A survey of Australian mental health occupational therapists

Mental health reform in the western developed world has resulted in new models of care and changed work practices for all mental health professionals. Occupational therapists, as with other mental health professionals, have been required to assume new roles and responsibilities. Literature from the United Kingdom has reflected concern about this new way of working. The aim of this exploratory study was to examine the current work practices of and issues faced by Australian mental health occupational therapists. One hundred and forty-eight respondents (74%) answered an occupational therapy practice in mental health questionnaire. The results from this survey suggest that there are two quite distinct groups of occupational therapists working in mental health settings in Australia. One group works as rehabilitation therapists in traditional activity-focused work roles. The other group works as case manager therapists and employs a much broader spectrum of clinical and support roles. The issues facing therapists include the development and maintenance of a clearly defined role, generic case management versus discipline-specific roles, recruitment and retention, the need for research and evidence-based practice, professional standing, and education and professional development. The concerns over the role of occupational therapy in mental health were similar to those in previous British studies. The implications of these findings include a need for education and training at the undergraduate and postgraduate levels to equip mental health occupational therapists with both discipline-specific and generic skills.

Global job satisfaction and facet description: The moderating role of facet importance

Recent research support sLocke's (1976) model of facet satisfaction in which the range of affect of objectively defined facet descriptions is moderated by subjective evaluations of facet importance (McFarlin & Rice, 1992). This study examined the utility of Locke's moderated model of face t satisfaction for the prediction of organizationally important global measures of job satisfaction. A large dataset of two groups of workers allowed testing over different time periods and across a broad range of satisfaction measures. The hypothesis derived from Locke's model, that global satisfaction would represent a linear function of facet satisfaction (i.e., facet description x facet importance), was not supported. Instead, a simple (have-want) discrepancy model (operationalized as facet description) provided the most consistent set of predictors. The results suggests that workers, when providing global measures of job satisfaction, may use cognitive heuristics to reduce the complexity of facet description x importance calculations. The implications of these data for Locke's model and directions for future research are outlined.

Do personality factors predict job satisfaction?

Two studies investigated the relationships between personality traits and aspects of job satisfaction. In Study 1, job applicants (n=250) completed the Eysenck Personality Profiler and the Work Values Questionnaire (WVQ), which requires respondents to rate various work-related facets according to the extent to which they contribute to their job satisfaction. These facets were combined into two composites (hygiene and motivator) based on previous research. The three personality superfactors accounted for a small percentage of the variance in importance ratings (about 5%). In Study 2, employees (n=82) completed a measure of the 'Big Five' personality traits and the Job Satisfaction Questionnaire (JSQ), which assesses both what respondents consider as important in their work environment as well as their satisfaction with their current job. Importance ratings were again combined into two composites while job satisfaction ratings were factor analyzed and three factors, differentiated along hygiene versus motivator lines, emerged. Personality traits again accounted for a small percentage of the total variance both in importance ratings and in levels of job satisfaction. It is concluded that personality does not have a strong or consistent influence either on what individuals perceive as important in their work environment or on their levels of job satisfaction. (C) 2002 Published by Elsevier Science Ltd.

The competence of mental health occupational therapists

This research sought to investigate the self-perceived competence of mental health occupational therapists in Queensland. The research is a post-hoc analysis of survey results that formed part of the 1995 Professional Development Strategy for Adult Mental Health Services for the Queensland Health Mental Health Unit. A sample of 55 occupational therapists was compared with other professionals in relation to both general self-efficacy and efficacy in specific competencies. The devised scale for measuring self-efficacy was found to have a high level of internal reliability. The results indicated that the general self-perceived competence of occupational therapists for the whole sample was comparable to that of other professional groups, but that in the community-based sample it was significantly higher than that of social workers or nurses. In addition, occupational therapists in community settings had significantly higher general self-perceived competence than occupational therapists in hospital locations. Greater length of experience in mental health was strongly predictive of higher levels of competence for occupational therapists than for other professionals. The results suggest that occupational therapists have adapted well to the demands of multidisciplinary community practice. The possible reasons for these results, and the implications for competency-based recruitment and training, are presented.

Attachment, marital interaction, and relationship satisfaction: A diary study

The relations among measures of attachment, spouse behavior, and marital satisfaction were assessed in a broad sample of 193 married couples, using both questionnaire and diary methods. Insecure attachment was associated with less favorable reports of spouse behavior, as assessed by diary checklists. Marital satisfaction was predicted by attachment treasures and reports of spouse behavior. The relation between attachment security and marital satisfaction was moderated, but not mediated, by reported spouse behavior. Specifically, insecure individuals' evaluations of their relationships were more reactive to recent spouse behavior, an effect that was especially marked for fearful participants and for those in longer-term marriages. Some gender differences in patterns of prediction were obtained. The results are discussed in terms of the working models associated with attachment styles, and the processes by which relationship satisfaction may be eroded over time.

Mental health: How well are occupational therapists equipped for a changed practice environment?

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How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Terminally ill cancer patients' wish to hasten death

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.

Defining quality of life for Chinese elderly stroke survivors

Purpose: This study aimed to identify the constituents and conceptual characteristics of the quality of life (QOL) of Chinese elderly stroke survivors. living in the community in Hong Kong. Method: A triangulated approach was used to identify the QOL components for this population. This process involved a comparison of QOL components gathered from three different methods, namely, focus group interviews, review of the literature and the contents of the generic Hong Kong Chinese version of the World Health Organization Quality of Life Scale (CWHOQOL-HK). Five health professionals were involved in the comparison process. A percentage of inter-judge agreement was used to determine the reliability of the comparisons made between the judges. Results: This study identified 36 components considered to contribute to the QOL of Chinese elderly stroke survivors in Hona Kong. The conceptual characteristics of their QOL generally concurred with those identified in the literature. Conclusion: Both similarities and differences were found in the QOL components identified in this study when compared to those identified in studies of Western populations who are elderly and had a stroke. The contents of the CWHOQOL-HK scale were found to lack adequacy in representing the QOL of Chinese elderly stroke survivors in Hong Kong. Recommendations are given, based on the findings of this study, to overcome this limitation for its application as a QOL measure for this population.