Academic journal article British Journal of Occupational Therapy

The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting

Academic journal article British Journal of Occupational Therapy

The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting

Article excerpt

Introduction

Central and local government are facing difficult decisions in funding allocation and in maintaining traditional methods and standards of service provision (Scottish Government 2010). Greater fiscal prudence in the health and social care sector, combined with increasing need, presents challenges for occupational therapy in delivering cost-effectiveness whilst also demonstrating its impact and meeting patient needs. To achieve service delivery and/or to advocate change, occupational therapy services must substantiate the rationale for practice and underpin clinical interventions in a theoretical framework. The integration of the Canadian Model of Occupational Performance (CMOP) in a service redesign is an example of this (Boniface et al 2008).

Wilding and Whiteford (2008) indicated that insufficient representation and promotion of the profession can have serious implications and argued that the need to become more visible is self-evident, especially to recipients of occupational therapy services and funding bodies. Despite the documented need for theory to underpin practice (Mitcham 2003), growing financial concerns resulting in radical changes in practice environments, and demand for new skill sets (Baptiste 2005), there is limited evidence outlining the use of theory to support occupational therapy in acute physical settings in the United Kingdom (UK).

Literature review

Occupational therapy in acute care

In Scotland, acute hospital care is typically diverse, but can include consultation with specialist clinicians, emergency treatment following accidents and short-term care of patients with worrying symptoms (Information Services Division 2011). The literature characterises acute practice as an area where occupational therapists work with patients experiencing impaired occupational performance (Eyres and Unsworth 2005), combined with an increasing pressure to discharge patients once they are medically stable (Crennan and MacRae 2010). Griffin and McConnell (2001) concluded from a survey of 349 occupational therapists (response rate 64.7%) in Australian acute hospitals that short stays in acute care result in a focus around self-care, with little time to address a client's leisure and work needs.

Several studies characterise the nature of occupational therapy in acute physical settings (Griffin and McConnell 2001, Wressle et al 2006), but they concentrate more on the practice and less on the premise underpinning it. Craig et al (2004) and Blaga and Robertson (2008) provided information on theory supporting practice, using questionnaires with both quantitative and qualitative elements exploring the models and frames of reference most used in acute physical health care settings in New Zealand. The results showed heterogeneity in the models and frame of reference used, with the most common being the compensatory frame of reference, the biomechanical frame of reference, the Model of Human Occupation (MOHO) and the CMOP The only two occupation-focused models identified in both studies were MOHO and CMOP, although therapists did not use the standardised assessments specific to these models. Instead, the models guided therapist reflections to keep the focus of input on the core values of the profession.

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This choice of occupation-focused models to guide reflection is supported by Ashby and Chandler (2010), who found that the most commonly included occupation-focused models taught in accredited occupational therapy programmes in Australia, Canada, the UK and the United States were the Canadian Model of Occupational Performance and Engagement (CMOP-E) and MOHO. Despite this emphasis on teaching CMOP-E and MOHO and their use in practice, Blaga and Robertson (2008) concluded that in acute physical health care settings, finding satisfactory ways to articulate practice could be further explored. These findings in the literature therefore guided the decision to explore the potential use of an alternative occupation-focused model. …

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