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The popularity of alternative therapies in the past two decades has been accompanied by a proliferation of sociological works in investigation different aspects of this phenomenon. A major strand of the literature in ‘the sociology of alternative medicine’, which concerns three social actors: users of alternative therapies, practitioners of alternative therapies; and physicians (the orthodoxy). Research on users of alternative medicine has mainly investigated the causes of people’s use of these modalities and has focused on why people use alternative medicine?
Research suggests the one reason people use alternative therapy, such as Occupational Therapy, is that they are dissatisfied with the health outcomes of orthodox medicine (Holden, 1978; West, 1988; Sharma, 1996; Spiegel et al., 1998). It is argued that conventional medicine has been unable to cure degenerative and chronic illness and has failed to alleviate pain associated with conditions such as arthritis, and back and neck injuries (Ingliss and West, 1983; Anyinam, 1990). Sharma’s (1992) qualitative study of 30 users of various alternative therapies in Britain, including Occupational therapist. Provided support to the idea that patients seek alternative therapies in order to cure an illness that has not been successfully dealt with by GPs. Similarly, Furnham and Smith (1988) and Furnham and Forey (1994) in their British studies compared patients of GP’s and patients of alternative practitioners and showed that the latter group was ore sceptical of the efficacy of orthodox medicine. They reached this conclusion based on the responses of subjects to statements such as ‘Doctors relieve or cure only a few problems that their patients have’, and ‘Most people are helped a great deal when they go to a doctor’.
Other arguments have been made about the use of alternative therapies, looking at how patients aren’t necessarily dissatisfied with the health outcome of biomedicine, but rather they are dissatisfied with the medical encounter or the doctor patient relationship (Parker and Tupling, 1976; Taylor, 1984; Easthope, 1993). According to this argument in the literature, doctors spend too little time with, and have little respect for, their patients, who often are not informed of the nature of their illnesses, diagnoses and prognoses. It is argued that doctors have lost their human touch and today’s medicine can best be characterised as Fordist medicine which produces alienated and dissatisfied patients. In support of this argument, Sharma’s (1992) interviews with alternative therapists’ clients reveal that they believe GPs spend too little time with patients. Furnham and Forey (1994) also found that users of alternative medicine are more likely to believe that GPs do not listen to what their patients have to say.
According to Nelson (1997) Occupational therapists understand the potentials of various occupational forms that are meaningful and purposeful to the individual. The therapist hopes and predicts that the occupational form will be perceptually, symbolically, and emotionally meaningful to the person; that the occupational form and the meanings the person actively assigns to it will result in multidimensional set of purposes, and that the person will engage in a voluntary occupational performance. In other words, when therapy is best, the person is full of purpose.
Therefore Occupational therapists have a huge concern set around the promotion of health.
Thorogood (2004) argues that sociology as a discipline is based on critical analysis and as such, can contribute to health promotion by focusing on questions that go beyond simple definition. In other words sociology can and should engage in debate around why health promotion has evolved the way it has rather then merely trying to establish a static definition of health promotion itself. In this way sociology can help health promotion to be reflective in terms of its role and development.
While this means sociology is distinct from health promotion, it is none the less a crucial contributor to the development and practice of health promotion.
Ryan et al (2006) approach to health promotion states that it has been hugely influenced by the fact that medicine has been the dominant model within health-service provision and a clear division exists between those who support the medical model of health and those who argue for a more holistic and/ or social model of health. Within health services, models of care are fairly well understood and well established as conceptual entities.
Models of Health Care
Looking at the bio-medical model, Atkinson (1988) discusses how within this model health is the absence of biological abnormality, it believes diseases have specific causes, that the human body is likened to a machine to be restored to health through personalised treatments that arrest, or reverse, the disease process, and that the health of a society is seen as largely dependent on the state of medical knowledge and the availability of medical resources.
Bio-medicine and the health care practices arising from it occupy a paradoxical position in contemporary societies. On the one hand, there is continued enthusiasm for new medical breakthroughs as people seek treatment for an increasing range of conditions. On the other hand, there is also some disillusionment with clinical medicine and growing distrust of doctors etc. despite massively increased investments in medical research and health care, most of the diseases of modern society remain stubbornly resistant to effective treatment, let alone cure.
Health professionals and doctors in particular, have been criticised for having a detached, impersonal approach. Some have linked this to the bio-medical model objectifying illness and reducing patients to little or more then a collection of symptoms.
Critics such as Oliver (1996) have argued that more attention should be given to the social, psychological and political aspects of illness and disability.
Professionals such as Occupational Therapist have responded to this by looking beyond the medical model and adopting a more person-centred approach to patient care.
In this context, sociologists are interested in the ways that individual experiences of illness are shaped by wider social contexts, emphasising that the transition from health to illness involves significant changes in social status and therefore the attention of governments and an increasing number of health professionals has turned to the social and environmental influences on health giving rise to a new social- medical model approach to health based on disease prevention and health promotion.
Taylor & Field (2007) focuses on how health is more than the absence of disease; it is a resource for everyday living. It looks at how diseases are caused by a combination of factors, many of them being environmental. The focus of enquiry is on the relationship between the body and its environment and how significant improvements in health care are mostly likely to come from changes in people’s behaviour and in the conditions under which they live.
Occupational therapists draw their attention on this model and it can be understood in there inter-related approaches.
The first focuses on individual behaviour and lifestyle choices, the second looks at peoples immediate social environment, and their relationships with others and the third is concerned with general socio-economic and environmental influences.
The emergence of a new philosophy sometimes referred to ‘postmodern’ value system has also led to the rise in alternative therapies (Bakx, 1991; Easthope, 1993; Sharma, 1993). Today most people regard nature as caring, gentle, safe and benevolent; they hold anti-science and anti-technology attitudes (Kurtz, 1994;Park 1996); they believe in a holistic view of health (Anyinam, 1990); they reject authority, especially scientific authority, and demand participation (Taylor, 1984; Easthope, 1993; Riessman, 1994); and they believe in individual responsibility (Cassileth, 1989; Coward, 1989). Alternative practitioners, such as Occupational therapist, commonly use natural and non-invasive treatments, espouse a holistic view of health, allow patients participation in the process of healing (Aaskter,1989), and stress that health comes from within the individual and it is ultimately the responsibility of the individual to achieve a desired state of health.
Sussman (p.31) looks at the holistic concept of behaviour stresses an organic and/ or functional relationship, a continuing interaction, and a fundamental interdependence among the traditionally defined “parts” or “areas” of human behaviour. Accordingly, the understanding of any aspect of human behaviour or any human problem involves consideration of the potentialities and limitations inherent in human biology; the characteristic ways of feeling, thinking, acting, and relating to other that comprise personality; the nature of physical environment, including natural resources, topographical features, and the man-made environment; the social nature of and the impact of significant social or reference groups; the nature of culture, its potentialities and the limitations it imposes; and the significance of time and mans orientation to time as a key factor in the ordering and regulation of behaviour.
In many respects, the holistic philosophy represents a reaction against certain forms of fragmentation and compartmentalisation which have characterised both scientific investigation and the approach to human problems during the first half of the 20th century. Implementation of the holistic approach is seen today in the growing body of research which crosses traditional discipline lines and in the renewed emphasis on comprehensive medicine, comprehensive mental health, and a comprehensive approach to a broad spectrum of human problems including delinquency, alcoholism, unemployment, disability etc. the holistic approach is compatible with an increasing awareness of the tendency for various forms of pathology to occur in clusters.
Medical Care and Professionalism
Medical care, once dominated by a restricted orthopaedic orientation, is now based on a growing recognition of the basic relationship between the anatomical, physiological, biochemical, and psychological functioning of the human body, and the reciprocal relationship between a disabled person’s body functioning manifestation of his personality and his capacity to fulfil basic roles in job, family and community.
In contrast, look at the study undergone by â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦
All participants found that Occupational therapy was being underutilised. One reason provided for this was the lack of understanding about the role of OT by other staff members. Participants of this study felt that the perspective of OT as more of a rehabilitation service and less as a holistic service had an impact on the low use of OT, this being within a hospice setting. They found OT was often “defined too much by exercises or functional tasks, and not recognising functional tasks become even more critical to someone who is becoming weaker and weaker and is in the process of dying.”
The hallmark of professionalism has been accountability for the application of expert knowledge to the service of others (Goode, 1960) Accountability includes both the obligation to answer questions regarding decisions and/or actions and the availability and applications of sanctions for illegal or inappropriate actions and behaviours (Brinkerhoff, 2004) health professionals have historically been accountable to their regulatory bodies for their autonomous exercise of professional judgment in determining services provided (Abbott, 19988). In recent years, the traditional approach to health professional accountability has been called into question for several reasons, one being escalation health expenditures (Degeling, 2000). Because all professional decisions related to health care have financial implications, this control has frequently translated into greater limits on professional practice.
Occupational Therapy and Rehabilitation
Sussman’s (1965) work on the sociology of rehabilitation is well recognised and has the support of the American Sociological Association. The book emerged from a conference on “Sociological Theory, Research and Rehabilitation” held in Carmel, California in March 1965.
According to Sussman, public interest in the concept of rehabilitation has greatly intensified in recent years. The term rehabilitation is being broadly applied to many kinds of disabling human problems, including physical disability, mental illnesses, mental retardation, alcoholism, drug addiction etc. Rehabilitation is used in both a limited and very comprehensive sense. It may refer to services concerned with education, physical functioning, psychological adjustment, social adaptions, vocational capabilities, or recreational activities.
Occupational therapy rehabilitation can involve one of several types of therapy, used together or separately, to help patients enter or re-enter the workforce. This can include physical therapy, counselling, and job training. The overall goal of these therapies is to remedy any situation that may cause a patient to fail to perform in both personal and professional environments.
Physical occupational therapy rehabilitation may be needed if a patient has been either injured or born with a physical handicap which interferes with everyday living. This can include the re-training of certain major muscle groups as well as education in using a wheelchair or other mobility aid to perform simple and complex tasks. In some more severe cases, employment may never be a possibility due to extreme physical limitations. For these patients, occupational therapy rehabilitation may act to teach them tasks as basic as eating with a fork and spoon or bathing themselves.
Counselling for mentally ill, aggressive or depressed patients is also a type of occupational therapy rehabilitation. Often, an employer will require specific workers to undergo this type of treatment to help them interact more efficiently with co-workers, stay motivated on the job, or to fully rehabilitate them after a traumatic experience or depressive episode. This helps patients overcome emotional issues that may hinder job performance or social development, and allows them to effectively express issues and interact with customers or clients.
Sometimes occupational therapy rehabilitation involves specific job training courses. This method may be used for mentally handicapped or brain damaged individuals, or those who have lost employment due to emotional or mental issues. Job training helps patients learn specific job related skills including how to perform basic job duties like lifting or typing, as well as how to interact with co-workers and customers.
In some cases, an occupational therapist or counsellor may be hired to settle a dispute or problem between colleagues or groups within a workplace. This may include argumentative co-workers who are aggressive to the point of hindered job performance. In these situations, the therapist will teach proper coping methods for dealing with anger and jealously in the workforce in the form of individual counselling sessions, seminars, or group therapy meetings.
Therapists and doctors often work together in occupational therapy rehabilitation for their patients. A combination of therapies and medications may be used in order to obtain full rehabilitative results. The primary goal of these tactics is to allow patients to live and work as normal as possible in society.
Disability and Rehabilitation
When looking at Occupational therapy in terms of rehabilitation, the experts agree that effective rehabilitation of the physically disabled involved helping the client to regain physical and social functions lost through injury or disease. Haber (1973) argues that disability should be conceptualised and measured by functional in capacities. Disability is then the inability to perform usual role activities as a result of a physical or mental impairment (loss of function) of long-term duration (Haber and Smith, 1971)
One view of rehabilitation success is taken by Ludwig and Adams (1968) and Diamond et al. (1968) who use patient cooperation and participation in treatment as a measure of outcome. Acceptance of the “sick role” implies that the patient cooperate and participate in the treatment process as outlined by the experts so that he can get better (Parsons, 1951; 1975). In this context, the good and successful patient is judged to be the person who complies with the “sick role”. Consequently, rehabilitation success might be an artefact.
There is no evidence to show that staff members tend to concentrate their efforts on those patients that they value highly or think have the best chance of demonstrating improvement (Kelman, 1964). However, appearance of patient “motivation” and “cooperation” in the rehabilitation settings does not accurately predict independent living after discharge (Kelman and Wilner, 1962).
According to Nagi, when trying to define the concept of disabilities looks at the terms ‘impairment’ and ‘disability’.
He explores these terms by looking at how every individual lives within an environment in which he is called upon to perform certain roles and tasks. The ability and inability of people can be meaningfully understood and estimated only in terms of the degree of their fulfilment of these roles and tasks, when an individual is described as being “unable” the description in incomplete till it answers the question, “unable to do what?”. In this sense, ability-inability constitutes an assessment of the individual’s level of functioning within an environment. Two categories of inability can be delineated on the basis of the time of onset. First are congenital inabilities. There are inborn limitations that are the result of anatomical malformations, physiological abnormalities, mental deficiencies, and/or general constitutional inadequacies. To be sure, abilities of all humans are subject tot limitations. Further more, Nagi argues, people differ greatly in degree of ability-inability without necessarily suffering from an active disorder or a residual impairment. However, although the cutting point between able and unable is hard to distinguish, the more severe conditions are usually recognised. The OASI program have defined disability as the “inability to engage in any substantial gainful activity by reason of a medically determinable impairment that is expected to be of long-continues and indefinite duration or to result in death.”
Potential for rehabilitation indicated a prognostic evaluation of the levels of functioning the individual is capable of reaching under certain circumstances. The assessment of ability-inability is obviously a necessary step toward the evaluation of rehabilitation potential. Occupational therapists ask patients to perform a variety of tasks that would require the use of different types of tools and equipment. Information sought in this evaluation includes an assessment of the following attributes: the quality and quantity of work done, physical and interpersonal work adjustment. Experience and skills, the degree to which the impairment disables the individual in the performance of certain tasks. The rehabilitation potential of the patient. Occupational therapists are informed by the physician when the risk to a patient’s health precluded certain tasks or the whole occupational evaluation.
Throught the mobilisation of the efforts of a highly trained team of medical including occupational therapists, rehabilitation envisions the maximum physical, mental, social, vocational and economic recovery possible. While the goals are attained many very with each individual case, Julius Roth has questioned whether such goals should legitimately be set by the patient or the therapist. The ultimate success of the program rests upon a remarkably intriguing interplay of the biogenic, sociogenic, and psychogenic components of human behaviour
The delivery of Occupational Therapy
Looking at where and how occupational therapy is delivered, it is delivered in Primary and Secondary Care following the patient’s journey and is governed by care pathways which include formal and informal carers.Â The service is equitable in access and is provided from cradle to graves. Primary care is provided for patients at first contact with the health service. By this very nature it must be generalist, being able to cope with whatever problems arise. General practitioners are the traditional primary care doctors but in recent years we have seen rise to a primary care team, including Occupational Therapist, Physiotherapist and speech therapist to name a few, offering a wider range of health professionals and their respective skills.
The World Health Organisation states in its blueprint for ‘Health for All by the Year 2000’ that there should be a special emphasis on primary health care services, particularly in developing countries in which funding is even more limited.
This recent emphasis on the importance of health care has further improved its status in the medical world. This is particularly true in areas in occupational therapy when there is a focus on for example, elderly in residential care, and other community care related interventions.
According to Tussing & Wren (2006) literature on primary care indicates a need for the following, all of which are weak or absent in the Irish system:
A primary care system which addresses the health needs of a mainly healthy population rather than concentrating on intervention in episodes of illness, an emphases on disease management for the chronically ill, supportive of self-care and home care, stronger evidence-based medicine, with appropriate protocols and guidelines, peer review and quality assurance, primary care infrastructure, supportive institutions, skilled substitutions, and GP interface.
On the other hand secondary care is usually specialist services that require beds, and sometimes expensive equipment. Therefore it is usually based in hospitals. For example, stroke patients may be referred to Occupational Therapist by physicians after hospitalisation. Occupational therapist might then work with them in a rehabilitation centre using specific equipment to regain independence.
Within recent years, much emphasis has been given to the development and expansion of a variety of out of hospital services for the chronically ill. However, such demonstrations continue to be slow to develop. Among the many issues involved in these attempts are those concerning the roles to be assumed by hospital or by community based agencies in relation to the provision of community care for those disabled patients who no longer require active hospital in-patient treatment. The studyâ€¦â€¦â€¦â€¦â€¦â€¦â€¦ was undertaken in order to define a more appropriate hospital role in relation to the continuing needs for rehabilitation care of a chronically ill and disabled population discharge to the community following extended hospital rehabilitation treatment. It evolved against a background of rather pessimistic clinical impressions and retrospective research probes which emphasised this population’s failure to maintain optimum health and social functioning in the community despite the achievement of these level while in the hospital. More specifically, concerns centred on this population’s high rate of rehospitalisation, its deterioration in social functioning and its failure to use or to receive needed health and health related services while in the community.
Occupational therapy plays an essential role in the acute care hospital and in other medically related facilities from the rehabilitation hospital, to sub acute sites, to extended care facilities, to the facilities of the future.
Though there are issues when it comes to acute care, Torrance, (1993) states that with increasing technology and quicker discharge, the need for therapeutic occupation increases. Occupational therapists are needed to work with patients in problem solving self-care occupations amidst the constraints of the tubes, monitors and fixators; to activate patients at risk because of the deleterious effects of bed rest; to help patients and caregivers plan realistically from what the patients will do and for how the patients will live and care for themselves after discharge but before healing; and to assess patients quality of life before and after hospitalisation.
Nelson (1997:20) gives an example:
“For an example of the importance of therapeutic occupation in an acute care setting, consider a 5 month old girl born with neuromuscular disease of unknown etiology. The disease is characterised by the total absence of many of the proximal muscles, including those responsible for respiration. Picture her with multiple intubations for respiration and nutrition and with life-support monitors. The occupational therapist carefully removes her from the crib and bounces her gently while talking to her in high-pitched, rhythmical tones. In response to this occupational form, the infants adaption’s are to learn to use the muscles controlling her vocal cords as she imitates the therapist; to learn to use the remaining muscles in her left arm as she grabs the therapists keys; and most of all to begin to learn that she too has a legitimate place in the human family. The therapist next places a piece of cloth playfully over the child’s face, as in our prior example of the importance of peek-a-boo in healthy development. Like a health baby, this baby too removes the cloth and laughs. Despite the high technology setting, this baby also needs to encounter the occupational form of peek-a-boo in order to develop a sense of self and a sense of other.”
Therefore Occupational models of practise are needed for the acute care hospital for patients at all points on the lifer span. Since many health problems require a level of medical treatment and personal care that extends beyond the range of services normally available in the patients home, modern society has developed formal institutions for patients care intended to help meet the more complex health needs of its members. Here, much of an occupational therapist work is carried out. Usually in rehabilitation centres within the hospital.
Looking at the hospital in more detail, the work of Cockerham (2007) draws on how it is the major social institution for the delivery of health care in the modern world, and how it offers considerable advantages to both patients and society. From the individuals point of view, the injured or sick person has access to centralised medical knowledge and the greatest array of technology within the hospital, and from the standpoint of society, as Renee Fox and Talcott Parsons (1952) argue, that when patients are within the hospital they are protecting their family from many disruptive effects of caring for the ill in the home and operates as a means of guiding the sick and injured into medically supervised institutions where their problems are less disruptive for society as a whole.
Many other concepts of Parsons have been criticised, taking his concept of the sick role, it has been argued that Parsons model cannot be applied to chronic illnesses from which patients cannot recover. More significantly, it had been shown that access to the sick role is rather more problematic that Parson’s model assumes. It has been suggested that parsons is really talking about a patient role rather then a sick role as there is a distinction between patients subjective experiences of illness and being objectively defined by doctors as having a disease.
It is true to say Occupational therapy rejects a lot of Talcott Parons sick role ideas, who believes that when an individual is in the “sick role” he or she is exempt from responsibility for the incapacity, as it is beyond their control, and is also exempt from normal social role obligations. While this is true to say, Lober (1975:214) observes that while the patient is in the hospital there is an idea of voluntary cooperation , one to one intimacy, and conditional permissiveness, for example, being temporarily excused from normal social activities on the condition of seeking medical advice and care.
Coe (1978) has also argued that acceptance is the most common form of patient adjustment to hospital routine and the most successful for short-stay patients, which most patients seeking Occupational therapy are, as the main aim is to get the patients back into society.
Chronically Ill and Care
According to Oliver (1996), as societies modernise the burden of disease is shifting from acute to chronic long-term illness and disability. While clinical medicine can treat many of these chronic conditions, it cannot cure many of them, and thus more and more people are spending a greater proportion of their lives coping with illness.
Occupational therapist deal with many terminally ill patients. According to â€¦â€¦â€¦â€¦â€¦â€¦.. Individuals with terminal illness face a number of problems related to social, emotional, spiritual and their physical well-being. Some individuals have expressed that the feeling of being a burden to family and friends is more distressing than physical pain (Lloyd, 1989). Carey, 1975 looks at how these individuals with terminal illnesses find the biggest challenges in looking for satisfactory meaning in their new life situation whole facing mortality.
Care for these patients has come along way, as in the past the care had primary focus on alleviating only the physical distress of the illness. Kubler-Ross (1997) describes how physicians, who are held back by their own views and feeling on death, are often unable to reach out to their dying patients to provide them with care and comfort. Therefore death in the past was almost seen as a failure of medicine. This ideology began to change with the emergence of the hospice in 1967 by De Cicely Saunfers, who founded St. Christopher’s hospice. Today we can recognise the hospice as a specialised facility for the care of dying patients that supports them in living life fully and comfortably while confronting death (National Hospice Organisation, 1996).
The American Occupational Therapy Association (AOTA) (1998) states the following inn relation to occupational therapy and the hospice:
“The AOTA affirms the right of a dying person to have access to a caring community within the health care system and believes in the need for personalised care of the dying individual throughout the course of a terminal illness. Occupational Therapy is based on the belief that all individuals engage in occupationsâ€¦ Occupational therapy practitioners are uniquely qualified to help the dying person continue to engage in meaningful daily occupations within the hospice community of care. (p.872)”
When a patient who has a terminal illness continues to lose their ability to care for themselves and carryout usual daily activities, fostering the patient’s independence in self-care, work, and leisure usually becomes a top priority of intervention (Holland & Tigges, 1981; Tigges, 1983; Tigges & Marcil, 1988). Tigges (1983) explains a framework that looks at “the human need of mastery-productive use of tie, energy, interest, and attention,” this is also known as the occupational role of performance paradigm (9.163).
Although some individuals with terminal illnesses are able to maintain many of their usual roles, it’s not always true for others. According to Gammage, McMahon, and Shanahan (1976), occupational therapist have a unique role in assisting patients to accept their new role as an individual with an illness and relinquish old occupational roles. Not only do occupational therapists focus on roles los
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