Hi Matthew I've certainly found the job to be very challenging so far. The difficult thing is that I'm not employed as an OT- I'm not employed by the therapy directorate, but by Trauma and Orthopaedics. The post is as an extended scope practitioner and within this I'm assuming responsibilities which were previously within the remit of medical staff. This was probably something which I hadn't properly taken on board before starting the job. I thought that I would still be working as an OT. I've really had to work hard to define the job role and my identity and at times I've really struggled. I've been in uniform, I've been out of uniform and I'm now back in uniform - finally having decided upon green trousers and a white polo shirt! This has been a source of amusement for a lot of people who feel that I can't let go of my OT roots! But then I've got absolutely no intention of doing that - which I think people now understand! In answer to your question about how I manage to address the patient's "occupational" needs - well, I would say that its a work in progress! I'm not working as an OT, but I do believe that I can bring my occupational bias to each outpatient appointment in terms of how I ask about functional capabilities and the advice which I provide. I would be delighted if people have any further ideas or any advice about working in extended scope practice. I've done a great deal of networking, but so far all the people in these type of posts are from physio and nursing. I've had some great advice/support, but it would be great to network with any OTs in similar positions.
all good wishes Claire >>> [EMAIL PROTECTED] 09/09/03 05:03pm >>> Hi all What an interesting discussion this is... I think that occupational therapists do know most about occupations and are the only professional group with skills in assessing occupational performance / function and then constructing (ideally occupation based) treatment programmes to address the occupational performance difficulties of the client. While other professions may know as much (and often more) about aspects of occupational performance, only occupational therapists put that together and take a truly occupational perspective - well most occupational therapists! In contrast to Claire, the longer I have been an OT the greater clarity I have gained about what that involves and what it means. Claire, given that occupation is a complex 'thing', I would be interested to hear how you manage to address your clients occupational needs as well as do all those other things which doctors or nurses might have done traditionally? I like your post Joe as it raises some key issues, as I see it anyway... two papers which I think are great at exploring what should determine our practice are... Wilcock, A. (1999). The Doris Sym Memorial Lecture: Developing a philosophy of occupation for health. British Journal of Occupational Therapy, 62(5), 192-198. Fortune, T. (2000). Occupational therapists: Is our therapy truly occupational or are we merely filling gaps? British Journal of Occupational Therapy, 63(5), 225-230. Matthew ----------------------------------------------- Matthew Molineux Senior Lecturer School of Professional Health Studies York St John College York YO31 7EX United Kingdom Tel (01904) 716 991 Fax (01904) 612 512 Email [EMAIL PROTECTED] -----Original Message----- From: Claire1 Stevens [mailto:[EMAIL PROTECTED] Sent: 09 September 2003 14:44 To: [EMAIL PROTECTED] Subject: Re: Re[10]: [OTlist] PT does it all!! Hi Ron and Joe Your ongoing debate is very interesting. I qualified as an OT in 1996 and have worked in orthopaedics and hands since 1998. I have recently started as an arthroplasty practitioner in Derby, England. This is a new post which I'm starting up from scratch. The main remit of my post is with regard to the follow up of routine hip and knee arthroplasty patients. The patients see me at the first 6/52 check and then at annual review instead of the consultant/registrar. I've found your debate particularly topical as I continue to develop the post. I think that it is possible to work from a "mechanistic" and a "holistic" viewpoint. I need to check wounds, rule out DVTs, assess ROM and interpret x-rays - mechanistic/reductionistic practice. But I also need to ensure that I'm facilitating the patient to participate in the activities/occupations which are felt to be meaningful. Is this the unique domain of OT? I don't know!! I actually find the longer I practice the more difficult it is to truly define OT. My post was also open to PT and nursing and I'm sure that each profession may have taken a slightly different focus. Would a nurse or a physio be addressing occupation in the same way as me? Should they? I don't think that considering an individual's occupation solely belongs to OT, but I do think that it provides our overall practice bias. And as such, surely we should be the experts!? Maybe we need some analogies - for example, there's a difference between being able to wire a plug and an entire house! I guess the important thing is to ensure that each profession is working to benefit the patient and to respect professional expertise. all good wishes Claire >>> [EMAIL PROTECTED] 09/09/03 02:23am >>> Hi Ron: You are right all states provide some form of regulation of OT in general, just not licensure (except that there 4 states that do not regulate OTAs- Virginia, New York, Hawaii, and Colorado). In my earlier post I slipped, I meant licensure to ensure and define our scope of practice. Sorry for the confusion. Ron, I think you know by now that I do believe in OT's strength and scope to be the most effective and efficient contributor to facilitate a person's independence/ ability to function in accordance to his developmental stage and per societal norms in daily living/ occupational tasks (even if they are not daily :-) (life functions- I do like this word) that he must, should and wishes to indulge in. I do not doubt that we bring in the 'specialization' to identify and address occupational limitations, maladaptations and deprivations. Just as PTs bring in the specialization to address 'physical functions' by 'physical means', and naturopathists bring in the 'specialization' to address/ fight pathology and promote health by 'natural' methods, or an MD brings in the specialization with 'allopathic' methods. We do have a role.....but again, as the work done by MD may be done by a DO, or that of an ND (Naturopathic Doctor) by a overzealous DC, most of what a DC does by a PT... our 'domain' is turfed/ shared by others - PT, nurses, DCs, SLPs, rec. therapists, etc.. In the general sense of the word, yes 'occupation' is our domain but to me strictly 'legally' it is not and, I really don't see how it can be. That is, legally we cannot claim it to ourselves and prevent it from being practiced by others. The question is not who is the best qualified, but do others perform it, too. If walking is an occupational task, it is addressed elsewhere, if sports is an occupation (vocational or leisure) for an athelete, sports rehab is addressed by someone else (including the psychosocial aspects of it), if self-care is an important aspect of occupational performance, nurses have been endorsed by medicare to do all the teaching and training they want in institutions or homehealth. Luckily, they have chosen not to or, do not feel comfortable doing......I was worried with the term ' rehabilitation nursing', when it first came out as a skillable service under Part A SNF-PPS. Since the scope of the word "occupation" is so wide, we will see it being practiced by others, may be under a different term. In my opinion, it is more worthwhile to unleash the breadth and scope of the profession and practice it 'holistically', fully understanding that no one person can handle all the issues by themselves. You will have a mental health OT believing (or at least focusing in this area) that OT is all in the head and limbic sytem, a physical-dysfn./ hand OT believing in the word that biomechanics is what moves the world that follows the laws of physics, a hi-tech OT transforming the environment into a spaceship to ensure that life still floats, a hospice OT believing that OT lies in ensuring that even death is a 'productive goal' in life...........all still bonded by a common thread ensuring that life-functions (the occupations of living) are best facilitated and preserved. The emphasis is on identifying, addressing/ treating those 'occupations' and it's effect on life. In different settings the dominance of different factors that affect occupational performance will differ- mental (psychopathological/ sociopathological, neuropsychiatric) issues or, physical issues ( orthopedic, neurological/ sensori-motor/ neurodevelopmental, cardiovascular), etc., with the need for the emphasis to shift from one approach to another. So do the skills. In the medical model, we can just blatantly say it is based upon the pathology/ disabilty. Or, as OTs have the opportunity to put in perspective of the client's unique need and place in the social arena. Again, not 'legally' but I truelly believe our uniqueness lies as the true 'link' between medical rehabilitation and social rehabilitation ( I look at SWs as the gateway to social rehab)....how often we act as the link or the lock is the question..... Ron thanks for a good debate. Would love to hear others' viewpoints. Thanks to the ones that did respond to this thread. ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: "Joe Wells" <[EMAIL PROTECTED]> Sent: Monday, September 08, 2003 11:38 AM Subject: Re[10]: [OTlist] PT does it all!! > Hello Joe: > > Will you further explain your below statement? > > I may be wrong, but I believe that all states provide some form of OT > regulation. However, not all states provide licensure. > > What is OT's unique contribution to healthcare? What is it that we do > that no other profession can do better or equally? > > Ron > > > =============================================================== > On 9/6/2003,[EMAIL PROTECTED] wrote: > > > JW> While I hope that "occupation" is our domain, legally we cannot claim it as > JW> ours only. With a couple of states yet to regulate OT in the US, anybody can > JW> practice it there. While the principle of occupation has certainly be > JW> claimed by our profession- and, "occupation" is what we "do-mainly", it is > JW> not our domain in the strictest legal sense, since it is practiced overtly > JW> or covertly by other professions. 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