Arthritis-Related Occupational Therapy: Making Invisible Ruling Relations Visible Using Institutional Ethnography

Abstract

Introduction: Occupational therapists' intention of enabling women with rheumatoid arthritis to participate in everyday life is fraught with challenges in everyday practice. Method: Inspired by institutional ethnography, this paper aims to make explicit how the work of occupational therapists in an outpatient rheumatology hospital setting is governed within invisible, ruling relations. An analytical description of the first author's clinical experience was a standpoint from which to explicate how occupational therapy is coordinated to the ruling relations of the Austrian health care system. Findings: Occupational therapy practice and research are ruled within a positivist, body-focused, medical apparatus, which renders largely invisible occupational therapists' knowledge of enabling people to engage in occupations that are meaningful to them. Conclusion: Occupational therapists have professional power that can be asserted by strategically using occupational therapy specific knowledge and language in textually mediated practices, from assessments and case files to media images, to give greater visibility and influence to the profession's work of enabling occupation.

Enacting Occupation-Based Practice: Exploring the Disjuncture between the Daily Lives of Mothers with Rheumatoid Arthritis and Institutional Processes

“…White et al (2013) recently investigated the role of occupations for people with chronic health conditions and found that engagement in occupations empowers individuals to manage and overcome challenges of a chronic health condition. Nevertheless, based on a review of arthritis-specific literature (Prodinger et al 2012), there were only a few studies where occupational engagement in the lived context was addressed. Rather, the majority of studies addressed bodily functions without any attention to individuals' occupations.…”

“…Such a paradigm has at its core a focus on the occupations that individuals choose to engage in, as well as the possibilities and resources that individuals have in their daily lives (Costa 2011). However, as noted by Prodinger et al (2012), occupational therapists are not always able to deliver an occupational approach in practice due to the setting in which they work. Limitations in practice settings may not be easily identifiable, yet they may hamper occupational therapists in assisting their clients to achieve optimal occupational outcomes or goals.…”

“…Others have identified that the capacity of occupational therapists to enact occupation-based practice is limited by the nature of the setting in which practice takes place. For example, if the focus within an institutional setting is predominantly on disease and disease-related issues, enacting an occupation-based paradigm in occupational therapy may constitute a challenge (Prodinger et al 2012, Townsend et al 2003, Wilding and Whiteford 2007.…”

Negotiating disability in everyday life: ethnographical accounts of women with rheumatoid arthritis

“…Despite this comprehensive, multidimensional and interactive conceptualization of disability, in the area of RA, which is the area of practice in which this study is located, disability remains to be frequently investigated in reference to persisting functional limitations of the individual [7][8][9][10]. Next to the body of knowledge on functional limitations of people with RA, there is an increasing body of knowledge about the impact of RA on society in terms of direct and indirect costs.…”

Can professionals actually enable occupational justice?

“…The awakening to occupational injustice beyond social injustice was to identify the occupational continued, for instance, questioning the influences of occupations on physical, mental and spiritual health (e.g., BRYANT, 2010; BRYANT et al, 2011;MARMOT et al, 2012;PRODINGER et al, 2012;PUUMALAINEN, 2011;WILCOCK, 2006;WILSON et al, 2008).…”