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 Researcher’s Practice Placement was Set Within

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 client’s involvement in their daily life, occupational therapists are actively engaged in providing functional therapies in different settings such as clinics, hospitals, community and homes(Wimpenny et al., 2010, pp.511).

The interaction between the skills, activity and attributes of the individual and the environment all tend to affect the ability of such a person to perform a given task.

Cooking was selected as the occupational therapy services that the practice placement team would provide given its relevance in improving the health status of the individuals with the complex health needs such as the elderly adults(Whalley, 2013, pp.174). This occupational therapy service involved cooking varieties of high-quality balanced foods (Whalley, 2013, pp.176). 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.

Most of the occupational therapists provide occupational therapy services to the seniors especially when they start getting affected by morbidity illnesses such as depression, memory loss or even injury due to continued reduction in motor skills. The level of independence in most of the older adults is shallow to the extent that cognitive abilities are feeble to the extent that these individuals can easily injure themselves while undertaking activities of daily lives (Whalley, 2013, pp.180). The practice placement team aimed at enhancing the independence level of elderly adults through r

estoring and improving their ability to cook. Cooking entails the use of sharp objects such as knives which if not correctly used may result in an individual injuring his or herself. Moreover, the cooking activity involves the use of risky equipment such as gas cooker and ovens which if not properly handled may lead to injuries(Creek and Lougher, 2011, pp.36).

An Overview of the Client Group that the Service Works with

The occupational therapy service that the researcher’s practice placement was set within entailed cooking as one of the activities of daily living that is important for the older adults in the community. Thus, the target group for this occupational therapy process is the elderly individuals who are over 64 years old. With the continued increase in age, the motor skills of the older adults keep on getting weaker and weaker as time progresses(Creek and Lougher, 2011, pp.38).

One of the primary reasons as to why the team chose cooking as the best self-care activity that the practice placement team was to focus on was because the majority of the older adults have limited opportunities to either cook or enjoy homemade foods or even both. The pathological changes that are related to cognitive impairment hinder the ability of the elderly individuals within the home setting to initiate or sustain meaningful activity(Missiuna et al., 2012, pp.43).

This limitation is acting as a major challenge towards the health care and well-being of the elderly adults since they are unable to cook for themselves especially at a point in their lives when they need balanced diet meals that can sustain their complex health care needs.

Introduction to Individual Being Focused on in My Portfolio

The portfolio will primarily focus on an elderly patient who has been diagnosed with dementia. Dementia is a medical condition that is most common in elder adults and involves progressive damage to the brain of an individual thus resulting in impaired cognition(Chan and Chan, 2009, pp.222). Through their academic curricula, continuously working with older people in various settings and having high expertise in activity analysis, occupational therapy practitioners tend to approach dementia as a condition that affects the occupational performance of the affected people(Chan and Chan, 2009, pp.224). The practice placement team will focus on comprehensively addressing the different functional implications of this older adult who is suffering from dementia. 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.

Some of the common problematic behaviours that are evident in older adults who are suffering from dementia include being disoriented and often wandering (Chan and Chan, 2009, pp.225). Dementia patients have the challenge of forgetting what they are supposed to be doing and end up roaming around unconsciously(Purandare, Luthra, Swarbrick and Burns, 2007, pp.778). This may be dangerous especially if the environment that they are in is relatively unsafe for them and they may end up injuring themselves. Along with uncharacteristic frequent outbursts, dementia patients find it is challenging to communicate with other people effectively, and this may hinder their health improvement especially when they are in pain or facing a particular health issue but they are unable to communicate on the same(Purandare, Luthra, Swarbrick and Burns, 2007, pp.779). Moreover, the individual who the practice placement team will focus on will be having an array of issues that include motor control issues, cognitive disorders, memory loss, behavioural and emotional problems as well as developmental disabilities(Purandare, Luthra, Swarbrick and Burns, 2007, pp.780).

Additionally, dementia patients tend to show repetitive non-productive behaviours such as folding and unfolding laundry. It is essential to refer the dementia patient to an occupational therapy during the early stages of this disease in whichmost of the higher-level executive skills are significantly reduced(Billington et al. 2013, pp.166). Difficulties in staying engaged in personally meaningful tasks and home safety start developing during the middle stages of the dementia disease (Billington et al. 2013, pp.166). However, the practice team will focus on the elderly adult who was diagnosed with dementia and whose condition is in the last stage in which one develops a difficulty with primary activities of daily living (ADL) and self-care. The team selected for this pebblePad portfolio will primarily be involved in providing occupational therapy activities that are related to self-care such as cooking.

Occupational Therapy Process Followed with the Elderly Adult Suffering from Dementia

Most of the elderly patients with complex health care needs such as dementia 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.164). The occupational therapy that is going to be provided by the practice placement team to the elderly adult who is suffering from dementia 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.166). 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 elderly adult who is suffering from dementia, 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

The occupational therapy process that is going to be undertaken in this exercise will involve conducted in three phases that is evaluation and goal setting, intervention and re-evaluation phase. Each of these phases has its steps that are supposed to be followed in the effort of ensuring high-quality outcomes. Based on the above diagram, the below steps or process will be extensively developed 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 choose the home of the elderly adult who is suffering from dementia as the most useful context in which the client-centred occupational therapy will be conducted. The main reason for choosing this context is because the client has a direct and personal relationship with his home environment thus making it convenient to implement an occupational therapy activity in such a situation as it will have a deeper meaning for the client. Moreover, this content is suitable for this exercise since the elderly adult who is suffering from dementia has been found to live with a relative who is often not around as she has to go to work on daily basis in the effort of ensuring there is enough money to take care of this individual who has numerous complex health issues that have been facilitated by his continued ageing status and the dementia disease.

Additionally, the home setting of this patient is favourable for implementing the occupational therapy activities since it creates an environment in which numerous resources can be used to undertake this therapy in the attempt of enhancing the independent level and quality of living of the selected individual. However, the home setting may limit the number of occupational therapy activities that this team may be able to implement in the attempt of assessing the health needs of this patient and implementing interventions that can contribute to better health outcomes of the elderly adult.

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 elderly adult who is suffering from dementia hence identifying his or her 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. The practice team identified that some of the health issues that the elderly adult who was suffering from dementia had already complained about before including continued memory loss, reduced cognitive capabilities and inability to independently undertake various activities f 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.

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. The practice placement team was actively involved in observing the occupational performance level of this elderly adult who is suffering from dementia.

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 and cooking. These activities of daily living were profoundly affected by the continued deterioration of cognitive capabilities and memory loss that inhibited this individual’s ability to be independent enough while undertaking those activities. 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, bathing, dressing and toileting. However, the elderly adult exhibited strong capability in eating without the need for a third party.

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. Based on the findings that the practice placement team obtained after observing the occupation performance of the elderly adult, 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 bathing, dressing, cooking and toileting 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. The practice placement team discovered that there existed several reasons that significantly contributed to the poor occupational performance of the elderly adult. For instance, cognitive efficacy has contributed substantially to the inability of the elderly adult patient who has been diagnosed with dementia to undertake most of the self-care activities. Secondly, continued memory loss has overtime affected the ability of this patient to conduct most of the activities of daily living. The team found out that there are numerous cases that this patient forgot to turn off the gas cooker after coking thus further putting his life in danger. Moreover, severe dementia accompanied by old age problems in which an individual continuously grows weaker and weaker significantly contributed to the low occupational performance of this patient.

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. 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 elderly adult. This model is most convenient for use, especially when delivering occupational therapy within the home setting as it is the case for this client. The restorative care models had been found by the team to be the most convenient 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 (elderly adult suffering from dementia) 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 given the high importance that is associated with this occupational therapy activity. The placement team which was also composed of other professionals undertook the task of assisting the elderly adult to 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. 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 rice and vegetable, the team decided to work on the functional skills. It is starting engaging the patient in the cooking process by assigning some less engaging tasks like chopping onions and carrots and lighting the gas cooker. The workgroup or the multidisciplinary team selected for this placement setting was 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 elderly adult was now able to perform most of the cooking task on his own thus indicating the success of the occupational therapy process that had been implemented by this team within this particular home setting.

To back this activity, the multidisciplinary team also set to improve or restore independent bathing as one of the other critical functional capabilities which were relatively low. Through the help of the occupational therapy process, the workgroup assisted the patient in bathing without using the bathtub or shower supported methods of bathing thus improving his functional skill related to independent bathing. The workgroup did this by allowing the patient to wash some of his parts such as legs and head without the assistance of a third party thus gradually restoring this functional skill that was slowly eroding.

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 principal investigator, a research physical therapist, three home care agency staffand a nursing student (myself) who were all directly and actively involved in providing occupational therapy to the selected practice placement setting. Other various tasks were being delegated to other juniors in the multidisciplinary team; the principal investigator remained the head of this workgroup team. The research physical therapist was also a crucial part of the pebblePad portfolio, and he actively helped in assessing the progress of the client while the occupational therapy process commenced. 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 staff from the home care agency was also very pivotal during this occupational therapy process. By having high experience and knowledge about how special health care is delivered in the home settings, she helped in guiding the rest of the team members on the best strategies to employ while using the undertaking the occupational therapy process to assist in eradicating any incident of health complication that may emerge given the fact the patient involved has complex health care needs. 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 functional skills of the elderly patient who had been selected as the critical participant of this exercise. Given the fact that most of the elderly patients who have complex health and social care needs tend to be very sensitive to actions or behaviours that they perceive to be impersonal, the multidisciplinary team sought the services of the staff who monitor patient satisfaction as way of preparing for any reaction that this team would receive from the patient or his family members who mostly was the one relative who was to be the breadwinner in this home. 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 standards of practice were 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. As part of the pebblePad portfolio which involved working with others, this relative was regularly engaged in the occupational therapy process through activities such as serving the client the meal and helping the multidisciplinary team locate those household materials that it would require when enhancing the occupational performance of the elderly adult involved in this exercise.

 
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