“I saw a real vulnerability and fragility in people during walking interviews even though they were verbally being very brave,” says Mary Butler, Senior Lecturer in the School of Occupational Therapy.
Backed by a prestigious ACC Post-Doctoral Career Development Award, one of only three awarded throughout New Zealand, Mary Butler set out to attempt to understand the longitudinal impacts of injury in those with pre-existing disabilities. Following a small cohort of participants with pre-existing co-morbidities including brain injuries, polio and severe burns, for a period of two years, she wanted to find out what factors mediate the speed of recovery. What she discovered was that “it all depends on support networks – the social capital available made all the difference in how quickly people recovered and how much they were able to function without continuing disability.”
Along the way she also made some subsequent discoveries. One of these discoveries was the validation of walking as a method of interviewing for adding richness and depth to the data. “When I sat down with people and interviewed people ‘normally’, that is, in a sedentary interview, the stories I got were very conforming. People would significantly downplay their injuries. However when we went for a walk where people would choose to walk and how far we would go would be very revealing of the reality of their bodies and injuries,” says Mary, “Mostly we want to say that people with disabilities can live life like everyone else, however sometimes there are significant adjustments and changes they have to face that in one way or another bring retirement from various occupations closer.”
“Taking research out of a fixed environment creates new understandings of disability,” says Mary.
Butler, M (2014). The Walking interview: an approach to investigating injury and people with pre-existing co-morbidities. Internet Journal of Allied Health Sciences and Practice. http://ijahsp.nova.edu Vol. 12 No. 3 ISSN 1540-580X
Friends protect against falls. This was among the findings of Linda Robertson who set out to investigate a current research gap by evaluating what factors contribute to the successful maintenance and sustainability of elderly mobility and falls preventions groups organised by Age Concern (Otago).
Using a qualitative, descriptive research method, individual interviews were conducted with seven focus groups comprised of group organisers and exercise group members. The study found that three major themes emerged.
The first was the already noted physical benefits of attending the group. Participants identified everyday movements they could now do that they couldn’t before, such as “standing up in church without having to hold on to the pews” as one participant reported.
The second, previously unidentified, theme was that of social connectedness. “The thing they talked about with most enthusiasm was the social value,” notes Linda. “Although they weren’t necessarily creating pals for life they were getting meaningful contact amongst a caring culture modelled by the peer leaders”.
Thirdly, support needs were identified as being of importance to the ongoing maintenance of the groups.
This research is significant as it has successfully identified some of the underpinning mechanisms that make elderly falls prevention programmes work. This gives hope that future elderly exercise groups will be able to replicate the success of these falls preventions group by ensuring that new groups are also peer-led and emphasise positive social links.
Robertson, L., Hale, B., Waters, D., Hale, L., & Andrew, A. (2014). Community peer-led exercise groups: Reasons for success. The Internet Journal of Allied Health Sciences and Practice, 12(2)
Dr Mary Butler
The many connections and relationships between people cannot necessarily be quantified financially. These networks are known as ‘social capital’, and are crucial for the functioning of a healthy society, according to Dr Mary Butler, a Senior Lecturer in Occupational Therapy.
“Increasing numbers of informal carers are looking after people in the community” she says. “Often these carers find themselves caring for a loved one without any financial support.”
Mary considered this concept by co-authoring the book Family Care and Social Capital: Transitions in Informal Care. The idea originated from work done a few years ago, which eventually led to the payment of family carers by the Ministry of Health.
Mary and her co-authors were interested in how people begin caring for family members start out as novices, but over time they often develop considerable clinical expertise.
“They go into it knowing nothing and may find the professional support available to them is not adequate, so they begin to develop expertise themselves,” she explains. “They are often highly intelligent, have a lot of resources in terms of social capital and make a significant difference to the quality of life of the person being cared for.”
The book contains a series of case studies that focus on different stages of life for the person being cared for in order to illustrate the realities of family care and social capital. It examines the key issues in caring for people at each stage, and provides useful information for medical, social work and occupational therapy students, as well as policy-makers.
“In doing so, this book fills a gap in the literature in terms of care across the lifetime,” she says.
Barrett, P., Hale, B. & Butler, M. (2013) Family Care and Social Capital: Transitions in informal care. Springer, Dordrecht.
Penelope Kinney and Dr Linda Wilson
The ability to withstand change and thrive in a new environment is a challenge for most people. People transitioning from forensic psychiatric secure units to open rehabilitation wards face a unique set of challenges.
Penelope Kinney, Senior Lecturer in Occupational Therapy at Otago Polytechnic has recently completed a thesis that focuses on these individuals’ experience, Exploring Connectedness: The meaning of transition experiences for patients within a forensic psychiatric service. She completed her qualitative research project in a series of interviews applying Heideggerian phenomenological methodology.
Her work provides an interpretation of the narratives she gathered from five males aged between 23 and 37. The interviews track each individual’s progress from anticipating their transition through to their initial experiences of “freedom”. They then explore the individual’s experiences of the stepping stones they faced in “doing what they had to do to prove themselves” and the acceptance of the fact that “assistance comes in many forms”.
Penelope’s findings identified the critical importance of identifying a genuine connection to occupations, people who support them and a place in the world that provided real meaning for these participants. “There needs to be a conscious effort to help these people make the connections they will require to thrive in the future,” she says.
Her aim was to provide insight into the service user’s direct experiences to help health professionals develop realistic and meaningful transition plans. “Clinicians often ask me the question: How did you get them to tell you that?
“I have the privileged position of being able to gain participants’ trust knowing that their individual disclosures will be kept in strict confidence.”
In 2010 she was one of seven occupational therapists whose abstract was accepted for presentation at the International Association of Forensic Mental Health Services conference in Vancouver, Canada. She presented her emerging data to an international audience.
“My overarching goal for future research is to collect more research data to continue to give insight into the ways in which occupational therapy can be applied within forensic psychiatric services to help these service users reintegrate into their communities.”
Kinney, P., Wilson, L. H., & Galvin, S. (2012) Exploring Connectedness: The meaning of transition experiences for those within a forensic psychiatric service. New Zealand Association of Occupational Therapists conference 2012, Hamilton, 19–22 September.
Clinical reasoning is an area of increasing interest for researchers, educators and clinicians in the field of occupational therapy. Understanding this decision-making process gives therapists greater insight into clinical reasoning and allows them to make positive changes in their own practice.
That’s the view of Dr Linda Robertson, principal lecturer at the Occupational Therapy Department of Otago Polytechnic, whose recent book Clinical Reasoning in Occupational Therapy: Controversies in Practice questions many of the assumptions about how we reason.
“Overtime, I became quite familiar with the academic literature and I was struck by how non-questioning much of the writing was. Textbooks on reasoning contain separate chapters that contradict one another and yet nobody comments on it. I was concerned about this, and that is how this book came about, pulling together what’s been written so far,” she said.
The book also contains excerpts of practice in the form of narratives from other expert clinicians. “One of the chapters in the book, ‘Kai Whakaora Ngangahau – Māori Occupational Therapists’ Collective Reasoning’, gives us an insight into Māori perspectives. We don’t have much in New Zealand in the way of written documentation about reasoning from a Māori perspective. I would like to further explore this area of reasoning in a bi-cultural society,” she says.
Dr Robertson believes that the Polytechnic programme should include more about the concept of biculturalism. “It is important to clearly define what’s going on for the [other] person and what they are concerned about, what you might want to deal with and then how you deal with it. Some cultures might be more individually oriented than other cultures. It’s being able to understand the genuine differences that’s important,” she says.