Experiences of occupational therapists addressing clients’ religious and spiritual concerns in occupational therapy practice. American Occupational Therapy Association Annual Conference Charlotte, NC April 29, 2006. Laura Feeney, MS, OTR/L Susan Toth-Cohen, PhD, OTR/L. - PowerPoint PPT Presentation
Experiences of occupational Experiences of occupational therapists addressing clients’ therapists addressing clients’ religious and spiritual concerns in religious and spiritual concerns in occupational therapy practice occupational therapy practice Laura Feeney, MS, OTR/L Laura Feeney, MS, OTR/L Susan Toth-Cohen, PhD, OTR/L Susan Toth-Cohen, PhD, OTR/L American Occupational Therapy Association Annual Conference Charlotte, NC April 29, 2006
Transcript
Experiences of occupational Experiences of occupational therapists addressing clients’ therapists addressing clients’
religious and spiritual concerns religious and spiritual concerns in occupational therapy practice in occupational therapy practice
Laura Feeney, MS, OTR/LLaura Feeney, MS, OTR/LSusan Toth-Cohen, PhD, OTR/L Susan Toth-Cohen, PhD, OTR/L
American Occupational Therapy Association Annual ConferenceCharlotte, NC April 29, 2006
What do We Know About What do We Know About Spirituality and Health?Spirituality and Health?
Overall, research findings suggest that there is a positive relationship between Overall, research findings suggest that there is a positive relationship between aspects of spirituality, such as religious involvement or prayer, and achievement aspects of spirituality, such as religious involvement or prayer, and achievement
of positive health outcomesof positive health outcomes
Spirituality and Positive Health
Outcomes
Spirituality and Improved Mental
Health and Emotional Well-being
Patient Views about Spirituality and Healthcare
How are spirituality and OT related?How are spirituality and OT related?..it is imperative to consider spirituality in OT practice, in order to support ..it is imperative to consider spirituality in OT practice, in order to support the client’s ability to engage in occupations and participate in life activities.the client’s ability to engage in occupations and participate in life activities.
(Egan & DeLaat, 1997)(Egan & DeLaat, 1997)
Practice Framework
Theories
Holism
Christiansen (1997) views this discrepancy between theory and practice as a lost opportunity Christiansen (1997) views this discrepancy between theory and practice as a lost opportunity to “understand the full potential of occupation to enhance the health and well-being of clients” to “understand the full potential of occupation to enhance the health and well-being of clients” ((p. 171).p. 171).
Few OT Few OT practitioners practitioners address spirituality address spirituality in their practicein their practice
Interviewed Canadian therapists who address spirituality Interviewed Canadian therapists who address spirituality in their practicein their practice
Findings: Four themes describing their experiencesFindings: Four themes describing their experiences1.1. addressing religious concernsaddressing religious concerns 2. addressing suffering2. addressing suffering3. encouraging the self3. encouraging the self 4. growing as a person4. growing as a person
Limitations:Limitations: 1.1. Little information on the actual content of the interactions Little information on the actual content of the interactions
between therapists and clients was presented between therapists and clients was presented 2.2. Canadian and U.S. healthcare systems are different, it is Canadian and U.S. healthcare systems are different, it is
uncertain to what extent findings are applicable to U.S. uncertain to what extent findings are applicable to U.S. occupational therapistsoccupational therapists
Purpose and ObjectivesPurpose and Objectives The purpose of this study is to explore the experiences of The purpose of this study is to explore the experiences of
occupational therapists (OTs) who address religious and occupational therapists (OTs) who address religious and spiritual concerns of clients in adult physical rehabilitation.spiritual concerns of clients in adult physical rehabilitation.
Objectives:Objectives: DescribeDescribe the ways in which occupational therapists the ways in which occupational therapists
practicing in adult physical rehabilitation address clients’ practicing in adult physical rehabilitation address clients’ religious and spiritual concernsreligious and spiritual concerns
IdentifyIdentify supports and barriers to addressing spiritual supports and barriers to addressing spiritual concerns in practiceconcerns in practice
ExploreExplore the influence of a therapist’s own faith tradition the influence of a therapist’s own faith tradition and beliefs on his/her experience of addressing clients’ and beliefs on his/her experience of addressing clients’ religious and spiritual concerns in practicereligious and spiritual concerns in practice
MethodsMethods
Qualitative design – phenomenologyQualitative design – phenomenology to accurately understand the lived experience of to accurately understand the lived experience of
participants (Krefting, 1991, van Manen, 2000). participants (Krefting, 1991, van Manen, 2000). Data gathered through semi-structured interview Data gathered through semi-structured interview
and participant reflection papers and participant reflection papers interviews lasting 1-2 hrs focused on eliciting details of interviews lasting 1-2 hrs focused on eliciting details of
participants’ experiences in addressing religious or participants’ experiences in addressing religious or spiritual concerns with their clientsspiritual concerns with their clients
participants composed a reflection paper describing an participants composed a reflection paper describing an experience in which (s)he addressed religious or spiritual experience in which (s)he addressed religious or spiritual concerns with a client. concerns with a client.
Why Phenomenology?Why Phenomenology? To understand what it is like To understand what it is like
when OTs address spiritual or when OTs address spiritual or religious concerns in everyday religious concerns in everyday practicepractice
To get a sense of how OTs do this To get a sense of how OTs do this -the essence of the experience, as -the essence of the experience, as they encounter patients/clients they encounter patients/clients with religious or spiritual with religious or spiritual concerns concerns (vs. what they think about what (vs. what they think about what should/should not happen—though a sense of this should/should not happen—though a sense of this emerges through their experiences)emerges through their experiences)
Sampling and Sampling and ParticipantsParticipants●●Theoretical sampling used for this project.Theoretical sampling used for this project.
●●Participants were limited to those with at Participants were limited to those with at least five years experience. least five years experience.
● ● 7 women, 1 man (ages 43-57)7 women, 1 man (ages 43-57)
Religious Background of Participants
Jewish
Catholic
Protestant
Other
32
21
3-part phenomenological analysis (Van Manen, 1990, p. 93) 3-part phenomenological analysis (Van Manen, 1990, p. 93)
Each researcher independently:Each researcher independently:
identified thematic phrases capturing participants’ identified thematic phrases capturing participants’ essential experience of addressing religious or spiritual essential experience of addressing religious or spiritual concernsconcerns
reflected on each transcript in terms of the four reflected on each transcript in terms of the four “existentials” of “existentials” of lived body, lived time, lived space,lived body, lived time, lived space, and and lived human relationlived human relation..
developed developed essential themes,essential themes, using the process of using the process of “imaginative variation” “imaginative variation”
ExistentialsExistentials How it feltHow it felt Perceptions of timePerceptions of time Their work Their work
environmentenvironment Relationships with Relationships with
others, especially others, especially the patient/client—the patient/client—but also with but also with administration, administration, employeesemployees
Lived bodyLived body Lived timeLived time Lived spaceLived space Lived human Lived human
Member checking process Member checking process Participants reviewed..Participants reviewed..
Chart of strategies used to address clients’ Chart of strategies used to address clients’ religious and spiritual concernsreligious and spiritual concerns
Table listing main themesTable listing main themes Continued contact with participants Continued contact with participants
Essential ThemesEssential ThemesThe Experience of Addressing Patients’/Clients Religious or Spiritual Concerns in Practice means that the OT …
o Is client-centeredo Is characterized by a holistic view of the patient/cliento Is influenced by personal beliefs but does not impose these beliefs on patient/cliento Experiences a personal connection with the patient/client
Essential ThemesEssential Themes
□ Uses what is important to client as start point or basis for therapy
-Observes client’s environment, language, and behaviors as cues to spirituality
-Focuses on client’s religious or spiritual beliefs
-Makes activities meaningful
Client-centered
Care Holistic view
of person
Personal Spiritual
Beliefs
Personal Connection
w-Client
□ Views client as a whole person with varied needs, including spiritual
□ Assesses client’s spiritual needs through initial evaluation
□ Incorporates spiritual/religious activities into therapy sessions
□ Strong personal spiritual beliefs influence how/ why therapist addresses spirituality in practice - personally participates in spiritual or religious activities -values religion/spirituality -refuses to impose beliefs on client
□ Develops a caring relationship
- Personal emotional component to treatment
- Importance of giving hope and support
Essential ThemesEssential Themes
□ Uses what is important to client as start point or basis for therapy
-Observes client’s environment, language, and behaviors as cues to spirituality
-Focuses on client’s religious or spiritual beliefs
-Makes activities meaningful
Client-centered
Care Sample Quotes ““This was her moment, this was This was her moment, this was
her therapy session, and I let her therapy session, and I let her decide what she wanted to her decide what she wanted to do with it.” (P1)do with it.” (P1)
““I think more when I do hand I think more when I do hand therapy than in almost any other therapy than in almost any other field are they that self-directed field are they that self-directed at what they want out of it, at what they want out of it, which is their prerogative and which is their prerogative and so, then I follow that lead.” (P3)so, then I follow that lead.” (P3)
““You go with the flow with what You go with the flow with what they’re going with, talking about they’re going with, talking about God.You look around the room God.You look around the room and see what they’ve got, what and see what they’ve got, what they’re interested in.” (P6)they’re interested in.” (P6)
Essential ThemesEssential Themes Holistic view
of person
□ Views client as a whole person with varied needs, including spiritual
□ Assesses client’s spiritual needs through initial evaluation
□ Incorporates spiritual/religious activities into therapy sessions
“ “ If we hadn’t addressed If we hadn’t addressed [his ability to participate [his ability to participate in a religious practice—in a religious practice—ritual bath], he would ritual bath], he would have accepted not have accepted not addressing it, but we addressing it, but we would have lost good would have lost good opportunities for good opportunities for good rehab within the context rehab within the context of who he is.”of who he is.” (P4) (P4)
Sample Quotes
Essential ThemesEssential Themes
““I think everybody seeks something I think everybody seeks something bigger than themselves and then bigger than themselves and then when they’re in a period of crisis when they’re in a period of crisis they want to pursue that and I they want to pursue that and I know how that is for me so I just know how that is for me so I just offer some encouragement in that offer some encouragement in that area.” (P3)area.” (P3)
““I feel like [addressing their I feel like [addressing their concerns] is part of who I am, and concerns] is part of who I am, and it’s part of why I am here.”it’s part of why I am here.” (P5) (P5)
“…“…because I’m spiritually based, I because I’m spiritually based, I probably approach everybody…sort probably approach everybody…sort of speaking to that higher being in of speaking to that higher being in them.” (P7)them.” (P7)
Sample Quotes
Personal Spiritual
Beliefs
□ Strong personal spiritual beliefs influence how/ why therapist addresses spirituality in practice - personally participates in spiritual or religious activities -values religion/spirituality -refuses to impose beliefs on client
Essential ThemesEssential Themes
““Sometimes just by the connection of having Sometimes just by the connection of having a caring person, who is your therapist, a caring person, who is your therapist, sometimes having them stop what they are sometimes having them stop what they are doing and give you your full attention. I feel doing and give you your full attention. I feel like that can help a person through the like that can help a person through the grieving process to feel that connection that grieving process to feel that connection that someone does care.” (P2)someone does care.” (P2)
““Namaste means that when I am in that Namaste means that when I am in that place of God within myself and you are in place of God within myself and you are in that place of God within yourself, we are that place of God within yourself, we are one. And so it sort of is uniting a place that one. And so it sort of is uniting a place that we unite. And I think that certainly when we unite. And I think that certainly when I’m speaking deeply and intimately with my I’m speaking deeply and intimately with my patient I feel like we are often in that place. patient I feel like we are often in that place. That therapeutic moment is connecting at That therapeutic moment is connecting at that place, of shared one-ness.”that place, of shared one-ness.” (P7) (P7)
Sample Quotes Personal
Connection w-Client
□ Develops a caring relationship
- Personal emotional component to treatment
- Importance of giving hope and support
VideoVideo
Participant Participant comments on comments on essential essential themesthemes
StrategiesStrategies You will discuss You will discuss
strategies you use to strategies you use to address religious or address religious or spiritual concerns, with spiritual concerns, with others at this session others at this session
We will then regroup, We will then regroup, discuss briefly, then discuss briefly, then present a case study of present a case study of a patient who presented a patient who presented with spiritual concernswith spiritual concerns
Strategies OTs Used to Address Strategies OTs Used to Address Spiritual or Religious Spiritual or Religious
Concerns in Practice with Concerns in Practice with Adults with Physical Adults with Physical
DisabilitiesDisabilities Discuss with patientDiscuss with patient Work to improve patient’s Work to improve patient’s
performance skills and patterns performance skills and patterns related to religious or spiritual related to religious or spiritual practicepractice
Decrease patient anxietyDecrease patient anxiety Use tools/areas related to religion Use tools/areas related to religion
for therapyfor therapy
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns Discuss with Discuss with
patient/clientpatient/client
• Assist patient’s coping strategies Assist patient’s coping strategies • Help patient identify resources Help patient identify resources • Identify ways to overcome the Identify ways to overcome the
effect of a person’s condition on effect of a person’s condition on the religious/ spiritual aspects of the religious/ spiritual aspects of his/her life his/her life
• Pairing patients with othersPairing patients with others
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns Discuss with patient/client (Discuss with patient/client (Sample Sample
Quotes)Quotes)
• ““And there are [religious] services in the And there are [religious] services in the hospital and they don’t even know about it, and hospital and they don’t even know about it, and I do make sure that I can tell them about I do make sure that I can tell them about those.”those.” (P1) (P1)
• I say, “you know, somebody’s really struggling I say, “you know, somebody’s really struggling and she’s talking about, you know, she doesn’t and she’s talking about, you know, she doesn’t want to pray anymore and she feels defeated. I want to pray anymore and she feels defeated. I noticed that you’ve found this and this and this noticed that you’ve found this and this and this really helpful, do you mind if I schedule you at really helpful, do you mind if I schedule you at the same time and maybe you could have some the same time and maybe you could have some dialog about that?”dialog about that?” (P3) (P3)
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Work to improve patient’s Work to improve patient’s performance skills and performance skills and patterns related to religious patterns related to religious or spiritual practiceor spiritual practice
• IADL – Work on meal preparation IADL – Work on meal preparation related to religious holidays related to religious holidays
• IADL – Practice functional mobility IADL – Practice functional mobility needed to attend/participate in needed to attend/participate in services services
• ADL- Transfers ADL- Transfers • ADL- Energy conservation and rest ADL- Energy conservation and rest
breaksbreaks• IADL- Standing tolerance IADL- Standing tolerance • ADL- Self Care (i.e. Dressing ADL- Self Care (i.e. Dressing
appropriately before being seen in appropriately before being seen in public) public)
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Work to improve patient’s Work to improve patient’s performance skills and patterns performance skills and patterns related to religious or spiritual related to religious or spiritual practicepractice ((Sample Quotes)Sample Quotes)
• ..a lot of times it’s about food prep. The apple ..a lot of times it’s about food prep. The apple cakes and…the Seders and the things like that. cakes and…the Seders and the things like that. And that’s important to them so then it’s And that’s important to them so then it’s important to us to let them be able to do that, important to us to let them be able to do that, adapting things.adapting things. (P8) (P8)
• ““[there are] very concrete situation[s] when you [there are] very concrete situation[s] when you know they have spiritual or religious practices know they have spiritual or religious practices um, we try to incorporate them, when um, we try to incorporate them, when appropriate into therapy. So I’ve had folks who appropriate into therapy. So I’ve had folks who practice Islam. We’ll see if we can adapt, if they practice Islam. We’ll see if we can adapt, if they can’t or have a hard time getting to the floor. can’t or have a hard time getting to the floor. Ah, that might actually be a good opportunity to Ah, that might actually be a good opportunity to get the body to practice that or to adapt the get the body to practice that or to adapt the environment for their prayers.”environment for their prayers.” (P4) (P4)
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Decrease patient anxietyDecrease patient anxiety
• Progressive relaxation Progressive relaxation • MeditationMeditation• Use of humor Use of humor • Centering Centering • Stress management Stress management
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Decrease patient anxietyDecrease patient anxiety ( (Sample Quotes)Sample Quotes)• ““I do a stress management class for the pulmonary I do a stress management class for the pulmonary
patients. One of the things we discuss is spiritual patients. One of the things we discuss is spiritual belief—meditation, prayer, as stress busters.”belief—meditation, prayer, as stress busters.” (P2) (P2)
• ““I will help them establish awareness of their inner I will help them establish awareness of their inner body states, physical states. And I always link that to body states, physical states. And I always link that to um, some really relaxation, centering techniques… um, some really relaxation, centering techniques… And when we talk about centering, I start them off And when we talk about centering, I start them off with a breathing component that is very concrete with a breathing component that is very concrete and physical.”and physical.” (P4) (P4)
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Uses tools/areas related to religion Uses tools/areas related to religion for therapyfor therapy
• Reading the Bible/Torah/Koran, etc. Reading the Bible/Torah/Koran, etc. • Having therapy in a chapel-like environmentHaving therapy in a chapel-like environment
Strategy for Addressing Spiritual or Religious ConcernsStrategy for Addressing Spiritual or Religious Concerns
Uses tools/areas related to religionUses tools/areas related to religion for therapy for therapy ((Sample Quotes)Sample Quotes)
• “…“…if they were in the middle of their prayers, or if they were in the middle of their prayers, or if they were in the middle of reading their Bible if they were in the middle of reading their Bible or the Koran, then I’d ask them to stand up and or the Koran, then I’d ask them to stand up and have them read it…” (P6)have them read it…” (P6)
• ““I’ll set up the pews to be as they would be in I’ll set up the pews to be as they would be in their church as they describe them, and then we their church as they describe them, and then we practice then getting out of the wheelchair or practice then getting out of the wheelchair or walking, using a walker, exploring what it would walking, using a walker, exploring what it would be like to have to get through people.” be like to have to get through people.” (P4) (P4)
Add new photo here…I can
collect these and add
Problem Solving:Case StudyProblem Solving:Case Study Watch the video:Watch the video:
What ideas do YOU have for What ideas do YOU have for addressing the person’s concerns?addressing the person’s concerns?
Please classify into ADL, IADL, Please classify into ADL, IADL, educationeducation
What barriers and supports would What barriers and supports would you find if treating the person at you find if treating the person at YOUR workplace?YOUR workplace?
How would you utilize the How would you utilize the supports and get beyond the supports and get beyond the barriers to provide intervention>barriers to provide intervention>
