My visit to an Occupational Therapist (OT) was in a hospital setting. I was able to shadow various OTs at work in their different areas, including care of the elderly, orthopaedic and neurological wards and the Acute Medical Assessment Unit. The occupational therapy staff work together with patients, carers and other health and social care professionals to provide a flexible and fast assessment of individuals needs to enable safe discharge. The team ensures that patients are receiving appropriate care and support at home rather than being admitted unnecessarily to hospital. OTs look at ways to promote and support the patients’ independence in everyday activities, such as walking, washing, getting off a chair, climbing the stairs, getting dressed, feeding, making meals etc. In the hospital OTs will look at how these activities may have been affected by the person’s current medical condition, whether this is a physical problem or it relates to a problem with memory or concentration.
The OTs working on the wards aim to reduce risk and support independence for when the individual returns to their own environment. Dependant on their needs, the occupational therapist supports the practise of patients everyday activities to help them improve and/or regain independence before they leave hospital, this may be through teaching new techniques. OTs handle referrals/liaison with other specialist and community services to help to accomplish their goals after leaving hospital and supply equipment or advice to make everyday activities easier. They provide information on how to access community equipment and support services. Any interventions will be planned with the service user and will only be undertaken with their consent and agreement.
Physiotherapists (PT) and OTs frequently work in a collaborative manner, and by the nature of the practical and functional breadth of these profession’s practice there may often be an overlap of scope of intervention during patient assessment.
Once patients are deemed physically fit they also have to be assessed by the therapy team. They have to ensure that they can maintain their health when they go home. If they are not able to regain their independence and they don’t receive any other support they may have to be readmitted to hospital. Occupational therapy has been shown to reduce hospital readmissions (Rogers, Bai, Lavin, & Anderson, 2016). This is through facilitating early mobilization, restoring function, preventing further decline, and coordinating care, including transition and discharge planning.
The first ward I visited was one focusing on the care of the elderly. The medical and occupational therapy team located here provide assessment and treatment for a wide range of medical conditions including cardiac and respiratory conditions or dementia. Following a functional assessment patients may not be discharged home but discharged to further rehabilitation wards or to residential and nursing homes. OTs need to assess a number of things to get an understanding of how they would manage at home. They look at the activities of daily living which include if they are independent in eating, bathing, dressing, toileting, transferring and continence. They see if they are able to walk, climb stairs, get in and out of a chair and if they can perform in the kitchen. It is also important to assess the social factors to see how the individual is living at home. For example, if they live alone, have a package of care and family support system. On the ward I saw a patient transfer herself, with support from an OT and PT, from lying in her bed to a chair with the use of a walking frame.
On the orthopaedic ward I saw OTs caring for patients who are admitted to hospital due to a traumatic accident or an elective surgery. They specialise in understanding the implications of surgery or injury and the needs of people who have orthopaedic injuries and how this will affect them when they return home. Prior to elective surgery a pre-assessment will be given to help patients understand the rehabilitation process following surgery and to plan for managing at home post-surgery. After a traumatic injury an OT plays an important role in helping people return to independence. This includes assisting with planning their discharge from hospital and taking into account their lifestyle, home environment and their continuing therapy and care needs.
At the time of my visit the ward was mostly trauma patients as most elective operations were cancelled due to a busy period for the hospital. I met a man with two fractures in his lower back from a car accident. With support from the OT and PT he was able to get out of bed and walk to the door with a walking frame. From the assessments the OT discovered that he had adequate support at home from his wife and son. Due to an appendix surgery early last year he was already living downstairs, with easy access to the bathroom and kitchen, meaning that he was able to remain independent in these areas.
The occupational therapy team are also stationed in the Emergency Department and Acute Medical Assessment Unit (AMU). In the AMU I learnt that the patients are often older and weaker with complex medical and care needs, leading to a full multidisciplinary team being at work. The main aim is to achieve timely, accurate and in-depth patient assessment as quickly as possible. Patients will generally stay for 48 hours or less, and after their assessment a decision will be made for either discharged home, or for transfer to an in-patient acute medical ward or other relevant speciality. While I was there I met an elderly lady that had a fall at home and her leg was badly swollen as a result. She was unable to transfer herself from the bed as the OT requested her to do. It was likely she was going to be moved to a different ward for further treatment and support.
Following this I joined the neurology occupational therapy team that provide specialist assessment and treatment to patients following a stroke or other neurological conditions. Patients may face a range of difficulties that make it hard for them to do the things they would like, including physical problems, problems with memory and thinking, problems with vision, changes in sensation and emotional problems such as anxiety or depression. They assess how the neurological conditions have affected their capabilities and provide solutions to help the patient’s complete everyday tasks.
I saw a man that was in hospital following a stroke with the OT and PT. They were aiding him in transferring from his bed to a chair with the use of a rotunda. This piece of equipment assists patients from a seated position, on a bed, chair or wheelchair into a standing position, and to another seated position. Caution had to be taken to ensure his blood pressure didn’t drop dangerously low.