Objectives-To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. Design-A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. Subjects-The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. Results-Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emergedfor physical therapy.

A qualitative study was carried out in order to investigate illness representations of people with non-epileptic seizures (NES) in relation to Leventhal's self-regulation or common sense model. Nine participants with NES took part in semi-structured interviews and transcripts were analysed using an approach from interpretative phenomenological analysis. Data were coded according to the five elements of the self-regulation model (identity, cause, time-line, consequences, controllability) and two additional themes. Particularly evident was participants' confusion about their experience, what to call their condition, and its cause. It was therefore difficult for participants to express clear ideas about the time-line of their illness and its control or cure. Also evident was a tendency to categorise illness in dualistic terms as either organic or psychological. There was some dissatisfaction with doctors where ideas about the nature of the illness did not match. It is concluded that a clear idea of illness identity and cause may be necessary for successful management.

A research study that looked at fitness for purpose of 312 occupational therapy and physiotherapy graduates was carried out between 1996 and 1999. The research was commissioned by the Department of Health and managed jointly by the Universities of East Anglia and Southampton. A particular emphasis of the research was the influence of joint undergraduate education on the performance of graduates in first post. A full report of the research can be found in Wiles et al (1999).Recommendations arising from the research report led to debate with service managers about the meaning of the results and thus the conclusions drawn. This paper was therefore prepared to explore the different perceptions of an educator and a service manager with regard to three themes arising from the research. These were the selection of students for occupational therapy education, the expectations of new graduates about their first post and the transition from student to therapist.

Vulnerable people constitute the majority of referrals to occupational therapy services, due to age and social, psychological and economic circumstances. People with learning disabilities may fit all these categories. An argument has been put that vulnerable people should not be subjects in research (de Raeve 1994) and that there may be unacceptable risks in being a subject in a socially sensitive research project (Barnitt and Partridge 1999). However, avoiding research with people with learning disabilities would mean that the voice of these clients would not be heard and it is known that they have expressed the wish to be consulted and involved in research (Atkinson 1989). A collaborative study was carried out with eight adults with learning disabilities who lived in a community residential home. Interviews were completed which dealt with aspects of intimate relationships. Three themes emerged from the interviews: the experience of intimate relationships, the future of a current relationship and the involvement of others in relationships. The findings showed that the people interviewed had a generally positive experience of such relationships. However, while the attitudes of staff and family towards intimate relationships were mostly empowering, some negative views still existed. The results have implications for occupational therapists working with people with learning disabilities.

The purpose of the study was to describe and then compare ethical dilemmas reported by eight physical therapists and eight occupational therapists. A co-operative research method was adopted with the therapists participating in the analysis of the transcripts of the interviews. The analysis was carried out using a 'multiple' readings methods taken from hermeneutic phenomenology. Results showed that the context or setting of the dilemma had a major effect on the therapists' reasoning. Features which emerged from the context were the site of the dilemma, the work group, the patient group and the hierarchical or power relations in operation. Physical therapists and occupational therapists showed differences in reasoning style with the former more likely to adopt a diagnostic or procedural style, and the latter a narrative style. Dealing with ethical dilemmas was found to be a skilled and stressful aspect of practice. Capacity to deal with the dilemmas was negatively influenced by uncertainty of outcome, emotional sequelae of the event, and social pressure to behave in certain ways. Positive influences included previous experience with similar dilemmas, time for reflection, and support from peers.

Cultural variation is an aspect of practice which may be neglected by therapists when assessing functional activities. A study was undertaken in which 15 people from a variety of cultural backgrounds were observed carrying out the activity of making a cup of tea. The results demonstrated that there were differences in the methods used between cultures. within cultures and between generations. If interventions by therapists are to be effective. it is imperative that assessments are culturally sensitive and that each client is treated as a unique individual. Occupational therapy departments, where making a cup of tea or making a hot drink is a routine part of client assessment, should review practice to allow for cultural variation.

A study was carried out to identify the self•care needs of 19 Hindu elders. With the rising number of people in this group, the occupational therapist has a responsibility to be aware of the cultural and religious practices associated with self-care for them. There is an expectation that occupational therapists will practise in a culturally sensitive way and this is stated clearly in the professional code of ethics (College of Occupational Therapists 1995). However, occupational therapists can only practise in a culturally sensitive way if they have an understanding of the culture of the client and his or her family and social group. There is, to date, little information for occupational therapists about the cultural and religious needs of Hindu elders, one of the groups they may meet during their professional practice. Thus, the purpose of this study was to explore the needs of elderly Hindus with regard to four aspects of self-care: dress, diet, bathing and toileting. The method used for the study was the snowball technique, with an access sample comprising four Hindu university students and the main sample comprising 19 of the students' elderly relatives. Interviews were carried out with the student sample and questionnaires were sent to the elderly relatives with regard to preferences in dressing, diet, bathing and toileting. The results showed that there were common issues related to religion and culture for many of the sample but that, additionally, there were unique issues related to personal circumstances with wide variation in family structures. By asking potential clients with particular cultural or religious beliefs about their needs, occupational therapists can provide a tailored service and gain an understanding of the significance of activities of daily living to Hindu elders.

No abstract