Daily Living Simulation Suite......

Just wanted to share our newly refurbished Simulation Suite with you. Our team have been working hard to creating a great learning space that has the most upto date equipment and will allow us to use cameras for simulation of real problems and solutions.
Take a look around and see what you think.

Bell Ringing and Occupational Therapy

 Thanks to our own Dr Jackie Taylor for this interesting post:

Bell-ringing and occupational therapy

I have a friend who is one of the bell-ringers at her local church. The other Sunday I was privileged to be able to sit squashed up in a corner of the bell-tower, watching the bell-ringers in action for 45 minutes, calling the congregation to the church.

Have you ever watched people ring bells? It’s fascinating. 

As an occupational therapist and occupational scientist I find it particularly fascinating because I have a set of concepts that help me to explore what is going on, and I have a language to describe what I see. So I don’t just see a group of people pulling on ropes, making a lot of noise; I see people engaged in a common occupation, which has an identifiable form and which invites a range of performances from the individuals thus engaged.

The form of bell-ringing

As I sat squashed in my corner (“sit very still, and we advise you not to cross your legs, as you don’t want your foot to get caught in a rope as it swings up”) I reflected on my total ignorance about this activity and yet, as someone interested in occupation, I was mentally filing aspects of the occupational form under headings of ‘human’, temporal’, ‘environment’, ‘objects’.  There were physical artefacts:  tools and equipment that the bell-ringers were very familiar with. There were the 8 long ropes hanging down from holes in the ceiling, each apparently controlling a huge bell. The bells, however, were invisible and I struggled to imagine the process of rocking and turning them which I was told was happening. In the centre of the room was a table with old books on it, and also some bottles of liquid which the ringers used occasionally on their hands, though, as an outsider, I don’t know the reason for this. You will see that the form of a complex occupation such as this cannot be fully understood by an outsider; true understanding comes through engagement. 

                                

In terms of environment, the bell tower was small and ancient. Reader, I want you to know that I felt the tower sway as the bells rung! I believe this is quite normal, and it has been happening for a 350 years or so, but nonetheless  ...... (I’m told that, if the tower were absolutely rigid, it would be damaged by the action of these heavy bells, all swinging together).

There were rules and formalities involved in the bell-ringing, and sequences of events that were important (five minutes at the beginning and the end of the session were devoted to getting the bells up into position and bringing them back). It was difficult to differentiate between the roles played by each person, but I could see that there was someone in charge (the Tower Captain, I later discovered) who called instructions, and who gently reprimanded those who had rung wrongly. My friend had explained that the eight bells are not rung to play tunes, but to ring out ‘methods’, based on number patterns.

Bell-ringing is an ancient occupation serving a town’s formal Christian worship, and helping to mark occasions such as weddings, funerals and national celebrations. The walls of the bell-tower held lists of successful peals rung from this tower (a peal is 3 hours of non-stop ringing without mistakes, I am told). There were also other intriguing documents and records that the outsider finds difficult to understand. This is an occupation embedded in a broader culture, history and community, whilst this particular team of bell-ringers also has its own micro-level culture, history and community.

Take a look at their website http://bingleybells.btck.co.uk/ and while you’re there, look at the two youtube videos to hear the bells and see the occupational performance.

Individual performance

The eight people who were pulling on the bell ropes had similarities and differences. They were maybe between 18 and 70 years old, half men and half women with different heights and physiques. They appeared to have different levels of experience. It is not my field of expertise, but I tried to assess which were the main muscle groups being employed as the ropes were pulled down to swing the heavy bells. Different techniques were used. I could see arms (triceps?, deltoid?), backs (trapezius?), abdomens and legs brought into play.

More intriguingly to me, I could see different techniques being used for keeping counts and rhythms when ringing the methods. Some watched each other, some watched the Captain, some moved their lips as they recited numbers or something else. The level of concentration was palpable. This occupation requires techniques and abilities that are physical, cognitive and subtly social.

And what else?

Being interested in occupational form and performance can be very distracting and all-absorbing. I made sure, during my short visit, that I listened to the bells and experienced their glorious noise. It is important to appreciate, as well as analyse.

I could continue my analysis for another 2000 words, after all, my own research interests lie with the meanings of occupations, but to access those, I would need, I think, to talk to the bell-ringers themselves. I won’t do that just now. Instead I’ll stop here and offer 2 thoughts. (1) Next time you hear church bells ringing, consider the efforts, skills and enjoyment of those responsible. (2) Next time you encounter an activity that you haven't thought about before, think about it deeply.

Dr Jackie Taylor

Transitions from unhealthy to healthy behaviour- a personal journey

  "If one does not believe in one's capability to perform a desired action, one will fail to adopt, initiate and maintain it".

Schwazer:  Health Action process Approach

In this blog post I attempt to consider the notion of transition from an unhealthy behaviour to a healthy behaviour using the Model of Human Occupation (MOHO) as a loose frame to focus my personal experience of being diagnosed with Type2 Diabetes. Firstly some very quick definitions to key you into the terminology I am using.

  I thought it best to go to the official site to define MOHO here:

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. 

Type 2 Diabetes, taken from the UK website

Type 2 diabetes develops when the insulin-producing cells in the body are unable to produce enough insulin, or when the insulin that is produced does not work properly (known as insulin resistance).Insulin is a hormone. It works as a chemical messenger that helps your body use the glucose in your blood to give you energy. You can think of it as the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel.

 

It is said that health is a process through which people become who they want to be (I apologise that I cannot find the original reference for this that came from nursing research). Much of the self-help literature offers the idea (myth?)  that it takes 28 days to adapt to change or 3 weeks to learn, 6 weeks to adopt and 6 months to internalise a new behaviour - but there is little evidence to support this within specific research areas, however, it seems to have worked for me this way. 

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context. - See more at: http://www.cade.uic.edu/moho/resources/about.aspx#sthash.Nq8aLYPW.dpuf

When we look at changing health behaviour, Schwazer offers the HAPA framework using  psychological and social sciences to discuss an approach to this which is designed to examine a set of psychological constructs that jointly aim at explaining what motivates people to change and how they take preventive action. In short, the motivation phase (or perhaps we might call this the initiation phase?)  describes how one needs to believe in one's capability to perform a desired action ("I am capable of initiating a healthier diet in spite of temptations"), otherwise one will fail to initiate that action.  In the subsequent volition phase (perhaps we may call this the adoption phase so as not to get tangled up with MOHO language?), after a person has developed an inclination toward adopting a particular health behaviour, the "good intention" has to be transformed into detailed instructions on how to perform the desired action. 

This had some resonance with me and I began to consider these issues in relation to me as an occupational therapist and using the elements of MOHO in the change I asserted. The sections in red refer to the language of the HAPA framework, I have linked them together with where I believe MOHO best fits with these categories and then given some personal reflection as to what this meant to me in my experience.

Volition:

A minimum level of threat or concern must exist before people start contemplating the benefits of possible actions and ruminate their competence to actually perform them 

• In order to consider change in healthy behaviour it was important to address and explore my relationship with food - values held, traditions practiced etc. 

• Food was a social event, a treat, a marker of time, a consolation. A way of sharing an experience and showing care and consideration with friends and family, and a link to the past.

•  This was all under threat and the advantages of change had to be weighed against the perceived effort and skill involved in making changes to all of this.

The message has to be framed in a way that allows individuals to draw on their coping resources and to exercise skills in order to control health threats (fear appeals are limited)

• The current stance by the NHS here in the UK is to approach the issue in a 'soft' way. Everything  in moderation is the message. What I observed through this within an education session with a group of people with a recent diagnosis was that this did not clearly offer the importance of change. There was little consideration of what coping resources or skills might be required 

• Utilising other sources from the internet and books, mainly from Australia (because in my view they seem to have a more well defined approach and attitude to the issue) I was able to find my way through often conflicting and usually complex messages to find a message that spoke to me enough to enable me to draw on coping strategies. The messages I found made me want to exert the effort required and make changes.

• Intrinsic motivation was also impacted by the future requirement of health care professionals to assess and judge my progress - I have never been able to easily accept being judged (I got through 3 driving instructors and 2 tests before I passed my driving test). So to avoid this I needed to adopt healthy behaviours.

 Intention is not enough on its own - it then has to be planned for and instructed within the  development of an internal coping dialogue 

•  Schwazer explains this as outcome expectancies- subjective beliefs on positive and negative outcomes and  perceived capability of a person to implement a certain behavior 

• I had to learn to challenge an internal dialogue that stated such things as "I don't have time to do all that cooking of fresh food", " I couldn't possibly eat that....", "I don't like ....", 

• I had to retrain my thinking on what was a treat, what was sociable, what was consolation etc. This was perhaps one of the hardest things, I had to identify my internal dialogue at each occasion where food was involved, what was I thinking, feeling about this. How did this fit with what I now knew to be "healthy" choice?

 Habituation

Intention has to be transformed into instruction

•  I scoured cookery books and each week I planned exactly what I was to eat every day - breakfast, lunch, dinner and snacks and by doing so learned about the science of food, how different groups work together, understood the concept of low Glycaemic Load (GL) for slow release and complex combinations that slowed sugar release or enhanced insulin effectiveness. And I finally began to understand portion control.

Action plans on how to create and adopt transitional behaviour, then have to be protected by cognitions in order to be maintained and not distracted by competing demands and intentions

•  By doing this I created a new routine for eating incoporating more time for cooking. In this way I began to enjoy making meals, creating an ambient environment (is now the time to admit that my favourite 'goto' music for meal prep is Steps??)

Avoidance of high risk situations

•  This was a bit harder to enforce. At first it was easier to avoid social situations where food would form part of the experience, but friends soon became slightly annoyed with me for this.

• Eventually this was impossible, but taking relearned coping strategies and with the support of friends and family I was able to find the confidence to ask questions of the food others had prepared and could make informed and healthy choices

Prioritise these intentions over other desires and intentions for a specific time period 

• My first HbA1c test would take place 3 months after initial diagnosis, therefore this became my first goal. I intended to keep these new behaviours for this period of time and then re-consider dependent upon the outcome of the test reading.

 Performance

Performing an intended health behaviour is an action, just as is refraining from a risk behaviour. The suppression of health-detrimental actions requires effort and persistence as well.

• As mentioned I learned how to cook healthy food, how to put food together what and how much to eat  

• I developed research skills to find and interpret the information available - there is much that is conflicting and complex in the available literature and learning to navigate through this is very difficult - and not something I have totally mastered to date I'm sure 

• I became so successful at suppressing health-detrimental actions that at the point of trying to 'fall off the wagon' and have treat to celebrate my first 3 months reading - and choose a cream cake - I couldn't do it and actually ..... I didn't want to do it - and I haven't

It is worth recognising, as with MOHO, that I continue to impact  on and be impacted on by the perceived and actual human and non-human environments.

• Human environment of support and personal networks of family friends and colleagues in both real and virtual world. 

• NHS support and advice

 

Outcome: BMI in normal range, HbA1c in non-diabetic range, Cholesterol normal range, weight loss - 3 stone and counting, feeling well :-)

This post is slightly away from the norm here as I feel I am exposing something more personal than I ususally do on this blog. I would welcome your comment and feedback as to whether this post was useful or interesting to your work or even personal circumstance. Any ideas for future posts would also be well received.
Many thanks 
Angela

Final Year Exam Papers ......(1983)

 As we welcome new students to their occupational therapy career and our final year students begin to look towards life away from the institution and into professional practice I thought I might share my  exam papers from my final year of training in 1983! Here in the UK this was, at that time, a diploma course and the exam was set nationally across all occupational therapy schools. What strikes me most is the language/terminology used and the very practical nature of the questions. There was little expectation of using theory to underpin answers or indeed references to support statements!

If you click on the photos you should be able to enlarge them, but to give you a taster here are some of the questions. Could you answer them?, o

Occupational Therapy for Pyschiatric Disorders and Mental Handicap

* Describe the assessment procedure you would use for the selection of patients for a group home. Outline a possible training programme for the selected patients.

* Describe how you would use TWO of the following activities:

      a) music to improve communication skills

      b) pottery to improve task performance skills

      c) art to improve group interaction skills

Occupational Therapy for Patients with Medical and Surgical Disorders:

* How may the community occupational therapist contribute to the management of a young mother who has multiple sclerosis?

* Write short notes on how TWO of the following activities can be used to improve hand function:

            a) stool seating

            b) gardening

            c) wrought iron work (metal craft)

Communication and Management:

* Unnecessary wastage costs money. Where might such a wastage occur in an occupational therapy department? Discuss the methods by which these may be reduced.

* Write a short report for your Head of Department on the possible uses of

                    EITHER: a) a microcomputer

                      OR        b) a video system.

Reflections on Romania - the Second Visit

Where do I begin? The facts are usually a good place to start, 2 lecturers, 2 undergraduate students, a recently graduated student and a representative from an Arts Charity spent 4 days in Timisoara, Western Romania looking at how collaborative links could be developed with an Art Therapy Centre and other institutions within the area. During the visit the students had the opportunity to run groups for some of the children that centred around the concept of identity. A there ends the easy part to report. The visit became a very intense role emerging placement with each stage challenging the fundamental principles of OT and the fundamental beliefs of us as a team. We met very welcoming people, some who were directors of their institution, who would have been more than happy for us to 'do' activities with their children and it was apparent this is what they thought OT would do. We also saw several other 'professionals' 'doing' occupational therapy and acknowledging that they used the principles of OT. And yet they were asking for OT, they want the profession to develop and be recognised within their country, so the questions that this posed to us are'what would 'true' OT do that would be different?' 'Why should a country invest money into a separate profession when it would appear to be incorporated within others jobs?'
Thank fully we came to some positive answers to those questions but it would be interesting to hear the thoughts of others.

Competant, Proficient or Expert

image: St Pancreas Station statue
One of our recent posts has been discussing the issue of what undergraduates need to know. I did consider leaving this thought as a comment on this post - but decided to create a new post instead and would be keen to know your thoughts.
I really like what Creek(2009) has to say in her letter "Achieving a higher level of expertise". In this letter she discusses the nature of expertise in practice and states that within education, students are "taught that using a model for practice represents the highest level of skill" of the OT - a point she refutes by using Benner and Tanner's (1987) work on how expert nurses work and her own description of expert practice "the context of the intervention modifies the occupational therapy process and the therapists thinking, negotiation and action" (Creek 2003 p17).
The point she is making in this letter is that undergraduates are taught how to be competant and not proficient or expert in occupational therapy- therefore undergraduates need to understand that their approach to models of practice tends to be limited to an acceptable yet limited standardised and routine approach. Only with practice and experience can this be moved forward. Therefore those practitioners that are flexible, responsive and 'eclectic' with their use of models and interventions could be said to be practicing at a proficient and/or expert level.

References:
Benner P, Tanner C (1987) Clinical Judgement: how expert nurses use intuition AmJ Nursing Jan 23-31
Creek J (2003) Occupational Therapy defined as a complex intervention London:COT
Creek J (2009) Letters to the Editor: Achieving a higher level of expertise BJOT 72(2) 90

Wikiflash is here!

OT Wikiflash is the rather curious name given to a time, this year during OT week (commencing November 3rd 2008), when we are trying to get a large number of members of the OT community to contribute to the online public encyclopaedia that is Wikipedia.

Wikipedia is a fantastic resource that many are turning to however there are problems with the system largely due to inaccuracies of content. These inaccuracies are often due to a number of reasons including editors plagiarising information, information being out of date (and thus wrong), and poor referencing. Despite this, increasing numbers of students, healthcare professionals and service users are turning to wikipedia as a first port of call.

OT currently has a tiny section in the wikipedia world with most content being US centric and largely focused on the title of "Occupational Therapy" rather than an explanation of our core skills, values and role. We are suggesting that the OT community in the UK takes a lead in updating and improving this resource. As a starting point we have created a website where you will find more information, including a “how to” guide, and some suggestions on what and where to make your contribution. You could do a little or a lot – anything and everything will help show what we do.

As well as benefiting the OT community, your contribution can also have a significant personal benefit as you can use your edits to demonstrate aspects of your CPD for the HPC re-registration process. For more information go to the website . Whilst we are specifically looking at this activity from a UK perspective, we have been discussing this idea across our networks and we are expecting that OTs in USA and NZ will also be taking part.

We look forward to a community of wiki-flashers in OT week!!

From little acorns .................

image:New cohorts 2008

Having spent the last few weeks inducting our new students onto both the new MSc Advanced Occupational Therapy programme and our Part Time and Full Time undergraduate programmes we are now getting ready to
deliver the first modules.
It is strange how the academic cycle is repeated each year and yet it never fails to be different each time. As new cohorts are admitted and each student's evolution from inductee to graduant occurs it becomes clear how the development of an occupational therapist is not just about gaining knowledge and skills. It is the philosophy and the way that an OT thinks that is internalised by each successful student. Each year I find that I am discussing issues with my personal tutees that embrace how they are changing as a result of their learning, managing not only their immediate studies but also their own environments, applying the values of occupation to their own circumstances. Occasionally they experience occupational imbalance as their studies take preference over other aspects of their life (ususally around assessment time) and then family responsibility may take priority and they have to cope with juggling roles and routines in order to achieve their goals, constantly evaluating and reassessing their circumstances and their objectives. In this way they begin to realise that OT is not a 9-5 job, but a way of being, a way of reacting to and living with their own world.
I think therefore that the recent editorial in BJOT by Sakellariou et al (2008) is very pertinent to our cohorts. They are discussing the importance of occupational therapists getting more involved - not just in their own world - but in aspects of the wider world about them. That as a profession we need to become much more political in our outlook, ensuring that we can "maximise the potential of our impact" by using "adaptable and transferable skills to help (them) navigate an unknown and rapidly changing terrain".
It is possible that the students we have inducted this week - both those undergraduates embarking on a new career and those already experienced practitioners on the MSc programme may indeed be preparing to work in areas that require them to develop and utilise this wider perspective as the profession continues to create areas for emerging practice and extending boundaries. We look forward to supporting you all through this steep learning curve and through the transitions to come.

Reference:
(the link above is only available to COT members)
Authors: Sakellariou, Dikaios; Pollard, Nick; Kronenberg, Frank Time to get political BJOT Vol 71 No 9 p359

Occupational Therapy and Web 2.0 Technology

Given that we have adopted a PBL approach to undergraduate learning and are used to attempting the student centred experience, I am frequently involved in conversations with colleagues that question the time that we are still spending in face to face contacts with student groups in order to ensure that learning outcomes are being met.
Now that our journey is fast taking us through a steep learning curve of podcasts, wikis and blogs I am becoming convinced that web 2.0 technologies have a place within occupational therapy education. For example, PBL groups can set up wikis that enable them to truly share their learning and their research in consideration of the trigger in a way that does not identify them to the rest of the group - great for those that have confidence issues. At the same time tutors can see who is contributing (or not) and whether the information is accurate and evidenced in an appropriate way. Individual students can then be mentored as necessary to get the most from the learning opportunity.
Another example is that key note lectures can be podcasted so that students can access this as revision, or even to gain a fuller understanding of the topic in a way that suits their own learning committment and style. These can be attached to discussion forums that facilitate student question and comment which tutors can engage in. In this way the content is engaged with in a much more comprehensive way. Thus the face to face time decreases - but the contact time becomes more focused and more student led.
I think that one of the main obstacles to adopting web 2.0 technologies is not about tutor or student motivation to engage with these new concepts, it is ensuring that both groups have the necessary access to the processes and the time to "play" with the concepts before going public.
Angela