British Journal of Occupational Therapy

The purpose of this study was to explore the prevocational needs of adolescents with juvenile idiopathic arthritis (JIA) from their own perspectives.

A focus group discussion was undertaken with eight adolescents with JIA (14.2–16.6 years) attending one United Kingdom hospital. The topics of interest were (i) attitudes towards education, prevocational readiness and employment in relation to JIA; (ii) perceived barriers; (iii) coping strategies; and (iv) preferred sources of support. The data were analysed according to standardised procedures that included data reduction, data display, conclusion drawing and conclusion verifying.

The provision of vocational support for young people with JIA was reported to be uncoordinated, limited and unresponsive to individual needs. A recurrent theme was that professionals generally underestimated adolescents' educational and vocational potential. This was felt to be true of teachers, careers advisers, admissions personnel at colleges and universities and potential employers. Most adolescents worried about discrimination and those in whom the JIA was not visible felt a dilemma about disclosure to potential employers.

The current framework of careers advice appeared to have failed the adolescents in this study who, in the absence of satisfactory support, found themselves consulting health professionals instead. Greater careers advice support for adolescents and professionals is warranted.

Occupational therapists make clinical decisions to help clients with upper limb performance dysfunction following brain injury to achieve their goals. Although occupational therapy services have traditionally been separated for paediatric and adult populations, it has been proposed that a common process can be used to make clinical decisions for children and adults with upper limb performance dysfunction following brain injury.

This study compared the factors that influenced the clinical decisions of experienced occupational therapists who worked with either children or adults with upper limb performance dysfunction after brain injury to determine if the clinical decision-making process was common for all clients with brain injury. Eleven occupational therapists with experience in working with clients with brain injury participated in two focus groups. Six had experience in working with children and five in working with adults. The discussions were audiotaped, transcribed and analysed using NUD*IST Version 4 data management software.

The intrinsic or client-related factors identified as influencing clinical decision making were the client's condition, personal attributes and occupational performance needs. The extrinsic factors were related both to the therapist (knowledge of ‘feel’, experience, treatment preferences, confidence and personal convictions and beliefs) and to the environment (context of service provision and organisational culture and constraints). The consistency in the factors identified across different caseloads appeared to indicate that a common protocol would be suitable for guiding clinical decision making for both children and adults with varying patterns and intensity of upper limb performance dysfunction. Further research is needed to determine the clinical usefulness of such a protocol and the consistency of client outcomes following its use.

This paper presents a follow-up to an earlier paper (Paterson et al 2005) on the topic of judgement artistry. Here the expertise literature is reviewed and the research findings related to developing judgement artistry are presented. Experts use cognitive, metacognitive and humanistic aspects of professional artistry to make highly skilled micro-, macro- and meta-judgements that are optimal for the given circumstances of the client and the context. The professional practice judgement artistry (PPJA) model presented in the earlier paper makes a unique contribution to professional development by offering a creative and challenging perspective on expertise. Finally, the overall research approach is critiqued, considering issues of credibility and rigour, and suggestions for future research are provided.

Occupational therapists often meet clients with infections in the course of their work, but research into such therapists' knowledge and practice of infection control procedures is limited. This small postal survey explored the deficit, gathering data from 63/93 (68%) occupational therapists working in 12 randomly selected English health care trusts. The results showed evidence of a discrepancy between respondents' knowledge and practice of infection control procedures. The respondents acknowledged the importance of infection control but did not always take the necessary precautions, reporting some difficulty in judging the latter. The reasons for the study findings and their potential implications for occupational therapy practice, research and education are considered.

In order to ascertain whether occupational therapy improved the mood, fatigue management and activities of daily living performance of oncology outpatients, a randomised controlled trial was used to compare an occupational therapy intervention at home with statutory service input. However, there were problems with recruitment and the collection of data, attributable in part to the nature of the disease, and therefore no conclusions regarding the role of occupational therapy could be drawn. Nevertheless, it is believed that this trial is important because it might assist clinicians planning future research in this area and because it counteracts publication bias (ISRCTN71264775).

This article aims firstly to describe the contribution of a keyworker in improving the patient-centred partnership between brain-injured patients, their carers and rehabilitation staff in a hospital-based neurorehabilitation setting. Secondly, the outcome of a survey exploring the usefulness of the applied keyworker model in a multidisciplinary brain injury rehabilitation service is presented. The outcome suggests that the majority of the 14 patients and relatives were satisfied with the set-up of the keyworker sessions and found both the support received and the information sharing helpful. All the seven rehabilitation staff found the keyworker system useful for involving patients and their relatives in the rehabilitation programme.

Driving ability is dependent on many skills within the purview and expertise of occupational therapy. In countries such as the United States and Australia, both the assessment and the training of driving skills are the focus of occupational therapists in helping older drivers. General practitioners have high expectations of the profession regarding the assessment and training of older drivers or drivers with special needs. This opinion piece summarises recent research into the use of driving simulators to improve the road safety of older adults by occupational therapists. Research confirms the high transferability of observations of driving behaviours between simulated driving and road assessment. The question remains: can the driving simulator be a clinical tool to screen out problematic older drivers before a more detailed but expensive road test is considered?