The Nature of Occupational Therapy Practice in Acute Physical Care Settings
Blaga, Luciana, Robertson, Linda, New Zealand Journal of Occupational Therapy
The acute care service is delivered in an environment where there are a range of challenges for occupational therapists (Griffin, 1993) particularly the dominance of the medical model. Its focus on curing illness does not sit easily with the professional focus of occupational therapy (Wilding & Whiteford, 2007). A second issue arises from discharging patients following a very short hospital stay because it creates pressures for fast decision making (Moats, 2006). More recently, negative opinions of the acute care service from within the profession itself (Whiteford, 2006) have provided further stimulus for occupational therapists to provide greater clarity of their role and to confidently rationalise their contribution to patient care. To understand how best to justify this area of work, the authors felt it was important to learn from those who work in this area about how they perceive their contribution to patients' care. Therefore the aim of this study was to ask the question: how is occupational therapy practiced in acute physical care settings in New Zealand? The study also sought to identify the ways in which therapists made sense of their practice, including their use of professional frameworks. What theoretical justification can be used as a basis for occupational therapy practice in acute care services?
There is limited research on occupational therapy in the acute care settings and even less that is specific to the New Zealand environment. Only two studies were found to have been carried out and published about New Zealand occupational therapy in an acute physical context: one was a pilot study which investigated the nature of acute physical occupational therapy practice using a questionnaire (Craig, Robertson & Milligan, 2004) and the other one used a focus group method to look at job satisfaction of therapists working in the same setting (Shiri, 2006). To gain information from a broader perspective than either of these studies, we developed a questionnaire that targeted all occupational therapists working in acute care practice in New Zealand (Blaga, 2006).
A literature search of the Cumulated Index of Nursing and Allied Health (CINAHL), ProQuest databases and occupational therapy textbooks was undertaken, using the key words: acute physical occupational therapy, and professional identity. A major feature of the acute setting identified in the literature is the pressure on fast discharge driven by economic constraints (Griffin & McConnell, 2001; Robertson & Finlay, 2007; Sutton, 1998). This particular pressure has an impact on the way health practitioners work. Griffin (1993) suggested that as a result of this, the occupational therapist's role is limited to assessing and planning for discharge, with little emphasis on treatment.
Further studies reinforced this point of view. For instance, Griffin and McConnell (2001) used a self-administered questionnaire with a sample of 226 therapists who worked in acute care in Australia (response rate 64.7 %). They discovered that the most frequently used assessments were initial interview and self-care and that intervention focused on safe discharge. A further Australian study using the Delphi technique (Griffin, 2002) looked at occupational therapy practice specifically in acute care orthopaedics and neurology. Again the consensus was that the primary aim of occupational therapy intervention in this setting was preparation for discharge and when discharge was not likely, referral for further rehabilitation.
Only one study was done in New Zealand (Craig et al., 2004) describing the nature of occupational therapy practice in acute care. It employed a self-administered questionnaire with open and closed questions that was sent to therapists in three District Health Boards (DHB). The authors made the point that there was confusion among respondents over the difference between assessment and treatment because they are closely intertwined. …