Developing an Occupational Profile…The Next Step – Flashcards
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definition of occ. profile
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Summary of a set of activities, routines, and roles that describe a client at any one point in time Information that describes the client's occupational history and experiences, patterns of daily living, interests, values, and needs (AOTA, 2008)
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purpose of occ. profile
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Simply, it's data that is collected by OTs to attempt to capture a clients occupational history -What is it that they have done, are doing, and will do in the future -Looking at specific occupations, roles, activities, and lifestyles -Focuses on the "simple things" we do each day -Looking for specific personal client descriptions of their activities, patterns of behavior, and where and with whom these activities are performed
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what do OTs try to identify with it?
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client problems or areas to be address during therapy...this is the occupational profile.
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What are the components of an occupational profile?
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-Consideration of the temporal context -Data collection >Interview >Participant Observation
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Temporal context component
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-Focus on present or recent occupations -Occupations that the client had right before experiencing a change are most critical to examine -Most accurate and relevant to client's sense of self, goals, ambitions, values -Critical to explore when the current occupations produce a negative sense of self -If a client desires change in their current performance in these occupations, it becomes the central goal of therapeutic intervention ---Starting points for therapeutic change
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Just because the occupational profile is concerned with present occupations, doesn't mean that we forget about the past occupations...why?
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-Formed and shaped current occupations and activity choices -Source of experience from with the client can continue to draw meaning and value
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why do you need to be aware of a client ambitions and future aspirations of occupations and roles?
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-Necessary for intervention planning -Necessary for adaptation and adjustments in occupation as the client moves forward in regaining function
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what determines the dimensions of the profile?
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-Time defines the dimensions of the profile -Profiles change as we mature, and respond to experiences in life -Illness and injury can alter patterns of daily living, and impact one's occupational profile, depending on the time the negative event occurred (childhood vs. adulthood vs. late life)
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what happens when an activity is out of context?
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an activity out of context, whether or not it is temporal, loses meaning Context (internal and external) facilitates particular occupations and activities (shape how they are performed, where they take place, and how important they are) -Internal = person's physical, social, virtual realities -External = dimensions of time (time of day, age) and space (physical features) Consider how the context of each activity is relevant to the success or failure of the activity
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when do you begin data collection?
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-Begins at the moment of meeting the client -Starts with just a basic interview, question and answer format -Continues through intervention and treatment processes -More information is gathered during client performance, as rapport builds and the client feels secure enough to share intimate details -Intervention plan and goals tend to change based on new data observed or learned from the patient
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The Interview component
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-Not just asking questions, but learning to perform active listening -Through listening, we can adapt the nature of the questions we continue to ask... -We want to ask more questions to clarify or better understand certain responses -Keep in mind that our clients are not used to answering questions about what they do in detail, let alone what the meaning is (value/beliefs/context) behind the activity or occupation -While we are probably not the first person in healthcare to ask questions, no one else has really asked particular details, such as what type of bed they sleep on, where their toilet is located, what type of routines they participate in throughout the day...
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what should the interview questions revolve?
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Our questions are often influenced by the client's particular contexts... Acute care hospital, rehab, SNF, outpatient, community Client diagnosis - Hand injury = grip and hand strength where as a TKR = activities that require prolonged standing or balance...
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what if the patient cannot communicate for the interview?
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(confusion, aphasia, child) -Interviewing family members who have more experience with the client to gain an occupational history or profile -Sometimes the family may be considered to be the clients, such as in the case of a young child...
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So what do you do if you cannot communicate with the client, and they have no additional support from family or friends to be their voice?
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Develop a hypothesized profile (comes from experience of other clients, knowledge of diagnosis, etc.)
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Participant Observation component
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-Technique when a researcher (OT) engages in various activities and occupations with people to learn about them (person and their occupational performance) and their lives -When we engage them in a task, it is intended to build a relationship that fosters change, and to gain insight from the client -Through engagement and interaction within an activity, observations are made -Rapport is KEY!
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what does observation do for OTs?
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-Provides new details about the client's performance within a specific context that supports or contrasts with what the OT has learned in the interview -Based on what we see, we modify or change the occupational profile, as well as activities used for intervention -Through rapport, the client can gain self-confidence and understand just how OT can support their performance...this motivates them to become active recipients of OT interventions (they help guide what they do in therapy...initiate positive change) -Gaps occur in our information/data gathered...
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is an occ. profile ever complete?
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-No occupational profile is ever complete, so we as OTs must identify the occupations, within context, that the person is willing to address with us at that particular time
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what is the occ. profile, simply?
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-an OT evaluation -Consists of 1.) developing the profile (interview) and 2.)analysis of occupational performance (observation) -The profile identifies the occupations that need to be evaluated for performance (client execution of particular tasks in those occupations) -Examine specific performance skill deficits so we can anticipate what parts of occupations my be impacted
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what do you do when it is "completed"?
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Once we have the profile (evaluation) completed, we can look at ways to improve performance The profile influences our intervention by providing identification of client needs and priorities -Important in choosing the types of intervention and purposeful activities The profile aids in our choice of theory/method/frame of reference to approach treatment and goals Knowing how a client adapted in previous life situations may give us insight into what route we choose to promote continued adaptation strategies
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Once you have the goals and interventions what can you use the profile to determine?
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-to determine if we have met acceptable outcomes -Subjective and Objective performance (collaboration, perceptions) -Health, participation, and engagement in activity -Resumption of impaired occupations or a change in or redefinition of the occupation itself
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what do successful outcomes represent for the client?
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-meaningful change -Outcomes may vary from client to client, though it is the same intervention -QoL is determined by the client satisfaction of performance
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definition of Activity synthesis
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Activities that come together to advance a client's ability to participate in occupations Changing or creating activities to promote occupational success
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how does activity synthesis happen in everyday life?
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-very sub-conscious reactions and changes to challenges or disruptions -If you're tired and falling asleep in class, you may try caffeine to overcome the challenge of staying alert -Humans naturally try and modify activity...think of it in terms of common sense...simple fixes to promote success or continued engagement
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how do OTs use activity synthesis?
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-activity synthesis is often thought about in use of Practice models and frames of reference -We use activity synthesis principles in our interventions -Intervention is guided through rationale and reasoning processes developed by understanding and knowledge of theory and models of practice -Synthesis is therefore based on an OTs skills and abilities, understanding of the client and client's needs, context of the activity, and practice model -Activities are used adapted modified or created with the parameters of the chosen practice model or frame of ref.
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Steps in the process to begin activity synthesis
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1. Determining activities which the client wants or needs to perform {Understand client goals, desires, capacities, limitations (performance skills)} 2. Complete an activity analysis to determine what tasks can be adapted or changed (activity demands) 3. Design or create activities that meet the needs and optimizes performance (Activities that are consistent with theoretical perspectives) 4. Present the activities to the client 5. Observe client performance and reanalyze, adapt, and resynthesize the activity to meet the client needs to promote meaningful performance to move towards the end goals
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what does true synthesis involve and when does it occur?
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-True synthesis involves more then just the activity, but also the meaning (remember - occupations are made up of clusters of meaningful activities) -True synthesis occurs when the activity, performance, and meaning all come together to produce client success in occupations and perceive improved quality of life - this makes the changes, adaptations, or new activities a permanent, daily occurrence within various life roles
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what can you do to the activity to improve synthesis?
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-Adapt and Grade -Modify -Create
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Adapt and Grade
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- change made to the activity or environment -Make it more challenging, or easier -Modify sequence or physical nature of the activity -Modify the time constraints
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Modify
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- change made not to the activity, but the way the activity is done
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Create
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- an activity that is specific for individual clients -Done to present a specific challenge to the client -To promote growth -May or may not initially have meaning to the client
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what can you do with the person(s) to improve activity synthesis?
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-Teach new skills -Refine skills -Maintain functional status or improved performance -Synthesize activity to maintain that level of strength after completion of interventions -Promote health and prevent illness or disease process
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when to change and modify activities
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Modifying activities could also be considered in terms of forward and backward chaining - each successive task makes the activity more complex Clients cannot always be the facilitators of change...need a trained eye with a good understanding of how activity, when modified, adapted, or created, can promote improved function we can't always figure out how to adapt a task we have always done the same way for years
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how do OTs figure this all out and incorporate this into practice?
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-We need to become artful practitioners -Artful in developing or choosing activities that suit our clients needs from a functional perspective, and the client's interests from a personal perspective -Based on experience, time, practice, and patience -New = novice, very technical and procedural in understanding of the client -Expert = improved understanding of how to quickly get to know the client and use the information to synthesize activity to improve function
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New & expert OTs
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-New = novice, very technical and procedural in understanding of the client -Expert = improved understanding of how to quickly get to know the client and use the information to synthesize activity to improve function
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what should client achieve through activity participation?
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-If one uses artful practice, the client should achieve occupational synthesis through activity participation -Occupational synthesis happens within the client (internal and often unconscious) -Happens when a therapist provides opportunities for a client to engage as a means of intervention, and then the client incorporates some of these activities into personally meaningful occupation -The synthesis takes place when the client incorporates these activities/occupations to continue as part of every day life
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how to achieve occupational synthesis
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-To achieve occupational synthesis, the OT treatment must be relevant to the client...the value and understand it's importance -Makes it easy for the client to transfer the tasks/activities into their real-life occupations
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questions to ask yourself
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-Do I understand the client's occupations? -Do I understand the client's patterns of activity? -Are my interventions reflecting this understanding? -Do my interventions result in enabling client engagement in occupations to improve quality of life and satisfaction?
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how is activity synthesis more than just activity analysis?
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it's the meshing, or bringing the meaning, purpose, activity, and vision of the end goals together to form occupational performance
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what exactly is occupational synthesis?
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where the client "gets it" or understands the importance of the activity and then meshes the activity (modified, adapted, created) with meaning into daily occupations, roles, and routines for successful performance
