7 minute read
Creativity and transdisciplinary practice in aged care
Occupational therapy is an innately creative profession. Our vibrant history is firmly steeped in the arts and crafts movement, with origins in the use of basket weaving and leatherwork as a means of rehabilitation and well-being. Of course, as the body of professional knowledge and evidence has continued to grow, so, too, have the frameworks and approaches to practice.
Renelle Harrison, Occupational Therapist
Contemporary practice – where do we fit?
Fast forward to present day, and we can see an evolution of the profession as we emphasised the biomedical approach, expanded horizons in recovery and mental health practice, and employed the principles of occupational therapy more broadly in the context of rehabilitation.
Occupational therapy now encompasses a wide range of models, frameworks and theoretical approaches. Practically, the profession is also further enriched by the breadth of interests and experiences held by this magical breed of practitioners. Today we see occupational therapists in a vast array of health and community settings – and yet while we appear to be almost everywhere, it sometimes seems as if we don’t really fit anywhere.
Such has been my own professional struggle of late. After the exciting new graduate years, I took up a series of roles in community and hospital settings and eventually landed in aged care.
What does OT mean anyway?
While I have always loved my clients and work, I have often felt that institutional environments placed various constraints that prevented me from fully outworking my occupational therapy principles and ideals. In other words, the ideal has been continually sacrificed on the altar of practicality.
In my aged care role, I have focused on pain management, as well as working with an allied health assistant to create and implement programs based on cognitive stimulation therapy for residents with dementia. In the course of my CPD, I was happy to see the overwhelming body of evidence in relation to the benefits of creativity and facilitating the older person to cultivate their own creative practice as a key aspect of healthy ageing. It became apparent to me that the creative process in and of itself held validity as an intervention for improving occupational performance.
The creative process itself, regardless of the end product, brings together elements of self-care and self-attentiveness, cognitive stimulation, biofeedback, motor and sensory components, rest and leisure, a sense of agency with strong interpersonal links and connection to our physical and cultural environments. The creative process helps us gain a sense of the world and our place in it – even touching on aspects of our spiritual being, an element of our theoretical approach as occupational therapists that often seems all too difficult to articulate in the reality of everyday practice, especially in aged care. With all the evidence and the obvious clinical benefits, why wasn’t I seeing more of this targeted and specific intervention in residential aged care?
I started to long for ways to reconnect with the origins of our profession; rediscovering what we have known all along, but reappropriating our rich heritage for contemporary practice. And I wondered: what does occupational therapy really mean to me in this context?
Exploring transdisciplinary practice
This line of thinking and questioning drove me back to my roots in undergraduate study, where I drew on the concept of transdisciplinary practice. As occupational therapists, we’re very familiar with the idea of multidisciplinary and interdisciplinary practice, but for me, transdisciplinary practice had been something left firmly in the textbooks.
“Transdisciplinarity integrates the natural, social and health sciences in a humanities context, and transcends their traditional
boundaries” (Choi and Pak, 2006). More than simply exchanging information, transdisciplinary practice promotes role release, transfer of skills and free-flowing communication. Pouring over the stories of artists and aged care residents in the course of my CPD, I knew that bringing professional artists into this space was integral to how this aspect of practice could be more fully explored. Artists bring a professional body of knowledge that supports the creative process in a deeply personal, intuitive manner, adding more dimensions to the occupational therapy perspective.
A project is born
The key to making a way forward was forging the synergistic partnerships that enabled sharing of knowledge and transfer of skills. I decided to reach out to my local regional arts body, Eastern Riverina Arts, with an idea that had been on the back burner of my mind: creating an opportunity for artists to complete a residency in an aged care facility. In a twist of fate, funding became available within a couple of months, and the genesis of a collaborative, transdisciplinary project was in motion.
The power of shared practice
The residency would give the artist time and space to freely explore ways and methods of unearthing and facilitating shared creative practice with individuals in residential care experiencing dementia or ill health. As the focus was on facilitating the creative process, there was less emphasis on the outcome, which relieved pressure on all involved to produce something. Instead, we could focus on the beauty of facilitating the process and how the aspects of each of our disciplinary areas overlapped or complemented each other, with the older person at the centre, leading the practice.
Lasting about six weeks, the program would be bookended by initial training, preparation and debriefing for artists. A former dementia clinical nurse consultant, occupational therapist and two local artists shared stories, space and knowledge as we embarked on the experience. An allied health assistant was also utilised to assist with selecting and providing initial information to participants for the creative ageing program, and creating another point of contact for artists when on site.
What followed was something I can only describe as an unveiling. Not only did we discover, transfer and draw on the professional skills of one another in cofacilitating creative practice, the participants themselves unveiled skills, perspectives, dreams and discoveries of their own, revealing new facets of identity, shared experience, engagement and roles, and ultimately new meaning in the process of creating as occupation. The flow-on effects also made shared memories with significant others – whether a spouse, friend or staff.
Reflections
The importance of holding space: Some participants were unsure of the process or not confident in their abilities, so the concept of holding space became central to facilitating a shared creative practice. Artists were key to holding the space as participants found traction to engage with the process and begin their work. The therapeutic use of self was a technique that bridged disciplinary boundaries easily.
The importance of knowledge translation: Occupational therapy has a wide body of evidence, but we also have a wide scope of practice. Becoming skilled in the art of knowledge translation will help us see more of our research hitting the ground in practice. Navigating this territory has opened my eyes to the possibilities of this area of practice for our profession.
Finding language to frame, forge and expand transdiscipline partnerships: Becoming aware of how our professional frameworks intersect, align and complement others is key to creating strategic partnerships. My biggest reflection: it will remain impossible until you do it. Expanding our horizons: Our various models of practice give us a unique perspective allowing us to frame occupational performance in terms of its various domains and subdomains, while also looking holistically at the person, their environmental contexts, and their goals and roles that feed into the richness of layered meaning through occupational engagement. I found engaging in transdisciplinary practice was like looking at the two sides of a coin, and then looking at that same coin again with coloured glasses. It expands the creative possibilities.
Back to the beginning
It’s an exciting time to be an occupational therapist. I look forward to what the future might hold as we continue to break barriers and show the world: “This is OT”.
About the author Renelle Harrison is an occupational therapist from Wagga Wagga, NSW. She uses the principles of her practice in clinical work, health writing and in forging strategic transdisciplinary partnerships to see occupational therapy take shape in new ways. Her interests are in paediatrics and ageing, public health and in implementing evidence into practice through effective knowledge translation.
Acknowledgement This project was funded by the NSW Government through Create NSW Arts Restart Package, with the assistance and support of Eastern Riverina Arts.
