OT unit notes - Summary Concepts of Occupational Therapy PDF

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OT Process & Models Describe and explain the purpose of the occupational therapy process An occupational therapist works systematically with a client through a sequence of actions called the occupational therapy process. The process includes the components of evaluation (or assessment), intervention, and outcomes. This process provides a framework through which occupational therapists assist and contribute to promoting health and ensures structure and consistency among therapists. Describe and explain the difference between the occupational therapy process and occupational therapy models The process is an overview of where you must go, the direction/s you will take The model is what will help you to get from start to finish The OT process is a map whereas the models are the mode of transport. Describe the different components of the Occupational Therapy Practice Framework (OTPF) Domain: What do we look at? What do we care about? Occupations, client factors, performance skills, performance patterns, contexts & environments. Process: Evaluation, Intervention, Targeting outcomes

Describe and explain the client and context/environment components that contribute to occupational performance Client factors: Values, beliefs and spirituality; Body functions; Body structures Context: Cultural – What behaviours are expected? What are accepted? Personal – Age, gender, sexuality, socioeconomics Temporal – Stage of life, time of year, length of occupation Virtual - Technology Environment: Physical (natural & built) & Social (relationships & their expectations)

PEOP model vs CMOPE model The PEOP model looks at occupational performance (ability to do an occupation to a desired level) C-MOPE looks at occupational performance & engagement (Be able to participate and engage in something that has meaning)

Communication Discuss the importance of communication skills for occupational therapists One of the most fundamental skills needed throughout the occupational therapy process. At every stage of the occupational therapy process, we need to utilise different types of communication to engage with our clients, their families/carers, our colleagues and supervisors Describe the Australian Occupational Therapy Competency Standard 4: Communication “Occupational therapists practise with open, responsive and appropriate communication to maximise the occupational performance and engagement of clients and relevant others” Types of communication Virtual, verbal, augmentative & alternative, written, non-verbal, formal, informal

1. 2. 3. 4. 5.

Recipe for great communication Clarity: Make your point clearly  When lots of complexity Brevity: Make your point quickly  When time/attention is short Context: Make your message relevant  Unfamiliarity with topic Impact: Make your message memorable  When there’s lots of noise Value: Make your message valuable  Scepticism/choices

Different audiences have different pallets, so adjust your ingredients to suit their taste

Relationships Why do we need good relationships? Because we want to achieve the best possible outcomes for our clients. Clients: We want to establish rapport, be client-centered, therapeutic use of self, have empathy Family: We want to give them a prognosis, inform them of support services, inform them what all the health professionals are doing, what discharge plans are etc. We need to be able to address concerns

Other health professionals: We need to be able to describe what our role is & make sure our knowledge and skills compliment Stakeholders: Justify why we are doing something or need something & facilitate continuity of care Models of health professional teams: Multi-disciplinary  Health professionals in the team are from different disciplines  Each health professional completes their own discipline-specific process (evaluation and intervention)  Information about discipline-specific progress is shared amongst the team Objective - Cooperation and coordination Inter-disciplinary  Health professionals in the team are from different disciplines  Team members plan goals and interventions in collaboration  Joint evaluation and intervention processes are common Objective - Integrate the client’s health care in a client-centred manner Trans-disciplinary  Health professionals do not take on a discipline-specific role  Team members share skills and knowledge with one another so that all team members can complete the evaluation and intervention process Objective - Create a system-based approach in an environment with limited resources or time restraints Key Worker  A specific type of trans-disciplinary care that is the model used in early intervention NDIS  The key worker is a health professional who acts as the primary contact for families to navigate therapy services Objective - Enables families to have one contact to streamline therapy, without having to coordinate multiple health professionals

Cultural Safety What is cultural safety? It is about creating an environment where service users feel ccomfortable expressing their culture, their culture is unthreatened & their culture is respected. What is cultural humility and how is it different from cultural safety? It is a shift in thinking; rather than aiming for competence in other cultures (this is not possible), the aim for service providers is to be self-aware, self-reflective, and self-critical, maintain respectful partnerships with service users & be a lifelong learner. Cultural humility of service providers may facilitate cultural safety of service users. What is critical reflexivity? Critical reflexivity involves an examination of the assumptions, beliefs, and values that underpin established clinical practices and ways of thinking. It is thinking about one's thinking. The act of being reflexive means that you are acknowledging the effect that your position in the world – economically, socially, culturally, geographically, and so on – has on yourself. Cultural identity Cultural identity is the identity or feeling of belonging to a group. It is part of a person's self-conception and selfperception based on various cultural categories such as (but not limited to):  Socio-economic status  Gender  Sexuality  Education  Age  Ethnicity  Religion  Ability

Ethics 4 principle approach to ethics 1. Non-maleficence non-maleficence = Shoe hurts  Do no harm  Duty of care beneficence = Shoe doesn’t add  Need to be aware of and consider potential harm caused by value to outfit either well-intended actions or a failure to act 2. Beneficence  Benefiting the client  Health professionals should add value to the lives of clients  Doing all that could possibly be done 3. Justice  Fairness – Making sure people with the same needs have the same acess to services without discrimination or prejudice  Comparative justice – If someone has greater needs they should receive more of the available services without discrimination or prejudice  Distributive justice – How services or resources are distributed amongst the community or population. Usually based on societal rules/norms e.g. lower income gets lower tax  Compensatory justice – Acknowledging that if people have experienced discrimination or injustice in the past then they should have the opportunity to receive more resources or services to make up for the imbalance e.g. Close the gap (Caucasian senior age is 65+, Aboriginal senior age is 45+) 4. Autonomy  Everyone has the right to their own values, beliefs and views  The right of self-determination  The values, beliefs and views of clients are prioritised over those of the health professional  Assumption: the individual has capacity

Additional ethical principles  Veracity – conformity to the truth/facts; honesty  Fidelity – Keeping promises; doing what you say you will do  Confidentiality – Keeping personal information private  Consent – Ensuring you have informed consent to proceed with OT process Ethical theories Deontology - Actions are right or wrong We can use reason to determine if something is good/bad, right/wrong. An action is good if at the same time you would be happy for everyone else in the world to do it. E.g. Jack in a hole – would they be happy for everyone else in the world to blow someone up Utalitarianism – For the greater good Morality is not based on the act itself but the consequences of the act. E.g. Big jack is one person, there are 2 other people. Blowing up big jack saves 2 lives OT’s usually have a deontology approach but the healthcare systems have a utilitarian approach. Ethical Decision Making Process 1. Recognise & define the ethical question 2. Gather relevant data 3. Formulate a moral diagnosis & analyse the problem using ethics theory/principles 4. Problem solve practical alternatives, weigh options & decide on an action 5. Act on a morally acceptable choice 6. Evaluate & reflect on the process/actions/results

Interview & Analysis

Why is a narrative summary important? Putting all of the information together in this way is important to gain an holistic occupational perspective of the person, integrating the way in which different factors impact the person’s current occupational roles, their performance, and engagement What is a narrative summary? The past, current and future perceptions, choices, interests, goals and needs that are unique to the person, organisation or population. Person:  Perception and meaning  Choices and responsibilities  Attitudes and motivation  Needs and goals Organisation:  Mission and history  Focus and priorities  Stakeholders and values  Needs and goals Population:  Environments and behaviours  Demographics and disparities  Incidence and prevalence  Needs and goals Why do we do an occupational profile? To understand our patients as occupational beings Interview format 1. Gain consent 2. Small talk – build rapport 3. Do they know what an OT is? 4. Typical day 5. Focus on info given from this 6. Ask why X is important to them 7. Link things to keep flow going 8. Don’t double barrel questions

Kavs format: Work Leisure Hobbies Family Living arrangements

Why is Activity and performance analysis important? Helps us to evaluate the strengths and challenges in the clients’ occupational performance and therefor give realistic intervention planning/implementation. Using occupation as therapeutic means and ends Difference between Activity analysis and Performance analysis? Activity analysis is looking at general person and environment factors in a task/activity whereas a Performance analysis considers the specific person and their environment factors in the task/activity.

The OT Process Steps

The steps that an OT undertakes to provide occupational therapy to the client. This includes anything an OT does in their clinical practice. 1. Receive referral 2. Gain context/background information (from referral, case file, next of kin) 3. Occupational interview (to develop an occupational profile) We do an interview to identify:  Barriers & enablers to occupational performance  Meaningful occupations and how often they do them  Why are those occupations meaningful?  Who they do those occupations with  Living situation  Family relationships/supports  Demographic information 4. Assessments  Initial assessment: What is the clients baseline level of functioning  Screening assessment: Looks at signs and symptoms related to their diagnosis. E.g. stroke – range of motion, balance, cognition  Standardised assessment: What specifically of those symptoms is the client having issues with  Functional assessment (occupational analysis): How these issues are impacting them for specific occupations. 5. Set goals 6. Formulate interventions 7. Re-evaluate 8. Modify interventions 9. Discharge planning 3 Reasons why we do an occupational analysis 1. To gain a greater depth of understanding of the activity/occupation.  You don’t know how to do every occupation, so must gain an understanding of it 2. How the client completes that occupation or activity  Everyone is different, we must tailor to them 3. To understand how the barriers impact on the client’s occupational performance Possible descriptions of OT for VIVA, based on practice context Hospital: An occupational therapist helps you get back to doing the things you need to do, want to do and are expected to do but can’t due to illness, disease or disability. So, my role can be to help facilitate you to get back to your home environment by working on such things as showering, toileting and other daily activities. Home: (Broad description). Our next step is to reintegrate into the community and as an OT I can help you with this by working on things such as shopping, driving and doing the hobbies you enjoy. Productive: (Broad description). My role is to help you get back to doing the things you do at work/uni such as writing & typing so that you can continue your role as a student/employee

Interventions Grading & Adapting

Activity Analysis (putting shirt on with some left arm paralysis – short version, should be 10-15 steps) 1. Use right upper limb to turn shirt so it is face down and bottom opening is toward you 2. Use left hand to grab corner of shirt whilst right limb pushes though shirt and sleeve 3. Use right upper limb, reach and grip left bottom corner of shirt and pull over head 4. Use right hand to grab left hand and pull through shirt and sleeve 5. Use right upper limb to pull down sides of shirt over the waist Identify the area that the client had trouble with (step 3) to place intervention Plan the intervention Use PEO to plan the intervention

Be clear on these. Grading is only done on the occupation and adaption is only done to the environment

1. Occupation Look at the occupation and see how we can grade it to make the task easier or more challenging Grading – measurable increase or decrease of an activity by altering factors such as size, quality, intensity e.g. support hip at step 3 2. Environment Can we/should we adapt the environment? Adapting – alterations/changes made to the environment (or objects in the environment) to enable the person to complete the activity e.g. high back chair, arm rest, button hook 3. Person What prompts/cues and what type of chaining should be used to teach the client Chaining Forward chaining: Start at the 1st step of the activity and repeat until client is efficient. Then do step 2 until efficient, then do steps 1&2 together until efficient etc Backward chaining: Have the client complete the last step on their own and assist them with the rest. Add in steps 1 at a time (reverse of fwd chaining) Total task chaining: Prompt and correct as the person is doing the steps (this type of chaining is not that great) Prompts and cues Use these whilst going the client goes through the steps of the activity  Indirect verbal: Direct the client without telling them specifically what to do e.g. what do we do next?  Direct verbal: Tell the client what the next step is  Gestural: Point to assist client  Visual: E.g. show them the left side of the shirt, use cards illustrating steps  Model: Do the activity with the client  Direct physical: Assist the client with the activity Indirect & direct verbal are good for people that have full cognition Gestural & visual work well for kids and the elderly Direct physical is for people with maximal dependence and disabilities...