Syllabus
OT9631 Practice in Context I Course Description
Clients’ occupational engagement is strongly related to the micro- and meso-environmental features that affect functional performance and engagement. In this course, micro- and meso-environmental features will be explored in depth whereas the macro-meso-environmental features will be addressed to a lesser extent. The course will be delivered in three modules, each addressing a different practice context.
Practice Contexts
This course will focus on occupational therapy in acute and rehabilitation practice in hospital and community-based contexts across the lifespan.
Course Content
Module 1: Acute Physical Health.
a. This module will explore OT treatment within physical health acute care settings. b. A variety of diagnostic categories will be addressed including: orthopaedics, neurology,
cardiovascular, oncology, and burns.
c. Specific diagnoses or health conditions addressed in this module include: hand injuries, joint replacement, cerebrovascular accident, spinal cord injury, Parkinson’s, delirium, myocardial infarction, leukemia and carcinomas.
d. Treatment approaches commonly used in acute care and their theoretical underpinnings will be explored including: splinting/orthotics, positioning/transferring/handling specific to conditions, motor relearning, facilitation of mobility, energy conservation, palliative care, pain management, death and dying, burn garments, and compression therapy.
e. Other acute care related issues will also be addressed such as: caseload prioritization, team skills, awareness of the hospital-based system, and some assessments commonly used in acute care such as the Chedoke McMaster Stroke Assessment and the Ashworth Scales of Spasticity.
Module 2: Rehabilitation Physical Health.
a. This module will explore occupational therapy treatment within physical health rehabilitation settings.
b. A variety of diagnostic categories will be addressed including: rheumatology, neurology, orthopaedics, cardiopulmonary, and endocrinology.
c. Specific diagnoses or health conditions that will be addressed include: rheumatoid arthritis and/or juvenile arthritis, spinal cord injury and/or spina bifida, cerebral vascular accident and/or cerebral palsy, acquired brain injury, multiple sclerosis, amputations, chronic pain, falls and fractures, chronic obstructive pulmonary disease and diabetes.
d. Treatment approaches commonly used in rehabilitation care settings and their theoretical underpinnings will be explored including: chronic disease self management, chronic pain management, joint protection, neurodevelopmental therapy, dysphagia, constraint-induced
therapy, cognitive-perceptual rehabilitation, residual limb care, prosthetic training, and foot care.
e. Other rehabilitation related issues will be addressed including: discharge and decisional capacity, sexuality, caregiver burden, the home care system, the long term care system, and Department of Veterans’ Affairs funding.
Module 3: Acute and Rehabilitation Mental Health.
a. Treatment of mental health issues and conditions in both the acute and rehabilitation settings will be addressed in this module.
b. A variety of diagnostic categories will be addressed including: psychotic disorders, mood disorders, anxiety disorders, developmental disorders, cognitive disorders, substance-related disorders, and personality disorders.
c. Specific diagnoses or health conditions that will be addressed include: schizophrenia, depression, obsessive compulsive disorder, agoraphobia, autism, developmental
coordination disorder, conduct disorder, dementia, substance use/induced disorders, and borderline personality disorder.
d. Treatment approaches commonly used in mental health and their theoretical underpinnings will be explored including: psychosocial rehabilitation, psychotherapies (cognitive
behavioural therapy, dialectical behaviour therapy, rational emotive behaviour therapy, and group therapy), relaxation training, Cognitive Orientation to Daily Occupational
Performance (CO-OP), applied behaviour analysis, social stories, and play/work activity based therapy.
e. Other issues related to mental health treatment such as discharge and decisional capacity, medications, self help and consumer initiatives, as well as corrections and financial systems will also be addressed.
Professional Perspectives
In the foreground, this course focuses on health and rehabilitation sciences, evidence informed practice, professional reasoning and client-centred practice in the acute and rehabilitation contexts. In the background, the course draws upon knowledge of human occupation, critical social and cultural theories, and ethical practice.
Client Populations
Modules in this course may focus on one or more of three sectors of the population – children and youth, adults, and older adults. Clients experiencing physical and mental health issues will be included in this course.
Objectives
This course develops intermediate and advanced competencies that students will utilize in their remaining placements and throughout the rest of the curriculum. Specific competencies that will be addressed in this course include:
Competence Level Attained (B, I, A)1 E. 1 “Competent” Expert in Enabling Occupation
E. 1.1 Function effectively as a client-centred expert in occupation, occupational performance, and occupational engagement.
E. 1.1.1 Demonstrate expertise in occupations, occupational performance, and occupational engagement with clients. E. 1.1.2 Advocate for the client and occupational therapy to create
positive first point of contact with client based on a referral, contract request, or the occupational therapists’ recognition of the real or potential occupational challenges.
E. 1.1.3 Incorporate the client’s perspective on meaning and relevance of needs and plans.
E. 1.1.4 Establish positive therapeutic relationships with clients that are characterized by understanding, trust, respect, honesty, and empathy.
E. 1.1.5 Demonstrate skills in client-centred practice including mediation, negotiation, awareness and respect for client.
Specifically, students will:
a. Demonstrate knowledge of the OPPM and their responsibility to be client-centred when working with clients across the lifespan. b. Act in a client-centred manner if any consumers come into classes
or labs as guest educators.
c. Explore barriers to client-centred, occupation-based interventions in the acute care environment and ways to overcome these. E. 1.2 Recognize the limits of personal expertise.
E. 1.2.1 Demonstrate insight into personal limitations and expertise. E. 1.2.2 Recognize situations where occupation, occupational
performance, and related processes should be limited or discontinued.
E. 1.2.3 Demonstrate effective, appropriate, and timely consultation with other health professionals as needed for optimal client service. E. 1.2.4 Arrange follow-up services for a client within their specific
circumstances. A I A A A A I A A 1
Specifically, students will:
a. Engage in self appraisal of skill
b. Address termination of services, interprofessional collaboration, and discharge planning in case study treatment plans
E. 1.3 Perform a complete and appropriate assessment of occupational performance.
E. 1.3.1 Establish a shared understanding of occupation and occupational performance issues with the client.
E. 1.3.2 Engage clients to clarify values, beliefs, assumptions, expectations, and desires.
E. 1.3.3 Assess the occupational performance in relevant areas, including self-care, productivity, and leisure; and within the context of roles, demands, expectations, goals and settings, and spiritual values of the client.
E. 1.3.4 Identify the client’s strengths and resources.
E. 1.3.5 Identify the strengths and resources of the occupational therapist in relation to the client’s needs.
E. 1.3.6 Assess cognitive, affective, connotative (e.g., meaning, values), and physical components related to occupation and occupational performance issues identified.
E. 1.3.7 Seek out and synthesize relevant information from other sources, such as family, caregivers, and other professionals. E. 1.3.8 Use appropriate investigative methods in an effective and ethical
manner throughout the assessment process. Specifically, students will:
a. Develop comprehensive but realistic assessment plans for case studies
b. Incorporate assessment findings and client preferences in case study treatment plans
c. Develop further knowledge and skills in administering standardized and non-standardized assessments
d. Explore ways to discuss sensitive matters with clients and families (e.g., wishes related to death and dying)
E. 1.4 Apply core expertise and professional reasoning.
E. 1.4.1 Apply relevant and current knowledge of the physical, social, psychosocial, environmental, and fundamental biomedical and social sciences to practice.
E. 1.4.2 Demonstrate sound use of relevant models, frameworks, and theories of occupational therapy.
E. 1.4.3 Demonstrate effective problem solving and judgment to address client needs. A A A I A I I A A A I
E. 1.4.4 Mediate or negotiate common ground or agree not to continue practice.
Specifically, students will:
a. Develop theory-based and coherent treatment plans for case studies
b. Be able to explain their clinical reasoning for a treatment plan E. 1.5 Synthesize assessment findings and reasoning to develop a targeted
action plan.
E. 1.5.1 Analyze tasks and activities relevant to occupational performance issues.
E. 1.5.2 Determine resources required for service delivery while identifying any limits or constraints on the various service delivery methods.
E. 1.5.3 Identify priority occupational issues and possible occupational goals.
E. 1.5.4 Analyze physical, cultural, social, and institution environmental impact on occupational performance issues.
E. 1.5.5 Analyze and propose physical design options to increase inclusion and accessibility in the built environment.
E. 1.5.6 Formulate and document possible recommendations based on best explanations.
E. 1.5.7 With client participation and power sharing as much as possible, develop the desired realistic, measurable, understandable, and targeted outcomes consistent with client values and life goals. Specifically, students will:
a. Develop realistic treatment plans for case studies that address pertinent occupational performance issues and micro- and meso-environmental barriers
b. Articulate these plans in SMART objectives
c. Identify the human and material resources necessary to implement the proposed plan of treatment
d. Articulate the clinical reasoning that led them to propose this plan of treatment
e. Be able to justify the recommendations included within a treatment plan (e.g., for splints, assistive technology, and/or environmental modifications)
E. 1.6 Demonstrate skilled and selective use of occupation and interventions to enable occupation.
E. 1.6.1 Consult, advocate, educate, and engage the client through occupation to implement the process.
A A A A A A A A A
E. 1.6.2 Implement targeted action plans relevant to the person, occupation, and environment.
E. 1.6.3 Propose physical design options to increase inclusion.
E. 1.6.4 Incorporate cultural, social, physical, and institutional options to increase inclusion.
E. 1.6.5 Implement interventions in an effective and ethical manner. E. 1.6.6 Adapt or redesign the plan as needed in monitoring progress
regularly.
E. 1.6.7 Document conclusion/exit and disseminate information and recommendations for next steps (e.g., discharge, coordinated transfer, or re-entry).
Specifically, students will:
a. Demonstrate splinting techniques at an intermediate level
b. Demonstrate NDT intervention techniques at an intermediate level and cognitive retraining techniques at a beginner level
c. Demonstrate psychotherapeutic techniques at a beginner level d. Explain both content and methods for client education (e.g., joint
protection/work simplification)
e. Articulate plans for monitoring and adjusting intervention f. Explain how to determine appropriate discharge timing g. Include discharge plans into treatment planning
A A A I A A E. 2 “Competent” Communicator E. 2.1 Engage in effective dialogue.
E. 2.1.1 Demonstrate active listening.
E. 2.1.2 Deliver information in a respectful, thoughtful manner. E. 2.1.3 Use plain language that is understandable.
E. 2.1.4 Respond to non-verbal cues.
E. 2.1.5 Employ approaches which encourage participation in decision-making.
E. 2.1.6 Appropriately communicate information related to the client’s occupational engagement and occupational performance. E. 2.1.7 Adapt communication approach to ensure that barriers to
communication (e.g., language, hearing loss, vision loss, inability to communicate verbally, cognitive loss) do not impact the client’s ability to direct their own care process.
E. 2.1.8 Employ teaching aids, written materials, and other resources that support effective communication.
Specifically, students will:
a. Communicate appropriately and effectively with consumers who come into classes or labs as guest educators
b. Discuss plans for communication with clients, family care givers, and colleagues as part of the treatment plan
A A A A A A A I
c. Identify strategies for effectively teaching clients (e.g., joint protection/work simplification)
E. 3 “Competent” Collaborator
E. 3.1 Work effectively in interprofessional and intraprofessional teams. E. 3.1.1 Demonstrate an understanding of the roles and responsibilities
of team members.
E. 3.1.3 Include the client as active team member whenever possible. E. 3.1.6 Work with team members to assess, plan, and provide an
integrated approach to services for clients.
E. 3.1.7 Respect team ethics, including confidentiality, resource allocation, and professionalism.
Specifically, students will:
a. Discuss interprofessional team collaboration as part of their treatment plans
b. Address client and family member contributions to treatment planning and implementation
E. 3.2 Effectively work with the team to manage and resolve conflict. E. 3.2.5 Demonstrate support for interprofessional team function. Specifically, students will:
a. Address interprofessional collaboration as part of their treatment plans
A A A A
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E. 4 “Competent” Practice Manager
E. 4.1 Manage day-to-day professional practice and career.
E. 4.1.1 Effectively and appropriately prioritize professional duties, including when faced with multiple clients and competing needs. E. 4.1.2 Allocate therapy services while balancing client needs and
available resources.
E. 4.1.3 Balance work priorities and manage time with respect to client services and practice requirements.
Specifically, students will:
a. Develop realistic intervention plans for case studies
b. Discuss how to set priorities within a busy acute care environment c. Address human and material resources needed to implement
proposed plans
E. 4.3 Supervise support personnel in occupational therapy.
E. 4.3.3 Develop a detailed understanding of the competencies of support personnel on the intraprofessional team.
E. 4.3.4 Assign appropriate work activities to support personnel working on the team. A A A A I
Specifically, students will:
a. Discuss which, if any, tasks associated with implementation of proposed treatment plans will be assigned to support personnel b. Assign duties to support personnel appropriately
c. Explain processes to appropriately supervise support personnel in relation to duties assigned
E. 5 “Competent” Change Agent
E 5.1 Advocate for the occupational potential, occupational performance, and occupational engagement of clients.
E. 5.1.1 Assist the client in obtaining funding and services, as necessary and appropriate, so as to achieve outcomes identified in the action plan.
E. 5.1.3 Balance the ethical and professional issues inherent in client advocacy, including altruism, autonomy, integrity, social justice and idealism.
E. 5.1.4 Manage the conflict inherent between the advocacy role for a client and the manager of finite services and resources. Specifically, students will:
a. Include in treatment plans information on accessing funding, where relevant
b. Propose realistic treatment plans for case studies c. Discuss how to set priorities in busy acute care settings
E. 5.2 Advocate for occupational needs related to the determinants of health, well-being, and equity for clients served.
E. 5.2.1 Identify the determinants of health of the clients served, including barriers to access services and resources.
E. 5.2.2 Identify vulnerable or marginalized clients among those served. E. 5.2.3 Advocate appropriately for the vulnerable or marginalized clients
to enable participation through occupation. Specifically, students will:
a. Discuss safety risks for clients (e.g., abuse)
b. Discuss mechanisms for advocating for client’s safety (e.g., Children’s Aid Society, patients’ rights advocate)
c. Address eligibility for community services as part of discharge planning
d. Discuss impact of education and health literacy on development of home treatment programs I I I I I I
E. 6. “Competent” Scholarly Practitioner
E. 6.1 Maintain and enhance personal competence through ongoing learning. E. 6.1.1 Conduct a regular assessment of personal learning needs. E. 6.1.3 Regularly review new knowledge and determine applicability to
I I
practice.
E. 6.1.4 Integrate new learning and evidence into practice. Specifically, students will:
a. Engage in self-appraisal of skill and learning within the course and seek assistance as necessary
b. Reflect on how to apply course learning in clinical settings E. 6.2 Critically evaluate information to support client, service, and practice
decisions.
E. 6.2.1 Critically appraise best evidence in order to address client, service, or practice questions.
Specifically, students will:
a. Seek evidence related to any intervention proposed
b. Be able to provide evidence to justify treatment recommendations E. 6.3 Facilitate the learning of clients, the team, and others.
E. 6.3.1 Identify the learning needs and desired learning outcomes of learners.
E. 6.3.3 Demonstrate effective teaching and assessment approaches. Specifically, students will be able to:
a. Develop client and family (home) therapy programs that are appropriate to the needs and abilities of the learners
I A I B E. 7 “Competent” Professional E. 7.1 Demonstrate ethical practice.
E. 7.1.1 Demonstrate appropriate professional behaviours, including honesty, integrity, commitment, compassion, respect, and altruism
E. 7.1.3 Comply with codes of ethics.
E. 7.1.4 Recognize and appropriately respond to ethical issues encountered in practice.
E. 7.1.5 Comply with client confidentiality, privacy practice standards, and legal requirements.
E. 7.1.6 Maintain appropriate relationships and boundaries with clients. Specifically, students will:
a. Behave in an ethical manner in relation to consumers who may come into classes or labs
b. Propose treatment plans that do not violate ethical principles (e.g., no breech of confidentiality when working with clients’ families) c. Understand legal responsibilities in practice (e.g., reporting of
abuse) A A I A A
d. Discuss how to establish equitable distribution of services in busy acute care settings
E. 7.2 Demonstrate commitment to competent practice.
E. 7.2.2 Comply with professional and regulatory practice standards. E. 7.2.3 Demonstrate a commitment to competent occupational therapy
practice.
E. 7.2.4 Maintain personal competence. Specifically, students will:
a. Propose treatment plans that comply with professional standards b. Behave professionally in classes and labs
c. Take responsibility for their own learning in the course E.7.3 Display awareness of diversity and the power issues involved in a
professional relationship.
E. 7.3.1 Demonstrate awareness of professional privilege and sensitivity to client issues related to professional privilege and client power. E. 7.3.2 Respect diversity including, but not limited to, the impact of age,
gender, religion, sexual orientation, ethnicity, cultural beliefs, and ability on participation and shared decision making. E. 7.3.3 Attend to diversity in providing services with respect to clients’
needs, values, and goals Specifically, students will:
a. Interact professionally with any consumers who come into classes or labs
b. Explore tensions in planning a client-centred treatment plan when the therapist disagrees with the client and/or family
c. Reflect on personal attitudes and how these may affect therapeutic relationships and treatment planning (e.g., attitudes and comfort level regarding death & dying)
A A I I I I
E. 8 Knowledge of Self and Others
E. 8.1. Demonstrate knowledge of personal values and assumptions. E. 8.2. Regularly reflect on the self in relationship to practice.
E. 8.3. Demonstrate therapeutic awareness interactions with clients.
E. 8.4. Intentionally interact with clients in a way that establishes and maintains a therapeutic relationship (Taylor, 2008).
Specifically, students will:
a. Explore tensions in planning a client-centred treatment plan when the therapist disagrees with the client and/or family
b. Reflect on personal attitudes and how these may affect therapeutic relationships and treatment planning (e.g., attitudes and comfort
I I I I
level regarding sexuality, attitudes and comfort level regarding death and dying)
Educational Approach Discourse.
Students will engage in learning through discourse by participating in class and case discussions. Students will engage in professional communication with faculty members, peers, and guest educators (clients and clinicians).
Responsibility.
Students will engage in responsibility to self through appropriate preparation for classes and labs and will demonstrate responsibility to others through constructive contributions to the learning environment. Ethical reasoning will inform discussions regarding treatment planning that is realistic and supports equitable treatment of all clients.
Experiential Learning.
