Clinical research has been identified with key occupational therapy issues such as professionalization and establishing the efficacy of practice within the competitive health care marketplace. The natural clinical practice setting provides the optimum environment for conducting research pertaining to practice, and a small but growing number of practitioners have managed to integrate research and practice in such an environment. While there has been a significant amount of literature advocating research involvement for practitioners primarily involved in clinical practice, no formal studies existed of the complex factors affecting a therapist's ability to integrate research with practice. This exploratory, descriptive study investigated an emerging role in occupational therapy: therapists who combine practitioner and researcher roles in their daily work with patients in clinical settings. Four major research questions were posed: (a) How does an occupational therapy practitioner adopt the practitioner /researcher role? (b) What activities constitute research in clinical settings? (c) How does the clinical environment affect research activities? and (d) What educational experiences do practitioner /researchers describe as important for accomplishing research in clinical settings? Goals were to develop an understanding of the emerging role by identifying personal, environmental, and educational factors, and determining their importance for current practitioners while obtaining recommendations for others. A custom-designed questionnaire was sent to the practitioner /researcher population (N = 116); the response rate was 89% (103). Quantitative analyses included measures of central tendency and variability. The Number Cruncher Statistical System computer program assisted with quantitative analyses and the Ethnograph computer program assisted written questionnaire analyses. Demographic information was collected to enhance data interpretation. Major findings include: (a) learning circumstances focusing on performance and application of clinical research were important for adopting a dual practice/research role; (b) research activities reflected the evolving character of the role; (c) support from facility administration and a personal commitment to research were critical for success; (d) formal courses were important for current research, but so were informal discussions regarding application and problem solving. A lack of opportunities for continuing education in research was reported. Implications for university curricula, continuing education, and clinical environments are discussed. Recommendations for future research are presented. / Ed. D.

Bakgrunn Ergoterapeuter skulle, med bakgrunn i  sin utdannelse, kunne anvende sin kompetanse til både helsefremmende arbeid generelt og til helsefremmende arbeidsplasser. Til tross for dette er det foreløpig få som har spesialisert seg innen områdene arbeidshelse og folkehelse. Ved å utnytte kompetansen sin til helsefremmende arbeidsplasser kunne ergoterapeutene bidratt til å påvirke både den enkelte arbeidstakers helse, arbeidsmiljøet og på sikt også det arbeidsrelaterte sykefraværet. Hensikt med studien var å tydeliggjøre hva ergoterapeuter selv mener de har av kompetanse omkring helsefremmende arbeid og hvordan de anvender denne kompetansen i sitt daglige arbeid, med spesifikt fokus på: -          hvilken kompetanse de mener at de har om helsefremmende arbeidsplasser; -          hva de mener de savner av kompetanse om helsefremmende arbeidsplasser; -          deres erfaringer med eget arbeidsmiljø som helsefremmende; og -          deres tanker og meninger om fremtidsutsikter for helsefremmende ergoterapi Metode I denne oppgaven er det valgt en kvalitativ tilnærming og data er samlet inn via fokusgruppediskusjoner. Analyse av materialet er gjort med kvalitativ innholdsanalyse. Resultatene viser at selv om ergoterapeutene i denne studien beskrev et salutogent fokus og et helsefremmende arbeidssett, arbeider de i dag hovedsakelig på individnivå. Individfokuset deres er sterkt forankret i deres praksis og ser ut til å påvirke yrkesutøvelsen slik at de ikke bruker sin helsefremmende kompetanse på system- og samfunnsnivå i vesentlig grad. Samtidig mente de at det er mye som tyder på at deres kompetanse er for lite kjent blant folk flest, samarbeidspartnere og hos myndighetene, hvilket kan forklare at den ikke blir benyttet. Sammenfatning Mens ergoterapeutenes utsagn tyder på at de har mye kunnskap og erfaring med helsefremmende arbeidsplasser, viser funnene at de ikke ser betydningen av å bruke denne kompetansen til å utvikle helsefremmende arbeidsplasser. Funnene viser videre at ergoterapeutene i denne studien skulle kunne anvende sin kompetanse til både helsefremmende arbeid generelt og til helsefremmende arbeidsplasser. Selv om dette er en kvalitativ studie, er det sannsynlig at resultatene kan gjelde generelt for ergoterapeuter i Norge, noe som kunne vært interessant å undersøke videre / Background. Occupational therapists are trained to use their general competence in health promotion to initiate healthy workplaces. However very few therapists specialize in areas that combine occupational health and public health. By using their competence regarding healthy workplaces, therapists could positively impact employee health and work environments and likely reduce sick leaves that result from working conditions. The purpose of this study was to clarify the therapists’ opinion of their own competence in health promotion, and also determine how they use that competence in their daily work, focusing especially on: -          self-evaluation of their own competence regarding healty workplaces; -          their opinions on what competence they lack in this area; -          their personal experience with healthy promotive workplaces; and -          their thoughts and opinion on the potential for health promotion in occupational therapy Method. We chose a qualitative approach using focus groups and prosessed collected data  using thematic content analysis. The findings suggest that although study participants maintain a salutogenetic focus and a health promotional way of working, they currently work mainly at an individual level. Focus on the individual is deeply rooted in their practice and seems to influence their work such that they hardly use their health promotion competence on a system or a societal level. They also described their competencies as unknown by citizens, collaborating partners and authorities, possibly explaining why their competence is not in demand. Conclusions. While their statements indicate much knowledge and experience about healthy workplaces, our findings show that they don’t appreciate the importance of using that competance to initiate healthy workplaces. We further determined that study participants should be able to use their general competence in health promotion to initiate healthy workplaces. Allthough this is a qualitative study, our results may be valid for all the occupational therapists in Norway, an aera that requires further investigation. / <p>ISBN 978-91-82721-92-4</p>

M.A. (Clinical Psychology) / The advances in psychopharmacology, as well as the establishment of various 'half-way houses' has changed the nature of psychiatric hospitals. Where once, the emphasis was on long-term, custodial care of patients, the, present emphasis is on short term care. Attempts are made to reintegrate patients into society as soon as possible. This approach has been partially successful. However, it appears that many patients, who were previously discharged as being ready to function and cope with everyday life, return to hospital, having decompensated after relatively short periods of time. The reasons for decompensation are manifold, and vary from individual to individual. It is the contention of this writer that one of the reasons for the limited success of treatment of some patients may lie in the nature of the interdisciplinary team approach to treatment currently operative in many psychiatric hospitals. Interdisciplinary teams are usually composed of psychiatrists, psychologists, social workers, occupational therapists and psychiatric nurses. The teams operate on the tacit assumption that no single approach holds the key to successful treatment of a patient...

Syfte: Syftet med litteraturöversikten var att beskriva arbetsterapeuters erfarenheter av reablement som tillvägagångsätt i vardagsrehabiliteringen hos hemmaboende äldre personer. Metod: En allmän litteraturöversikt av kvalitativa studier valdes som design för att sammanställa den tidigare forskningen som besvarade studiens syfte. Datainsamling skedde från två databaser inom medicin och hälsa. Data från tio kvalitativa artiklar sammanställdes och analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysen resulterade i fem kategorier; att kartlägga, bedöma och strävan efter att sätta upp aktivitetsfokuserade mål, att stödja den äldre personen till självständighet och delaktighet i meningsfulla aktiviteter, att följa upp och att motivera till en fortsatt rehabilitering, att samarbeta i ett interdisciplinärt team och att samarbeta med anhöriga samt ett övergripande tema; betydelsen av ett personcentrerat förhållningssätt och att ha en samsyn. Slutsats: Essensen med reablement var att i ett interdisciplinärt samarbete stödja de äldre personernas självständighet och delaktighet i de dagliga aktiviteterna. Arbetsterapeuterna hade en grundläggande roll med att förverkliga ett personcentrerat förhållningsätt och en samsyn i det interdisciplinära teamet inklusive den äldre personen och anhöriga. Enligt arbetsterapeuterna förutsatteförverkligandet en gemensam målsättning, ett välorganiserat interdisciplinärt samarbete med avsatta resurser under en begränsad tid och goda kommunikationsstrategier. / Purpose: The purpose of the literature review was to describe occupational therapists’ experiences of reablement as an approach in everyday rehabilitation of home-dwelling older adults. Method: A general literature review of qualitative studies was chosen as a design to compile the previous research that answered the purpose of the study. Data collection took place from two databases in medicine and health. Data from ten qualitative articles were compiled and was analyzed with a qualitative content analysis. Results: The analysis resulted in five categories; to map, assess and strive to set activity-focused goals, to support the olderperson to independence and participation in meaningful activities, to follow up and motivate to a continued rehabilitation, to collaborate in an interdisciplinary team and to collaborate with relatives and an overarching theme; the importance of a person-centred approach andhaving a consensus. Conclusion: The essence of reablement was to support the older people’sindependence and participation in daily activities in an interdisciplinary collaboration. The occupational therapists had a fundamental role in realizing a person-centered approach and a consensus in the interdiciplinary team including the older person and relatives. According to the occupational therapists, the realization required a common goal, a well-organized interdisciplinary collaboration with allocated resources for a limited time and good communication strategies.

Bakgrund: I dagsläget finns kunskapsluckor angående vad äldre upplever som meningsfulla aktiviteter. Författarna vill genom denna intervjustudie bidra med kunskap om äldre personers subjektiva upplevelser av meningsfulla aktiviteter. Syfte: Att beskriva äldre personers upplevelser och erfarenheter av meningsfulla aktiviteter samt vad som hindrar eller främjar meningsfulla aktiviteter. Metod: Kvalitativ intervjustudie med induktiv och fenomenologisk ansats. Datainsamlingen skedde genom semistrukturerade intervjuer med tio äldre personer som gått i pension. Ett strategiskt urval användes. Dataanalysen utgick från en kvalitativ innehållsanalys. Resultat: I analysen framkom tre huvudkategorier som beskriver resultatet: Upplevelsen av meningsfulla aktiviteter är subjektivt, faktorer som kan verka hindrande vid utförandet av meningsfulla aktiviteter samt faktorer som kan verka främjande för utförandet av meningsfulla aktiviteter. Slutsatser: Betydelsen av meningsfulla aktiviteter beror  på den unika personen och dennes sammanhang. Studien visar att främjande faktorer för utförandet av meningsfulla aktiviteter är den sociala delaktigheten och en positiv inställning medan kroppsliga och ekonomiska begränsningar upplevs som hindrande faktorer. Val av meningsfulla aktiviteter utifrån personen kan bidra till en mer positiv inställning samt en känsla av kontroll och autonomi hos personen. Ur ett arbetsterapeutiskt perspektiv bör även andra aktiviteter och sammanhang utöver basala behov utforskas och belysas, då dessa kan vara meningsfulla för individen. / Background: Currently, there are knowledge gaps regarding what the elderly perceive as meaningful activities. Through this interview study, the authors want to contribute knowledge about older people's subjective experiences of meaningful activities. Purpose: To describe older people’s experiences of meaningful activities and what hinders or promotes meaningful activities. Method: Qualitative interview study with inductive and phenomenological approach. Data collection took place through semi-structured interviews with ten elderly people who had retired. A strategic sampling was used. The data analysis was based on a qualitative content analysis. Results: In the analysis, three main categories emerged that describe the result: The experience of meaningful activities is subjective, factors that can act as obstacles to the performance of meaningful activities, and factors that can act as a promotion for the performance of meaningful activities. Conclusions: The meaning of meaningful activities depends on the unique person and their context. The study shows that promoting factors for the performance of meaningful activities are social participation and a positive attitude, while physical and financial limitations are perceived as hindering factors. Choosing meaningful activities based on the person can contribute to a more positive attitude and a sense of control and autonomy in the person. From an occupational therapy perspective, other activities and contexts in addition to basic needs should also be explored and highlighted, as these may be meaningful for the individual.

Foreign-trained healthcare professionals consist of a sizable and important portion of the United States healthcare workforce (Chen et al., 2013; Farkas, 2003; Lowell, 2012). Foreign-trained healthcare workers often encounter various challenges in acclimating and integrating into the American society and workforce. Even though foreign-trained occupational therapists are considered essential, and their difficulties in adjusting are well-recognized, there are very limited bridging and training programs designated solely for this population that incorporate a comprehensive approach and meets their unique needs. Therefore, this doctoral project aimed to understand the barriers to integrating into the local workforce and proposed ways for supporting these highly- educated and experienced professionals in their new country. The resulting solution is A Bright Future Ahead, an online educational and vocational program designed for new foreign occupational therapists. The program’s content and structure are based on existing programs for adjacent health professionals while customizing the program’s layout and content to target occupational therapists. A Bright Future Ahead suggests a multi-layered solution that requires an enormous investment in the program’s development and implementation; however, this program can be expanded in the future to other professions that share similar professional credentialing processes and experience akin barriers.

Introduction: Cerebral palsy (CP) is the leading cause of physical disability in children and youth worldwide and is a diagnosis that requires lifelong treatment. There are gaps in research on children with CP in Tanzania. Both occupational therapists and physiotherapists have a central role in rehabilitation interventions. They work to improve function and facilitate participation for the children.  Aim: To explore physiotherapists’ and occupational therapists’ experiences of treatment for children with cerebral palsy in the Kilimanjaro region, Tanzania.  Method: We performed six semi-structured interviews with three physiotherapists and three occupational therapists working with children with CP. The interviews were then analysed through a qualitative content analysis from an inductive approach.  Result: The result included five subthemes: Lack of support from society is a challenge for parents, Many challenges in therapy for the professionals, Education and support are crucial, Attitudes and non-inclusive environments limit participation and Seeing improvements in treatment and awareness. The subthemes resulted in the theme A holistic approach is necessary, which encompasses all subthemes and describes the need for the therapists to include all aspects in the child’s surroundings in assessment and treatment planning, but also to create a more inclusive living environment through increasing knowledge in society. Conclusion: The professionals saw that a holistic approach is necessary in the treatment of children with CP, as the child’s development is affected by biological, psychological, social and environmental factors. They saw opportunites for improving the treatment and increasing participation on local and national levels. / Inledning: Cerebral pares (CP) är den vanligaste orsaken till fysisk funktionsnedsättning hos barn och ungdomar över hela världen och är en diagnos som kräver livslång behandling. Det finns luckor i forskning om barn med CP i Tanzania. Både arbetsterapeuter och fysioterapeuter har en central roll i rehabiliteringsinsatser. De arbetar för att förbättra funktion och främja delaktighet för barnen. Syfte: Att utforska fysioterapeuters och arbetsterapeuters erfarenheter av behandling av barn med cerebral pares i Kilimanjaroregionen, Tanzania. Metod: Vi genomförde sex semistrukturerade intervjuer med tre fysioterapeuter och tre arbetsterapeuter som arbetar med barn med CP. Intervjuerna analyserades med kvalitativ innehållsanalys utifrån en induktiv ansats. Resultat: Resultatet innefattar fem subteman: Brist på stöd från samhället är en utmaning för föräldrar, Många utmaningar i terapin för de professionella, Utbildning och stöd är avgörande, Attityder och icke-inkluderande miljöer begränsar delaktighet och Ser förbättringar i behandling och medvetenhet. Dessa subteman utmynnade i temat En holistisk ansats är nödvändig som omfattar alla subteman och beskriver behovet av att terapeuterna tar med alla aspekter i barnets omgivning i bedömning och behandlingsplanering, men också att skapa en mer inkluderande livsmiljö genom ökad kunskap i samhället. Konklusion: De professionella såg att en holistisk ansats är nödvändig vid behandling av barn med CP, eftersom barnets utveckling påverkas av biologiska, psykologiska, sociala och miljömässiga faktorer. De såg möjligheter att förbättra behandlingen och öka delaktigheten på lokal och nationell nivå.

Syfte: Syftet med studien var att beskriva om aktivitetskorten i I-HOPE motsvarar äldre personers aktiviteter i hemmet utifrån svenska förhållanden samt identifiera behov av att komplettera med ytterligare aktiviteter. Metod: Datainsamling utfördes med en kvantitativ standardiserad webbenkät med kvalitativt inslag. Totalt deltog 41 personer mellan 65 och 87 år med en medelåldern av 73.3 år och standardavvikelse på 5.1 år. Samtliga deltagare bodde i ordinärt boende i Södra Norrland kust- och inland i Sverige. Datamaterialet bearbetades med kvantitativ analysmetod, resultatet presenterades i löptext med tabeller och figurer. Svaren från webbänktens öppna fråga angående saknade aktiviteter kategoriserades i grupper utifrån de faktiska svaren. Resultat: Resultatet från studien visade att samtliga deltagare kunde identifiera 18 av de 44 aktivitetskorten utan vägledning och 16 aktivitetskort kunde 75-99% av deltagarna identifiera utan vägledning.Vidare var det 10 aktivitetskort som färre än 50% av studiens deltagare identifierade utan vägledning. På flertalet aktivitetskort kunde deltagarna identifiera aktiviteten men de identifierade sig sedan inte med miljön, utrustningen eller hur aktiviteten utfördes. Resultatet visade även att 10 av de 44 aktiviteterna inte utfördes av samtliga deltagare i studien. Vidare framkom behov av att komplettera I-HOPE med ytterligare aktivitetskort för att svara mot svenska förhållande. Slutsats: Utifrån studiens resultat finner författarna ett behov av att komplettera med fler aktivitetskort samt att revidera ett antal av bilderna på de befintliga aktivitetskorten i bedömningsinstrumentet I-HOPE. / Purpose: The purpose of the study was to describe whether the activity cards in I-HOPE correspond to older people's activities in the home based on Swedish conditions and identify the need to supplement additional activities. Method: Data collection was performed with a quantitative standardized web quote with qualitative elements. In total, 41 participants participated between 65 and 87 years with an average age of 73.3 years and a standard deviation of 5.1 years. All participants lived in Ordinary accommodation in southern Norway, coastal and inland in Sweden. The data was processed using quantitative analysis method, the result was presented in running text with tables and figures. The answers from the web site's open question about missing activities were categorized into groups based on the actual answers. Results: The result of the study showed that it was 18 of the 44 activity cards that all participants could identify without guidance. 16 activity cards were 75-99% of the participants who could identify. In addition, there were 10 activity cards that fewer than 50% of the study participants were able to Identify without guidance. On most activity cards, participants were able to identify the activity without guidance but they could not identify with the environment, equipment or how the activity was performed. The result also showed that 10 of the 44 activities were not performed by all participants in the study. Furthermore, there was a need to supplement I-HOPE with additional activity cards to respond to Swedish conditions. Conclusion: Based on the results of the study, the authors find a need to supplement more activity cards and to revise a number of the pictures on the existing activity cards in the I-HOPE assessment tool.

Personer som lider av emotionellt instabil personlighetsstörning (IPS) upplever mångfacetterad aktivitetsobalans i sin vardag. Arbetsterapeuter strävar till att stödja aktivitetsbalans och öka upplevelsen av tillfredsställelse men kunskapen om hur man kan stödja dessa personers upplevelse av balans är bristfällig. Syftet med denna studie var att beskriva hur arbetsterapeuter resonerar kring att stödja aktivitetsbalans hos personer som lider av IPS. Sju arbetsterapeuter intervjuades för ändamålet. Materialet analyserades enligt kvalitativ innehållsanalys. Resultatet framhävde som resonemangets grunddrag att variera mellan teoribaser samt mellan att arbeta med synliga aktivitetsmönster och upplevd balans. Det reflekterar att arbetsterapeuters metoder och resonemang kan bidra till att skapa aktivitetsbalans. Nya insatser som mångsidigare inbegriper det sociala sammanhanget behövs Vidare forsnkning behövs om de arbetsterapeutiska insatsernas effekter för att stärka deras evidens. / People suffering from emotionally unstable personality disorder face various forms of occupational imbalance in their daily life. Occupational therapists strive to suppport occupational balance and thus increase the experience of satisfaction. Knowledge of how to support the experience of balance is yet insufficient. The aim of this study was to describe the reasoning of occupational therapists when working with people suffering from emotionally unstable personality disorder and supporting occupational balance. Seven occupational therapists were interviewed. Analyses were conducted using qualitative content analysis. Results emphasise that the reasoning is based upon combining different theoretical perspectives and varying between working with visible occupational patterns and individually experienced balance. This accentuates that the reasoning and methods of occupational therapists may contribute to create occupational balance. Broader methods considering also the social context are needed. Also, further studies evaluating the effects of already existing methods used in occupational therapy is needed to strengthen the evidence.

<p>The relationship between the Swedish state’s welfare political commitments and the emergence and development of three female-dominated welfare state occupational groups - nurses, home relief helpers and occupational therapists - is at the heart of this thesis. The primary aim is to study the professional possibilities and limitations created by the state’s welfare political commitments in health care, family policy and rehabilitation.</p><p>The thesis emphasises the importance of regarding the state as a historically conditioned actor and as an organisation of organisations. The state is not a unified and static actor and this makes it difficult to speak of the state’s relationship to different welfare occupations in general terms. Nurses, home relief helpers and occupational therapists have encountered the state in different historical contexts and established ties to different parts of the state. Abbott’s (1988) term jurisdiction is used to characterise the area within welfare politics that nurses, home relief helpers and occupational therapists have made claims on or been allotted. The struggle for jurisdiction takes place on three, analytically separate but in reality interconnected arenas. These arenas are the workplace, the media arena and the legal arena. The thesis limits itself to the legal arena, that is, the state’s administrative, planning and legislative structures. At the centre of the analysis of the legal arena are the Swedish Government Commission and the welfare political reform work that to a large degree has been formed by these institutions’ function and work.</p><p>An important conclusion from these three case studies is that the state’s welfare political commitments have been central for the emergence of nurses, home relief helpers and occupational therapists and their development into welfare state occupational groups. The state’s welfare political ambitions have contributed considerably to the transformation of nurse, home relief helpers and occupational therapists into modern occupational groups. Dependency on the state has not always been easy to handle however. The state’s welfare political interests have often contradicted the wishes of the professions regarding the content, length and organisation of training programmes, as well as regarding continuing education and licensing. The state has been unwilling to provide more training than deemed necessary from a welfare political perspective. An important conclusion from this study is that it is difficult for welfare state occupational groups to steer their professional project in a direction that falls outside of the state’s welfare political commitments.</p>