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The Process of Occupational Therapy NBCOT TEST BANK
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The Process of Occupational Therapy NBCOT TEST BANKOverview of the process of occupational therapy Correct Answer: -The OT process is comprised of three
main aspects of service delivery: evaluation, intervention and outcomes
-This process is client-centered,, interactive and dynamic
Referral Correct Answer: -The basic request for occupational therapy services. This may also be termed
an order or a consultation
-Sources include the individual, family or caregivers, physicians, social workers, physical therapists, nurse
practitioner, allied health professionals, teachers, administrators, insurance companies, employers,
state and local/public and private agencies
-The content and form of a referral/order varies among program types and practice areas and can range
from highly specific (eg. a resting hand splint) to the very general (eg. evaluate for developmental
delays)
-While anyone can refer themselves or others to occupational therapy services, the ability of the
occupational therapy to act upon the referral is determined by the state licensure laws and/or third
party reimbursers
Screening Correct Answer: -The acquisition of information to determine the need for an in depth
evaluation and to obtain a preliminary understanding of the individual's needs, limitations, assests, and
resources
-Screening procedures are usually brief and easy to administer since they must be applied to a large
number of individuals (ie. all persons who receive an OT referral need to be screened to determine the
appropriateness of the referral)
-Screening tools measure broad performance abilities and include chart/medical record review,
checklists, structured observations, and/or brief interviews with the individual, family, and/or caregivers
-The outcome of the screening will determine the client factors, areas of occupation, performance skills,
patterns, and/or contexts that require further evaluation
Evaluation Correct Answer: -The comprehensive process of obtaining and interpreting the data
necessary to understand the individual, system or situation
-If the individual and the OT do not share a common language, an interpreter must be used to ensure
the validity of the information obtained and that no cultural or religious norms are violated that may
compromise the therapeutic process
-Obtain a history of the individual's past level of functional performance
-Select an appropriate standardized or nonstandardized evaluation tool
-Determine which assessment will attain information essential for setting goals and planning
intervention
-Administer the assessment according to recommended guidelines, administration protocols, and/or
standardized procedures (observe standard precautions)
-Score or rate assessment results according to published guidelines or standardized procedures
-Interpret the assessment results in relation to uniform terminology, the practice framework, and/or a
specific frame of reference: 1) integrate referral, screening, and diagnostic information and data
gathered from assessment 2) relate all information to functional abilities and disabilities relevant to
person's roles and environmental contexts 3) use caution when interpreting information based on self
report or a highly structured assessment as results may not reflect performance in natural contexts 4)
,identify functional deficits in occupational performance areas relevant to the individual 5) in
school/educational settings, assessment information must be related to the multiple aspects of
educational performance (academic, mobility, psychosocial, behavioral, self care)
-Collaborate with the individual, family, caregivers and other team members to obtain a broader picture
of the person's situation and to put the OT assessment results into a larger context ( in
school/educational settings, medically necessary OT must be separated from educational relevant OT;
referrals to after school, home care, and/or community based OT services are indicated for non-
educational OT)
-Prioritize identified problems in collaboration with the individual to develop intervention plan
-Document and communicate the evaluation findings to relevant parties (ie. consumer, team members,
and third party payers)
-Refer to other professionals or specialists within the profession, as needed, for further evaluation
Considerations in determining appropriate assessments Correct Answer: -Individual's baseline
functional level, major concerns, and pressing needs as determined through the screening process
-The environmental context in which the assessment will be conducted (the length of stay of the setting
influences comprehensiveness of evaluation; the primary focus of the setting [eg. prevocational versus
self management]; legislative guidelines and restrictions [eg. in a school setting, assessments must focus
on areas related to the child's educational needs]; the facility's resources of space, equipment and
supplies)
-The environmental context of the individual's current and expected environment (sociocultural aspects
including roles, values, norms, supports [for example, in some cultures home management is only
considered a valued role for females, so there is no need to do a home management evaluation for a
male of this cultural background]; physical environment characteristics. [for example, it would be
essential to measure functional mobility endurance for a person who lives in a third floor walk-up
apartment])
-The temporal context of the individual and his/her disability (person's chronological and developmental
age; anticipated duration of disability [eg. short-term, long-term, permanent]; recent occurrence of
illness or exacerbation of a long-standing, chronic condition; stage of illness [eg. acute stage versus
terminal stage])
-The evaluation tool 's compatibility with frame of reference selected to guide intervention planning
-Consider ethical concerns and potential ethical conflicts
Standard precautions Correct Answer: -Handwashing: 1) wash hands after touching blood, body fluids,
secretions, excretions, and contaminated items, whether or not gloves are worn 2) wash hands
immediately after removing gloves, between patient contacts and when otherwise indicated to reduce
transmission of microorganisms 3) wash hands between tasks and procedures on the same patient to
prevent cross-contamination of different body sites 4) use plain (nonantimicrobial) soap for routine
handwashing 5) an antimicrobial agent or waterless antiseptic agent may be used for specific
circumstances (hyperendemic infections) as defined by Infection Control
-Gloves: 1) wear gloves (clean, unsterile gloves are adequate) when touching blood, body fluids,
secretions, excretions, and contaminated items; put on clean gloves just before touching mucous
membranes and nonintact skin 2) change gloves between tasks and procedures on the same patient
after contact with materials that may contain high concentrations of microorganisms 3) remove gloves
promptly after use, before touching uncontaminated items and environmental surfaces, and before
going on to another patient; wash hands immediately after glove removal to avoid transfer of
microorganisms to other patients or environments
,-Mask and eye protection or face shield: wear a mask and eye protection or a face shield to protect
mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are
likely to generate splashes or sprays of blood, body fluids, secretions, and excretions
-Gown: 1) wear a gown (a clean, unsterile gown is adequate) to protect skin and prevent soiling of
clothing during procedures and patient-care activities that are likely to generate splashes or sprays of
blood, body fluids, secretions, and excretions 2) select a gown that is appropriate for the activity and the
amount of fluid likely to be encountered 3) remove a soiled gown as soon as possible and wash hands to
avoid transfer of microorganisms to other patients or environments
-Patient-care equipment: 1) handle used patient-care equipment soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin and mucous membranes exposures,
contamination of clothing, and transfer of microorganisms to other patients or environments 2) ensure
that reusable equipment is not used for the care of another patient until it has been cleaned and
reprocessed appropriately 3) ensure that single-use items are discarded properly
-Environmental control: follow hospital procedures for the routine care, cleaning, and disinfection of
environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces
-Linen: handle, transport, and process used linen soiled with blood, body fluids, secretions, and
excretions in a manner that prevents skin and mucous membrane exposures and contamination of
clothing, and avoids transfer of microorganisms to other patients or environments
-Occupational health and bloodborne pathogens: 1) prevent injuries when using needles, scalpels, and
other sharp instruments or devices; when handling sharp instruments after procedures, when cleaning
used instruments; and when disposing of used needles 2) never recap used needles, or otherwise
manipulate them using both hands, or use any other technique that involves directing the point of a
needle toward any part of the body; rather, use either a one-handed "scoop" technique or a mechanical
device designed for holding the needle sheath 3) do not remove used needles from disposable syringes
by hand, and do not bend, break, or otherwise manipulate used needles by hand 4) place used
disposable syringes and needles, scalpel blades, or other sharp items in appropriate puncture-resistant
container for transport to the reprocessing area 5) use mouthpieces, resuscitation bags, or other
ventilation devices as an alternative to mouth-to-mouth resuscitation
-Patient placement: 1) use a private room for a patient who contaminates the environment or who does
not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control 2)
consult Infection Control if a private room is not available
Transmission-based precautions Correct Answer: -Airborne precautions: in addition to Standard
Precautions, use Airborne Precautions, or the equivalent, for patients known or suspected to be infected
with serious illness transmitted by airborne droplet nuclei (small-particle residue) that remain
suspended in the air and that can be dispersed widely by air currents within a room or over a long
distance (for example, Mycobaterium tuberculosis, measles virus, chickenpox virus): 1) respiratory
isolation room 2) wear respiratory protection (mask) when entering room 3) limit movement and
transport of patient to essential purposes only. Mask patient when transporting out of area
-Droplet precautions: in addition to Standard Precautions, use Droplet Precautions, or the equivalent,
for patients known or suspected to be infected with serious illness microorganisms transmitted by large
particle droplets that can be generated by the patient during coughing, sneezing, talking or the
performance of procedures (for example, mumps, rubella, pertussis, influenza) 1) isolation room 2) wear
respiratory protection (mask) when entering room 3) limit movement and transport of patient to
essential purposes only. Mask patient when transporting out of area
-Contact precautions: in addition to Standard Precautions, use Contact Precautions, or the equivalent,
for specified patients known or suspected to be infected or colonized with serious illness transmitted by
direct patient contact (hand or skin-to-skin contact) or contact with items in patient environment: 1)
, isolation room 2) wear gloves when entering room; change gloves after having contact with infective
material; remove gloves before leaving patient's room; wash hands immediately with an antimicrobial
agent or waterless antiseptic agent. After glove removal and handwashing, ensure that hands do not
touch contaminated environmental items 3) wear a gown when entering room if you anticipate your
clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's
room, or if the patient is incontinent or has diarrhea, ileostomy, colostomy, or wound drainage not
contained by dressing. Remove gown before leaving patient's room; after gown removal, ensure that
clothing does not contact potentially contaminated environmental surfaces 4) single-patient-use
equipment 5) limit movement and transport of patient to essential purposes only. Use precautions when
transporting patient to minimize risk of transmission of microorganisms to other patients and
contamination of environmental surfaces or equipment
Psychometric properties of assessments Correct Answer: -Standardization: 1) a standardized evaluation
is one that is uniform and well-establish 2) it is always the same in content, administration, and scoring
3) characteristics of a standardized instrument - a description of its purpose; an administration and
scoring protocol; established norms and validity
-The administration protocol: 1) provides instructions on what to do, ensuring all administrations of the
assessment are consistent 2) identifies materials needed for the assessment 3) provides exact wording
of directions to give to the individual
-The scoring protocol: 1) provides ratings and criteria for determining ratings 2) provides norms for the
range of ratings for a specific population 3) types of normative data - age; gender; diagnostic groupings
4) norms are used for a comparative analysis of an individual's score (an individual's characteristics must
match the characteristics of the population used to establish the norms [eg. you cannot compare a 25
year old's score with norms based on a 10 year old or a 65 year old]; if the client is dissimilar from the
"normed" population, interpretations based on these norms would be inaccurate
-Validity measures the assessment's accuracy to determine if the tool measures what it was intended to
measure
-Reliability establishes the consistency and stability of the evaluation
Types of validity Correct Answer: -Measures the assessment's accuracy to determine if the tool
measures what it was intended to measure
-Face validity establishes how well the assessment instrument appears "on the face of it" to meet its
stated purpose (eg. an activity configuration looks like it measures time use)
-Content validity establishes that the content included in the evaluation is representative of the content
that could be measured (eg. does the content of a role checklist provide an adequate listing roles?)
-Criterion validity compares the assessment tool to another one with already established validity
-Types of criterion validity: 1) concurrent validity compares the results of two instruments given at about
the same time 2) predictive validity compares the degree to which an instrument can predict
performance on a future criterion
-Criterion validity is reported as a correlation. The higher the correlation, the better the criterion validity
Types of reliability Correct Answer: -Establishes the consistency and stability of the evaluation
-If reliable, the evaluation measurements/scores are the same from time to time, place to place, and
evaluation to evaluation
-Inter-rater reliability or inter-observer reliability establishes that different raters using the same
assessment tool will achieve the same results
-Test-restest reliability establishes that the same results will be obtained when the evaluation is
administrated twice by the same administrator
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