Airport

The similarity between NHS general hospitals and airports is hard to miss: the concourse areas are occupied by people who are filling time, trying to find places or being wheeled along. Possibly designed to be like shopping malls but the people present use retail as a distraction or for very necessary necessities. Once away from these areas, striped banks of signs confuse and give hope. In the last hospital I visited, a member of staff kindly helped me and my fellow travellers identify our destination, while earlier a public address system made gate announcements of the “Dr Bryant will see you now” kind.

The airport analogy offers a insight into the transit between different areas of the hospital and out of it, and makes me wonder about the extraordinary policy which sets targets for the rate of throughput. For no airline would apply such targets if their planes were grounded. Yet social care cuts mean the planes are not just grounded, they aren’t there: the packages and places that would enable people to move on cannot be delivered or provided.

There is a limit to viewing a hospital as a place of transit because the destination for a significant number is the end of life itself. It’s possible that the continued denial of this reality is also unhelpful. It does not fit with the notion of consumer, because it underlines our ultimate failure as a consumer. We cannot buy or request the means to prevent our own death. Nor can we take control of the process to hasten it. So the very core business of a hospital, of life and death, is remote from the consumer project.

Occupational form

This is a slightly revised version of the blog I posted last November, suggesting that the occupational form is an important and useful concept for practice in health and social care. I start by drawing on my own experience of occupational meanings, functions and forms. Since I first wrote this blog I have been diagnosed with vasculitis, specifically granulomatosis with polyangiitis. I’ve more recently become interested in how novel occupational forms emerge, but more of that another time.

A brief blog, because the occupational form of blogging in itself is challenging for me at the moment. I have iritis (inflammation of the iris in the eye), which means I am trying to limit my time looking at screens, to promote my own recovery. I also have fluctuating issues with my joints, especially my wrists, which sometimes makes using a keyboard painful.  So functionally, in terms of a purposeful occupation*, maybe blogging is not so good for my health. The meaning of blogging for me changes rapidly, dependent on my pain, medication, light levels, general feelings. But I can control the form of blogging: by keeping it short, by using my iPad, adjusting the brightness levels of the screen.

Nelson and Jepson-Thomas (2003) connected occupational therapy in theory with interactions between form, function and meaning. There has been much interest in meaningful occupation, but I have struggled to see how this is the most important focus for doing occupational therapy, as meanings are continually constructed and revised. Creating scope for meaning making is dependent on form and function (giving time and space for people to take control of the process, engaging with the occupation). A focus on the function of occupation (in terms of purpose) is evident in the use of tools to clarify plans: we need to to know why we are proposing an occupation. This fits well with taking a structured or targeted approach to health and well being: putting oneself or another through a defined process and plan. It does not always fit so well with complicated situations, such as working with groups of people, or fluctuating conditions, like mine.

The occupational form as a focus offers another perspective to balance occupational therapy planning and delivery. The form can be adapted (for a blog, I could record a podcast, get someone to help, leave it for another day). As it is adapted, the meaning will certainly change (it’s not so important after all) and the purpose/function will shift (involving another person means I might have to be clearer about why I’m doing this). The process of adapting the form is intrinsically reflective and should be collaborative, for therapists who believe in person-centred practice. Adapting the form is what we do as occupational therapists, to make it possible for people to participate. The changes in the form could be measured or captured in narratives, to evaluate occupational therapy in everyday practice and formal research. So in my own research and practice, I have found it helpful to focus on the occupational form (Bryant 2016). It also appeals to me as a creative person.

Focusing on the form also enables a practical engagement with culture and other dimensions of experience (age, gender, ability/disability, race). We can talk about why a person does something in a particular way to discover meaning and function. However to enable them to do what they need to do, a focus on how they do it (occupational form) is the gateway to successful adaptation, when required.

*Creek(2010) helpfully distinguishes between function in terms of purpose (what are we trying to achieve) and function in terms of ability to do something (“she regained full functional use of her left hand”).

Bryant W (2016) The Dr Elizabeth Casson Memorial Lecture 2016: Occupational alienation – A concept for modelling participation in practice and research. British Journal of Occupational Therapy Vol. 79(9)

Creek J (2010) The core concepts of occupational therapy. London: Jessica Kingsley

Nelson D, Jepson-Thomas J (2003) Occupational form, occupational performance, and a conceptual framework for therapeutic occupation. In Kramer P, Hinojosa J, Brasic Royeen C (eds) Perspectives in human occupation. Participation in life. Philadelphia, Lippincott, Williams & Wilkins. Chapter 5: 87-155