Occupational Science & Occupational Therapy - Masters by Research Theses
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Item An exploration of how the wheelchair procurement system in Ireland compares to the needs and wants of the wheelchair users and clinicians, and how it influences everyday life(University College Cork, 2023) Murphy, Jack D.; Pennisi, Yvone; Boyle, Bryan; University College CorkIntroduction: For many people, wheelchairs are an essential part of daily life to enable participation and engagement in occupations. Despite being a vital personal mobility aid, the literature points to inefficient systems which procure and provide wheelchairs to the users. This places undue stress and pressure on both clinicians and service users alike. In Ireland, publicly funded wheelchair procurement occurs through the Health Service Executive [HSE] via use of a standardised national wheelchair contract. Prior to the introduction of the wheelchair contract, ownness for procuring wheelchairs fell to individual clinicians, and/or locally held contracts in some areas in Ireland. The aim of the new national wheelchair contract was to standardise the quality of wheelchairs provided by the HSE, reduce monetary waste, and reduce the workload on individual clinicians to procure wheelchairs. The experiences of those who use the wheelchair procurement system in Ireland everyday are yet to be investigated. This leads to questions regarding how the wheelchair procurement system is working from the perspectives of both the occupational therapists and service users. This project aims to review how the introduction of a national standardised wheelchair contract impacts time-savings, monetary savings, administration load and quality of life of the wheelchair users. Background: The background requires understanding two perspectives: how disability has been viewed historically and how this may have influenced daily life and policy engagement; and how the wheelchair procurement works here in Ireland, specifically using a wheelchair contract system to streamline the procurement process. Literature: The literature indicates that wheelchair provision is studied frequently, however wheelchair procurement is rarely studied. The procurement of wheelchairs is an integral aspect of provision and has the potential to impact its effectiveness. The literature indicates the importance of the meaning of the wheelchair to the user, and its impact on identity. This presents an opportunity for investigation to explore if this meaning is reflected in the wheelchair contract in Ireland. Additionally, the literature looks more broadly at how the wheelchair systems impact the user in terms of the status, regulatory frameworks and funding of these devices. Methodology: This project utilises a descriptive phenomenology methodology to explore the lived experiences of those whom the wheelchair contract directly impacts. Ethical approval was gained prior to commencement of data collection. This research was conducted in the midst of the COVID-19 global pandemic, which impacted the timeframes of the project. Five Occupational Therapists and four Manual Wheelchair Users were recruited for in-depth, semi-structured qualitative interviews, from gatekeepers including the Irish Wheelchair Association and the Association of Occupational Therapists Ireland. Findings: The project has three main findings. These included Personal Factors, which describe all of the factors identified by participants which impacted decisions with regards to wheelchair procurement. Next, the Impact of the System refers to the structures in place which must be navigated by participants to obtain their wheelchairs. Additionally, the final theme is a description of the ‘Business’ of Wheelchair Provision. This section describes the realities of working with Businesses and this is reflected in how the HSE is run like a Business. Discussion: The contract intended to streamline and standardise wheelchair provision and procurement for occupational therapists in Ireland. With wheelchair procurement being an important step in the overall process of wheelchair provision, the project uncovered interesting findings with regards to how it is used and its practical implementation. The wheelchair contract is used in different ways. The occupational therapist group use this directly, while the manual wheelchair user group use it indirectly. Conclusion: The wheelchair contract was noted to be dichotomous in nature. Participants were frustrated with the system inefficiencies which impact procurement and provision. However, participants felt the wheelchair contract was a step in the right direction despite some of its shortcomings.Item Exploring the daily life experiences of UCC registered doctoral [PhD/ MD/ Practitioner Doctorate] students and how the UCC “Everyday Matters: Healthy Habits for University Life” digital badge impacted their daily life and well-being(University College Cork, 2022) Skipp Prendergast, Alison; Hunt, Eithne; Usher, Ruth; Bank of IrelandBackground - Poor mental health and well-being among university students, including doctoral students, is a growing concern globally. Engaging in occupations every day and maintaining occupational balance is believed to improve health and increase well-being. However, little is currently known about the daily life, occupational balance, and well-being of doctoral students. Whole university approaches to promoting student well-being and success are urgently needed, along a continuum of support including universal, targeted, and intensive interventions. The “Everyday Matters: Healthy Habits for University Life” digital badge (EMDB) is an occupation-based time-use and well-being universal intervention offered to doctoral students as a cocurricular micro-credential at University College Cork (UCC). This study explored and described the daily life experiences of doctoral students and how pursuing their degree impacted their occupational balance and well-being, as well as examined doctoral students’ experience of participating in the EMDB. Method - Purposive sampling methods were used in this qualitative interpretive descriptive study to recruit 10 UCC PhD/MD/Practitioner Doctorate students who completed the EMDB. Data were generated through individual semi-structured interviews and thematic analysis was completed. Findings - Doctoral students have a range of roles, responsibilities, and occupations that they need to and want to engage in on a daily basis. For many, balancing their daily occupations and roles alongside their doctoral degree is challenging. Undertaking a doctoral degree can have both a positive and negative impact on well-being. The EMDB successfully supported the daily lives and well-being of doctoral students. Conclusion - Obtaining an insight into the perspectives and experiences of students allows a better understanding of the students’ doctoral journey. Supporting the well-being of doctoral students is essential to enhance their doctoral journey and assist them in successfully completing their degree.Item How do children and young people with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists?(University College Cork, 2022-03-26) Hynes, Patrick Joseph; Lynch, Helen; Robinson, KatieBackground: The UN Convention on the Rights of Persons with Disabilities (CRDP) was adopted by the United Nations General assembly in 2006 to protect, promote and ensure full equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. The right of all children to be heard and taken seriously constitutes one of the fundamental values of the United Nations Convention on the Rights of the Child (UNCRC). For children with disabilities the UNCRC applies, confirming the child’s right to have a voice in all matters that affect them. Children with disabilities face barriers to participation and threats to enactment of their rights, including in healthcare settings such as those provided by the disciplines of occupational therapy, speech and language therapy, and physiotherapy. Children with disabilities frequently access these services. These disciplines purport to deliver client centred services in line with human rights. However, little is known about children’s experiences of these therapies as voiced by children themselves. Aim/Objectives: Through the completion of a systematic review of qualitative evidence, this study aimed to explore how children with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists. Methods: A systematic search of seven databases was undertaken, and included studies were synthesised following the stages of meta-ethnography described by Noblit and Hare (1988). Databases searched were Academic Search Complete, AMED, CINAHL complete, MEDLINE, APA PsycINFO, APA PsycARTICLES, and Social Sciences Full Text (H.W. Wilson). The Preferred Reporting Items for Systemic Reviews and Meta-Analysis Protocols (PRISMA-P) checklist was used to illustrate the research strategy procedures. Searches were limited to English language publications. No limits were applied to date of publication. The Critical Skills Appraisal Skills Programme (CASP) Qualitative Studies Checklist was used to critically appraise the quality of the included papers. Findings: Sixteen studies were included in the synthesis. Four interrelated themes were identified; “Interpersonal experience of therapy”, “Who is in the driving seat? – Children’s experiences of power in therapy”, “The nuts and bolts of therapy: experiencing therapy in the here and now”, and “Making sense of therapy”. Conclusions: The value of qualitative research can be seen in this review due to the rich data that was extracted from a range of qualitative papers. Children with intellectual and/or developmental disabilities described how they experienced therapy sessions. Common experiences included having fun (and a desire for therapy to be more fun) and conversely boredom, discomfort and pain were also commonly experienced. Children described their interpersonal experiences and relationship with the therapist during therapy including their experiences of engagement, communication and trust and their experiences of therapist attunement. Children described how they understood therapy and its purpose, including their experiences of making progress in therapy or achieving outcomes and how therapy related to their view of themselves and their views of ability and disability. Children reported on their experiences of power in therapy, with finding suggesting that therapists often hold power over decisions and goals for therapy, and less frequently children hold power, often regarding smaller decisions. Findings point to the need for occupational therapists, speech and language therapists, and physiotherapists who work with children with intellectual and/or developmental disabilities to further create opportunities for children to be part of the decision-making process and goal setting process. Through interrogation and reflection on their practice, therapists have the potential to be poised for action to utilise a model such as Lundy’s model of participation (Lundy, 2007) to ensure that children experience the full participation in therapy of having their voice heard in all matters that affect them.Item School connectedness: a qualitative case study through an occupational lens(University College Cork, 2022) O'Leary, Jennifer; Boyle, Bryan; Lynch, HelenBackground: School connectedness is an under researched concept in all professions. While the term “belonging” has been used within occupational science, “connectedness” is not a term frequently used. To date, there is one study based on school connectedness and occupation and there is no study in an Irish context. The relationship, if any, between occupation and school connectedness is not understood. Given the strong position of belonging in occupational science, this concept must be understood in a school context. Since the passing of Ann Wilcock (1940-2019), there has been a call for research which continues to build on her Occupational Perspective of Health (doing, being, becoming, belonging). This study aims to do so within a school context. Aim/ Objectives: This research study had three aims; 1) To better understand students and their school’s personnel perceptions of school connectedness 2) To further understand what determines a student’s sense of connectedness to the school environment according to the students and the school personnel 3) To explore the relationship between student’s school-based occupations and their sense of school connectedness. Study Design: This research study is a qualitative single instrumental case study. This study commenced by an entire sixth class group completing a creative exercise to elicit data. Ten students engaged in a focus group and individual semi-structured interviews. This study also had four school personnel engage in individual semi-structured interviews. Thematic data analysis was conducted. Findings: Four themes emerged from the findings; 1) The Importance of the Student’s Social Context on School Connectedness 2) Occupational Influence on School Connectedness 3) Co-constructing an Environment for School Connectedness 4) How Community Connectedness is Reflected in the School. Conclusions: This study established a new perspective of school connectedness through an occupational lens. School connectedness is necessary for enhancing every student’s school occupational performance. Findings outline that due to the impact school connectedness has on occupational participation, occupational therapists should promote school connectedness through a whole school approach. Findings enhance the need to consider the value of interdependence as an outcome to practice.Item Occupation, identity and belonging within community: experiences of mental health disability(University College Cork, 2020-04-18) Cassidy, Caoileann; Jackson, Jeanne; Lynch, HelenBackground: This is a qualitative research study exploring the perspectives of Irish people with self-reported mental health disability in participating in occupation within their community environments. The relatedness of occupation to health and the concept of belonging requires further research and understanding within the discipline of Occupational Science and within the practice of Occupational Therapy. Methodology: Purposive sampling was employed to recruit three participants, from one national mental health support organisation. A phenomenological and narrative framework was adopted in this research. This informed the use of narrative interviews and observation methods to gather data about occupations enacted by participants within their community environments. Open ended narrative interviews were adopted to encourage storied accounts of participants’ experiences, with each participant engaging in two interviews. Following the first interview, each participant collaborated with the researcher in planning an observation session, with the researcher as complete participant, in a chosen occupation within their local, familiar environment. Following this each participant engaged in a second interview with the researcher. Data Collection and Analysis: Digital audio recordings were transcribed anonymously and verbatim from interviews, coupled with field notes from observations, using thematic analysis. This analysis upheld the integrity of each story while illuminating shared meaning of participants’ chosen occupations. Findings: In answer to the research questions, two primary themes were identified, with each theme encompassing two subthemes. The first theme “Experiencing Normality and Promoting Health” explores how participants in this study experienced feeling or anticipated feeling normal through their participation in occupation. Additionally, they chose occupations to promote their physical and mental health when navigating changes to their identities as a result of their mental health distress or disability. The second theme was “Meaning Making and Experiences of Inclusion and Exclusion within Community” exploring participants meaning making through occupation in their local environments, within places and amongst others. The first subtheme captures how participants participated in meaning making with others. The second focuses on their experiences of inclusion and exclusion with stigma emerging from their surrounding environments, impacting feelings of belonging. Discussion: The findings of this study inform understanding of occupation and expand knowledge of its relationship to health, specifically mental health. It contributes to existing research concerning the impact of the social world on a person’s occupational choices, possibilities and resultant identities. Further these findings have elicited greater understanding about the meaning of these occupations to participants and how this enabled their participation through “being” and “belonging” in their communities. Conclusion: The results of this study contribute to theory generation of occupation within the discipline of occupational science and to the clinical practice of occupational therapy. The findings of the current research indicate that stigma and experiences of exclusion prevail for people with mental health disabilities. Results also find that participation in occupation, within affirming environments can create experiences of normality and promote health. Further, participation in occupation fosters experiences of inclusion and belonging.