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Daily Tip:
Community development program in a rural setting
08.22.07 (5:34 pm)   [edit]
The purpose of this assignment is to discuss the implications of implementing a community development program in a rural setting. The community development project that was completed in the second year of the occupational therapy degree was a leisure activity and lifestyle redesign program for people over 65. Discussion will be made of the challenges that need to be overcome to implement a community development program in a rural area. Older adults in small rural communities have different needs to those in large metropolitan areas. Factors such as lifestyle, location, government and access shape the occupational needs of this population. The development and implementation of programs that aim to promote participation in community activities, particularly in rural areas, are important for health promotion (Savage, Bailey & O'Connell, 2003, p. 156). The use of participatory action research will enable a cohesive group to develop that nurtures the self-reliant character of the elderly members and enhances occupational performance and participation (Cockburn & Trentham, 2002, p. 21). The original program was a community 'introduction to leisure activities' program for people in the Cessnock area who were over 65 years. The program was intended to improve occupational performance through participation in a range of leisure options. Jackson, Carlson, Mandel, Zemke, and Clark (1998, p. 326) state that occupation can be used to acquire friendship with fellow participants. The program was intended to run over eight weeks with group and individual interventions. The Positive Ageing Strategy for the Hunter (2004) provided 36 needs that were identified for the elderly, therefore the program focused on the occupational needs of social participation, relationships, and community involvement. The Australian Institute of Health and Welfare (2005) stated that in the Cessnock region fifty-two percent of community aged care package recipients lived alone. The long-term goals of the program were to enhance health and increase occupational functioning, community involvement and life satisfaction (Australian Association of Gerontology [AAG], 2000, p. 6). The program was suitable for 15 participants in the group with 2 occupational therapists facilitating the sessions. Leisure activities included Tai Chi, book club, Line Dancing, and a Cinema outing. Rubin, Chan, and Thomas (2003, p. 29) state that the leisure satisfaction questionnaire is a valid standardized assessment measure. This was used alongside non-standardized methods of evaluation and program review. According to the rural, remote, and metropolitan areas classification system with a population of approximately 45,000 Cessnock is a large rural center (Cessnock City Council, 2007; Rural Doctors, 2005). In smaller rural communities it is equally important for individuals to have access to opportunities that allow for involvement and interaction. There is continuing change in small rural communities causing implications for the growing ageing population (Foskey, 1998, p. 1). An out-migration of the younger population in small rural communities increases the proportion of peoples aged over 65 (Larson, 2006, p. 552). When younger people leave the small rural communities there is a disruption to the social support systems that exist for the ageing individuals (Foskey, 1998, p. 3). Local governments are limited with the services they can provide to the community with an often insufficient budget from money raised through property tax and state government grants. Local governments are responsible for the construction and maintenance of roads, bridges, streets, guttering, drainage and health care services (Australian Bureau of Statistics, 2004). The provision of appropriate access to community facilities and leisure options are often unmet. Older people from small rural communities have been described as self-reliant and self-sufficient (de la Rue & Coulson, 2003). One of the reasons for this is that the rural lifestyle often forces people to continue working and completing large amounts of hard tasks daily. This lifestyle causes people to have a different perception of health and what is meaningful and often results in occupational imbalance (de la Rue & Coulson, 2003). Savage, Bailey and O'Connell (2003, p. 154) completed a study that assessed the relationship well health had with participation in community activities. Using scales to measure physical and mental health the researchers found that people over 65 years were among the groups that had the lowest community participation rates (Savage, Bailey & O'Connell, 2003, p. 156). An example of rural ageing issues is evident within a study conducted by Wythes and Lyons (2006, p. 531) with a group of retired Australian men in a rural area. The phenomenological study identified how hobbies and leisure interests can assist in maintaining meaning after retirement. Wythes and Lyons (2006, p. 539) states that friendships and social contacts play an important part in enhancing life experiencing after retirement in small rural communities. The participants expressed feelings of loneliness when contact was lost with people they associated with during their working career (Wythes & Lyons, 2006, p. 539). A programme suitable for similar rural target groups will be beneficial for improving occupational performance and meaning. Due to the issues that exist specific to the rural environment a leisure programme as the one previously described is not suitable for a small rural community. The aim of the programme will remain the same, in that it is still intended that a lifestyle redesign will achieve occupational performance (Jackson, Carlson, Mandel, Zemke, & Clark, 1998, p. 326). It is still the goal to increase community involvement, encourage interaction between participants and to allow individuals to develop an interest and sense of belonging (AAG, 2000, p. 6). The biggest change will be the method of delivery and the content of the programme. A community development programme using a participatory action research approach is an appropriate choice for the rural community culture. In small rural communities there is a strong sense of meaning in productivity, with quality of life being attributed to ones perceived ability to continuing to contribute (Foskey, 1998, p. 6). Participatory action research is used to empower people to produce action (Polit & Beck, 2006, p. 226). This approach will allow the well elderly members of the community to define their own problem and needs, develop their approach and collaborate their efforts to produce an end product (Polit & Beck, 2006, p. 226). The occupational therapist will play a guidance role rather than facilitate or lead the group. The group members will be responsible for involving other members of the community through surveying people to find out what the community feels would be beneficial in the area. Group members also have the opportunity to explore their creativity and recognise their strengths (Polit & Beck, 2006, p. 227; Meyer, 2006, p. 274). The approach will create a task-oriented group. The group will be able to identify roles for the members such as leader, treasurer, and public liaison. These roles will enhance the sense of the purpose and responsibility that the well elderly, particularly recent retirees in small rural communities are seeking (Finlay, 2003, p. 21; de la Rue & Coulson, 2003). The second change to the programme is the duration. The original programme ran for eight weeks. This programme is designed to be a permanent group. The participatory action research phases will take approximately three months to complete and will require the occupational therapist to form a partnership with the group members throughout the research and design process (Cockburn & Trentham, 2002, p. 26). After the completion of the project the group will have the skills, confidence and ability to continue contributing to the community. Another important change to the original lifestyle program is the method of collection for participants. The participants for the original programme were to be targeted via representatives from the Aged Care Assessment Team [ACAT] and Home and Community Services [HACS] (Hunter Health, 2004). Due to the value system and way of life in the rural environment, the well elderly target group would most likely not be accessing ACAT or HACS. Information packages included introductory letters will be sent to the community members directly, and also be available through the general practitioner if one in available. In small rural communities older people who work voluntarily are already providing many services (Foskey, 1998, p. 4). One of the services is the provision of community transport. This is a consideration that needs to be accounted for as in the original programme transport to and from the weekly meeting was provided by the local hospitals community patient transport bus. It is also important to hold the meetings central to the participants' homes. Payne's Crossing, a small rural community lies within the Cessnock City Council for local government area and health care services, however it is 43 kilometres from the regional center (Cessnock City Council, 2007; Gregory's, 2006, p. 913). Therefore it would not suitable for a group designed for this community to be held at the Cessnock Community Center. Occupational therapists work with older people normally at an individual level. They often have involvement with the rehabilitation process, home safety, sensory stimulation, life reviews, and the provision of equipment (Carlson, Fanchiang, Zemke, & Clark, 1996, p. 89). These interventions are targeted at the frail aged and often result from referrals after the person has accessed the hospital services. Occupational therapists new to small rural communities, may find it difficult to be accepted by the community. Using participatory action research as the basis for the new programme will provide the occupational therapist will an opportunity to be introduced to the wider community (Loos, Oldenburg, & O'Hara, 2001, p. 226). The initial phases of the needs assessment research provides the therapist with valuable information about the background of the community (Loos, Oldenburg, & O'Hara, 2001, p. 226). It is also important that the occupational therapist recognises that occupational performance abilities slowly decline as people age and develop the programme at an appropriate level for the participants to achieve success (Hayase, Mosenteen, Thimmaiah, Zemke, & Atler, 2004, p.197). In small rural communities occupational therapists largely work as sole practitioners. A lack of access to resources and equipment has been identified as a challenge for rural therapists (Devine, 2006, p. 208; Lee & Mackenzie, 2003, p. 36). A community development programme such as this one can involve community stakeholders and group members can use community fundraising activities to build the pool or resources available for the project to be done. Instead of working in the health care system there is possibilities for occupational therapists to work with government and non-government agencies (World Federation of Occupational Therapists, 2004). Occupational therapists have a potential for a role in developing and implementing programmes at a community level to benefit the ageing population. Additional funding from these organisations will assist with resources for the implementation of new programmes. Some therapists have identified that a distinction between personal and professional life is difficult to attain in small rural communities (Devine, 2006, p. 209). It is important to embrace the rural culture and lifestyle. Support community events and allow time to develop a balanced relationship with the community. Long working hours, independent administrative and management responsibility, and a lack of direct professional support are the cause of further challenges that need to be overcome by occupational therapists in small rural communities (Lannin & Longland, 2003, p. 185). Lannin and Longland (2003, p. 185) also discussed the need for individual therapists to take initiative and be responsible for their continuing professional development. Compared to urban-based therapists the access to ongoing professional development for rural-based therapists is non-equivalent. It is still possible for therapists to access distance education modules and videoconference support (Lannin & Longland, 2003, p. 186). Community development programmes that are suitably developed and implemented in small rural communities will give the individuals an opportunity to continue community involvement through participation and interaction as well as potentially having long-term benefits for the community. References Australian Association of Gerontology. (2000). Ageing well, ageing productively. Retrieved March 9, 2007, from http://aag/asn/au/policy/ pdf_... Australian Bureau of Statistics. (2004). National regional profile: regional statistics, local government area, Dungog. Canberra, Australian Capital Territory: Author. Retrieved March 9, 2007, from AusStats database. Australian Institute of Health and Welfare. (2005). Upward trends for community aged care packages continues. Retrieved August 28th, 2005, from http://www.aihw.gov.au/mediac... Carlson, M., Fanchiang, S., Zemke, R., & Clark, F. (1996). A meta-analysis of the effectiveness of occupational therapy for older persons. American Journal of Occupational Therapy, 50(2), 89-98. Cessnock City Council. (2007). Cessnock city council: Community profile. Retrieved May 9th, 2007, from http://www.id.com.au/cessnock... Cockburn, L. & Trentham, B. (2002). Participatory action research: integrating community occupational therapy practice and research. Canadian Journal of Occupational Therapy, 69(1), pp. 20-30. de la Rue, M. & Coulson, I. (2003). The meaning of well-being: voices from older rural women. Rural and Remote Health, 3. Retrieved March 9, 2007, from AUSTHealth database. Devine, S. (2006). Perceptions of occupational therapists practicing in rural Australia: A graduate perspective. Australian Occupational Therapy Journal, 53(3), 205-210. Hayase, D., Monsenteen, D., Thimmaiah, D., Zemke, S., Atler, K., & Fisher, A.G. (2004). Age-related changed in activities of daily living ability. Australian Occupational Therapy Journal, 51, 192-198. Finlay, L. (1993). Groupwork in occupational therapy. London; Chapman & Hall. p.21. Foskey, R. (1998). Ageing in small rural communities. Australian Institute of Family Studies Conference. Retrieved March 9, 2007, from http://0-www.aifs.gov.au Gregory's. (2006). Street Directory: Maxi. (18th ed.). Macquarie Park, New South Wales; Universal Publishers. Hunter Health. (2004). Aged care and rehabilitation services. Retrieved May 14th, 2007, from http://www.hunter.health.nsw.... Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark, F. (1998). Occupation in lifestyle redesign: The well elderly study occupational therapy program. American Journal of Occupational Therapy, 52(5), 326-336. Lannin, N. & Longland, S. (2003). Critical shortage of occupational therapists in rural Australia: Changing our long-held beliefs provides a solution. Australian Occupational Therapy Journal, 50(3), 184-187. Larson, A. (2006). Rural health's demographic destiny. Rural and Remote Health, 6, 511. Lee, S. & Mackenzie, L. (2003). Starting out in rural New South Wales: the experiences of new graduate occupational therapists. Australian Journal of Rural Health, 11, 36-43. Retrieved March 9, 2007, from AUSTHealth database. Loos, C., Oldenburg, B., & O'Hara, L. (2001). Planning of a community-based approach to injury control and safety promotion in a rural community. Australian Journal of Rural Health, 9(5), 222-228. Retrieved May 9, 2007, from AUSTHealth database. Meyer, J. (2006). Action Research in, K. Gerrish and A. Lacey (Eds.). The research process in nursing. (5th ed.). Oxford, UK; Blackwell Publishing. Polit, D.F. & Beck, C.T. (2006). Essentials of nursing research: Methods, appraisal and utilization. (6th ed.). Philadelphia, PA; Lippincott, Williams & Wilkins. Positive Ageing Strategy for the Hunter. (2004). Research report. Retrieved November 4th, 2005, from http://www.dadhc.nsw.gov.au/N... Rubin, S.E., Chan, F., & Thomas, D.L. (2003). Assessing changes in life skills and quality of life resulting from rehabilitation services. Journal of Rehabilitation 2003(3) 29 Rural Doctors. (2005). Rural, remote, metropolitan areas (rrma) classication. Retrieved May 9th, 2007, from http://www.ruraldoc.com.au/Ab... Savage, S.A., Bailey, S.R., & O'Connell, B. (2003). Health status and participation in a range of activities in an Australian community. Rural and Remote Health, 3, 154-166. Retrieved May 10th, 2007, from AUSTHealth Database. World Federation of Occupational Therapists. (2004). Relations with international organisations. Retrieved May 15, 2007, from http://www.wfot.org/inside.as... Wythe, A.J. & Lyons, M. (2006). Leaving the land: An exploratory study of retirement for a small group of Australian men. Rural and Remote Health, 6, 531-543. Retrieved May 10th, 2007, from AUSTHealth Database.
 
occupational therapy in palliative care with a lady with cancer
08.22.07 (5:29 pm)   [edit]
excerpt from a larger speech... According to the World Federation of OTs, our basic paradigm is no different for palliative care, that is, our primary goal is to assist people to be as independent or involved in activities and roles that they consider important in their lives. In palliative care there are two main themes of the OT role, purposeful activity and quality of life. (WFOT, 2004) Purposeful activity involves facilitating involvement in usual life experiences within a person’s occupational capacity and volition, as well as help them adapt to changing roles in order to enhance meaning, esteem, and control. For Jane, a main aim is to achieve a level of independence that she is satisfied with, in everyday activities, as her level of independence will be challenged with the progression of cancer. These goals neeed to be constantly reset depending on her disease progression and fluctuation. (Kielhofner, 2002, p.15) Quality of life involves exploring what brings meaning and value to ones life with a focus on the present moment. For Jane, this means enabling her to be engaged in activities that are important to her. These can be reminiscence activities such as making a DVD to be played at her daughters wedding day, because of the great importance given to expressing human relationships through occupation when a person knows they are approaching death. (Burkhardt, 2006, p.1165; Pollard, 2006, p.149) As the OT role involves helping people redefine and explore their life roles it is extremely important to consider the role Jane has of being terminally ill. Although occupational and spiritual needs can be overshadowed by the terminal care process, the occupation of dying is an intense experience for both Jane and her family. We can engage Jane to celebrate her achievements, communicate something about herself, and create a sense of closure. An intervention may be expressive art or redeveloping an interest in past creative interests. (Pollard, 2006, p.151) A study by Cooper and Littlechild identified the use of the following interventions as being commonly used by OT’s working with terminally ill oncology patients such as Jane; cognitive/ perceptual and home assessments, self care, transfer, and mobility training, equipment provision and pressure care, education, and symptom control for relaxation, stress, fatigue, and anxiety as well as psychological support and recreational therapy. (Cooper & Littlechild, 2004, p. 330) In palliative care, establishing a personal connection is important for an effective therapeutic relationship. In Pochnau, Liu, and Boman’s qualitative study of OT experiences working in palliative care, they found the following are vital for the therapist to maintain wellness. Self-nuturance including reflection and self-expression through activity, satisfaction of giving themselves (or therapeutic use of self) and coping through venting and debriefing. (Prochnau, Lui, Boman, 2003, p.199) A challenge of working in a multi-disciplinary team in palliative care, is to create effective and appropriate coordination of the team. This is to share our unique skills with the team and address the complex needs of Jane and her family. In palliative care especially there is a need for evidence based care and professional integration. Research has shown that it is important to incorporate aspects of interprofessional educational programs as they have proven to be cost effective and have led to improvements to patient care. It is important to understanding the role of the other team members for example in Jane’s case, it may be valuable for her and Bob to attend emotionally focussed couples therapy, conducted by the psychologist. As studies have shown the effectiveness of this therapy for couple facing end of life cancer. (Koffman & Higginson, 2005, p.262; McLean & Jones, 2007, p.603; Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998, p.53)
 
last semester of uni
08.22.07 (5:26 pm)   [edit]
am in my last semester of uni got electives this semester decided to take philosophy with critical thinking and argument using pure logic, truth tables and logical deduction. had my first exam yesterday, it was rather stressful. only just had enough time, my friend got to the last question which was worth 30% and only had 1 minute 19 seconds, shes the one thats stressing. i have a speech this afternoon to give. i'll put that up for u in a few