OCT 117 – Practice placement (year 1)

1. OCT 117 – Practice placement (year 1) Case study presentation 10529913

2. Objectives of presentation • To describe placement setting • To provide insight to the role of the OT within the setting • To present a typical client referred to service Reflection on case study and placement

3. My placement • Key aims and objectives: • To prevent hospital admissions • To reduce duration of hospital admissions for patients requiring intermediate care • To support people in crisis to remain in their usual place of residence • In order to achieve aims referred by GP or health professionals • Provides Holistic and client centred approach • Integrated health and social care within one team with multi disciplinary input • Team made up of RMN, RN, Social workers, OT, PT and support worker

4. The role of the occupational therapist • Assess patient in their own home at time of crisis – OT’s in the team have to develop skills to be able to assess patients in a crisis situation • Specifically become involved with moving and handling assessments. • Identifying, providing and trialling equipment. • Task analysis e.g. Washing and dressing • Supports patient and family, ensuring patient safety. • Advisory information and education around other services and equipment available. • Extended scope practice (COT, 2011) e.g. taking clinical observations, empowered to put in place POC • Client- centred frame of reference shapes client- centred approach to practice (Parker, 2011).

5. Key policies and legislation Care Act (2014); asset based approach (aging population and increasingly complex health needs), safeguarding, preventative measures for health deterioration (Department of Health [DOH], 2012). Mental Capacity Act (2005); right to make own decisions, Deprivation of Liberty Safeguarding, best interest (DOH, 2016) Health and Social Care Act (2012); integrated working within health and social care services (DOH, 2012) Health and Safety at Work Act (1974), Manual Handling Operations Regulations (1992); Safe Operative Procedure’s, moving and handling College of Occupational Therapists Code of Ethics and Professional Conduct; service provision, client welfare, professionalism (College of Occupational Therapists [COT], 2015) Lone Working Policy; personal safety when working alone, alarm systems used (********, 2015) Safeguarding Adults Policy; practice of identifying abuse, developing safety plans and making alerts (********, 2016)

6. PEOP ‘…a client centred model organized to improve the everyday performance of necessary and valued occupations of individuals, organisations and the populations, and their meaningful participation in the world around them.’ (Smith and Hudson, 2012) (Christiansen et al, 2005; cited in Turpin and Iwama, 2011a, p.91)

7. OT Process ‘….An occupational therapist’s core professional reasoning skills are based upon an understanding of the inter-relationship between occupation and health and wellbeing: identifying and assessing occupational needs; analysing and prioritising these with the service user; facilitating occupational performance, and evaluating, reflecting and acting on occupational outcomes…’ (COT, 2015) (Creek, 2003) Occupational therapy process

8. Casestudy Evidenced based (Christiansen et al, 2011) The OT process using the PEOP model Comprehensive list of factors; useful guide for a novice Occupational Therapist who leans towards more prescriptive frameworks until they acquire tacit expertise (Robertson 2012) The models the occupational therapists use ensure they approach the situation with unique occupation focus and the occupational therapy process gives a format to apply model through practice (Fawcett 2007) Helps to establish patient history, perceptions, short & long term goals, creating information about patients strengths and weaknesses (Christiansen et al, 2011) Top-down rather than bottom-up model, so is holistic (fitting within remit of service) and person-centred (Fawcett 2007) Emphasis on the interaction between person & environment, and how this affects occupation (Turpin and Iwama, 2011)

9. Case study: ‘Bill’ • Client will be referred to as ‘BILL’ for confidentiality purposes. • Verbal consent was obtained throughout whole process. Occupational therapy process

10. Case study: ‘Bill’ Referral • GP referral • Unpredictable deterioration • Diagnosis of Compartment Syndrome • Referral appropriate as Bill dependant and unsafe in home environment – crisis response needed • if intervention and support had not been provided within 24-48 hour period Bill would have been at high risk within in his home environment due to limited use of his hands could be at risk of dehydration and poor personal hygiene and possible risk of falls. Occupational therapy process

11. Case study: ‘Bill’ Information gathering Phone call to patient/ family Info gathered from referral phone call from GP or other HCP Initial assessment Customer review • Clinical information system Occupational therapy process

12. ’Bill’ Information gathering/initial assessment Occupational therapy process

13. Spiritual Loves to paint and sail, prepare and cook food. Very active person. Social Support Lives alone but has supportive family and surrounding network Culture & Values Independence important, seeks participation in activities to maintain health and wellbeing Occupation Physiological Compartment syndrome in both forearms and hands. Restricted movement and painful at times. Needs to rest arms as much as possible. Occupation Performance & Participation Environment Extrinsic factors Person Intrinsic factors Built environment & Technology Lives in a bungalow, close to amenities, easy access to public transport. Equipment in situ - Mowbray Cognitive Mild aphasia, alert and orientated Performance Natural environment Level assess to and from bungalow Psychological Good self esteem, motivated to regain independence. Quality of Life Well Being PEOP model representing ‘Bill’ (Christiansen et al, 2005; cited in Turpin and Iwama, 2011a, p.91)

14. ‘Bill’ Occupation What is my occupational focus!? Still actively participate in meaningful activities. E.g. Sailing, judging of dog shows, cooking and painting To be as independent as possible with personal care To be able to independently cook and prepare meals

15. ‘Bill’ Performance ….Bill is having to rest his hands as much as possible due to the occupational disruption he has experience and this is currently impacting hugely on his occupational participation and performance…. Main outcome will be to return to formal level of function and maximise bills independence…

16. Why the need for occupational therapy input? Compensatory approach (Polglaseand Treseder, 2012) … a client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working withpeople and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. WFOT (2010) (Care Act, 2014) Wishes to remain as independent as possible Still wishing to actively engage in activities that are meaningful Recognised that specific OT skills to are needed Occupational therapists have an important role to play in re-enablement (Social Care Institute for Excellence and COT, 2011). Re-enablement with POC Education approach (James, 2014)

17. Aims, Objectives and Goal setting LTA To regain complete independence, to remain and home, to be able to drive again STA STA To be able to complete all PADL’s independently Safely prepare and make light meals and drinks Occupational therapy process

18. Aims, Objectives and Goal setting LTA To regain complete independence, to remain and home, to be able to drive again Client centred approach (Parker, 2011). OT process influenced by patient aim STA STA To be able to complete all PADL’s independently Safely prepare and make light meals and drinks Occupational therapy process

19. ‘Bill’ Smart goal setting Short term ’….To be able to complete all activities of daily living independently within 4-8 weeks….’ ‘…to regain formal level of independence and to drive again...’ Long term

20. Aims, Objectives and Goal setting • Specific – outlining intervention under goals and activities • Measureable – as it can be evaluated at a set date a the end of the service input. • Achievable – HCPs carry out interventions achievable in the setting • Realistic – HCPs carry out interventions realistic for the setting • Timely– includes planned start and end dates • (McCullough, 2014)

21. Action planning…. …..to provide a service to ensure Bills safety at home, educate Bill around products/aids that will be able to help him regain a little independence with his eating and drinking and to look to provide equipment to also facilitate him with all self care activities….. Occupational therapy process

22. Intervention approach/plan Education approach (James, 2014), Compensatory approach and rehabilitation (Polglase and Treseder, 2012) Intervention Occupational therapy process

23. Intervention approach/plan Intervention Client centred approach (Parker, 2011) Occupational therapy process

24. Intervention approach/plan Intervention Compensatory approach (Polglase and Treseder, 2012) Occupational therapy process

25. Intervention Intervention approach/plan QDS POC will be put in place to assist with and address the limitations Bill is experiencing Occupational therapy process

26. Action planning • …Cantilever table to help facilitate drinking best option as able to take drink independently when needed as the cup can rest on the table at the right height, as with other tables Bill would have to lean forwards putting him a higher risk of falls. enabling Bill to still be able to maintain fluid intake and still rest his hands as much as possible… • Other options…. • Different drink aids – sports bottle? Would have to be an enclosed bottle to ensure no spillages would be made, reducing risk to risk to bill (Millbrook Equipment services, n.d.) Occupational therapy process

27. Action planning (Millbrook Equipment services, n.d.) Occupational therapy process

28. Ongoing assessment and revision of action • Visit to patient to establish how they have been managing with the interventions that have been put into place • Patient happy with service and feels he is being sufficiently supported. No further input currently needed, follow up call in 1 week. • Initial review • Called patient to review progress • Patient informed us he is progressing well and would like to reduce his current POC, Discussed upcoming consultant/physiotherapy appointments. • Visit to review the patient in 5-10 days • Follow up call • Discussion of progress/Review of POC • Patient’s hand function rapidly returning, confidence is building well • Been issued hand splints at recent appointment, patient wishes to still have POC and OT input from the team in case he is struggling with his hand splints • Discussed with patient other equipment available – not currently needed • 2nd review/visit • Patient keen to reduce POC down to just one visit a day, feel confident that can independently complete all washing and dressing activities. • Very happy that he is able to cook/prepare his meals again. • Would like to reduce care to one visit a day to help with dinner prep. • Informed patient would review in 1-2 weeks • Follow up call • Visit to discharge patient • Hand function return to a satisfactory level for him to complete activities/occupations safely and independently • SMART goals achieved, discharge from service. Consent gained from patient to be contacted so review of service can be conducted. • Final review/visit

29. Outcome and end of intervention/discharge Outcome Interventions put into place were effective as Bill achieved short term goals although an earlier referral to the service and the consultant earlier could have helped to facilitate recovery quicker PROMs Service has a Module dashboard – patient experience/friends and family experiences can be recorded. Enables patient reported outcome measures (PROMs) gaining an insight into how the patient perceives their health and the impact the interventions/adjustments have had on their quality of life (COT, 2010) Discharge Discussed options with Bill in case further support is needed going forward before discharging from service. When considering long term goals have advised to driving centre that enables him to trial driving to ensure hand function is sufficient enough to drive again

30. Review/reflection on case study Case chosen as interesting condition, from response could see the need for OT Learnt a lot about problem solving, judging situations and possible solutions. Insight into clinical reasoning for intervention planning - prescribing/ not prescribing equipment. Great sense of achievement when equipment prescribed/interventions work, and seeing the whole process through. Remained neutral, and impartial important in maintaining professional and therapeutic relationship (COT, 2015). Occupational therapy process

31. Reflection on placement

32. References • Christiansen, C. , Buam, C. and Bass, J. (2011) ‘Person-environment-occupational performance (PEOP) Model’ in Duncan, A.S. (Ed) Foundations for Practice in occupational therapy (5th Edn.). Edinburgh: Elsevier Science Health Science div. • College of Occupational Therapists (COT) (2011) Professional standards for occupational therapy [Online] Available at: https://www.cot.co.uk/standards-ethics/capability-competence-and-lifelong-learning (Accessed: 10th August 2016) • College of Occupational Therapists [COT], 2010. The importance of outcome measures. [Online] Available at: http://www.slideshare.net/baotcot/the-importance-ofmeasuringoutcomes Accessed: 20 August 2016 • College of Occupational Therapists (COT), (2015). Code of ethics and professional conduct. London: COT • Creek J (2003) Occupational therapy defined as a complex intervention, (College of Occupational Therapists: London). Available on COT website. • Department of Health [DOH], (2012). Overview of the Health and Social Care Act factsheet. [Online] Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138257/A1.-Factsheet-Overview-240412.pdf Accessed: 10 August 2016. • Department of Health [DOH], (2015). Care Act factsheet. [Online] Available at: https://www.gov.uk/government/publications/care-act-2014-part-1-factsheets/care-act-factsheets. (Accessed: 10 August 2016 ) • Department of Health [DOH], (2016). Mental Capacity Act 2005: Code of Practice. [Online] Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf (Accessed: 10 August 2016. ) • Fawcett, A. L. (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists. Chichester: Wiley. • Great Britain. Parliament (2014) Care Act 2014. London: Stationery Office. Available at: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted • Health and Safety at Work Act, 1974. [Online]. Available at: http://www.legislation.gov.uk/ukpga/1974/37/contents (Accessed: 10 August 2016)

33. References • James, A. B. (2014) ‘Activities of Daily Living and Instrumental Activities of Daily Living’ in Schell, B.B.A.(Ed), Scaffa, M.E. (Ed), Gillen, G. (Ed.) and Cohn, E.S. (Ed.) in Willard and Spackman’s occupational therapy (12th edn.) Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.pp.610-651 • Manual Handling Operations Regulations, 1992. [Online]. Available at: http://www.legislation.gov.uk/uksi/1992/2793/contents/made (Accessed: 10 August 2016) • McCullough, S. (2014) ‘Planning and implementing interventions’ in Bryant, W. (Ed.), Fieldhouse, J (Ed.) , and Bannigan, K (Ed.) Creek's Occupational Therapy and Mental Health (5th Edn.) Edinburgh: Elsevier Churchill Lvgst. • Millbrook Equipment services(n.d.) [Online] Available at: http://www.millbrook-healthcare.co.uk/ (Accessed: 10 August 2016) • Parker, D. M. (2011) ‘The client centred frame of reference’ in Duncan, E.A.S., (ed.) Foundations for practice in occupational therapy. Bookshelf [Online]. Available at: https://bookshelf.vitalsource.com/#/books/9780702046612/cfi/6/6[;vnd.vst.idref=B978-0-7020-3232-5.00026-8]!/4/2[B978-0-7020-3232-5.00026-8] (Accessed: 10 August 2016) • Polglase, T. and Treseder, R. (2012) The occupational therapy handbook: Practice education. United Kingdom: M&K Update. • Robertson, L. (2012) Clinical reasoning in occupational therapy: Controversies in practice. Oxford, United Kingdom: Wiley-Blackwell. • Smith, D. And Hudson, S. (2012). ‘Using the Person Environment Occupational Performance conceptual model as an analysing framework for health literacy.’ in Journal of communication in healthcare, 5(1), 3-11. doi: 10.1179/1753807611Y.0000000021 • Social Care Institute for Excellence; College of Occupational Therapists (2011) Reablement: a key role for occupational therapists. (At a Glance Briefing 46). London: Social Care Institute for Excellence. [Online] Available at: http://www.scie.org.uk/publications/ataglance/ataglance46.asp (Accessed 20 August 2016)

34. References • Turpin, M. and Iwama, M. K. (2011) ’Person-environment-occupation models’ in Using occupational therapy models in practice: A field guide. Edinburgh: Churchill Livingstone Title. pp. 89-116. • Turpin, M. and Iwama, M. K. (2011a) ’Person-environment-occupation models’ in Using occupational therapy models in practice: A field guide. Edinburgh: Churchill Livingstone Title. pp. 91. • World Federation of Occupational Therapists (2010) Statement on occupational therapy. Forrestfield, AU: WFOT. Available at: http://www.wfot.org/Portals/0/PDF/STATEMENT%20ON%20OCCUPATIONAL%20THERAPY%20300811.pdf • XXX XXX XXX (2015). Lone working policy: Incorporating the operational procedure for Lone worker device. [Online] Available at: http://xxxxx.xxxxxxx.xxx.xxxxx.xxx.uk/Documents/Policies,PGDsandProtocols.aspx. (Accessed: 10 August 2016) • XXX XXX XXX (2016). Safeguarding Adults Policy. [Online] Available at: http://xxxxx.xxxxxxx.xxx.xxxxx.xxx.uk/Documents/Policies,PGDsandProtocols.aspx. (Accessed: 22 August 2016)

35. Any questions ?