British Journal of Occupational Therapy

A multidisciplinary project is under way to develop a computer model which will simulate the hip fracture care process in both a large teaching hospital and a district general hospital (Currie et al 1998). This paper describes the occupational therapy contribution to the project.

The complex process of care will be simulated by integrating each clinical group's patient intervention (strategy) at each point of the patient's journey. As part of this research, the literature was referred to for evidence to support current occupational therapy and to form a structure for simulation. The occupational therapy strategy is represented as a flow chart which leads the patient from admission to the acute orthopaedic ward, through to assessment, rehabilitation and, finally, discharge. The literature suggested that the way in which each occupational therapist individualised this strategy (based on Hagedorn's [1997] model) was influenced by his or her own clinical reasoning, which might in turn affect outcome.

The notion that mental modelling (clinical reasoning) might be simulated has led to the suggestion that computer simulation could be used as a learning tool to develop clinical reasoning skills in the novice, with the aim of improving patient care.

This is a two-part article about legal aspects of safety in two overlapping areas of work relevant to occupational therapists: disability equipment and manual handling.

This first part, on safe use of equipment, considers negligence, consumer protection and health and safety at work law, including codes of practice, guidance and notices from bodies such as the Health and Safety Executive and the Medical Devices Agency. A number of common and relatively straightforward themes are picked out through what otherwise might appear to be a forbidding body of law; these are illustrated with practical examples.

It is argued that in judging whether a particular action or omission was unlawful and breached safety obligations, the courts do not generally resort to incomprehensible principles. Instead, they often, in effect, simply hold up a mirror to the professional(s) involved and ask whether reasonably competent or practicable steps were taken. To the extent that this is so, it is clear that avoidance of legal liability is very much more within the power of occupational therapists and their employer organisations than is often supposed and that such avoidance is consonant both with patient and client welfare and with good professional practice.

As the main occupation of childhood, play is considered by occupational therapists as an important vehicle for the assessment and treatment of preschool children. For the child with autistic spectrum disorder (ASD), play not only offers a mechanism whereby the severity of the disorder can be ascertained but also enables interventions to be implemented and monitored.

This paper aims to summarise the current literature as it relates to the play of children with ASD. By doing so, it alerts the reader to the complexity of the issue of play as a means of assessment and intervention and highlights areas of continuing clinical and research concern.

Parenthood is considered a major life role. Yet for people with a major mental illness, it is one that is fraught with difficulties and for which they receive the least support. Research on parenting and parenting programmes for people with a major mental illness is sparse and most of the papers presented do not provide a working model that can be easily replicated. This lack of support for parents or knowledge of working parenting programmes has often resulted in children being placed in care.

Occupational therapists working in an Australian mental health service developed a two-stream programme which aimed to consolidate the parent/child relationship and enable the parents to develop effective parenting skills. This programme has a parents' educational stream and a stream with developmentally appropriate activities for the children. Observed outcomes have included the parents becoming more responsive to their children, increased treatment compliance, improved community access, and a decrease in the number of children in temporary foster care.

This article presents a case study of the assessment and treatment of an 8-year-old boy with developmental disabilities following meningitis. It aims to explore the extent to which clinical child psychologists and paediatric occupational therapists share a common frame of reference that enables them to work jointly, in an effective and complementary way, to improve clinical standards.

Following a combined programme of intervention, the outcome assessment showed significant improvement in the specific components of visual attention and visual search. However, more generalised improvement in daily living skills was not apparent. The implications for joint working between health professionals and for collaboration with teachers are discussed.

Occupational therapists working in community mental health teams (CMHTs) experience the difficulty of balancing the expectations of their profession with those of the team, their employers, the purchasers and the client group within the wider context of health care. This paper uses role theory as a framework to examine why occupational therapists may perceive threats to their professional identity and experience pressure to conform to the defined CMHT ‘role set’. It examines the concepts of role definition, role signs, role ambiguity, role incompatibility and role conflict and the resulting role stress.

Occupational therapists need to identify their role problems and either develop strategies to resolve them or suffer role strain. Conformity to the expectations of the role set may mean becoming less effective and less able to distinguish their role from that of the other members of the CMHT. This will have very real consequences for the future of occupational therapy within both CMHTs and the wider context of health care.

One of the major challenges of coping with head injury is that people are often unprepared for, and unaware of, the potentially harsh reality that can have an impact on the family. This study was carried out to examine the association between motor, cognitive, behavioural, perceptual, and speech and language disabilities and the levels of stress and strain on the carers.

Two scales were used to measure stress and strain. The results showed that, in this group (n = 70), behavioural disabilities were most strongly associated with the carers' self-concepts, such as self-esteem and feelings of competence. Motor and cognitive disabilities were associated with strain on roles and activities outside the caregiving situation.

These results have implications for practice and service providers. They indicate that services and intervention strategies must place greater emphasis on addressing the possible impact of behavioural disabilities on the carer's self-concept and that respite services should be available to allow the carer time to fulfil other roles and responsibilities that are neglected due to cognitive and motor disabilities.