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OTalk

#OTalk 28th September 2021 – Thermoregulation for wheelchair users: preventing problems with heat and moisture

This #OTalk is hosted by @WheelAir_

Overheating, over-sweating and excessive moisture build-up are common complaints among wheelchair users. Either due to a medical condition or restrictive seating configurations, many wheelchair users struggle to control heat and moisture levels in the seat contact areas.

At WheelAir, we feel that there is a general lack of understanding and awareness of how heat and moisture complications manifest and how serious an issue thermoregulation can be for wheelchair users.

Overheating

The body uses four mechanisms to maintain thermoregulation: conduction, convection, radiation and evaporation. However, for people with sweating dysfunction, caused by a spinal cord injury for example, no evaporation heat loss can take place. Such overheating drastically heightens the risk of developing heat stress or fatigue, as well as other issues such as heat-induced seizures and muscle spasms. Having to “just deal with” overheating and warm environments can, therefore, be very dangerous for wheelchair users if precautions aren’t taken.

Over-sweating and moisture build-up

Similarly, over-sweating or excessive moisture build-up can have serious consequences for wheelchair users. This is because the skin microclimate – that is, the temperature, humidity and airflow next to the skin surface – is an indirect pressure ulcer risk factor. Temperature and humidity affects the structure and function of the skin, lowering possible damage thresholds for the skin and underlying soft tissues. Even for people who are unable to sweat, such as those with a complete SCI, excessive moisture build-up is a problem. Even when not sweating, the skin releases moisture automatically through a much more passive process called transepidermal water loss (TWL). This is an unavoidable process and, of course, TWL increases when someone is sitting all day.

Research on heat and moisture

The team at WheelAir has spent the past 5 years researching heat and moisture to better understand how to recognise symptoms. We have now created a clinical assessment toolkit to improve the efficiency of evaluating heat and moisture risks for wheelchair users. The toolkit is designed to better inform and educate those involved in the decision-making and reimbursement processes, such as OTs, about the prevention or treatment of heat and moisture related complaints, such as pressure injuries or skin rash.

We want to facilitate OTalk to discuss these newly devised clinical tools and hear from OTs about their experiences of handling heat and moisture issues for wheelchair users.

About WheelAir

The WheelAir system is the first temperature control system designed to fit any wheelchair. All of our products are designed to disperse air evenly across the wheelchair contact area to lower the user’s core temperature and keep the skin dry and clean.

The very first WheelAir was brought to life in 2015 by our Managing Director, Corien Staels, as her final university project during her textiles degree after her university tutor, who was a wheelchair user, told Corien of the problems associated with overheating. Intrigued, Corien wanted to know more and discovered that overheating in a wheelchair is not only very uncomfortable, but also potentially dangerous. She learned that people were using ice-packs and water sprays to keep cool and it seemed ridiculous to her that in this day and age, there wasn’t a technological solution. And so she came up with the WheelAir concept – a simple idea that has already made a lot of impact. Ultimately, WheelAir’s vision is to create a world where every wheelchair user feels comfortable and in control of their temperature.

QUESTIONS:

1. We have had a very hot summer, what symptoms have you seen for wheelchair user clients in the past few months? How have they been managing staying cool and avoiding overheating?

2. Similarly, have moisture related issues been more of a challenge during the hot summer months? Are people struggling with sweating too much, skin issues like rashes, and finding it difficult to stay cool and dry?

3. In general, what types of symptoms do you see with heat and moisture related issues for wheelchair users? How often do you see these as issues for wheelchair users?

4. If a client has heat and/or moisture related symptoms, what do you usually suggest for solutions?

5. How can training about overheating, sweat, and microclimate management improve for Occupational Therapists that work with wheelchair users?

OTalk

The Role of Occupational Therapy in Primary Care Mental Health Teams

This #OTalk is hosted by Helen Parmenter and Cheryl Carr who are both occupational therapists working in primary care teams.

Increasing complexity is one of the major factors responsible for the rising workload in general practice (Baird et al 2016) and involves patients presenting with two or more health conditions which also interact with other social difficulties such as poverty, trauma, isolation etc.
Often these difficulties are considered in isolation when people try and access services meaning patients often fall through the gaps between specialist mental health services, social care and Improving Access to Psychological therapies with their management being held by their local GP.

As part of the NHS long term plan, which NHS England published in 2019, local areas are being asked to realign community mental health services with primary care networks, creating ‘new and integrated models of primary and community mental health care’ by 2023/24 (NHS England 2019, p 69) resulting in the establishment of primary care networks (PCNs).

A diverse range of mental health needs are seen in primary care, with general practices supporting people with a wide range of diagnoses and complexities, including people with psychosis, bipolar disorder, personality disorders and other needs. (The Kings fund, 2020 )

Examples of population needs may include:

  • People with complex needs that do not fulfil criteria for specialist mental health services
  • Child and adolescent mental health needs that do not fulfil criteria for secondary care services
  • Mental health needs among older people
  • People with long-term mental health conditions discharged from secondary care
  • People with persistent physical symptoms which impact on their mental wellbeing
  • Psychological needs of people with long-term physical health conditions
  • People at risk of suicide, but not in contact with specialist mental health services

With the establishment of the PCNs, an increasing number of roles are emerging for occupational therapists to work within these newly established teams which often comprise of a mix of GPs, social prescribers, peers support workers, coaches, counsellors and psychological practitioners.

Within primary care mental health services occupational therapists are involved in activities such as
-Risks assessments for acute distress
-Personalised care planning for self-management
-Patient activation to achieve personal goals
-Social prescribing, and signposting or referral onto recovery support and services
(RCOT)

With services in their infancy and roles being developed in practice with opportunities to shape our own unique contribution, we look forward to hearing form the wider community about their thoughts about how occupational therapists can develop this opportunity to promote their skills to others, identify gaps, develop new ways of working and become imbedded as partners in their local communities.

Questions that will be discussed during this #OTalk are:

  1.  What help or support do you wish patients had in primary care mental health services?
  2.  What key skills can OTs utilise to be most effective in their roles?
  3.  How can OT’s be effective and timely with complex presentations?
  4.  What might be the best ways for OTs to demonstrate their outcomes to others both within the GP surgeries and beyond?

References;

Baird B, Charles A, Honeyman M, Maguire D, Das P (2016). Understanding pressures in general practice [online]. The King’s Fund website. Available at: http://www.kingsfund.org.uk/publications/ pressures-in-general-practice (accessed on 21st July 2021).
The Kings Fund (2020). Mental Health and primary care networks: understanding the opportunities. The Kings Fund website. Available at: https://www.kingsfund.org.uk/publications/mental-health-primary-care-networks (accessed 26th July 2021)

NHS England (2019). The NHS long term plan [online]. NHS England website. Available at: http://www.longtermplan.nhs.uk/publication/nhs-long-term-plan (accessed on 20 July 2021).

RCOT. Occupational therapy in primary care. RCOT website Available at: https://www.rcot.co.uk/occupational-therapy-primary-care (accessed 20 July 2021)

OTalk

#OTalk Tuesday 14th September 2021 – Following Boris Johnsons announcement on more funding for social care. What is the OT’s community thoughts?

This week our very own @OT_rach will try her best to guild you thorough the British Prime minister announcement from Tuesday 7th September, that has been described as  ‘A once in a generation’ shake-up of adult social care and how it is to be funded.

The cabinets have agreed upon a new plan to modernise the social care system, ensuring it is better integrated with healthcare, that will be financed through tax rises. 

Photo credit Sky News – Social Care Graphic

The Guardian reported 

In the short term, much of the money being raised will finance the NHS to catch up with elective surgery and other appointments delayed due to Covid. While the financing plan is UK-wide, the actual implementation of health and social care is run by each UK nation. 

‘Next year, national insurance contributions for employees, employers and the self-employed will rise by 1.25%, then in April 2023, while the rises will stay the same, the tax rise will be rebranded as a health and social care levy, which will appear separately on people’s tax records.’

The Observer goes on to reports that Downing Street says the tax increase will raise an additional £12bn a year.  A total of £36bn over three years of which the following has been allocated:

  • £16bn Direct NHS funding in England
  • £8.9bn for ‘health-based Covid response’ in Englan
  • £5.4bn for social care in England, of which £500,000 is for training £5.7bn for devolved nations, to support health and social care.
  • £5.7bn for devolved nations, to support health and social care.

Source: HM Government

Changes are also being made to the contributions people will pay towards social care, if and when they may need these services.

Currently in England if you have 

  • Assets less than £23,250 – Care is completely funded by state.
  • Assists over 23,250 – care is self-funded with no cap.
  • Those above the state pension age who still work do not normally pay national insurance.

The changes from October 2023 will mean if you have

  • Assets less than £20,000 – Care is completely funded by state.
  • Assets £20,000 to £100,000 – Care is self-funded with a cap of total contributions at £86,000 or until you reach less than 20,000
  • As of 2023, those above state pension age will begin to pay the new rebranded ‘health and social care levy’.

This is where it gets a bit more complicated well for me at least.  National insurance is a UK-wide system, it is reported that income from theses changes will be distributed across the four UK nations, and that by 2024-25.

  • Scotland, will benefit from an extra £1.1bn
  • Wales an extra £700m
  • Northern Ireland an extra £400m 

Although those living in Northern Ireland, Scotland and Wales contributions towards their social care need may differ form those in explained above for England. 

Lastly other than the prospect of a white paper to develop longer-term plans. The overhaul of social care and promise to bring health and social care systems together, has very little further detail. 

“We’re pleased that the government is starting to look at the future for social care, but today’s announcement is thin on detail other than on the levy. There is also little on how the government proposes to break down the historic divisions between health and social care, beyond a short reference to the development of a future integration plan and vague mention of reform. 

“Social care should be provided to all who need it and free at the point of use, to help address the inequalities COVID-19 has shone a light on in the sector. Whilst today’s announcement will provide relief to some, the announcement of £5.4bn over three years with no guarantees of sustainable funding beyond this is a big concern for the long-term future of care. 

“Nor does it say the government will address the real issues in the social care workforce which are leading to chronic shortages all over the country. Occupational therapists as well as other allied health professions will have listened in vain to hear about how the government intends to tackle the issues they face on a daily basis. 

“Whilst it is positive that in principle the government has committed at least £500m of funding for the development of the social care workforce, it is not nearly enough to fund this, mental health support, and also reform key aspects of the workforce. For social care staff it is offset by the extra levy that they and their employers will pay, which will take more resources out of the system.

“It is now the time to improve access, quality, and levels of social care and rehabilitation support, so that those who need it receive the care they need, when they need it. Those working in social care must have parity of esteem with the NHS workforce and be given proper development opportunities. We cannot wait until 2023 to start tackling these issues, we need to start now.”

So taking all this in to account and your own experiences of working in health and social care fields the chat will ask the following questions.

The Questions

  1. What were your initial thoughts following this announcement?
  2. Why should our profession concern itself with the details of this ‘once in a generation’ shake-up of adult social care?
  3. Who do you think will befit most and least from the Prime Ministers announcement on social care?
  4. How might these changes impact Occupational Therapy practice? 
  5. Are you happy with The RCOT response to this announcement?

Ref

https://www.rcot.co.uk/news/rcot-response-government’s-announcement-social-care-funding-reform

https://www.theguardian.com/society/2021/sep/07/what-has-boris-johnson-announced-social-care-plan

POST CHAT

Host:  Rachel Booth @OT_rach

Support on OTalk Account: OT_rach

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.
OTalk

#OTalk Research – 7th September 2021 – Writing productively

This week’s chat will be co-hosted by Katrina Bannigan @KatrinaBannigan from Glasgow Caledonian University with Nikki Daniels @NikkiDanielsOT on the #OTalk account.

Most of us are aware of the importance of writing, particularly peer reviewed papers, to ensure that our research findings have impact. That said, peer reviewed papers are not the whole story because so much of what we do as researchers is dependent on writing, for example, blogs, social media posts and patient information leaflets. Yet, even though writing is an important part of the research process, many of us struggle to write and most would argue it is challenging to find time to write. This is because we think we can only be productive if we have a substantial period of time to write. Rowena Murray has challenged us to rethink our approach to writing and there are a number of things we can do to become more productive writers.

One of the things she suggests is social writing— writing in a group with other people—which can increase motivation and promote accountability (Murray, 2015). To gauge if there was any interest in a writing group for occupational therapists, I wrote a blog and asked anyone who was interested to contact me. This led to me starting the occupational therapy writing group (@otwg_gcu) in February this year. Group sessions are held on zoom twice a week

  • 18.00-20.00 (BST) on Tuesdays
  • 09.00-11.00 (BST) on Fridays 

Only occupational therapists are invited to make it as comfortable and non-threatening an environment as possible. It seems to be working as we have had attendance at every session since it started usually between 9-18 people. Students who have attended the group found it so helpful they started their own group for students as part of their dissertation module; they wrote about their experience in a blog. Other people have described it as

  • The @otwg_gcu is excellent! Such as supportive space for a mix of academics, clinicians and students to set goals and focus on writing. Highly recommend” (Dr Carolynne White @Carolynne_OT March 18) 
  • …“I’ve seen great feedback on it, great way to protect time to do writing and get peer support” (Dr Mary Birken, @MaryBirken, March 2021)
  • This has been such a boost for my writing productivity..definitely time well spent. And joyous to connect with other OTs! (Dr Leisle Ezekiel, @lezeki, August 2021)
  • Starting a regular writing habit through @otwg_gcu has really helped me keep on track with writing and feel productive. Structure helps juggling competing demands” (Leona McQuaid, @LeonaMcquaid, August 2021)

This is why this month’s research #OTalk is focussing on writing productively. So whether you are a student, practitioner, researcher, manager, commissioner or policy maker please join in the discussion to share your experience and/ or learn about strategies for writing productively and how the @otwg_gcu is supporting occupational therapists to write.

Why not join in this #Otalk discussion and start to explore your writing habits? After all, our Chair of Council, Professor Diane Cox (2017), described writing about our work as being part of our lives as occupational beings. In the #OTalk discussion we will use the following questions to structure the discussion but please feel free to join in with other questions and perspectives:

  1. Is Professor Diane Cox (2017) right when she says writing about our work is part of our lives as occupational beings?
  1. Does anything prevent you from writing?
  1. Do you have any useful strategies, or writing habits, to support your writing productivity?
  1. Do you think a writing group can provide a source of writing accountability?
  1. What one habit will you adopt in the coming year to become more productive as a writer?

Reference

COX, D. (2017) The Dr Elizabeth Casson Memorial Lecture 2017: Life as an occupational being. British Journal of Occupational Therapy, 80(9) 525–532. DOI: 10.1177/0308022617722331
MURRAY, R. (2015). Writing in social spaces. Routledge.


POST CHAT

Host:  Katrina Bannigan. @KatrinaBannigan.

Support on OTalk Account: @NikkiDanielsOT

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

OTalk

#OTalk 31th August 2021 – Start as you mean to go on … how are you going to ensure you are prepared for the next HCPC audit cycle?

This weeks chat will be hosted by I am Sarah Lawson @SLawsonOT

For occupational therapists our Health and Care Professions Council (HCPC) re-registration window is currently open. How did you feel as we approached the 1 August 2021 and the beginning of our HCPC renewal and audit cycle? Which of the following do you identify with?

Are you a Bull in the China shop? Collecting CPD Certificates, attending anything that says it is free CPD with out any consideration for how this learning benefits your practice or service users. You write lots of reflections, but they are all bit random and you’re not sure how to relate them to the HCPC Standards.

Are you an Ostrich? Do you have your head buried in the sand, you’ll think about CPD if you’re selected for HCPC audit? You’ve managed to escape this time and you don’t need to think about it for another 2 years.

Do you procrastinate and sit on the fence? You have kept some CPD records, but they need organising and you’re not sure how to go about it. You always have plans to get organised next week or next time you have annual leave but that time never comes…

OR 

Are you a strategist? Confident that your CPD Portfolio is up to date, accurate and that you could easily submit your CPD Profile with evidence if you were one of the 2.5% selected by the HCPC for audit? (Hearle et al. 2016; Hearle and Lawson 2020)

You may identify with aspects of some or all of these. You may be newly registered and wondering how to organise your CPD. The aim of tonight’s #OTalk to is help you think about CPD, to start as you mean to go on for the new audit cycle and set some realistic goals to achieve over the coming year or two.

Why me hosting this #OTalk?

I am Sarah Lawson @SLawsonOT, a PhD Candidate researching occupational therapists’ engagement in CPD and their use of the TRAMm Model. I research, think, write, and dream (!) about CPD alongside lecturing @GlyndwrUniversity | @GlyndwrOT and maintaining my clinical skills working @TheChristieNHS 

I am also co-author of A Strategic Guide to Continuing Professional Development for Health and Care Professionals: The TRAMm Model which is also available for members of the Royal College of Occupational Therapists (RCOT) to read via their website.

The TRAMm Model (Hearle et al. 2016; Hearle and Lawson 2020) is based on the premise that Continuing Professional Development (CPD) is a personal and subjective journey, as well as our professional responsibility and mandatory requirement of registration. CPD involves the recognition of and engagement in lifelong learning. To be effective we need to Tell others, Record and Apply what we have learnt, Monitor our progress and measure the impact. I am really interested in the amount of learning we do as part of our everyday work and life that could contribute to our CPD if we recognise and record it as such. 

As we begin our new 2 year audit cycle, and renew our HCPC registration (if you haven’t yet renewed, information is available via the HCPC website) how are you going to ensure that you are organised for the new audit cycle? During this chat I’d like to encourage you to think about CPD and to set some realistic goals that we can plan to review at another #OTalk during 2022. 

  1. As a start point for tonight’s #OTalk I’d like to take a moment to consider why it is so important that we engage in CPD. Why are we a @The_HCPC regulated profession?
  1. As our professional responsibility, do you know and understand what the HCPC Standards for CPD are, how many there are and what they mean? If not, what might help you understand them?
  1. Within your everyday work and life how do you recognise that you are learning something that could contribute to your CPD?
  1. Reflecting on our learning and development is fundamental to CPD engagement, how do you ensure that your reflections capture your learning along with how you apply this learning in practice?
  1. How do you measure/evaluate the impact of your learning and development on yourself and others?
  1. What CPD goals are you going to set yourself now?
  1. What have you learnt from this #OTalk, how will you ensure that it contributes to your CPD?

References

Hearle, D., Lawson, S. & Morris, R. (2016) A Strategic Guide to Continuing Professional Development for Health and Care Professionals: The TRAMm Model. Keswick: M&K Publishing. 

Hearle, D. & Lawson, S. (2020a) A Strategic Guide to Continuing Professional Development for Health and Care Professionals: The TRAMm Model. (2nd Ed). Keswick: M&K Publishing.

Some Resources to support your CPD

TRAMmCPD

CPD Engagement

Recognising and Capturing CPD Vlog/Podcast Elizabeth Casson Masterclass 

Health and Care Professions Council (HCPC)

HCPC CPD

HCPC Three simple steps to be ready for a CPD Audit

HCPC Recognise, reflect, resolve: The Benefits of Reflecting on your Practice

RCOT 

CPD@RCOT

RCOT Standards for occupational therapy practice, conduct and ethics

Principles for CPD and Lifelong learning

Post Chat

Host: @SLawsonOT from TRAMm Model.

Support on OTalk Account: @colourful_ot

Evidence your CPD. If you joined in the chat you can download the below as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD