Ot test summary for test 2 PDF

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Week 13:!

Four principles that guide contemporary occupational therapy: ▪ Client-centred practice! ▪ Occupation-centred practice! ▪ Evidence-based practice! ▪ Culturally relevant practice!

Canadian practice process framework: ! • Societal Context • Practice Context • Frames of Reference! Applying the CPPF Both the societal context AND the practice context include the following environmental factors:! •Physical! •Cultural! •Institutional ! •Social!

Applying CPPF The practice context also includes personal factors for the client AND the occupational therapist: • Personal nature- health, age, gender, ethnicity • Knowledge, skills and abilities- education, professional knowledge, occupational experiences, language, habits ! • Perspectives- past, present and future-values, preconceived ideas, vision, motivations, hopes, dreams! CPPF - the eight action points 1. Initiate/enter! 2. Set the stage! 3. Assess/evaluate! 4. Agree on objectives/plan ! 5. Implement plan! 6. Monitor/modify! 7. Evaluate outcome! 8. Conclude/exit! CMOP-E ▪ Person-affective, physical, cognitive, spiritual! ▪ Environment-social, physical, institutional, cultural! ▪ Occupation-leisure, self care, work! ▪ Engagement-should discuss barriers and enablers interact to affect valued occupations to the person! Preparation for an Effective Interview ▪ Prepare the interviewee: What are the person’s needs? are they able to make informed consent? e.g. children! ▪ Setting: where? Access? Safety, comfort? ! ▪ Scheduling: when? How long? breaks! ▪ Your attitude to the interview: respect, be curious, non verbal communication! Interview structure - three parts 1. Beginning •Greet & thank the interviewee! •Introduce yourself and your role •Clarify the purpose of the interview! •Clarify the process of the interview! •Reiterate terms of the interview (explain ethical considerations eg., confidentiality, what will happen with the information they give you)! •Explain consent form and gain signature! •Ask if the person has any questions or concerns! 2. Middle • Semi-structured interview format! • Use of main headings with questions into the area! • Respond to the person’s responses ! • Actively listen!!

3. End • • • • • •

Start winding up ~10 minutes before conclusion time! Summary of main areas covered! Invite interviewee to clarify/add missing information! Confirm ethical considerations (eg., confidentiality, what will happen with the information they give you)! Future plan (if any)! Thank interviewee!

Five steps to active listening Step One - Joining by Preparing Prepare yourself, prepare the client, prepare the environment! Step Two – Joining by Attending SOLER – Squarely face, Open posture, Lean slightly forward, Eye contact, Relaxed posture ! Step Three - Following Skills • Door opener; minimal encouragers; attentive silence; ! • Open questioning – how, what and when! Step Four - Reflecting Skills • Paraphrasing! • Reflecting feelings! • Reflecting meanings! Step Five - Drawing to a conclusion • Summative reflecting! • Questions for when it is time to look at solutions (e.g. What have you tried? What do you think you could do?)! • Summarising at end of interview! Gibbs Model of Reflection

Activity analysis • Involves asking questions about an activity! • Investigating what doing the activity involves! • Investigating whether the client could participate in the activity and what it might be like for the client to do so! • Investigating what therapeutic potential the activity has for the client! • Investigating whether and how the client could perform the activity as part of his/ her occupational life! Most Activity Analyses’ formats • Brief description of the activity! • Describe the occupational performance of an activity in sequential steps (procedural task analysis)! • Analyse the activity in terms of performance areas, skills, patterns, demands, client factors, contexts! • Identify precautions, contraindications, criteria for successful completion of the activity! • Consider modification/grading/adapting as alternatives! Adapting and Grading - Adapting- An alteration made by a therapist or client to an object or environment in order to challenge or to improve the client’s ability to perform. Change in structure, function or form that provides a better adjustment to the environment. - Grading- Measurable increasing or decreasing of activity by alteration of factors such as size, effort or energy, attention, judgement, or discrimination. To challenge the patient’s ability by progressively altering the person, environment or occupation (eg the process, tools, materials) to increase or decrease performance demands Clinical Reasoning The processes used by clinicians to plan, direct, perform and reflect on client care – it is a complex and multifaceted process and includes:! • Scientific reasoning (evidence based practice)! • Narrative reasoning! • Pragmatic reasoning! • Ethical reasoning! • Interactive reasoning! Recovery Three types: ▪ Clinical recovery (as cure i.e. physical) ! ▪ Social recovery (emphasis is on function = rehabilitation)! ▪ Personal recovery – recreating a meaningful life # *(emotional recovery / healing) !

10 components to working in a recovery orientated way 1. Self direction! 2. Individualised and person centred! 3. Empowerment! 4. Holistic! 5. Non-linear! 6. Strengths based! 7. Peer support! 8. Respect! 9. Responsibility! 10.Hope! The Canadian Occupational Performance Measure (COPM) ▪ An individualised outcome measure to be used at the beginning of OT intervention, as necessary throughout and at the end of treatment. It detects change in a client’s self perception of their occupational performance over time. ! ▪ Identifies problem areas in client’s occupational performance! ▪ Provides a rating of client’s priorities of problem areas! ▪ Evaluates client’s performance and satisfaction of these problem areas! ▪ Measures changes in client’s perceptions of these problems in occupational performance over time! ▪ Appropriate for people with a range of disabilities over a wide range of developmental stages.! Purpose of COPM • The COPM assists the client-therapist team to identify and quantify problems of occupational performance. ! • Forms the basis of treatment goals! • Measures success or outcomes as identified by the client-therapist team from the client’s perspective.! • Uses a “top down” approach! Administration of COPM ▪Step 1: semi-structured interview to determine the occupational performance difficulties! ▪Step 2: client rates importance of each item! ▪Step 3: client chooses most important items! ▪ Step 4: client rates own performance and satisfaction! ▪Step 5: calculate total performance and satisfaction scores! Teaching Techniques Forward chaining! Reverse chaining! Total task chaining! Errorless learning!

Hierarchy of Prompts (usually begin at the bottom of the ladder and move up if your client requires more directive prompts/ assistance) Physical prompts! Modelling!

Gestural prompt!

Directive verbal prompt!

Non-directive verbal prompt!

Documentation ▪ Use black pen! ▪ Client’s full name and case number! ▪ Record date and time when entering note.! ▪ Health professional’s surname and initials, with signature and credentials at end of case note! ▪ Countersignature of supervising OT required while training! ▪ All documentation will be succinct, accurate, objective and timely using person centred language! ▪ Sign and date every entry! Hand Writing in Medical Records ▪ Waterproof permanent black ink! ▪ No correction errors or tape-draw single line through error, correct error and initial the change! ▪ If you need to add to record later, include current date, time, initials! ▪ Sign and date every entry! ▪ Client details must be on every page%! ▪ Document asap! ▪ Client information first (not health professional) ! Ethics Four Principles Approach ▪ Autonomy! ▪ Beneficence! ▪ Non-maleficence! ▪ Justice...