British Journal of Occupational Therapy

The first paper (Sweeney et al 2001) in this series of three on supervision in occupational therapy reported the views and experiences of occupational therapy supervisors. In contrast to the supervisor experience, where there remains a paucity of evidence in the general literature, the clinician as supervisee has been relatively well explored. However, the literature on the experiences of the occupational therapy supervisee is virtually nonexistent.

This paper, the second in the series, describes a grounded theory study which set out to explore the process of first-line supervision from the perspective of the novice occupational therapy supervisee (those employed at basic grade and senior II levels). Data collection took the form of semi-structured, one-to-one interviews with 30 female supervisees, who were drawn from a wide range of clinical specialties within the National Health Service in the South West of England.

The findings suggested that there existed a large gap between what many of the supervisees expected from supervision and what they actually received. In addition, there was evidence that the typical supervisee entered the supervision process with the aim of presenting a professional face to her supervisor and to the wider health care team and that she did this to protect her fragile sense of competence. Many supervisees employed a range of covert strategies within the supervision setting in order to facilitate the presentation of a professional face. The use of this approach carried with it a number of risks and benefits for the supervisee.

The final paper in the series will discuss the implications of these two studies of supervisor and supervisee experience in order to distil recommendations for the future practice of supervision within the profession.

While historically a number of approaches and disciplines have proved to be effective in the management of altered body image, there is little evidence within the occupational therapy literature to suggest that this is an area actively pursued outside the realm of eating disorders. The concept of altered body image in relation to occupational therapy is explored, within the context of life-threatening disease. A review of multidisciplinary input in this area indicates that a number of factors contribute to the difficulty in identifying, assessing and treating this complex concept.

This article suggests that occupational therapists, with their unique perspective of activity as a facilitator of change in occupational performance, are well placed to address altered body image concerns. Education and training in this area are required if occupational therapists are to do so with confidence and competence, irrespective of clinical condition or setting, in order to contribute positively to the rehabilitation process and the individual's overall quality of life. Further research in the management of altered body image by occupational therapists is recommended.

Thirty-two out of 33 occupational therapy services within London operate priority systems (Scott 1999), but there is a scarcity of published research into the accuracy of such systems. A study by Leonard (1993) identified discrepancies between priorities allocated before and after assessment, while Grime (1990) discussed the decision-making processes employed by community occupational therapists. Recognising that demand for services will continue to grow in the new millennium, this study investigated whether cases were prioritised appropriately within a team and identified the factors within referrals that influenced prioritising decisions.

The referrals (n=45) were prioritised by the team leader, who then allocated the cases to the occupational therapists without revealing the priorities. The occupational therapists reprioritised the cases after the initial assessments; the priorities were then compared and the influencing factors identified. The results indicated that 56% (10 out of 18) of the lower priority cases were inaccurately prioritised, with a tendency to underestimate the priority.

The service's referral-taking procedure was reviewed and the study replicated. The second study indicated that the accuracy of prioritising improved following revision of the guidelines, although further issues around service user involvement were highlighted.

Interactive journals in the form of fieldwork logs and learners' logs were introduced into the fieldwork curriculum of the 4-year undergraduate occupational therapy programme at the University of Cape Town, South Africa. The aim was to promote critical reflection and clinical reasoning. The challenge then lay in assessing these journals to evaluate student performance, while also providing a vehicle for promoting professional understanding. This article describes the development of portfolios as an approach to assessing student journals, together with the evaluation criteria that were developed and the educational rationale underpinning this design.

Stress and burnout for human service workers has received increasing attention over a number of years. It has been suggested that health care professionals may be particularly at risk of stress and burnout because of the amount and type of direct client contact that makes up their work.

For workers in the field of mental health, additional stressors are present owing to organisational restructuring and new models of care. Mental health occupational therapists may be vulnerable to stress and burnout owing to the nature of their work, the types of client they see, the changed work environment and professional issues. It is recommended that occupational therapists become aware of the factors contributing to stress and burnout and develop strategies to maintain their wellbeing in the workforce.

In this paper, I will consider occupational science as a key to broadening horizons in occupational therapy. I start by clarifying and defining what occupational science is, and discuss the benefits that rigorous study of humans as occupational beings may bring to occupational therapy.

I suggest that adopting occupational science will assist occupational therapists to think in occupational rather than medical terms. This alone would extend the profession's domain of concern considerably, because it becomes clear that it is not only the people with disorder of body or mind who are occupationally handicapped. Humans have ‘occupational needs’ which are related to maintaining health, and many health outcomes, either good or bad, can be traced back to basic occupational determinants that people have created over time.

Our twentieth century founders recognised that we needed such a science and, even earlier, social philosophers wrote of its importance. If occupational therapists work as agents of change according to a sound knowledge base built upon the unique aspect of life and health which is their domain, they will be able to respond and develop according to rapidly changing economies and values.

This keynote address was given on 4 July 2001 at the 25th Annual Conference of the College of Occupational Therapists, held at the University of Wales, Swansea.