OTHY101 Study Notes with case studies PDF

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Summary

Study Notes With case studies. Explores the models that are explained throughout the unit. Note these are not in-depth explanations....

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OTHY101 REVISION

ICF International Classification of function disability - Helps to understand health and health related states

ICF is used by all allied health partners - It is a classification tool for statistical information - It uses consideration of health, goal setting, assessments, etc in clinical practice - ICF F words; Fitness, Function, Friendships, Fun, Family Strengths - International classification Weaknesses - Classifies against normal people - Does not explain cause of disease

Basic Assumptions Complexity of occupations - Context - Meaning - Purpose - History - Occupational performance - Occupational form What are basic assumptions - Occupational therapy has a set of assumptions/ beliefs which are held to be true unless disproved 4 basic assumptions of Townsend and Polatajko - Occupation affects health and wellbeing - Occupations brings meaning to life - Occupation organises time and brings structure to living - Occupations are idiosyncratic (unique)

CMOP-E Canadian Model of Occupational Performance and Engagement - Guidelines for assessment, intervention and measuring outcomes in OT

PERSON (SCAP) Spirituality—Essence of a person Performance components Cognitive—Mental and intellectual functions Affective—Feelings, emotions, social functioning Physical—Sensory and motor functions

OCCUPATION Selfcare—Occupations for looking after the self Productivity—Occupations that make a social or economic contribution or provide sustenance Leisure—Occupations for enjoyment

ENVIRONMENT (SCIP) Social—Social interaction in daily life, social groups Cultural—component of social environment, belief or value system of a particular group Institutional—Formal and informal structures that govern society Physical—Built or natural environment

OCCUPATIONAL PERFORMANCE Occupational performance is the result of a dynamic relationship between person, environment and occupations over a person’s life. - The ability to choose, organise and satisfactory perform meaningful occupations

OCCUPATIONAL ENGAGEMENT To involve oneself or participate in an occupation—Choice, importance, satisfactory

CMOP-E in Action Person Spirituality

Occupational Performance (Issue of importance with Person, environment and occupation overlapping) 

Persistence Work ethic ie. during rehabilitation

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Cognitive Aphasia - (Speech + behaviour) Decreased cognitive ability Poor judgement

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Affective  Not wearing the splint  Hard work in rehabilitation (motivation) Physical  Stroke  Limited mobility/standing and participation in ADLs  Right Hemiplegia Environment

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Occupational Engagement Issue of importance with Person, environment and occupation overlapping)  

Social Plays wheelchair basketball Richard (became her caregiver, flat mate) Therapists, doctors, nurses etc

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Working - wants to give back e.g. share her story with others (needs help with her speech this can be improved with help from a speech pathologist) Limited mobility, confined to wheelchair Walking and standing for long periods Speech is impaired Cognitive functions e.g. poor judgment, impulsive behaviour, made everyday life activities difficult Impaired participation in activities of daily living (ADLs)

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Rehab outpatient (regular check ups and therapy engagement) Education engagement (HSC completion) Local sports club worker Community engagement e.g. Wheelchair basketball spectator/player

Cultural The support of the rehab groups guided her into an assisted living home. Allowing her access to services?? → gov putting money into the services e.g NDIS

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Institutional Recreation Therapy : Government (pension) Health care system (Hospital)

   Physical:  

Apartment (the support of Richard) Assisted living complex (community environment helps with social interaction)

Occupation Self-care: 

performing rehab/therapy exercises, mobility, showering, personal hygiene

Productivity: 

working at local sports club, attaining HSC, writing on computer, attending rehab/OT/physio sessions, selling drugs, visiting hospital, travelling to places

Leisure: 

spectating wheelchair basketball games, drug use, alcohol

PEO MODEL Person Environment Occupation - A conceptual framework to provide a systematic way to analyse complex occupational performance issues within the context of occupational therapy practice

Occupational performance - Dynamic relationship between person, environment and occupation over a persons life span

Person

- An integrated whole who incoperates spirituality, social and cultural experience and observable occupational performance components - Spiritual - Cognitive - Affective - Physical Environment - Social

- Cultural - Institutional - Physical Occupation - Clusters of activites and tasks which people engage while carrying out various roles in multiple environments - Chosen to fulfil a purpose and for the value and meaning which individuals/ groups attribute them Performance Components - Feeling (affective) - Thinking (cognitive)

- Doing (physical) - All contribute to successful engagement in occupation Application in assessment - Persons strength and difficulties - Environmental conditions what can be changed - Occupational demandsaffective, cognitive and physical - Intervention can target the person, the environment, the occupation together, or any two or three

PEO in action Person Spiritual  Painting/art  Passion for sharing lived experiences  His wife Cognitive  Hears voices  Audiovisual hallucinations  Psychosis Affective

 Anxious  Depression  Paranoia  Episodes of psychosis  PTSD Physical  Experienced abuse  Sleeping difficulties  Fatigue Environment Social  His partner  His adoptive family  Kieran  Foster parents Cultural  Cultural stigmas on mental health conditions Institutional:  Art exhibitions to showcase his work  Mental health unit  Hospital  Being in foster home system  Mental health system Physical  home/bedroom  Where his job physically is  Moving between foster homes  Art studio  ‘My mental health unit’ → place he went occupation  He is an artist  Has a job → media engagement manager at changing minds P/O:  “Frightened of people”- Doesn't want to do go out and do occupations  Injections and therapy sessions that improve his engagement when doing occupations  Painting that expresses his emotions  Smoking- coping mechanism  Psychologist relapse action plan that helps him keep track  Relationship with co-worker who’s understanding P/E:  Family upbringing- Abuse > PTSD  “Frightened to go out” and interact with people in the social environment  Not use to independence at home without the support of mental health ward  Support units e.g. partner, work relationships O/E:  Mental health ward that promotes good occupations such as painting  His new job in an understanding environment Interventions/ strategies to improve performance   

Smoking Art Injection

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Keeping up with Medications Physiologist doctors appointments Mental health clinic Intervention plan created with psychologist Discussing condition openly

MOHO Model of Human Occupation

VHP Volition

Experience—Immediate thoughts and feelings that emerge in the midst of and in response to performance Interpretation—Recalling and reflecting on performance in terms of its significance for oneself and ones world Anticipation—Process of noticing and reacting to potentials or expectations for action Volition processes - Activity choices—Short term, deliberate decisions to enter and exit occupational activities - Occupational choices—Commitments to enter into a course of action or to sustain regular performance over time

Habituation

Habitats

- Acquired tendencies to respond and perform in certain consistent ways in familiar environments or situations - Require repetition to establish pattern - Require consistent environmental circumstances Internalised roles - Reflected by patterns in action - May be acquired through process of socialisation - May be self defined and shaped by interrelated and ongoing nature of a set task or required personal circumstance

Performance Capacity

- The key to understanding the model is to understand that all components described above are in constant dynamic interaction with each other. And when any part of it changes the whole dynamic will shift.

Three Levels of Doing Participation - Engagement in work, play, or activities of daily living that are part of ones socio cultural context and that are desired and/ or necessary to ones wellbeing

Performance - Doing and occupational tasks

Skills - Observable goal directed actions that a person uses while performing - Includes motor, process and communication and interaction skills

Occupational performance - Comprise discrete acts or units of doing, that are performed - Involves completing a discrete act that may involve a series of steps that led to a coherent whole or desired activity - Acts become habits when repeated based on volition - Acts take shape within social and physical environment Occupational Skills Motor skills - Moving ones body or objects in ones environment Process skills - Logically sequencing actions overtime - Selecting and using appropriate tools and materials - Adapting performance to overcome obstacles Communication and interaction skills - Being able to convey ones intentions and needs to express oneself in a way that allows for involvement and coordination social action with others.

Occupational Identity - A composite sense of who one is and wishes to become and is generated from ones history of occupational participation - Personal causation - Interests - Role identity - Values - Volitional choice

Occupational Competence - The degree to which one sustains a successful pattern of occupational participation that reflects ones occupational identity - Identity into action - Expectations of role, values and standards - Satisfaction

Occupational Adaptation

- All of the above put into action

KAWA Model - Developed by Japanese occupational therapists - Discussed what they/ their clients lived for an what they felt was essential to life and fulfilment Basic assumptions of KAWA - Applicable to individuals or to communities - Culturally relevant – all universal assumptions regarding the explanatory power and applicability of this model are dismissed, making the model open to change by occupational therapists, to match the diverse social and cultural contexts of their diverse clients. - Decentralised self – the lines between self and environment and context are blurred - The self is not unilaterally empowered

Water

- Life energy/ flow - Water has symbolic meanings - Self is influenced or shaped by the surrounding social context at a given time and place - A person’s state of well-being coincides with life flow - Occupational therapy’s purpose is to enhance life flow - Circumstances and structures in a client’s life determine his/her life flow River wall and floor - Environment Rocks - Impediments to life’s flow - Life’s circumstances - Problematic - Vary in size and number - Present at birth or acquired - Situated in environment position relevant Driftwood - Personal attributes - Values

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Character Personality Skill Immaterial Material Living situation Positive or negative Space between obstructions - Spaces through which the client’s life energy still flows - These spaces represent occupation KAWA model Johnson Maker- Adeng Rocks       

Literacy skills Spent 12 years in refugee camp War in Sudan Assignments Lack of Father figure Moving countries Older than other classmates at school

Driftwood      

Persistence to learn Values his community and culture Supportive community Lismore English 4th language Education at refugee camps Passion for politics, medicine and the church

River side walls and Floor      

Family Community → culture, Lismore, Sudanese School community → teachers Sudan vs Aus His experiences School principal

Water and Life flow      

Helping and serving others Reenforcing change → in both South Sudan and Aus Expressing cultural importance Girlfriend Sport (soccer) Public speaking (politics)

Occupational science and occupational justice Occupational + Science - Exploring the scientific basis of our use of the occupation as treatment modality - Further developed our understanding of the need to investigate, to study and to understand occupation

Occupational + Science – interdisciplinary dialogue - occupation and science - behavioural scientists - social scientists - research into work life balance Occupational Science - Naming occupation as the core domain of concern for our profession brings with it -

the responsibility of knowing it at all levels We must make explicit our assumptions about occupation We must also undertake careful study of occupation Created a science to provide foundational knowledge for effective OT practice and develop a professional identity focused on occupation “The study of the human as an occupational being including the need for and capacity to engage in and orchestrate daily occupations in the environment over a lifespan” The study of the occupational nature of people and how they adapt to the challenges and experiences of their environments through the use of occupations Provides way of thinking and a knowledge base in which the fundamentals from many theories are integrated to provide an understanding of the occupational human Occupational Science: unpacking everyday life to inform other professions in addition to OT

Occupational Justice -

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Offers a new lens for looking at and acting on local and world struggles from an occupational perspective Considering these struggles from the standpoint of what people want to do, what they need to do, and what they can do considering their personal and situational circumstances Diverges from social justice as it concentrates on: Interest in individual as well as group difference A concern for the enablement of diverse participation in society Focuses on relationship between occupation, health and quality of life

Occupational risk factors (outcomes of injustice) -

Occupational alienation Occupational deprivation Occupational marginalisation Occupational imbalance

Occupational Alienation -

Prolonged experiences of disconnection, isolation, emptiness When a person experiences the occupation as being meaningless or purposeless Lack of a sense of identity, a limited or confined expression of spirit Eg: jobs perceived as being repetitive, ‘mind numbing’ Occupational absurdity: the work has lost its connection with meaning for the individual and in the broader social context

Occupational Deprivation -

A state of prolonged preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside the control of the individual Eg: deprived of opportunities due to poverty, disability, social forces, conflict, displacement, incarceration, etc Older people who have had a stroke, can no longer drive and don’t have access to public transport may become isolated

Occupational Marginalisation -

People not afforded the opportunity to participate in occupations and to exert choices and decision making related to occupational participation

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Relegates people to invisible or less valued occupations Often occurs through discrimination due to age, gender, ability, etc

Occupational Imbalance -

Temporal concept Refers to the allocation of time use for particular purposes Based on the reasoning that human health and well-being require a variation in productive, self-sustaining and leisure occupations Individual spends a greater or lesser amount of time undertaking one type of occupation

Occupational justice and OT -

Allows us to go beyond the ideas of physical and mental disabilities and consider other reasons for restricted participation It is vital for us to understand how a person’s social, cultural and economic situations shape the occupations they participate in and why We must keep the concept of occupational justice in the forefront of our minds in order to present health and social equities (and inequities) from an occupational perspective

Spirituality - Spirituality is not dependent on religious affiliation or practice - Spirituality is seen as central to the human experience regardless of belief frameworks

Context - Symbolic meaning of places, objects & communities - Religious

- Personal - Cultural Spirituality within the scope of OT - When surveyed, the majority of [American, British and Canadian] occupational therapists agreed that spirituality was an important part of life, and an important aspect of health and therapy

Holistic Approach to OT - Mind - Body - Spirit OT models and spirituality - PEO - Person is viewed holistically - mind, body and spirit; cultural component of -

environment considers practices based on people’s value and belief systems CMOP-E - Spirituality is the central component; defined as the essence of the person MOHO – Volition; an ongoing process over time as people experience, interpret, anticipate and choose occupations. Includes personal causation, values and interests. KAWA– Water, life flow or life energy; that which is essential for life and is personally rejuvenating; well-being is associated with a strong deep and unimpeded life flow.

Problems of integrating spirituality into OT - Diversity in definitions of spirituality; absence of language - Unsure about the role of spirituality in practice - Lack of training, confidence and skills in addressing spirituality in practice - Concerned about projecting their own beliefs onto clients - Personal – professional boundary - Doing versus being Occupation and spirituality - Provide social support - Practices may be essential to their coping strategy - May influence their choice of occupations

Spirituality experienced through occupation - Familiar - Expressive - Purposeful - Temporal - Meaningful

- Occupations imbued with spiritual ritual and tradition Integrating Spirituality into OT - Direct Interventions - Assessment - Working with Chaplains - Spiritual practices - Indirect Interventions - Narrative Ritual - Appreciation of nature - Creativity - Work - Addressing client’s religious concerns - Assisting clients in dealing with suffering - Helping clients to recognise their own worth and efficacy

Practice exam Using the peop, identify the key person factors that may prevent Julia from participating in her desired occupations?

Spirituality—Essence of a person Performance components Cognitive—Mental and intellectual functions Affective—Feelings, emotions, social functioning Physical—Sensory and motor functions - Julia would obviously become physically affected as the stroke has caused weakness and movement difficulties on the right side of her body. These physical factors may prevent her from cleaning her house as she can find it difficult to carry larger objects around due to her weakness. The cognitive affects of her stroke have resulted in an impaired short term memory, causing her to often forget what she was doing. Being a senior marketing executive Julia may often find it diff...