A Survey of Medication Management in Occupational Therapy Practice.

A descriptive study was conducted through the use of an online survey to gain understanding of the current occupational therapy practices of medication management. Although most respondents felt this topic is important, 24% of those surveyed reported not including medication management in their practice. Results suggest cognition was an important consideration when addressing medication management as well as the need to increase occupational therapy practitioners' knowledge and use of medication management.

Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers.

INTRODUCTION: The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners' development of critical thinking. METHODS: We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions. RESULTS: Three major themes emerged regarding participants' descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning). DISCUSSION: An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.

Evidence for Interventions to Improve and Maintain Occupational Performance and Participation for People With Serious Mental Illness: A Systematic Review.

OBJECTIVE: This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep. METHOD: Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis. RESULTS: Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions. CONCLUSION: Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.

A multi-site study of strategies to teach critical thinking: 'why do you think that?'.

CONTEXT: Critical thinking (CT) is a fundamental skill for clinicians. It plays an essential role in clinical decision making, which has implications for diagnostic accuracy, appropriate management and, ultimately, patient outcomes. Many theoretical frameworks have conceptualised CT and its related constructs. Nevertheless, it is unclear how this topic is taught by faculty staff who teach health professionals. METHODS: The purpose of this multi-site qualitative study was to characterise the instructional strategies of faculty members actively teaching CT. We used semi-structured interviews to answer the following questions: (i) What approaches do faculty staff recognised by peers as good teachers in CT use to teach CT? (ii) How explicit is this teaching? We used snowball recruitment at eight participating institutions to identify faculty staff considered to be local experts in teaching CT. Forty-four eligible faculty members agreed to participate in semi-structured interviews, which were recorded and transcribed. We used the framework method to analyse the qualitative data. RESULTS: We organised the findings into themes of what faulty staff teach to learners (habits of mind, such as higher-order thinking and metacognition), how they teach (guiding principles of clinical relevance and perspective shifting, and concrete strategies such as questioning and group interaction) and why they teach CT (to produce the best possible health outcomes for patients). CONCLUSION: This work has practical recommendations for the individual faculty member. Promoting higher-level cognition, asking questions that probe the learner's understanding and linking discussions to the clinical context are some of the approaches that can be incorporated immediately.

Process-oriented guided-inquiry learning: a natural fit for occupational therapy education.

After a brief review of the major group cooperative learning strategies, this article presents the format and use of Process-Oriented Guided-Inquiry Learning (POGIL) as a recommended teaching strategy for occupational therapy classes. This recommendation is based upon evidence of effectiveness of this strategy for enhancing critical thinking, content retention, and teamwork. Strategies for learning the process and suggestions for its use are based upon literature evidence and the authors' experiences with this strategy over 4 years in a class on evidence-based practice.

Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: a systematic review.

This systematic review investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on recovery in the areas of community integration and normative life roles for people with serious mental illness. The review included occupation- and activity-based interventions and interventions addressing performance skills and performance patterns, aspects of context and environment, activity demands, and client factors. The results indicated that the evidence of the effectiveness of social skills training is moderate to strong. The evidence for the effectiveness of life skills and instrumental activities of daily living (IADLs) training to improve performance is moderate, as is the evidence for neurocognitive training paired with skills training in the areas of work, social participation, and IADLs. The evidence for client-centered intervention and increased intensity and duration of treatment is limited but positive, and the evidence that providing intervention in the natural context is more beneficial than in the clinic setting is inconclusive.

Mental health evidence in the American Journal of Occupational Therapy.

We reviewed the mental health articles published in the American Journal of Occupational Therapy (AJOT) from 2008 through 2009 in light of meeting the Centennial Vision charge of supporting practice through evidence. Seven articles that addressed mental health practice were published in AJOT over these years. Review of the articles found that only two addressed effectiveness of occupational therapy intervention; one was rated as Level II evidence, and the other was rated as Level V evidence. Two articles addressed instrument development and testing. Three articles were basic research studies that expanded consideration about the needs of people with mental health conditions. Scholars and clinicians have begun to embrace the charge of the Centennial Vision to support practice with evidence and continue to embrace mental health practice but have a distance to travel. We hope that in the coming years, the profession will see more evidence published in AJOT supporting mental health as practiced by occupational therapists.

Impact of the changing health care environment on fieldwork education: perceptions of occupational therapy educators.

To investigate how clinical fieldwork educators and academic fieldwork coordinators view the impact of the changing health care environment on student fieldwork education, current practice, and future of the profession, a 48-item questionnaire assessing the influence of recent changes in the health care system on fieldwork education was sent to 125 occupational therapy fieldwork educators and coordinators (response rate 62.4%). Differences between fieldwork educators and coordinators were analyzed statistically using nonparametric methods. Alpha level was set at p < 0.01 for all statistical comparisons. Fieldwork educators and coordinators agreed productivity expectations, number of hours worked, and time spent in documentation have increased, while job security, time for continuing education, and quality of patient care under the current reimbursement system have decreased, but diverged on several other issues. Fieldwork educators believed reimbursement issues did not affect their ability to accept fieldwork students, whereas academic coordinators believed declining reimbursement had negatively affected fieldwork educators' ability to accept students. Factors thought to facilitate the fieldwork shortage included cost reductions, changes in reimbursement, and increased productivity demands on clinicians.

A comparison of distance education instructional methods in occupational therapy.

The progression of technology is rapidly bringing new opportunities to students and academic institutions, resulting in a need for additional information to determine the most effective strategies for teaching distance learners. The purpose of this study was to compare the effectiveness of three instructional strategies (two-way interactive video and audio, chat rooms, and independent learning) and student preferences regarding instructional methods in a mental health programming distance learning course. Precourse and postcourse surveys were completed by 22 occupational therapy students enrolled in the course. Effectiveness of the teaching methods was determined based on the results of students' examinations. The findings indicated that there were no statistically significant differences in student performance on multiple-choice examinations using the three instructional methods. Of students, 77% indicated a preference for two-way interactive video and audio instruction. To provide effective education via distance learning methods, faculty members need to structure assignments that facilitate interaction and communication among learners. As distance education becomes more commonplace, it is important to identify the methods of instruction that are the most effective in delivering essential course content and the methods that provide the atmosphere most conducive to learning.