Experiences of occupational therapists addressing clients

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Experiences of occupational therapists addressing
clients religious and spiritual concerns in
occupational therapy practice
American Occupational Therapy Association Annual
Conference Charlotte, NC April 29, 2006

• Laura Feeney, MS, OTR/L
• Susan Toth-Cohen, PhD, OTR/L

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What do We Know About Spirituality and Health?

• Overall, research findings suggest that there is
  a positive relationship between aspects of
  spirituality, such as religious involvement or
  prayer, and achievement of positive health
  outcomes

Spirituality and Improved Mental Health and
Emotional Well-being
Spirituality and Positive Health Outcomes
Patient Views about Spirituality and Healthcare
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How are spirituality and OT related?
..it is imperative to consider spirituality in OT
practice, in order to support the clients
ability to engage in occupations and participate
in life activities. (Egan DeLaat,
1997)
Practice Framework Theories Holism
Few OT practitioners address spirituality in
their practice

• Christiansen (1997) views this discrepancy
  between theory and practice as a lost opportunity
  to understand the full potential of occupation
  to enhance the health and well-being of clients
  (p. 171).

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Egan and Swedersky, 2003

• Interviewed Canadian therapists who address
  spirituality in their practice
• Findings Four themes describing their
  experiences
• 1. addressing religious concerns 2. addressing
  suffering
• 3. encouraging the self 4. growing as a
  person
• Limitations
• Little information on the actual content of the
  interactions between therapists and clients was
  presented
• Canadian and U.S. healthcare systems are
  different, it is uncertain to what extent
  findings are applicable to U.S. occupational
  therapists

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Purpose and Objectives

• The purpose of this study is to explore the
  experiences of occupational therapists (OTs) who
  address religious and spiritual concerns of
  clients in adult physical rehabilitation.
• Objectives
• Describe the ways in which occupational
  therapists practicing in adult physical
  rehabilitation address clients religious and
  spiritual concerns
• Identify supports and barriers to addressing
  spiritual concerns in practice
• Explore the influence of a therapists own faith
  tradition and beliefs on his/her experience of
  addressing clients religious and spiritual
  concerns in practice

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Methods

• Qualitative design phenomenology
• to accurately understand the lived experience of
  participants (Krefting, 1991, van Manen, 2000).
• Data gathered through semi-structured interview
  and participant reflection papers
• interviews lasting 1-2 hrs focused on eliciting
  details of participants experiences in
  addressing religious or spiritual concerns with
  their clients
• participants composed a reflection paper
  describing an experience in which (s)he addressed
  religious or spiritual concerns with a client.

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Why Phenomenology?

• To understand what it is like when OTs address
  spiritual or religious concerns in everyday
  practice
• To get a sense of how OTs do this -the essence of
  the experience, as they encounter
  patients/clients with religious or spiritual
  concerns (vs. what they think about what
  should/should not happenthough a sense of this
  emerges through their experiences)

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Sampling and Participants

• ?Theoretical sampling used for this project.
• ?Participants were limited to those with at
  least five years experience.
• ? 7 women, 1 man (ages 43-57)

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Analysis

• 3-part phenomenological analysis (Van Manen,
  1990, p. 93)
• Each researcher independently
• identified thematic phrases capturing
  participants essential experience of addressing
  religious or spiritual concerns
• reflected on each transcript in terms of the four
  existentials of lived body, lived time, lived
  space, and lived human relation.
• developed essential themes, using the process of
  imaginative variation

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Phenomenological analysis (Van Manen,
1990)Existentials

• How it felt
• Perceptions of time
• Their work environment
• Relationships with others, especially the
  patient/clientbut also with administration,
  employees

• Lived body
• Lived time
• Lived space
• Lived human relations (largest category discussed)

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Credibility Strategies

• Member checking process
• Participants reviewed..
• Chart of strategies used to address clients
  religious and spiritual concerns
• Table listing main themes
• Continued contact with participants

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Essential Themes
The Experience of Addressing Patients/Clients
Religious or Spiritual Concerns in Practice means
that the OT

• Is client-centered
• Is characterized by a holistic view of the
  patient/client
• Is influenced by personal beliefs but does not
  impose these beliefs on patient/client
• Experiences a personal connection with the
  patient/client

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Essential Themes

• Client-centered Care

Holistic view of person
Personal Spiritual Beliefs
Personal Connection w-Client

• ? Uses what is important to client as start point
  or basis for therapy
• -Observes clients environment, language, and
  behaviors as cues to spirituality
• -Focuses on clients religious or spiritual
  beliefs
• -Makes activities meaningful

? Views client as a whole person with varied
needs, including spiritual ? Assesses clients
spiritual needs through initial evaluation ?
Incorporates spiritual/religious activities into
therapy sessions
? Strong personal spiritual beliefs influence
how/ why therapist addresses spirituality in
practice - personally participates in spiritual
or religious activities -values
religion/spirituality -refuses to
impose beliefs on client
? Develops a caring relationship - Personal
emotional component to treatment - Importance of
giving hope and support
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Essential Themes

• Client-centered Care

Sample Quotes

• This was her moment, this was her therapy
  session, and I let her decide what she wanted to
  do with it. (P1)
• I think more when I do hand therapy than in
  almost any other field are they that
  self-directed at what they want out of it, which
  is their prerogative and so, then I follow that
  lead. (P3)
• You go with the flow with what theyre going
  with, talking about God.You look around the room
  and see what theyve got, what theyre interested
  in. (P6)

• ? Uses what is important to client as start point
  or basis for therapy
• -Observes clients environment, language, and
  behaviors as cues to spirituality
• -Focuses on clients religious or spiritual
  beliefs
• -Makes activities meaningful

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Essential Themes
Sample Quotes
Holistic view of person

• If we hadnt addressed his ability to
  participate in a religious practiceritual bath,
  he would have accepted not addressing it, but we
  would have lost good opportunities for good rehab
  within the context of who he is. (P4)

? Views client as a whole person with varied
needs, including spiritual ? Assesses clients
spiritual needs through initial evaluation ?
Incorporates spiritual/religious activities into
therapy sessions
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Essential Themes
Personal Spiritual Beliefs
Sample Quotes

• I think everybody seeks something bigger than
  themselves and then when theyre in a period of
  crisis they want to pursue that and I know how
  that is for me so I just offer some encouragement
  in that area. (P3)
• I feel like addressing their concerns is part
  of who I am, and its part of why I am here.
  (P5)
• because Im spiritually based, I probably
  approach everybodysort of speaking to that
  higher being in them. (P7)

? Strong personal spiritual beliefs influence
how/ why therapist addresses spirituality in
practice - personally participates in spiritual
or religious activities -values
religion/spirituality -refuses to
impose beliefs on client
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Essential Themes
Sample Quotes
Personal Connection w-Client

• Sometimes just by the connection of having a
  caring person, who is your therapist, sometimes
  having them stop what they are doing and give you
  your full attention. I feel like that can help a
  person through the grieving process to feel that
  connection that someone does care. (P2)
• Namaste means that when I am in that place of
  God within myself and you are in that place of
  God within yourself, we are one. And so it sort
  of is uniting a place that we unite. And I think
  that certainly when Im speaking deeply and
  intimately with my patient I feel like we are
  often in that place. That therapeutic moment is
  connecting at that place, of shared one-ness.
  (P7)

? Develops a caring relationship - Personal
emotional component to treatment - Importance of
giving hope and support
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Video

• Participant comments on essential themes

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Strategies

• You will discuss strategies you use to address
  religious or spiritual concerns, with others at
  this session
• We will then regroup, discuss briefly, then
  present a case study of a patient who presented
  with spiritual concerns

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Strategies OTs Used to Address Spiritual or
Religious Concerns in Practice with Adults with
Physical Disabilities

• Discuss with patient
• Work to improve patients performance skills and
  patterns related to religious or spiritual
  practice
• Decrease patient anxiety
• Use tools/areas related to religion for therapy

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Strategy for Addressing Spiritual or Religious
Concerns

• Discuss with patient/client
• Assist patients coping strategies
• Help patient identify resources
• Identify ways to overcome the effect of a
  persons condition on the religious/ spiritual
  aspects of his/her life
• Pairing patients with others

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Strategy for Addressing Spiritual or Religious
Concerns

• Discuss with patient/client (Sample Quotes)
• And there are religious services in the
  hospital and they dont even know about it, and I
  do make sure that I can tell them about those.
  (P1)
• I say, you know, somebodys really struggling
  and shes talking about, you know, she doesnt
  want to pray anymore and she feels defeated. I
  noticed that youve found this and this and this
  really helpful, do you mind if I schedule you at
  the same time and maybe you could have some
  dialog about that? (P3)

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Strategy for Addressing Spiritual or Religious
Concerns

• Work to improve patients performance skills and
  patterns related to religious or spiritual
  practice
• IADL Work on meal preparation related to
  religious holidays
• IADL Practice functional mobility needed to
  attend/participate in services
• ADL- Transfers
• ADL- Energy conservation and rest breaks
• IADL- Standing tolerance
• ADL- Self Care (i.e. Dressing appropriately
  before being seen in public)

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Strategy for Addressing Spiritual or Religious
Concerns

• Work to improve patients performance skills and
  patterns related to religious or spiritual
  practice (Sample Quotes)
• ..a lot of times its about food prep. The apple
  cakes andthe Seders and the things like that.
  And thats important to them so then its
  important to us to let them be able to do that,
  adapting things. (P8)
• there are very concrete situations when you
  know they have spiritual or religious practices
  um, we try to incorporate them, when appropriate
  into therapy. So Ive had folks who practice
  Islam. Well see if we can adapt, if they cant
  or have a hard time getting to the floor. Ah,
  that might actually be a good opportunity to get
  the body to practice that or to adapt the
  environment for their prayers. (P4)

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Strategy for Addressing Spiritual or Religious
Concerns

• Decrease patient anxiety
• Progressive relaxation
• Meditation
• Use of humor
• Centering
• Stress management

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Strategy for Addressing Spiritual or Religious
Concerns

• Decrease patient anxiety (Sample Quotes)
• I do a stress management class for the
  pulmonary patients. One of the things we discuss
  is spiritual beliefmeditation, prayer, as stress
  busters. (P2)
• I will help them establish awareness of their
  inner body states, physical states. And I always
  link that to um, some really relaxation,
  centering techniques And when we talk about
  centering, I start them off with a breathing
  component that is very concrete and physical.
  (P4)

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Strategy for Addressing Spiritual or Religious
Concerns

• Uses tools/areas related to religion for therapy
• Reading the Bible/Torah/Koran, etc.
• Having therapy in a chapel-like environment

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Strategy for Addressing Spiritual or Religious
Concerns

• Uses tools/areas related to religion for therapy
  (Sample Quotes)
• if they were in the middle of their prayers, or
  if they were in the middle of reading their Bible
  or the Koran, then Id ask them to stand up and
  have them read it (P6)
• Ill set up the pews to be as they would be in
  their church as they describe them, and then we
  practice then getting out of the wheelchair or
  walking, using a walker, exploring what it would
  be like to have to get through people. (P4)

Add new photo hereI can collect these and add
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Problem SolvingCase Study

• Watch the video
• What ideas do YOU have for addressing the
  persons concerns?
• Please classify into ADL, IADL, education
• What barriers and supports would you find if
  treating the person at YOUR workplace?
• How would you utilize the supports and get beyond
  the barriers to provide interventiongt

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Contact Us!

• Laura Feeney, MS, OTR/L
• Laura_feeney_ot_at_yahoo.com
• Susan Toth-Cohen, PhD, OTR/L
• Susan.toth-cohen_at_jefferson.edu