#OTalk – 23rd August 2016 – The impact of dysfunctional sleeping patterns on inpatient mental health facilities

This week’s #OTalk will be hosted by Erin (@erinnnnn14). Join us tonight on Twitter using the #OTalk hashtag at 8pm GMT+1 (click the link to convert to your local time – opens in new window).

 

Sleep as an occupation is still a frequently contested concept in our profession. Literature suggests that it is because sleep is considered as ‘time wasted’, something that we are not directly engaging with or something we can influence or direct (Green, 2008). However, the lack of, or dysfunctional sleeping patterns, can affect the occupational performance of the activities that we engage in during the day. Sleep problems can have a detrimental affect on our physical and mental health. Frequently, inpatient mental health facilities offer ‘Sleep Hygiene’ groups to facilitate better understanding of the importance of ‘good sleep’ but is this enough to be able to support patient care and recovery?

 

I’m currently an MSc (pre-registration) student. I am just finishing a placement in a mental health rehabilitation hospital for males. The therapy programme is rich, varied and tailored towards the needs of the patients however sleep is something that continually affects patient engagement. I’m really interested in hearing your thoughts and experiences and how we should best proceed as professionals to better support the patients we work with.

 

Questions I would like to consider this evening with regards to this are as follows:

 

  1. (The big question!) Should we consider sleep as a meaningful occupation?
  2. What role does OT have with regards to sleep dysfunction?
  3. How can better sleep routines be incorporated into the clinical environment?
  4. If sleep is considered as a coping strategy for a patient then how can OT support them to access other means of managing?
  5. What strategies can be put in place by an MDT to better support functional sleep routines for patients?
  6. What are the advantages and challenges for the profession with regards to developing our understanding of the role of occupational therapy and sleep?
  7. What are your experiences, challenges and difficulties in your settings with regards to sleep?
  8. Final thoughts, ‘lightbulb’ moments and hopes for the future for the profession and sleep.

Post Chat Updates

The Numbers

2,176,148 Impressions
747 Tweets
60 Participants

Online Transcript

PDF of Transcript: #OTalk 23 August 2016

#OTalk Participants

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#OTalk Journal Club 19th April 2016 – BJOT Editorial

Being the #OTgeeks that we are, the #OTalk team contributed to an editorial in the British Journal of Occupational Therapy which was published last week. Hopefully, this will give us the motivation to plough on with the write-up of our 2014 research evaluating the impact of #OTalk!

We would not be #OTalk without our community, and thought this week’s #OTalk would be a great opportunity to further explore some of the issues we touched on in our editorial. Join us tomorrow, Tuesday 19th April at 8pm GMT+1 on Twitter using the #OTalk hashtag to discuss online communities of research and practice.

BJOT

 

The full-text of the editorial can be accessed for free at the Sage Journals website – either in web or PDF form (links open in a new window).

 

Here are some questions to start off the conversation:

  • For you, what is the value of building an online communities of practice?
  • How do you build your online networks? How do you maintain them?
  • How do you decide what tools are helpful or a hindrance?
  • How do you balance your time online?

 

If you would like further inspiration, you can also check out our 2013 poster about developing online communities of practice.

Post Chat Updates:

The Numbers

1,511,661 Impressions
536 Tweets
81 Participants

Online Transcript from Health Care HashTags

PDF of transcript: 19th April 2016

#OTalk Participants

 

Position Now Open Again: #OTalk Student Digital Leader Intern

Welcome to the Team (Permanently), Kelly!

The #OTalk crew are excited to announce that our Student Digital Leader Intern, Kelly (@OTontheTracks), has agreed to become a permanent member of the team.

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Kelly started her role in April 2015 and quickly became a valued member of our team, a rock we can depend on and a good friend. Kelly has shown tremendous dedication to her role, actively participating in chats and promoting #OTalk at every possible opportunity. She has made sure that all previous chats on the on the otalk.co.uk website have a transcript, and created a wonderful ‘Welcome to OT’ video. We really appreciate how motivated she is and how easy she is to get along with, and we are so happy to have her onboard.

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Now Recruiting for #OTalk Student Digital Leader Intern(s)

We love the fresh perspectives and energy that students bring to the #OTalk community, and we have always had students in the team (@GillyGorry and @GeekyOT both started their #OTalk journeys as students). With this in mind, we have decided to re-open applications for the position of #OTalk Student Digital Leader Intern.

We want to recruit one or two UK/Ireland-based interns who are pre-registration students at the time of application to support the running of #OTalk for a 6-9 month period. A list of responsibilities and projects can be found below, along with an indication of the skills we are seeking. In return for your support, you will receive mentoring in digital leadership from the #OTalk team, and guidance to host/support-host a few chats throughout the internship. This experience will help develop your professional networks and will look great on a CV. You will receive a reference on completion of the internship.

Our outgoing Student Digital Leader Intern, Kelly, summed up her experience saying:

“Undertaking the Student Digital Leader Intern position with the #OTalk team created so many fantastic opportunities that I could  never have imagined I would be a part of as a student occupational therapist.

Being part of the #OTalk team has opened up a world of expertise and experience to learn from. I have developed a range of transferable skills I can take with me into my career as qualified occupational therapist and had lots of fun along the way”

 

#OTalk Student Digital Leader Intern – Responsibilities and Project

  • OTalk Blog – Transcript posting.
    To support the team by posting transcripts for selected chats within 48 hours of a chat and in linking to the summary page
  • OTalk Facebook
    Creating a Facebook event for each chat from the OTalk Facebook page
  • OTalk Twitter – Promoting
    Regular tweets from OTalk and personal accounts to promote the chats.
  • OTalk Twitter – Follows.
    To review follows on the OTalk Twitter account, block spam accounts and to follow back/create lists for the OTalk account.
  • OTalk Twitter – Hosting.
    To host a minimum of one chat during the internship and to support an additional two chats with guest hosts (Training will be provided – more can be hosted as desired).
  • OTalk Experience Summary.
    Along with the OTalk crew to write up an account of the experience of interning for publication.
  • OTalk Development.
    Engagement in online team meetings to review chat effectiveness, suggest future development and feedback on the relevance of OTalk for students.

 

Interns ideally need to be:

  • Excellent communicators
  • Familiar with the use of Twitter
  • Familiar with the use of Gmail, Google calendars and Google Drive
  • Familiar with the use of Skype
  • Familiar with WordPress blog editing dashboard
  • Able to create PDFs of transcripts
  • Available on Tuesday nights between 8pm – 9pm at least once a month
  • Available for 30 minutes on Wednesdays or Thursdays to post chat transcript
  • Able to access the Internet and have a laptop/smartphone that will enable blog editing and Twitter/Facebook access.
  • Passionate about the occupational therapy profession
  • Promoters of the positive application of social networking for professional development
  • Responsible and professional in their use of social media (social media accounts of applicants will be reviewed as part of the application process)
  • Engaging with CPD on a regular basis

(Training to use the relevant software will be provided so please still apply if you meet most of the outline above)

 

If you are interested in this position please send the following to otalk.occhat@gmail.com by 23:55 on the 15th May:

  • A personal statement of no more than 500 words demonstrating your suitability for the internship
  • A Biography of between 100-200 words (that includes your name and university, and a link to your LinkedIn profile) [Write this as if you are introducing yourself to the #OTalk Community on the blog]
  • Your skype username
  • The name and e-mail of a referee who can be contacted if you are invited to interview

Please direct any queries to the team using the above email address or Direct Message us on @OTalk_

Shortlisted applicants will be invited to a Skype interview by the end of May and will be in post by the beginning of June.

Please note this is a voluntary role (we are all volunteers and #OTalk is not-for-profit.

#OTalk – 9th June 2015 – ‘Assessment Tools: Help or Hindrance? Door-Opener or Straightjacket?’

Thank you to Nichola (@Nnikki_Duffy) for offering to host this #OTalk – I’m sure it will be very interesting! Do join us at 8pm BST on Tuesday – all welcome!

-@geekyOT

My relationship with assessment tools has been a journey, as a newly qualified practitioner I found security, confidence and like a beacon on a light house they guided my assessment structure. They provided me with an outcome measure that could demonstrate the effectiveness of interventions and provided an effective audit that demonstrated the need for more OT’s.

Interestingly COT (2013) not only promotes the use of standardised outcome measures, but warns that without incurring such data through credible/reliable sources, the evidence base to support the value of OT will fail to grow, unable to meet the challenge of producing the robust information needed to support future commissioning.

However what if that guiding light fails to illuminate the person in their entirety and context? I remember having a discussion with a wonderful group of masters’ students who described the use of standardised assessments tools as trying to fit people into boxes. Lots of wonderful critical thinking going on, however on reflection I can distinctively remember in practice thinking I wish there was just another box!

However through the use of an assessment tool that was sensitive enough to illuminate a person’s capabilities at the exploratory level, family and care staff could see strength, not only loss, while providing a way of capturing the words ‘I feel like myself again’.

In context the strength of the assessment tool does not absolve the professional from there responsibility to recognise and respond to issues (Hocking, 2010), acknowledging that an assessment tool is a part of the assessment. Professionally Hocking (2010) identified that we have a profession responsibility to acknowledge our limitations, do we have the needed proficiency in administering certain assessment tools? Do we follow our assessment tool blindly, failing to review regularly against new evidence and theory?

Other questions to consider:

 

  • What assessment tools to you use in practice?

 

  • It what ways can assessment tools become opened doors?

 

  • It what ways can assessment tools become straightjackets?

 

  • What are our professional responsibilities when using assessment tools?

 

  • What are some of the challenges experienced when using assessment tools?

 

Useful Resources:

 

COT (2013) Position Statement: Occupational therapists’ use of standardized outcome measures. http://www.cot.co.uk/sites/default/files/position_statements/public/COT%20Position%20Statement%20-%20measuring%20outcomes.pdf#search=”use of outcome measures”

COT, Occupational Therapy Assessments for Older People with Dementia: http://www.cot.co.uk/sites/default/files/ss-older-people/public/OT-Assessments-for-Older-People-with-Dementia.pdf#search=”assessment tools”

Laver Fawcett, A,J. (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists : theory, skills and application. Chichester : John Wiley.

#OTalk – 19th May 2015 – Dementia: See the Person (Dementia Awareness Week)

This year, Dementia Awareness Week (#DAW2015) will run from 17-23 May. Join us on Tuesday 19th May 8pm BST (click the link to convert to your time zone) for an #OTalk tweetchat hosted by Nichola Duffy (@Nnikki_Duffy).

SeeThePerson

 

I’m not where I’m meant to be…

 

If you had asked me three years ago which clinical area I wanted to specialise in, I would have unequivocally and confidently answered neurology/ headache disorders. Yes I’m one of those annoying people that had a five-year plan!  As you can guess from the title of the blog I’m not working in neurology, my five year plan went out of the window when I started working in a pilot post as a community mental health OT working in a memory team (initially within care homes). I promise I’m not trying to convert every OT to work within the memory team (she says with her fingers crossed) but I think I have the best job in the world!

Leven et al. (2011) described the role of OT as ‘one of the most promising psychosocial interventions for those living with dementia and carers’ (p.743)

The journey travelled by each individual living with dementia is just that; individual (unique), even those with the same level of underlying pathology may experience differences in occupational performance (Holthe, Thorsen and Josephsson, 2007). Burns and lliffe (2009) defines dementia as a clinical syndrome that affects memory, disturbances in language, psychological and psychiatric thinking impacting on the  ability to perform everyday activities. However a more potent description can be found in the World Health Organisation’s (WHO, 2012) publication ‘Dementia a Public Health Priority’ defining the diagnosis as ‘overwhelming’, not only for those living with a dementia diagnosis but also care givers and families.

As OT’s we have a responsibility to  look beyond the neurological impairment and focus on strengths, capabilities and valued occuaptions. With occupational therapists having a specific responsibility to utilise approaches that ‘penetrate the bubble’ as Perrin (1997) described many years ago, to really See The Person living with dementia, not only symptoms.

I’ve also felt that one of the strengths of our professions is described in the WFOT (2010) position statement as ‘listening to the voice’ whether that is the individual, families, caregivers etc. Baldwin (2008) discusses the importance of the narrative, the stories we tell, listen to, reinforce and their ability to empower an individual, stating ‘through our stories we can give voice to or silence others’. Working in a dementia care setting this statement of advocating or ‘giving those a voice’ I believe is at the centre of what I do and I can truly say I’m exactly where I’m meant to be.

Within my trust we have adopted the statement SeeThePerson, so as we approach dementia awareness week it may be fitting to ask ourselves:

  1. Do we really see the person?
  2. What skills do occupational therapists have to enable us to look beyond the patient to see the person?
  3. What are some of the perceived barriers to delivering person centred care?

Nichola Duffy @Nikki_Duffy.

‘I have become a storyteller. Not with jokes or funny stories, although funny things happen to me a lot. But to tell others about living with Alzheimers. To tell people my story, my hopes and my intentions and, more importantly my expectations. Breaking the stereotype of a person with Alzheimers or other dementia as very elderly and in the final stages is very important to me. And it starts by speaking out, one person at a time.’

Jim Mann (2010)

Resources:

What is dementia?

https://www.youtube.com/watch?v=6q-H1-XwCZA

Barbara, the whole story

https://www.youtube.com/watch?v=DtA2sMAjU_Y

Dementia – Briefing 2 – Meaningful Activity: This briefing is aimed at occupational therapy practitioners interested in developing their knowledge and experience of working with older people. Its purpose is to distinguish between dementia, delirium and depression.

https://www.cot.co.uk/briefings/dementia-briefing-2-meaningful-activity

COT (2012) Dementia- hOT topics have a comprehensive list of a number of related articles.

https://www.cot.co.uk/system/files/privatedownloads/hot-topics/Dementia-Jan2012.pdf

Some useful articles/books on person centred care:

Bartlett, R. and O’Connor, D. (2007) ‘From personhood to citizenship: Broadening the lens for dementia practice and research.’ Journal of Aging Studies, 21(2) 107–118. doi: 10.1016/j.jaging.2006.09.002.

Brooker, D. (2007) Person-Centred Dementia Care: Making Services Better. London: Jessica Kingsley Publishers

Clarke A., Hanson E. and Ross H. (2003) ‘Seeing the person behind the patient: enhancing the care of older people using a biographical approach’, Journal of Clinical Nursing, 12(5) pp. 697–706. doi: 10.1046/j.1365-2702.2003.00784.x.

Clissett, P., Porock, D., Harwood, R. and Gladman J. (2013) ‘The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families’, International Journal of Nursing Studies, 50(11) pp.1495-1503. doi: 10.1016/j.ijnurstu.2013.03.001.

Cook, A. (2008) Dementia And Well-Being: Possibilities And Challenges. Edinburgh: Dunedin Academic.

Kitwood, T. (1997) Dementia Reconsidered : The Person Comes First. Buckingham : Open University Press.

#OTalk – 31st March 2015 – Focus on Models: Vona du Toit Model of Creative Ability

Although it’s hard to pick favourites, the Focus on Models series is one I’ve enjoyed and have been looking forward to developing further. I’m very excited to announce that the next model we’ll be exploring is the Vona du Toit Model of Creative Ability.

I discovered this model during one of the SOTLS conferences, and liked it so much I paid to go on the training by Wendy Sherwood. My appetite wasn’t satiated, so I arranged to do my final placement at the Welland Centre. It was a fantastic experience, one which still influences my practice. Although the model can take some time to get your head around, it’s well worth the effort, and there’s a wealth of information on the VdT MoCA Foundation website.  

So without further ado, here’s Alison (@amkane87), Sarah (@vdtmocaot) and Roshni’s (@KhatriRoshni) pre-chat blog post!

-Clarissa (@geekyOT)

VdT MoCA #OTalk Blog

The Vona du Toit Model of Creative Ability (VdTMoCA) is a developmental and recovery based model of occupational therapy practice that was developed in the late 1960’s in South Africa.  It is based on the theories of motivation, action and normal development.  Central to creative ability theory is the belief that human beings progress through developmental levels of behaviour and skill development and are motivated to develop these in a sequential manner.  As Occupational Therapists, we know that in order to effectively treat someone, we need to understand their current level of occupational functioning. The model identifies that motivation governs all action, therefore in order to understand somebody’s developmental level of motivation, their actions need to be observed.  The model describes specific occupational performance (actions) and corresponding levels of motivation to enable a therapist to identify an individual’s current level of functioning – their level of creative ability – and provides accompanying specific treatment principles to elicit growth to the next level of creative ability.  Creative ability develops within four specific occupational performance areas which are social ability, personal management, use of free time and work ability.

The model is extensively used by South African OT’s and was introduced to the UK in 2004. Since then, Wendy Sherwood (OT and Educator) has been championing the model in order for it to have gained popularity, particularly in mental health and forensic services.  Since 2012 Wendy has led the Vona du Toit Model of Creative Ability Foundation UK (VdTMoCAF) to support the community of OT practitioners interested in the use and evidence base of the model.  One initiative of the VdTMoCA Foundation is the development of Centres of Excellence in the use of  the model who share their practice with others.  You can find out more about the model and the work of the foundation at www.vdtmocaf-uk.com

The Berrywood and Welland Adult Acute Mental Health Services at Northamptonshire Healthcare NHS Foundation Trust  are  the first centre of excellence in the model and have regular open days, welcoming OT staff who are interested in learning more about the model. The Tweet chat hosts are Alison Kane who is currently working as an Occupational Therapist at the Berrywood Hospital, Sarah Wilson who is the OT manager over these services and a VdTMoCAF director, and Roshni Khatri who is a lecturer at the University of Northampton and has used the VdTMoCA in Neuro and Paediatric areas of practice.

Common terms;

Creative Ability; one’s ability to change in response to life’s demands- the creation of oneself (Sherwood, MCAIG 2010).

Creative capacity; total creative potential in an individual.

Useful links;

VdTMoCAF website link

VdT MoCA Open Resource

Post-Chat Update

Thank you to everyone who joined in the chat.

The Numbers

888,751 Impressions
613 Tweets
46 Participants

Sarah has compiled a Storify about the chat which you can read at this link. You can also find the transcript at Healthcare Hashtags, or download the PDF.

Remember to document your participation in your CPD Portfolio. Check out our ‘OTalk and Your CPD‘ page for more info.

#OTalk – 17th March 2015 – Therapeutic Modes (Therapeutic Use of Self)

Last year, Bob Collins hosted an #OTalk called ‘Interpersonal Skills: Intangible or Teachable‘ (click the link to read more – opens in a new window). Building on this discussion,  Hazel Clerkin (@hazelclerkin) will be hosting this week’s #OTalk about the therapeutic modes from Taylor’s Intentional Relationship Model. Hazel was the first person to introduce me to the model – something I now regularly use to reflect on my practice – so I’m pleased she’s agreed to host this chat.

– Clarissa (@geekyOT)

Therapeutic Use of Self

Taylor (2008, p.14) identifies the aim of therapeutic use of self (TUS) in practice is to facilitate the therapeutic relationship and in turn facilitate a clients occupational engagement, thus increasing therapy outcomes. Davison (2011) highlights that “the values concepts and skills required for therapeutic use of self are fundamental to entry level practice and should be taught in a student-centred, active manor”, however extensive education in TUS is not typical in most occupational therapy programmes (Bailey & Cohn, 2001; Ledet, Esparza & Peloquin, 2005; Peloquin & Davidson, 1993; Sands, 1995).

Taylor (2008) developed the Intentional Relationship Model to deliver TUS and how it can be utilized to promote occupational engagement and promote positive therapy outcomes. This model offers a set of concrete tools and interpersonal skills in TUS.   “Therapeutic Modes” which are advocating, collaborating, empathising, encouraging, instructing, problem solving can be used by the occupational therapist to facilitate TUS.  The modes should be adopted and vary, according to client characteristics, therapeutic responding and interpersonal reasoning.  The modes promote the therapist’s ability to establish and maintain relationships with clients and manage possible difficult behaviour to achieve optimum therapy outcomes

Clarissa and I designed a role play workshop using six modes of TUS, advocating, encouraging, instructing, problem-solving, empathising and encouraging as outlined by (Taylor, 2008). We delivered the workshop to occupational therapy students, and assisted them to integrate each of the modes through a role play case study. The results of the workshop indicate that students perceived skill level in TUS increased after participating in the role play workshop.

It should be noted that this increase was statistically significant for problem solving, collaborating, instructing and advocating modes and not significant for empathising and encouraging modes. This study indicates a need for further research into effective deliverance of skills to occupational therapy students such as empathising and encouraging within the therapeutic relationship.

Therapeutic Modes (Taylor, 2008, page reference to follow)

Advocating Mode

  • Facilitate and consult
  • Ensure opportunities for participation and access
  • Legal rights, barriers, obstacles to independence
  • Approach interpersonal difficulties by adjusting and accommodating the needs of the client.

Collaborating Mode

  • Therapist to make decisions jointly with clients, involve clients in reasoning about therapy, and expect clients to participate actively in therapy.
  • Facilitate the clients active participation in therapy
  • Encourage the client to make more decisions in therapy
  • Inform the client they are responsible for the outcomes of therapy
  • Define the therapeutic relationship as a shared effort to explore and pilot test new goals or skills
  • Insist that the client provide direct and honest feedback about his or her experience in therapy
  • This mode works well with client who are excessively dependent, symptom focussing, resistant, denial, difficulty with rapport and trust.

Empathising Mode

  • Therapist to strive to understand the client’s interpersonal needs and perspectives as accurately as possible. Paying particular attention to client’s emotional experiences.
  • Articulate the clients need or perspective, so the client feels heard
  • Strive to understand the behaviour from the clients perspective
  • Validate the need of the client.
  • This mode works well with clients who are manipulative, excessively dependent, symptom focussing, resistant, and denial, difficulty with rapport and trust, hostility towards the therapist.

Encouraging Mode

  • Therapist to compliment, applaud, and cheer. Rejoice and celebrate when clients are successful.
  • Instils clients with hope, courage, will, participation and perform
  • Examine the extent to which a client values and are interested in a given activity.
  • Focus on selecting and altering activities to make them more appealing, pleasurable and attractive
  • Frequent use of positive reinforcement, positive feedback, humour, entertaining antics, cheering, coaxing, compliments, applause, motivational words.

Instructing Mode

  • Therapists to emphasise education in clients.
  • Label and define the negative behaviour for the client so they are aware of it and they are aware you are aware of it
  • Set a limit on the behaviour
  • Highlight the negative consequences of the behaviour for the therapeutic relationship and the outcome of therapy
  • Teach alternative more adaptive ways the client can get their needs met within the relationship.
  • This mode works well with emotional disengagement, passivity, isolative, difficulty with rapport and trust, hostility

Problem Solving Mode

  • Ask the client strategic questions
  • Discuss the advantages as well as the negative consequences of the clients behaviour
  • Negotiate with the client to find an alternative way of obtaining gratification of his or her needs.
  • This works well with resistance, emotional disengagement, isolation, passivity.

Questions

Q1. Have you come across the Intentional Relationship Model before? What are your thoughts on it? How might this theory be useful?

Q2. Thinking about the various therapeutic modes, are there any that you are more comfortable with? How do you think you developed skills in these modes?

Q3. Do you believe therapeutic use of self can be taught? How can we support students to develop skills/confidence in this area? What do you think of the idea of using role play?

References

Bailey, D.M. & Cohn, E. (2001) ’Understanding others: a course to learn interactive clinical reasoning’, Occupational Therapy in Health Care, 15, pp.31-46.

Davidson, D.A. (2011) ’Therapeutic use of self in academic education: a mixed methods study’ , Occupational Therapy in Mental Health, 27, pp.87-102.

Ledet, L., Esparza, C.K. & Peloquin, S.M. (2005)’The conceptualization, formative evaluation, and design of a process for student professional development’, American Journal of Occupational Therapy, 59, pp. 457-466.

Peloquin, S.M. & Davidson, D.A. (1993) ’Interpersonal skills for practice: an elective course’, American Journal of Occupational Therapy, 47 (3), pp.260-264.

Sands, M. (1995) ‘Readying occupational therapy assistant students for level II fieldwork : beyond academics to personal behaviours and attitudes’, American Journal of Occupational Therapy, 49 (2), pp.150-152.

Taylor, R.R. (2008). The Intentional relationship: occupational therapy and use of self. Philadelphia: F.A.Davis Company

Post chat updates:

The Numbers

1,242,362 Impressions
622 Tweets
56 Participants

#OTalk Participants

Healthcare Social Media Transcript (online).

PDF of Transcript. #OTalk – 17 Mar 2015