HEALTH

This
essay discusses the contribution of occupations in health and well-being.  It starts by introducing some key term and
definitions. In order to understand the role of occupation in health and
well-being clearly, it is important to understand how health and well-being are
defined overtime.  

 

As
the name implies, occupation therapy is concerned with enabling people to
achieve health and well-being through occupation. Occupation is at the centre
of Occupational therapy. The word occupation is derived from the general concept
of occupying one self and seizing control of one’s self (Clark et., 1991). Despite
the effort of many eminent occupational therapists and associations there is no
single generally accepted definition of occupation. The term occupation tends
to be used interchangeably throughout literature with two other terms: task and
activity. Recently occupation
has been described as the dominant ‘activity’ of human beings, usually
consisting of self-care, work and leisure (Kielhofner, 2009) and as purposeful
activity, which engages an individual’s time, energy and attention (Reed &
Sanderson, 1983). Occupations are not any kind of activities, they have a sense
of purpose and meaning ranging from basic needs to human self-actualisation.
Understanding of occupation requires careful examination of the doing, the
doer, the context or situation in which the occupation is found, and the
relationships among these elements (book). It is also important to see
occupation as subjective experience, participation alone is insufficient,
individual subjective experience of occupation has far greater influence in
health (Canadian journal). According to Wilcock (1999) the simplest way to
describe occupation is as a synthesis of doing, being and becoming. Thus,
occupation is not simple what is done but instead it encompasses engagement,
individual’s occupational identity and performance. (Canadian journal).

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Occupation
performance and engagement

There is strong relation between occupation and health
and well-being. However, ideas about what is health and well-being are different
according to cultural and spiritual philosophies, socially dominant and
individual views, the type of economy and the health technology available
(Wilcock 1996).  The term health has
lacked a definitive definition. The current World Health Organisation
definition of health, formulated in 1948 describe health as state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity. The main criticism of the definition is, it unintentionally
contributes to the medicalisation of society and the requirement for complete
health would leave most people unhealthy most of the time (M Huber 2011).  Recently the World Health Organisation (WHO) (2001) introduced the
International Classification of Functioning Disability and Health (ICF), which
focuses on how people live with health conditions and can achieve satisfying
productive lives (Baum, 2003).  It
suggests health is an interaction between bodily function, activity engagement
and participation as influenced by environmental and personal factors (Baum,
2003). However, wellbeing is a subjective experience, mainly people relate it
to pleasure and happiness. It encompasses mental, physical and social
dimensions. But, physical well-being is the aspect that has received the most
attention and the easiest to understand. In an 80s Resource Centre for Health
and Well-being Brochure, wellbeing is defined as “a state that transcends the
limitation of body, space, time, and circumstances and reflects the fact that
one is at peace with one’s self and others” (Johnson and Schmit, 1986). (Description). More
recently well-being has also been defined within the health promotion
fraternity as: – a subjective assessment of health- which is less concerned
with biological function than with feeling such as: self-esteem and a
sense” of belonging through social integration (Wilcock 1996).  (Description)

Discuss
why occupation is considered important to the health and well-being of humans

To understand how occupation, contribute to health and
well-being, it is important to consider the question through biological
perspective. Anna Wilcock, an eminent occupational scientist, argued that
occupation is essential to individuals and species survival, because the basic
biological needs for substances, self-care, shelter, and safety are met through
the things people do (Wilcock 1993). Understanding occupation is immensely
complex. The three elements- people, occupation and environment and their
dynamic relationship helps to explain why understanding the nature of
occupation is difficult. Occupation keeps us alive. In the long term,
occupation can provide, the physical activity, mental stimulation, and social
interaction we need to keep our bodies, minds and community healthy. In
addition, through participation in occupation, we express ourselves, develop
skills, experience pleasure and involvement, and achieve the things we believe
to be important (Willard and spackman’s 11 edition). Mary Catherine Bateson, a
well-known anthropologist and author wrote: the capacity to do something useful
for yourself or others is the key to personhood, whether it involves the
ability to earn a living, cook a meal, put on shoes in the morning, or whether
other skill needs to be mastered at the moment (Bateson, 1999). That is, people
use occupation to develop an understand of who they are, what they might do,
the context in which they might act, who they might become (Hocking 2001). A
notable study of how occupation influences health and wellbeing was Clark et
al.’s (1997) a randomized controlled trial examining the dynamic interplay
between occupation, health, and well-being of healthy, community dwelling older
adults. Clark et al. determined that participating in a meaningful occupation
enhanced participants’ physical and mental health, occupational functioning,
and life satisfaction. Another recent report “Healthy people 2020” prepared for
the us government is one of the many authoritative sources asserting that
physical activity helps maintain healthy weight for people of all ages and
strength and agility in older adults. That report also associate good mental
health with productive occupations, noting that mental illness often results in
people being unable to manage their responsibility as parents and partners
(Healthy people 2020, nd).  Conversely
people who are unable to participate in their choice of occupation, for
whatever reasons, can suffer from occupation imbalance, deprivation and
alienation. Occupation balance is very important, doing too little, doing too
much or doing things that expose us to risk can have deteriorating effect. As there
is intrinsic relationship between occupation, activity, health and wellbeing,
therefore occupation can be used to regain and promote good health (RCOT 2003).

Occupation
performance.

Occupation performance refer to the ability to choose and
satisfactory perform meaningful occupations that are culturally defined, and
appropriate for looking one’s self, enjoying life, and contributing to the
social and economic fabrics in a community (CAOT, 2002).  Occupation performance is the result of the
interaction between the person, occupation and environment.  Change in the environment can affect person, occupation
and occupation performance. Alternatively, change in the person or occupation
can bring change in the environment.

  Explain the
role of occupational therapists in enabling people to achieve or restore
well-being

The role of occupational therapist is to inform, support,
facilitate and provide opportunity for clients to perform activities in order
to promote function, quality of life, and the realisation of potential (COT
2003). Occupational therapists understand the interaction between the person,
the environment and the activities they need to accomplish in their daily life.
Thus, they help clients by motivating them to take an active role in a
meaningful activity, monitor the therapeutic environment to minimise barriers
and by providing solutions to challenges related with routines and changing
habits.

  Describe
the occupational therapy process

Occupational therapy intervention is a
process of collaboration and negotiation between the therapist, client and
carer in which the client is helped to identify his/her problems and/or goals
and to find effective ways of dealing with them.

The occupational therapy process stages appear to be
simple but occupational therapists must have enough knowledge and skills to
work with clients to enable occupation. The therapeutic relationship between
the client and the occupational therapist is very important, as both parts are
participating in the process and bring different experience.  The main purpose of the occupational therapy
process is to provide structure so that occupational therapist can address client’s
health-related problems based on evidence. According to McColl and Pranger it
serves to “instruct therapist about how to intervene to produce a desired
effect” (1994, p.251).  The process is
neither condition- (i.e., diagnosis, condition, disorder) nor age-specific and
can be applied in any practical setting-hospitals, outpatient clinic, schools,
workplace, or clients home (Willard and Spackman’s 2014 p 265).  Occupational therapy practitioners customise
the process with the end goal of supporting the client’s health and
participation through engagement in occupation (AOTA 2018).  Occupational therapy process is unique as it uses
occupation as an end goal and means to achieve the goal. In the words of fisher
(2009), if we are to practice as occupational therapy practitioners, we must
use occupation as our primary form of therapy. Creek (2003) describes 11 stages: referral or
reason for contact; information gathering; initial interview; reason for
intervention/needs identification/problem formulation; set goals; action plan;
action; ongoing assessment; outcome and outcome measurement; end of
intervention or discharge followed by a final review. The occupational
therapist starts by looking at the client’s range and balance of occupation,
both current and feature range of activities, tasks or skills that will
remediate the deficit and enable the client to enact his or her occupation more
effectively (COT 2003). Having identified where the problem is, the practitioner
shifts the focus inward in to activities, tasks and skills that are meaningful
to the client and can enable the client to perform his/her occupation
effectively. At the end of the process the therapist shifts the focus outwards
again to see what effect the intervention has had on the client’s overall
pattern of occupations (RCOT 2003).   

occupational therapist needs to select specific
theoretical approaches for use with a particular client.   

Models of practice help to organize how one views and
assesses the things about a person or their environment that support or limit
their performance (Fisher 1998).  Models
of occupation therapy helps the transition of occupation therapy theory in to
practice. Specific benefits of the occupational therapy models of practice can
include adding structure and organisation to everyday practice, providing a
transparent guide and direction to intervention, improving communication and
collaboration within occupational therapy and across disciplines, and
facilitating evidence-based, client-centred and professional reasoning practices
(Hussey, et al., 2007). MOHO is one of the models of occupational therapy. It was
introduced in 1980s and continue to be refined up to three decades later
(kielhofner 2008). MOHO considers human beings to be an open system consisting
of volitional, habituation, and performance capacity and considers how these
three aspects interact with each other and the environment. It helps
practitioners to understand how occupation is motivated, organised, performed
and affected by the environment.  

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