THE PROFESSIONAL FOUNDATION OF OCCUPATIONAL THERAPY IN DENMARK – A COLLECTION OF DOCUMENTS CONCERNING:
MISSION VISIONS VALUES PROFESSIONAL ETHICS COOPERATION ERGOTERAPEUTFORENINGEN: THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS 2008
The Professional Foundation of Occupational Therapy in Denmark 1
THE PROFESSIONAL FOUNDATION OF OCCUPATIONAL THERAPY IN DENMARK OCCUPATIONAL THERAPISTS REPRESENT THE INTERESTS OF CITIZENS WITHIN CERTAIN FRAMEWORKS AND CONDITIONS LAID DOWN BY SOCIETY.
Occupational therapy is a profession committed to offering knowledge and specialised assistance to citizens in defined situations. In practice, the task of the occupational therapist is to represent specific aspects of the interests and needs of the individual citizen. Of course, the work is always carried out within particular financial, political and institutional frameworks. The harsh reality is that occupational therapists have to be able to make defensible choices every day, and must often navigate in a context of interwoven problems, where many different interests are at stake. For example: s (OW CAN ) BALANCE THE DEMANDS MADE ON ME BOTH AS THE client’s professional helper and as a loyal employee and person in authority within the health system? s !RE THE POLITICAL HORIZONS AND THE CLINICAL GUIDELINES WRONG OR BADLY THOUGHT OUT #AN ) IN THIS PARTICULAR CASE MAKE A compromise with my professional standards? s )F MY CLIENT CANNOT GIVE HER AGREEMENT ON A WELL INFORMED BASIS AM ) JUSTIFIED IN INSISTING ON MY PROFESSIONAL VIEWS and services in this particular case? Occupational therapists are faced with many situational DILEMMAS WHICH AS PROFESSIONALS THEY SHOULD BE ABLE TO TACKLE RATIONALLY ON THE BASIS OF SOUND ARGUMENTS )N MANY cases, therefore, the documents concerning the professional FOUNDATION ADDRESS THE QUESTION OF BEING ABLE TO DISTINGUISH conceptions of what occupational therapists actually do in their daily work from what occupational therapists think they SHOULD BE DOING Finding answers to these questions cannot merely be an internal professional matter, but must take place in an open dialogue with the rest of society. The Danish Association of Occupational Therapists, Ergoterapeutforeningen, hopes that this publication will help occupational therapists to become better at identifying and justifying their professional points of view.
2 The Professional Foundation of Occupational Therapy in Denmark
4HE !SSOCIATION ALSO HOPES TO INVOLVE ALL OUR COOPERATIVE PARTNERS IN A DIALOGUE ABOUT PROFESSIONALISM AND INTERPROFES SIONALISM ON THE BASIS OF WHICH THE VARIOUS AGENTS WITHIN THE health sector will shape the nature of future services. THIS COLLECTION OF DOCUMENTS FORMS ONLY A PART OF THE PROFESSIONAL FOUNDATION
The foundation proper of occupational therapy consists of two elements: s &IRSTLY THAT THERE ARE IDENTIFIABLE SETS OF PROBLEMS WHICH particular citizens require assistance with. s 3ECONDLY THAT THERE ARE OCCUPATIONAL THERAPISTS WHO POS SESS THE SPECIAL KNOWLEDGE THE ABILITIES AND THE WILL TO attempt to solve them. 4HERE ARE A NUMBER OF BASIC PRECONDITIONS FOR THE EXISTENCE AND GROWTH OF THE PROFESSION A RECOGNIZED FIRST CYCLE BACHE LOR DEGREE A BODY OF RESEARCH AND EVIDENCE AND AUTHORISA TION FROM THE $ANISH .ATIONAL "OARD OF (EALTH (OWEVER THIS COLLECTION OF DOCUMENTS DOES NOT AIM TO SUBSTANTIATE THESE BASIC PRECONDITIONS 2ATHER IT CONCERNS THE ROLE OF THE $ANISH !SSOCIATION OF /CCUPATIONAL 4HERAPISTS IN THE DEVELOPMENT OF THE PROFESSION 3INCE THE $ANISH !SSOCIATION OF /C CUPATIONAL 4HERAPISTS HAS BEEN THE PROFESSIONAL ASSOCIATION
for occupational therapy in Danish society and for occupational thera pists working in the field. Today, the REFORE THE $ANISH !SSOCIATION OF /C cupational Therapists takes a fully RECOGNISED SHARE OF THE RESPONSIBI lity for the organization and develop ment of occupational therapy as an acknowledged and trustworthy pro fession. Through this collection of documents, the Danish Association of Occupational Therapists wishes to make its own contribution to the foundation of the profession more widely available in a comprehensive written form, both to occupational therapists themselves and to those persons and agencies we cooperate with. In other words, the aim of the collection is to offer an overview of the current situation and to make a contribution to the ongoing professional self-criticism and self-management – and indeed to other developments in the profession – which are taking place in occupational therapy circles at the present time. The professional foundation is meant to make more precise those non-formal and formal contracts which occupational therapists and the OTA constantly enter into with the society around us. The professional foundation consists of seven documents. We might have chosen, for example, six or eight, but the se-
lected documents constitute the actual set which the various decision-making bodies and committees of the Danish Association of Occupational Therapists have drawn up in recent years. The seven documents deal with the overall values, principles and visions which society may expect the profession to formulate and present: "This is what occupational therapists and the Danish Association of Occupational Therapists stand for. Is this what society in fact expects of us as professionals?" The documents cannot be seen as definitive statements, but aim rather to inspire a professional and political debate, thus constantly refining the contracts between occupational therapy and society. In several cases, the contents of the documents overlap, which means that individual documents can be understood and applied in their own right, independently of the other texts concerning the professional foundation. 4HE %XECUTIVE #OUNCIL OF THE $ANISH !SSOCIATION OF /CCUPA tional Therapists #OPENHAGEN !UGUST
'UNNER 'AMBORG President Ergoterapeutforeningen The documents concerning the professional foundation will be revised and added to as the need arises. The professional foundation can be downloaded and commented on at www. etf.dk.
The Professional Foundation of Occupational Therapy in Denmark 3
THE MISSION OF OCCUPATIONAL THERAPY AND THE OBJECTIVE FOUNDATION FOR THE EXISTENCE OF A CONTRACT WITH SOCIETY APPROVED BY THE EXECUTIVE COUNCIL OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, FEBRUARY 2008
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Occupational therapy as a necessary social welfare service is legitimised by the different kinds of occupational problems that place restrictions on the everyday lives of individuals. Occupational problems typically occur in connection with physical and mental illness, work accidents and other traumas, chronic diseases, poverty, discrimination, or other circumstances in society or the person's environment that inhibit occupation. The mission of occupational therapy in society is thus to contribute to a situation in which citizens can exercise their right to occupation and participation in their daily lives as private individuals, in the world of work and as citizens in civil society. One aspect of the profession's right to existence is thus that it aims to prevent unbidden passivity, social isolation and exclusion that are dangerous to health.
DEFINITION OF OCCUPATIONAL THERAPY AS A SOCIAL WELFARE SERVICE (DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, 2006)
Occupational therapy is a question of promoting occupation and participation in everyday activities by individuals and groups of people. By 'activities of everyday life' is meant pursuits that are meaningful or necessary for the individual, related to daily life, work, leisure and general involvement in the life of society. In occupational therapy, meaningful activities are used both as a means and as an end to promote health, prevent and rehabilitate reduced functional ability and occupational limitations, and to assess, re-establish and further develop people's opportunities to participate in daily life.
Occupational therapy may be directed towards the development of a person's skills, adjusting the level of difficulty of activities to suit the performer and/or modifying the environment. DEFINITION OF OCCUPATIONAL THERAPY AS A PROFESSION (DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, 2006)
Occupational therapy is a profession within the social and health service in Denmark, practised on the basis of a professional bachelor degree and authorisation by the Danish National Board of Health. Occupational therapy is practised in the light of an objective related to disease prevention and rehabilitation, in cooperation with target groups that experience occupational problems in their daily lives. Occupational therapists apply specific knowledge and methods to create coherence between people, their activities and their environment, with a view to enabling occupational performance and participation, because these promote health and a good life. For further clarification of the terms used in the above definition, see Appendix 3.
DEFINITION OF OCCUPATIONAL THERAPY BY THE WORLD FEDERATION OF OCCUPATIONAL THERAPY (WFOT)
Occupational therapy is a profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate successfully in the activities of daily life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to live meaningful lives, or by modifying the environment to better support participation.
Togi Adelvard, 90 years old. Bad circulation. Under treatment at the Day Training Centre in Brøndby. 4 The Professional Foundation of Occupational Therapy in Denmark
The Professional Foundation of Occupational Therapy in Denmark 5
BASIC ETHICAL VALUE OF THE PROFESSION (DRAWN UP BY THE ETHICAL SUBCOMMITTEE OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS , APRIL 2007)
The basic ethical values in occupational therapy are occupation and participation. These are not just concepts central to the profession, but must be understood as basic ethical values as such. The assumption central to the theory and practice of occupational therapy is that a good life must embrace occupation and participation and that a life characterised by passivity and social exclusion would in these terms be deficient. Basically, a good life consists of occupations. A person may live without being involved in any form of occupation, but cannot be said to have a life, which is a condition for having a good life. However, occupations only improve a person's life to the extent that the person wholeheartedly participates in them, that is, finds the occupations worthwhile and contributes to them as an equal, acknowledged and creative participant. Occupations presuppose a relationship to something outside the person, and are generally connected with relations and pursuits, that is, with the other people the person enters into relationships with and the environments within which the pursuits take place. Occupational therapy also builds on the assumption that occupational problems are never simply a person's own problem, but that as a rule they call for top quality professional assistance. In consequence, the basic services provided by occupational therapy are concerned with the assessment, prevention and treatment of occupational problems and with compensatory measures. The goal is to create coherence between people, their activities and their environment with a view to facilitating, promoting and supporting participation in worthwhile activities, that is, activities which are really enriching and significant for the life of the individual.
6 The Professional Foundation of Occupational Therapy in Denmark
BASIC ETHICAL VALUE
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(DRAWN UP BY THE ETHICAL SUBCOMMITTEE OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS , 2007)
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A. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS THE CLIENT
Value: occupation and participation as citizens' rights s /CCUPATIONAL THERAPY PROMOTES THE OPPORTUNITIES FOR INDIVIdual citizens to take responsibility for their own lives and for the consequences of the way they choose to act. Value: professionalism s 4HE OCCUPATIONAL THERAPIST PROVIDES EFFECTIVE SERVICES IN ACcordance with the needs of the client, drawing on her own professional competencies and the available resources. Value: respect s 4HE OCCUPATIONAL THERAPIST RESPECTS THE RIGHT OF THE INDIVIdual to self-determination and participation in decision-making, including the right to refuse occupational therapy services. s 4HE OCCUPATIONAL THERAPIST SHOWS RESPECT FOR THE VALUES CULture, philosophy of life, habits and personality of the individual. s 4HE OCCUPATIONAL THERAPIST HELPS INDIVIDUALS TO PRESERVE THEIR self-respect, dignity, private life, autonomy and integrity. s 4HE OCCUPATIONAL THERAPIST WORKS TO MEET THE WISHES AND needs of individuals, not least when their capacity for judgement and communication is reduced.
ETHICAL GUIDELINES OF THE PROFESSION
treatment in a dialogue with the patient based on equality, including, as required, the patient's family and other networks, with a view to the patient's resources and needs.
Value: creativity s 4HE OCCUPATIONAL THERAPIST INFORMS THE CLIENT OF a variety of different approaches based on the widest possible knowledge of the person's situation, opportunities and rights.
Value: clarity s 4HE OCCUPATIONAL THERAPIST GIVES THE CLIENT INFORmation about the nature, purpose and duration of the service offered and continues to do so for the duration of it. s 4HE OCCUPATIONAL THERAPIST ENSURES THAT THE PAtient has understood the occupational therapy service offered, including available types of treatment, possible side effects and the right to refuse treatment. s 4HE PATIENT HAS THE RIGHT TO BE INFORMED ABOUT channels for making complaints. s 4HE OCCUPATIONAL THERAPIST ENSURES THAT THE PAtient understands the general conditions of the service offered, including the time framework and any payment required of the patient.
Value: responsibility s 4HE OCCUPATIONAL THERAPIST IS RESPONSIBLE FOR ENSURING PROFESsional conduct, so that abuse, for example of a verbal or sexual nature, or in the form of violence or coercion, does not occur in the meeting between patient and occupational therapist. s 4HE OCCUPATIONAL THERAPIST HAS THE RIGHT TO REFUSE WISHES CONcerning treatment which cannot be professionally justified.
B. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS CLIENTS' RELATIVES
Value: equality in the balance of power between client and occupational therapist s 0ATIENTS REQUIRING OCCUPATIONAL THERAPY HAVE THE SAME RIGHT of access to occupational therapy regardless of age, sex, religion, nationality, political conviction, religion, handicap, diagnosis, sexual preference and social status. s 4HE OCCUPATIONAL THERAPIST PLANS AND TARGETS A COURSE OF
Value: respect s 4HE OCCUPATIONAL THERAPIST COOPERATES WITH RELATIVES TO PROmote the interests and wishes of the client. s 4HE OCCUPATIONAL THERAPIST SHALL ADOPT A RESPECTFUL AND CAring attitude to relatives. If a conflict of interest should arise between a patient and the patient's relatives, the interests of the patient must be safeguarded.
Value: cooperation with the client s 4HE OCCUPATIONAL THERAPIST IS CLIENT CENTRED THAT IS SHE respects the interests, priorities, values and wishes of the client.
The Professional Foundation of Occupational Therapy in Denmark 7
Value: responsibility s 4HE OCCUPATIONAL THERAPIST MUST EXERCISE RESTRAINED watchfulness when conflicts of interest arise between an identified user of occupational therapy services and this person's relatives. Value: equality in the balance of power between clients' relatives and occupational therapist s 4HE OCCUPATIONAL THERAPIST SHOWS UNDERSTANDING REgarding possible differences between her own personal and professional norms and the standpoint of the relatives. The occupational therapist presents her own professional experience and knowledge in such a way that the relatives can make use of these when making decisions and establishing priorities. Value: clarity s 4HE OCCUPATIONAL THERAPIST EXPLAINS CLEARLY TO ANY RElatives the nature of her professional recommendations, their possibilities and limitations. C. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS COLLEAGUES AND COOPERATIVE PARTNERS
Value: clarity s 4HE OCCUPATIONAL THERAPIST FOCUSES ON CLARIFYING HER OWN PROfessional services and their significance in interprofessional courses of rehabilitation and treatment. Value: respect s 4HE OCCUPATIONAL THERAPIST RESPECTS THE PROFESSIONAL JUDGEment of other cooperative partners as well as their lawful rights and collective agreements. Value: equality in the balance of power between professions s 4HE OCCUPATIONAL THERAPIST IS OPEN AND ATTENTIVE TO THE OPInions of others and weighs varying interests against each other. s 4HE OCCUPATIONAL THERAPIST ENTERS ON AN EQUAL FOOTING INTO cooperation with other professions. Value: cooperation s 4HE OCCUPATIONAL THERAPIST LIKE OTHER PROFESSIONALS CONTRIbutes the best her profession has to offer and cooperates with other occupational therapists and other professionals to raise the quality of treatment and to promote the health and rehabilitation of patients. s 4HE OCCUPATIONAL THERAPIST SEEKS HELP FROM OTHER AGENCIES as required. s 4HE OCCUPATIONAL THERAPIST PROMOTES COOPERATION AND COMmon goals. s 4HE OCCUPATIONAL THERAPIST SEEKS TO PROMOTE COOPERATION between different professions, sectors and levels within the health and social areas. s 4HE OCCUPATIONAL THERAPIST REFERS CLIENTS TO OTHER PROFESSIOnals when this is deemed necessary. s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO A PLEASANT AND CON-
8 The Professional Foundation of Occupational Therapy in Denmark
structive work environment and supports colleagues in difficult situations. D. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS EMPLOYERS
Value: responsibility s 4HE OCCUPATIONAL THERAPIST STRIVES TO BE OBJECTIVE ABOUT ANY task or job. s 4HE OCCUPATIONAL THERAPIST PROVIDES COST EFFECTIVE SERVICES and is actively aware of the financial framework for her work. s 4HE OCCUPATIONAL THERAPIST IS RELIABLE AND LOYAL AND WORKS IN accordance with current agreements. s 4HE OCCUPATIONAL THERAPIST REPRESENTS THE INTERESTS OF THE patient, if there should arise a conflict of loyalties between the rules of the place of employment and the ability to practise occupational therapy in a responsible manner, and shall inform the management of this. Value: clarity s 4HE OCCUPATIONAL THERAPIST INFORMS HER EMPLOYEE ABOUT PERsonal interests and double roles which might affect her work. s 4HE OCCUPATIONAL THERAPIST REPORTS ON AND DOCUMENTS DEvelopment work and results. s 4HE OCCUPATIONAL THERAPIST INFORMS HER EMPLOYEE WHEN WORK conditions are inadequate. Value: professionalism s 4HE OCCUPATIONAL THERAPISTgS PRACTICE IS EVIDENCE BASED THAT is, it can be justified from the perspective of the user, in terms of occupation, from her own experience, and in the light of theory and research. s 4HE OCCUPATIONAL THERAPIST KEEPS ABREAST OF PROFESSIONAL DEvelopments and tutors and instructs students and assistants. s 4HE OCCUPATIONAL THERAPIST CONSISTENTLY DOCUMENTS EVALUAtes and applies quality assurance and quality development to her practice.
E. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS SOCIETY
Value: professionalism s 4HE OCCUPATIONAL THERAPIST SHARES THE RESPONSIBILITY FOR THE training of students of occupational therapy. s 4HE OCCUPATIONAL THERAPIST HAS KNOWLEDGE OF UNDERSTANDS and complies with current legislation concerning, for example, authorisation, patient safety, professional secrecy and keeping orderly records. Ignorance of the law does not constitute a valid excuse for transgressing it. s 4HE OCCUPATIONAL THERAPIST APPLIES HER PROFESSIONAL SKILLS TO the development of top quality social services in society. s 4HE OCCUPATIONAL THERAPIST FOLLOWS DEVELOPMENTS WITHIN SOcial and health policies and is ready to discuss them. s 4HE OCCUPATIONAL THERAPIST SUPPORTS PRIORITIES THAT ENSURE A just distribution of resources and take account of those ca-
tegories of patients in greatest need of occupational therapy. s 4HE OCCUPATIONAL THERAPIST HELPS TO SPELL OUT THE EFFECT POLItical priorities have on occupational therapy. Value: clarity s 4HE OCCUPATIONAL THERAPIST MAKES SURE THAT INFORMATION ABOUT occupational therapy is accessible to the general public, users, cooperative partners and decision-makers, to provide a basis for the most appropriate use of occupational therapy skills. s 4HE OCCUPATIONAL THERAPIST ACTIVELY ASSURES THE DISSEMINATION of her own research and development findings with a view to strengthening evidence-based occupational therapy practice. Value: responsibility s 4HE OCCUPATIONAL THERAPIST PROMOTES THE HEALTH FUNCTIONAL ability, occupation and participation of the general population. s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO THE DEVELOPMENT OF an all-embracing welfare society which promotes health and is inclusive. s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO THE RESPONSIBLE USE of society's resources and establishes priorities concerning occupational therapy resources in the light of: s CONDITIONS SET BY THE OVERALL POLITICAL LEGISLATIVE AND ADMINIstrative frameworks; s THE EFFECT ON FUNCTION OCCUPATION AND PARTICIPATION WHAT IS professionally justifiable in view of the need for services, the content and quality of the provision offered, and the consequences for the individual user of these services: s THE BALANCE BETWEEN UTILITY TO THE INDIVIDUAL AND THE GENERAL utility; s SHORT TERM AND LONG TERM FINANCIAL CONSIDERATIONS AND other services offered. s 4HE OCCUPATIONAL THERAPIST DRAWS ATTENTION TO PROFESSIONALLY indefensible situations and refuses to be part of them.
s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO THE DEVELOPment of the profession and its credibility. Value: clarity s 4HE OCCUPATIONAL THERAPIST PROVIDES ACCURATE INFORMAtion about the range of skills offered by the profession. s 4HE OCCUPATIONAL THERAPIST IS AWARE OF AND INFORMS others about, the limits of her own capabilities. s 4HE OCCUPATIONAL THERAPIST STRIVES TO BE OPEN AND HOnest. s 4HE OCCUPATIONAL THERAPIST WHEN APPEARING OR communicating in public, is aware of whether she is acting as an employee, a professional person or a private person. Value: responsibility s 4HE OCCUPATIONAL THERAPIST IS AWARE OF AND ACTS IN ACcordance with current legislation, guidelines and agreements and ensures that her professional practice conforms to legal requirements concerning sound professional practice. s 4HE OCCUPATIONAL THERAPIST BASES THE EXERCISE OF HER PROFESsion on well-documented knowledge and experience and on clinical guidelines. s 4HE OCCUPATIONAL THERAPIST SEEKS THE APPROVAL OF 4HE $ANISH National Committee on Biomedical Research Ethics in accordance with current regulations.
F. THE OCCUPATIONAL THERAPIST'S ETHICAL RESPONSIBILITY TOWARDS THE PROFESSION
Value: professionalism s 4HE OCCUPATIONAL THERAPIST IS AWARE OF AND ADHERES TO THE Helsinki Declaration and other relevant requirements and guidelines concerning research ethics. s 4HE OCCUPATIONAL THERAPIST WEIGHS UP HER RESEARCH ACTIVITIES in relation to their relevance for the profession and usefulness to society, stressing function, occupation and participation. s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO PROFESSIONAL DEvelopment and research related to function, occupation and participation. s 4HE OCCUPATIONAL THERAPIST MAINTAINS AND RENEWS HER PROFESsional knowledge and skills and duly adapts her practice. s 4HE OCCUPATIONAL THERAPIST FOLLOWS DEVELOPMENTS IN THE PROfession and within the health service. s 4HE OCCUPATIONAL THERAPIST DISSEMINATES RESEARCH AND DEvelopment results, for example, in journals, at conferences and via electronic media.
s 4HE OCCUPATIONAL THERAPIST ENSURES THAT THE PROFESSION IS NOT brought into discredit by any form of oral or written communication, for example, handouts, sales brochures, agony columns or blogs, advertisements and the selling of products. s 4HE OCCUPATIONAL THERAPIST TAKES RESPONSIBILITY FOR THE INCORporation of these ethical guidelines into occupational therapy work. s 4HE OCCUPATIONAL THERAPIST IN HER WORK MAKES PROFESSIOnally justifiable judgements, adopts critical professional positions and shows courage and circumspection. s 4HE OCCUPATIONAL THERAPIST PROTECTS THE REPUTATION OF THE PROfession. Value: creativity s 4HE OCCUPATIONAL THERAPIST CONTRIBUTES TO INDIVIDUAL PROGRAMmes of rehabilitation and treatment characterised by careful reflection, imagination and untraditional solutions.
The Professional Foundation of Occupational Therapy in Denmark 9
10 The Professional Foundation of Occupational Therapy in Denmark
PASSED BY THE REPRESENTATIVE ASSEMBLY OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, NOVEMBER 2007
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VISIONS FOR SOCIETY
A good society provides the frameworks and conditions necessary for all citizens to participate actively in their own lives and thus be accepted and valued members of society. This calls for society to be inclusive and accessible to all. A good society has a coherent set of social and health policies which accept public responsibility for the welfare of citizens and their right to rehabilitation. VISIONS CONCERNING CITIZENS AS ACTIVE PARTICIPANTS
All people have the right to play an active role in their private lives, on the labour market and in society, according to their resources and interests. This right is independent of culture, gender, age and ethnic origin, as well as of political, sexual and ideological preferences. All people who have reduced functional ability and/or occupational problems have the right to information about occupational therapy services offered by society and to know how to access such information. All people who meet the criteria laid down in Danish law concerning occupational therapy services offered, and the purpose of them, are to be offered such services.
VISIONS CONCERNING OCCUPATIONAL THERAPISTS AS ACTIVE PARTICIPANTS
Occupational therapists are all respected professionals who participate actively in the development of the Danish Association of Occupational Therapists, of occupational therapy as a profession, and in the development of a client-centred social
VISIONS OF THE PROFESSION: ACTIVE PARTICIPANTS IN SOCIETY
and health service imbued with a cooperative spirit. Occupational therapists make a valued and publicly recognised contribution to the welfare services offered by society when citizens with special needs are to be ensured their right to a good and active life.
VISIONS CONCERNING THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS AS AN ACTIVE PARTICIPANT
The Danish Association of Occupational Therapists, with its active members, shop stewards, elected politicians and employees, is the central agency that ensures proper and up-to-date working conditions for occupational therapists in Denmark and the development of the profession's standards, evidence base and usefulness for target groups and society as a whole. The vision of the Danish Association of Occupational Therapists is to provide an organisation for all occupational therapists in Denmark, who should clearly experience the advantages of membership throughout their working lives and careers. The Danish Association of Occupational Therapists is a reliable and respected organisation in the eyes of employers, other professional organisations, civil authorities, patient and user groups and other relevant cooperative partners. The Danish Association of Occupational Therapists plays a decisive and prominent role in the provision of varied and effective rehabilitation in Denmark.
Catharina Nyvang, 9 years old. Spastic paralysis/Cerebral Parese. Has undergone treatment at Vangede Huse. The Professional Foundation of Occupational Therapy in Denmark 11
VALUES OF AND PRINCIPLES FOR THE PROFESSIONAL PRACTICE OF OCCUPATIONAL THERAPY THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, MAY 2005
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This document deals with six professional values which characterise important aspects of the foundation on which good occupational therapy is practised, and should be practised. The identification of these six values, and the more detailed formulation of principles and descriptions of recommended professional behaviour derived from them, is the outcome of a long developmental project carried out by the sub-committee of the Danish Association of Occupational Therapists known as the DEPU (Dansk Ergoterapeutisk Professions Udvikling – 'The professional development of Danish occupational therapy') and of the subsequent debate among members of the Association in May 2005.
Value: respect Principle: occupational therapists act in a respectful manner. Occupational therapists treat citizens and their relatives in a respectful and dignified manner. Occupational therapists regard all people as equal, irrespective of culture, creed, social status, etc. When cooperating with other professionals, occupational therapists show a knowledge of and respect for the professional skills of others. Occupational therapists respect the society and the place of work to which they belong. Value: responsibility Principle: occupational therapists show responsibility in connection with the practice of their profession. Occupational therapists are aware of the profession's paradigms, ethical guidelines, basic values and current standards, and practise in accordance with these. Occupational therapists practise on the basis of current legislation and regulations. Occupational therapists assume responsibility and show loyalty, acting as they do in an context bounded on the one hand by consideration for society and on the other by consideration for the needs and expectations of the individual citizen. Value: equality Principle: in the practice of occupational therapy, citizens and occupational therapists cooperate on an equal footing. Citizens contribute knowledge and requirements concerning
12 The Professional Foundation of Occupational Therapy in Denmark
their own situation; the occupational therapist contributes her professional skills, personal qualities and the services she can offer. Occupational therapists ensure that citizens gain the greatest possible insight into and influence on their own situation. Occupational therapists, in their cooperation with others, act with credibility, attentiveness and empathy. Value: clarity Principle: the work of occupational therapists is made clear through dialogue and written communication. Occupational therapists are obliged to keep records in accordance with current legislation with a view to protecting citizens' rights. When cooperating with citizens, the occupational therapist clearly explains occupational therapy measures orally and in writing. Occupational therapists use written and oral means to explain citizens' goals and ongoing occupational therapy measures to cooperative partners. Value: creativity Principle: occupational therapists display creativity and flexibility. Occupational therapists think and act inventively to promote citizens' occupations and participation. Occupational therapists investigate with open minds new ways of finding individual solutions to citizens' occupational problems. Value: professional development Principle: occupational therapists develop their own practice and contribute to the development of the profession. Occupational therapists reflect on, document and improve their own practice. Occupational therapists participate in quality development and research. Occupational therapists join professional networks to further the development of the profession
PASSED BY THE REPRESENTATIVE ASSEMBLY OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, NOVEMBER 2007
THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS IS OWNED BY THE MEMBERS
The Danish Association of Occupational Therapists is an association owned by all those occupational therapists who are members. The Association only exists in virtue of the decision made by members to continue to contribute to a community centred round the profession. The Association is supported financially by cooperative efforts, but there are no shareholders or other interested parties who earn money from the activities of the Association. THE OVERALL AIM OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS
The overall aim of the Danish Association of Occupational Therapists is to protect the interests of occupational therapists. These interests are defined in §2 of the Charter of the Association, which states that the Association shall: s SUPPORT ITS MEMBERS IN THEIR WORKING LIFE s OBTAIN THE BEST POSSIBLE WAGE AND WORKING CONDITIONS FOR ITS members; s BE A DRIVING FORCE IN THE DEVELOPMENT OF THE OCCUPATIONAL therapy profession; s HAVE AN IMPACT ON THE DEVELOPMENT OF SOCIETY FROM AN occupational therapy point of view; and s CREATE SCOPE AND A FRAMEWORK FOR NETWORKING AMONG ITS members. The overall aim of the Association thus lays down that the Association shall in various ways 'protect the interests' of occupational therapists, and that this protection of interests takes place in a field of action between particular services offered to the members themselves and more complex political activities undertaken – on behalf of the members – to consolidate the professional interests of occupational therapists both at the individual and societal levels. THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS DEPENDS AND BUILDS ON THE INVOLVEMENT OF OCCUPATIONAL THERAPISTS
The Association follows the system of representative democracy, the members being represented in the daily affairs of the Association by five full-time and salaried elected officers: the national chairman, the vice-chairman and the regional chairmen. In addition, the Association employs professional staff
DECLARATION ON THE DEMOCRATIC RIGHTS OF MEMBERS OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS
who work on a variety of tasks, passing on their work to members in the form of products, knowledge, guidance, advice, information, and so on. Basically, both the employees and the elected officers work on the basis of attitudes, wishes and goals arising from the interaction between the profession of occupational therapy and practising occupational therapists on the one side and society on the other. As an organisation, the Danish Association of Occupational Therapists acts in precisely this area of tension between profession and society – and the activities of the Association cover both services offered to the members and the protection of their interests. As a player on the stage of professional politics, therefore, the Danish Association of Occupational Therapists depends completely on a direct interchange with its members, both in terms of human contact and attitudes. In other words, the Association cannot deliver services to, or be the mouthpiece for, occupational therapists without their active cooperation. Occupational therapists have to make their opinions known, so that the Association is carried along by its members, developing relevant services through knowledge about, and in dialogue with, occupational therapists. The Association can only set its goals – and know whether these goals have been achieved – through direct contact with and an understanding of the members and through their active contributions. The policies and decisions of the Association are worthless unless they are recognised by occupational therapists and carried further by them in attitude and action. In fine, the Danish Association of Occupational Therapists can only function if the members play a direct and active role in their association, by personal attendance and involvement, through the channels of representation, through dialogue and loyal membership – or through all the other ways in which members of an association can support their professional community. FORMAL DEMOCRATIC PROCEDURES FOR INFLUENCE AND DIALOGUE
Since the Danish Association of Occupational Therapists can only exercise its function through the participation of its members, a vital factor in the life of the Association is the way in
The Professional Foundation of Occupational Therapy in Denmark 13
which the procedures for influence and dialogue are formed and practised within the Association. The Charter of the Association lays down the formal procedures agreed by occupational therapists in common concerning how the Association is to be constructed and how it is to act. A structure has been set up, involving a Representative Assembly, an Executive Council and regional councils. The tasks of the national chairman, vice-chairman and regional chairmen have been laid down. Election periods, election procedures and rules for nominations have been determined. The rights and duties of the Association and its members have been defined; thus, through the formal structures laid down in the Charter, a basic approach has been formulated as to how a proper, well-functioning common association can be run in practice. This constitutes the formal democratic framework of the Danish Association of Occupational Therapists. PROCEDURES FOR THE PRACTICE OF DEMOCRACY IN THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS
Formal democracy becomes concrete through real people and their actions. Therefore it is important to take a look at the way in which non-formal democracy (i.e. procedures not laid down in the Charter) is practised within the Association. One could say that the Charter simply presents a number of democratic intentions, but this raises an important question: how are these democratic intentions realised in practice? KNOWLEDGE, ACCESSIBILITY AND FREEDOM OF SPEECH
THE Danish Association of Occupational Therapists wishes to identify three basic factors in the realisation of a democratic association in practice, factors which the Association commits itself to strengthen, support and develop in all its activities. The first factor is the knowledge possessed by members Knowledge of their profession, knowledge of their Association: knowledge is the decisive factor in terms of individual occupational therapists' insight into their Association and in terms of the visibility of the Association's actions and activities. Knowledge creates transparency and is absolutely crucial if the individual member is to experience her professional community with other occupational therapists through the Association, get an overall view of the way the profession works in society, and act as a democratic individual, that is, as an active participant in her own working life and in the life of society as a whole. The Danish Association of Occupational Therapists must
therefore at all times regard the giving of information to members as one of the three most important factors in the realisation of a democratic association in practice. Information has to be targeted, so the Association must distinguish between groups of members, and be aware of the different kinds of knowledge needed by different occupational therapists and groups of occupational therapists, developing as much as possible all the relevant ways and occasions for passing on information from the Association. This calls for ongoing dialogue with these groups of members concerning their wishes and needs. This is the first prerequisite for democratic participation on the part of the members. The second factor is accessibility The accessibility of – and actual access to – the Association's various departments and key figures is of vital importance both to individual members and groups of members. Members should be able to call their Association, meet its representatives at various functions, experience the Association as active on their behalf and talk to its representatives, whether employed or elected, to be given the right answers or to express their own opinions. Members should experience goodwill, feel that they are being listened to, that they are spoken to in a professional and dignified manner and that in all such interaction are they met with respect and trust – no matter who they are, or what may be the occasion of their contacting the Association. This is the second prerequisite for democratic participation on the part of the members. The third factor is freedom of speech for the members To have freedom of speech means that members are offered real opportunities to express their opinions on various subjects. Of course, freedom of speech also covers the rights of members to elect members of the Executive Council, the national chairman, the vice-chairman, and so on – but in practice, in everyday life, freedom of speech means that members can personally express their opinions, that they be asked to do so, that they are heard, and that they are given opportunities to state their own position and be encouraged to do so. The employees and elected officers of the Association must therefore be aware of and develop their own forms of dialogue with members, so that members are given the widest possible range of opportunities and ways of making their voices heard, for example, via emails, the Internet, the journal of the Association, questionnaires, opinion polls or focus group interviews, and via membership meetings. This is the third prerequisite for democratic participation on the part of the members. Eva Johanssen, 56 years old. Occupational therapist in Brøndby.
14 The Professional Foundation of Occupational Therapy in Denmark
The Professional Foundation of Occupational Therapy in Denmark 15
THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS' STRATEGY FOR COOPERATION WITH OTHER ORGANISATIONS PASSED BY THE REPRESENTATIVE ASSEMBLY OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS, NOVEMBER 2007
The Association's strategy for cooperation with other organisations regionally and nationally is based on an assessment of the Association's needs held up against its opportunities. The Danish Association of Occupational Therapists looks after a wide variety of interests. This is necessary because occupational therapists are employed in many different kinds of jobs in Danish municipalities and regions and because the Danish Association of Occupational Therapists has to meet on an equal footing and work alongside employees, other organisations, civil authorities, etc. This interaction is vital if the Association is to represent the interests it is responsible for and exercise political influence. The basic conditions under which the Association works – that is, a small organisation representing many interests – is what motivates the Association to enter into many different forms of cooperation. As an organisation, the Danish Association of Occupational Therapists needs the strength which a number of interest groups or organisations can muster working together. At the same time, the Danish Association of Occupational Therapists wishes to be a strong and independent professional association, competent to make those decisions which its field of action calls for. The Danish Association of Occupational Therapists believes that a mono-professional association with a clear profile offers the best basis for membership solidarity, the best motivation for membership and the best service for members. For this reason, the Danish Association of Occupational Therapists wishes to expand and cultivate its external cooperation without compromising the Association's professional and political independence and sovereign right to make decisions.
THE OVERALL APPROACH OF THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS TO COOPERATION WITH OTHER ORGANISATIONS
s 7E REGARD COOPERATION AS A MEANS n NOT AS A GOAL IN ITSELF s #OOPERATION TAKES PLACE WITHIN FORMAL FRAMEWORKS LOCAL NETworks and through personal contacts. s 7E ARE ESPECIALLY ATTENTIVE TO OUR AIMS AND POSSIBILITIES WHEN entering into forms of cooperation that involve long-term financial commitments. s .EW FORMS OF FORMAL COOPERATION ARE ALWAYS ASSESSED IN THE light of our ability to live up to existing ones. WHY DOES THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS COOPERATE WITH OTHER ORGANISATIONS?
s We cooperate in order to make occupational therapy better known and to further recognition of and respect for the profession. s 7E COOPERATE IN ORDER TO CONSOLIDATE ALLIANCES AND TO BE STRONGER than if we stood alone. s 7E COOPERATE IN ORDER TO PROMOTE UNDERSTANDING OF THE !SSOCIAtion's interests. s 7E COOPERATE IN ORDER TO BE STRONGER WHEN STRUGGLING FOR BETTER conditions.
16 The Professional Foundation of Occupational Therapy in Denmark
WHEN DOES THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS COOPERATE WITH OTHER ORGANISATIONS?
s 7E COOPERATE WHEN IT BENEFITS OUR PROFESSIONAL INTERESTS s 7E COOPERATE WHEN IT BENEFITS THE INTERESTS OF OUR MEMBERS s 7E COOPERATE WHEN RELEVANT OCCASIONS ARISE FOR EXAMPLE WHEN new bills are introduced or political problems call for debate. s 7E COOPERATE WHEN EXTERNAL EVENTS DETERMINE THAT THE OPPOsite is not an issue. IN WHAT AREAS DOES THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS COOPERATE WITH OTHER ORGANISATIONS?
s .EGOTIATIONS s 0ROFESSIONAL UNDERGRADUATE AND POST GRADUATE EDUCATION s 2ESEARCH AND DEVELOPMENT s (EALTH POLICY s 3OCIAL POLICY s ,ABOUR MARKET POLICY s )NTERNATIONAL RELATIONS s !DMINISTRATION AND ORGANISATION HOW DOES THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS COOPERATE WITH OTHER ORGANISATIONS?
s 7E CULTIVATE OUR NETWORKS AND PERSONAL CONTACT WITH COOPERAtive partners. s 7E AIM ALWAYS TO GET THE BEST RESULTS FROM OUR COOPERATIVE efforts. s 7E SEEK COOPERATIVE PARTNERS WHO ARE RELIABLE AND STABLE s 7E ALWAYS STRIVE TO BE A CONSTRUCTIVE AND RELIABLE COOPERATIVE partner ourselves. WHO DOES THE DANISH ASSOCIATION OF OCCUPATIONAL THERAPISTS COOPERATE WITH?
s /THER PROFESSIONAL ORGANISATIONS AND CONFEDERATIONS FOR example the main trade union, FTF (Confederation of Professionals in Denmark), the Health Cartel (central negotiating organisation), The Association of Danish Physiotherapists and The Danish Nurses' Organisation. s 0UBLIC AUTHORITIES SUCH AS 4HE .ATIONAL "OARD OF (EALTH 4HE Ministry of Health and Prevention and The National Board of Social Services. s 0UBLIC INSTITUTIONS SUCH AS 4HE #ENTRE OF %XCELLENCE FOR 2EHAbilitation and Physical Activity and The Centre of Excellence for Social Psychiatry. s 6ARIOUS COUNCILS AND BOARDS SUCH AS 4HE $ANISH .ATIONAL Council for Quality Development in the Health Service and The Patient Complaints Board. s %MPLOYEES SUCH AS 4HE .ATIONAL !SSOCIATION OF $ANISH -UNIcipalities, Danish Regions and Falck. s 0ATIENTSg ORGANISATIONS SUCH AS $ISABLED 0EOPLES /RGANISA tions Denmark (DPOD) and The Danish Arthritis Foundation. s "RANCH ORGANISATIONS SUCH AS 4HE $ANISH 2EHABILITATION Group. s 2ESEARCH AND EDUCATIONAL INSTITUTIONS SUCH AS THE UNDERGRAduate and postgraduate departments of University Colleges and The University of South Denmark. s )NTERNATIONAL ORGANISATIONS SUCH AS OUR .ORDIC SISTER ORGANIsations, COTEC, WFOT and ENOTHE.
The Danish Working Environment Act: The aim of the Danish Working Environment Act is to create a safe and healthy working environment which shall at any time be in accordance with the technical and social development of society, and the basis on which the enterprises themselves will be able to solve questions relating to safety and health under the guidance of the employers' and workers' organisations, and under the guidance and supervision of the Danish Working Environment Authority. Concerning the working environment there are a number of executive orders, guidelines and other documents relating to preventive health, for example, concerning the carrying out of work, the arrangement of the workplace, the organisation of security measures, and particular working environment problems, such as violence, harassment, indoor climate, stress, etc. The website of the Danish Association of Occupational Therapists (www.etf.dk) contains a section on working life with links to rules and guidelines concerning topics related to the working environment. These are mostly in Danish. However, the English section of the Danish Working Environment Authority website (http://www.at.dk/sw7737. asp99) contains many relevant documents in translation. Authorisation: The 'Act on the authorisation of health care personnel and the practice of the health care professions' covers the authorisation of all health personnel in Denmark – including occupational therapists. The Act includes provisions concerning rights and duties, inspection and penal clauses. An occupational therapist covered by the Authorisation Act has the right to use the title 'Occupational Therapist', and is obliged to be meticulous, conscientious and impartial in her work, and to respect Danish legislation and regulations which apply to her work, such as record keeping or professional secrecy in terms of the sanctity of people's private lives. Accepting authorisation means recognising that one can be deprived of authorisation or possibly punished if one does not live up to one's obligations. Occupational therapists do not have a monopoly on a particular area of activity, but the official comments on the bill proposing the Authorisation Act do describe the area of activity of occupational therapists. Further information about authorisation in Denmark may be found on the CIRIUS website (for occupational therapy see: http://www.ciriusonline.dk/Default.aspx?ID=6836).
There have been a number of national and regional surveys of patients' experiences of the health service in Denmark. They are to be found (in Danish) at www.patientoplevelser.dk. The (Danish Public Health Service) Patient Complaints Board deals with complaints about professional activity within the Danish Health Service. The Danish Association of Occupational Therapists is represented on this Board. Further information about the Patient Complaints Board (in Danish) may be found on www.pkn.dk. The English section of the website of the Danish Society for Patient Safety (www.patientsikkerhed.dk) offers a translation of the 2003 'Patient Safety Act'. Otherwise, the website presents a series of relevant reports (in Danish). The (Consolidation) Act on Social Services This Act regulates large sections of the occupational therapy area of work, including: s 3HELTERED EMPLOYMENT AND SOCIAL AND OTHER ACTIVITIES s !SSISTIVE TECHNOLOGY THE DESIGN OF LIVING SPACE AND TRANSPORTAtion. s /FFERS OF ACCOMMODATION s 3PECIAL SUPPORT FOR CHILDREN AND YOUNG PERSONS s $UTY OF NOTIFICATION A complete (unofficial) translation of the Act on Social Services is to be found at the Ministry of Social Welfare website (http://eng. social.dk/) under 'Legislation'. A variety of guidelines, executive orders and other documents connected with the Act are to be found (in Danish) at www.etf.dk/210.
APPENDIX 1 EXAMPLES OF CURRENT LEGISLATION CONCERNING OCCUPATIONAL THERAPY
The Danish Health Act This Act covers many areas central to occupational therapy. The Act, with its attendant comments, executive orders and guidelines, lays down – partly by means of obligatory agreements between the Danish regions and their municipalities – who is responsible for what tasks in relation to: s 2EHABILITATION AND RETRAINING s $ISEASE PREVENTION AND HEALTH PROMOTION s 0ARTS OF THE ASSISTIVE TECHNOLOGY AREA s 0ROVISION FOR THE MENTALLY ILL The Danish Health Act is not available in English. The Danish version and the accompanying executive orders may be found at www.etf.dk/ rehabilitering.
The Folkeskole (Consolidation) Act Concerning the Danish state comprehensive school (the Danish Folkeskole), of special interest to occupational therapists are the following documents: 'Executive Order on special education in the Danish Folkeskole and other special educational measures'; and, 'Guidelines concerning intervention in the Danish Folkeskole concerning pupils whose development requires special attention or support'. Both these documents are to be found (in Danish) on www.etf.dk/210.
Educational legislation The bachelor degree in occupational therapy is regulated by the 2008 'Act on degree programmes at Business Academies and Professional Bachelor Degrees'. In addition, there is a specific 'Executive Order on the degree programme leading to a Professional Bachelor Degree in Occupational Therapy', which further defines the aims, content and planning of the bachelor programme. Postgraduate and continuing professional education are covered by legislation on adult education and many executive orders concerning individual programmes, e.g. diploma and master courses. Acts and executive orders (in Danish) may be found under the relevant topics at www.etf.dk/uddannelse.
Patient safety The Danish Health Care Act presents regulations and laws concerning patient safety. These – along with surveys of patients' degrees of satisfaction and the way professionals experience cooperation with patients under treatment – provide a basis for the involvement and selfdetermination of patients in connection with courses of treatment.
Guidelines for occupational therapists concerning record keeping These guidelines from The National Board of Health state the minimum requirements for record keeping by occupational therapists – requirements which the Board sees as meeting the provisions of the Authorisation Act concerning being meticulous and conscientious. The guidelines (in Danish) are to be found at www.etf.dk/documentation.
APPENDIX 2 REFERENCES OF SPECIAL RELEVANCE TO THE PROFESSIONAL FOUNDATION OF OCCUPATIONAL THERAPY International declarations: EU declarations on the rights of disabled people. ec.europa.eu/emploWorld federation of occupational therapists (Wfot) position statement yment_social/disability/index_en.html. on human rights, including occupation and participation, 2006. Wfot’s The European Disability Forum is an umbrella organization representing definition of occupational therapy (2004). Wfot operational Plan 2006 50 million disabled people in Europe. See www.edf-feph.org for declato 2008. All found at www.wfot.org.au. rations on rights of disabled people in the EU. Council of occupational therapists for the European Countries: Code of Ethics and standard of Practice. See www.cotec-europe.org/. Danish Association of Occupational Therapists: The Charter, political focus areas, policy statements, etc. of the Danish UN declarations on the rights of disabled people: www.un.org/esa/ Association of Occupational Therapists are to be found at www.etf.dk/ socdev/enable/sitemap.htm. foreningsdokumenter/. WHO website with relevant links concerning disability and human rights. www.who.int/topics/disabilities/en/.
The Professional Foundation of Occupational Therapy in Denmark 17
18 The Professional Foundation of Occupational Therapy in Denmark
APPENDIX 3 CLARIFICATION OF THE TERMS USED IN THE DEFINITION OF OCCUPATIONAL THERAPY AS A PROFESSION Occupational therapy is a profession within the social and health service in Denmark, practised on the basis of a professional bachelor degree and authorisation by the Danish National Board of Health. Occupational therapy is practised in the light of an objective related to disease prevention and rehabilitation, in cooperation with target groups that experience occupational problems in their daily lives. Occupational therapists apply specific knowledge and methods to create harmony between people, their activities and their environment, with a view to enabling occupational performance and participation, as these promote health and a good life. Profession "A type of occupation, the practice of which requires specialised, systematic and scientific training. Access to the profession is gained by passing specific examinations, which gives the right to titles and diplomas, thus sanctioning the roles played by the various professions in terms of the division of labour". (Sehested, 1997 – trans. by the translator). The social and health service in Denmark The social and health service consists of many different organisations and systems, which carry out general tasks and provide public services as required by The Danish Health Act and The (Consolidation) Act on Social Services. Most Danish occupational therapists are employed by Danish regions and their municipalities; a smaller number are employed in private organisations and companies. Professional bachelor degree A professional Bachelor Degree in Occupational Therapy may be gained after 3 years of study at a Danish 'Professionshøjskole' (University College), including obligatory periods of clinical placement. The holder of a professional bachelor degree possesses knowledge of and insight into the central subjects and methods of the profession, which qualifies the holder to practise and work independently within the profession towards which the degree course is directed and to take postgraduate studies at master or PhD levels (The Danish Ministry of Education, 2000; The Danish Ministry of Education, 2003). Authorisation by the Danish National Board of Health Successfully completing the Danish degree programme in occupational therapy, or a recognised foreign equivalent, enables the holder to use the title 'Bachelor of Occupational Therapy (B.OC.T.)', and gives the right to receive authorisation from The Danish National Board of Health (The Ministry of Interior and Health, 2006; The Danish National Board of Health, 2006). An objective related to disease prevention and rehabilitation Occupational therapy plays a central role in interprofessional rehabilitation. Occupational therapy treats occupational problems and improves peoples' opportunities to carry out activities in daily life and to participate in private and social life. Occupational therapy thus aims to prevent disease, ageing, functional limitations and a work environment hazardous to health from excluding people from living active everyday lives. Target groups The target groups of occupational therapy are people with somatic and mental diseases, as well as people with chronic illnesses, disabilities and
BIBLIOGRAPHY Bendixen, Madsen & Tjørnov. In Borg, Runge & Tjørnov (2007): Basisbog I ergoterapi – aktivitet og deltagelse i hverdagslivet. Denmark, Munksgaard.
social problems. In addition, occupational therapists work to prevent disease and social problems in order to promote health. Occupational problems Occupational problems is the collective term for those categories of problems which occupational therapists have the skills to identify and tackle. Occupational problems arise, for example, as the result of illness, lifestyle, ageing, working conditions, congenital functional limitations or obstacles to occupation arising from the person's surroundings and environment. Occupational problems manifest themselves as problems connected with carrying out necessary and desirable everyday activities, and are thus problems which can be alleviated by adapting surroundings, by training and by reorganising everyday activities. Knowledge and methods The practice of occupational therapy is based on a wide theoretical and practical knowledge of human physical, mental, cognitive and social conditions and life circumstances, and of factors in the environment which influence the opportunities of individuals for occupational performance and participation in daily life. Knowledge and methods in occupational therapy are related to rehabilitation, treatment, training, health promotion and disease prevention, as well as to research and development work. Create harmony between people, their activities and their environment One basic condition for a good life is that people experience a balance between their capabilities, what they want to do and the opportunities offered by their daily lives. Occupational therapists, in cooperation with patients and clients, attempt to create coherence and balance between people's capabilities and conditions of life and those factors in their environment which influence their opportunities for occupation and participation in everyday life. Enabling occupational performance Occupational therapy improves the opportunities for individuals to perform everyday activities by working with their personal capabilities and those barriers that have a negative influence on their opportunities for occupation and participation in everyday life. Occupation Engagement in occupation takes place round the clock and consists of activities in the home, at work and at leisure. In order for occupation to create coherence and balance in people's lives and support their participation in, for example, family and social life, their activities must have a personal goal, meaning and cultural significance. In occupational Therapy, therefore, occupation is a central term for human patterns of being and action, and is at the same time regarded as a therapeutic medium (Kielhofner, 2004). Participation This term is an intrinsic part of the way occupational therapists understand occupation and concerns people's opportunities to gain access to and be involved in diverse social and societal contexts – alone and with others (Bendixen, Madsen & Tjørnov in Borg, Runge & Tjørnov, 2007).
The Danish National Board of Health (2006): Ergoterapeut med dansk uddannelse, www.sst.dk/uddannelse/Ergoterapeut/autorisation_med_ dansk_udd. aspx. Townsend, E (1997): Enabling Occupation. Ottawa, Coat Publications ACE.
The Ministry of Interior and Health (2006): Lov om autorisation af sundhedpsersoner og anden regulering af sundhedsfaglig virksomhed (Authorisation Act). Kielhofner, Gary (2004): Conceptual Foundations of Occupational Therapy. 3rd. Edition. Philadelphia, F. A. Davis. Sehested, Karina (1997): Professioner og strukturændringer. In Ejersbo, Niels: Politikere, ledere og professionelle I kommunerne: effekter af strukturændringer. Odense University Press.
Danish Ministry of Education (2000): Bekendtgørelse om uddannelsen til professionsbachelor, http://www.retsinfo.dk/_gEtdoC_/ b20010011305. (Executive Order on Professional Bachelor Degrees). Danish Ministry of Education (2003): Mod en dansk kvalifikationsnøgle for videregående uddannelser, us.uvm.dk/videre/generelt/kvalifikationsnoglerapport.doc. (Report on a Danish Qualifications Framework for Higher Education).
Grethe Nielsen, 75 years old. Healthy spouse of a resident at the Day Training Centre in Brøndby. The Professional Foundation of Occupational Therapy in Denmark 19
0HOTOGRAPHY 3IF -EINCKE
TABLE OF CONTENTS
THE PROFESSIONAL FOUNDATION OF OCCUPATIONAL THERAPY IN DENMARK Introduction.
DOCUMENT 1 The mission of occupational therapy and the objective foundation for the existence of a contract with society. Definitions of occupational therapy.
DOCUMENT 2 Basic ethical value of the profession: Occupation and participation as the basis for a good life.
DOCUMENT 3 s %THICAL GUIDELINES OF THE PROFESSION s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY TOWARDS THE CLIENT s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY TOWARDS CLIENTSg RELATIVES s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY TOWARDS COLLEAGUES AND cooperative partners. s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY TOWARDS EMPLOYERS s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY TOWARDS SOCIETY s 4HE OCCUPATIONAL THERAPISTgS ETHICAL RESPONSIBILITY towards the profession.
DOCUMENT 4 Visions of the profession: active participants in society: s #ITIZENS AS ACTIVE PARTICIPANTS s /CCUPATIONAL THERAPISTS AS ACTIVE PARTICIPANTS s 4HE $ANISH !SSOCIATION OF /CCUPATIONAL 4HERApists as an active participant.
DOCUMENT 5 Values of and principles for the professional practice of Occupational Therapy.
DOCUMENT 6 Values and principles concerning the democratic rights of members of the Danish Association of Occupational Therapists.
DOCUMENT 7 The Danish Association of Occupational Therapists' strategy for cooperation with other organisations.
APPENDICES Appendix 1 Examples of current legislation concerning occupational therapy. Appendix 2 References of special relevance to the professional foundation of occupa tional therapy. Appendix 3 Clarification of the terms used in the definition of occupational therapy as a profession The Danish Association of Occupational Therapists/ Ergoterapeutforeningen Nørre Voldgade 90 DK-1358 København K Phone: 0045 33414700 Fax: 0045 33414710 [email protected]
20 The Professional Foundation of Occupational Therapy in Denmark