Becoming an occupational therapist and care expert

Becoming an occupational therapist and care expert has been both a personal and professional journey for me. On a personal level, I have been the primary caregiver for my mother, who experienced the illness trajectory of motor neurone disease (MND). On a professional level, I have over twenty-one years of experience in assessing and developing rehabilitation and support programs, I have managed a diverse range of clients. My work has included individuals with head and brain injuries, polytrauma, and orthopaedic conditions, with a specialisation in community neurological rehabilitation. Additionally, I have provided rapid response services, falls prevention programs, healthcare education, and palliative and end-of-life care.

As an occupational therapist and care expert, I utilise my skills and knowledge to understand a person’s situation, encompassing their environment, losses, and potential for future rehabilitation. Based on this comprehensive understanding, I offer tailored recommendations and assemble appropriate multidisciplinary teams of professionals to assist clients in regaining their quality of life following an illness or injury.

Beyond my work as an occupational therapist, I have experience as a researcher, author, and educator, which keeps me informed about evolving trends in the field. I have completed a multi-phase study utilising two distinct methodologies: hermeneutic phenomenology and autoethnography. This research aimed to interpret the meaning of existence for the person with motor neurone disease, and their family caregivers. After earning my PhD, I established my independent practice.

From my research findings, I developed the temporal model of care, a person-centered care model focused on understanding individuals within a broader temporal context, beyond the confines of their illness or injury. In 2023, I authored a book chapter detailing my research journey, published papers, and the development of my person-centered care model. This model emphasises individuality and consists of three key elements: 1) presuppositions, 2) acceptance, and 3) temporality.

Temporal Model of Care

Presuppositions

• Professionals must be aware of their presuppositions (preunderstanding and prejudices) and open to new perspectives (Gadamer, 1975).

• Gadamer (1975) recommends not trying to put oneself in the shoes of another because to do so is to ignore one's presuppositions and historical awareness.

Acceptance

• Professionals must accept what shows itself rather than applying theories or their professional ideas on what constitutes a person’s needs.

• Professionals must accept that a person may wish to discuss loss, uncertainty, and other concerns. Such concerns about life and death are ‘existential concerns’ recognised and accepted in cancer care.

• Professionals need to accept that a person may not want the illness trajectory of MND, and they have the freedom to make choices to refuse treatments and on how and where to die.

Temporality

• Professionals must understand (interpret) a person in a wider temporal frame and beyond their illness/injury context.

• A person contacts their deeper modes of temporality: because of the experienced present and anticipated future, they reinterpret and redefine their lived through past (Heidegger, 1927/1962; Polt, 1999; Sartre, 1969).

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Lived Through Past

• A person has a unique history, culture, and practice.

• A person with an illness/injury whose cognition is not affected is fully aware of their

past; the memories cannot be removed, but the ability to communicate them can.

• The assessment process involves professionals enabling the person to talk about

their lived-through past.

• The outcome is for the person to define their identities and find meaning in life as

it has been lived.

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Experienced Present

• A person is self-interpreting and exist in a social and cultural world with others.

• A person with an illness/injury may experience the present in crisis because life has

no meaning. Frankl (1962) suggests that suffering people cannot move forward into

the future.

• The assessment process involves listening to ‘what is important for a person.’

• The outcome is for the professional to understand what is important for a person,

thus creating feelings of recognition, respect and trust.

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Anticipated Future

• A person has the freedom and the right to make choices.

• A person with an illness/injury may wish to talk about their anticipated future and

how to exert choices.

• The assessment process involves listening to their loss of a once-projected future,

their concerns for a future of being unable to communicate, move and breathe at

end-of-life, and their concerns for others.

• The outcome is for recognition of the complex nature of decision-making for the

future.

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I utilise the temporal model of care to specialise in preparing occupational therapy and care reports that comply with civil regulations and cover a range of complex injuries for court proceedings. The types of injuries and conditions I can report include Brain injury, Orthopaedic injury, Progressive Neurological Disease, Palliative and end-of-life care.

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