Date Presented 04/200/21 Using narrative responses to the Veterans Affairs Bereaved Family Survey, we have identified practice areas that fall within the OT Practice Framework (3rd ed.). Intervention in the identified OT practice areas could improve the end-of-life health care experience for both patients and providers. Narrative responses can be used to identify areas to improve quality of care and may provide initial support for implementing innovative practices. Primary Author and Speaker: Matthew Donald McCaa Additional Authors and Speakers: Megan Bewernitz, LaTonya Summers

Importance: Societal stigma gravely impedes occupational justice for transgender and gender-nonconforming (TGNC) people, producing vast health disparities for this population. Objective: To test the feasibility of an intervention to reduce stigma and improve the well-being of TGNC people. Design: A parallel, mixed-methods design was used to test feasibility in the areas of acceptability, demand, and limited efficacy. Setting: Community. Participants: Forty-two audience members and 5 TGNC interviewees. Intervention: Virtual, narrative-informed play reading and moderated discussion about gender diversity and affirmative care. Outcomes and Measures: The valid and reliable Acceptance and Action Questionnaire–Stigma was used to assess stigma beliefs. An open-ended, qualitative question assessed TGNC interviewees’ experiences. Results: Recruitment and participant responses to the intervention indicated feasibility in the areas of acceptability, demand, and limited efficacy. However, future efforts at obtaining a diverse TGNC sample are needed. Conclusions and Relevance: The intervention decreased stigma beliefs in audience members and offered a positive experience for TGNC participants. Feasibility outcomes warrant future efficacy testing. What This Article Adds: This article adds an innovative intervention for promoting occupational justice to support the health and well-being of TGNC people. The community-based intervention facilitates change in societal attitudes and stigmatizing beliefs.

Transformative learning involves the questioning of worldviews and underpins shifts in values and identity that are integral to critical occupational therapy practices. Cognitive theories of transformative learning name, but do not address, the experiential dimensions of transformation. The aim of this article is to conceptualize transformative learning from the perspective of narrative phenomenology in occupational therapy. An argument is presented that draws on research in occupational therapy professional reasoning and that makes visible the dimensions of transformation that are inherently experiential and meaning oriented. Three key concepts for a transformative pedagogy are defined and illustrated: scenes, emplotment, and embodied metaphors. The article concludes with the types of learning objectives for which this approach is suited and the pedagogical values that underpin these teaching practices. This article adds to the domain of health care education by defining and illustrating experiential and meaning-based practices as signature pedagogies for transformative learning.

OBJECTIVE. Hurricane Sandy was the second largest and costliest hurricane in U.S. history to affect multiple states and communities. This article describes the lived experiences of 24 occupational therapy students who lived through Hurricane Sandy using the Recovery Model to frame the research. METHOD. Occupational therapy student narratives were collected and analyzed using qualitative methods and framed by the Recovery Model. Directed content and thematic analysis was performed using the 10 components of the Recovery Model. RESULTS. The 10 components of the Recovery Model were experienced by or had an impact on the occupational therapy students as they coped and recovered in the aftermath of the natural disaster. CONCLUSION. This study provides insight into the lived experiences and recovery perspectives of occupational therapy students who experienced Hurricane Sandy. Further research is indicated in applying the Recovery Model to people who survive disasters.

Occupational therapists are encouraged to reflect on doing, being, and becoming not only as it relates to the development of their profession but also in their own lives ( Wilcock 1999 ). This article is a description of that process for me and my family in our journey through perinatal loss. This autoethnography uses a personally situated account of perinatal death. This article is a form of self-narrative that places me and my family in social context through the lens of an occupational therapist. This article aims to convey the meanings attached to the experience of grief and loss in the context of participation in everyday occupations. By sharing a perspective on the lived experience and connecting it to the literature on grief and occupation, readers will be able to decide if the connection holds as valid from a theoretical and clinical perspective.

OBJECTIVE. The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming. METHOD. The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah’s goals of going to preschool and becoming a friend. RESULTS. Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person–task–social context, pushing participation, and engaging in narrative micronegotiations. CONCLUSION. Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.

Engagement in two interlinked areas of occupation, familial social participation and caring for my father at the end of his life, led to a journey of self-discovery. A qualitative research methodology, autoethnography, is used to develop a narrative that examines engagement in these two occupations before, during, and after my father’s illness and death. I discuss meanings and purposes of familial social participation and caregiving, suggesting that transforming fear of death to awareness of death is a central purpose of caregiving. Implications for therapists and caregivers include considerations about the value of occupation, discussion of a continuum of caregiving, examination of boundaries when caring for a parent, thoughts about the roles of altruism, love, anger, and “bad faith” in caregiving, and analysis of sons as caregivers for fathers. Further research on meanings and purposes of caregiving is proposed.

This research examines the lived experiences of six novice occupational therapists (0–2 years experience) and eight career occupational therapists (≥ 5 years in the everyday practice in adult rehabilitation. The study focused specifically on therapists’ experiences of working together with patients and the ways in which these experiences unfolded over the course of therapy. Data were generated using a combination of phenomenological interviews with all 14 therapist-participants (Phase I) and participant observation of four therapist-patient dyads throughout the course of rehabilitation therapy (Phase II). Verbatim transcriptions of all interviews from Phase I and Phase II and field notes from Phase II were analyzed using a narrative approach. The analysis revealed that Finding Common Ground was a shared meaning of working together with patients regarding therapy goals and expectations. Findings suggest that occupational therapists may resist negotiating differences with patients over therapy goals and expectations and instead rely primarily on compatibility as the basis of finding common ground. Findings reveal the importance for occupational therapists to be (1) open to negotiating differences with patients over goals and expectations, (2) aware of the ideologies that may influence their practices, and (3) adequately prepared to deal effectively with the challenging interpersonal aspects of practice.

PURPOSE. This paper explores the importance of family daily routines and rituals for the family’s functioning and sense of identity. METHODS. The findings of this paper are derived from an analysis of the morning routines of 40 families with children with disabilities in the United States and Canada. The participants lived in urban and rural areas. Forty of the 49 participants were mothers and the majority of the families were of European descent. Between one and four interviews were conducted with each participant. Topics included the family’s story, daily routines, and particular occupations. Data on the morning routines of the families were analyzed for order and affective and symbolic meaning using a narrative approach. FINDINGS. The findings are presented as narratives of morning activities in five families. These narratives are examples for rituals, routines, and the absence of a routine. Rituals are discussed in terms of their affective and symbolic qualities, routines are discussed in terms of the order they give to family life, whereas the lack of family routine is discussed in terms of lack of order in the family. CONCLUSIONS. Family routines and rituals are organizational and meaning systems that may affect family’s ability to adapt them.

OBJECTIVE. This study aimed to examine how engagement in creative occupations informed six older retired people’s occupational identities. METHOD. Occupational narratives were gathered from in-depth interviews with 6 participants (75 years of age or older) who had extended experience of participation in creative occupations. A process of narrative-type inquiry produced summarized, chronological stories for each participant. Subsequently, a process of paradigmatic-type narrative analysis produced thematic categories related to how a sense of self is associated with creative occupational engagement in later life. RESULTS. Four themes derived from data analysis included the relevance of relational practices, changing self-awareness, enduring qualities, and reflective processes to the formation of a sense of self. CONCLUSION. This study adds to an understanding of how leisure occupations maintained across the life cycle contribute to building an occupational identity.

Objective. This study examined whether adding the Canadian Occupational Performance Measure (COPM) to existing occupational therapy evaluation measures used in a subacute skilled nursing facility unit enhanced the accuracy of therapists’ predictions of the functional status of clients at discharge. Method. This study utilized a prospective comparison design. Two independent predictive variables were developed using the standard Functional Independent Measure (FIM), and an enhanced FIM that included narrative information from the Canadian Occupational Performance Measure (FIM/COPM). These variables were subsequently compared with the actual FIM discharge (DFIM) scores for 31 clients. The primary author (D.S.) gathered data from chart review and conducted the statistical analysis. The data were analyzed using descriptive correlations (Pearson r) and comparison statistics (Wilcoxon signed rank test). Results. Comparison statistics (Wilcoxon signed rank test) revealed a statistically significant difference between the standard FIM predictive score and the discharge FIM score. No statistically significant difference was found between the FIM/COPM predictive score and the discharge FIM score. These findings suggest that predictive scores based solely on information attained from the standard FIM resulted in less accuracy in outcome predictions. Correlational analyses further supported these conclusions. Conclusion. The findings support the study hypothesis that use of the COPM in combination with the FIM enhances accuracy in prediction of outcomes for rehabilitative services for persons in adult physical disabilities settings.

Objective. This study is the first part of a longitudinal investigation of the retirement process. This stage of the inquiry concerned how older persons anticipate their retirement. Method. Thirty-two workers were randomly selected from all workers age 63 years in a suburb of Stockholm. They participated in semistructured interviews about their work and their expectations for retirement. Results. The participants’ narratives illustrated the complex work of interpreting the past and expected meaning in one’s occupational life. The narratives, which anticipated widely different future trajectories, revealed many of the challenges and dilemmas of anticipating retirement and the close association of work experience to expectations for retirement. In particular, the narratives highlighted the participants’ concerns about maintaining the quality of experience in activity. The findings also demonstrate the process by which persons anticipate and make choices about life change. Conclusions. People anticipate retirement through volitional narratives in which they link together past, present, and future. Understanding this volitional process of interpreting, anticipating, and making choices is important to understanding how people adapt to life changes.