The broken leg part 2 – What does ‘Independent’ really mean?

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 A dictionary definition of the word independent shows it has many meanings, including ‘not influenced or controlled by others in matters of opinion, conduct, etc.; thinking or acting for oneself.’  ‘Not dependent; not depending or contingent upon something else for existence, operation, etc.’ Not relying on another or others for aid or support, and in Politics. a person who votes for candidates, measures, etc., in accordance with his or her own judgment and without regard to the endorsement of, or the positions taken by, any party.’

http://www.dictionary.com/browse/independent

But in the world of occupational therapy what does independent mean, to the therapist and to the person they are providing a service for?  This is something I have been thinking a lot about as I recover from a broken leg.

This recovery has been complicated by my existing disability, a right hemiplegia from cerebral palsy after a lack of oxygen to the brain during my birth.  The last three months have been some of the toughest of my life so far, and it’s all been down to my ability to come to terms with the lack of independence.

The issues of independence first began to play on my mind, after sadly a poor experience of occupational therapy whist in hospital.  I don’t think it would be appropriate for me to go in to this is to detail, but I will say I was concerned with their interpretation of independence.

After my operation I was having difficulty standing and began to transfer using a banana board, however my right leg was stiff and heavy with the extra weight of the pot, I could not transfer without someone holding it.

This was observed by one of the four OT’s I saw over the 16 days I was in hospital.  On discharge I ran in to difficulty and rang the OT to come out to do a home visit to reassess to my needs.  We disagreed on the help and assistance I required.

This mainly focused on the OT’s opinion I had independently transferred from the hospital bed to a chair.  I pointed out that the OT had held my leg during this transfer.  For me this was not an independent transfer. I must stress this is just my opinion and how the treatment I received felt.  But the OT service saw a broken leg and not the added complication for the hemiplegia and bariatric needs.

Discharge was not planned on admission, and unfortunately, in my opinion discharge from hospital was delayed due to the lack for forward planning by the OT team.  At this stage I cut ties with the OT service and sourced my own equipment paying for it myself, getting it in a timely manner with the help of some friends and family.

Interestingly enough whist in hospital. I was asked by the OTalk team to become a full team member. The first twitter chat I supported was ironic.  It explored if OTs within acute hospitals assessed and treated the mental health needs of their clients.  This again in my opinion was an area not addressed by any profession during my admission. #Otalk Blog

The affect of the broken leg on my mental health has been the most difficult part, those who are familiar with hemiplegia will also know that it is not just a physical disability and some of the symptoms include feeling depressed, heightened emotional sensitivity with inability to handle stressful situations.

Whist in hospital I found it incredibly difficult to manage my emotions, this was possibly made harder by the fact I was in over Christmas and New Year.  Social media, the tool I love became a focus of paranoia.  I made some mistakes in taking this out on people I love, something I am still dealing with the repercussions of 3 months on.  I was tearful on a daily basis’s and of course bored beyond belief. Friends and family did their best to visit and entertain me, during this time.  I am an extremely lucky person to have people in my life that have managed the moods, the tears and the frustrations.

Admitting and asking for help can be a hard, as a person with a disability you spend your life fighting systems and working hard to achieve despite the obstacles.  This might be some little victories like having a trampoline party as child because you were not invited to one earlier in the year as that’s child’s parents did not think you would be able to use the trampoline.  Or the large things like finish a degree, despite being turned down for your first placement because the educators had preconceptions about your physical abilities.

Some readers maybe thinking, I thought this blog was about independence, so sorry if I have gone off topic slightly, but I wanted to set the scene.

Those that have studied or have read about independence within OT will understand about codependence.  You might question is anyone truly independent? We all rely on others for something.  I found myself asking questions like, If I can use the toilet without assistance but need to be wheeled to or use a walking frame to get to the toilet is this independent??

Where does choice come in to this? can you or should you chose which parts of your life you want to be independent.  One example I have for this is prior to the fall, I would only wear flat slip on shoes without socks, as I find manipulating my hemi foot in to socks and shoes difficult.  However, after the operation my foot and leg have been very swollen. I’ve brought a wide fitting pair of shoes but due to the type of shoe I need to wear socks with them.

My first visit to the hospital physiotherapist, (10 days after having the pot removed) we had a discussion about putting my shoes and socks on, her priority for me to do this myself, however putting on this type of shoe is not something I would not normally do, although its something I know I need to work on it was not my priority at that time.

Over the past 3 months my independence abilities have changed on a daily basis some days I was more independent than others.  The equipment I’ve needed to assist me has changed dramatically from my initial thinking.

Facing getting out and about was one of the biggest challenges, for both myself and my family.  I became dependent on them when ever I wanted to leave the house, and a trip out needed to be planned in detail, much like a new mother with a new born baby.  I found I needed to plan longer rest periods than I did before the fall.

Tools like social media and the internet have helped with this I found I liked to look up where we have planed to go in detail, I look at pictures to help me understand the access issues and the distance I might need to walk, the anxiety of the unknown began to consume me.  My current challenge is to begin to go out without the safety net of the family, although I still require assistance to get my walking frame or wheelchair out of the car, I’m beginning by meeting a friend for lunch.

So I’m independently planning trips out with the toosl available to me, however I still require someone to accompany me, is this independent?

To help me explore independence in the future I’m planning on hosting a #Otalk on the subject on April 12th at 8pm I hope to see you online then.

 Rachel @OT_rach

 

 

The Broken Leg Part 1 – From the other side –  What I have learnt.

For none regular readers of my blog,  I’m a occupational therapist who works for a mental health trust,  but i also have a disability – if you are interested to can read theses below post to give you an insight in to my life before this event.

A week in the life of an occupational therapist with a disability for OT week 2015

#otalk 14th October 2014 hemiplegia

occupational therapy professionals with a disability

What to call this blog, many titles have come to mind as I’m laid staring at a pink wall and clock that says the wrong time and date.

Among the ideas –

  • Thank you Apple watch
  • The waiting game
  • Mothers are the best
  • How small the world can become?
  • Communication feels like the hardest thing to do
  • Beep ………….beep ……………beep

 

But I settled with from the other side – what have I learnt.   As much I’m hating this experience I’m trying to find the positives.  I’m learning lots that hopefully will improve my practice and maybe that of the the odd blog reader.

What happened  – Sunday 20th Dec 2015 I was busy getting the house ready for hosting a party.  About 11am I was walking down the stairs with the washing when my right foot lost its footing about 4 steps from the bottom, the basket went forward and I went backwards, I heard a cracking sound as I lay there for few seconds to catch my breath, I know I had broken my leg.

My mobile phone was in the washing basket and had actually landed under the foot of the broken leg. Luckily I was wearing my apple watch.  I knew I needed to get the door open before an ambulance came.  My brother has a spare key so a tried him first however he did not answer.  My neighbour had a key, but she has just given birth to a little girl, using the ring feature on the apple watch, I rang her first to make sure she was in, and then some friends who live round the corner.

Whistled I waited for friends to arrive I rang the ambulance, again on the apple watch. I also tried to ring my mum but she was away at a friends, rang my dad to let him know, and then my brother rang me back.  My friends arrived and open the door, my brother shortly after.

Then we waited for the ambulance.  I’ve done a lot of waiting this week, but the three hours waiting laying on the stairs was the worst.  My friends and brother did their best to make me comfortable placing pillows under my head and back.  We tried to stand me twice but the pain was too much.  Laid there I was convinced I would be home in time for the party, (how silly that seems now) so instructed the boys to get the desserts out of the freezer, and told them where they could find something to eat, (I was nil by month of course).  Mum had also rang and set off on the just over 2 hours’ journey from her friend’s house to mine.  She arrived at my house at the exact time same time as the ambulance.

I need to praise the paramedic’s once they arrived. They were so patient and kind. I was in a difficult position on the stairs and had little strength left after supporting my self with my left leg for 3 hours.  They had great problem solving skills and used a slide sheet to move me up the stairs enough to stand on one leg and be move on to a stretcher.

At this point I’m still convinced I’ll be home for the party if not a bit late, so sent a message to everyone, saying I would let them know.

I don’t remember much once we hit the hospital, other than the x-ray showed I had fractured my tibia in several places and also broken bones in the ankle.  I was going to need an operation, they gave my drugs whilst they reset the ankle and then moved me to the ward.  I cancelled the party.

The waiting starts – Its difficult for me to write the next paragraphs, I work in and love what the NHS is, but unfortunately not all care is perfect, and when you’re on the receiving end even the smallest thing can be seen as so wrong and big.

Firstly, I have received some first class care, from a few staff members, these are the things they did that made the difference.

  • Told me their name. (more than once)
  • Stop for a brief chat.
  • Took their time when helping me move, wash or help use the toilet
  • Listen to me
  • Asked what I could do and what I needed help with.
  • Just pop their head in.
  • Told me everything they were about to do before they touch or moved me.
  • Gave me encouragement
  • Made sure things were put back in my reach before they left.
  • Asked if there was anything else they could do for me.

 

However unfortunately this was not always the case, the most frustrating was communication issues.

When I came on to the ward I was swabbed in the month and nose, no one told me why then at 2.30 in the morning I was woken and moved to a side room, told I had tested positive.  I had to ask for what.  MRSA was the answer. I was given stuff to wash with every day and told I would be re swabbed in 5 days,  by day 7 this had not happened,  I had to asked,  2 days later I had to ask for the result,  I was clear.

From admission I was nil by mouth waiting for an operation, however when the surgeon came round at 10.30 on day 2, I was told I would not be operated on that day.  However, this message did not seem to be passed on to the ward and I was not fed at lunch time, again I had to ask.  I ordered tea, but it never came.  The nil by month went on until day 8, having to remind people every day I was nil by mouth became frustrating, staff were often putting water within my reach and asking if I wanted lunch or not giving me any when I could have it. coupled with the problem of being told I was on/off the list for an operation. Sometimes the nursing staff informed me and offered food,  but often I had to ask.  On one occasion the nursing staff were told at 1pm,  but no one told me until 3.30pm.  I went without food and water unnecessarily many times.

Day 3 I heard the ward round outside my door but they never came in, I complained, but just felt like the buck was passed.  There was not enough time.

Lesson number 1 Not having enough time to communicate with your service user should never be an excuse, you might not have time but it’s likely that’s the one of a few things they do have.

The nil by month went on until day 8, having to remind people every day I was nil by mouth became frustrating, staff were often putting water within my reach and asking if I wanted lunch or not giving me any when I could have it.

I had some bad experiences will staff manually handling me.  Before the operation the leg was in a back slab, it was painful when moved and the heal rubbed constantly on the back slab, which kept me awake at night.

You learnt pressing the nurse call could mean anything from a 5 to 15 min wait, whilst it beeps continuously at you, the longest I waited was 25min.    On one occasion a staff member took the bed controls without me noticing or her saying anything, the bed was suddenly moved and I scream out in pain shouting, ‘let the patient use the controls’ –  she shouted back – ‘we never let the patient use the controls!!!!!!!!!!’  She also refused to use the glide sheet provided.

Lesson number 2 – The patient is the expert in how they feel and want to be treated.  Always inform the patient before doing anything around them, and if they can and it suits them let them have the control.

In part 2, I plan to explore, the therapy, how to be an occupational being in one room, the emotional roller-coaster and more waiting.

A week in the life of an Occupational Therapist with a disability – For #OTweek15

The World Federation of Occupational Therapist (WFOT) define Occupational therapy as ‘a client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement.’ (WFOT 2012)

“Occupation” is also defined as
‘everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do.’

The British Association of Occupational Therapists and College of Occupational Therapists (BAOT/COT) are asking members to engaging in OT week – (2nd – 8th of November 2015) and promote the work and role of an occupational therapist.

This year, I thought I would use social media to promote occupational therapy as this is an occupation I enjoy. I will be posting on my Twitter, and Instagram accounts, as well has updating this blog on a daily basis.

I hope to show ‘a week in the life of an Occupational Therapist with a disability,’ to both demonstrate what my job entails and how I as a person with a disability engage in the occupations I want to, need to, or are expected to do, explaining any modifying of the occupation or the environment that supports my occupational engagement.

Occupational therapist think of occupations in three area, self care, productive and leisure. I will share photos and posts of occupations within these three areas throughout the week. Please feel free to share, and ask questions at any time.

Rachel @OT_rach

Day 1 Monday 2nd November 
For those that are not regulars to my blog, I have a right hemiplegia/cerebral palsy diagnosis due to lack of oxygen to the brain at birth. I also have dyslexia.

This morning started like most days, with pussycat my cat waking me promptly at 7am.
I’m currently recovering from a sprained ankle meaning first thing on morning the trip out of bed to the bathroom and downstairs to feed the cat can be a painful and tricky one.

IMG_0370The morning is mainly self care tasks, I sorted out the washing and prepared my breakfast. Carried both back upstairs in the washing basket. I find it difficult to balance going upstairs whilst carrying something so tend to place the basket on the stairs two at a time. After my breakfast I have a quick shower, my shower has handrails and a seat.
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Although my right hand is not as weak as the my right leg/foot, I still find some fine motor skills difficult like doing zips and buttons. I tend to avoid these in clothes. Typical outfit for me for work would be leggings and some sort of dress I can pull over my head, and slip on shoes.  And of course wearing my I ❤️ OT badge.
imageThen the productivity starts. I packed up my lunch and prepared to leave the house and drive my car, which is an automatic adapted to the left accelerator, to work. (I work in acute psychiatry)

This morning I had a first year OT student start. I spent some time replying to emails from Friday. I explained the nature of the OT team to the student, before taking her to a multi-disciplinary team (MDT) meeting. Theses meetings happen daily and every patient on the ward is discussed. This was followed by a formulation meeting for a patient that is been with us for about a week now. It was agreed this patient could have leave to the occupational therapy department. I then took this patient over to the department, showed them around and gave them a copy of the timetable. The person expressed an interest in the pottery session.

I spent a little more time with the student talking them through the morning. We then joined the OT team for  lunch, chatting about our weekends, comparing trick or treater experiences and I also checked my twitter feed.

In the afternoon I had some mandatory training, Basic Life Support. This included using mannequins to do CPR practice. I find it difficult to get up and off the floor so asked the tutor if the mannequin could be placed on the table in order for me to engage.

Once’s the training was over, I give the team a quick ring to check that the afternoon at gone well. I then drove home to write this blog. Which I’m dictating using Siri on my iPhone. Having dyslexia, this is often a tool I use when writing a blog or tweeting.

I’m staying at a hotel in Leeds tomorrow night so will be packing.  As I’m getting the train I need to think about fitting everything into a small suitcase that I’m able to lift and manipulate on and off the train independently.

For some leisure this evening, I’m going round to one of my oldest and dearest friends house’s. The biggest challenge visiting Dominic’s house is that his living room is on the first floor. He also has a very low sofa which I find difficult getting off. His house is also a no shoe house which is fine but with the current pain I’ve got in my ankle I prefer to wear shoes for support. To combat this I’m taking my slippers, and Dominic as usual will have to help me get off the sofa.

Day 2 Tuesday 3rd November 2015

Occupational therapist are interested in enabling people with their daily routine, as mentioned in yesterdays post, my cat helps me with my morning routine by waking me everyday at 7am. However this morning I changed my routine slightly much to pussycats annoyance.

Having looked in my dairy I knew I had to get in to work early this morning to fit everything in before leaving promptly to catch a train. As i can be slow on a morning, I had prepared last night by showering, packing an over night bag, preparing my lunch and setting out my clothes for the morning.

IMG_0388I chose to get dressed before going down stairs to feed the cat. Getting to work 1 hour early, I spent this time catching up on emails, before a 9am supervision session with my student. A quick meeting with staff to plan the day and help set up the morning construction group, which is a new group to our timetable. This group will ofter service users the opportunity to make objects out of wood. The first few weeks is concentrated on making the shadow broads that will be used to keep a track of what equipment we have.
This was followed by the daily MDT meeting and two formulation meetings for new admissions which took me up to lunch time. After lunch I pop to my ward to introduce myself and role to a new admission, encouraging them to attend this afternoons session, and made plans to see then again on Thursday.

I then had a supervision session with one of my band 5 OT in which we discussed a person I had been working with last week, but had now moved the band 5 ward. We discussed my assessment so far, and the plan I had put in place for the OT assistant to follow.

This was then followed by a catch up with the student, who had been in the baking session this afternoon.
I left work early to meet up with my mum and catch a train to Leeds.

I’m currently the chair on the BAOT Northern and Yorkshire committee, we have been asked to present at an OT conference in Leeds tomorrow, for #OTweek15. My mum Mary Booth, is a retired occupational therapist, but is also on the regional committee as the current treasurer.

We are staying in a local hotel in which I have booked an accessible room as I find it difficult to get in and out of a bath. Booking online is alway a bit of a gamble as sometimes a hotels understanding of accessible is different from mine.

Negotiating the journey from the train to the hotel, as always has it challenges such as getting off the train in a short time frame. Then faced with an escalator, my worst fear. The motor skills such as balance and coordination to step on to moving object is not my strong point, especially with the extra demand of a suitcase. So instead it was walk against the crowds to a lift. We then waited for a taxi and I prayed for a taxi that was not too high or low to get in and out off. We got a low one!!! Getting in and out other peoples cars can be difficult as my own car is the prefect height for me, which is why I much prefer to drive at every opportunity. But having driven in Leeds before the train felt like the safer option.

For some leisure this evening we are meting up with Amy my brothers girlfriend who is currently in her 4th year of a Dietetics degree. Going somewhere new always presents itself with a level of anxiety for me. How will I get there? How far will I need walk? Most people rate a restaurant on the quality of food, for me its always about the quality of the seating. Will I be able get up for the chair without difficulty? Will there be enough leg room? Amy sent me the link to the restaurant and I didn’t look at the menu, instead I looked at the pictures of the table and chairs. In the confirmation email of our booking, it stated “some of our tables have high bar stools if this is not suitable for your party please contact us” so we had to ring to ensure we are not seated at the high tables.

Normally on Tuesday nights I would be engaging in the twitter chat #OTalk,( Otalk )which tonight is looking at how we promote OT, but I’m out for a meal.  However I am planning on doing a bit of OT promotion with Amy and some of her Dietetics student friends, having packed some stickers saying I love OT for them to wear during dinner.

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Day 3 Wednesday 4th November 2015

FullSizeRenderToday has been a productive one witha little bit leisure but not a lot of self care. My nights sleep was poor due to an uncomfortable bed in the hotel, waking throughout the night with back pain. As I left pussycat at home, I relied on my phone to wake me up, however my back did this for me. I decided against the shower, as it had high step up and no hand rails.

The productive part of my day was attending the first OT sessions at Leeds Teaching NHS Trust, in my role as chair of BAOT Northern and Yorkshire committee, along with Mary our treasurer and Keith our careers promotion lead.

You can see what the Leeds teaching NHS trust OT’s have been getting up to all #OTweek15 by finding them on Twitter @LTHTrust and @LTHTOT.

In brief they are running daily information stalls with a different theme each day to promote OT to both colleagues anIMG_0409d patients. They also hosted their first ever OT sessions, which was an opportunity for OT’s across the trust to get together for some CPD and hear what each other have been getting up to. I was particularly impressed with a presentation by Claire England – Senior OT, who presented ‘Life in colour – developing an outpatient pain management group for teenagers.’ As a advocate for group work, it was great to see what Claire and her colleagues had achieved.

We then got some lunch before heading back to the train station. As we were traveling off peak the station was quieter and therefore less anxiety provoking. Although by this time I was feeling pretty tired, having done more walking than usual. I began to think about how I needed to save some energy for rest of the week.

I have plans to meet a friend tonight, go out for bonfire night tomorrow and catch a train to London with my family early Friday. However as I sit on the train with pain in my back and right leg, I realised I needed to make some sacrifices and rest my body. I decided to ask my friend to meet earlier and somewhere close to my home, and have resigned to the fact I need to miss tomorrows plans for bonfire night to conserve some energy for the weekend.

I have also connected with Jo Southall on twitter today, a student OT who runs the Facebook page ‘DisabilOT’. She is running a twitter chat tonight at 7pm #OTandME15 for OT’s and the general public to engage in. I’m hope to join in from my bed later tonight.

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Day 4 Thursday 5th November 2015.

Pussycat appeared happy to be able to wake me as usual this morning, however today was one of those days I prefer to refer to as a codeine day. Being in pain it took me a little longer to get ready, meaning I did not have time to prepare some lunch.

The productivity started with supervision of the fitness instructor, followed by the daily MDT meeting. I then met with a colleague from the trust research department as I had identified some patients for her to see today as part of a research project.

This mornings groups included pottery and knit and natter, which were ran by the OT assistants. I spend some time arranging Section 17 leave (a legal requirement under the mental health act to allow a patient to leave the grounds of the hospital ) for one of the occupational therapy assistants to take a patient out on some leave this afternoon for a meal.

imageAfter lunch – my student and two of the band 5 OT’s ran a group to explore the importance of sleep, asking the group members firstly to make a mind map of things that help them sleep. Finishing the group with something practical, making lavender pouches, from lavender that was picked in the garden earlier in the week.
Once the groups had finished, the OT team meet for our daily handover and we discussed three new referrals.

I then spent some time with one of the band 5 OT’s who is new to the team and discussed a functional assessment she is planning on doing tomorrow morning. Going over which standardised assessment she might like to use and the paperwork the trust has for completing assessments.

After this we both spent time writing up notes for the patients we had seen today.

I’m on holiday from work tomorrow, and having been out off the office yesterday I had a little bit to catch up on so stayed late to answer emails.  Luckily my office is on the first floor and has a large window, so I was able to enjoy a fireworks display whilst working.
Once home my mind turned to the weekend. Travelling to London with my mother, brother and his girlfriend. I began to think about what we had planned and which category of occupation the purpose of our visit might be. I decided it was self care. Unfortunately we lost my grandmother this August. She lived in London for most of her life and wished for her ashes to be spread on the field across from her old house.

Feeling quite tired I made some tea, packed my suitcase and engaged in leisure occupation of watching some television, catching up on a few things I’ve missed during the week.

Day 5 6th November 2015

Another change to the daily routine this morning, getting up at 6am, pussycat looked most confused. As mentioned yesterday I have taken a days holiday from work today. I collected my brother Dan and his girlfriend Amy on the way to the train station, where we met up with Mum.

We caught the 7.32IMG_0438am Grand Central train to London. On the train we chatted about our weekend plans and played a game of Self care, Productivity and Leisure. Discussing occupations we have engaged in this week and which category we felt they fitted in to. For mum washing her clothes was productivity however myself and Amy felt this was more self care. Amy spent some time spell checking this blog, I think this was more productivity for her however I like to think there was some leisure in it some where. Dan slept for most of the journey – self care?.

Occupational therapists should allow the person they are working with to define which occupations fit in to which category, as what is self care to one person could be leisure to another like getting your hair cut. For some people cooking is productivity and for others its leisure .

Amy a dietetic student then invented a game, Protein, Carbs or Fats, naming food type and getting us to chose which they belonged to.

IMG_2422Once in London the leisure occupations started, we ditched the luggage and ventured out. To lessen the amount of walking we decided to get on a tour bus. Even though we know the city well, Mum lived her for the first 40 years of her life, having both me and dan here, a tour bus is still a great way and easy way to see the city.

Getting to the hotel about 5pm, although we did not do to much walking my ankle was really painful, so a short rest whilst I wrote this blog, before going out for food at the first restaurant we come across. My mind is ready to enjoy a night in the city of my birth, however my body is telling me its time to rest.

Day 6 November 7th November

Just a quick post today, a woke in the hotel room this morning, (i should point out a normal week does not include two overnights in a hotel, just so happens this week is a busy one.) But i think its a good example of how the change of environment impacts on my ability to carry out a my normal morning and self care routines.

I have booked the accessible room again, this time the bed was much more comfortable although very low, a great level for someone in a wheel chair to transfer, but not so good for me to stand up from first thing in the morning. Also the bathroom was sort of accessible, with a very low bath, however still not easy for me to get in and out of so I washed at the sink and washed my hair over the bath .

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We decided to take a taxi from Kings cross to my Nan’s old house in East Acton. There we meet with Nan’s old neighbour, my cousins and Dans god mother Pam. We eat cake, drank tea, reminisced, before venturing out in the rain to say good bye to Nan and scatter her ashes on the field across from her old house.

After this we chose to indulge in a spot of shopping, one of my favourite occupations, Portobello market is not far, however due to the rain we opted for Westfields shopping centre instead. However on a Saturday, it was really busy. Luckily I know this shopping centre well so could plan our route to minimise stress and walking distances.

We traveled back on the underground, you already know that escalators are my worst fear, and the one’s on London underground seen to go much faster. I’m not as scared about going up as I am about coming down, so with the aid of transport for London’s guild to step free underground https://tfl.gov.uk/transport-accessibility/wheelchair-access-and-avoiding-stairs and my memory I could work out a route that did not including going down any escalators, however at times this does mean walking further. To manage going an escalator I need to have free hands and someoneI trust in front of me.

IMG_0463Feeling pretty tired on the walk back to the hotel, we stopped for fish and chips to eat in the room. Dan and Amy had arranged meet some friends in Soho, again i really wanted to go, but needed to listen my body and rest.Back at the hotel I had some time to review twitter and see what people were tweeting about today. Jennifer Creek has challenged my use of self care, productivity and leisure as a way to explain categorises of occupations, I love to be challenged and yes she is very right she says, categorisation of occupations are artificial – only appropriate or useful for limited professional purposes.

Day 7 8th November 2015

I had a slow morning as our train was not till 9.48am and the hotel was directly opposite the station. We were leaving mum behind has she has business in London.

At the station we had some slight drama, as we arrived and sat down to wait for our train, next to us were three unattended supermarket shopping bags. I asked the people around if they belonged to anyone but no one claimed them. I rushed to find a member of staff to inform and showed them the bags. By this time Dan and Amy had been watching the bags for over five mins, when a woman walked in from outside and explained she could not get signal on the on her phone so had gone outside. Slightly frustrated about the lack of thinking this women portrayed, we walked to catch the train.

I tried to be productive during the journey home, spending some time making a storify of #OTweek15 however the wifi was not great.

Once back up north, I popped to my mums to refill her cat feeders before heading home. I had planned to catch up on a some work, but instead got a shower, my first opportunity to really feel clean since Friday. I then put on my PJ’s before watching some telly, finishing this blog and the storify of the week.

It all starts again tomorrow.

I’d be interested to hear what you thought of this weeks blog. Please leave any comments below, and thanks for reading, I have enjoyed writing it.

An update on my Six challenges from #COT2015 for #OTweek

Following the College of Occupational Therapists (COT) conference this year, (#COT2015) I wrote a blog about my experience and learning and set myself 6 challenges, 4 months on I want to revisit this blog and review if at all I have addressed or met any of my challenges.

You can read the original blog here College of Occupational Therapist 39th annual conference June – 30th July 2nd 2015 Brighton #cot2015

To put theses challenges into context for blog readers I work in an acute mental health inpatient setting.

Challenge number 1. Look at how my team can introduce mindfulness in to our timetable.

I have discussed this idea with the team, however it as yet is not part of the timetable, first some of the team will need to access the training that is available in the trust and then I’m hoping to revisit this with the next timetable review meeting.

Challenge number 2. Revisit the TRAMm model and get my CPD up to date, improving how I measure my CPD.

I am now active in using TRAMm I update my TRAMm tracker on a weekly basis. I have also presented how to use TRAMm to the other OT clinical leads in my trust, as a result others have started to use the model. Within the OT learning network I help to co-ordinate we are completing a TRAMm Trail at the end of each session for all participants to use.

Challenge number 3. To ensure within my service the voice of occupational therapy is both heard and fully understood, along with thinking about and developing a plan for how best to promote OT within the trust, and wider for this OT week.

This is and I think will always be a work in progress, since the conference I have tried to be clear with colleagues about the work i have done with service users explained the core occupational therapy and helping them understand OT as a treatment process, and not just someone that does art or cooking. I continue to work with the OT professional Lead and other OT clinical leads to develop the service. For OT week, the regional committee (which I chair) will be in Leeds for an event. We also plan to tweet and retweet what OT staff and students in the region are doing during OT week, and hopefully further promote Occupational Therapy.

Challenge number 4.  Are mine and the intervention of my team truly client centred, or just what we have always done? Further refection and discussion to be had with the team.

Again I feel this is an ongoing challenge that needs further thoughts. Running an open time table with regular groups it can be easy to become complacent and go though the motions. I recently attended a CPD event with Jennifer Creek called getting back to basics, and this has encouraged me to relook at core OT skills like activity analysts.

Within supervision with OT assistants i have revisited this core tool to ensure they continue to use the groups they run as assessment and treatment tools, constantly reflecting on their interaction with service users and use appropriate grading and addition skills. As for my own practice being client centre,

I have recently worked with a person who challenges me everyday, getting the right balance for this person to meet their goals, whist remaining safe. It is a daily discussion with the MDT, however the team have reflect that least restrictive practice works well with this person and access to occupational therapy and the the the OT team has been central to this persons care.

I have reflected on the need to discuss my and the MDT decision making process with the OT team on a daily basis to keep everyone working together towards the same goals for this person.

Challenge number 5. Improve the access to football and sports.

Shortly after returning from conference I had a meeting with a local sports complex, we now have access to those resources at the complex once a week. We are now able to offer our service users a weekly physical session in an everyday sports environment.

Challenge number 6. With my team to concentrate on how we can use the garden space better.

We now have a dedicated garden session, which all staff engage in, we have also worked with the trust volunteer service and currently have one volunteer helping with this session. the garden area is beginning to be a place people enjoy spending time in, and we have also used the space run other sessions like a knit and natter session.

So in conclusion four months on from the conference, I still have some way to go, but feel the team have made a great start meeting the 6 challenges.

I’m attending the OT show at the end of the month so let’s hope i am equally challenged at this event.

In memory of Joyce O’Connor (11th October 1919 to 23rd August 2015)

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My nan was one of the most amazing women I knew.

She didn’t  changed the world, wasn’t an explorer, a great inventor or an inspiring leader, she was however a funny and caring woman to humans and cats alike and most importantly just my nan.

Born in 1919,  she has seen a lot of change. Living her younger years in Norfolk,  moving to London as a married women and stating a family. She brought up her son and daughter single handedly,  after her husband was killed in a motor bike accident in 1952.
She spend her life caring for elderly family members and cleaning houses for a living to ensure her children had opportunities she never had.  In later years she help bring up her five grandchild and she open up her home to family’s who needed a place in London to stay whitest their sick children were in hospital.
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Thought out her life she took great pleasure in the company of cats, many were known just to move in. She was out lived by happily named pussy cat, who now resides with me.
Everyone that knew her or meet her enjoyed her company.  When in London she had many a visitor,  most of my close friends have known her hospitality in hotel O’Connor East Acton.
A favourite story’s of her’s is how she would cheer up the jehovah’s witnesses that regularly visited by putting bailey’s secretly in their tea.  Her response when we told her you can’t do that nan,  well they shouldn’t be so miserable.
She made the move after a fall, to live in Middlesbrough to be close to her daughter,  the last two year of her life was spent getting out more than she had in the past ten.  With regular visits out to mine and mums for Sunday dinners. We spend our last Christmas  together in my first house. One of my favourite memory’s is celebrating my 31st birthday with her and my friends in the garden of her care home,  or #grannyInTheGarden as we called it.
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She loved an ice cream and we would often pop to Redcar and Saltburn, to indulge this.  One of her last trip out was to the cinema where her grandson works to see Paddington bear,  her first cinema trip for 30 year.  She laugh from start to finish.  Nan had a laugh that was infectious and she taught me to always see the brighter side of life.  Something I promise to try and carry on.
She would joke about living to 100 to get her letter from the queen, unfortunately she only made it to 96,  but in her last months she talked of living a good life and let her family know she was ready.
She might not have changed the world but her love and kindness is imprinted on many hearts.

College of occupational therapist 39th Annual conference, June 30th –July 2nd 2015 Brighton. #COT2015

I’m on the train home from Brighton after attending this year’s conference, and trying to use the time productively to write a blog about what I have seen and learnt.

Before the conference I downloaded the COT conference app, which can be downloaded from any app store for free, this was a great resource, both before and during the event. I spent time picking what I wanted to attend reading their abstracts and viewing any posters that had been uploaded.

Day 1.IMG_8448

Registration started from 11.30 after which I had the time to put up my poster, and add my face to the Twitter wall of fame.
We were welcomed by Julia Scott (CEO of COT) and Sara Foster (chair of council) as we walked in to the opening plenary. Julia then opened the conference by introducing Ruby Wax, who entertained the audience with her wit, her recovery story and her move to become a CBT mindful therapist. If I’m honest I was disappointed that she did not really link her talk to OT, however she gave an insight into her depression stating “depression is not about sadness, I could not get out of my chair”. She expressed a belief that mental health should be explored within the school education system and that by teaching children about menIMG_8461tal health and giving them tools like mindfulness to cope with their emotional issues this would equipment them for life. Ruby advocated trying new occupations, which can help with the recovery progress. She went on to explain how mindfulness, slowing down, and focusing on the moment can all help with your overall emotional wellbeing.

Mindfulness as a therapist is something I have not used, I have attended some session about mindfulness, but always want to ensure my interventions are occupation focused, I think Rudy’s talk and the twitter chat about what she was saying has helped me further understand how mindfulness can help with engaging in both routine and new occupations.

Challenge no 1. Look at how my team can introduce mindfulness in to our timetable.

IMG_8470My first workshop was Session 4 – How to measure your continuing Professional Development and how the TRAMm Model can help. Ran by Sarah Lawson and Deb Hearle.

Twitter account @TRAMMCPD

Wed-site www.trammcpd.com

TRAMm (Tell, Record, Activity, Monitor, Measure) is a model I first become aware of in an #OTalk more than a year ago. I have begun to use it for my CPD and appraisals at work, but always struggled with the monitor part. I really enjoyed the workshop it gave me confidence that I was using the model correctly and further ideas about what was meant and how I could evidence the measure part better.

Challenge number 2 revisit the TRAMm model and get my CPD up to date, improving how I measure my CPD. 

Welcome drinks followed this, a great chance to do some networking. To finish off the night I met with 18 other OT’s and student for an OT curry night – http://currynighttees.wordpress

Day 2

The opening plenary speakers was Suzanne Rastrick @SuzanneRastrick

Suzanne is the Chief Allied Health Professions officer at NHS England, she aimed to give us an overview of how the general election results will impact out profession.

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She began by reminding us of the government priorities for health which include obesity, diabetes, general practice and the culture of the NHS. Understanding what the commissioners big picture looks like is vital, and she focused her address on how we has AHP’s can ensure commissioners and the government understand what we do and why we do it, giving us some useful resources like the commissioning for outcomes guide and how the impact of OT may be demonstrated through long term qualitative outcomes

Suzanne argued that commissioners don’t understand OT, as we don’t focus on explaining what occupation really means, she highlighted when service users are given their own budgets it’s OT’s and AHP services they are often choosing to purchase. She encouraged us to sell ourselves better, within our services and not to be afraid to use our words in doing so, she also advocated using social media as an away to connect and engage with wider audiences.

Her words were brought home even more, during the coffee break when I was at the IMG_8612COT stand among the exhibitors exhibition, picking up flyers for this years OT week 2nd -8th November 2015 – which is focusing on getting us to demonstrate how OT improves lives and saves money through early intervention and prevention.

Other highlights from the exhibitor’s hall were catching up with the South East BAOT regional group, filling in their survey monkey and discussing how the conference is coming to the Northern and Yorkshire region next year.

I also spend time talking with Imply showers and hearing how they are working alongside OT’s to ensure their products are the best they can be. Another great idea I came across was from the stair lift recycling service, who also recycle mobility scooters.

Challenge number 3 – to ensure within my service the voice of occupational therapy is both heard and fully understood, along with thinking about and developing a plan for how best to promote OT within the trust, and wider for this OT week.

I attended session 16 –papers

16.1
 The role of occupational therapy in forensic settings: reducing risk of reoffending Connell C,
 Birmingham and Solihull Mental Health Foundation Trust, UK – Connell explained her research themes were occupational perspective of risk assessment and formulation. Volitional realignment, developing protective factors, community integration, and enhancing understanding. She explored OT’s understand of the volitional contribution to offending and how OT’s can use occupation to realign that behavior.

16.2 
How do people with mental health and substance misuse problems experience belonging? Blank A1, Semb R2
University of Worcester, UK1, Buskerud and Vestfold University College, Norway2. Blank explored if doing was connected to a feeling of belonging, she explained how those with mental health problems might have barriers to belonging, these included early family experiences, embodied feelings of belonging, concluding that doing is important for health and well being but may not be necessary for belonging.

I found these papers of interest, reflecting on the importance of occupation and its power to change lives. The concept of belonging made me think about where OT to should carried out in hospital, does an OT department environment create a since of belonging?

During lunch time I meet up with a friend from a mental health trust in London, who wanted a twitter lesson, in order to introduce it as a tool in their next in service conference. Twitter as a CPD tool is something I have been exploring over the last few years, and find it an invaluable resource. What is great about COT conference is they have really embraced twitter as a major part of the event. Giving priority seating to tweeters. Engaging in twitter within a conference is a hard skill to master but one worth having ago at. I feel it has improved my ability to multitask, and find it helps me concentrate better on what the presenter is says, waiting for that key message to tweet. Tweeter has become my note book, and can easily be turn in to CPD evidence with tool like storify here is mine form #COT2015 https://storify.com/OT_rach/college-of-occupationaltherapist-39th-annual-confe

The hash-tag #COT2015 was treading throughout the conference at its peak hitting the number two spot within the UK, see all the twitter states here http://www.symplur.com/healthcare-hashtags/cot2015/
IMG_8615Therese Jackson (@therese_jackson) gave this year’s Elizabeth Casson Memorial Lecture
 – Pushing the boundaries and leading the way. Therese is a Consultant Occupational Therapist in stroke, internationally renowned author and presenter.  Therese spoke about how Occupational therapy is promoting itself including the Guardian pull out earlier in the year, but reminded the professionals that while not in the public eye as much as other health professions, we should not become complaisant and remember the learning from the Frances Report to in general, ensuring that we deliver the best service possible. Therese made reference to the HCPC document preventing small problems from becoming big problems in health care, and the #mynameis campaign.

Therese gave examples within her own work and research of person centered care, putting both cost effectiveness and a good experience for the service user together. She made us think about if our interventions are truly client centered and meeting the needs of that person. We will be able to read the full lecture when it is published in BJOT.

Challenge number 4 – are mine and the intervention of my team truly client centered, or just what we have always done? Further refection and discussion to be had with the team.

IMG_1182My next session was Exploring the added value of using football therapeutically Pettican A1, Hynes J2, Pearson D2
University of Essex, UK1, Positive Mental Attitude Sports Academy, UK2. We heard from a service user who engaged in a football group as an adult mental health inpatient and moved to co facilitating a football team in the community with peers. There was lots of group discussion in the group about football and other sports, I reflected on how I could make better use of the football facilities we have on the PICU and intend to take this back to the ward manager for further development.

Challenge number 5 – improve the access to football and sports.

Wednesday was also the gala dinner, after a quick turn around we ventured to the Hilton hotel for lovely food, networking and a bit of dancing.

Day 3 

The third day was kicked off with Recovering ordinary lives: the next steps session. Led by Genevieve Smyth (@GenevieveSmyth), the College’s Professional Advisor, Mental Health and Learning Disabilities, together with Karen Morris,(@morrisKOT) Research and Development Lead from the College’s Specialist Section – Mental Health.’

They are currently analysing the results of a recent survey hosted on COT/BAOT website, which had 145 respondents. There was a discussion the importance of evidence based practice and some quotes from both commissioners and service users of the recovering ordinary lives document.  Comments from the audience stated that therapists need to ensure that they publish their research work and the positive impact on both service users and cost-effective services.

Next was session 67

IMG_867467.1 Making occupation matter in an intensive eating disorder day service Sørlie C, Cowan M South London and Maudsley NHS Foundation Trust, UK, they showed how  OT role within eating disorders, had been changed to ensuring occupation was at the heart. One way was to introduce an occupation matters group to discuss how service users felt about occupations and the barriers to them.   They also spent time talking to managers of service giving a presentation about what occupational therapy was using a quote I will definitely be using in the future ‘occupation is as important as food and drink.’  

I loved hearing in session 73.2 about their Urban Eden –  Brown L, Walton P, Hartman R, Clarke H, Dunne Mills S, Thompson P Manchester Mental Health and Social Care Trust, UK

Hearing how OT’s acquired a garden space and used it as a great resource as they had limited resources and space elsewhere in the hospital, I’m shamed to say that I hadn’t thought about gardening in the same way that they had. I was interested to see a list of activities that could be carried out in the garden space. I began to reflect on the occupational therapy garden I manage and how I don’t value its potential, much to one of my occupational therapy assistants annoyance. I think they will be pleased that I’m coming back from this conference with new ideas and an emphasis to concentrate on how we can use the garden space as a therapeutic tool more than just gardening –that’s challenge number 6. 

After lunch – there was two my workshops before the closing plenary.

I chose to attend Prepare for a Care Quality Commission inspection: view from a CQC occupational therapy specialist advisor by Booth M, Specialist advisor for Care Quality Commission, UK, and Clinical commissioning – what occupational therapists need to know, with O’Higgins H, Yeomans J Southern Derbyshire Clinical Commissioning Group, UK

Both were really informative, and gave insight in to these processes.

IMG_8723The conference was finished off with an inspiring closing talk “What have you got to do this week?” by Karin Turner who was in a car accident in 2008, she explained how this changed her life, leaving her with a mild brain injury.  She reminded us that as occupational therapists we need to remember the person before the accident or problem brought them to need our services.  She told her story of how an occupational therapist helped her to grade her energy levels and eventually was able to return to work, however this wasn’t a straightforward story, with many bumps in the road, but she is now in a place where she can see a future and expressed a wish to train as an occupational therapist.  Truly one of the best outcomes.

The three days were over and as you can see from this blog I have learnt many things and I’ve set myself a number of challenges which I intend to get straight to work on.

#OTalk Tues 14th October 2014 – Hemiplegia

please take part in this Otalk about Hemiplegia

OTalk

The week (13th -17th Oct 2014) is Hemiplegia Awareness Week and as an occupational therapist with hemiplegia I thought it would be interesting to host an #OTalk on the subject.

When thinking about how to fill an hour’s Twitter chat, I first thought, well I have hemiplegia but I’m not an expert, so have done some reading, but this video with Al Murray may also challenge or add to your knowledge of hemiplegia http://www.youtube.com/user/hemihelp

I was also pleased to see an article in this month’s OT news (October 22(10) 2014 page 7), “Hemiplegia magic camps reach their Dynamo finale.” In which two occupational therapists Dido Green and Amarlie Moore work with Breath Arts Health Research to conduct clinical tests that examined how hand function and self-esteem can improve after children with Hemiplegia attended a magic camp and learnt tricks.

The article demonstrates that by engaging the children in fun and…

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Fair Pay for Angels – Why I am Striking

So why am I striking today Monday, 13 October 2014 for 4 hours 7-11am.

I’ve blogged before about how my parents are responsible for my political thinking, and striking is no exception.  I was brought up to believe you should look after those less fortunate than yourself and to put society’s needs  before your own.

I’ll be the first to tell you that the NHS is not perfect far from it.  But I truly believe that it’s central, to a caring society.  It’s the place where people go when they’re weak, vulnerable and in need of help. 

Continuing to improve and keep best practice with the patient needs being first.  Is best done in a service that is publicly lead and publicly funded, not corrupted by private companies that will put costs before people.  Just look at hold Pharmacy companies have over the NHS – making profit of people lives.

Don’t get me wrong cost-effectiveness is important to the NHS and there are some amazing examples that how this is currently being done.

So why in this time of economic uncertainty am I asking for fair pay, effectively being paid more for what I  do?  Well I’m not asking for me.

As a band seven working in the NHS I do okay.  I can afford to eat, fill my car with petrol and pay my mortgage,  however I’m single if I had dependents this will be a very different story.

The cost of living has dramatically increased, the weekly shop is more expensive, the yearly holiday becoming less affordable, filling the car and putting the heating on a weekly worry.

I happened to be in London this weekend and struck up a conversation with a taxi driver, as you do.  Once he learnt I worked for the NHS he called me an angel.  I argued with him saying I was not, I just do what needs to be done.

Maybe I was wrong.   NHS workers help people recover, they mend, extend, create comfortability, they change people’s lives – that sounds a bit like an angel to me.

Unison reports

People in the UK are facing the biggest fall in real wages since the 1870s. Thousands of public service workers have had their pay frozen and capped since 2010, and inflation means the value of their pay packet has fallen by an average of 16%.

All workers, whether they work in the public, private or voluntary sector, have faced major cuts in the value of their pay over the last few years. Meanwhile, the average director of a FTSE 100 company enjoyed a 14% pay rise in 2013, and dividends going to shareholders are expected to jump by 24% in 2014, hitting just under £100bn.

Rather than putting some of their wealth back into society, many millionaires (individuals and companies) are using off-shoring and loop-holes to dodge tax.  

Read more here http://www.unison.org.uk/our-campaigns/unison-campaigns/worth-it/the-facts/ 

That doesn’t sound fair to me, that doesn’t sound like society is looking after itself, that doesn’t sound like the angels are getting a fair deal.

Once they’ve looked after those in need, surely they should be able to go home and look after their own.

Fair pay for what they do,  that’s why I’m striking!