Maintaining client mental well-being within a physical health setting through therapeutic mechanisms: A scoping review for occupational therapy

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Orange, Monica
Author ORCID Profiles (clickable)
Master of Occupational Therapy
Otago Polytechnic
Robinson, Rita
Mills, Darren
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
mental health services
well being
physical health
occupational therapy
New Zealand
delivery of health care
scoping reviews
Orange, M. (2021). Maintaining client mental well-being within a physical health setting through therapeutic mechanisms: A scoping review for occupational therapy. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Occupational Therapy). Otago Polytechnic, New Zealand.
BACKGROUND Well-being is a subjective concept embedded within the core values of the occupational therapy philosophy. Well-being is comprised of mental/emotional, physical, cultural/spiritual, social, financial, environmental, intellectual, and vocational aspects which have direct impact on the perceived mental and physical health, and quality of life of an individual. An individual’s perception of their well-being also influences the occupations that they engage in, their roles and routines, resilience, and how they cope with day-to-day life. The way the clinicians address an individual’s holistic well-being has a powerful influence on occupational therapy outcomes and experiences while accessing healthcare services. Occupational therapy is said to be a holistic practice; however, due to the mental health and physical health gap, clinicians who work within a physical health focused setting often find themselves faced with barriers when clients present with mental well-being concerns which negatively impact their engagement with rehabilitation interventions. Mental health and physical health co-morbidities are an increasingly common occurrence; however, there is a lack of literature which explicitly links the two and supports therapists in finding proactive solutions which align with their unique skillset to help to bridge this gap. OBJECTIVES This research was conducted to identify what is currently known about the skills, strategies, and techniques used within occupational therapy practice to promote mental well-being within a physical health setting; and to collate this information in the form of a scoping review for the occupational therapy community to access METHOD A scoping review methodology was used to achieve the outlined objectives and explore the given research topic. A priori protocol, informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute, guided the researcher through a ten-step review process. While using a consistent search strategy, four online databases (ProQuest, EBSCOhost, Gale Cengage, & Google Scholar) were utilized to locate articles with relevance to the research topic. Articles were examined according to the predetermined eligibility criteria at the article title, abstract, and full-text level. A data extraction process also assisted the researcher in the manual evaluation of each of the articles during the level-two screening process. Ten percent of all articles were randomly selected to be independently verified by a research supervisor to ensure validity and consistency. Completion of this process yielded nine final scoping articles. FINDINGS Information extracted from the nine final scoping articles was collated and grouped into themes. Collectively, the articles provided insight about what is known about the facilitators and barriers to addressing psychological well-being within clinical settings; the relationship between occupation and well-being; positive changes recommended for occupational therapy and healthcare service delivery to more prominently encompass well-being values; effective approaches for enhancing the mental and holistic well-being of all individuals; specific interventions and strategies with therapeutic attributes; and assessments which can be added to the occupational therapist’s toolkit to consistently address the mental well-being of their client throughout the rehabilitation recovery process. CONCLUSIONS The occupational therapist’s unique occupational identity and informed, therapeutic, holistic, and person-centered skillset makes members of this profession equipped and capable leaders during a shift in healthcare service delivery which focuses on mental well-being promotion and the prioritization of subjectively measured holistic well-being outcomes. Although there are current barriers which decrease clinician’s self-efficacy to effectively address a client’s mental well-being within a physical health setting, there are many solutions which can be implemented alongside regular therapy interventions to enhance the experience of the service user. Conclusions drawn from the collated evidence outlined within this review indicate that the mental/physical health gap can be minimized by normalizing well-being as a standard practice; integrating positive mental well-being strategies into primary care; and increasing the use of person-centered practices which demonstrate cultural responsiveness, provide opportunities for spiritual expression, and facilitate creative interventions with respect to the individuality of each person. These interventions can easily be integrated into an occupation identity well-being perspective, which provides a unique occupational therapy slant to supporting well-being.
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