Occupation-centered practice in skilled nursing facilities: Myth or reality?
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The purpose of this dissertation was to explore occupation-centered practice within the context of a skilled nursing facility for short term rehabilitation clients. Additionally, methodological research was conducted to examine the validity, utility, and reliability of the Occupation-Centered Intervention Assessment (OCIA), an assessment tool designed to capture occupation-centered practice within skilled nursing facilities. The Occupational Therapy Intervention Process Model provided theoretical guidance throughout the dissertation. Study one provided a systematic review of the published literature from 1991-2014 that described or examined occupational therapy practice with clients who receive short term rehabilitation services in skilled nursing facilities. Of the sixteen identified research studies, eleven of the research studies described or examined the effectiveness of interventions that utilized occupation as the intervention, focused on occupation as the therapeutic modality, or did both while eleven research studies described or examined the effectiveness of interventions that included exercise, rote practice, or a passive intervention (some studies described multiple interventions). Study two involved measurement of content validity, utility, and inter-rater reliability of the OCIA. Overall, it was determined that with increased clarity of the manual, minor changes to the personal relevance continua, and adequate training before using the tool, the OCIA demonstrated strong inter-rater reliability and good content validity. Study three involved observing and rating occupational therapy treatment sessions at skilled nursing facilities. A total of 57 interventions were observed, scored with the OCIA and supplemented with field notes and schematics. Overall, exercise and rote practice was found to be the most common intervention category administered to the short term rehabilitation clients in skilled nursing facilities. While upper body exercises, functional mobility, standing/stepping/walking, and basic self-care activities were the four most common interventions provided to these clients. The combined results of this dissertation indicated that a wide range of interventions, both occupation-centered and non occupation-centered, are provided to short term rehabilitation clients within the context of skilled nursing facilities and more research is warranted to determine the effectiveness of occupation-centered interventions.