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Co-author: MaryBeth Gallagher PhD, OTR/L BCMH
'This paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting.'
Introduction
Occupational disruption has been defined as a transient or temporary condition of restriction from participation in necessary or meaningful occupations. This interruption often, but not always, resolves itself as the human adapts (Whiteford, 2010). The arrival of the COVID-19 virus and the subsequent pandemic has had a tremendous impact on our daily habits and routines. It has meant that people have become socially distanced, unemployed and ‘repurposed.’ This is certainly true in the healthcare organization in which we are employed, where employee wellness has the potential to be eroded by these additional stressors. If as occupational therapists, the situation described here is something you recognize within yourself and your work environment, this paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting. This article presents the response of a small team of occupational therapists to the challenges posed to employee wellness in the face of unmitigated occupational disruption from the COVID-19 virus. The article also describes the processes and practices that were developed to support our colleagues. It concludes with recommendations to replicate and or adapt our approach to nurturing employee wellness.
The Impact of Occupational Disruption
The occupational disruption caused by this pandemic has meant that healthy and well people, used to accessing meaningful occupations of their choosing, have experienced a disruption to their doing that impacts on their ability to be well and stay well. The level of disruption from the COVID-19 virus to the daily routines of a country, and indeed the whole world, is generally experienced by a small minority who encounter sudden traumatic life events that impact on physical, mental and emotional intactness. When the pandemic began to alter our daily practice, we went to the literature seeking knowledge to address some of the challenges we were encountering and build an evidence base for our practice in hospital based mental health during the COVID-19 virus pandemic. Whalley Hammell’s 2020 article details issues related to engagement in living during this crisis and the worldwide occupational disruption that has resulted. It’s message and the content within presented an opportunity for us to consider how to provide occupational therapy to address the occupational disruption impacting ourselves and our colleagues. This conceptualization of occupational disruption presented us with multiple opportunities to impact positively on our health care colleagues and the system response to the pandemic.
Despite facing many barriers to implementing occupation centered and occupation based practice (Fisher, 2013) within an in-patient setting, keeping an occupational perspective remains critical. Leveraging our knowledge of the role of occupation in the lives of humans enabled us to seize the opportunity to develop health promoting interventions when it arose, and we were able to engender internal team collaboration to address employee health and wellness. It enabled us to educate our colleagues broadly about occupational therapy philosophy, our occupational lens, our role in wellness and the value of our contribution to a systemic wellness program for addressing the needs of individuals.
The Whalley Hammell paper (2020) mentions two key frameworks that have addressed building resilience in individuals experiencing trauma and disruption. The first is Rachel Thibeault’s 5 C framework (2011) developed from her extensive work with populations experiencing civil war and torture. The second was a program in the UK, “5 a day” that focused on ensuring a daily diet of occupations that promote mental health, similar to how nutrition and dietetics use the ‘5 a day’ of fruits and vegetables to support physical health. These concepts then formed the basis for the development of an employee health and wellness program from within occupational therapy. Our intent is to coalesce with the system level health and wellness program established almost exclusively for medics in 2018, to proffer an occupational approach.
After identifying relevant theoretical concepts, we returned to the literature to explore occupational therapy’s participation in wellness programs. While there are limited examples outside of vocational rehabilitation, the faculty practice at USC Chan Division of Occupational Science and Occupational Therapy ran an ‘executive health’ program. This long-established practice employs Lifestyle Redesign (trademark) principles to support people experiencing a range of lifestyle based conditions impacting mental and physical health, including executive health.
Existing wellness programs within organizations appear to be incentive driven and target particular populations, like people who smoke and those who are obese. These programs tend to assume people are ready to change or modify behaviors. Additionally, the success of these programs is generally measured by the uptake number (Boudreau and Frederick 2016). These identified limitations provide an opportunity for an occupational perspective that can foster a person’s intrinsic motivation to build a healthier lifestyle. These health promoting routines could include connecting with others, and providing restoration, purpose and satisfaction in one’s daily habits.
The Occupational Therapy Process in Health and Wellness
Our program focused on wellness, wellbeing, and health promotion. We defined wellness as an active process of becoming aware and making choices towards a healthy and fulfilling way of life. It is a conscious, self-directed and evolving process of achieving full potential (National Wellness Institute). These dimensions of wellness emphasize a dynamic process through which an individual makes health promoting, conscious and intentional choices about what to do and how to be. These are fundamental to establishing habits that build resilience to effectively manage mental and physical wellbeing, both in the workplace and beyond. The target audience for this wellness program is anyone across our healthcare system experiencing occupational disruption including administrative staff, environmental service staff, security, medical and rehabilitation staff.
Additionally, as a teaching hospital we believe this wellness program is valuable for supporting our students with disrupted and postponed placement experiences due to the COVID-19 virus.
Using an occupational therapy process, we created a wellness program based on the five tenets of resiliency building: contribution, creation, centering, contemplation and connection (Thibeault, 2011). The process begins with an occupational needs assessment. For this, we chose to use the Engagement in Meaningful Activity Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002). This survey is designed to garner the level of meaning a person experiences in their day to activities. It poses twelve questions related to the level of meaning experienced in daily activities over the last thirty days. Respondents answer with 1 (rarely), 2 (sometimes), 3 (usually) or 4 (always). The scores are then added to determine the overall level (low, moderate or high) of meaning a person is experiencing in their daily occupations. Most of the respondents are not occupational therapists and the tool is virtually accessible. Therefore, we have proposed within the survey which daily occupation relates to which of the five Cs. For example: The activities I do reflect the kind of person I am. We suggested this might address contemplation due to the internal focus on values. Respondents are then asked to identify the two lowest scoring Cs from the survey. From there, they are provided with a template of a tailored plan for building resiliency in response to identified occupational needs in the form of an included visual map. The visual map is an occupation analysis of identified actions based on meaning of engagement for individuals. For example, if a person was creating an action plan to increase how reflective of their values their activities are, one action might be; spend 5 minutes alone a day thinking about your personal values. Then, having identified an important value, choose one occupation that is symbolic or representative of that value. Audio enhanced resources expanding on each of the 5C’s can then be accessed to further develop the person’s visual map and wellness and resiliency plan.
Sustaining and Promoting the Program
Due to the recent launch of this wellness initiative, data is not yet available to fully determine the efficacy. However, anecdotally it has been well received with respondents reporting the resources as ‘comprehensive’, ‘impressive’ and ‘very useful’. At the time of writing, there is ongoing enthusiasm for this initiative from all levels of management and participants.
It is our intention to make this wellness program integral to ongoing employee health and wellness and not just a response to the COVID-19 virus. We have identified a need for an occupational perspective in supporting employee health and wellness. This is especially important within a very large organization even when that organization has already taken steps to support employee wellness. The literature identifies high levels of burnout and compassion fatigue among healthcare workers. The nature of healthcare practice in which one is consistently working to improve the health and lives of people experiencing ill health, trauma and deprived social circumstances, has its emotional impact at a conscious and unconscious level. Often one of the first indicators of workplace stress is an emotional impact and a loss of meaning in what we do (Reith 2018). We believe as occupational therapists that this needs addressing to enhance and maintain a healthy, well and engaged workforce.
If the situation described here resonates in your practice and your setting, or indeed is something you recognize within yourself, the strategies presented here may be useful for intervention in your own setting. Firstly, become cognizant of the occupational disruption present in your own personal and professional experience. Some examples of what could contribute to occupational disruption beyond the COVID-19 virus, include a lack of formal supervision, frequent and enduring use of peers as buffers of stress and emotional processing, increasing demands on your time, expertise, and participation in daily challenges inherent in healthcare. Next, identify needs that could be nurtured through an occupational perspective of workplace wellness. Recognize how your current practice already includes strategies that could be supportive and valuable to those who do not have a ‘diagnosis’, but whose occupational disruption comes from the pandemic and high workplace stress. Then using the occupational therapy process described above as a guide, use your occupational lens to assess levels of meaning, create action plans and begin to build resiliency and wellness.
Conclusion
In this paper, we have described the occupational therapy process to address wellness in our setting in response to the occupational disruption caused by the current the COVID-19 virus. We identified a need to address the wellness of ourselves and our colleagues. We used an assessment of meaning, as meaning is linked to positive mental health, and provided interventions to improve resiliency building in daily life through our altered sense of doing and being. This initiative has broadened the scope of mental health practice in our setting and highlighted the pivotal role that occupational therapy plays in maintaining health and wellness.
References
Boudreau, J. and Frederick, B. (2016) Why corporate wellness programs need a dose of occupational therapy and analytics. Accessed on 4/2/2020, at https://www.visier.com/clarity/why-corporate-wellness-programs/
Fisher, A. G. (2013) Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy. 20 (3), pp.162-173.
Goldberg, B., Brintnell, E. S. and Goldberg, J. (2002) The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occupational Therapy in Mental Health. 18 (2), pp.17-44.
Hettler, B. (1976) About wellness. Retrieved from National Wellness Institute. Accessed on 6/3/2020, at http://www.nationalwellness.org
Reith, T. P. (2018) Burnout in United States healthcare professionals: a narrative review. Cureus, 10 (12).
Thibeault, R. (2011) Occupational gifts. Spirituality and occupational therapy, pp.111-120.
Whalley Hammell, K. (2020) Engagement in living during the COVID-19 pandemic and ensuing occupational disruption. OT Now. Accessed on 4/2/2020, at http://caot.ca/document/7179/Ensuring%20occupational%20disruption.pdf