Rethinking an Individualistic Focus of Occupational Therapy. Staffan Josephsson, Karin Johansson, Soemitro Poerbodipoero & Sissel Alsaker

Transcription

1 Rethinking an Individualistic Focus of Occupational Therapy Staffan Josephsson, Karin Johansson, Soemitro Poerbodipoero & Sissel Alsaker

2 Client centered- individual in focus Occupational therapy services have traditionally been focusing on individuals and their occupational functioning Consequently assessment and evaluation of services has been focusing on individual functioning.

3 Social turn Shift both in theory and in clinical models Highlight on social structures processes and values as central in occupational functioning.

4 ? Clinical work-forms, documentation of intervention and evaluation are still on an individual level. Gap between theory and practice?

5 Aims Problematize and discuss traditional individual focus of interventions and outcome-measures of occupational therapy Generate possible ideas and suggestion for future development of occupational therapy assessment and evaluation.

6 How? Drawing from studies on the everyday life of people with disabilities in Sweden Norway and The Netherlands we will meet three dilemmas relating to the social turn in our practices Together discuss and reflect on implications for theory, practice and education

7 Three dilemmas Introduced by; Soemitro Poerbodipoero Karin Johansson Sissel Alsaker Discussion

8 Caregivers Burden: screening and evaluation in transitional care of older people Soemitro Poerbodipoero Amsterdam School of Health Professions (ASHP), Department of occupational therapy.

9 Transition project Objective reduce the risk of functional decline in older persons after an acute hospitalization DEFENCE model, consisting of the following three steps: 1] identification of high-risk patients, followed by 2] a systematic inventory of existing geriatric problems, 3] followed by a specific in-hospital intervention

10 Caregivers Burden Care givers Strain Index (CSI) Individual Measurement Screening Count yes responses. Any positive answer may indicate a need for intervention in that area. A score of 7 or higher indicates a high level of stress 1. Sleep disturbed 2. Inconvenient 4. Physical strain 5. Confining 7. Family adjustments 8. Changes in personal plans 9. Other demands on time 10. Emotional adjustments 12. Behaviour upsetting 13. Recipient change upsetting 15. Work adjustments 16. Feel completely overwhelmed 17. Financial strain

11 Dialogues Listen.. I don t do negative scoring..you never know what the consequences are. They want me to be a caregiver and if they made me one they give me roles and responsibilities which have nothing to do with caregiving as I see it Most caregivers fear.. Do not trust.. What if I say no?! I want to talk about it. So I said yes to helping out. But when I registered they hooked me up with somebody I didn t know! It doesn t make the doctor ask again next time, maybe he will but he still doesn t know what he is asking questions about. It is my wife!` You have to speak up, yourself When you realize caregiving is not giving anymore but just taking it is too late. You have to keep doing things for yourself.. Dialogues with elderly contain communicative dilemmas and mixed loyalties (Hellström)

12 Caregiving: the odyssey of becoming more human `It sucks out strength and determination. It turns simple ideas of efficacy and hope into big question marks. It can amplify anguish and desperation. It can divide the self. It can bring out family conflicts. It can separate out those who care from those who can t or won t handle it. It is very difficult.`

13 Caregiving: the odyssey of becoming more human (2) It is also far more complex, uncertain, and unbounded than professional medical and nursing models suggest. I know about the moral core of caregiving not nearly so much from my professional life as a psychiatrist and medical anthropologist, nor principally from the research literature and my own studies, but primarily because of my new life of practice as the primary caregiver for Joan Kleinman. I learned to be a caregiver by doing it, because I had to do it; it was there to do.

14 Caregivers Strain Index What is already known about the topic? The Caregiver Strain Index focuses on negative aspects of caring. Most carers can identify something positive about caring. Positive aspects of caring can mediate carer strain.

15 Caregivers Strain Index 1. Sleep disturbed 2. Inconvenient 4. Physical strain 5. Confining 7. Family adjustments 8. Changes in personal plans 9. Other demands on time 10. Emotional adjustments 12. Behaviour upsetting 13. Recipient change upsetting 15. Work adjustments 16. Feel completely overwhelmed 17. Financial strain 18. Care is important 3. Recipient appreciates care 6. Enough time for self 11. Handle the care fine 14. Happy to care `Positive aspects of care appear to enhance the understanding and measurement of carer strain.`

16 References Al-Janabi, H., et al., The inclusion of positive aspects of caring in the Caregiver Strain Index: Tests of feasibility and validity. Int. J. Nurs. Stud. (2010), doi: /j.ijnurstu Hellström Muhli, U. Accounts of professional and institutional tension in the context of Swedish elderly care. Journal of Aging Studies (24) Kleinman, A. The art of medicine. Caregiving: the odyssey of becoming more human. The Lancet (373 ) 24, 2009

17 Receiving Home Modifications: older persons experiences of an aesthetics of the everyday Karin Johansson Karolinska Institutet, Department NVS, division of occupational therapy.

18 Inga and Sven: Just look at it, you can t live with this 15 november 2010 Karin Johansson 18

19 Anna: Now I take a big step over the threshold because it sinks down and then makes a cracking sound and I think, I mean, disturbs the neighbours. Then I take the walker in backwards. But of course this is not always good, walking backwards I mean. Well, I think something could happen. It has happened, I have fallen. 15 november 2010 Karin Johansson 19

20 Doris: I didn t take one for the lift door up here on the sixth floor and that would have been much better, because that door is very heavy to open. And then it wouldn t have cost so much because they [were] already here and had fixed the lift downstairs, [.] But then I d be thinking, ugh, no it had cost so much, this thing with the balcony, so I ll just try to get along up here.

21 Values associated with being part of the construction of the Swedish welfare state during the first half of the 20 th century: Everyone is guaranteed a certain level of standard. A house should be kept clean Citizens have obligations towards the welfare state. You shouln d cause excesive costs for the society The welfare state has obligations towards the citizens. Someone who has contibuted to the society has the right to resources

22 Theoretical frame Aesthetics of the everyday (Leddy 2005) Anthropology of morals explore how societies ideologically and emotionally found their cultural distinction between good and evil, and how social agents concretely work out this separation in their everyday life (Fassin, 2008) Anthropology of the senses: one might feel dirt, smell the landlord s neglect and hear the sound of being at home. (Pink, 2004) 15 november 2010 Karin Johansson 22

23 Theoretical frame Sensory experiences are generated and expressed through moral judgements of how good or bad is materialized in the everyday use of objects Experiences of an aesthetic quality are generated and expressed through moral tales that serve as sense-making tools to guide people how to work out the separation of good or bad. 15 november 2010 Karin Johansson 23

24 .. Calls for a need to understand DOING as expressions of cultural moral values

25 Rethinking an individualistic focus of Occupational Therapy Individuals, Meaning and action : Dilemma? Sissel Alsaker, ass. Professor, PhD, OT, Sør-Trøndelag University College, Trondheim Norway ENOTHE workshop 3, Oct 14th 2010 Stockholm

26 Yerxa 2009; OT s pupose is to enable people to become agents and to obtain satisfaction through actualizing their unique interests

27 What do science tell us? * use generalized knowledge What do OT-experience tell? * treat the individual person

28 Findings (Alsaker & Josephsson 2010): Meaning is narrative and has to be done/enacted/performed, implying; doing activities is individual and localizes the actor in a cultural context. Here cultural meaning resides, and doing activities render it possible for the individual to connect to the everyday world she is living within.

29 Are activity/occupations the meaningmaker? Are we making use of the availability of everyday occupations?

30 Dilemmas: Is meaning an individual asset? Is it possible to access meaning in everyday activities/occupation in a clinical setting?

31 Implying? the activity/occupation is the medium (transformative agent) for linking/ joining together the individual and the social/cultural? References: *Alsaker, S., & Josephsson, S. (2010). Occupation and meaning: Narrative in everyday activities of women with chronic rheumatic conditions.otjr - Occupation, Participation and Health, 30(2), *Alsaker, S., Bongaardt, R., & Josephsson, S. (2009). Studying narrativein-action in women with chronic rheumatic conditions. Qualitative Health Research, 19(8), *Mattingly, C. (1998). Healing Dramas and Clinical Plots. The narrative structure of experience. Los Angeles: University of California Press. *Yerxa, E. J. (2009). Infinite distance between the I and the It. American Journal of Occupational Therapy, 63(4),

32 ! Discussion