Read Full Text: Moving from theory to practice in occupational therapy education for planetary health: A theoretical view
Journal: Australian occupational therapy journal
Year Published: 2023
CEU Podcast: #59: OT Education for Planetary Health with Moses Ikiugu
What does planetary health have to do with occupational therapy?
The authors of this week’s article contend that engagement with environmental sustainability is foundational for our profession.
Their goal is to help OT students and professionals translate environmental awareness to practical action.
They believe that three skills can close the theory-practice gap:
- Clinical reasoning
- Bidirectional questioning
- Interprofessional education
This is a new topic for the Club, and we’re excited to have Moses Ikiugu, PhD, OTR/L, FAOT join us on the OT Potential Podcast next week. Dr. Ikiugu is a pioneer in connecting OT practice to global health, and he’ll share how studying planetary health has influenced his work as an OT educator. And, as always, we’ll bring it all back to how this research can help improve your daily practice.
Let’s dive in.
What is planetary health?
Planetary health is a combination of two factors:
- The health of civilization
- The health of essential natural systems
What this ultimately means is: human health depends on planetary health.
Human occupations have altered water, land, and ecosystems. This has led to widespread degradation of the natural environment.
If we don’t want our own health to suffer as a consequence, we have an urgent need to completely transform human values and practices.
These calls have come from many entities, including:
- Glasgow Climate Pact, United Nations
- Building Climate Resilient Health Systems, World Health Organization
What does planetary health have to do with OT?
At its core, OT considers people, environments, and occupations.
This naturally makes us notice the link between what people do and their own surroundings. And, that awareness uniquely positions OT professionals to promote sustainable occupations. Sustainable occupations can support global efforts to combat climate change, while addressing related lifestyle diseases.
Indeed, it has been argued that engagement in environmental sustainability is fundamental to the achievement of our professional purview:
- Occupational therapy and environmental sustainability (2015)
- Occupation and environmental sustainability: A scoping review (2020)
Planetary health and OT education
Multiple papers have been written about introducing planetary health content into medical education, including:
- “I teach it because it is the biggest threat to health”: Integrating sustainable healthcare into health professions education (2020)
- Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education curriculum (2019)
That said, such papers have primarily been aimed at medical doctors. Allied health’s role in planetary health is just beginning to be explored. And, at this point, literature on how to embed environmental sustainability into curricula is scarce, which leads us to this paper…
What was the purpose of this paper?
This theoretical paper aimed to contribute to the conversation around translating awareness of planetary health to practical action.
To do so, the authors sought to provide transferable skills for occupational therapy education. Three practical skills are suggested as a means to close the theory-practice gap. The skills incorporate educational processes supporting the transition from novice to expert health practitioner.
Here are the 3 skills:
1. Environmental and sustainable clinical reasoning
As outlined in Clinical and Professional Reasoning in Occupational Therapy, there are 4 forms of clinical reasoning in occupational therapy:
- Pragmatic
- Narrative
- Ethical
- Scientific
In this vein, the authors propose two additional forms of clinical reasoning:
Environmental reasoning (novice):
A foundational form of reasoning whereby the therapist assesses the environmental cost of a proposed intervention. When applying environmental reasoning, the therapist explicitly considers the impacts of all forms of resources required from the perspective of the potential carbon footprint (reduce/reuse/recycle level).
Sustainable reasoning (expert):
An advanced form of reasoning whereby the therapist assesses the cost of the proposed intervention from three discrete perspectives (environmental, social, and financial), and consolidates costs along the triple bottom line. The social perspective is articulated using the 3Fs (finitude, fragility, fairness). This type of clinical reasoning necessitates the integration of ethical and pragmatic reasoning in that the therapeutic benefits to the individual are explicitly considered alongside environmental impacts and climate justice. Application of sustainable reasoning prompts the practitioner to seek solutions that consider societal- and global-level human health and environmental sustainability.
Embedding environmental reasoning into OT curricula may help us adhere to the guidelines set by The World Federation of Occupational Therapy:
(Our upcoming podcast guest was an author of these guidelines!!)
2. Bidirectional questioning
Historically, occupational therapy has focused on the individual—in both theory and practice. We know this as “person-centered care.”
Yet, this simplistic worldview can neglect the interconnectedness of society, as well as how humans interact with nature. For example, health promotion efforts often focus too much on individual responsibility vs. societal issues.
Indigenous knowledge reminds us of the interconnectedness of all things. To incorporate this knowledge into OT practice, the authors recommend the concept of “two-eyed seeing,” which they describe as:
“learning to see from one eye with the strengths of Indigenous knowledges and ways of knowing, and from the other eye with the strengths of Western knowledges and ways of knowing, and using both these eyes together, for the benefit of all”
Bidirectional questioning is a practical manifestation of this two-eyed seeing. It is a two-way analysis that removes a single individual as the focal point of care. Instead, it asks not only about individual participation, but also how this impacts the environment. It also acknowledges the reciprocity between human health and environmental health.
Put simply, it asks: what does this individual need…AND what does the world need from the individual?
3. Interprofessional collaboration
Interprofessional learning has come to be viewed as an essential part of healthcare students’ training.
The authors propose that when OT learners are provided with opportunities for interprofessional learning (either university- or placement-based), they should be prompted to explicitly seek opportunities for sustainability learning.
More in-depth suggestions for what this could look like are outlined in this article:
Building an environmentally accountable medical curriculum through international collaboration
Discussion
This paper suggests that OT education should encourage students to develop environmental reasoning as novices. This would then evolve into sustainability clinical reasoning as they become experts.
Sustainable clinical reasoning, bidirectional questioning, and interprofessional collaboration could equip students to make contributions to sustainable, quality healthcare.
This sustainable, quality healthcare has the potential to:
- Maximize health gains
- Minimize cost and environmental harm
- Take advantage of every opportunity to add social value
Takeaways for OT practitioners
(Please note: These are my personal takeaways. They are not mentioned specifically in the article.)
1.) OT meets “People, Planet, Profit”
I found this article to be personally moving, because it integrated with a maxim I’ve learned as a business owner.
“People, Planet, Profit” is known as the triple bottom line, and it is often reserved for thinking about business strategy. By making it a part of OT clinical reasoning, it pushes clinicians to think holistically. And, it allows us as practitioners to integrate our care for the environment into our work.
This type of expansive thinking is OT at its best.
2.) Shout out to the trailblazers in this work!
In addition to the incredible writers cited in this article, I want to acknowledge several groups that are leading us forward in this movement.
In the United States, we have the group: OTs for Environmental Action.
Also, big shout out to the OT professionals who have gone a step further by offering nature-based therapy! I just added a directory of nature-based OT practitioners on this page.
Lastly, I can’t wait to talk with Dr. Ikiugu about his own trailblazing next week! Please leave your thoughts and questions for us in the comments below!
Here’s the full APA citation for this article:
Hess, K. Y., & Rihtman, T. (2023). Moving from theory to practice in occupational therapy education for planetary health: A theoretical view. Australian occupational therapy journal, 10.1111/1440-1630.12868. Advance online publication.
Earn one hour of continuing education by listening to the podcast on this article!!
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In this podcast episode, we dive even deeper into this topic, with OT (and Club member!), Moses Ikiugu. You may be eligible for continuing education credit for listening to this podcast. Please read our course page for more details!