How has the therapeutic use of self been used over time throughout Occupational Therapy’s history?
Physiological observations (or “obs” ) are recorded from patients in acute settings at various intervals, depending on how closely they need to be monitored for any potential changes. During and for 24hrs after thrombolysis, a patient’s obs are recorded every 15 minutes. Usually obs are taken every 4 hours although if one physiological aspect is fluctuating this is increased to hourly to keep a closer check on indications of any conditions which may adversely affect the patients health eg infection, dehydration, haemorrhage etc.
Usual obs taken for acute patients are:
- Heart Rate– usually 50-80 bpm, recorded by pulse or heart monitor
- Respiratory Rate (RR)– usually 14-20 breaths/minute, recorded by counting chest movements
- Temperature – usually 36-37’C
- O2 saturation– usually 95- 98% although smokers/COPD may have a lower target saturation set by doctor eg 85%
- AVPU– Alert/responds to Verbal/ responds to Pain/Unresponsive; measuring drowsiness with a shortened version of the Glasgow Coma Scale
- Glasgow Coma Scale (GCS)– patient’s level of consciousness cored out of 15. Note that a coma patient or toaster will have a minimum score of 3. Aphasic patients are scored out of 10, and you should test a stroke patient’s unaffected side since a side with hemiparesis does not truly reflect their level of consciousness.
- Blood Pressure (BP)- usually 120/80 (systolic over diastolic) although expected to be higher in stroke patients. BP is often higher in stroke patients, up to 220/110. A sudden drop in BP can cause patient to faint/collapse, known as syncope. A fluctuation in BP during sit to stand can also cause patient nausea and dizziness, and lying down can reduce these symptoms in this circumstance. According to NICE guidelines, BP should be ideally be 185/100 or lower for patients who are potentially suitable for thrombolysis.
- Blood Glucose– 5-7 mmol/litre is normal, 7-11 mmol/l indicates impaired glucose tolerance. Above 11 mmol/l indicates diabetes. Medication such as steroids can increase the blood glucose level in a patient. Higher blood glucose leads to reduced immunity and increased risk of seizures in stroke patients. According to NICE guidelines, patients with acute stroke should be treated to maintain a blood glucose concentration between 4 and 11 mmol/l.
“Difficult, but important”
Reflection is an important yet ethereal skill that all Occupational Therapists need to master.
Part of completing a reflection is an inner sense of discomfort (in fact the first stage of reflection as described by Boyd & Fales 1983) so it’s no wonder many people put it off and may even try to get by without it, perhaps carrying out token reflections just to comply with CPD or course requirements. To begin with, reflecting on your actions is something that requires conscious effort after the event but eventually, according to Johns (2000), it will become an automatic thought process even when you’re in the middle of experiencing the event. When deciding which model to use, it can helpful to find out what learning style you are according to Honey & Mumford. You can relate these to the knowledge types shown in Carper/Johns’ reflective models.
Below is a rough guide to the different models of reflection out there, and which situations they’re best geared towards. They are ordered (in my opinion) from the easier ones for the beginner who is trying to break down and evaluate a situation, to the more complex ones that build on the basics and hope to elicit a change in your personal beliefs and challenge your assumptions. Gillie Bolton suggests exercises for creative ways to reflect in her book Reflective Practice: Writing and Professional Development (chapter 4).
Like Inception, you’ll naturally find yourself going deeper with your analysis of an event the more experience you gain with reflective models. Enjoy the ride!
Gibbs reflective cycle (1988)
Good for: Good old Gibbs. Basic, good starting point, six distinctive stages. Makes you aware of all the stages you go through when experiencing an event.
Criticisms are: superficial reflection- no referral to critical thinking/analysis/assumptions or viewing it from a different perspective (Atkins & Murphy 1993). Does not have the number or depth of probing questions as other models.
+++++++++++++ Read more
The OT process is when we apply the theories of occupation in an ordered way to a practical situation. Many different models of the OT process have been developed, and they each attempt to guide a therapist through the stages of applying occupational theory to a practical client situation. Some models may be more useful in particular situations or with particular clients than others.
Part of the artistry of an being an OT, and the difference between being a technician and a professional, is being able to adopt a holistic approach and use a model most appropriate to the individual client’s unique blend of problems in order to achieve a positive outcome. Technicians follow instruction in order to carry out processes whereas professionals use a blend of artistry with science to determine the best model and interventions for each unique patient.
Some examples of OT process models are below:
- PEOP Person-Environment-Occupational Performance
- CMOP-E Canadian Model of Occupational Performance & Engagement
- MOHO Model of Human Occupation
- MoCA Model of Creative Ability
- Biopsychosocial model
- Max Neef model
- Capability approach
- Medical model
- Kawa (river) model
- Social disability model
- European Conceptual Framework for Occupational Therapy
- EHP Ecology of Human Performance
- OA Occupational Adaptation model
- OPM(A) Occupational−Performance Model (Australia)
You may have come across the term before, you may not, but if you’re an OT you’ve probably utilised it without realising already. Therapeutic use of self is a useful technique employed by occupational therapists in order to engage clients and therefore illicit a better outcome during the OT process. Essentially it’s being aware of yourself (your verbal language, body language, which personal information you choose to share…) when you’re interacting with a client, and using your own personality & interpersonal skills in order to build rapport and ultimately make the client feel at ease, motivated, and that they can trust you.
In order to use yourself therapeutically, you must first be aware of your interactions with a client to then be able to adapt them to suit the style of the client. It can be useful to consider some models in order to structure your thoughts, and provide guidance for an occupational therapy student who is just beginning to reflect on their own therapeutic style.
Taylor (2008) has recently proposed the Intentional Relationship model, which categorises the six therapeutic modes -or types of client-therapist interactions- into six categories.
The modes in the Intentional Relationship model (IRM) are: Read more
As a student getting your ideas across in essays is crucial in order to convey you have grasped the ideas and can see both sides. These skills will still be needed when you are writing or reading research papers once you’re qualified, or when you need to convey one or both sides of a treatment approach in a report about patient care to others in an MDT. Any points you make need to be backed up with evidence to make them valid.
Critical thinking requires quite a few skills to be carried out effectively, including observation, categorisation, analysis, judgement/reasoning, making final decision, persuasion, perseverance in repetition of examining facts, and objectivity. This last skill forms the basis of being able to critically analyse both sides of a situation or concept.
Evidence used in essays must be:
Appropriate – Making the same point as you and not similar or just on the same topic. Also must be recent unless it’s a historically seminal piece of work about principles or foundations.
Proportionate – Specific statements about defined populations or findings may only need one piece of evidence, but the bigger the statement the more evidence you need- views from for and against camps are needed to represent the whole debate.
Synthesised – How is it synthsised or worked into the flow of the essay? How does the evidence move your point towards its conclusion? So what if the research shows that ‘banana therapy is most effective for under 30s’ …what statement that you’ve made in your essay is it proving?
Recently I got to represent Occupational Therapy at a postgraduate event, and it was great being able to help future OT students by offering some advice here and there. A lot of them commented that it was really helpful having current students there, as well as the University’s admission tutors, and it made me cast my mind back to the stressful months & weeks before my interview when I’d have sat through the every episode of Big Bang Theory in return for a student godmother to ask three questions to.
Below are some of the most common questions together with the advice I gave:
How do I get OT shadowing experience?
You can try contacting local hospitals’ OT departments and asking them. However in my experience, the success rate for people obtaining shadowing experience this way is low. A better way is to use your existing contacts, and think outside the box. By this I mean think about who you already know, and think about all the places where OTs work (clue: it’s not just hospitals).
Some ideas are:
Traditional settings– hospitals, outpatient clinics, schools, nurseries, supported living facilities, day centres for people with learning disabilities, community health teams, hand clinics.
Non-traditional settings– mental health/psychiatric facilities, equine therapy/animal assisted therapies, assistive technology centres, research labs, prosthetic/orthotic clinics, chronic pain management clinics, palliative care/hospices, oncology depts, military hospitals/rehab centres, private schools, independent practitioners, prisons/criminal justice system, vocational rehabilitation, community-based or mental health outreach teams, A&E.
OTs are generally acknowledged to be the nicest people you’ll ever meet. The ones that I contacted ranged from willing-to-help to bent-over-backwards-to-offer-clinical-contact-and-photocopied-relevant-book-pages-for-me. Even if you don’t have a family member who’s an OT, ask around if anyone knows of one and you will be surprised. Then be shameless in approaching them directly for help! The worst they can do is politely decline, but I guarantee they won’t. Read more