Application Of Canadian Model Of Occupational Performance And Engagement (CMOP-E) For Mr. Jozef's Essay.

The Concept of Occupational Therapy and Application of Model for Patient Care

‘To analyse and justify the application of a chosen model to a case scenario, and to consider the appropriateness of a second model.’

Demonstrating an understanding of the use of models in practice. This requires students to provide an evidence based rationale for the choice and application of one model covered in the module, and the appropriateness of a second model.

The following client has been referred to you as the community occupational therapist.

Mr JozefJurik is 51 years old, he moved to England 25 years ago from Slovakia as he had met his English partner Teresa, now his wife of 24 years, at language school.  Jozef is proud of his Slovakian heritage, and Roman Catholic faith, but has always missed his parents and brother, and kept in regular contact with them.  

Jozef is a mechanic by trade and has enjoyed employment at a large Derby based engineering company throughout the time he has been based in England. Jozef has enjoyed updating his skills to use digital technology and enjoys teaching apprentices, junior staff and inducting new team members. His boss has always regarded him as one of the most reliable and hardworking members of company, of which Jozef has been proud.

Jozef and Teresa have two sons, who left home about two years ago; Jozef and Teresa saw this as an opportunity to move to a small quiet village on the outskirts of Derby to enjoy the countryside, have a larger garden with a vegetable plot and spend more time outdoors; their sons remain living in Derby. Unfortunately Teresa’s mother in Devon in the last 6 months has become unwell; hence when Teresa finishes her part time teaching job on Thursday lunchtime, she drives straight to Devon to care for her mother, often only returning on a Sunday night before going to work on Monday morning. Jozef misses Teresa during this time, he feels very guilty as he feels family values are of upmost importance, so he agrees she should be looking after her mother, however due to a flare up of symptoms in his rheumatoid arthritis he has not been able to drive to join her in Devon when he finishes work on a Friday evening. Also there is limited public transport in the village, and no Catholic Church, hence Jozef cannot get into Derby to see his sons, or to attend church, and he finds this upsetting.

Currently Jozef is off long term sick from work, and has been for the last two months.  This is in part due to his rheumatoid arthritis, including early morning stiffness and joint pain within his wrist and ankle joints, and fatigue. Jozef has also been seen by his GP who has prescribed him sertraline to manage the symptoms of depression. Jozef is worried about letting his company down; due to problems with his wrists he feels he would struggle to operate the technology and complete heavy manual tasks at work, he has early morning stiffness, and is concerned that he may struggle to stand due to ankle joint pain.  Jozef is also finding that he has reduced stamina and energy in undertaking day to day tasks, both at home and prior to being off from work, within his work setting. He is concerned he is letting Teresa down, as he is doing little round the house when she is away at her mothers, and he is extremely worried that he might be labelled as a bad employee. He dwells on these negative thoughts and seems to think of little else.

Jozef is normally very particular about his appearance, but Teresa has commented to him that he seems not to be taking as much care of himself and his appearance. Teresa is very concerned about Jozef, she identifies that previously she would have described him as chatty, and always doing something, but in the last few weeks he is very quiet, does very little and at times becomes tearful, seeming very unmotivated, assuming everything will go wrong.

Currently Jozef has few leisure pursuits, but had previously been a keen Derby County football supporter, both attending home games and meeting friends at the pub to watch away matches, neither of which he is currently doing. Previously Jozef had also been a keen gardener, and enjoyed driving, but his recent loss of confidence has impacted on his ability to engage in these occupations.

Jozef’s family in Slovakia  have contacted Teresa to express concern that Jozef has stopped making much contact with them by phone, skype or e mail and that when he does all he talks about is how much of a failure he is as both a husband and employee.

• Select onemodel (either CMOP-E or MOHO).
• Justifyyour choice of either CMOP-E or MOHO and how you will assess Jozef using the chosen model.
• Justification for your choice must be supported from evidence in the literature.

• Select oneother model from either PEO, Kawa or VdTMoCA.
• Discuss how your chosen model (PEO, Kawa or VdTMoCA) might be moreappropriate to use with Jozef than the model you chose in Section 1 (CMOP-E or MOHO).
• Discuss ways in which your chosen model (PEO, Kawa or VdTMoCA) might be less appropriate to use with Jozef than the model you chose in Section 1 (CMOP-E or MOHO).
• Justification for your choice must be supported from evidence by the literature.

The Concept of Occupational Therapy and Application of Model for Patient Care

The current assignment focuses on the concept of occupational therapy and the application of models for catering to the requirements of the patients. The present assignment focuses on the case study of Mr. Jozef who is a 51 year old mechanic by trade and had moved to England with his wife Teresa 25 years ago. The man had been adversely affected with rheumatoid arthritis which limits his day to day activities along with his ability to work channelizing him towards depression and disability. In the current scenario the Canadian Model of Occupational Performance and Engagement (CMOP-E) have been taken into consideration for analysing the patient condition and providing him proper support care.

The CMOP-E model puts the patient, i.e. Jozef at the centre of the care services which helps in providing sufficient amount of autonomy to the health care service users. As outlined by Delany et al. (2013), the occupation is the prime concern domain. The application of the model enhances the optimal functioning of the therapist within a team of multidisciplinary nature. The introduction of the parameter of engagement into the scenario broadens the professional scope of practise. The model embodies justice, well being and health as the sole criterions.  For concerns represented by the case of Jozef, there are three elements of COMP-E that needs to be discussed, person, occupation and environment. The model helps in putting the patient at the centre of the care processes but also evaluates the social determinants such as the surrounding environment and its effect on the mental health of Jozef.

The main emphasis of the model is on occupational performance which is achieved due to the interplay between a number of factors such as the person, occupation and environment (Bilics et al. 2011). The model is based upon a number of theoretical underpinnings such as the humanistic theories. As commented by Pohlman et al. (2010), such theories help in emphasising upon important variables such as client centeredness. Additionally, the development and learning theories are also promulgated to enable the occupational therapist acquire skills that will be able to decipher the issues associated with Jozef and be able to interpret those issues. 

The components of the CMOP-E model are interrelated in that a change in one component has a drastic effect on the other components. As commented by Bilics  et al.(2011), such function-dysfunction continuum can bring about occupational dysfunction.  The function continuum is established by a harmonious interdependent relationship between person, occupation and the environment. Therefore, it can be stated that applying this theoretical model can help in enabling both Jozef and his therapists to gain a better understanding of current situation and the issues that Jozef is struggling with.  However, as argued by Baum and Bass-Haugen (2014), there are a number of limitations of the model where a slight change in one of the variables can bring about a huge paradigm in the other parameter. Moreover, large scale restrictions are faced from the external environment for the implementation of the models within the healthcare. Some of the challenges faced in this aspect are lack of appropriate levels of knowledge regarding the benefits of the integration of a particular model. In case of Jozef, the limitations that restricted successful implementation of the theoretical framework are the restricted amount of information available about him and his reluctance to share more information with the therapist; along with that it has to be mentioned in this context that if the therapist ailed to have a clear and comprehensible understanding of the condition represented by the patient, he will not be able to arrive at the most suitable suggestive strategies to implemented (Pohlman et al. 2010).

The Case of Mr. Jozef and his Requirements

The CMOP-E model could be applied here for the assessment of the patient condition by a strict evaluation of each of the three parameters such as the person, occupation and the environment. In the present context, the patient Mr. Jozef had multiple concerns and have been suffering from chronic rheumatoid arthritis. He had been living in the countryside alone with his wife. Although, he misses his sons and his family sheltered at the Slovakia region, who he cannot go and meet. This could be attributed to his severe disability which has made life miserable for him. The inability to perform the daily set of activities might have made him more prone to depression.

Person

In the CMOP-E model, the spirituality of the care user is placed at the centre of the model and is represented by a triangle. The three main performance indicators based upon which the evaluation is done are –cognitive, affective and physical. The cognitive factors here refer to the decision making skills possessed by the patient which are the major determinants of the person centred approach. Therefore, the application of the model provides sufficient opportunity to Jozef to participate in the care planning and decision making approach. Therefore, the model helps in the establishment of a client centred approach. As commented by Zbogar et al. (2017), the affective factor covers the social determinants which happen to produce a serious impact upon the level of mental well being of the person.

As commented by Kumar et al.(2014), the CMOP-E places spirituality within the occupational practices and is positioned at the core of the patient centred practices. The spirituality would help in the establishment of an essence of self within Jozef. It has been reported that Mr. Jozef had been feeling futile about himself due to the inability of contributing towards the well being of his family. Additionally, the physical aspect of the CMOP-E model would help in addressing the physical disabilities faced by Mr. Jozef. The daily life activities of Mr. Josef had been challenged owing to his chronic arthritis condition. However spirituality may be confusing as occupation should be at the centre, being the core value for occupational therapist, although it can be neglected that the spirituality of an individual is instrumental in the overall wellbeing of the patient. In this context, one of the major desires with Jozef had been after he left Slovakia had been to retain his spirituality. When he shifted to the village side, the absence of any catholic church might have had a significant impact on his psychological wellbeing and in turn could have influenced his physical wellbeing and performance. 

Analyzing the Canadian Model of Occupational Performance and Engagement (CMOP-E)

The outer circle of the model represents the environment within which the occupations are functional and the individuals exist. The environment has an adverse effect on the individuals and the existent occupations. The components could be further broken down into – physical, cultural, institutional and social (Abao?lu et al. 2017). With regards to Mr. Jozef the social factors plays a curial role over here. Due to the increasing sickness level and separation from his children and family Mr. Jozef had been increasingly prone to depression. It can be stated the growing distance from his family may have contributed to his depression; the model used may help Jozef understand how his environment may both currently negatively impact on him, but how in future it could also support him.

The occupation aspect could be further divided into three major components such as –self care, leisure and productivity. The inner circle of the CMOP-E model represents occupation and is of prime importance over here. It is through occupation that the person interacts with the environment. Therefore, the occupation can serve as link between the occupational therapists and the person. As Jozef currently is not engaged in many occupations it is facilitating a sense of disconnection between his inner spirituality and his environment, and especially if he could visualise this in the diagram it might help him understand his current situation further.

In this respect, Mr. Jozef was undergoing depression which could have limited his responses to the support services. The cultural criticisms also possess a major hindrance to the application of the model (Niemiec et al. 2016).  Additionally, failure in including the family members of Mr. Jozef in the support care and decision making process could result in a situation of conflict between the therapist and the respective client.

The clinical condition of Jozef had made him unable to perform his daily set of activities. It has been represented in the case study that Jozef had been suffering greatly with rheumatoid arthritis which crippled him with recurring acute joint pain rendering him unable to stand on his own. The mentioned medical constrain coupled with the extreme fatigue restricted Jozef’s ability to move around freely. According to the COMP-E model, it is very important to explore the impact of the environment and the patient’s own feelings in order to decipher the contributing factor behind the manifestation of the symptoms in the patient (Niemiec et al. 2016). Jozef had been subjected to increased melancholy and feelings of depression due to the mobility restriction and not being able to connect to his personal and professional identity, for which the doctor had prescribed him sentranile.

Application of CMOP-E for Mr. Jozef

Jozef had been disconnected from his professional sphere due to his medical complication and it affected his cognitive health significantly. Hence it can be considered an essential cause behind the depression and societal withdrawal that Jozef had been under. However, the COMP- E model also takes into consideration the effect of the surrounding environment on the cognitive health and wellbeing of the patient (Niemiec et al. 2016). according to the case study, Jozef had no leisurely activities, could not participate in gardening which had been a regular regime for him all throughout his life and due to his deteriorating arthritis he could not get out of the house to socialize as well. Furthermore, after he relocated to the countryside with his wife, the absence of any catholic church also facilitated to the complete detachment and de-motivation he faced in his new environment. The impact of environment is a key stakeholder in the concept of psychological wellbeing of a human being and hence this detachment contributed to facilitate guilt, worry and social isolation further complicating his cognitive health (Procknow and Leung, 2015).

Additionally, the surrounding environment also offers greater levels of challenges for the optimal expression and the exercising of the model. In this respect, the lack of awareness about the health concerns and lack of sufficient amount of support from the family members of the Jozef can challenge the rate of success of the model (Procknow and Leung, 2015). In this respect, Jozef’s wife had been away for a while due to the ill health of her mother. Jozef’s depression also reduced the amount of conversation he had previously with his family. As asserted by Ghitza (2014), lack of a supportive environment is both detrimental for the concerned person and the occupational therapists. The therapists are dependent on sufficient collaboration and participation from the person and their respective families. This could affect the person centred approach promulgated by the model thereby affecting the objective of growth and success outcomes.

The assessment method emphasises upon implementation of supportive systems and frameworks for management of the health conditions and deteriorating symptoms expressed by Mr. Jozef. For assessment and redressal of the physical limitations possessed by Jozef a care plan needs to be designed putting light exercises and balance training at the centre of the model.  As commented by Schiavi et al.(2017), use of new and improved technologies such as provision of friendly and virtual mobile interface could help patients like Jozef connect directly with the healthcare executives. This can help in providing direct access and help to the Jozefs’. Moreover, the model being result focussed helps in bringing about positive health outcomes in the patient.

Limitations of CMOP-E and Challenges in Healthcare

For the assessment of the present condition of Jozef a standardized assessment tool had been used over here such as the Canadian Model of Occupational performance (COPM). The model analyses the different personal and professional engagements of a person and the manner in which it affects the well being of the person. Thus, over here five key occupational areas are considered and given a score between 1-10 based upon the performance and satisfaction levels of the client. In the present context, Jozef was a 51 year old man who had been living in England with his wife and is affected with rheumatoid arthritis. This affects his daily set of activities and life in general. The five key performance areas have been identified by Jozef as follows such as unable to manage his daily set of activities alone.  In this context, being affected with rheumatoid arthritis Jozef takes consecutively longer duration of time in managing his daily set of activities. The present health condition of Jozef has also made him unable to continue in his professional life. This further compromises his economic independence and makes him more dependent on others.

The ill health of Jozef also does not allow him to accompany his wife occasionally for the long drives. He also misses being with his children who are settled far away from him.  Jozef had always been   spiritually inclined and likes visiting churches. However, the present condition of Jozef does not allow him to travel or walk long distances up to the country church. Jozef had been interested in some of the activities such as gardening as a hobby. However, the present conditions of Jozef doesnot provide him sufficient time to vest in activities which could make him happy or reduce his depression. The performance has been rated between 1 to 10; where 1 means ‘extremely important’, whereas 10 means ‘not important at all’. In terms of satisfaction vice versa scores have been observed where 1 means ‘not at all satisfied’ and 10 means ‘extremely satisfied’

Table 1: performance and satisfaction measure using COPM

(Source: Author)

Therefore, from the reassessment of the scores based on the rating given by Jozef we can say that Jozef is extremely depressed about his present physical dilemma and superimposed restrictions. He also thinks his performance is extremely poor in each individual areas of interest and is not satisfied with it. Therefore, the assessment helps in understanding the current situation of Jozef and the also the measures which could be implemented for providing him with additional support care.

There are a number of advantages and disadvantages of the CMOP-E model which could be evaluated further in the context of care delivery to patients like Mr. Jozef. The main benefits provided by the implementation of the model are that the model places the patients at the centre of the care delivery process.  This helps in providing more autonomy to patients such as Jozef, where they are made a part of the decision making process. Therefore, involvements of patients like Mr. Jozef in the care planning would help in infusing more positivity within him and help him is regaining control over his life. The person centred approach also places emphasis upon inculcating the hobbies and the interests of the people within the care delivery process (Larsson-Lund  and Nyman, 2017).  This could help in reducing the depression faced by people like Jozef and making him an integrated part of the care plan.

There are a number of disadvantages of the process pertaining to the other two abstracts of the CMOP-E model such as the occupation and environment. The model places the spirituality at the centre of the care delivery process.  As mentioned by Eklund et al. (2017), lacking sufficient amount of skills can disregard most of the benefits received from the model. Additionally, placing occupation at the centre results in greater level of scrutiny and speculations from patients like Jozef and their respective families.

The vona du toit model of creative ability or the VdtMoCA is an occupational therapy model which could be used for provision of care and support services to patients like Mr. Jozef. The VdtMoCA model is different from the CMOP-E model in that four different perspectives had been taken into consideration. As mentioned by Abao?lu (2017), analysing the neuro behavioural aspects of patients like MR. Jozef helps in providing additional level of support. Therefore, the model rests upon the different intrinsic factor which shapes the perceptive knowledge of a person.  As commented by Casteleijn (2014), thus expanding upon the model can provide more autonomy to the users by inculcating the policies of informed decision making.

The VdtMoCA model further emphasises upon occupation and performance as two overlapping features (Abao?lu et al. 2017). Thus, the model considers performance as one of the variables which will be able to address how and why lack of productivity caused significant challenges in this scenrio. However, performance enhancement is further subject to appropriate levels of individual or group participation. This allows the patient to become an integrated part of the care delivery process and reduces the chances of gaps in the services and the loopholes. The model emphasises that a human being passes through developmental cycles of behaviour and skill development (Abao?lu et al. 2017). The progressions through the various stages of life are further governed by motivations and actions. As commented by Joubert (2013), the lack of motivation can generate a feeling of depression and futility within an individual. The motivation level can be rated from 1- 9 , with the highest action achieved at number 9. Thus, implementation of the model helps to identify and develop existing abilities within the patient. As lack of occupational productivity and performance questioned sense of self worth and value in Jozef, using this model will be appropriate for Jozef.

The VdtMoCA model could be applied in the case study of Mr. Jozef as the implementation of the model could be beneficial in generating motivation in the patient. Here, the patient had been suffering from a number of physical and psychosocial issues. The health condition of the concerned patient demanded that he be provided with constant support services. However, owing to the ill health of his mother in law his wife would be away at times. The physical condition of the patient would also not allow him to travel long distance and meet his sons or drive up to his mother-in-law’s house with his wife.

Therefore, application of the models such as CMOP-E by occupational therapists would have helped in relieving the adverse conditions faced by Jozef. However, the application of the VdtMoCA model also takes into consideration the overlapping parameters between occupation and performance. However, as asserted by Wilcox (2016), the model helps in reaching the different levels of motivation which helps in the inculcation of self-managerial skills within the Jozef.

The model places relative emphasis upon the development of creative levels for reaching the utmost patient satisfaction. However, limitations such as  lack of  time for achieving each and every level of behaviour and motivation development, lack of sufficient amount of support from the patient and the their respective families can act as hindrances. One of the objectives specified by the model is achieving sufficient amount of participation from the society for reaching the highest stage of motivation and positive action development. As argued by Niemiec, , Halle, and Sarkisian (2016), the availability of sufficient amount of participation is often subjected to collaboration between a vast number of health care channels. However, due to residing in the countryside the  family may not have sufficient amount of availability to healthcare services.

VdtMoCA model is best suited to apply within the context of Mr. Jozef due to the multidisciplinary approach of the model. The model takes into consideration all the intrinsic and extrinsic factors which further govern the mental and overall well being in a person(Delany, 2010). The intrinsic and extrinsic factors help in establishment of a person centred approach Since Mr. Jozef was suffering from depression the inculcation of the VdtMoCA model can help in generating motivation in the service user. This helps in catering to the grievances of the patient.

The model helps in providing sufficient space and freedom to patients like Mr, Jozef in realizing their ambitions and wishes. The model helps in providing sufficient opportunity to patients like Mr. Jozef for expanding upon their spirituality aspects. The model also emphasizes the ideals of informed decision making, which puts the family members patients like Jozef in a more comfortable or dominating position.

Conclusion

The assignment focuses upon the implementation of two such models which helps in evaluation of the care concerns of the patients suffering from multiple issues. The models which have been evaluated and compared through the assignment are the CPOM-E model and the VdtMoCA model. The assignment further focuses upon standardising and assessment of the patient condition through the implementation of occupational therapy models. However, the limitations need to be taken into consideration which further helps in establishment of the care goals. Thus, person centred approach; optimal occupational services can play a huge role in the improvement of the care services.

References 

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