Laura Feeney, MS, OTR/L Susan Toth-Cohen, PhD, OTR/L

Experiences of occupational therapists addressing clients’ religious and spiritual concerns in occupational therapy practice American Occupational Therapy Association Annual Conference Charlotte, NC April 29, 2006 Laura Feeney, MS, OTR/L Susan Toth-Cohen, PhD, OTR/L

What do We Know About Spirituality and Health? Overall, research findings suggest that there is a positive relationship between aspects of spirituality, such as religious involvement or prayer, and achievement of positive health outcomes Spirituality and Improved Mental Health and Emotional Well-being Spiritualityand Positive Health Outcomes Patient Views about Spirituality and Healthcare

How are spirituality and OT related? ..it is imperative to consider spirituality in OT practice, in order to support the client’s ability to engage in occupations and participate in life activities. (Egan & DeLaat, 1997) Christiansen (1997) views this discrepancy between theory and practice as a lost opportunity to “understand the full potential of occupation to enhance the health and well-being of clients” (p. 171). Practice Framework Theories Holism Few OT practitioners address spirituality in their practice

Egan and Swedersky, 2003 • Interviewed Canadian therapists who address spirituality in their practice • Findings: Four themes describing their experiences 1. addressing religious concerns 2. addressing suffering 3. encouraging the self 4. growing as a person • Limitations: • Little information on the actual content of the interactions between therapists and clients was presented • Canadian and U.S. healthcare systems are different, it is uncertain to what extent findings are applicable to U.S. occupational therapists

Purpose and Objectives • The purpose of this study is to explore the experiences of occupational therapists (OTs) who address religious and spiritual concerns of clients in adult physical rehabilitation. Objectives: • Describe the ways in which occupational therapists practicing in adult physical rehabilitation address clients’ religious and spiritual concerns • Identify supports and barriers to addressing spiritual concerns in practice • Explore the influence of a therapist’s own faith tradition and beliefs on his/her experience of addressing clients’ religious and spiritual concerns in practice

Methods • Qualitative design – phenomenology • to accurately understand the lived experience of participants (Krefting, 1991, van Manen, 2000). • Data gathered through semi-structured interview and participant reflection papers • interviews lasting 1-2 hrs focused on eliciting details of participants’ experiences in addressing religious or spiritual concerns with their clients • participants composed a reflection paper describing an experience in which (s)he addressed religious or spiritual concerns with a client.

Why Phenomenology? • To understand what it is like when OTs address spiritual or religious concerns in everyday practice • To get a sense of how OTs do this -the essence of the experience, as they encounter patients/clients with religious or spiritual concerns (vs. what they think about what should/should not happen—though a sense of this emerges through their experiences)

Religious Background of Participants 1 Jewish 3 2 Catholic 2 Protestant Other Sampling and Participants ●Theoretical sampling used for this project. ●Participants were limited to those with at least five years experience. ● 7 women, 1 man (ages 43-57)

Analysis 3-part phenomenological analysis (Van Manen, 1990, p. 93) Each researcher independently: • identified thematic phrases capturing participants’ essential experience of addressing religious or spiritual concerns • reflected on each transcript in terms of the four “existentials” of lived body, lived time, lived space, and lived human relation. • developed essential themes, using the process of “imaginative variation”

How it felt Perceptions of time Their work environment Relationships with others, especially the patient/client—but also with administration, employees Phenomenological analysis (Van Manen, 1990)|Existentials • Lived body • Lived time • Lived space • Lived human relations (largest category discussed)

Credibility Strategies Member checking process • Participants reviewed.. • Chart of strategies used to address clients’ religious and spiritual concerns • Table listing main themes • Continued contact with participants

Essential Themes The Experience of Addressing Patients’/Clients Religious or Spiritual Concerns in Practice means that the OT … • Is client-centered • Is characterized by a holistic view of the patient/client • Is influenced by personal beliefs but does not impose these beliefs on patient/client • Experiences a personal connection with the patient/client

Essential Themes Client-centered Care Holistic view of person Personal Spiritual Beliefs Personal Connection w-Client □ Uses what is important to client as start point or basis for therapy -Observes client’s environment, language, and behaviors as cues to spirituality -Focuses on client’s religious or spiritual beliefs -Makes activities meaningful □ Views client as a whole person with varied needs, including spiritual □ Assesses client’s spiritual needs through initial evaluation □ Incorporates spiritual/religious activities into therapy sessions □ Strong personal spiritual beliefs influence how/ why therapist addresses spirituality in practice- personally participates in spiritual or religious activities -values religion/spirituality -refuses to impose beliefs on client □ Develops a caring relationship - Personal emotional component to treatment - Importance of giving hope and support

Essential Themes Client-centered Care Sample Quotes □ Uses what is important to client as start point or basis for therapy -Observes client’s environment, language, and behaviors as cues to spirituality -Focuses on client’s religious or spiritual beliefs -Makes activities meaningful • “This was her moment, this was her therapy session, and I let her decide what she wanted to do with it.” (P1) • “I think more when I do hand therapy than in almost any other field are they that self-directed at what they want out of it, which is their prerogative and so, then I follow that lead.” (P3) • “You go with the flow with what they’re going with, talking about God.You look around the room and see what they’ve got, what they’re interested in.” (P6)

Essential Themes Sample Quotes Holistic view of person • “ If we hadn’t addressed [his ability to participate in a religious practice—ritual bath], he would have accepted not addressing it, but we would have lost good opportunities for good rehab within the context of who he is.” (P4) □ Views client as a whole person with varied needs, including spiritual □ Assesses client’s spiritual needs through initial evaluation □ Incorporates spiritual/religious activities into therapy sessions

Essential Themes Personal Spiritual Beliefs Sample Quotes • “I think everybody seeks something bigger than themselves and then when they’re in a period of crisis they want to pursue that and I know how that is for me so I just offer some encouragement in that area.” (P3) • “I feel like [addressing their concerns] is part of who I am, and it’s part of why I am here.” (P5) • “…because I’m spiritually based, I probably approach everybody…sort of speaking to that higher being in them.” (P7) □ Strong personal spiritual beliefs influence how/ why therapist addresses spirituality in practice- personally participates in spiritual or religious activities -values religion/spirituality -refuses to impose beliefs on client

Essential Themes Sample Quotes Personal Connection w-Client • “Sometimes just by the connection of having a caring person, who is your therapist, sometimes having them stop what they are doing and give you your full attention. I feel like that can help a person through the grieving process to feel that connection that someone does care.” (P2) • “Namaste means that when I am in that place of God within myself and you are in that place of God within yourself, we are one. And so it sort of is uniting a place that we unite. And I think that certainly when I’m speaking deeply and intimately with my patient I feel like we are often in that place. That therapeutic moment is connecting at that place, of shared one-ness.” (P7) □ Develops a caring relationship - Personal emotional component to treatment - Importance of giving hope and support

Video • Participant comments on essential themes

Strategies • You will discuss strategies you use to address religious or spiritual concerns, with others at this session • We will then regroup, discuss briefly, then present a case study of a patient who presented with spiritual concerns

Strategies OTs Used to Address Spiritual or Religious Concerns in Practice with Adults with Physical Disabilities • Discuss with patient • Work to improve patient’s performance skills and patterns related to religious or spiritual practice • Decrease patient anxiety • Use tools/areas related to religion for therapy

Strategy for Addressing Spiritual or Religious Concerns • Discuss with patient/client • Assist patient’s coping strategies • Help patient identify resources • Identify ways to overcome the effect of a person’s condition on the religious/ spiritual aspects of his/her life • Pairing patients with others

Strategy for Addressing Spiritual or Religious Concerns • Discuss with patient/client (Sample Quotes) • “And there are [religious] services in the hospital and they don’t even know about it, and I do make sure that I can tell them about those.” (P1) • I say, “you know, somebody’s really struggling and she’s talking about, you know, she doesn’t want to pray anymore and she feels defeated. I noticed that you’ve found this and this and this really helpful, do you mind if I schedule you at the same time and maybe you could have some dialog about that?” (P3)

Strategy for Addressing Spiritual or Religious Concerns • Work to improve patient’s performance skills and patterns related to religious or spiritual practice • IADL – Work on meal preparation related to religious holidays • IADL – Practice functional mobility needed to attend/participate in services • ADL- Transfers • ADL- Energy conservation and rest breaks • IADL- Standing tolerance • ADL- Self Care (i.e. Dressing appropriately before being seen in public)

Strategy for Addressing Spiritual or Religious Concerns • Work to improve patient’s performance skills and patterns related to religious or spiritual practice(Sample Quotes) • ..a lot of times it’s about food prep. The apple cakes and…the Seders and the things like that. And that’s important to them so then it’s important to us to let them be able to do that, adapting things. (P8) • “[there are] very concrete situation[s] when you know they have spiritual or religious practices um, we try to incorporate them, when appropriate into therapy. So I’ve had folks who practice Islam. We’ll see if we can adapt, if they can’t or have a hard time getting to the floor. Ah, that might actually be a good opportunity to get the body to practice that or to adapt the environment for their prayers.” (P4)

Strategy for Addressing Spiritual or Religious Concerns • Decrease patient anxiety • Progressive relaxation • Meditation • Use of humor • Centering • Stress management

Strategy for Addressing Spiritual or Religious Concerns • Decrease patient anxiety (Sample Quotes) • “I do a stress management class for the pulmonary patients. One of the things we discuss is spiritual belief—meditation, prayer, as stress busters.” (P2) • “I will help them establish awareness of their inner body states, physical states. And I always link that to um, some really relaxation, centering techniques… And when we talk about centering, I start them off with a breathing component that is very concrete and physical.” (P4)

Strategy for Addressing Spiritual or Religious Concerns • Uses tools/areas related to religion for therapy • Reading the Bible/Torah/Koran, etc. • Having therapy in a chapel-like environment

Strategy for Addressing Spiritual or Religious Concerns • Uses tools/areas related to religion for therapy (Sample Quotes) • “…if they were in the middle of their prayers, or if they were in the middle of reading their Bible or the Koran, then I’d ask them to stand up and have them read it…” (P6) • “I’ll set up the pews to be as they would be in their church as they describe them, and then we practice then getting out of the wheelchair or walking, using a walker, exploring what it would be like to have to get through people.” (P4) Add new photo here…I can collect these and add

Problem Solving:Case Study • Watch the video: • What ideas do YOU have for addressing the person’s concerns? • Please classify into ADL, IADL, education • What barriers and supports would you find if treating the person at YOUR workplace? • How would you utilize the supports and get beyond the barriers to provide intervention>

Contact Us! Laura Feeney, MS, OTR/L • Laura_feeney_ot@yahoo.com Susan Toth-Cohen, PhD, OTR/L • Susan.toth-cohen@jefferson.edu

Laura Feeney, MS, OTR/L Susan Toth-Cohen, PhD, OTR/L