Exploring Practice and Taking Action to Enable Human Rights and Occupational Justice in an Australian Hospital Context: An Action Research Study

It may be argued that human rights have become an
increasingly important moral discourse in contemporary society and
that Australian occupational therapists have a legal and ethical
obligation to address matters of human rights. The emerging theory
of occupational justice has potential to assist therapists to identify
and address issues of occupational inequity or absence of
occupational rights in practice. However, there is need for research
about how occupational justice can be applied in occupational
therapy practice, to overcome long-standing patterns of hegemony.

An action research study was therefore undertaken at a
metropolitan hospital in Melbourne, Australia to explore the primary
question: How do occupational therapists reflect upon and act to
enable human rights and occupational justice in their practice? Over
the course of 10 months, nine occupational therapists engaged in
monthly focus groups and in three rounds of individual interviews. Data was collected through audio recording and transcribing focus groups and interviews. The transcribed data was formally analysed using thematic analysis within a framework of hermeneutic phenomenology.

A finding of this qualitative research was that initially the coresearchers
tended not to see and address the full range of occupational injustices that impacted on their clients, due to their cultural heritage as Australians and a lack of an agreed set of professional beliefs about human rights and occupational justice. The influence of medical and fiscal hegemony in the hospital precluded
co-researchers from thinking about clients from an occupationally just
perspective; co-researchers were initially unaware of how their
loyalty to the hospital contributed to their discriminatory practices and
their gate-keeping of services. Moreover, a dominant technical risk
discourse contributed to a lack of occupational rights in the hospital,
and to a climate of solicitousness that was a barrier to enabling
occupational justice.

Through the research, the co-researchers engaged in local,
contextualised discussions about people’s lived realities and
experiences of injustice. This was found to be effective for cultivating
a human rights culture within this group of practice scholars. Through
the process of learning and critique, the co-researchers developed
their sense of agency and became more likely to implement
enabling, emancipatory practices.

The co-researchers made three kinds of change to enable
occupational justice. They used stories as a means to highlight their
clients’ humanity. They facilitated permeability between the hospital
and community, thereby enriching the ward with opportunities for people’s active participation. They used advocacy to engage their
colleagues in public reasoning about matters of occupational rights.

A three-step model for the process of creating occupationally
just practice was created. The first step entailed assisting the coresearchers
to better understand the contextual influences that
shaped and constrained their practice of human rights and
occupational justice. The second step was to create a human rights
culture and thus inspire the co-researchers to make a commitment to
change. In the third step, the co-researchers acted for human rights
and occupational justice by creating spaces for participation and
partnership with clients, colleagues and community members.

This action research illustrated that applying the occupational
science concept of occupational justice and using continual
discursive practices may enhance occupational therapy practice and
praxis. Furthermore, the co-researchers (and I) constructed new
practice-based meanings about occupational justice which
foreground the concepts of participatory occupational spaces. Thus,
demonstrating there is potential for taking a context-specific
approach to shaping of occupational science epistemology.