How occupational therapists engage adult clients with cognitive impairments in assessments
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This qualitative descriptive study explored how nine occupational therapists working in physical and mental health settings, engage adult clients with cognitive impairments in assessments. The multi-disciplinary literature relating to this topic was explored and showed there is a lack of discussion about engaging people with cognitive impairments in health related assessments. The methodology consisted of a qualitative descriptive design within a naturalistic approach. Semi structured interviews guided by an interview schedule were conducted, digitally recorded and transcribed. Inductive analysis involved coding the data, then grouping codes into similar themes, which were refined through an iterative process. Two main themes emerged from the data with several subthemes in each. The findings showed that the participants used a complex process and individually developed strategies to engage adult clients with cognitive impairments in assessments. The first theme, called Managing a Complex Process, described the steps the occupational therapists used with clients and families. In this process, the therapists were required to obtain informed consent, prepare for the assessment, consider the impact of having a third party present during the assessment as well as the role of standardized versus functional assessments. The second major theme, called Recruiting Cooperation, addressed how the participants used the relationship with the client to recruit him or her to engage in the assessment. The participants utilized verbal and non-verbal communication skills and also described using their own past experiences. The therapists’ personal attributes played an important role in successfully managing this aspect of the process. The findings provide a snapshot of the complex processes to engage someone with a cognitive impairment in an assessment and have a number of implications for practice, the profession and further research. In practice, there need to be clear clinical pathways for obtaining informed consent with clients with cognitive impairment. Therapists need to consider developing a variety of strategies to engage this particular client group in an assessment, as one strategy may not work for all clients. For the occupational therapy profession, further research is required on the use of standardized assessments when assessing someone with a cognitive impairment and exploring the difficulties therapists have in engaging clients in assessments that are not occupation based. Lastly, a replication of this study with an observational component and a larger sample size is recommended. In the absence of local and international research, it would be beneficial to explore strategies other therapists are using in other countries.