The School of Health & Social Care

Occupational Therapy: How Occupational Therapists work with others to promote Health and Wellbeing

Representing work by Year 3 students supported by Kirsty Stanley, Lecturer in Occupational Therapy

Interprofessional Education (IPE) is a key part of undergraduate training in the School of Health and Social Care. In their final year students from different courses develop a group project based upon an agreed topic of contemporary relevance to the well-being of individuals and / or communities.

The following list represents those groups of students that take part in Level H (Year 3) IPE at BU. Brief indication of how OTs may work with other groups is made at the end. The following examples only represent snapshots of how OTs either do or could work with each of the other groups.

Adult Nursing
(Kirsty Stanley)

Adult Nurses and OTs routinely work with each other on hospital wards and in the community. In hospitals nurses are often the professionals that have the greatest contact with clients. Their role is therefore vitally important in terms of continuity of communication, in-depth knowledge of the client’s medical condition and coordination of referrals to appropriate professionals including OTs. OTs and Physiotherapists often design rehabilitation regimes (on positioning, mobility, participation in self care, grooming and feeding) that they rely on nurses to reinforce when they themselves can not be there. In the community a district nurse, OT and pharmacist may work together to promote greater independence in medications management in terms of appropriate management of conditions (such as pain) as well as in more practical terms (such as opening packets and picking up tablets). OTs can provide gadgets that enable clients to be more independent in managing medical interventions such as putting on TED stockings and applying creams to hard to reach areas.

Mental Health Nursing
(Kirsty Stanley)

Mental Health Nurses and OTs work together in both acute and community psychiatry. Nurses in these areas will be involved in educating clients about their conditions and reinforcing appropriate medical interventions. Group work run by both professions is a key mode of treatment in in-patient settings. Health promotion and relapse prevention groups can benefit from a focus on a healthy balance of occupation. Our increasingly busy productive lives can have a direct impact on mental health and wellbeing. In the community both Nurses and OTs may be care co-ordinators for clients, responsible for identifying and implementing strategies to meet these needs with other professionals and agencies.

Learning Disabilities Nursing
(Cas Stanley Learning Disabilities OT)

The Nursing staff and OT would work together to develop behavioural approaches that aim to reduce challenging behaviour thereby reducing anxiety and stress. This in turn would allow the individual with learning disabilities to take part in daily activities and be part of the community. Nursing staff may look at the role of medication in this process and OTs may look at sensory integration strategies and together they may look at providing structure and boundaries. Both would work on helping clients to access the right services. Within the Moving On project (moving clients from NHS funded units into the community) the OT and LD Nurse would work together to write Individual service designs and also enable Health Promotion such as the management of health and medication, anxiety and increasing self-esteem.

Child Nursing
(Alison Grant Year 3 student)

Working in special schools for children with severe disability the paediatric nurse and OT will work jointly on issues concerning

Medications- how these may impact on function and independence
Positioning and seating - adopting functional positions for children without impacting on health needs. Children with severe disability can experience increased difficulties with gastric reflux and breathing problems if positioned poorly. Also an example of child who if positioned incorrectly could trigger an epileptic seizure.
Pressure care - high tone and postural difficulties can lead to pressure sores. The nurse would be involved in treating and providing pressure relief cushions whilst the OT would be considering positioning and seating to manage further problems and improve function.
Disabled children may also have a higher risk of illness and therefore health promotion is important

Within the community the OT may be addressing safety issues within the home or school for the child whilst a nurse may be sharing strategies to manage behavioural issues to increase the child's safety.

Midwives
(Karen Long and Victoria Kishere Year 3 Students)
OTs and midwives may coordinate the care of certain individuals, this group may include women with spinal cord injuries that have subsequently become pregnant. Thus liaising would be with the aim of maintaining optimal functioning for the mother during pregnancy. OTs would facilitate any necessary adaptations to the home environment to enable the mother to care for her newborn. Women with spinal cord injuries who are pregnant need careful monitoring for pressure sores as they become heavier. Additionally, arrangements may need to be changed regarding any current package of care which may need to be extended through pregnancy and post partum period. A problem solving approach needs to be adopted in anticipation of the needs of the mother following the birth. This may involve additional equipment or methods of working for the mother (Turner 2005).

How is OT relevant in neonatal care? According to Inga Warren, an OT consultant in neonatology, premature babies are susceptible to a range of complex cognitive, motor, sensory, emotional and social problems. The role of the OT is to help facilitate the interaction between mother and baby which is so crucial at this stage and helping the baby in self-regulation. Intervention in the early months is important as it takes advantage of the neuroplasticity of the brain (Samuels, 2008). A search of the Midwives Journal from 2002 to date made no mention of Occupational therapy in the field of midwifery and surprisingly there were no articles on mothers with a disability. A discussion with a practicing midwife revealed that she has not come into contact with OTs during her career. However, she did say that for women who are hard of hearing, the dept. has a flashing light which indicates to the woman that her baby is crying. So it may be that an OT would be involved in arranging a device such as this or perhaps working alongside a woman with MS prior to her going into labour and coming up with strategies to manage fatigue throughout labour and beyond. Another area an OT could be involved with is with adapted baby equipment which would allow a disabled parent to take an active role in the care of their baby. This has been highlighted in the article 'Who's carrying the baby?' which highlights the problems of baby transportation for parents in wheelchairs and the involvement of REMAP (charity which uses volunteers who design/adapt equipment which is not commercially available). (Evans and Orpwood, 2007). Perhaps there is a need for the role of the OT within midwifery services to be developed further.

Physiotherapists
(Kirsty Stanley)

Within hospital and community based services Physiotherapists and OTs work closely together to enable functional participation in occupations and mobility. One example of a joint treatment session is washing and dressing following a stroke. By carrying out the activity sat on a plinth the Physiotherapist can work on trunk control and sitting balance and in standing they can facilitate weight transference and alignment with a longer term goal of progressing towards walking (Turner, 2005) Within the same activity the OT can work on cognitive and perceptual skills such as appropriate object recognition and use, management of neglect of one side of the body, planning and sequencing. In learning disabilities it may be necessary for the OT to prepare a client for hands-on Physiotherapy intervention by addressing the sensory needs of that client.

Social Work
(Elizabeth Selway Year 3 Student and Kirsty Stanley)

In some cases, particularly when working with Social Services colleagues, OTs may use the Single Assessment Process (SAP) or Integrated Care Pathway (ICP) to communicate with other members of the MDT. OTs often work with Social Workers/Care Managers to coordinate packages of care (POC) for clients. For Social Workers advocating for clients and enabling them to access appropriate financial, social and care support can mean the difference between whether or not they achieve their occupational goals.

Community Work
(Elizabeth Selway Year 3 Student and Kirsty Stanley)

OTs can be based in the traditional setting of the OT dept in a hospital and go out in to the community from there. Sometimes, they are based in community- based facilities such as day centres or community centres. Increasingly, OTs may be based in GP surgeries and go out into the community from there. OTs value working in the community highly, as it allows them to see clients in their own environment, which is at the heart of the philosophy of OT. OTs aim, in any setting, is always to see clients as independent as possible in their own environment (Wilson, 1984). Its philosophy extends beyond the person’s diagnosis; encouraging clients to continue to participate in their chosen occupations, despite their disability. OTs working in the community may need to communicate with statutory (health and social services) and non- statutory bodies, the voluntary and private sectors. OTs also look at adapting a client’s environment and they may employ strategies such as education of the wider community. OTs could work with community workers in disadvantaged areas to tackle occupational deprivation and injustice providing opportunities to engage in meaningful occupation and to improve the balance of productive, restorative and pleasurable occupations. For example, supporting community improvement projects that enable people with disabilities to take an active part in this process.

Paramedic Science
(Yvonne Noble Year 3 Student)

Paramedics and OTs can both be ‘Emergency Care Practitioners’ (NHS Careers 2008) being the first point of contact for people in need of unscheduled care. Treating patients in their own homes, in GP centres or Accident and Emergency and identifying and addressing both health and social care needs could prevent the need for hospital admission. Paramedics attending repeated fallers and clients with uncontrolled or poorly managed conditions can refer onto OT services sharing important information that will enable clients to remain safe and independent at home.

Operating Department Practitioners
(Kirsty Stanley)

Operating Department Practitioners (ODP) and OT I believe have little opportunity to work together in practice. The BU course website indicates that ODPs may work within A&E and Day Surgery units, potentially alongside OTs. In terms of occupation ODPs would be well placed to identify potential difficulties that patients may have in participating in occupations post-operatively and therefore could suggest relevant referral to OT. There is perhaps a need for further investigation into potential collaborative working which should begin by developing a greater appreciation of each others role.

Speech and Language Therapists
(Kirsty Stanley)

OTs take a client-centred approach to intervention. Communication is essential in determining a client’s goals and in enabling participation in most activities involving others. OTs and Speech and Language Therapists would therefore work together to identify appropriate modes of communication (such as information and communication technologies) and ways to overcome speech difficulties (such as expressive speech problems post stroke) in order to enable occupation.

Nutritionist
(Kirsty Stanley)

OTs and Nutritionists can work together to improve the nutritional intake of clients. OTs may work on positioning to ensure safe and effective nutritional intake. They may also work on developing skills in cooking to enable a client to be motivated to manage their intake themselves (such as in eating disorders). Adequate nutrition is of course vital to enable successful participation in a range of occupations. Nutritional intervention may be necessary before an OT can succeed in their work.

Psychologist
(Kirsty Stanley)

Psychologists may work on issues such as bereavement, anxiety and phobias. Such issues are potentially blocks to participation in occupation. Development of strategies to manage these will potentially be very useful to clients when working with OTs on occupations that may be triggers to such issues.

References

Evans, N. and Orpwood, R. 2007. 'Who's carrying the baby?' British Journal of Occupational Therapy 70(6), 254 - 258.
NHS Careers. 2008. Emergency Care Practitioners. Available from: http://www.nhscareers.nhs.uk/details/Default.aspx?Id=414
Samuels, T., 2008. 'Right from the start': OT in neonatology. Occupational Therapy News, 16(8), 23.
Turner. A., Foster, M. and Johnson (eds). 2005. Occupational Therapy and Physical Dysfunction: Principles, Skills and Practice. 5th ed. Edinburgh: Churchill Livingstone.
Wilson, M., 1984. Occupational therapy in short-term psychiatry. London: Churchill Livingstone.