Tools of Practice: A View of Changes in Occupational Therapy in Aotearoa New Zealand
Wilson, Linda H., Cheetham, Kaye, New Zealand Journal of Occupational Therapy
The expression 'tools of practice' has had a particular meaning in occupational therapy since Anne Cronin Mosey first articulated them in 1981 (Mosey, 1981). Mosey defined the occupational therapy tools of practice as: the teaching learning process, human, and non-human environments, conscious use of self, activity groups, activity analysis, and activity synthesis. The publication of her book 'Configuration of a profession' (1981) provided many therapists with an exciting way to see the diverse knowledge and skills used by the profession that were previously unnamed and uncodified. Her vision was a significant contributor to the ideas underpinning the profession and clinicians, educators, and students were advised they "should recognise in this book the basis for re-examination of the foundations and ever changing structural components of the profession" (Gillette, 1982, p.678).
Mosey's (1981) use of the word tool is conceptual, contrasting with the customary use of 'tool' which refers to an artefact, an implement or simple machine (Sykes, 1980) used in an occupation or pursuit. Mosey used the term as an idiom and included all those things needed to perform the specific tasks of occupational therapy practice. Throughout this article, the term tools of practice is used in both ways, referring to Mosey's tools and to actual equipment.
Despite people being employed in a range of occupation related roles, in various settings, since the 1914-18 war it was not until 1940 that a formal training programme for occupational therapists was started, leading to the profession we now know (Skilton, 1981). A professional association began in 1948 and one year later registration was instituted by an Act of Parliament. There are some 1700 therapists currently practising and over 5000 have been registered since then. Growth in the number of therapists, along with changes in health and disability services and community attitudes, diversified occupational therapy. From early practice in mental and public hospitals, occupational therapists now work in schools, voluntary organisations, and in independent practice, with people who have a wide range of health conditions, and/or circumstances that affect their ability to engage in occupations.
Historical analyses of literature may help to develop more understanding of past practices and thus can usefully be used to inform the future. The findings of this literature review are presented as three eras that are not mutually exclusive; rather they overlap and flow into one another. Ultimately, each era remains evident in the profession today and deserves to be acknowledged and respected. The emergence of new practices does not negate the need for established practices and so we argue that all practice domains remain legitimate.
Reviewing the literature
The New Zealand Association of Occupational Therapists (NZAOT), and its antecedents, has had a publication of various names and formats, since 1948. Both Levine (1986) and Schwartz (1988) have written about the value of historical research to the profession of occupational therapy so in keeping with their advice a systematic examination of NZAOT newsletters and journals was undertaken. Tortenstahl (1990) supported this approach when he stated, "A proper way to study professional groups is then, often, to examine their history and prehistory" (p .45). Professional publications have a range of information that can help to reveal the evolution of practice. We located descriptions of practice, product advertisements, and book reviews to extract an understanding of practice from 1948 to today. Articles were examined to identify data about the authors, practice settings, tools and approaches to practice in the form suggested by Cusick (1995). There are caveats to using this type of data as a window to the past. For instance, product advertising can only be an indicator of practice because suppliers only advertise where they perceive potential purchasers. …