Occupational Intervention
This portfolio will demonstrate how the occupational therapy process was completed with one individual in my practice placement setting and how the occupational therapist worked with other professions, as part of a team to meet the identified needs of the individuals.
To address these, this portfolio will contain the following information;
• An introduction providing an overview of a placement taken and the relevant client groups who access the service
• An introduction to one client I will be focusing on and provide a precise representation of the occupational therapy process that was followed by the individual, different aspects of the occupational therapy process that was used.
• How ‘working with people’ occurred during the implementation of the occupational therapy process and where Acts, policies, guidelines or standards have influenced the practice of the occupational therapist and the rest of the team.
The practice placement setting is in a Cognitive Impairment Dementia Service (CIDS) also known as a Memory Service. It is situated in one local area of England. The service provides assessment and treatment for people over 18 years old who experience problems with memory such as thinking, knowing and remembering.
The team is made up of experienced and specially trained mental health professionals, who are specially trained to help people who either have dementia or are concerned that they may have dementia. The Team members include;
• Psychiatrists Doctors who diagnose dementia and have an expert understanding of how dementia and other health condition affect people
• Community psychiatric nurses (CPN) Trained nurses with specialist knowledge of dementia, who often complete the first assessment and provide support especially when new difficulties arise.
• Community support workers (CSW) Work with team members and patients to offer extra one to one help as needed. Occupational therapists
• Occupational therapists (OT) have a crucial role in supporting people with remaining safe, independent and as active as possible. They will usually assess you in your own home.
• Clinical psychologists Help in the assessment before diagnosis and support people (patients and carers) in talking through any difficulties they may have
• Administrative staff Provide vital support to the whole team and help address queries when people phone the team.
According to the Royal College of occupational therapists (RCOT), the role of an Occupational therapist is to provide practical support, to facilitate recovery and enable individuals in their quest to overcome difficulties which hindrances to their ability to take part in the day to day activities. Support from an occupational therapist (OT) helps to influences client’s well-being by increasing their level of independence this improves their quality of life (College of Occupational Therapists, 2015) National Health Service website stated that Occupational therapy is necessary when an individual requires assistance with conditions that may limit them either mentally or physically.
The occupational therapy team at service work together with patients to develop daily routines that allow them to maintain independence and achieve a maximize quality of life. We also aim to support the individual to create new ways of doing everyday tasks, making alternations to the home to enable a person to continue living in their own home for longer. Care at service includes considering each person’s diverse needs by working with other multidisciplinary who may use other forms of care. e.g., the Doctors prescribing medication to improve their quality of life. However, an OT is passionate about helping patients deal with conditions in the waning years. When caring for people who have dementia, it is essential to ensure that help is always available (Lash, 2014). However, other approaches can be adapted to improve life for those with the condition without necessarily moving them to a nursing home. Since some people may not be comfortable living away from home, their homes can be improved or altered to enable them to live at home before living in a nursing home. While individuals may be suffering from the same condition, their needs tend to differ. As such, individuals at Memory Clinic receive customized services based on their specific needs.
Cognitive Impairment Dementia Service (CIDS)
The service provides assessment and treatment for people who experience problems with their (cognitive abilities) mental abilities, such as thinking, knowing and also remembering with people who have already developed dementia either in the early stages or later stages of dementia and those who are worried they may develop dementia with time. While planning community care for older adults, patients who have concerns regarding possible cognitive impairment/ dementia are referred by to a psychiatric doctor. The team facilitates early detection, diagnosis, and assessment of needs for an adult with a memory problem, as well as supporting the carer. Group session and therapies are also provided. The clients are usually assed in their own home, following assessment, the team offers short and long-term treatment and support. Treatment will depend on the needs of an individual and their caregivers. Soon after diagnosis, Clients’ will be given the name of care coordinator who will discuss what help and support needed. Most of the clients are the elderly suffering from Mind cognitive impairment be diagnosed with early stage of dementia.
The following link presents causes of memory loss and forgetfulness, that is, dementia.
https://youtu.be/j7I3WGMcFc4
According to the information from the link, memory loss could result from stress, depression, anxiety, confusion, difficulties in paying attention, old age, and poor sleep patterns.
Occupational therapy process and assessment
An initial prompt visit to fully assess a new patient and gather information to understand what might be causing the problems that have been identified using assessment tools. Results can vary depending on the intelligence of the client and their previous education, and how literate they are. MOHOST and AMPS are the likely occupational therapy assessment tools used to assess client functional skills in (CIDS)
This portfolio will focus on one service-user who has been referred to the service diagnosed with Mild Cognitive Imperative (MCI). I will call her Mrs. E, she is 94 years old. Her daughter is her primary carer; she will be called Ann (not her real name).
Presenting Situation
Her GP referred Mrs. E following her daughters concerned about her short-term memory. Mrs. E was previously seen by the memory services in December 2016 by the team and was discharged due to her level of functioning, as she performed well on assessment and functionally stable. she scored 24/30 on Montreal Cognitive Assessment (MoCA). Mrs. E does not feel there is anything wrong with her memory during this visit. She mentioned writing things down a lot more than before and had to make a list when going shopping hence she will forget what to buy. Mrs. E denied all concerned raised by her daughter, and at some point, she said ‘if she said so.’ Ann continues to express what she does well; going to local shop, Tesco, laundry, and chemists.
Background
Mrs. E lives alone in a rented property; there are no stairs. She is independent in all personal activities of daily living (ADLs) her daughter assists taking her bedding to the laundry as she does not have a washing machine. Mrs. E explained she cleans some of her clothes by hand and hangs them out to dry. There are no concerns regarding her hygiene. Mrs. E daily routine consists of waking up, having a wash, making breakfast which is usually cornflakes and toast. She may go out for food shopping, spend time doing crosswords or watching television and then prepare her evening meal which is either oven food or meat and veg. She has a good appetite; she denied noticing any changes in taste or smell. She is currently happy with her daily routine and declined to join any clubs or day centers. She reported having an “ok” sleeping pattern. Mrs. E reported She goes to bed around 9 pm and wakes up at 10 am if she has nothing planned for her day. She tends to have difficulty getting to sleep due to noisy neighbors and lying in awake in bed “thinking of everything” She has no naps during the day. Mrs. E mentioned that she maintains other personal activities, cook her meal (sometimes she will be reminded by her daughter to put her meal out from the fridge) and engage in activities such as crossword, and watching TV.)
Light of the above, Mrs. E was discharged back to a General Practitioner with a recommendation to be reviewed in a year’s time if she gets deteriorate. After a year and a half, Mrs. E’s daughter raises concerns of increased forgetfulness manifest as increased repetitiveness and at times poor recall of recent events. Mrs was referred back to the memory clinic, and she was allocated to Occupational Therapy (OT) This is due to a suspected decline in functional skills.
OCCUPATIONAL THERAPY INTERVENTION
Assessment
Assessment is gathering of relevant information that informs the prioritization and development of clinical goals for intervention.” (Duncan,2014, p.37). Assessment can be structured or unstructured implement, it depends on the motive, both can be valid (Kielhofner & Forsyth2008).
Mrs. E was assessed in her home by a clinical psychologist and an occupational therapist in the presence of her daughter. MoCA tools were used to asses her due to her level of education, and she scored 18/30 compared to the score of 2016 where she scored 24/30. This shows cognition deficit. Based on the unstructured observational assessment, Mrs. E daughter(Ann) reported her concerns as the main carer with permission from Mrs. E. Ann stated Mrs. E sometimes skips a meal or forgot to bring food out of the freezer or cook it. She had to call three times a day to remind her to take it out. However, whenever she visits, she always counts the food in the Freezer to ensure she takes her meal, at times she will find out she missed one or two meals. She also said Mrs. E burnt her pots occasionally and she scared of her safety in time of fire hazard. Ann also noticed that Mrs. E has not been cleaning her house thoroughly and not engaging in any meaningful activity, the only thing they do together when she visits her is crossword. She reported her mum being less active over the last six months and hardly goes out of the house. Although Mrs. E watches TV occasional but put the volume up as reported by people living upstairs of the house, (Concern of hard hearing was raised by the nurse who applies eye drop, daily). Mrs. E denied any hard hearing; she reported that the Nurse was too loud as she was shouting while speaking. Ann feels that her mum’s memory has gotten progressively worse since then, she has noticed mainly short-term memory loss, and she feels her long-term memory is reasonable. Mrs. E denied any concerns regarding her memory. She reported feeling good at ‘92’ but generally felt alright with herself, nevertheless, she stated she enjoyed herself.
During the assessment, there were no obvious signs of word-finding difficulty, but some repetitiveness noticed while having a conversation with her, she asked if she has pilled Potatoes for dinner three times in spaces of 10 mins. However, when booking an appointment with her for functional assessment to watch her making a sandwich, she asked about the appointment date and time twice after she has written it in her diary. She was prompted to check her diary again, and within mins, she asked again what date her next appointment was, reinstating to see us again on Tuesday. (This shows signs of forgetfulness).
It was the role of the carer, the OT, the community psychiatric nurse, and the clinical psychologist to ensure that she shows up to the appointment. The carer, Ann, was responsible for reminding her mother of the appointment on a daily basis and keep the healthcare team on any noticeable changes that occurred on Mrs. E in their absence.
Cognitive assessment
When dealing with a client who is exhibiting issues related to her mental health, it is important to start by assessing one’s cognitive level (Fauth et al., 2016). In the case of Mrs. E, The Assessment of Motor and Process Skills (AMPS) and MOHOTS were used. The purpose was to establish whether Mrs. E was able to carry out motor skills as well as develop her cognitive abilities before coming up with a diagnosis. The assessment was carried out by a community psychiatric with the help of a community social worker. The role of the social worker was to ensure that the patient, the carer, and the CSN had all the support they required to ensure efficiency. The community social worker was responsible for contacting the administrative staff in the case the nurse was in need of any form of additional assistance including financial aid.
Overall quality of Activities of daily living (ADL) task performance
Mrs. E was observed carrying out two ADL tasks which she carries out regularly. Both tasks were rated Average difficulty by AMPS. Mrs. E was able to complete both tasks successfully. On both tasks based on a standardized distribution of assessments for her age, she exhibited mild to moderate physical inefficiency. She exhibited mild to moderate process inefficiency. During the assessment, Mrs. E did forget to restore the butter and cream cheese back to the fridge without prompting. She also forgot whether sugar was required in one of the hot drinks and asked twice in quick succession.
All the observations and the assessments were fed back to the team in memory clinic during the Triage meeting. Appointment by the occupational therapist in collaboration with the clinical psychologist was made with the psychiatrists to see Mrs. E in two months for further medical intervention since the assessment showed signs of Dementia.
Policies and their implications
Some of the legislation and policies that influence the practice include Codes of Ethics and Professional Conduct, which recognizes the importance of multiagency collaboration as well as the Mental Capacity Act 2005 which occupational therapists to support people when making their own decisions while assuming their capacity (Dimond, 2010). The National Service Framework for Mental Health guide the occupational therapy processes in the UK. When working with the same patient, the Code of Ethics and Professional Conduct requires professionals to liaise with each other to agree on the areas of responsibility (Atchison and Dirette, 2011). Over the years, the National Dementia Strategy for England has been attempting to raise awareness of the importance of early diagnosis and management of dementia (Szczepura et al., 2016). Since policies and legislation are constantly changing, occupational therapists must, therefore, be apt to adjust the processes per the policies and legislation.
Occupational Therapists should work as part of a multidisciplinary team to deliver quality care on time to people who need it most.
Conclusion
It is aligned with, and complementary to, Code of Ethics and Professional Conduct that you should recognize the need for multi professionals and multi-agency collaboration to ensure that well co-ordinates services are delivered in the most effective way (COT, 2015, P.30). According to Code of Ethics and Professional Conduct, if you and another practitioner are involved in the treatment of the same service user, you should work co-cooperatively, liaising with each other and agreeing areas of responsibility. (COT, 2015, p.31). Working with people occurred in the Mrs. E intervention when multidisciplinary came together as a team to deliver quality care to her. The professionals that were involved in care included a general practitioner, her Care(daughter), the Nurse that applied her eyes drop, the community psychiatric nurse, the social worker, the administrative staff, the clinical psychologist, the psychiatrist doctors, and the occupational therapist.
References
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Creek, J., 2003.Occupational Therapy Defined as a Complex Intervention. Collège of Occupational Therapists London.
Dimond, B. 2010 Legal aspects of occupational therapy. Oxford: Wiley Blackwell.
Duncan, E.A.S., (2014) Foundation for Practice in Occupational therapy. Elsevier: Churchill Livingstone.
Fan, C.W., Morley, M., Garnham, M., Heasman, D. and Taylor, R., 2016. Examining changes in occupational participation in forensic patients using the Model of Human Occupation Screening Tool. British Journal of Occupational Therapy, 79(12), pp.727-733.
Fauth, E.B., Norton, M.C. and Weyerman, J.J., 2016. Is Alzheimer’s Disease and Dementia the Same Thing? Clarifying Types and Symptoms of Dementia.
Kielhofner, G., Forsyth. (2008) Assessment: choosing and using structure and unstructured means of gathering information in: Kielhofner, G.(Ed.) Model of Human Occupation: Theory and Application, fourth ed. Lippincott Williams& Wilkins, Baltimore 155-170.
Lash, E., 2014. What is Dementia? The Law and Ethics of Dementia, p.1.
National Health Service (NHS) (2014) Occupational therapy. Available at: https://www.nhs.uk/conditions/occupational-therapy/(Accessed: 20 March 2018).
Royal College of Occupational Therapists (2017) Professional Standards for Occupational Therapy Practice, pp. 12-16.
Szczepura, A., Wild, D., Khan, A.J., Owen, D.W., Palmer, T., Muhammad, T., Clark, M.D.
Urden, L.D., Stacy, K.M. and Lough, M.E., 2017. Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.
