#OTalk – 5th April 2016 Forensic Occupational Therapy and Practice Placement Education

Forensic Occupational Therapy and PPE

Forensic mental health services refer to those that provide care and treatment for mentally disordered offenders, that is, people who have been in contact with the criminal justice system, and who require care and treatment in a secure hospital for their mental illness or disorder.

Within forensic mental health occupational therapy has become a well established component of the multidisciplinary team and is a core part of service provision.

Much of my experience during my training, my employment as a HCSW whilst I was training, and now I’m a qualified Occupational Therapist has been within forensic services. From locked rehab to low, medium and high secure hospitals (I have experienced them all!) , working with males and females with a variety of diagnosis; mental illness, personality disorders and learning disabilities, all with offending histories, very complex backgrounds and experience of occupational injustice.

I currently work in a medium secure unit within the women’s service, which provides a standard medium secure care pathway and an enhanced medium secure care pathway. I will be taking my first student in a few weeks time which has got me thinking about my experience as a second year student within a high secure hospital, the experience of others that I know as students in secure services, and so has raised some questions for me regarding students and forensic occupational therapy.

I remember initially feeling very anxious about my placement, which was actually my first ever experience in mental health. I was an 18 (or maybe 19) year old, entering a high secure hospital to be assessed putting the ‘theory’ I’d learnt at uni into practice. I wondered what would the environment be like, how would I manage my feelings working with people who had committed horrific crimes, what would be expected of me, would I be safe, how did the OT process work in a place like this, if I wasn’t allowed to tell patients things about myself how would I build up any relationships…. Now I’m on the other side of the table, planning an induction and wondering how best to impart my knowledge, support and provide an excellent placement experience for my Student.

There are so many learning opportunities within forensic mental health and I would urge all students to be aware of this area of practice! I am happy to talk about my experiences further with anyone who is interested. I also have a few ideas for other forensic related #OTalks potentially in the future…

Questions To Consider:

1) How does university prepare students for placements in mental health settings? Could this be improved, if so how?
2) How may the experience and learning differ between placements within secure services and acute mental health units?
3) How can secure settings be as student friendly as possible and ensure a positive learning environment?
4) What do you think would make a successful Student OT within forensic mental health?
5) What do you think would make a successful Educator within forensic mental health?
6) Should PPE in forensic services be elective?
7) Do any other OTs out there in forensic services have any resources which may be especially useful for a student on placement within this setting?

Lauren Hodgetts (@Lauren_OT)

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PDF Transcript: #OTalk 5 April 2016

#OTalk 29th March OT – Shifting CPD Focus

So what does this concept of Shifting CPD Focus mean?

The simple answer is many things, however the idea for this chat came about from shifts I made personally into using my CPD time to explore more occupational science than clinical occupational therapy concepts, particularly in relation to my own life. [Note: Although I was working as an academic when I made this shift it has continued to remain part of my CPD now I am back in clinical practice – along with developing my clinical and conditional knowledge]. Not only do I think this shift has reinvigorated me in terms of my own health and wellbeing, I think it had led to me being re-enthused by the underpinning philosophy of the profession and also to starting to make changes to the way I practice that I hope benefits clients.

This #OTalk, however, is about more than that and there are more shifts in focus that I think we can discuss. We’ll see how the chat goes but here are some shifts that I’ve identified and maybe there are others I’ve missed. In the chat I would love for people to share how they manage these shifts and ask for advice with shifts in focus they might be struggling with.

The ‘answer’ is probably going to be to balance where we direct our focus but we all know theory is different from putting it in practice.

Occupational Therapy Theory vs Occupational Science Theory

You vs clients/others

Internal vs External

Present vs Future (and not forgetting the Past)

Clinical vs Research

Considering things at the Client, Therapist and Service Level

Thoughts and Feelings vs Theory and Action

The Day Job vs The Profession

Practical vs Theoretical

Online vs Offline

Paid vs Unpaid

Putting it into Practice – Occupational Balance and other related concepts

Quality vs Quantity

Condition and Symptoms vs Occupational Effects

Reflection – Models vs Creative Methods

The first question of the night will be – Looking at the list of ‘Shifts in focus’ which struck you as ones you would like to explore and are there any others that you can think of.

And then we’ll take it from there.

I hope you enjoy the chat and that it opens up more ways for you to engage in CPD practices that are fulfilling, meaningful and of benefit to you and your clients.

Kirsty @kirstyes

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#OTalk 22nd March 2016 – The role of seating in pressure management

Many people, as a result of disabilities, diseases and conditions spend long periods of time sitting or confined to bedrest. The role of the occupational therapist is to correctly assess the needs of the patient, helping them to retain a level of occupation and independence, enabling them to complete functional tasks which are most important to them.

Pressure Management

Pressure Management is of paramount importance to consider for these patients with low mobility. A pressure ulcer is a localised injury to the skin and/or underlying tissue, usually
over a bony prominence caused by pressure or pressure in combination with shear, commonly formed in sitting or lying in one position for a period of time.

Pressure ulcers [or pressure injuries as they are being referred to more and more,] can be
debilitating and cause unnecessary pain and discomfort for the patient, as well as placing
extra burden onto care staff and expenses to care facilities. It is estimated that 1 in 5
patients across the continuum of care still suffer from pressure ulcers despite the amount of research and advanced clinical resources now available. For elderly patients, it has been
cited that 60% with a pressure ulcer die within one year, and in the UK alone £2-£3.1 billion is spent annually treating pressure ulcers – these are scary statistics.

Typically through the years the focus when thinking about relieving pressure ulcers and in
pressure management, has been on surfaces: i.e. beds, mattresses, and cushions. It’s often been the case that a patients pressure care needs are managed on a pressure relieving surface for much of the day, and then they are moved into an unsuitable chair with inadequate postural or pressure support which eliminates the benefits accrued by the
mattress, undoing all the good work. This traditional over reliance on mattresses and the lack of focus on seating is in part to blame for the increasing incidence of pressure ulcers across the world.

Seating Assessment

A seating assessment should be carried out by an occupational therapist or qualified seating specialist, to determine the extent of the postural and pressure management needs of the patient. The impact of specialist, individualised seating solutions positively affects the patients’ health and quality of life in many ways from supporting posture, reducing the risk of pressure ulcers, and most importantly, providing comfort. Best results are achieved for patients when proper therapeutic chairs are used in conjunction with pressure relieving beds and mattresses. This goes far beyond the typical idea that a pressure relieving cushion is enough.

Challenging Case Studies

If the patients’ primary medical condition creates secondary postural or medical complications, properly seating the patient can become more challenging. Incorrect seating can, for example, limit their social interaction, their physiological functions and the ability to carry out small tasks such as eating, drinking or reading a book.

Therefore, maximising the ability to interact and remain engaged with their surroundings as well as maintaining good overall skin care, respiration and so on, become important
considerations when selecting seating.

Evidence Based Practice

Seating Matters have recently unveiled their results of their 2 year research study with Ulster University, which clinically proves a reduction in pressure ulcers by 88.3% by using Seating Matters chairs. To find out more about the study please click here.

Martina Tierney/Seating Matters

Twitter: @Seatingmatters

Changing the world of healthcare Seating. Specialist seating for adults and children suffering from low mobility due to disability or disease. Worlds only tilt in space bariatric chair. Clinical evidence supporting the range which proves a reduction in pressure ulcers by 88.3%. Designed by Martina Tierney Occupational Therapist. Author of ‘The Clinician’s Seating Handbook’

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#OTalk 15th March 2016 – Preparing for Placement

As my first placement is fast approaching, I want explore the benefits of role emerging placements versus more traditional placements.

We are told in order to promote and develop the profession, an element of risk in stepping away from the ‘traditional’ OT settings, and creating new less known roles are needed, to pave the way for future OT’s to continue down the road less travelled.

However, these placements have brought about much initial anxiety on OT students, where a role structure is not available and so feel that they are not ready for autonomous working.

Occupational Therapy is more established within the NHS and Social Care sector, with greater investment in research. There can be a clear expectation of a placement role with supervisors on hand for questions and reflections, and some students want this type of placement to gain experience in the area they wish to work upon qualification. Though, does this type of placement disadvantage students from acquiring problem solving skills, as protocols and procedures are already in place?

For Role Emerging placements, the ability to work beyond a person’s illness and their treatment, develop confidence from autonomous working and gain skills for employability beyond the NHS, can facilitate professional identity. On the other hand, is it expecting too much of a student to apply justification and clinical reasoning for interventions whilst in training?

What placements work best for students?

Are role emerging placements suitable for all students?

What are the benefits of working in the private or voluntary sector? And what extra skills are required from students?

Deborah Tunnicliffe @MrsDebT77

Yr1 BSc Occupational Therapy Student

University of Derby

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Following the chat Shelagh Creegan @ShelaghAHP sent us an email highlighting some resources she felt would be of interest in relation to this chat. Thanks Shelagh.

”Following on from last night’s chat, I am forwarding a list of resources (below) which I wonder may be of interest to the followers of #OTalk.

It includes a 5 minute film clip about a role emerging placement for OT students split between the Fire Service and Community Mental Health Service for Older People.

It also includes links to publications, posters and press releases … not forgetting the #OTalk on these role emerging placements in August 2015.”

Here is a link to the film clip:

http://www.nes.scot.nhs.uk/education-and-training/by-discipline/allied-health-professions/resources,-publications-and-useful-links/occupational-therapy-placements-with-the-scottish-fire-and-rescue-service.aspx

I have also appended below some links to various media articles and other sites in linked to the placements:

http://www.firescotland.gov.uk/news-campaigns/news/2013/11/sfrs-nhs-tayside-join-forces-to-protect-vulnerable-from-fire.aspx

http://www.firescotland.gov.uk/news-campaigns/news/2014/12/student-placements-a-win-for-sfrs-and-nhs.aspx

https://otalk.co.uk/2014/08/16/otalk-19-august-2014-occupational-therapy-and-the-fire-service/

Fire Service Placements Knowledge Slide

Student Placement Poster

http://www.knowledge.scot.nhs.uk/ahpcommunity/ndp-workstreams/mental-health.aspx

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4068894/Final%20Report%20Fire%20Service%20Student%20and%20Educator%20Stories1.pdf

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4068892/firesafetyBMC%20Research%20Notes.pdf

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4068893/fireandsafetyOutput%20Booklet.pdf

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4060077/Fire_Safety_A0_poster_FINAL.pdf

And finally here is some articles regarding the E-learning module launch:

http://www.firescotland.gov.uk/news-campaigns/news/2015/09/new-dundee-partnership-module-aims-to-protect-vulnerable-from-fire.aspx

http://www.arbroathherald.co.uk/news/local-news/sfrs-and-nhs-tayside-create-new-e-learning-module-1-3875759

http://www.montrosereview.co.uk/news/local-headlines/sfrs-and-nhs-tayside-create-new-e-learning-module-1-3875759

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#OTalk – 8th March 2016 – OT for adults with Lower Limb Amputation: What is Best Practice?

Vicky Leonard
Twitter: @OT_Vicky
Occupational Therapist at Nottingham University Hospitals
Student at the University of Nottingham, Masters is Research Methods (NIHR Funded).

Amputation of the lower limb is life changing both physically and emotionally and has consequences for daily functioning and quality of life. The aim of occupational therapy is to reduce the impact of amputation on the person’s functioning and to promote re-integration into activities of daily living and their environment (COT 2011). Through occupational therapy, people who have had a new amputation should be enabled to achieve the highest level of independence possible for them. This is important as hospital length of stay following surgery for lower limb amputation is often extended due to environmental or social issues and many of the patients in this group are elderly with co-morbidities. These are all factors which fall within the remit of occupational therapy.

Although clinical wisdom supports the role of occupational therapy in the acute setting for people with lower limb amputation (LLA), current literature does not confirm or refute this. Despite recommendations from the College of Occupational Therapists (COT), there are currently no primary research studies to support the effectiveness of occupational therapy rehabilitation for inpatients following LLA (Spiliotopoulou and Atwal 2011). What evidence there is does not explore the occupational therapist’s role in recovery and rehabilitation and most of the literature which currently exists originates from studies of people referred for prosthetic training to rehabilitation centres (Fleury et al 2013, Pernot et al 1997).

I am keen to start a discussion around what types of assessments and interventions OTs use for adults with LLA, what they feel is best practice and what they perceive to be the benefits and limitations of their current practice.

I am currently undertaking a Masters in Research Methods and my empirical work will specifically investigate current OT practice in the UK for adults with new LLA, with a view to sending out a survey to OTs who work in this clinical area.

References:

COT (2011) Occupational therapy with people who have had lower limb amputations: Evidence Based Guidelines, London: College of Occupational Therapists

Fleury, A M., Salih, S A., Peel, N M. (2013) ‘Rehabilitation of the older vascular amputee: A review of the literature’, Geriatrics Gerontology International, 13, pp. 264 – 273

Pernot, H F M., De Witte, L P., Lindeman, E., Cluitmans, J. (1997) ‘Daily functioning of the lower extremity amputee: an overview of literature’, Clinical Rehabilitation, 11, pp. 93-106

Spiliotopoulou, G. and Atwal, A. (2011) ‘Is occupational therapy practice for older adults with lower limb amputations evidence based? A systematic review’, Prosthetics and Orthotics International, 36 (1), pp. 7-14

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