Using Theory to Underpin an Integrated Occupational Therapy Service through the Canadian Model of Occupational Performance

Abstract

The aim of this action research study was to embed the theoretical tenets of the Canadian Model of Occupational Performance and its structures in a way that was appropriate to, and would be used by, all staff within an integrated health and social care setting. The action research involved 10 phases of reflection and action, with data analysis occurring between the cycles. The findings showed the importance of taking time to embed theory before implementing model structures in order to prevent those structures, and particularly the paperwork, becoming superficial. In addition, the importance of using theoretical structures (models) flexibly and adapting them to particular services was identified. A more generally applicable finding was that occupational therapists can and should demonstrate their theory through their practice and that this can be done by using a model to illustrate their clinical and, more specifically, their conditional clinical reasoning (Mattingly and Fleming 1994). In addition, the demonstration of clinical reasoning proved vital in making the client-centred and occupational beliefs of the model overt. It was concluded that implementing theory and using occupation-based literature (Williams and Bannigan 2008) in this way can take a long time but is worthwhile because it provides a sound and strong base for the profession's identity.

Instructing Occupational Therapy Students in Use of Theory to Guide Practice

“…This view is consistent with Boniface et al's (2008) statement that "Occupational therapy should demonstrate its theory through its practice" (p. 537) in order for occupational therapy practitioners to cement their professionalism. Ikiugu (2012) also observed that unqualified acceptance of EBP without evaluation of evidence to ensure that it validates the profession of occupational therapy could be detrimental to its unique identity.…”

“…Unfortunately, deemphasis of theory as a guide to practice may be detrimental to the well-being of the profession (Hinojosa, 2013). Use of theory to inform decision-making is what differentiates professionals from non-professionals (Boniface et al, 2008). Therefore, competent occupational therapy practitioners should be ready and able to explain how they use the profession's theoretical conceptual practice models to inform their clinical decisions.…”

Re‐visioning practice through action research

“…The new vision is true to the profession's philosophical base (Boniface et al, 2008) and aligns with the World Health Organization's (2002) emphasis on re-orientating health services to address participation outcomes. For occupational therapy, one risk of not responding to the challenge to reform and re-vision practice is that the hegemonic ideas emanating from medical, scientific and fiscal discourses that currently dominate health and social care settings (Wilding, 2011) will continue to shape and constrain the profession.…”

“…In the UK, Boniface et al (2008) achieved some success in a 4-year-long programme. This involved 270 therapists in the decision to adopt a new model of practice, by providing existing and new therapists with a formal 1-day training opportunity.…”

“…The notion of creating communities of practice, which Wegner (1998) described as small groups of practitioners brought together to work collaboratively to develop practice knowledge and skills, features in the work of Boniface et al (2008), Forsyth et al (2005 and Wilding (2008). This concept and Wilding's method provided the foundations for the study described here.…”