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Essay: Foundations of Occupational Therapy: Exploring the FOT Wall, Nature of Occupation and Core Skills

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  • Published: 1 April 2019*
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  • Words: 2,083 (approx)
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• Introduction (250) 157

Occupational therapy is a client centred health profession that focuses on promoting the health of an individual. It also enables individual’s to engage in activities of everyday life by supporting the individual or modifying the occupation or environment. The World Federation of Occupational Therapy (2010) defines occupation as an everyday activity that a person needs, wants and is expected to do that can be done as an individual, as a family or as a community to pass someone’s time and allow the individual’s life to have purpose and meaning. Christiansen and Townsend (2010) also define occupation as goal-directed activity that is necessary for an individual’s existence and wellbeing.

This assessment will discuss the Foundations of Occupational Therapy Wall, the nature of occupation, the core skills of an occupational therapist and the models of practice that an occupational therapist follows. It will begin with the main foundations and base of occupational therapy, the Foundations of Occupational Therapy Wall.

• FOT Wall (875) 552

The Foundations of Occupational Therapy (FOT) Wall is the main foundations of Occupational Therapy. It is made up of four layers, the base layer being paradigms, the second layer being theories and concepts, the third layer being models of practice and the top layer being tools and techniques.

Paradigms, which make up the base layer of the FOT Wall, are a shared collection of assumptions, beliefs, ideas, values, standards and rules that are shared by members of a group of individuals, such as members of the same profession. (Kuhn, 1970) They allow individuals to view the world around them in a particular way. When new evidence and experiences occur, then there is often a change in beliefs or assumptions and therefore paradigms shift. For professions like Occupational Therapy, paradigms define practice and create ideals about how an Occupational Therapist should practice as well as shaping how Occupational Therapist’s define and justify the care and service provided to patients. (Tornebohm 1985, cited by Kielhofner, 2009) They also help to mold Occupational Therapist’s understanding of their profession and their service and their perspective of their patient’s needs and what is important to them. (Kielhofner, 2009)

Theories and concepts make up the second layer of the FOT Wall. Concepts are ideas that summarise an observation or infer made. When one or more concepts are linked together then assumptions are made, these assumptions then form the base of a theory. (Reed and Sanderson, 1999) Theories offer explanations and specify the relationship between different concepts which creates predictions that are based on evidence. There are many different theories around Occupational Therapy and one of these theories is the Theory of the Human Need for Occupation which is the work of Wilcock in 1993. (Find references for this)

Models of Practice, which make up the third layer of the FOT Wall, are a point where the theory of Occupational Therapy and the practice come together to support Occupational Therapists with a practical explanation of what happens and an understanding and ability to address the issues in practice. There are many different models of practice for Occupational Therapy including the Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Occupational Therapy Intervention Process Model (OTIPM). These models of practice will be discussed in detail later on in the assessment.

Finally, tools and techniques, which make up the top layer of the FOT Wall, are the procedures and strategies that an Occupational Therapist uses every day in their practice. These tools and techniques can be things like a written assessments and information gathering about a client’s needs and occupational performance, equipment assessment and provision to meet client’s needs or techniques like active listening and rapport building to allow a client to feel comfortable around the Occupational Therapist and be open about their condition and needs. The tools and techniques of an Occupational Therapist are constructed from all of the previous layers of the wall.

Overall, the Foundations of Occupational Therapy Wall makes up the main structure of Occupational Therapy and this wall allows Occupational Therapist’s to have something to guide them and something for them to follow to ensure that they are the best Occupational Therapist they can be. These foundations then allow the Occupational Therapist to continue to have an understanding of the nature of occupation.

• Nature of Occupation (875) 36

The nature of occupation is the relationship between health, wellbeing and occupation and that each one has an impact on the other, also how the engagement in occupations has benefits to an individual’s health and wellbeing.

(Pinterest Assessment)

• Core Skills (875) 930

According to the College of Occupational Therapists (2009) the core skills of an Occupational Therapist are the expert knowledge and abilities which are shared by all Occupational Therapists no matter what field they are in or what level of practice they are at.

In 2003, the work of Creek stated that there are seven core skills that are created based upon occupation and activity. These seven core skills are, collaboration with client, assessment, enablement, problem solving, using activity as a therapeutic tool, group work and environmental adaptation. The first core skill, collaboration with the client, involves the Occupational Therapist building a professional rapport with the client to allow them to work collaboratively which will enable the client to engage in the therapeutic process. The second core skill, assessment, involves observing the client’s needs and to be able to assess their functional ability, potential and limitations, as well as observing the clients social and physical environment. The third core skill, enablement, involves allowing clients to maintain and achieve their activities of daily living such as personal care, leisure and domestic. The fourth core skill, problem solving, involves finding and solving occupational performance issues. The fifth core skill, using activity as a therapeutic tool, involves using activities by analysing, adapting and applying them for therapeutic purposes to improve the health and wellbeing of the client. The sixth core skill, group work, involves working with activity groups by planning, leading and organising sessions. The seventh and final core skill, environmental adaptation, much like assessment involves analysing and identifying environmental problems that may prevent the client from functioning and participating in activities of daily living and then adapting the environment to increase function and participation.  (Creek, 2003)

Another key skill that an Occupational Therapist needs is occupational analysis. Occupational analysis, also known as occupational performance analysis or performance analysis is part of the assessment process for an occupational therapist which helps to identify and define the actions of a client that may support or restrict that client’s occupational performance. It is a structured and observational process that is used in context to assess how effective and how much quality the finer details of the process that the client carries out are such as how the client performs an occupation and if the client is competent and motivated or familiar with what to do and how to carry out the occupation. It does not consider the final outcome or end result of the occupation. This is done by analysing six perspectives, performance areas (which are activities of daily living, instrumental activities of daily living, work, rest, play, leisure and social participation (Thomas, 2012)), the client’s performance skills (which are motor skills, process skills and social interaction skills), the client’s performance patterns (which are the client’s roles, habits and routines), performance contexts (which are the environments; physical, cultural or social), the activity demands (which are effort, objects, process and body functions needed) and finally the client’s person factors (which are values and beliefs, spirituality and body structures). (Chard, 2010) As stated above, occupational therapists analyse performance areas which are made up of, activities of daily living (such as washing, dressing, eating, feeding and functional mobility), instrumental activities of daily living (such as using communication devices, financial management, meal preparation and cleaning up and shopping), rest and sleep (such as sleeping habits, periods of inactivity and preparing for sleep), work (such as job performance, employment interests, seeking employment or retirement), play (such as exploration and participation), social participation (such as in the community, with family or with friends), leisure and education. (AOTA, 2014 and Thomas, 2012)

A final key skill an Occupational Therapist needs in clinical reasoning also known as professional reasoning. It assists decision making and “involves deliberation about what appropriate action is in this particular case, with this particular patient, at this particular time” stated by Mattingley (1991, p.981). It considers, the person, the condition and needs of the client, the evidence-base, the occupational therapists own knowledge and skills, the potential risks and the possible alternatives. Clinical reasoning relies upon three track reasoning and narrative reasoning. Three track reasoning is made up of procedural reasoning, interactive reasoning and conditional reasoning. Procedural reasoning is where the needs and problems of the client are identified, setting the goals the client and occupational therapist want to achieve and finally planning the treatment that will be provided. Interactive reasoning is aiming to understand the client as an individual by engaging the client, understanding their disability or condition, relieving tension, constructing a shared language and determining if session is going well. And finally, conditional reasoning is where the occupational therapist must consider the condition as a whole and consider how it may change and consider that the success or failure of the therapy is dependent on the client. (Mattingley and Fleming, 1991) The work of Mattingley states that narrative reasoning is where an occupational therapist uses story telling and story making to help to understand the meaning of the client’s experience all from the client’s perspective. Clinical reasoning also consists of pragmatic reasoning which is the practical considerations such as understanding the practical implications that may affect the therapy and also the world in which therapy occurs (Schell and Cevero, 1993) and also ethical reasoning which is where an occupational therapist considers what should be done.

Overall, all of these core skills of occupational therapists are used together to provide the best care possible for clients and for occupational therapists to provide a holistic approach to their therapy. These core skills then help them to use models of practice effectively.

• Models of Practice (875) 133

Models of Practice are a professional requirement under Section 13 of the Standards of Proficiency for Occupational Therapy (2013) which states that Occupational Therapists must “understand and be able to apply the theoretical concepts underpinning occupational therapy”.  They are used to help to define the scope of an Occupational Therapist’s practice by providing guidance about what practice is ideal for any setting, as well as helping to put into action Occupational Therapy’s unique understanding of occupation and how it relates to everyday life and ensuring that an Occupational Therapist is comprehensive and holistic when collecting information (Turpin and Iwama, 2011). Three of the Models of Practice are (as stated above) the Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Occupational Therapy Intervention Process Model (OTIPM).

• Conclusion (250)

Reference List

Chard, G (2010) Analaysis of occupational performance. In Curtin, M. Molineux, M. and Supyk-Melson, J. (eds) (2010) Occupational therapy and physical dysfunction: Enabling occupation. 6th ed. Edinburgh, Churchill Livingstone Elsevier.

Christiansen, C. and Townsend, E. (2010) Introduction to Occupation: The Art and Science of Living. London, Pearson Education Ltd.

College of Occupational Therapists (2009) Definitions and Core Skills for Occupational Therapists. London, College of Occupational Therapists.

Creek, J. (2003) Occupational therapy defined as a complex intervention. London, College of Occupational Therapists.

Duncan, E. (2011) Foundations for Practice in Occupational Therapy. 5th ed. Edinburgh, Churchill Livingstone Elsevier.

Fleming, MH. (1991) Clinical reasoning in medicine compared with clinical reasoning in occupational therapy. American Journal of Occupational Therapy. 45 (11), p.989.

Health and Care Professions Council (2013) Standards of Proficiency: Occupational Therapy.  London, Health and Care Professions Council

Kielhofner (2009) Conceptual Foundations of Occupational Therapy Practice. 4th ed. Philadelphia, USA: F.A. Davis.

Kuhn, T. (1970) The Structure of Scientific Revolutions. Chicago: University Chicago Press.

Mattingley, C. (1991) What is clinical reasoning? The American Journal of Occupational Therapy. 45. (11), p. 981.

Reed, K. and Sanderson, S. (1999) Concepts of Occupational Therapy. 4th ed. Philadelphia, Lippincott Williams & Wilkins.

Schell, B. and Cevero, R. (1993) Clinical reasoning in occupational therapy: An integrative review. American Journal of Occupational Therapy. 47, pp. 605-610.

Thomas H (2012) What is activity analysis? In Thomas, H. (2015) Occupation-based activity analysis. 2nd ed. Thorofare, NJ: Slack Inc.

Turpin, M. and Iwama, M. (2011) Using Occupational Therapy Models In Practice: A Field Guide. Edinburgh, Churchill Livingstone Elsevier.

World Federation of Occupational Therapists (2010) Definition of Occupational Therapy. [Internet]. Available from: http://www.wfot.org/aboutus/aboutoccupationaltherapy/definitionofoccupationaltherapy.aspx [Accessed 30.12.15]

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