Insights from a Hospice OT Working in Sweden

Hospice Occupational Therapy. GettyImages

Occupational therapy is a globally strong profession. Which means occupational therapists get to enjoy the global perspective of colleagues working in different cultures and health care systems.

Jens Roved is a hospice occupational therapist working in Sweden. I wanted to share this interview, both because it gives insight into a one OT’s experience in the niche of hospice care and to showcase the work and influences of a colleague working in a different medical system than our own.

Where did you go to school?

I am a Danish citizen, but I took my education at Lunds University in Sweden. My education took me eight years to finish since I was knocked down on the streets in Copenhagen after only one semester and suffered a brain damage. After a rehabilitation period at Center for Rehabilitation of Brain Injury (Copenhagen, Denmark), I went back to university but only as a halftime student meaning my years of education stretched over a longer period. In return, this meant that I had a good opportunity to follow how OT education changed over time. I also had more time to go in-depth with Occupational Science.

What drew you to occupational therapy in the first place?

That is a funny question to try and answer. Originally, I wanted to be a physiotherapist but then one summer I went way up north in Sweden on vacation and there I met a girl that I fell in love with. She asked me why I did not consider occupational therapy.

I started wondering about it and then decided to apply for both occupational therapy and physiotherapy in both Umeå (in north Sweden) and Lund (just in case). My time in the north turned out to be but a summer fling so I decided to take the offer of studying at Lunds University. I decided for occupational therapy because the education seemed more flexible and had avenues in a lot more different directions than physiotherapy, amongst those Occupational Science.

Turned out later that I was right in my assumptions.

How did you discover hospice occupational therapy?

We had a lecture by an occupational therapist named Marie Hansson, who worked in hospice. She was very exciting and we sort of clicked with each other. When given the opportunity to do one of my practice turns, I enlisted to spend five weeks at Hospice in Malmö where she works. After I finished my education I contacted her to ask her if I could come and work with her while I was applying for jobs. She asked around and everyone agreed to this. For half a year, I worked for free and slowly got a foothold in that lead to me being given a job offer in the summer of 2014, despite having a brain injury and only being able to work halftime.

What does a typical day of work look like for you?

I start work at 8 a.m. by going through the journal notes of the patients I am involved with and also reading up on new patients. Then I have a chat with my colleague who I share office with and we usually talk about our work and how we can improve.

We discuss group activities and plans for excursions with our patients.

Around 9 a.m. I start working with the patients. We have various activity offers during the day for those who have the strength to leave the facility, for example going outside to get fresh air in the parks around us. We also have creative group activities for those who like to socialize. I spent a lot of time talking to patients about their occupational narrative and what they want to get done. I try to help them with that. Sometimes sitting for a half-hour just talking is what a patient value the most.

I cooperate tightly with the physiotherapist about the physical condition and performance of our patients and we often discuss the potential and resources of our patients. With the patients, we discuss what they want to use their narrowing resources for. Some patients want to go home for a few hours with relatives and we offer that as well as the help needed to be able to do this.

My day ends at 15:30 and by that time I am going home to spend time with my little family of fiancé and two small daughters. In my free time, I often spent time both reflecting on and researching possibilities of how to incorporate nature-based, cultural, and de-stressing activities into the work with my patients. 

What are some of the unique ways occupational therapists contribute to the hospice process?

Occupational therapists can contribute to the hospice environment by our focus on activity, meaning, value and well-being. The two of us base our work on a wide variety of occupational research. We find much value in Frank Kronenberg’s volumes about Occupational Therapy without Borders and also Moses Ikiugu and Nick Pollards book Meaningful Living Across the Lifespan. In our practical work we often turn to the research done on Lunds University presented in the Value and Meanings in Occupations model (Persson, D., Erlandsson, L-K., & Eklund, M.) which incorporates thinking about activity as intrinsically connected with meaning and value and we use occupation as ”a personalised dynamic interaction between person, task, and environment, imprinted with concrete, symbolic and self-reward value dimensions” (Persson, D., Erlandsson, L-K., Eklund, M. & Iwarsson, S.; Value Dimensions, and Complexity in Human Occupation – A Tentative Structure for Analysis. Scandinavian Journal of Occupational Therapy, 2001; 8: 7-18).

We have also been asked to contribute to a national plan for palliative care in early interventions where we suggested addressing reduced occupational potential by incorporating Occupational Justice concepts such as Occupational Imbalance, Occupational Deprivation, and Occupational Alienation.

We have this focus also in our daily work. In daily practice, we contribute by ensuring that patients are offered possibilities to partake in activities as well as getting a chance to share their lifetime occupational narrative. This in combination with group activities, Mindfulness, Medical Yoga and the social stimulations inborn in this  gives our patients a chance to fulfill some of the basic human occupational needs. We use assistive devices and care as a resource offered to our patients so that they can focus their energy on what is important for them to do in their occupational life. We need more resources to Occupational Therapy though in order to accommodate our patient’s needs and wishes

Did you have any training beyond occupational therapy school to prepare you for this specialty?

Not beyond my practice term here and the work I did for free before getting a job offer. I am supposed to take a broad sense introduction course in palliative care offered to everyone when they are starting to work here but haven’t had time to go yet. It is in the pipeline, though.

What is one area of growth you would like to see for OTs in hospice over the next 5 years?

I would want to see much more focus on Occupational Justice and the underlying concepts of Occupational Imbalance, Occupational Deprivation and Occupational Alienation. We need the whole palliative health care sector to adhere to initiatives that are based on preventing patients experiencing such harmful interventions that onsets the feeling of being treated with injustice. We need to be very careful in listening to and adhering to the patient’s wishes and sense of meaning and value also when it comes to distributing economic resources in the palliative health care system. We need more occupational therapist resources, and we need more focus on how occupational therapists can operate in the medical team for the benefit of the patients. 

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