Annotation copyright by Book News, Inc. Genau das ist das Thema dieses Buchs. Es befasst sich - zum ersten Mal in deutscher Sprache - mit dem Klinischen Reasoning in der Ergotherapie. Author : Helene J. Anhand eines bundesweiten Projektes erfahren Sie zudem, wie Befundaufnahme und Dokumentation nach dem Modell in Deutschland praktisch umgesetzt werden.
Ihre Expertise kann diese deutschsprachige Ausgabe zu einem Standardwerk der Ergotherapie machen. Author : Barbara J. In addition, the reasoning process is explored in a way that is helpful to occupational therapy students and practitioners at all levels. Das vorliegende Manual This text provides a current and well-rounded view of the field- from theoretical rationale to evaluation, treatment, and follow-up.
Table 1. As the table reveals, these organizations are relatively new, all having been established between the years and The various Websites provide a broad- based sense of the commonalities shared by these organizations and the differences in their focuses. While all of the organizations have as primary aims promoting research on occupation, particularly as it relates to health, they differ in the degree of emphasis they place on other aims such as multidisciplinarity, promoting social justice, or linking occupational science to occupational therapy.
A promising new development is that in and , two international Think Tanks were held, the first in Australia Wicks, and the second in the United States, with representatives from as many as 14 countries and five continents, most of whom were from the organizations listed in Table 1. The key result of the Think Tanks was the unanimous decision to move forward in seeking affiliative relationships among the organizations and in supporting ISOS as a potential umbrella organization.
TABLE 1. Year Name Founded Website. Another indicator that occupational science is flourishing is the number and quality of scientific symposia that are being held.
For 19 consecutive years, an annual occupational science symposium has been held at USC featuring over presentations on interdisciplinary occupational science-related themes and relevant research. These symposia have typically included presentations from world-renowned scientists, philosophers, and scholars.
Among the most eminent presenters have been primatologist Jane Goodall, neuroscientist Antonio Damasio, sociologist Andrew Abbott, rehabilitation scientist Margaret Stineman, neuroscientist Candace Pert, philosopher John Searle, psychologist Mihaly Csikszentmihalyi, psychologist Jerome Bruner, anthropologist and linguist Mary Catherine Bateson, and physicist Stephen Hawking.
As scientific societies have been established throughout the world devoted to furthering occupational science, they too have held annual symposia. Between and , 18 such symposia were convened. Collectively, these symposia including those held at USC in this time period have included over presentations, with speakers from over a dozen countries.
It is interesting to note the most frequently addressed topics included occupation and health,. The populations that were most frequently addressed were women; individuals with chronic illnesses or disabilities; and infants, children, and adolescents. People who are homeless, inmates and ex-inmates, college students, individuals identifying as gay, lesbian, bisexual, or transgender, and refugees and immigrants were also participants in occupational science research presented at these symposia.
Finally, perhaps the key indicators of the vitality of occupational science are the number and the quality of papers that its scholars produce annually in peer-reviewed journals.
These benchmarks, of course, are difficult to track thoroughly for several reasons. First, papers that occupational scientists produce are often not identified in P. Second, it is difficult to develop criteria for inclusion of articles as occupational science. Additionally, occupational scientists might publish their work in interdisciplinary journals without indicating in the manuscript that their study or piece of scholarship is occupational science. Nevertheless, two studies have recently been undertaken that identify publication trends in occupational science.
Molke, Laliberte-Rudman, and Polatajko focused on the years and to detect changes in publication patterns between these two points in time. To be included in the study, the publications had to meet the following criteria: 1 the phrase occupational science or science of occupation was in the title, identified as a key word in the abstract, or in a collective title, and 2 the publication was not a book review, letter to the editor, or workshop summary.
The authors found that only 10 publications qualified in one year after occupational science had been founded but that in , 44 papers were identified, a fourfold increase. Moreover, in the second time period, there was a pronounced expansion in the number of authors from countries other than the United States compared to the author pool in Also, in , the publications had appeared in a wider range of journals and showed a growth trend in the numbers employing qualitative methods in contrast to quantitative or mixed methods.
Finally, the most common themes emerging from the review that were perceived to be shaping the direction of the emergent field were identified: 1 providing a broad and general understanding of occupation, 2 nurturing occupational therapy by providing it with a science- based foundation, 3 seeing occupational science as a vehicle for defending occupational therapy's commitment to certain values or ideals, and 4 describing the discipline as one that achieves social reform by championing occupation's place in social justice, a theme that was seen largely in the latter set of publications and in those written by Canadian and Australian.
The second study, which has just been completed by Glover , builds on the preceding one by examining many more years to gain a finer-grained picture of publication trends. To be included in the study, the publication had to have appeared in a journal in any of the years between and As in the first study, the publication had to use the term occupational science or science of occupation in its title, key words, or abstract. However, in this study, only articles that appeared in peer-reviewed journals were included because these are considered by the scientific community to be the most legitimate vehicle for disseminating new findings.
The selection process resulted in the identification of articles. When publications from the earlier years were compared to those in later years, Glover found that although publication numbers fluctuated from year to year, in general, more articles were published in more recent years.
Furthermore, over time the proportion of data-based articles increased, most being qualitative in nature. Also, the majority of publications addressed adults 18 to 64 years of age and without disability, although a hefty Authors tended to be from the United States, Canada, and Australia, although other countries were also represented.
Finally, in later years, a greater proportion of articles indicated that the work reported had been supported by extramural funding. This trend is particularly important because the prestige and growth of an academic discipline are largely contingent on receiving grants from federal and other agencies.
In summary, although these two studies represent only a first cut in assessing how occupational science publications are developing, they nevertheless suggest that the discipline has grown impressively as it enters its third decade.
By the year , we envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs.
AOTA, , paragraph 1. How does occupational science relate to this vision? Or, to back up a bit, what is the relationship between occupational science and occupational therapy? We will make the case that the relationship between occupational science and occupational therapy is symbiotic, that each contributes to the survival of the other Clark, , and that occupational science. The founders of occupational science, as we have explained, originally conceived of the discipline as basic in nature but as existing, in part, to nurture occupational therapy Clark et al.
Designating the science as basic at the time made sense for two reasons: First, the founders saw the advantage of building theory on occupation basic science , in the general sense, without concern for its specific application in therapy applied science. At that time, no P. For example, this discipline could contribute new knowledge on occupation and synthesize existing interdisciplinary knowledge for use by those who are interested in preventing chronic illness and disability, promoting global health, or simply expanding our understanding of this central feature of human existence.
The second reason was more practical. Universities in the decade of the s privileged basic science over applied science. The climate was such that the chances of being able to establish a new basic science rather than an applied one were better. However, it should be reiterated that in the founders' original conceptualization, occupational science was always intended to furnish knowledge that could be used to theoretically inform, and thereby refine and develop, occupational therapy interventions.
Much attention has been placed on the relationship between occupational therapy and occupational science in the beginning, a kind of creation story, in which occupational science is purported to have grown out of occupational therapy. In fact, the ties between occupational science and occupational therapy were reinforced in nine years after the founding of the discipline when Zemke and Clark a, b moved away from defining occupational science as a basic science, recommending that its focus be not only on the nature of occupation, but also on how it is used in occupational therapy contexts.
Generation of knowledge for occupational therapy is frequently described as the primary aim or purpose for the discipline,. Interest in the study of occupation as related to the practice of occupational therapy has surged in recent years, and many people in the field consider it to be part of a kind of course correction to return current practice to its philosophical roots, overcoming the reductionism that marked the tight coupling of the field with biomedicine, particularly around the s e.
Similarly, studies on the impact of occupation on the health of individuals, communities, and the global arena can result in an expansion in occupational therapy's scope of practice. In addressing a wide variety of topics that are relevant to the general population, occupational science can broaden occupational therapy's professional jurisdiction while appropriating the profession greater stature and credibility. For example, as scientific evidence is produced that demonstrates the ways in which health-promoting activity lessens the risk for developing chronic diseases or disability, occupational therapy will become better positioned to stake a claim in the prevention arena.
Just as much of dental practice since the discovery of fluoride is dedicated to prevention, so too could a significant amount of occupational therapy practice be aimed at preventing the very diseases and disabilities that its practitioners have traditionally remediated.
In this way, the profession will be able to stake out new territory for its therapeutic work Abbott, Finally, the applied arm of occupational science can produce the much-needed outcome studies on intervention effectiveness. This broader conceptualization of occupational science, that is, as a comprehensive translational science, is the way in which the discipline is now taking shape in the United States, a development that provides a goodness-of-fit with what is required for realization of AOTA's Centennial Vision.
Figure 1. In this model, occupational science is seen as contributing its subject matter and research findings to the universe of knowledge. In doing so, it enriches other academic disciplines and professions, simultaneously creating widespread understanding of its focus. Reciprocally, these fields supply intellectual content and research findings that are of relevance to occupation back to occupational science. Occupational science is also shown as being highly intermeshed with occupational therapy.
The various kinds of knowledge that are generated by the field, overall, are seen as bolstering the scientific credibility of the profession and could lead to increased growth in third-party payment for occupational therapy services and the enactment of public policies that render occupational therapy services more widely available. Syntheses of interdisciplinary knowledge and basic science on occupation can be translated into innovative treatment advances or used to refine existing protocols.
They can also provide justification for. As can be seen in Figure 1. However, for occupational science and occupational therapy to be intermeshed in this way and to further key aspects of the Centennial Vision, a carefully thought-out division of labor is required. In Figure 1. Practitioners occupational therapy assistants and occupational therapists are depicted as working across diverse settings, where they will implement traditional and new models of practice for individuals, groups, and communities.
They may also be invited to share. Occupational scientists with PhD or ScD degrees are seen as constituting the core tenure-track faculty and the main cadre of researchers developing the body of occupational science knowledge, doing large-scale outcome studies, and infusing findings in curricula. Practitioners and faculty who have Doctor of Occupational Therapy OTD degrees are pictured as being in the lead position for drawing from occupational science to develop intervention models and study their effectiveness, as well as for joining faculty who have PhDs in updating curricula in accord with new scientific breakthroughs.
We conceive of this new breed of OTDs as pioneer experts in clinical practice and as leaders in facilitating education, policy, or administrative changes to create alignments with the Centennial Vision. A research team that has been funded through federal grant support. The trajectory of research activities as designed by this team is depicted in Figure 1. The research program begins by identifying a problem worthy of investigation Step 1.
For example, in the USC Well Elderly Study, the problem was framed as whether or not an activity occupation based intervention could slow down the declines that are normally associated with aging or improve health in the elderly Clark et al. The group used qualitative research methods to obtain a detailed and complex understanding of the contextual factors that needed to be taken into consideration Step 2 Mandel et al.
Following this qualitative work, which can be thought of as more basic than applied science, the findings were then used to enhance aspects of occupational therapy practice, by refining existing approaches or creating new interventions Step 3 Mandel et al. The research group sought federal funding to conduct a large-scale clinical trial Step 4 that employs quantitative methods to demonstrate the cost-effectiveness Step 5 of the new or refined therapeutic approach applied science.
If the results of the trial demonstrate effectiveness, the next step is to obtain funding to conduct subsequent studies on the.
This work, in turn, can lead to further theory development and practice improvements Step 7. The process, which initially might have seemed disconnected from practice, culminates in therapeutic innovation and the delivery of outcomes data that can have a positive effect on reimbursement for services and public policy decisions. This line of thinking assumes that contextual factors and other complex life circumstances are not particularly relevant to the care of patients who have, or are at risk for, discrete biologically based impairments, diseases, or disabilities.
It also is grounded in the preconception that a discipline that is focused on explaining occupation and its impact on health is too removed in its emphases from traditional biomedical procedures and practices to have genuine payoffs in the provision of care. We will try to illustrate that such circumscribed reasoning is limiting and problematic. The PUPS study team selected the problem of pressure ulcer prevention in people with spinal cord injury to work on for three reasons Step 1 in Figure 1.
First, the general area of pressure ulcer prevention had been identified as a significant national health concern. Second, existing best practices have failed to address the problem adequately with the costs of wound management soaring. Having the expertise to do cost-effectiveness studies, the PUPS research team was attracted to this research area in part because of the potential through scientific discovery to reduce the burden of these health care costs. However, finally, and perhaps most importantly, a literature review had revealed that recurrent pressure ulcers were serious threats to the quality of life of people with spinal cord injuries, compromising their potential to express themselves as occupational beings Clark et al.
Typically, the occurrence of an advanced pressure ulcer requires months of confinement to bed, creates a decrease in functional ability because of muscle loss due to surgery, and can cause depression and an overwhelming sense of helplessness.
The PUPS team therefore decided to use a full-fledged occupational science-based strategy incorporating the steps in the translational research template shown in Figure 1. In executing the second step of the translational research template see Figure 1.
The methodology entailed conducting in-depth interviews and participant observation of events that led to pressure ulcer development in the lives of 19 people with spinal cord injury and one person with spinal myelitis, all of whom had had a history of recurrent pressure ulcer development.
The findings underscored the significant degree to which a complex cluster of factors led to the emergence of pressure ulcers Clark et al. They also led to the creation of a set of models that described the daily lifestyle factors that influenced the likelihood of incurring a pressure ulcer Clark et al. From the findings, it was clear that focusing on conventionally linked factors such as equipment breakdowns or failure to comply with the pressure relief procedures was insufficient in explaining how the participants developed pressure ulcers.
Factors related to occupation, such as moment-to-moment decision making on whether or not to engage in a high-risk activity, negotiating tradeoffs between pursuing a passion and resting when an ulcer was in an early stage, or problem solving in unanticipated and unusual circumstances such as being trapped in an airport for 16 hours, were often pivotal in contributing to pressure ulcer development.
To date, this research program has demonstrated that prevention efforts need to take into account the unique constellations of circumstances in a person's everyday life Clark et al.
These manuals contain narratives of the life circumstances that led to the development of pressure ulcers in the 20 study participants. The format is interactive, containing elements such as decision trees, questions addressing various dilemmas related to pressure ulcer risk with a choice of several possible solutions of varying degrees of correctness, and highlighted words embedded in the stories that represent factors that place particular participants at risk for pressure ulcer development.
Clicking on the highlighted text in the Rehabilitation Professionals Manual takes the reader to a corresponding article in the Companion Manual that summarizes recent research on the topic of interest. At this point, with a manual of interventions in hand that incorporates traditional occupational therapy approaches to pressure ulcer prevention with new strategies derived from the PUPS study, the research team is now attempting to secure federal funding to conduct a large-scale randomized clinical trial with hopes of demonstrating the intervention's cost-effectiveness.
Members of the team also intend to develop an assessment based on the findings that will be capable of predicting risk with more exactitude than is typical of currently used pressure ulcer risk assessments.
Assuming that they are successful, the PUPS study will be able to demonstrate the way in which occupational science supports the development of state-of-the- art rehabilitation interventions, contributes to a complex understanding of pressure ulcer risk, translates into concrete occupational therapy approaches, and provides consumer access to new information on the factors that lead to the development of pressure ulcers.
In this way, occupational science can fortify occupational therapy. In turn, occupational therapy, strengthened by occupational science, will be better positioned for securing new reimbursement streams and expanding its scope. As occupational therapy becomes recognized as a scientifically driven and evidence-based practice, its clinicians will go on to.
How is the described relationship between occupational science and occupational therapy mutually beneficial? What do you think are the most pressing problems to address through the proposed translational science research program? In your mind, jump ahead 10 years. Envision yourself to be writing a section describing recent developments in occupational science over the past decade. What might you be able to say or hope to be able to say? We thank all the members of the USC Well Elderly Study group for their contributions to the Well Elderly study, some of the content of which is covered in this chapter.
Creating an academic discipline that supports practice. American Occupational Therapy Association. Carlson, M. Further thoughts on the pitfalls of partition: A response to Mosey. The American Journal of Occupational Therapy, 49 1 , Clark, F.
Occupation embedded in real life: Interweaving occupational science and occupational therapy. The American Journal of Occupational Therapy, 47 12 , One person's thoughts on the future of occupational science. Journal of Occupational Science, 13 3 , Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention.
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Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. Cutajar, R. Occupations and pressure sore development in Saudi men with paraplegia. British Journal of Occupational Therapy, 68, Dickie, V. Occupation as transactional experience: A critique of individualism in occupational science. Journal of Occupational Science, 13 1 , Dunn, C.
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In Occupational science: The evolving discipline pp. Certainly, sir. Well, my goodness! Identify and evaluate ways of knowing occupation. Articulate different ways of defining and classifying occupation. Describe the relationship between occupation and context. Many occupations are ordinary and become part of the context of daily living. In the myriad of activities people do every day, they do occupation all their lives, perhaps without ever knowing it. Occupations are ordinary, but they can also be special when they represent a new achievement such as driving a car or when they are part of celebrations and rites of passage.
Preparing and hosting Thanksgiving dinner for the first time and baking the pies for the annual family holiday for the twentieth time are examples of special occupations. Occupations tend. But even special P. Hocking, Wright-St. Clair, and Bunrayong illustrated the complexity of traditional occupations in their study of holiday food preparation by older women in Thailand and New Zealand.
Nevertheless, the doing of food-centered occupations around holidays was a tradition for both groups. To be human is to be occupational. Occupation is a biological imperative, evident in the evolutionary history of humankind, the current behaviors of our primate relatives, and the survival needs that must be met through occupation Clark, ; Krishnagiri, ; Wilcock, ; Wood, Humans also have occupational needs beyond survival.
According to Molineux , occupational therapists now understand humans, their function, and their therapeutic needs in an occupational manner in which occupation is life itself [emphasis added]. Understanding occupation is more than having an easy definition which is a daunting challenge in its own right. To know what occupation is, it is necessary to examine what humans do with their time, how such activities are organized, what purposes they serve, and what they mean for individuals and society.
Personal experience of doing occupation, whether consciously attended to or not, provides a fundamental understanding of occupation—what it is, how it happens, what it means, what is good about it, and what is not.
This way of knowing is both basic and extraordinarily rich. If you had asked me about gardening when I was young, I would have described the hard work of weeding the family garden on hot summer days, emphasizing that gardening was a chore. In my parents' garden I learned a great deal about how to garden, such as varieties of flowers and vegetables, sunshine and rain requirements, weed identification, and how to grasp a weed to pull it out with all its roots. This is knowledge of rules and techniques, of how to do gardening.
Now, many years later, I know gardening in a very different way. Weeding is one of my great pleasures. I understand the challenges of learning to garden in new places, the patience required to discover what will grow where, and the right time of year to plant. To be useful to occupational therapy practitioners, knowledge of occupation based on personal experience demands examination and reflection.
What do we do, how do we do it, when and where does it take place, and what does it mean? Who else is involved directly and indirectly? What capacities does it require in us? What does it cost? Is it challenging or easy? How has this occupation changed over time? What would it be like if we no longer had this occupation? My gardening example illustrates how occupation is a transaction with the environment or context of other people, plants, earth, and weather. It includes the temporal nature of occupation— seasonal variations but also change over time and perhaps some notion of occupation filling time.
That I call myself a gardener exemplifies how occupation has become part of my identity and suggests that it might be difficult for me to give up gardening. Basic as it is, however, understanding derived from personal experience is insufficient as the basis for practice. Reliance solely on this source of knowledge has the risk of expecting everyone to experience occupation in the same manner as the therapist.
So while occupational therapy practitioners will profit in being attuned to their own occupations, they must also turn their view to the occupation around them and to understanding occupation through study and research.
Looking Outward to Know Occupation Observation of the world through an occupational lens is another rich source of occupational knowledge. Connoisseurs of occupation can train themselves to new ways of seeing a world rich with occupations: the way a restaurant hostess manages a crowd when the wait for seating is long, the economy of movement of a construction worker doing a repetitive task,.
People like to talk about what they do, and the student of occupation can learn a great deal by asking for information about people's work and play. By being observant and asking questions, people increase their repertoires of occupational knowledge far beyond the boundaries of personal interests, practices, and capabilities Figure 2.
Observation of others' occupations enriches the occupational therapy practitioner's knowledge of the range of occupational possibilities and of human responses to occupational opportunities. But while this sort of knowledge goes far beyond the limits of personal experience, it is still bounded by the world any one person is able to access, and it lacks the depth of knowledge that is developed through research and scholarship.
Turning to Research and Scholarship to Understand Occupation Knowledge of occupation that comes from personal experience and observation must be augmented with understanding of occupation drawn from research in occupational therapy and occupational science as well as other disciplines.
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