Theory driving practice and the impact upon bathing
By Adam Ferry, Occupational Therapist
As an occupational therapist, the most rewarding aspect of work is empowering and supporting individuals to overcome the barriers to their daily lives. For many, bathing is one of the first daily activities we engage in and goes beyond just the physical skills required but rather, involves a combination of physical, sensory, cognitive, and emotional capabilities. Bathing doesn’t just support our personal hygiene; it offers a time for relaxation, maintaining our dignity and so much more.
But for many individuals who experience challenges with bathing whether due to physical limitations or cognitive impairments, it can have a profound impact upon their overall quality of life. Understanding how theory drives our practice to enhance bathing for individuals is critical for achieving person-centered outcomes.
This blog will briefly explore what is meant by theory, how theory is applicable in practice and the impact this has upon how we approach bathing and supporting the clients we work with.
What is OT theory?
Occupational Therapy is underpinned by various theories and models that help guide how we assess and implement interventions (treatment). When I think about models, I consider these to be the philosophical structures that define our scope of practice and theoretical frameworks that guide us to think about different approaches to interventions.
Below are some key theories that drive practice:
- The Model of Human Occupation (MOHO)
This is one of the most widely used models in OT practice that focuses upon motivation, pattern of behaviour, and the skills that guides individuals to perform their occupations. When applied to bathing, using this model would enable the OT to consider the values, roles, and routines associated with bathing and how participation could be influenced by a combination of intrinsic and extrinsic needs. - The Person-Environment-Occupation model (PEO)
Similar to the MOHO, the PEO model is another foundational key theory driving practice in OT. This model focuses upon the interplay between the person, their environment and how these constructs impact upon an individual’s occupations and performance in activity. - Canadian Model of Occupational Performance and Engagement (CMOP-E)
The CMOP-E also considers the cognitive, physical, and emotional-wellbeing of the individual
Impact of theory on bathing
Individuals are unique beings with specific needs. By taking a theory-driven approach, we are better equipped to assess the needs of the individual, the environment, and the occupation, not just the occupation itself. For example,
- Promoting safety – applying theory in practice highlights possibles risks and barriers stemming from the environment inhibiting bathing which enforces outcome-focused strategies to enable engagement safely.
- Supporting emotional wellbeing – theoretical frameworks can encourage clinicians to explore the emotional barriers that may arise during bathing for individuals. Bathing may not require environmental modifications or equipment, but rather, interventions to support emotional and cognitive functioning.
- Developing independence – a core value in occupational therapy is promoting independence and by using theory to drive our practice, this ensures collaborative working with the clients that we are supporting, enhancing their sense of violation and self-efficacy.
- Enhancing quality of life – as previously mentioned, bathing is not just a physical task for hygiene purposes; it is a critical aspect of someone’s daily routine that can impact their quality of life. Occupational therapy theories recognise the importance of meaningful activities and focuses upon intrinsic and extrinsic challenges that could be inhibiting bathing.
- Client-centered practice – Theory spotlights individuals’ goals, values, preferences, and aspirations ensuring that their wants and wishes are taken into account when devising interventions to support bathing. I find this particularly important when there is a significant difference amongst care givers and/or other care providers opinions.
- Flexibility – using theory in my everyday practice not only ensures that my interventions and approaches are evidence-based but, it also encourages me to problem-solve, be pragmatic, and be innovative.
Whilst theory offers many advantages and drives practice, it is also important to reflect upon possible disadvantages and how this could impact practice and bathing. As an example,
- Some theories may not always account for the complexities of real-life practice which could involve unpredictable variables that isn’t always captured by a model. As an example, limited resources, budget constraints, policy, and/or cost effectiveness Vs. outcome driven.
- Time constraints – as an OT, we are often positioned in fast paced environments with limited time for in-depth assessments and/or theoretical analyses.
Conclusion
Understanding the power of theory to shape our practice is an imperative skill to support individuals that we are working with. The theories we apply, whether MOHO or PEO, guides our critical thinking and understanding of the complexities of bathing as a vital daily activity.
How someone accesses the bath is very different to why someone accesses it. Without asking the why, it is unlikely that we have gathered all the information to make a holistic and occupation focused recommendation.