The Art and Science of Occupational Therapy

Introduction to Occupational Therapy

Albert Einstein famously suggested that “imagination is more important than knowledge” (Lavelle 2014). As knowledge can be limited, on the other hand, imagination is based on experience and knowledge in another work imagination is creativity in action. It has been indicated that there is no clear definition of creativity as it is defined differently in each discipline. However, creativity could be defined as the ability to produce work or an idea that is unexpected and valuable (Sternberg and Lubart 1998).

Neuroscientists have studied creativity using brain imaging technology and discovered that there is not just single brain area or hemisphere responsible for creativity, but over 40 different areas of the brain are involved with creativity (Nalbantian and Matthews 2019). Studies show engaging in ‘mind-wandering’ assist in creativity flowing. Moreover, scientists believe that humans spend approximately 30% of their day mind-wandering, which might allow their subconscious to keep working on a problem without the involvement of higher cognitive functions (Nalbantian and Matthews 2019). Buzan (2001) established the inner creativity theory that indicates anyone can be creative and everyone has the potential to be creative. He also suggested speed of thoughts/fluency, that means how fast someone can generate ideas and is one of the hallmarks of creative genius that can be developed by practising faster thinking (Buzan and Buzan 1996; Buzan 2001).

This reflective practice piece aims in discussing reflective practice and creativity within the Occupational Therapy [OT] profession. Furthermore, the Rolfe et al. (2001) reflective framework will be used to reflect on chosen creative skills. This is using Livescribe echo Smartpen in writing clients’ progress note/documentation, which falls under creative problem-solving skills in management and leadership creativity.

Occupational Therapy and Creativity

This section will discuss creativity within the OT profession and how Occupational Therapists [OTs] incorporates it into practice. It is believed that a creative individual would have particular personal characteristics and abilities. These include high self-esteem, attraction to complexity, unusual ideas, flexibility, engage in meaningful activity, good problem-solving skills, fluency of ideas, self-acceptance and ability for self-criticism (Maslow 1968; Kneller 1966; Csikszentmihalyi 1996; Sternberg and Lubart 1998; Gardner 1999). 

According to Amabile (1996), creativity in individuals focuses on intrinsic motivation rather than extrinsic. Intrinsic motivation is the interests and motivation to do something because a person finds it satisfying, enjoy doing, is curious about it and/or personally challenging (Amabile 1996). It is believed that intrinsic motivation is the core for enhancing creativity and being productive (Amabile and Kramer 2011). On the other hand, it is suggested that extrinsic factors such as personal, social, physical and environmental circumstances would influence creativity (Dul et al. 2011). Furthermore, in an experiment with adults, Amabile (1996) discovered that even thinking about extrinsic motivators or constraints would lead to being less creative. Moreover, she indicated that social environment factors have a significant impact on creativity by impacting motivation. This means when being watched while working, having an expectation, a thought of competition, rewards, or evaluation that might be set by an organization would lead to producing less creative work. Receiving the right support and having appropriate resources may promote creativity.

In addition, Amabile and Kramer (2011) discussed the inner work life theory and how it promotes creativity, as they found that individuals are most creative when they have the most positive inner work-life experiences. It can be defined as a psychological experience and engagement of day by day work that includes individuals’ perceptions, both intrinsic and extrinsic motivation, positive and negative emotions (Amabile and Kramer 2011). They also discovered creativity is higher on good inner work life, individuals demonstrate a higher level of commitment to work duties, productivity level increase and are better colleagues to each other.

Creativity in Management and Leadership

Engagement in occupations such as work can be either restricted or supported according to many factors. One of these factors is the environment. The environment in the OT profession is more than nature and buildings, it includes physical, cultural, political and social elements of the workplace (Creek 2010; Park et al. 2019). These elements would either promote engagement, performance, motivation and creativity of an individual or restricted it.

In regards to creativity in the workplace, managers and leaders of an organization have a different perspective of it, where some believe it is important for enhancing workers’ level of motivation, others view it as a waste of time and reducing organization productivity. Therefore, it is believed that workplace environment and/or organizational visions would either promote or inhibit creativity, where managers and leaders play fundamental roles in the creative principle.

Within an organization, there are different roles and responsibilities of managers and leaders. Manager’s roles include; planning, problem-solving and motivating and encouraging others. On the other hand, leaders are responsible for improving organization, empowering and problem-anticipation. Moreover, creativity in management refers to the ability to provide creative problem solving and empowering individuals to develop their creative skills. In contrast, creative leadership is a concept of working cooperatively to promote creative ideas.

Empowerment, encouragement and inspiration form supervisors/ managers certainly enhance creativity, however, creativity truly promoted when the entire organization supports it (Mubarak and Noor 2018). Freedom and choice of what to do and how you perform what you are expected to do are called occupational rights/choice (Parnell, Whiteford and Wilding 2019). In the OT profession, choosing to use a Smartpen to write clients’ documentation is considered an occupational right. However, some organization have policies and regulations which may contradict with individuals’ rights.

Flow and Creativity

Flow theory is first introduced by Csikszentmihalyi, who defined it as the state of deep concentration that can be accomplished when engaging in an activity/task that challenges own skills (Nakamura and Csikszentmihalyi, 2014). He found a relationship between creativity and flow.

Reflective Practice

Since the obligation for a practitioner is to keep their knowledge up to date when considering implanting interventions, becoming a reflective practitioner has become increasingly important. In addition to this, in most healthcare disciplines reflective practice is an increasingly fundamental principle of Continuing Professional Development [CPD] (McLeod et al. 2015). Reflective practice can be defined as the ability to learn and evaluate own action, knowledge, bridging the gap between theory and practice, linking new knowledge to existing ones and enhancing critical awareness (Knasel et al. 2000; Moon 2013; Mann et al. 2009). Furthermore, it is an acquired skill that needs to be learned and maintain practising to improve it (Stagnitti et al.2013). OTs utilise reflective practice to ensure providing evidence-based interventions and that clients receive quality care (Taylor 2011).

It has been suggested that to further develop OT role and expertise, learning should occur from experience (McGill 2004). According to Larkin and Pépin (2013), an effective way of development is through reflection. Reflection is considered as an informal CPD that involves lifelong learning, which refers to skills a practitioner performs throughout their life to develop their knowledge and competence in a particular field (Larkin and Pépin 2013; Mann, K. et al. 2009). Evidence shows that engaging in reflective practice specifically in healthcare settings would enhance practitioners’ motivation in delivering best practice and promote performance (Taylor 2011). Moreover, Gibbs (1988) argues that knowledge and experience alone are not sufficient to improve performance however, reflection on own experience allows for future changes and development in practice. Noticeably, reflective practice is fundamental to develop expertise and professional identity.

Although evidence shows the importance and positive outcome of reflective practice in healthcare, many barriers would obstruct the process. For instance, excessive workload, workplace culture, organizations’ policy and time constraints (Thompson and Thompson 2008). Therefore, it is believed that OTs should maintain reflective practise to develop competence, role identity and expertise. There are many reflective models in which OTs utilise for reflection such as, Fish and Twinn (1997), Johns (1994), Rolfe et al. (2001), Gibbs (1988), Boud et.al. (1985), Day (1993) and Boyd and Fales (1983).

Johari Window

I have been advised by my previous supervisors that during supervision, I am too hard on myself. As in debriefing and supervision session, I tend to focus on negative aspects of my practice rather than concentrating on positive and things I have done well. I used to believe that by doing that it would increase my motivation to improve my performance. However, after undertaking this module the ‘Art and Science of Occupational Therapy’ I came into the realisation that I could use my creative thinking to find a solution. This is so to use the Johari window to better understand me.

The Johari window was introduced by psychologists Joseph Luft and Harrington Ingham where the name comes from. It is one of the tools/techniques that would have positive outcomes when applied in workplaces. As it is a technique that assists individuals to better understand their relationship with themselves and others (Luft and Ingham 1955). Johari window contains four aspects, these are open, hidden, blind and unknown (figure 1). It is anticipated that the Johari window is a great tool that every practitioner should use as it is believed to increase self-awareness, which is important in self-reflection.

Reflection and Rationale Behind Choosing the Smartpen as A Creative Skill

Problem-solving is an essential skill required in practice. It is well known that OTs ‘think on their feet’, which means that OTs required to make a decision and take action right away. Therefore, having creative thinking falls under creative problem-solving. The reason for choosing the Smartpen as a problem solver for writing clients’ progress notes is because during my undergraduate study in one of my placements I was placed at a very busy acute/inpatient setting in a big hospital where all notes were handwritten. Given that English is my second language, I found it extremely challenging to read clients’ progress notes before the session, it used to take a very long time no less than 30 min.

Although the hospital goal was to be paperless, their strategy was to scan all handwriting progress notes into a hospital system which has created more challenges for me, as the scanned files wherein a very poor resolution. It took me even longer to read and try to make sense of the written notes especially that most healthcare teams use a medical abbreviation, which increased the complexity. As a result, I used to miss a lot of critical information about clients such as medical precautions. At that time there was nothing could be done and my placement supervisor indicated that she never supervised a student with the same problem. The reason was that she used to supervise native speakers’ student and I was the first international student whose first language is not English. In my opinion, my supervisor had not used her creativity to solve the challenge I was facing.

Moreover, I had more challenges to take handwriting notes during my interaction with clients. As my supervisor refused to allow me to take any device in clients' sessions because she believed it will distract clients. I could not take my IPad with me to type notes as a consequence. Back then I started thinking of how I could problem-solve this challenge in using a device that is understated to clients. At the time I started reading about Smartpens, which I have seen during an assistive technology conference I attended. I discussed with my supervisor about the Smartpen before purchasing. I explained that the Smartpen will assist me in focusing on what clients say and not worry about missing important information during clients' interaction.

However, my supervisor point of view of having such a device is considered inappropriate, she believes that only disabled or individuals with special needs require assistive technology. But as a practitioner and a healthy individual, it is a stupid idea to have it. Her perspective has in some ways impacted my decision to purchase the Smartpen, as she said to me even if you buy it, the hospital will not permit you to use it in taking notes. In summary, I believe that even if you are creative and have a creative problem-solving skill, supervisors/managers and the organization you work in would inhibit your creativity.

Livescribe Echo Smartpen reflective framework (Rolfe et al, 2001), there are many different types and brands of Smartpens. The Smartpen chosen in this reflective practice is the Livescribe echo version. Many features led to choosing this specific version of the Smartpen some of these features will be discussed below.

All Livescribe Smartpen accessories are easy to purchase from the official Livescribe website. These include Livescribe Dot Paper (specialized notebook for the Smartpen), headset and ink cartridge.

Additionally, the Smartpen comes with echo desktop software that can be downloaded in any device whether computers, laptops and smartphones. It supports all systems Windows, Mac, iOS and Android which would assist in creating an electronic backup of all notes (audio & handwritten) and access them easily at any time to clean any unwanted notes and easy search notes.

Also, the echo software allows sharing notes (text, handwriting and/or audio) via email, SMS, Evernote, OneNote and via sharing application on smartphones such as WhatsApp and LinkedIn. Moreover, for security, each pen has a unique authorize code to connect the Smartpen with the desktop software.

Refer to table 1 for more features regarding the echo Smartpen;

Features

Smartpen brand: Livescribe

Version: 2GB echo Smartpen

Livescribe Dot Paper

Micro-USB for charging and data transfer

Microphone

A camera behind the ink cartridge record everything you write

OLED window that displays Battery indicator and time

Convert audio to digital text

Print notes

Record audio and playback directly from pen and linking audio recordings to notes

Replay audio directly from the paper by tapping on notes

Add documents and Web pages alongside handwritten notes

Price £151

Table1: Information about Livescribe Smartpen (Livescribe 2020)

Below is an in-depth analysis of the use of the echo Smartpen in documenting clients’ progress notes by OTs utilizing Rolfe et al framework. It is a reflective cycle that contains three parts these are, What, So what? and Now what? (Rolfe et al. 2001).

What?

Aims and purposes of using the Smartpen for documentation as an OT practitioner are:

First, the handwritten notes in the Smartpen can be transcribed into typed text and the audio recording can be converted into text by a single click within the software. This feature would assist OTs in time management and reduce the pressure from excessive caseload. It has been suggested that when practitioners write notes during clients' sessions, they cannot fully focus on the intervention they delivered (Fritz 2016). Second, when under pressure for high productivity, practitioners would provide their clients with simple treatment intervention. When practitioners provide a good intervention session, they possibly won’t be able to get into documentation (Rosner 2007). It is anticipated that concentrating on increasing productivity by meeting more clients and not having time to write proper documentation would reduce practitioners' satisfaction and motivation (Ghosh, Long and Murphy 2020). The use of the Smartpen would save OTs' time and allow them to focus on delivering the best intervention and not worrying about documentation.

It is often seen that people are not able to maintain a workable balance in their lives. Occupational Balance refers to the balance in all dimensions of life and well-being. These are; leisure activities, housework and work/employment (Christiansen and Townsend 2004; Clouston, 2014; Clouston 2015). During my survey, in many OT settings, I saw that they spend most of their working hours writing reports and clients' documentation, which resulted in occupational imbalance. For instance, in vocational and outpatient rehabilitation centres. In many organizations, the report needs to be done within 48 hours after clients' interaction to ensure right measurements, implementation and clinical reasoning included which would lead practitioners to have overtime hours to finish all documentation required. This hampered their productivity and their zeal to work as the documentation is a very mundane task. Therefore, I thought that the invention of Smartpens is a boon for OTs as it converts the long hours of their manual work at seconds speed into electronic form.

So What?

When I asked my supervisor to take this Smartpen to the sessions with clients, he simply refused. Therefore I wanted to point out the reasons why the Smartpen considered as a creative problem-solving skill for documentation.

First of all, documentation within OT profession is a fundamental requirement during and after clients' interaction for legal purposes, to produce evidence-based and best practice (Buchanan et al 2016; Davis et al 2008; Sames 2015; Tickle-Degnen 2000). Evidence indicates medical errors occur because of poor communication between healthcare teams (Edwards and Moczygemba 2004; Kaushalet al. 2001). Good documentation improves clinical outcomes such as reduces the waiting list, reduces harms and medical errors (Rodziewicz and Hipskind, 2020).

In a variety of researches it is seen that in busy work environments such as hospitals, many practitioners tend to write brief documentation in clients' files which would have negative consequences. In a study which aimed at looking how comprehensively OTs documentation is, it suggested that OTs notes were inadequate and did not include sufficient clients' information, which is important to produce robust evidence (Buchanan et al. 2016). In response to the requirement for increased clients’ safety, it has been suggested that clinical documentation needs improvement (Atrain Education 2020). Therefore, it wouldn’t be wrong to say that healthcare organizations owe a responsibility in providing options for allowing practitioners to use such Smartpens for documentation to improve communication between healthcare teams and avoid medical errors.

Along with this, active listening is a key communication skill that OTs required during clients' interaction to facilitate the establishment of a therapeutic relationship. Active listening is when practitioner focus, respect, clarify, engage, reflect and acknowledge what clients' say (Jahromi, et al 2016). It has been indicated that clients prefer active listening. This would assist OT in building trust and establishing rapport with clients (Ennis et al. 2013). Evidence shows that when a practitioner provides a client chance to speak for 1 min and 30 seconds without interruption, they would tell everything that a practitioner needs to establish a treatment plan (Phelan, et al 2015). Hence it would be appreciable having a Smartpen during clients' interaction is a great way for OTs to demonstrate active listening.

I can understand that confidentiality is a core element within the OT profession (Hugman and Carter 2016) and some patients could be very conservative when it comes to sharing their information. So to redress that, this Smartpen has high security with unique code to access the echo software in computer devices. These include fingerprint, face ID and voice recognition, which gives practitioners to connect and use the Smartpen while keeping clients' confidentiality.

Now what?

To make this device compulsory in a certain line of professions, I should contact the health practitioners and the health advisory board and make them aware of the importance of this device in their profession and how can that reduce their manual work to the minimal. A client who goes to any OT, he goes with this trust and faith and his problems shall be solved. In reflection, prescribing assistive technology for clients is one of OTs role and responsibilities. Assistive technology refers to any device or adaptation equipment that promotes functioning for individuals to perform activities of daily living independently (Akyurek et al. 2017). This could make the OTs feel obligated towards their clients and make them realize the fact that this device could lessen their unnecessary extra work and that time they could use for some more productive work.

Moreover, a study suggested that creativity is important in a therapeutic process for both therapist and clients (Oven 2020). She also indicated that for therapists, creativity promotes the ability to solve problems. Using assistive technology in clinical practice such as Smartpen anticipated having positive outcome including, creative problem solving, time management, satisfaction and providing best practice. If this gets into the action, then the whole therapeutic world would take a new direction towards digitalization. Having a record of the patients etched in a device forever would ease the task of OTs and the clients too. Neither of them would have to worry about either of the records. This could pose as a stepping stone for other lines of the profession like legal industry, research and development industry, education industry etc where everything is written and kept a record off in writing. So much of time, resources and effort get wasted in pinning down every activity.

Conclusion on Occupational Therapy

In conclusion, this module has enhanced not only my confidence and ability as a practitioner to provide intervention at a leadership level but also increased knowledge, critical analytical skills and ability to provide evidence to support chosen creativity skill. Most importantly, the fact that anyone can be creative. It has promoted my motivation in becoming creative OT by thinking outside the box in my practice especially in choosing interventions for my clients. In reflection, I have also learnt that there is nothing wrong to use assistive technology as a practitioner to deliver best practice and provide better outcomes.

Furthermore, this reflective practice was a gentle reminder of the importance of reflection in practice. There is no doubt that reflective practice is a way of enhancing performance, which develops expertise and ensuring evidence-based practice. As discussed, documentation is an essential requirement within the practice, where literature shows that occupational therapists are not meeting the standard. This is an important recognition that I would take into consideration during practice and increase awareness of other healthcare practitioners too. Being an active listener and writing good documentation might be challenging, there are many creative ways that we as practitioners could invent to assist us such as using the Smartpen.

Finally, reading about the inner work life concept from ‘the progress principle’ book has increased my awareness, knowledge and responsibility for inner work lives of my own and my colleagues. Last but not least, the Johari window concept has brought to attention on how I could become a better contributor to the success and sharing positive vibes within an organization by explaining and reminding colleagues of the importance of increasing self-awareness using the Johari window. 

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Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Occupational Therapy Assignment Help

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