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The
following essay is based on case study two and will explore the occupational
issues experienced by Rosie being a first time mother to a new born and the
ways in which an occupational therapist (OT) may be able to provide support
with the challenging situation she is currently under using a model of
occupation as well as the suggestion of therapy implementation supported by
theories of occupational science which is a theory of human nature that defines
people as occupational beings with a need to carry out certain occupations in
order to meet the basic needs and have a sense of self belonging in society.

Occupational
issues arise when an individual has limited ability to partake in activities
including self-care, productivity and leisure ultimately impacting the way in
which a person performs a given task. Being a new mum, the preconceived
expectations of having a child can frequently be misjudged and often result in
having a greater impact than initially calculated. It is evident that there are
issues surrounding sleep and self-care. Sleep is incredibly important and being
deprived of it can result in having a ‘shorter attention span’, and can greatly
‘affect mood’ (Kirsten Braun Health Journal 2014). Such difficulties are the
result of her engaging in the co-occupation (an occupation that requires more
than one person) of being a parent and having the responsibility of looking
after her child and attending to the needs of her new born. According to an online
article new mums on average receive ‘less than
four hours sleep a night’ with many reporting that it greatly impacts their
behaviour resulting in ‘rows with their partners’ which could cause more
frustration for both parents. Interestingly, there seems to be a cultural
aspect in relation to sleep, whereby ‘our own mothers’ would have received at
least ‘six hours’ of sleep per night. This may be due to the advances of
technology and the need for the latest ‘two way baby monitors’ which ‘74% of
respondents’ obtained resulting in the mothers being woken up more to attain
for the needs of the child that would not have necessarily been an issue some
generations ago (Guardian 2007). A depravation of sleep could equate to
cognitive problems in the long term as well as other severe health
complications, this is supported by an online article that states a bad nights
sleep ‘impairs the hippocampus’ as well as other areas of the brain such as the
‘amygdala’. These components are essential for ‘decision making’ and ‘memory’
and could therefore negatively impact those aspects and prove to be a struggle
during her daily activities (The independent 2017).

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It is easy to perceive that she frequently feels unorganized and not
ready for the next day, this
may be the result of different priorities being emphasised in order to put the
baby first and therefore routines such as self-care which were previously
predominant and carried out without any thought are now inferior. Forming
routines are extremely important for an individual’s well-being as they
establish a clear structure that provides stability to one’s day and having a
baby will undoubtedly disrupt the daily structure for Rosie. Florence Clark
cites the work of Corbin (1999) and defines routines as ‘habitual and
predictable ways of living’ these ways of living provide familiarity to an
individual thus contributing to an orderly structure that can be easily
followed. This structure results in an overall calm state of mind as there is
limited disturbances to the regular routine a person is accustomed to. As this
is not the case for Rosie it results in her feeling unprepared and often leads
to her not wanting to go out which is negatively impacting her social life if
she is spending most of her time inside the house looking after Elena.

Becoming a
parent is a significant occupational transition (change in daily pattern based
on life circumstances) as one diverts their attention, resources and time to
the child it requires great effort and self-sacrifice and therefore results in
a severe disruption to an individual’s lifestyle as they start to adapt to the
extensive needs of being a parent. Due to sociocultural expectations of the
mother taking time off work as oppose to the father she would not be carrying
out the existing occupational pattern of going to work and no longer having
that routine can be a great change for Rosie and could potentially result in
her feeling unsettled. The importance of manual labour has been emphasised by
Joanne Ross (2007) who states that ‘work occupies the most central position’
and provides us with an important ‘life role’. Although she has taken on a new
internalised role of being a parent the essence of labour is limited and she
may be struggling with engaging in activity she views to be purposeful and
suited to her occupational identity potentially leading to occupational
apartheid as she is over occupied in being a mother. In addition to this, there
is no change in the role she currently occupies so therefore she in unable to
alter between different identities this could negatively impact her lifestyle
as she is limited to only having one major internalised role of being a parent
and therefore there is no form of contrast in what her routine consists of. It
is important that there is variety in what a person does in order for a person
to remain in a healthy state of mind as only having one role can be draining
resulting in feelings of deprivation as she is unable to fulfil her
occupational identity. Although it could be argued that she is also a partner
therefore there is a change in her role at home as she wouldn’t be carrying out
the same duties as a mother nonetheless most of the time spent with her partner
would be regarding Elena which again limits the idea of role reversal.

Occupational
balance can be defined as a ‘consistent pattern of occupations that result in
reduced stress and improved health and wellbeing’ (Christiansen and Matuska
2008). It could be argued that having the child is forming a new pattern that
requires adjustment and as she herself explains she is feeling stressed as she
feels like she is unable to cope with the highly demanding lifestyle. From this
the connotation can be assumed that there is little balance in her life due to
the onset of stress exploiting the idea that the requirements of being a parent
may be more challenging than she had anticipated. In order for one to be
considered healthy there must be equal time allocated to three parts:
self-care, leisure and productivity. Spending too much or too little time doing
either of these factors would result in occupational imbalance. This imbalance
is prominent in Rosie as she is spending almost all of her time looking after
the new-born and therefore any previous leisure activities such as going out
are not being fulfilled. In modern society there is little appreciation for being
a mother and although this label is widely recognised it is not always
considered to be an occupation. This could exploit the issues of her being
marginalised and not valued as her partner often feels embarrassed when Elena
interrupts his business meetings.

Over our life
span we develop skills and gain competence in doing certain occupations as our
repertoire strengthens. Through her education she has developed cognitive and
social skills these would make up her competence development (micro) this can be
supported through theories such as memory that increase her ability to retain
information to later use it. The occupations she engages in have changed over
time and her now being a mum she will develop a new set of skills and therefore
increase her repertoire (meso) to increase her suitability to her new role
these would be eternally changing as being a parent isn’t a static process but
rather one that requires flexibility as a child requirements will adjust throughout
their life course and therefore parenting techniques that may have been
suitable when she was an infant won’t necessarily be appropriate.

The MOHO
model can be applied to this case study as it can explain how her occupations
are performed with regards to her personal motivation and capacity and
therefore can use what Rosie deems to be motivating to strengthen her occupational
performance. The model consists of three sub systems: volition, habituation and
performance capacity. The three aspects are not subjected to a vacuum and
intertwine in an environment that is influenced by personal factors as well as
the context. Volition refers to her personal motivation to carry out an
occupational activity. At this moment in time it is clear that a lack of
capability is present as she feels her life is demanding and is finding it
difficult to organise her daily routine to her usual standard. Likewise, she
feels untidy and unprepared thus doesn’t personally believe she is capable of
doing the activities she had done prior to having Elena, resulting in feelings
of frustration. She values her work highly and is interested in returning to
work when appropriate in order to resume her occupational participation as an
accountant.

Habituation
includes organising ones actions into routines and forming patterns which are
synthesised through habits and roles. Habits can be defined as ‘acquired
tendencies to respond and perform in certain consistent ways in familiar
environments’ (Kielhofner 2002, p22). Her current environment is not one she
was subjected to before having a child and therefore the sense of familiarly is
weakened as she adjusts to her new circumstances thus old habits are difficult
to adhere to as well as the formation of new ones. In addition, she has gained
a new occupational identity of being a parent and the widely recognised role of
being a mother has specific social expectations of being attentive and
self-sacrificing which are difficult standards to attend to and as a result of
this she feels guilty for not being as prepared as she had planned and
potentially feels as if she is not good enough due to struggles in managing her
previous daily routines.

Performance
capacity implies the ability to perform activities in relation to physical and
mental potential. Having a child has a great impact on women’s body and mind,
it is a physically demanding process and although she has not reported of any
physical problems or decreased ability with regards to motor and processing
skill it is clear that her emotional stability as well as cognition have
weakened to some extent. This is evident in her disturbed circadian rhythm and
her feelings of frustration and isolation. The environment she is under is
relatively overloaded and quite stressful. She is surrounded by loving family
and friends however her husband works away from home and therefore is unable to
help with the duties of looking after Elena as well as provide comfort and
support for Rosie herself. Even though her family aren’t in proximate distance
she is contact with them has sisters with children that can provide any advice
if she needs them.

The
occupational therapy process is dynamic and focuses on implementing certain
goals that a patient views to be important to them in order to improve their
way of living. Using Creeks (2010) linear process it would be clear that the
problems Rosie is currently facing are in regards to her sleeping, daily
routine, isolation from work colleagues, childcare and how much information she
will remembers from her qualification. An OT may suggest for Rosie to take
turns attending to Elena’s needs with her partner so both of them can get some
rest. This could be determined by a rota that they could stick to so it is
fair. In regards to her missing her work colleagues she could arrange a time to
meet them and spend some time with them providing she can get someone to look
after Elena. To manage her daily routine better she should set at least 30
minutes to herself a day to get on top of her self-care whether it may be
taking a relaxing bath or participating in exercise. In order for her to feel
prepared for going back to work she should read up on her knowledge to ensure
she remembers the facts and then ask her partner to test her as studies have
shown that regular test have increased the length of time memories are kept.
Once this has been implemented it should be reviewed once more to ensure the
goals she had set have been completed to her satisfaction and would give her a
chance to suggest any other concerns or outcomes wanted to be achieved.

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