range of skills (see Vignette 1) to maintain their competence in a swiftly developing healthcare environment (Ryan et al 2003). It is for this reason that this book has been developed in four key sections that outline the broad range of skills required by practitioners to deliver best practice: Thinking, judgement and decision-making skills; Professional skills; Evidence-based and research skills; and Leadership, supervision and management skills.
Vignette 1 A day in the life of an occupational therapist
Beth is an advanced clinical occupational therapist in an acute mental health inpatient service. She arrives at work at 8.30 am and is immediately greeted by a client who has been on the ward for a week. The client is worried about a visit that she will bereceiving from her parents in the afternoon and wants to share her concerns with Beth, asking her what she should do: Beth spends some time listening to the client and arranges to see her later. Beth then attends the ward handover meeting with the nursing and psychiatric staff and discusses the relevance and urgency of several clients who the team have referred and wish to be assessed. The turnover on the ward is fast, so she may not have time to see them all and needs to judge which referrals are highest priority. Having completed the handover meeting, Beth then prepares and runs an open creative arts group for clients on the ward: this is always a challenging session as the needs of the group are varied, but the creative medium is popular throughout the ward and the group enables Beth to observe clients’ range of functioning in a group setting. Once the group is completed and the notes are written up, Beth returns to the client she met first thing. The client shares some more details with Beth who decides to take a problem-solving approach to help the client generate her own solutions to the difficulties she foresees will arise when her parents visit.
Beth’s next task is to carry out an initial assessment with a 26-year-old man (Chris), who was recently readmitted to the ward. Beth has heard that Chris is unhappy at being on the ward once again and is also aware that he is viewed by the nursing staff as being non-compliant with his medication and the ward routine. Beth’s first aim is to engage with Chris and communicate with him that she wished to understand what he thought his difficulties were, and that she wanted to discover if there was anything he felt he wished to address. Her hope was that together they would be able to agree on what his functional problems were and develop an intervention plan they could both agree with and work towards.
Having spent longer than anticipated with Chris it was time to rush to her lunchtime journal club meeting. The journal club is a monthly interdisciplinary event that Beth had initially set up with a clinical psychologist. The club has now been attended by staff from various professional groups for over a year and some changes to practice have occurred due to discussions that have taken place. Beth had recently carried out an audit of the club and it was found to be well attended and highly valued. The findings of the audit had been submitted to a clinical effectiveness conference and her abstract was accepted for a poster presentation. Beth has now developed a draft poster and wants to show it to the journal club members to get some feedback before it is finalized.
Beth’s afternoon begins with a clinical supervision session with her junior occupational therapist. This is quickly followed by a kitchen session with another client who is preparing to go home after an unusually lengthy admission (by this ward’s standards). After this she attends the ward development meeting. This is a staff meeting for the senior staff members on the ward and plans new developments to its structure and routine. Beth is concerned about the level of therapeutic engagement as a whole and wants to encourage all staff to be more interactive with clients. However, she is very aware of ward politics and draws on all her leadership and personal management skills to be able to communicate these issues with the rest of the team. After the meeting, Beth returns to her ward office. This is the first chance she has had to read her emails. Amongst the usual stuff, two messages stick out: one of them is from the hospital’s practice education facilitator to ask Beth if she would mind having an occupational therapy student, for 6 weeks, starting the following week? Another email is from a colleague in the local university with whom Beth is a co-grant applicant on a pilot research study application examining the effectiveness of an activity scheduling programme they have developed for clients with eating disorders: Beth needs to review the procedure that her colleague has suggested they use for recruiting participants. Half an hour before home time… Beth makes herself a well-deserved coffee and reaches for a copy of an article on using conceptual models in practice that she had recently seen in a journal…
‘Skills for Practice in Occupational Therapy’ addresses the aptitudes and competencies required by today’s practitioners; and introduces these in a way that is accessible, relevant, closely linked to theory, and evidence based. If ‘Foundations for Practice in Occupational Therapy’ (Duncan 2006b) strove to link theory with practice, ‘Skills for Practice in Occupational Therapy’ endeavours to link practice with theory!
Whilst this book does contain practical advice and guidance on a range of issues, it is not designed to be a ‘How to do’ textbook that will take you step by step through an intervention or theoretical approach. Similarly, it does not purport to cover every necessary skill for practice. Instead the book covers a broad range of skills that are essential for today’s practitioner. The chapters vary in theoretical and academic depth. Several of the chapters present complex areas of study that have been subject to research and theoretical development for many years: these chapters aim to introduce the topic to the reader, provide them with a foundation of knowledge in the area and signpost them to other resources to develop their knowledge further. Other chapters are inherently pragmatic. This diversity of depth and focus is appropriate as it reflects the differing types of skills that occupational therapists use in their everyday practice.
Practitioners spend a lot of time thinking, judging/assessing, collaborating with clients, making decisions and reflecting on what they have done. Yet how often, and for how long, do people spend time to stop and consider why they made certain decisions, on what evidence they based their decisions, how successful their strategy of collaborating with clients is, and how evidence-based their judgements in practice are? These skills are central, yet largely invisible to competent and successful practice. Section 1 untangles the vast literature of this field and introduces the reader to a range of ideas, theories and evidence that highlight ways in which practitioners’ thinking, judgements, decisions and reflections are influenced and can be enhanced.
Section 2 focuses on the everyday skills practitioners use when intervening with clients. The chapters in this section focus on the core skills (Creek 2003) that occupational therapists use in practice:
Each of these skills assists practitioners to enable their clients to develop, maintain or explore their daily lives, enhance their well-being and minimize the effects of occupational dysfunction or environmental barriers. Additionally this section includes chapters on goal setting and report writing and record keeping; neglected but essential components of skilled practice. Each chapter, though practice focused, is closely linked to developments in evidence, theory and policy.
Section 3 addresses the importance of evidence-based and research skills in practice. Research is now the business of every practitioner (Bannigan et al 2007). In the UK, the College of Occupational Therapists has stated that, ‘occupational therapists have a responsibility to contribute to the continuing development of the profession by utilizing critical evaluation, and participating in audit and research’ (p. 17). A contemporary textbook on ‘Skills for Practice in Occupational Therapy’ cannot be without a section to guide practitioners in finding relevant research and appraising it for quality, examining how to implement the recommendations of research into practice, and evaluate how successful this has been. Further, occupational therapists now have to examine how they can undertake research in practice. Despite the very real challenges that face practitioners who wish to undertake research, it can be done. This section outlines various approaches that have been successful in undertaking clinically relevant research in practice and discusses the strengths and limitations of each. The section concludes with a chapter that contains important information on the skills that are required by practitioners in order to successfully present or publish their work.
Making good clinical judgements, having expert professional skills, finding and using the best evidence and engaging with research are all essential skills for practice. Yet, if a practitioner does not have high-quality personal and interpersonal skills their work will not reach its full potential. Section 4 addresses precisely these issues for practice. Every practitioner can be a leader; it is not an attribute that is solely attributed to people in authority, and being in authority does not mean that a person will be able to lead. First and foremost skilled leadership requires leadership of self. Amongst other attributes effective practitioners need to be authentic, have integrity and be trusted by others. But, even with these positive attributes (and others are necessary too) there is no escaping the demands of working in health and social care environments where practitioners frequently face challenging situations and people, and clients too! Therefore positive self management (looking after one’s personal resources) is also vital for the individual who wishes to be an effective and skilled practitioner. When a practitioner can manage themselves, their influence on others will grow and so too will the range of issues that they have an impact on and influence in their work environment. Sometimes this will evidence itself through practitioners leading changes in a wider circle than their immediate professional discipline (as seen in Vignette 1). At other times it will be observable through the influence they have with their colleagues within their professional discipline; either informally or through formal structures such as student or clinical supervision.
So what do occupational therapists do? Perhaps this question cannot be truly answered through a catchy strap line. Competent occupational therapists are required to have a startling depth and breadth of knowledge, practical skills, and personal and professional attributes. ‘Skills for Practice in Occupational Therapy’ provides students and practitioners with an introduction and overview of the essential skills for practice. So, next time someone asks you what do you do….give them a copy of the book!
Bannigan K, Hughes S, Booth M. Research is now every occupational therapists business. The British Journal of Occupational Therapy. 2007;70(3):95.
Chambers. The Chambers Dictionary. Edinburgh: Chambers Harrap, 1994.
Creek J. Occupational Therapy defined as a complex intervention. London: College of Occupational Therapists, 2003.
Duncan EAS. Introduction. Duncan EAS, editor. Foundations for Practice in Occupational Therapy, 4th edn. Edinburgh: Elsevier/Churchill Livingstone. 2006:3-9.
Duncan EAS, editor. Foundations for Practice in Occupational Therapy, 4th edn, Edinburgh: Elsevier/Churchill Livingstone, 2006.
Hagedorn. Tools for Practice in Occupational Therapy. Edinburgh: Churchill Livingstone, 2000.
Ryan SE, Esdaile SA, Brown G. Appreciating the big picture: You are part of it! The socio-political influences on health practice in the public and private sphere. In: Brown G, Esdaile SE, Ryan SE, editors. Becoming an Advanced Health Care Practitioner. Edinburgh: Butterworth Heinemann; 2003:1-29.