Professional Thinking and Accountability through the Flow of Life’s Occupations
Occupational therapy is a service delivery profession consistent with the academic history and provision of other graduate professional programs within the Kosair Charities College of Health and Natural Sciences at Spalding University. The Occupational Therapy Doctorate (OTD) is the fourth doctoral degree program within the university. The OTD flows like a river (such as the Ohio River); connecting knowledge from liberal arts and sciences with professional concepts, theories, research, ethical decision making, occupational therapy process skills and quality of life outcomes. These tributary tenets allow for the emergence of reflective and evidence informed occupational therapy practice within OTD students and graduates. An occupational therapist must understand the history and ongoing evolution and vision of the occupational therapy profession, including the impact of occupation upon the health and wellness of individuals, groups, populations, communities and society at large. Occupational performance, performance skills, performance patterns, and context are essential to the application of the occupational therapy process and are aggregated components within the OTD curriculum.
The Auerbach School of Occupational Therapy constructed content focus areas throughout the 36-month, 9 trimester OTD program that unites students’ learning into one comprehensive learning experience. The bedrock of this unifying framework drawing all OTD courses into an inherent whole occurs through the curriculum design. The curriculum design is pulled together through the curriculum threads which are derived from the OTD conceptual framework and student learning outcomes embedded within OTD program courses. The curriculum threads provide an educational structure that supports the students in meeting the needs of the times within rapidly changing and dynamic health and human service delivery systems. The threads also frame student learning outcomes in order for the OTD student to demonstrate competence in basic and advanced skills as a direct care provider, consultant, educator, manager, researcher, theorist, and advocate for the profession and consumers. The curriculum design provides river and kayak metaphorical structures to describe the learning process. Metaphors provide ways of thinking, understanding, and seeing the world to allow shared perceptions.
As humans, we become through doing; bridging our knowledge, skills, and competence within the process of performing daily actions, continually creating new knowledge, skills, and shared constructions. Much like learning to kayak down a river, the OTD curriculum allows students to learn to navigate tides, catchments, canals and currents within the learning journey in order to develop thinking skills that create the ability to paddle into a science driven, evidenced-informed occupational therapy practice. Faculty members act as compassionate coaches who, through trusting collaborative relationships teach the student the skill of ‘kayaking’ on the river of occupation. Faculty guide, help, pilot, and at times, grab hold of student’s kayak handles to tow one through the dynamic ever-changing torrents and eco-systems of learning.
The curriculum design, KAYAKING ON THE RIVER of OCCUPATION: Professional Thinking and Accountability through the Flow of Life’s Occupations, provides contextual metaphors that emphasize a narrative focus of the students’ and faculty’s personal and professional thinking skills and accountable actions. This focus occurs within the active process of engaging in the lifelong learning process for navigating the intertwining river channels of knowledge, skills, and competencies of within the occupational therapy process. As the learning journey begins, the students and faculty plan the journey, learn about their crafts (kayaks) and eventually are traveling together along the river in kayaks. In order to propel the kayaks through the water, everyone must actively engage in moving their paddle(s), yet there is much skill involved in successfully navigating and steering the kayak through the water. The skill and flow of movement through water emerges as the journey progresses. Eventually, students gain skill and competence, can navigate rough waters, handle challenges and explore river channels and tributaries on their own. Entry-level and advanced practice skills emerge as a student progresses through the curriculum and focuses upon his/her specific learning needs and desired capstone experiences.
The first learning process in the journey, involves propelling the kayak with the paddle. This active process is framed as professional accountability. The demonstration of professional accountability includes using occupation-based reasoning for the engagement in ethical, effective, efficient, and evidence-based actions. Professional accountability is represented by moving the kayak paddle in ways that propels the kayak through the water and includes the following:
Seeing, identifying, and becoming aware of challenges,
Owning one’s role and need for action to move forward through the river’s tides and currents,
Developing a plan of action to avoid getting stuck on sandbars and hidden obstacles within the river,
Implementing the plan of action and continuing to monitor the changing context and one’s forward motion, and
Reflecting upon current outcomes and explore new ways to improve competence for navigating the dynamic changing waters within the river.
Accountability becomes the process by which one moves the paddle within the currents and curriculum flow, propelling the student forward. Professional accountability is essential for becoming a productive, competent occupational therapist. The program and its faculty support the educational process by creating an environmental context, learning activities, and supportive structures that enhance professional accountability.
In the beginning of the journey, faculty members are compassionate coaches who help, instruct students on human factors and potential contextual factors that may lie ahead, and are role model guides demonstrating the leadership and advocacy tools required for success within the curriculum and as a competent occupational therapy professional.
As students flow through the curriculum trimesters, they move from anxious novices utterly captivated and at times immobilized by the raw beauty of the river, sky, and potentiality of the occupational journey, to finally, at the end of the journey into entry-level and advanced practitioners who find beauty in their actions for meeting the occupational needs of society and embracing the vast knowledge of the ever-changing River of Occupation. At the end of the journey, the OTD graduate becomes the compassionate coach who provides contextual support for clients’ receiving occupational therapy services who face challenges and may have become capsized within the River of Occupation.
The students’ commitment to the values of responsibility and accountability is a basic cornerstone of the OTD educational program and for achieving the ASOT vision and that of the occupational therapy profession. Commitment to the wellbeing of the clients and families who receive occupational therapy services is a fundamental requirement. Important ramifications of this requirement include: adequate preparation; sensitivity to the client and family’s unique environment, cultural competency/diversity, and spiritual needs; concern for the client’s best interests; and consultation with fellow professionals. In addition, graduates from the occupational therapy doctoral program must have a genuine commitment to continuing competence as professional practitioners. This commitment reflects the belief that learning and professional development is a lifelong process and that up to date evidenced-based knowledge is crucial for best practice.
The second foundational process within the OTD curriculum design is the evolution and refinement of professional thinking skills. Occupational therapists operate in increasingly complex health and human service delivery systems. In order to function efficiently and effectively within such systems, high-level thinking and problem-solving skills are required. Professional thinking incorporates and integrates reflective and evidence-based practice processes and emerges as a confluence of professional behaviors. Reflective practice measures within the curriculum include critical-analysis of practice, ethical decision making, strengths-based processes, self-awareness, emotional intelligence, therapeutic use of self, and synthesis of these varied aspects within therapeutic relationships. Evidence-based practice measures require analysis of the best available, current, valid and relevant research to inform practice decisions. The best available relevant research must be considered alongside clients’ needs, values, priorities and resources in order to achieve therapeutic outcomes. The integration of reflective and evidence-informed practice emerges as professional thinking skills and behaviors in a way that the OTD student can reflect in action with a solid foundation of evidence to support informed decision making. (Bannigan & Moores, 2009).
The curriculum design is based within nine trimesters of knowledge and competence demonstration. The learning outcomes supports and requires the students’ development of planning, priority setting, and time management skills. These skills are critical for powerful occupation-based actions and fluid occupational based reasoning to emerge. The above skills serve the profession as a whole in assuring reflective, ethical, skilled, flexible, adaptable, science driven, and evidence-based practitioners able to work in a globally connected, constantly changing, and fast paced service delivery environments. Consequently, as knowledge and needs change, occupational therapists must be accountable to the profession, their employing organizations, and clients by maintaining/upgrading their individual practice, knowledge, skills, and competence. The curriculum design aspires OTD graduates to develop into powerful occupational therapy leaders. The graduates are able to develop, perform and achieve reflective, conceptual, evidence-based practice outcomes.
Professional actions and behaviors that promote the OTD graduate in successfully navigating varied practice settings are demonstrated through the curriculum threads. Every course within the academic program is moored by competencies which frame the four essential curricular threads. The four curricular threads represent professional thinking skills and professional competencies defined within the curriculum and are evidenced within the OTD curriculum threads that include:
Occupational Needs of Society: Successful implementation of the occupational therapy process depends on the ability of the therapist to incorporate professional thinking skills that focus on the innate needs and priorities of individuals, groups, populations, and communities. The therapist and clients must collaborate in the development joint accountability processes for successful occupational therapy outcomes. Ethics is a systematic reflection on and analysis of morality. Thus, ethics is a fundamental part of the life and occupational needs of everyone in society and takes on a specific form when someone assumes the role of an occupational therapist. Aligning with the Spalding University mission, the OTD program is committed to addressing the evolving needs of the times embedded within ethical, professional practice. The OTD program provides learning opportunities that empower students to transform into competent therapists dedicated to diversity, peace, justice, and compassionate care that addresses the complex needs of society.
Leadership in Practice & Advocacy: The professional skills of leadership and effective team participation are vital for successful occupational therapy service delivery. Occupational therapy students are provided varied experiential and problem-based opportunities to build intra-disciplinary, interdisciplinary, management and consultation skills throughout the OTD curriculum. Courses emphasize the concepts of professional thinking and joint accountability of the occupational therapy practitioner as part of a broader team. The OTD program emphasizes responsible and active participation of students and graduates for self-directed practice as occupational therapists in a variety of service delivery systems. Advocacy involves actions that bring forth empowerment. Advocacy represents the strategies devised, actions taken, and solutions proposed to influence professionally sound and ethical decision-making that creates positive change for clients within their natural environment and for the profession of occupational therapy. The OTD curriculum fosters advocacy measures throughout the curriculum as students engage in: activities for promoting the profession, consumer education, health literacy projects, influencing policy, various community and service learning activities.
Critical Thinking/Occupation Based Reasoning/Ethical Reasoning: The occupational therapy process requires reflective, evidence-informed actions that culminate in the facilitation of engagement in meaningful occupations by individuals, groups, populations and communities. The occupational therapist uses professional thinking skills to collect information and make sound ethical practice decisions. OTD students and graduates must learn to reflect on observed phenomena, relate those observations to conceptual frameworks, and to generate new practice questions. This capacity leads to heightened awareness for improving potential effectiveness and the achievement of occupation-based outcomes. Conceptually based entry-level and advanced professional practice is achieved through critical reasoning process that includes each student’s capacity to:
Demonstrate professional thinking skills and accountable actions,
Apply the theories of occupational therapy,
Recognize contextual determinants upon occupational performance,
Analyze varied activities and the role of occupation across the life span,
Implement the steps of the occupational therapy process,
Discover relationships and connections among areas of study,
Identify opportunities for research and theory development in emerging areas,
Demonstrate awareness of the role of prevention and wellness within the profession, and
Validate ethical reasoning as a fundamental component for decision making.
4. Compassionate Client-Centered Care: Compassionate client-centered care is an approach to care in which clients are viewed as whole persons. Clients may be individuals, families, groups, communities, aggregates, organizations, systems, and populations. Clients may seek or receive occupational therapy interventions related to health promotion, wellness, disease prevention, illness or injury management, habilitation, and/or rehabilitation processes for enhancing participation in life activities. This approach to care involves empowerment through respecting the person’s autonomy, self-determination, and participation in decision-making. It gives voice to, and takes into consideration the clients’ values, desires, goals, lifestyle(s), family situations, social and cultural circumstances in all therapeutic processes. Compassion is based within a Humanistic perspective and is a center point of the OTD curriculum, defining all social interactions. Compassion links the occupational therapy practitioner with the client through empathy and is often characterized through compassionate actions. The essential professional skills of compassionate client centered care include competent, confidential care in which the client is a partner. The OTD student and graduate must seek to enhance occupational potential(s) through engagement in compassionate and ethical reasoning actions with all he/she works alongside.
Most importantly, the Professional Thinking and Accountability through the Flow of Life’s Occupations curriculum model instills in each OTD student and graduate the passionate desire to become a compassionate coach that assists clients through the process of developing personal accountability in goal setting and successful future occupational performance. The occupational therapist must join with the client in a therapeutic relationship to foster and encourage the client to exercise authority and autonomy. A client who has confidence in his or her own dignity and potential is more likely to experience feelings of control. Occupational therapists, through the therapeutic use of self, play a vital role in the lives of individuals who experience illness or injury. This occurs through transforming professional thinking and accountability into processes that create self-empowerment and personal accountability life models for clients served.
Professional thinking and accountability concepts flow within the River of Occupation as the OTD students’ kayaks move through the water, resulting in the curriculum design of Professional Thinking and Accountability through the Flow of Life’s Occupations. Adaptation-in-context describes the behavioral process of learners’ continual active acquisition of knowledge, skills and competence in relation with the ever-evolving dynamic flow of the river environment. The metaphor of kayaks within the river provides the visual image of the fusion between professional thinking and accountability concepts, the flow of occupation and the OTD Mission, ASOT Vision and Spalding University’s Mission. This flowing movement within the river is the symbolic application to the curriculum design and may be summarized as:
The University’s Mission, Auerbach School of Occupational Therapy’s Vision and the Occupational Therapy Doctorate Mission are represented by the bridges over the Ohio River and the dynamic river bank itself. The bridges represent the connections that link and provide shared meanings and structures for the diverse individuals who come together as part of the learning community.
The narrative flow of the OTD curriculum is represented by the water flowing within the river bank with its twists, turns, sandbars, obstacles, tributaries, locks, smooth and gentle waters as well as turbulent white water. The river is always flowing, in ever changing and shifting currents or context that propels students and faculty onward within the learning process.
The curriculum’s core professional competencies, (threads) are represented by the components of the kayak itself.The kayak is a paddle craft that is lightweight, highly maneuverable and contains a cockpit seating device to allow one to move effectively and efficiently through various flowing waters.
The kayak’s bungee shock cords and lifeline provide a system for storage and the “X” shape strapping allows a paddler the ability to perform self-rescues if necessary. The shock cords and lifeline represent the students’ capacity for meeting the occupational needs of society - empowering students to become therapists dedicated to diversity, peace, justice, and care for the complex needs of society. In a very real sense, OTD students and graduates liberate and free individuals with disabilities and life-altering conditions; enabling them to maximize their occupational potential.
The grab handles on the bow and stern of the kayak provide secure gripping for moving the kayak.As OTD students learn to paddle, the development of the professional skills of supervision, delegation and collaboration while working with the occupational therapy assistant, service extenders, and other discipline professional team members are essential leadership attributes addressed in the program of study. The grab handles represent leadership in practice & advocacy emphasizing the concept of the individual occupational therapy practitioner (student and faculty member) as part of a broader team that may at times need to model, support, and possibly grab ahold to tow another in need of guidance through the challenging, changing and flowing life waters.Additionally, occupational therapists must develop and use collaborative team skills with the client and family to assure the delivery of compassionate client-centered services. Courses with the OTD curriculum emphasize the concept of the individual occupational therapy practitioner as part of a broader team whose major contributions focus upon client empowerment and occupational therapy performance.
The kayak’s rudder provides a safe lock down position when transporting a kayak. In addition, when crossing open water, experiencing waves, or strong currents, the kayak would be pushed and thrown around without a rudder.A rudder can be moved up/down or side to side in order to maneuver the kayak effectively through the water.The successful use and maneuverability of the kayak’s rudder represents the OTD students’ capacity to utilize critical thinking/occupation-based reasoning. Just as rudder use is crucial for guiding the kayak skillfully down the river, avoiding debris, impediments and wrong turns that may arise during the journey; critical thinking and occupation-based reasoning skills help guide the OTD student’s professional thinking for effective problem solving to ensure the facilitation of the client’s engagement in meaningful occupations and the achievement of positive therapy outcomes.
The kayak’s cockpit (backboard, seat, hip pad, thigh brace and unseen foot braces) is the area the paddler sits in to control the kayak. The cockpit represents compassionate client-centered care which is the OTD student’s major contact point with others within the occupational therapy process.Importantly, compassion is the central driving force of all programs and courses within Spalding University. Faculty continually strive to demonstrate compassion during mentoring, teaching, instructing and advising of students throughout the 36-month program. Students engage in varied experiential learning opportunities throughout the curriculum in which compassionate actions come alive. Compassion is a lived experience within the university’s culture and the OTD student will take the core foundation of compassionate client centered care out into the world upon graduation.
The courses in the OTD curriculum and their learning objectives/strategies are symbolized by the synchronized action of the multiple kayaks, propelled by students and faculty alike, moving down the river in the desired direction. The OTD curriculum and the embedded courses are thoughtfully planned for linkage to the overall curricular threads and learning outcomes. The student’s active engagement in the process of doing is represented through paddling one’s kayak to move through the curriculum’s program of study. The program of study is represented by flowing currents of nine different trimesters culminating in the OTD Capstone Project. The development of professional thinking skills and accountability are represented by ongoing changing conditions and developments that occur based upon student needs/feedback, faculty observations/judgment, and changing environments. In the same way that one paddles the kayak through the flowing water currents; over obstacles, and unseen objects in the river water; occupational therapy doctoral students learn knowledge, develop skills and demonstrate competence to become entry-level and advanced occupational therapy practitioners with skills in clinical practice, research, program and policy development, leadership and advocacy and educational processes and constructs.
The River of Occupation analogy illustrates how the curriculum design and related processes coupled with students’ active participation and faculty guidance creates a shared understanding and narrative flow of doing and becoming an occupational therapist. Moving the kayak’s paddle depicts the student’s demonstration of professional thinking skills, accountability and active learning. Later, as skill and competence develop, ever-evolving river navigation represents of the flowing, ever current, changing curriculum model. The student’s lived experiences of paddling the kayak creates professional thinking, reflection, evidence-informed knowledge, skills, and competencies allowing him/her to flow into the ever-changing river context which represents the complexities within varied practice environments.
The occupational therapy community, made up of faculty members, students, community partners, and other interested individuals, who promote the use of occupation as a theoretical and applied framework are all engaged in advancing the students’ capacities for advanced practice competence. Occupational therapy doctoral program graduates evolve into skilled kayakers who eventually become experienced river guides. This transformation occurs after completion of all didactic and Fieldwork experiences and the successful culmination of the OTD Capstone Project. Demonstration of professional thinking, evidence-informed knowledge, skills, and competencies within occupational therapy content domains occurs through engaging in the doing-in-action OTD curriculum. An OTD graduate’s professional thinking skills and accountability continue to transform through professional lifelong learning as he/she navigates the professional kayak through the River of Occupation.
The OTD program’s curriculum learning outcomes is the development of competent entry-level and advanced occupational therapy practitioners who assume roles in a variety of service delivery systems such as, hospitals, rehabilitation facilities, long-term care facilities, out-patient facilities and clinics, community-based programs, schools, home health agencies and other emerging practice areas. Due to the liberal studies educational base that is a major part of the structural bridge of Spalding University’s Mission, along with the application of reflective, evidence-informed occupation and occupational therapy evaluation, intervention and outcome concepts which includes the completion of the OTD Capstone, graduates are prepared to compassionately serve diverse needs and populations across the developmental lifespan. Graduates have the capacity to work in various fields of practice, education, and/or research arenas.
In practice, occupational therapists encounter problems, challenges, and adaptive demands that exceed the solutions learned in the academic setting. They must continue to adapt and evolve professional thinking skills to acquire the knowledge and evidence necessary to develop new and unique solutions for existing and future practice settings. Beginning in the academic setting, to assure future success and competency, occupational therapy doctoral program students must develop the professional thinking skills for assuming responsibility for continued evidence-informed practice and lifelong learning. The curriculum is designed to place responsibility of learning upon students through case-based identification and utilization of needed learning resources. Throughout the curriculum, students are encouraged to develop their own learning objectives which focus on individual strengths and areas for development and improvement.
As students gain skill in paddling the kayak through the flowing curriculum waters, they move towards the OTD Capstone Project. It is here where, with assistance from their faculty supervisor and program facility mentor, they set out on their own journey into advanced clinical practice, research, policy and program development, leadership and advocacy, theory or educational concentration(s). Occupational therapists need to have beginning and advanced professional thinking skills for contributing to the accumulated body of occupational therapy evidence. In order to develop competence for the OTD Capstone Project embedded within identified curriculum trimester courses, students engage in increasingly complex assignments involving research and critical evidence analysis, issues of measurement, quality of life outcomes, evidence-informed practice, theoretical analysis and expansion, program development and evaluation, leadership, advocacy and policy impacts. Faculty supervise, mentor, coach, and assist the student in developing the professional thinking skills for identifying, evaluating, and contributing to refereed literature that occurs through completion of the OTD Capstone Project.
Ethics is a systematic reflection on and analysis of morality. Thus, ethics is a fundamental part of life’s occupations. Ethical reasoning takes on a specific form when someone assumes the role of an occupational therapist. Many people find that religious teaching, parents and family, friends, books, school, and media are influential in their lived experiences and ideas about morality. Sometimes one’s very early upbringing remains the essential river bank bedrock of one’s personal morality throughout life. Many others have adolescent, young life, mid-life or even old-aged experiences in which a serious reevaluation of morality takes place. Entrance into the world of occupational therapy may precipitate re-evaluation experiences if a student’s expectation and perceptions on how ethical practice occurs differs from one’s own personal ideas. A career in occupational therapy requires many complex choices. Ethical and legal considerations are presented throughout the OTD curriculum to focus the students’ examination of values and beliefs and integration of these concepts with occupational therapy clinical practice, research, and educational experiences.
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