Health professionals' enactment of their accountability obligations: doing the best they can.

In the current context of health care, health professionals' accountability obligations may be more extensive than the degree of autonomy that they are permitted to exercise. To date, how professionals fulfil their obligations with regard to this potential for dissonance has not been investigated. The purpose of this Grounded Theory study was to examine how one professional group, occupational therapists, enacted their accountability obligations within their current practice context. Interviews with 21 therapists across three practice sectors in one Canadian province elicited a detailed portrait of the contextual elements within which accountability enactment took place, and a view of the dynamic interplay of these elements with the decision-making involved in fulfilling professional accountabilities. Practitioners moved back and forth between conscious juggling of accountability expectations and more automatically applying tacit practice knowledge. Beyond non-negotiable bottom line commitments to their formal ethical obligations and to retaining autonomy for their clinical recommendations, practitioners' decisions reflected the goal of doing their best. However, participants' efforts to find a balance between satisfactorily fulfilling their obligations and acknowledging the frequently unavoidable reality of contextual constraints elicited inconsistent patterns. The study findings raise concerns about ensuring quality of services and the impact on professionals. Although practitioners have an important role to play in addressing these challenges, other stakeholders, for example, the professional regulatory bodies, also must play a role in creating a coherent accountability framework. Further research is needed to obtain greater understanding of professional accountability enactment across health professions, practice sectors and health jurisdictions, and to explore managerial and professional regulatory bodies' perspectives, roles and responsibilities.

Keyboarding for students with handwriting problems: a literature review.

A literature review is presented regarding keyboarding for school students experiencing handwriting difficulties. Despite the overall dearth of research, some general conclusions appear warranted. Students need to be able to keyboard at least as fast as they can handwrite and should learn the touch-keyboarding method if possible. Appropriate instruction appears critical for the development of keyboarding competency. The upper elementary age is an appropriate time to start teaching keyboarding, with students possibly requiring 25-30 total hours of instruction. Students experiencing handwriting difficulties might need customized goals and strategies. Although the existing literature regarding the role of performance components in keyboarding provides some direction to clinicians, further investigation is required.

Consumer participation in the employment rehabilitation process: contextual factors and implications for practice.

Rehabilitation models of practice have emerged that offer persons' with disabilities opportunities to have an active role in the work entry or re(entry) process. Despite the growth and interest in empowering client involvement in practice, consumer views on the determinants of participation are not fully understood. Thus, consumer feedback on using a self-directed approach to employment rehabilitation was elicited to identify factors integral to their participation in the process. Focus groups were conducted with 35 adult consumers with developmental, mental health, physical and learning disabilities to gain insights into their involvement in a participatory approach to find employment. Content analysis of data revealed barriers and facilitators, which hindered or enabled consumer involvement in the vocational service process. This article discusses the importance of considering issues across the rehabilitation system, practice and lived contexts when implementing participatory approaches in vocational rehabilitation settings.

Assistive technology and handwriting problems: what do occupational therapists recommend?

BACKGROUND: Handwriting difficulties for students are a common reason for referral to occupational therapy. Little research evidence is available concerning the factors guiding technology recommendations for these children. PURPOSE: The objective of this survey research was to describe the technology-related recommendations and factors involved in the decisions made by Canadian occupational therapists for these students. RESULTS: More therapists recommended the use of keyboard-based strategies (93%) than dictation-based strategies (72%). Experienced therapists were more likely to prescribe technology tools. Dictation to a scribe (93%) and desktop computers (89%) were the strategies most frequently recommended. Equipment cost and availability of funding, and the availability of support in the school for the student were the most influential factors, respectively, on the keyboard and dictation strategy type prescribed. PRACTICE IMPLICATIONS: The results confirmed that occupational therapists prescribe a range of technology solutions. Factors influencing these recommendations differ depending on the nature of the technology, the person, environment or occupation. Knowing the factors guiding occupational therapist technology recommendations will help provide valuable information about the practical implications of the available technologies.

A multidimensional view of health.

CONTEXT: Emergence and burgeoning of specialized health care structures have contributed to the diversity in health services. Inadvertently, the separation and resultant independent functioning of health and rehabilitation organizations have impeded opportunities for health care workers to interact with one another. Consequently, providers may lack knowledge on available health services within communities in which they preside. Educational approaches that can assist health professionals improve awareness of services across organizational divides are needed. OBJECTIVES: The new International Classification of Functioning Disability and Health (ICF), offers a multidimensional view of health, which can be used in education sessions to increase provider awareness of how health is mediated across health paradigms. This paper explores the conceptual basis of the ICF and its use in promoting a broader view of health essential for treating consumers with complex health problems and enhancing knowledge sharing amongst professionals. METHODS: A single case study design is used to demonstrate how the ICF's conceptual framework offers providers a means to promote mutual understanding of differences in health services and to assist them in sharing knowledge on the services provided with others. CONCLUSION: Conceptually, the ICF can be used as a basis for structuring inter-organizational educational initiatives to increase knowledge sharing amongst organizations and health care workers. In addition, introducing health professionals to a multidimensional view of health can assist them to understand the breadth of health services in the community and to consider a more comprehensive set of health determinants and dimensions in caring for consumers.