Summary and Reflection

In conclusion occupational therapists who work in rural or remote areas practice in a specific way that suits this setting. It is seen that the approach a therapist takes might differ slightly due to the location of where they practice. Also that the caseload may be quite varied compared to a therapist who works in a more urban setting. This would appear to be a generalised concept for different parts of the world.

In reflection the findings about the practice of occupational therapists in remote settings are very similar to my own view of how a therapist may have to work when working in such a different setting. The need for the therapist to change in areas such as the approach taken when working in such a different environment as well as having quite a different caseload to what is considered to be the norm. 

Some influencing factors that I consider to have impacted on my view of this role of an occupational therapist would include:

• Family members who work as nurses in remote areas of Australia
• Family who have accessed occupational therapy services in rural Alaska and their experiences of this
• Peers who have had the opportunity to work in community settings in New Zealand that has had a remote element to it and their experience of how their therapist practiced in that setting
• Courses throughout this course have also challenged my thinking around the role of an occupational therapist and how this differs between settings.

Overall the experience of creating this blog has continued to develop my interest in this practice area. I hope from these postings you have learnt something about this area of occupational therapy and how this profession may differ in ways yet remain the same in essence.

Scope of Practice for Occupational Therapist in Remote Settings

Boshoff & Hartshorne (2008) state, “it is important to note that country therapists mostly have a varied caseload” (p. 257). This is in relation to the conditions clients have on their caseloads. Thus therapists in rural areas need to be versatile as they could be seeing clients with mental or physical health issues and they could be of paediatric age to older persons and everything in between.

At an undergraduate level, learning is currently varied among these areas that it would be an ideal way of incorporating this knowledge learned into practice by being in a setting where the caseload is so varied. Yet the concept of having a varied caseload could be quite daunting, especially as a new graduate where the knowledge used to practice is at this stage based off theory and limited experience. If practicing in this area as a more experienced occupational therapist I could see this as being a challenge and a way to improve in areas of learning, in regards to the clients the interventions used and the approach taken to meet the needs in a remote setting.

Boshoff, K., & Hartshorne, S. (2008). Profile of occupational therapy practice in rural and remote South Australia. Australian Journal of Rural Health, 16, pp. 255-261. doi: 10.1111/j.1440-1584.2008.00988.x

Practicing in a Rural Setting

This post will briefly identify the way a clinician would practice in a rural setting. Identifying key skills and approaches the therapist needs and some problems that may be encountered requiring the therapists use of these particular approaches. 

Firstly, it is important to remember that an occupational therapist remains the same in that their values and beliefs are constant regardless of what setting they are in. Thus the role of the occupational therapist does not differ greatly in a remote setting; the main aim of occupational therapy is constant in that they are working with people to optimize functional occupational performance.

The aspects in a rural setting that may change is the approach that the therapist takes. Thomas & Clark (2007) identify six themes that emerged from a qualitative research study of allied health professionals working in remote locations of Northern Australia. One theme identified is that the clinician should be “organised but flexible”, this has been highlighted as an approach clinicians should take as there are variables that are encountered in rural areas that may not be as common in a more urban setting. This includes the range of places interventions may be carried out, the need to improvise and use limited resources creatively, and the ability to ‘go with the flow’ as community issues may arise in remote areas which the clinician has to be flexible towards in order to “try and work something out just as it unfolds” (Thomas & Clark, 2007, p. 217).

Another highlighted approach is that of “cooperation and mediation”, in remote settings it is stated that “infrequent visits, time limitations and scarce resources necessitated effective communication and cooperation with others” (Thomas & Clark, 2007, p. 118), this is identified as an approach to use with other allied health professionals in the setting as well local services and health workers in the rural location. It is identified that clinicians working in remote settings often have to establish relationships with key people in the communities they visit as direct communication with clients can sometimes not be efficient and therefore having established relationships in their communities will help with this. It is identified that communication is a part of training yet in this practice setting it is important for clinicians to extend the standard realms of communication of client-therapist to include the wider community.  

The third key theme discussed in Thomas & Clark (2007) is “culturally aware and accepting communicators” (p. 219), this theme is specific to the location of the research conducted however the points from this theme are likely transferable into other remote locations in the world. Thomas & Clark (2007) discuss this approach in relation to the Indigenous populations in many remote communities of Northern Australia, in order to have a safe cultural practice it is suggested that clinicians alter their communication with Indigenous people by being sensitive to their style of communication. This includes clinicians reading body language and non-verbal signs, as well as having the ability to wait for responses without filling the silence.

Therapists who use a consultative approach in remote settings are seen to “demonstrate a level of respect and power sharing with clients, which is necessary to empower communities to find solutions to health problems that are sustainable and that reduce dependency on the ‘visiting experts’” (Thomas & Clark, 2007, p. 219).

Thomas, Y., & Clark, M. (2007). The aptitudes of allied health professionals working in remote communities. International Journal of Therapy and Rehabilitation 14, (5), pp. 216-220.

Occupational Justice

Occupational justice is a concept I have learnt about during various courses offered throughout this occupational therapy degree. In occupational therapy this concept concerns us as; it is “an evolving concept that describes a vision of society in which all populations have the opportunities, resources, privilege, and rights to participate to their potential in their desired occupations” (Wilcock & Townsend 2004, as cited in Whiteford & Townsend, 2011, p. 65). In relation to my topic I believe this principle therefore means that regardless of where you live you should have the same opportunities to access occupational therapy services. Therefore if you live in a remote area or an urban hub you should receive the same treatment and occupational therapy services. 

In reality this may not happen due to the accessibility to these services. There are many contributing factors for the reasons why occupational therapy services are inaccessible. These may include:

• No service within a particular geographical location
• The service is limited to a geographical area making it inaccessible to people outside of these boundaries
• Lack of occupational therapists in an area
• Lack of funding to allow services to meet the needs of people in remote areas
• Inability to make a way to occupational therapy services

These barriers are just some of the things that cause occupational injustice. As occupational therapists, by removing these barriers we are able to contribute to occupational justice being obtained.

Whiteford, G., & Townsend, E. (2011). Participatory occupational justice framework (POJF 2010): Enabling occupational participation and inclusion. In F. Kroneberg, N. Pollard, D. Sakellariou (Eds.), Occupational therapies without borders: Volume 2. Towards an ecology of occupation-based practices (pp. 65-84). Edinburgh, UK: Churchill Livingstone.

Definitions and Meanings

As this blog is talking about Occupational Therapists working in rural and remote areas it is important first to define these.

Rural (2012), “in, relating to, or characteristic of the countryside rather than the town”.

Remote (2012), “(of a place) situated far from the main centres of population; distant”.

The definitions of these words are quite similar in some ways, yet the interpretation of these can be quite different and individual to various people. To one person they may consider being in a rural location when there are farmlands or other natural geography in that area, to another it could be considered rural when there is simply no access to a fast-food outlet. In comparison another may consider rural as being a three or more hour drive from the nearest hospital. All of these situations may be referred to as remote locations as well depending on the individuals interpretation of the word and it is for that reason that throughout this blog these two words will be interchangeable.

To understand the reason for these different interpretations of rural and remote it is important to consider ‘worldview’. Worldview is “a philosophy of life or conception of the world” (Worldview, 2012), that therefore has influence on how people see or interpret things resulting in these variations among different individuals.

In occupational therapy the term rural or remote is likely to vary significantly also, based on the worldview of therapists, organisations, and even countries. This may also be a result of the size of the country, region that services are offered in and the number of services available in a particular area.

Personally, I would historically have considered rural and remote to be the countryside and of a distance from a main township or CBD. This was definitely influenced by my experience of growing up and living in New Zealand. This view of mine has definitely altered over time to consider rural as being a lot further away from major amenities, to an extent that it could be a few hours to a few days drive to reach any major township or services such as a hospital. This has been influenced by my travels, the experience of my parents as nurses in remote places of Australia, and literature that I have found.

Remote. (2012). In Oxford dictionaries. Retrieved June 12, 2012, from http://oxforddictionaries.com/definition/english/remote?q=remote

Rural. (2012). In Oxford dictionaries. Retrieved June 12, 2012, from http://oxforddictionaries.com/definition/english/rural?q=rural

Worldview. (2012). In Google dictionary. Retrieved June 12, 2012, from https://www.google.co.nz/#hl=en&q=worldview&tbs=dfn:1&tbo=u&sa=X&ei=vo4PPU7ALPCTiAf794F4&sqi=2&ved=0CFkQkQ4&bav=on.2,or.r_gc.r_pw.r_qf.,cf.osb&fp=e406f5e9e17aa29b&biw=1366&bih=639

An Introduction

My name is Nancy Sheridan and I am a third year occupational therapy student, as part of the final year I am to complete a presentation at the student conference. This blog will identify some aspects within occupational therapy that I have learnt during my training and how this is specific to occupational therapists working in rural and remote places in different parts of the world.

The reason I have chosen this as the topic of my blog is that it is an area of interest to me once I have graduated, it is also similar to the current occupations of some of my family members which involve working in rural and remote areas.