Introduction

This essay sets critically discuss the topic about occupational therapy by constructing a pebble pad portfolio that demonstrates how occupational therapy process was completed and how occupational therapist worked with other professionals as a team in the effort of meeting the needs of the individual chosen for this exercise. Some of the critical components of this portfolio include an overview of the occupational therapy services undertaken within the practice placement setting and an overview of the client group that the service will work with during the occupational therapy process. Other components include an introduction of one of the individual that the portfolio will focus on, a clear representation of the occupational therapy process that was followed and how “working with people” occurred during the implementation of the occupational therapy process.

Overview of the Occupational Therapy Service that Provided in the Researcher’s Practice Placement

Occupational therapy focuses on assisting people to actively and meaningfully participate in their day to day activities. Most of the scholars are in consensus that occupation in this context comprises of how individuals enjoy life (leisure), contribute to the society through either paid or unpaid work (productivity) and how one takes care of his or her self (self-care) (Wimpenny et al., 2010, pp.509). Circumstances such as disability, progressive ageing and environmental change all tend to limit how an individual participates in these occupations. In the effort of getting rid of these obstacles and optimising the clients’ involvement in their daily life, occupational therapists are actively engaged in providing functional therapies in different settings such as clinics, hospitals, community, acute inpatient wards and homes among others (Wimpenny et al., 2010, pp.511). Effective interaction between the environment and the skills, activity and attributes of an individual all tend to affect the ability of such a person to perform a given task.

In the acute inpatient ward which is the practice placement in which this study was carried, most of the admitted patients were in the age between 17 and 65 years. In most cases, nursing practitioners within the acute inpatient ward setting tend to have a hard time in effectively identifying the complex health needs of the patients through the use of interviews(Stevenson, Nilsson, Petersson and Johansson, 2010, pp.65). This challenge is caused by the poor mental state of most of the patients that are admitted in the acute inpatient wards. Thus, most of the professionals and medical researcher have recommended the use of ward-based group activities which involve engaging the patients into participating in various group activities hence enabling the health practitioners in this health care setting effectively assess the health needs of the individual patients indirectly(Stevenson, Nilsson, Petersson and Johansson, 2010, pp.68).

Some of the group activities that are part of the occupational therapy service or program include creative arts, cooking breakfast, engaging in music lessons and art therapies among others(Rouse and Hitch, 2014, pp.59). However, the researcher together with the rest of the team during this practice placement setting focused on cooking breakfast, art therapy and musical appreciation.Cooking is one of the activities of the daily lives that is capable of improving the life skills of the affected group of people hence leading to better quality of life(Rouse and Hitch, 2014, pp.62).

The entire practice placement team engaged the target patients in the cooking exercise which involved cooking breakfast foods such as avocado toast with eggs, berry and yoghurt smoothie, quinoa fruit salad, tomato toast with bread and quinoa and chia porridge. The practice placement team would critically assess the ability of the clients to cook these foods as a group whereby the contribution of each was paramount in determining the group success in coming up with an excellent breakfast meal (Rouse and Hitch, 2014, pp.64).

Moreover, the client group was also engaged in art therapy sessions as part of the occupational therapy service which aimed at assessing and determining the health needs of the client group(Landgarten, 2013, pp.49). Art therapy as a diagnostic is considered to be an essential form of psychotherapy which encompasses the act of encouraging patients to express themselves through modelling, sculpting, drawing and painting. Some of the art therapy activities that the practice placement team helped the client group engage in include line arts, painting, making scribble drawing and creating portraits (Landgarten, 2013, pp.53).

The last occupational therapy service that the practice placement team employed was music appreciation and involved instructing the patients to listen to songs after which they would ask them what they had heard and understood from each song(Kamioka et al., 2014, pp.733). This activity was aimed at assessing the cognitive capabilities of the patients involved.The team used these activities to conduct an in-depth evaluation of the emotional and psychological undertones of the patients through the art (Kamioka et al., 2014, pp.738).

An Overview of the Client Group

According to a recent review by Mental Health Nurse, the majority of the patients that are found in the acute inpatient wards are diagnosed with severe mental conditions which require specialised care from the professionals with the required skills and competence to deal with mental health issues(Creamer and Austin, 2017, pp. 233). The target group for this practice placement study was the individuals who were suffering from mental health problems. According to an audit conducted by the Crisis Resolution Team which is dedicated to providing intensive and short-term home treatment of the mental health ill patients in England, the number of hospital admissions of individuals who have been diagnosed with mental health disease has been increasing at an alarming rate(Creamer and Austin, 2017, pp. 235).

This justifies the reason why the practice placement team decided to focus on this particular group of patients. Mental health ill patients have complex health and social needs which required a specialised multidisciplinary team that can be able to provide much needed intensive care. According to recent National Health Service reports, it has been discovered that most of the mentally ill patients that are admitted in the acute inpatient wards tend to suffer from personality disorders such as schizophrenia, Schizotypal, bipolar, EUDP and schizoaffective disorders among others(Mohammed, Sidhu, Rudge and Stevens, 2012, pp.87). Individuals with complex mental health needs tend to behave and think in ways that are contrary to the general expectations of the society thus exhibiting personality traits that are rather unfriendly and infit in the community and the country as a whole

Introduction to Individual Being Focused on in My Portfolio

The PebblePad Portfolio will focus on a 40-year-old patient who is suffering from both a mental health illness and a personality disorder known as bipolar disease. Bipolar disorder is a type of medical condition or brain disorder in which an individual suffers from unusual shifts in the activity levels, mood swings and energy level thus affecting his or her ability to properly function and undertake most of the activities of daily living. The bipolar patients tend to face a hard time in conducting daily activities, and their independence level tends to decline as the condition continued to worsen. Occupational therapy practitioners tend to approach bipolar as one of the mental health condition that affects the occupational performance of the affected people.

The practice placement team will focus on meeting the complex health and social needs of the patient diagnosed with bipolar as one of the mental health condition that is common in most of the patients that are present in an acute inpatient ward. Through active interaction with this patient, the practice placement team will evaluate the patient with the goal of determining his or her impairments, strengths and identify those performance areas that need intervention. Bipolar patients exhibit various health challenges that affect the way they behave and interact with other people. Some of these health challenges include being hostile, aggressive and exercising risk-taking behaviours that tend to significantly put their lives in danger as it was the case for the chosen patient in this study.

Moreover, the individual chosen for this portfolio had communication problems that by a great extent hindered him from expressing himself when in pain or need of something. This selected patient also possessed an array of issues that include motor control issues, cognitive disorders, memory loss, behavioural and emotional problems as well as developmental disabilities. These health care needs of the individual selected for this portfolio were significant evidence that the practice placement team would play a significant role in identifying key health issues facing patients in acute inpatient wards who have shown to have reduced ability to independently undertake most of the activities of daily living such as cooking and bathing.

Occupational Therapy Process Followed with the Individual

Most of the mental health patients have complex health care needs that require the help of occupational therapists who are actively involved in the provision of occupational therapy that is designed to enhance their ability to live a more independent and productive life (Yuill and Hollis, 2011, pp.165).The occupational therapy that is going to be provided by the practice placement team to the mental health patient who has been diagnosed with bipolar will aim at improving his or her day to day life skills thus ultimately thus leading to a better quality of living (Yuill and Hollis, 2011, pp.168).

The team involved will go beyond the surface symptoms of this individual and conduct a detailed health assessment that will aim at identifying all the underlying issues that are affecting this patient (Yuill and Hollis, 2011, pp.168). When considering the health and social care needs of this individual who is suffering from bipolar disorder, the team will utilise a holistic approach that will enable it to determine all the critical health issues that this individual is facing and start addressing them in the order of priority (Van’t Leven et al., 2012.pp.744)

The occupational process therapy process that is going to be followed by the selected practice placement team will strictly follow the guidelines that are stipulated in the below occupational therapy process model.

Figure 1: Occupational Therapy Process Model

Source: (Wimpenny et al., 2010, pp.513)

Based on the above diagram, the below steps or process will be extensively be followed by the occupational therapy practice team while providing an intervention that will be aimed at improving the quality and the health status of the identified individual.

Establishing Client-Centered Performance Context and Identifying Key Resources

The practice placement team will primarily be involved in providing client-centered care within the acute inpatient ward setting where there exists patients will have various mental health problems. The main reason that the practice placement team choose this setting was that it is only in an acute inpatient ward setting that the complex health problems of the patients are effectively met as required by them.

This context provides a favourable environment in which health care practitioners and clinicians can closely monitor the health progress of the patients with the unique needs and administer the right treatment on time. Moreover, the acute inpatient wards provide an excellent environment in which there exists of the health care resources that are needed to meet the health need of the patients. This setting has high reliable staff that is available at all time, adequate medications such as painkillers which can help relieve the pain of the patients as they await the right treatment to be administered to them.

Identifying Strengths and Problems of the Client’s Occupational Performance

The next step that the team is going to undertake is conducting an in-depth assessment of all the current health status of the bipolar patient suffering from complex mental health problems in the effort of identifying his strengths and weaknesses. It is during this stage that the practice placement team will manage to discover those health issues that the client can sustain and those that are beyond his ability and which are continuously contributing to the deterioration of his health status (Wimpenny et al., 2010, pp.515).

The practice team identified that some of the health issues that the bipolar patient who was had already complained about before included continued memory loss, being unusually aggressive,  reduced cognitive capabilities, random mood swings that put his life in danger and inability to independently undertake various activities of daily living such as cooking, grooming, washing clothes and cleaning the house. Identification of these reported challenges of functional performance acted as a good ground under which the appropriate occupational therapy activities would be undertaken to help improve the health status of this client patient (Wimpenny et al., 2010, pp.516).

Observing Client’s Performance of the Prioritized Tasks for Analysis Purposes

This step in closely related to the previous level in the sense that it helps an occupational therapist or health practitioner confirm whether the reported claims of non-functional occupational performance are accurate or not. This analysis and assessment enable the concerned professionals to determine the most accurate client-centred interventions based on the health and social care needs of the patient (Fisher, 2014, pp.103). The practice placement team was actively involved in observing the occupational performance level of this bipolar patient who was suffering from various complex mental health issues such as mood swings and being aggressive.

Defining and Describing the Findings Obtained from Observing the Client

This step involves differentiating those tasks that the client has exhibited no difficulty in performing from those which occupational performance was relatively low. The practice placement team discovered that the client had trouble in undertaking self-care related activities such as bathing, dressing, cooking and effectively interacting with other people without putting their lives or his in danger. These activities of daily living were profoundly affected by the continued deterioration of cognitive capabilities and changes in mood swings and activity levels which resulted in him being unproductive for many hours thus reducing his independence level.  After observing the client for two days, the team discovered that the client had a lot of challenges in conducting most of the self-care needs such as cooking.

Establishing and Finalizing Client-Centered and Occupational-Focused Goals

At this stage, there is the need for formulating the various goals and objectives that the occupational therapy or health practitioner will target at accomplishing while trying to improve the health status of the patient (Turpin and Iwama, 2011, pp.66). Based on the findings that the practice placement team obtained after observing the occupation performance of the bipolar patient, it came up with various goals. For instance, through the occupational therapy that it was going to implement, it aimed at increasing the independence level and functional skills of the client in undertaking activities of daily living such as cooking, painting and drawing which the client showed to have a lot of difficulty in conducting them.

Interpreting the Reasons behind Client’s Occupational Performance Problems

This step involves determining and explaining the various causes of the poor occupational performance of the client (Turpin and Iwama, 2011, pp.68). The practice placement team discovered that there existed several reasons that significantly contributed to the poor occupational performance of the elderly adult. For instance, changes in activity level and mood swings have contributed substantially to the inability of the bipolar patient to undertake most of the self-care activities. The team also discovered that the various mental health problems that the bipolar patient was suffering from significantly reduced his occupational performance level.

Selecting the Best Model for Use to Improve Occupational Skills of the Patient Depending on the Current Health Status

Depending on the health and social care needs, there exist various occupational performance enhancement models that are vulnerable to use by occupational therapists. Some of the typical examples of such models include the acquisitional model, restorative model and education and teaching model (Townsend, 2011, pp.65). After critically analysing the different health care needs of the client, the team decided to use restorative care model for use in enhancing the functional skills of the bipolar patient.

This model is most convenient for use, especially when delivering occupational therapy within the acute inpatient ward. The restorative care models had been found by the team to be the most suitable in the sense that it made it easy for them to operationalize the concept of assessing and maximizing the functional independence capabilities of the individual selected for this exercise through the different episodes of self-care activities that were to be implemented during this occupational therapy process.

The main occupational therapy activity that the practice placement team or workgroup focused on was cooking breakfast which he was to undertake as a group activity. The placement team which was also composed of other professionals took the task of assisting the bipolar patient among others with mental health problems regain his ability to cook balanced food on his own. The first five days involved reminding the client about various cooking procedures given the fact that his cognitive functioning had already significantly deteriorated. The workgroup would practically demonstrate these procedures to the patient thus enabling him to recall such necessary procedures. Moreover, in the effort of improving the activity level of the patient, the practice placement team introduced rewards such as fruits among other presents as a way of encouraging the patient to remain fully engaged.

After the team noticed a significant improvement in the client’s cognitive skills such as the ability to remember most of the required procedures of cooking simple foods such as toasted bread, the team decided to work on improving activity level of the patient. It is starting engaging the patient in the cooking process by assigning him some less engaging tasks like chopping onions and tomatoes and lighting the gas cooker. The workgroup or the multidisciplinary team selected for this placement setting slowly increased the level of client engagement in the cooking activities for the next three weeks. It is after two months that the practice placement team was able to notice that the bipolar patient was now able to perform most of the cooking tasks effectively both on his own and a group. This helped in confirming the success of the occupational therapy process that had been implemented by this team within this particular acute inpatient ward.

How Working with People Occurred During the Occupational Therapy Process

During the implementation of the occupational therapy process, a multidisciplinary team was involved which worked in collaboration with other individuals such as the client’s relative. The interdisciplinary team was composed of the principal investigator, a research physical therapist and a nursing student (myself) who were all directly and actively involved in providing occupational therapy to the selected practice placement setting (Åkerblom, Perrin, Fischer and McCracken, 2015, pp.607).

The principal investigator remained the head of this workgroup team. The research physical therapist was also a crucial part of the pebbled portfolio, and he actively helped in assessing the progress of the client while the occupational therapy process commenced (Welsh, 2012, pp.58). Through using his experienced and skills, this highly educated and licensed health care professional was actively involved in restoring the functional abilities of the client. The nursing practice student was rarely assigned any critical roles during the implementation of the occupational therapy process but helped in undertaking minor roles when the need arose.

The occupational therapy process was scheduled to be implemented for three months period in which there were high expectations that the team would manage to enhance the mental health status and functional skills of the bipolar patient who had been selected as the critical participant of this exercise. The multidisciplinary team sought the services of the staff who monitor patient satisfaction as a way of preparing for any reaction that this team would receive from the patient or his family members (Körner, 2010, pp.747).

The staff who monitor patient satisfaction was also meant to help the multidisciplinary team in maintaining ethical standards such as ensuring anonymity of the patient involved in this exercise making sure that professional code of conduct among other rules of practice was upheld. It was essential to ensure that all the relevant Health and Care Professions Council Standards of Conduct, Performance and Proficiency and various Code of Ethics and Professional Conduct for Occupational Therapists among other ethical standards were maintained throughout as way of meeting the legal requirements during this exercise (Hudon et al., 2014, pp.778).

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