Sensory Integration Module 1 - another string to my OT bow!

Earlier this year I was very fortunate to gain funding to complete a training course in Sensory Integration - an area that I have been interested in throughout my training and career. This was such an exciting opportunity for me and in May I attended the 5 day Sensory Integration Module 1 course in Birmingham ran by the Sensory Integration Network. 

It was an intense 5 days to say the least due to the vast amount of information that we had to cover in that time and in such depth too! We covered everything from the neuron right through every sensory system and how sensory information is received and processed throughout human development across the lifespan. The first 3 days were extremely theory and powerpoint heavy so I was thankful for the times that we were able to create visual diagrams of the different pathways because I am much more of a visual learner. The last 2 days we looked at examples of different case studies and this was so helpful to apply the learned theory to practice and it started to make a lot more sense!

The course was a great opportunity for networking and I met lots of OTs most of which worked in paediatric settings. I did however meet some who worked in inpatient mental health and learning disabilities which was great to share ideas and chat about how my role is different. 

After the course ended the learning really began and I spent a lot of time revising the information I had taken away with me from the course ready for the assessment. I created a collage of the nervous system pathways and cortex on my wall so I could map this out visually and I also watched a lot of YouTube videos. Youtube is a great resource for anatomy! 

The learning and revision accumulated to over 300 hours of study and I had to complete an exam on neuroscience, 2 case studies and a reflection as well as working full time! It really was hard work but I am very proud to say that the results came and I did pass! 

This now means that I have enhanced knowledge of sensory integration theory and more in-depth knowledge of the neuroscience behind it and ultimately means that I can now assess and make suggestions for compensatory approaches to sensory processing difficulties and ultimately address occupational performance for patients who may experience problems with this using the basic concepts of sensory integration theory. I cannot however use an Ayres Sensory Integration approach and professional standards of OT state that further postgraduate training is needed for this (Levels, 2, 3 and 4) to become an advanced sensory practitioner. 

I have already started work with some patients that I currently work with and I am producing personalised sensory profile documents for each patient who display sensory processing behaviours/challenges to enable the wider team to support the individuals with their sensory processing. Below is a refection of my learning, development and how I will utilise this in my current job role.

Enhanced knowledge and professional skills:

I have enhanced my knowledge in neuroscience and the structure of the nervous system and sensory pathways. This postgraduate learning experience has been invaluable to me as I completed a masters level degree in Occupational Therapy which was primarily research based therefore, did not explore anatomy and physiology in depth and my undergraduate degree is in Fine Art and not science based. Ultimately this has given me a basic foundation to develop my knowledge of sensory integration (SI) theory and the ability to apply this to supporting patients that I work with on a daily basis. It has enabled me to develop skills that have further enhanced my OT core skills in observations, information gathering, goal setting and intervention planning as I now understand and can recognise sensory difficulties and possible causes of these. This will enable me to support patients further in an enhanced, holistic and person centred framework, which is patient led according to their needs.

This training has enhanced my professional skills as an OT in actively promoting what OT can offer as a profession and will develop my role within the nursing team even further giving me specialist skills and knowledge to utilise. It has enabled me to highlight through observation, sensory deficits within individuals' daily routines, which I can now make recommendations for and implement sensory strategies.

Changing attitudes for me and my team:

Currently, there are no SI trained practitioners and a gap within the service to support patients with sensory needs. Having the skills and knowledge to assess for sensory processing difficulties and suggest interventions for these is extremely valuable and will ultimately improve outcomes for patients. Furthermore, from a professional perspective as Ayres Sensory Integration is a theory rooted within OT, it will further enable me to promote the philosophies of OT within the nursing team and the wider multidisciplinary team (MDT) ultimately changing professional attitudes and attitudes towards intervention and understanding behaviours exhibited by patients.

My team will notice the following changes and benefits:

·     The introduction of sensory assessments and screening tools and the discussion of these within patient development meetings and integration into individual care plans.

·      An introduction of sensory equipment to the environment such as; ear defenders, gym balls, bean bags, tactile sensory bins.

·      Suggestions of training sessions tailored for patients with learning disabilities introduced to current recovery college timetable and sensory themed activity groups.

·      Holistic person centred working, positive outcomes for patients and improved participation in daily living activities.

Barriers I may encounter as I implement change are:

• ·      Funding for equipment and assessment tools

• ·      Time to complete SI specific assessments and training

• ·      Willingness for staff in the MDT to learn and develop awareness of SI

• ·      Environment: secure unit, some sensory equipment may be restricted

My suggested solutions to the barriers highlighted are through training and information sharing within discussions involving the MDT and ward manager as well as individual care planning, thorough risk assessment and adapted/individualised training sessions for patients.

What!? You work nights!? What does an OT do on nights?

So it is 12:30am and I am wide awake. This could possibly be due to the hot weather but it is mostly due to the fact I am still in night shift mode after finishing my last night shift on Tuesday morning. I figured this would be a good time to do a blog post as I have been reflecting a lot over the past week.

Working nights is part of my role as an Inpatient Recovery Practitioner and it is the part of the role that tends to shock people the most and the part that I always get asked the question "what does an OT do on nights?"

At first I understandably felt quite negatively about this part of the role and was quite apprehensive! At first I, myself had no idea what an OT does on nights because it is not something traditionally carried out by OTs. You can see by the fact that I am wide awake at 12:30am on my day/night off that there are some negatives to working nights and it does tend to mess up my body clock a bit, however the positives and experience definitely outweigh the negatives. Working nights gives me an amazing opportunity to experience patients' evening and nighttime routines which gives me a rounded view of that person as an occupational being, how they function and how sometimes their night time habits and routines can affect their occupational performance during the day.

Evenings tend to be a lot more relaxed on the ward as week days during the day are busy with people having assessments, meetings, trips out etc. Being on shift in the evening enables me to engage patients in activities and groups in a much more informal way. I have realised that I have this sort of occupational filter in my head at all times when observing someone in a group or activity... like an internal MOHOST! I'm observing people all of the time and due to this I definitely document my activity notes differently to my nursing colleagues! Working nights and long days has definitely given me an opportunity to build really good relationships with the patients I work with and I feel that I have a better relationship with them in my role now when compared to if I was working off the ward.

Night shifts are a great opportunity to complete paperwork such as care plans and assessments and I'm thankful for the opportunity to complete these during a quieter time as a busy ward can be distracting in the day when completing care plans! I often get told that an OTs skills are wasted on nights and people do not understand what OTs can do on nights. However as part of the rationale for my role and the working hours it was discussed by management that even a nurses' skills are wasted on nights. This view is so true however, no professionals'  skills are wasted at all but it is something that always sticks with me and when I get asked "what does an OT do on nights?" or get told  "An OTs skills are wasted on nights, I don't see what you can do"

We can do anything.

Presenting at CWP's AHP day

Last week I co-presented at an AHP CPD event with my clinical lead OT. It is the first time I have done a 'proper' presentation at an event like this in front of a large number of people (or what seemed a large number of people to me!) and I was understandably very nervous! My presentation was an updated version of the one I discussed in my previous blog post and We discussed my role now 9 months on.

Attending the day and hearing about the current direction of health and social care really made me realise how important my job role really is. I don't really think about it much when I go about my day to day practice and the event really made me stop and reflect.

We heard from lots of inspiring OTs in non-traditional roles including cardiac rehab (Involving performing ECG's and blood pressure) and driving assessors! It was great to hear about how we as OTs can take our core skills and apply them to pretty much anything! The world is literally our oyster as the saying goes. Hearing other OTs talking about more traditional nursing aspects of their job role really made me reflect on my role and where I should be using this more as an opportunity to gain as many skills possible. So far I haven't undertaken roles such as physical observations (blood pressure, temperature and weight measurements) however, I have realised that I absolutely could do this and it will not stop me from being an OT and won't take away my OT core skills, it will only enhance them and enable me to apply these further to a different setting and a different skill set. This ultimately may make the service we provide a bit smoother for patients and my team as well as improving my knowledge of this aspect of the job.

Within my presentation I discussed some theory in relation to AHP's and I reviewed an updated systematic review:

Saxon, R. L., Gray, M. A., & Oprescu, F. I. (2014). Extended roles for allied health professionals: an updated systematic review of the evidence. Journal of Multidisciplinary Healthcare, 7, 479–488. 

The research highlighted current pressures and barriers within health and social care including; An ageing population, pressures for funding, long waiting lists etc. As discussed, AHP’s are identified by commissioners and services as possessing the key clinical skills and capability to bridge these service demand gaps and act as first point of contact within a patients' healthcare journey. In the paper they referred to non-traditional roles as 'new extended scope AHP roles' and discussed that these are being trialled with clinicians accessing specialised training outside the scope of their discipline which really reflects my role. It is discussed that these roles may involve identified tasks traditionally undertaken by medical, nursing, physiotherapy, speech therapy or other health professionals. Enhancing job depth by adding skills within a profession and expanding job breadth by working across professional boundaries.

This paper made me really excited and made me realise how relevant my role and similar roles are in the current health care climate. However, there is very limited research but the available research suggests that extended scope AHP’s could be a cost effective and consumer accepted investment that health services can make to improve patient outcomes. In terms of OT there are a lot of initiatives ran by the RCOT such as the 'improving lives, saving money' campaign however I think it is important for us as OTs and AHPs in these 'extended scope' roles to get our voices heard out there and prove that we absolutely are the change that can bridge these service demand gaps in healthcare. I am currently involved in a research project in work evaluating the Inpatient Recovery Practitioner role and gaining the views of both staff and patients on the role which is very exciting.

The experience of presenting on the day was a brilliant one that left me feeling more confident about presenting and really quite proud. When I stood up there and talked through the experience of being newly qualified and going into a brand new role, basically leaping into the unknown it makes me realise how brave I was and how thankful I am for taking that leap because I absolutely love my job and all the experiences it brings. It was also a lovely experience to stand up there and see so many familiar faces too! I met with OTs who had been my mentors and educators on placements and had the chance to catch up with them and chat about my progress and their practice. It was really great and shows the importance and benefits of networking at events like that.

Presenting about my role 9 months on showed how far I have come in that time and that I am more confident in defining my job role and actually understanding it! It has developed well so far and I definitely have a good role on the ward in promoting meaningful occupation, care plan input focusing on person - environment - occupation and this is facilitated and enhances as discussed above with my working hours. The patients have a good understanding that I am an OT and will often approach me to facilitate activity groups or 1:1 activities such as arts and crafts, gardening and cooking. The role is still a work in progress and I am developing all of the time.

This week I have also been catching up with tweets from the RCOT annual conference which I couldn't make this year. The tweets have been great and some of the themes I have discussed in this post seem to be a running theme through the conference as well.
This tweet from @Helen_OTUK from a presentation by the inspiring Jennifer Creek was brought to my attention and it sums up this post perfectly:

My message to any OT is to take that leap into the unknown! It feels scary because we are taught to practice in a black and white, established way through fears of role blurring and people not understanding the value of what OTs can offer. But when we do that we don't show our true potential because OT practice is far from black and white, it is every colour in the rainbow! Lets all be brave and take that leap to learning new skills and experiences and show our true potential because we can do anything!

I was on shift last week for the first time as shift leader with nurses who were completely unfamiliar with our ward as we had staff sickness. I was told by the end of the shift by the nursing staff "Wow, so you're a qualified OT? I am impressed... you're as good as a qualified nurse"

And whilst you could take offence to that, to me it was the best compliment ever! Improving and developing our relationships with our health professional colleagues is an important step in the journey and bridging those stereotypes and gaps in the MDT is vital. As is sharing our own OT values and skills with our colleagues. Lets be practitioners on the margins!

Going with the flow

So I am now almost 5 months on in my post...5 months! I honestly don't know where the time has gone. It has been busy and full on but I feel now that I am settling into my role and my confidence is growing on each shift. I was always going to take some time with it being a brand new role and me being a brand new OT but I am getting there. The beauty of that is that I can be creative with it and I can develop aspects of it further and make changes as I continue to develop more.

In December I co-facilitated a presentation about my role to OTs that work within the trust within learning disabilities in a variety of settings and this was received really positively and especially in relation to COT's Improving Lives Saving Money Campaign in regards to promoting OT and the impact of OT within a varying range of settings. I thought I would use this blog post as a bit of a reflection from the presentation as I have settled in more since then and to reflect and share some of my experiences so far.

Below is some information about the job description for my role as an Inpatient Recovery Practitioner and how this really reflected the philosophies of OT and how this fits into the inpatient setting. A lot of this is what attracted me to apply for the job.

Part of my role that can become a little confusing is the use of the language in it's title. Inpatient Recovery Practitioner... and I'm an Occupational Therapist which as OTs we know is a constant battle to define! As a combination, it can be a little tricky. (That's opening up a massive can of worms right there so I won't get too distracted from my point!) The language I am focusing on here is 'recovery'. 

The concept of recovery can be viewed in a very reductionist, medical model focused way in that someone with a physical health condition can recover from a broken leg for example. Recovery however is a complex process and can be viewed holistically in both physical and mental health which is an ideal perspective for us as OTs and how we practice. We would look at the person physically recovering from the broken leg, assess their physical and social environment but also focus on their anxieties around accessing the community again independently through a graded approach as the individual may have fears of falling again etc. But how does someone recover with a learning disability? 

In mental health the Recovery Model is commonly used and focuses on enabling a person to stay in control of their lives whilst living with a mental health condition. It does not suggest that the person will be able to recover or return to a place that they were before but just focuses on how to make the best of the situation they are in at that time. The Recovery Model is viewed as a journey and not a destination and focuses on the person and what is meaningful and important to them and does not just focus on the condition. 

 https://www.mentalhealth.org.uk/a-to-z/r/recovery

These concepts of recovery are transferrable can be used to support people with a learning disability. If you followed by blog as I student you may know I am passionate about Autism and a big part of my masters research and dissertation was focused on the lack of awareness of mental health conditions experienced in those with Autism and learning disabilities. Here is some brief theory that focuses on this:

• Rosenblatt (2008) revealed that at least one in three people with Autism Spectrum Disorder are encountering extreme difficulties with their mental health.

• It is highlighted that 40% of people with ASD have symptoms of anxiety comparative to 15% of the general population, resulting in low self-esteem, low motivation, increased challenging behaviours and lack of routine (Segers and Rawana, 2014).    

• Hirvikoski et al (2016) reported that people with ASD are at risk of dying prematurely with adults 9 times more likely to die from suicide.    

As with anybody, mental health conditions can occur at any time and with any person. It is not black and white which makes a recovery focus ideal for those with a learning disability and/or Autism. Through the model of recovery within the secure inpatient setting we can enable a person to be the best that they can be and improve/work on managing risk behaviours, highlight and provide the best support and approach for the person and work on goals and aspirations that are meaningful for the person. We focus on how we can best support a person's physical health, mental health, risk behaviour and their learning disability. It is so holistic and I love it! It is an ideal place to be in as an OT.

Anyway back to the presentation I did. I focused some of it on the challenges and positives of the role. I did not want to call the challenges negatives as I don't view them as negatives and on reflection a lot of the challenges are actually real positives!

• Newly qualified OT

Whilst being a newly qualified OT meant that it was all going to be very new and I was going into a new role I feel that this was both a challenge but a real positive for me because I did not have years of experience in a certain area and I didn't practise in a certain way. I was open minded coming in straight from my training with a variety of different skills and ready to apply these to any setting and in any role. I am currently working on my preceptorship booklet with my supervisor which is great for my learning, development and it has enabled me time to reflect on my progress so far and where I would like to take the role into the future.

• Working within a nursing team

On refection thinking about my role, I have actually done a really brave and scary thing for a newly qualified practitioner! I had no idea how a nursing team worked, the routine, shift times and different professional perspective, there was so much to learn! Now I regularly take the role of shift leader within the team and co-ordinate the day. I am also working in the role of a 'named nurse' but under the title 'named practitioner' and 'associate practitioner' and this involves me working with individuals on their goal and aspirations, writing person centred care plans and detailed risk assessments and my OT perspective is so important for this! I have been working with an individual and taking a compensatory approach to the physical environment as this has an affect on the persons mental and physical wellbeing and occupational performance. I was able to rationalise this with the very basic foundations of OT practice looking at the person environment and occupational performance and offering this perspective to the nursing team who have reflected to me that they would never have approached this in that way which is a real positive!

Some of the challenges are the logistics of the shift so for example, I cannot administer medication and therefore cannot be left on the ward on my own at any time. This can sometimes mean that nursing staff have to call in other nursing staff from other buildings to cover their breaks and can be a little bit tricky sometimes! 

• New to forensic setting

Again, this was challenging, all very new and a brave leap for me to make but it is such an amazing learning experience and an amazing environment for my first role. I have learned on a very basic level so far about different sections of the mental health act, criminal processes, restrictions, court proceedings etc etc. Paramount to this I have observed and developed an awareness of the affects of these legalities on the person. I have learned the affect of the secure environment on the person and how this affects individuals on a daily basis and their occupational functioning which is such an amazing learning experience as an OT.

• Defining my role

I have touched upon this in my discussion above really and I do view this as a challenge as most of us OTs do sometimes. How we define ourselves can depend on the area we work in and with OTs working in such a vast variety of roles, the task of coming up with one simple definition is pretty difficult! The way I define myself can be really difficult, and it perplexed a lot of the nursing and support staff that I come into contact with at first! However, I do take time to discuss my role when people ask me about it and I try to explain this as in depth as possible. It is a great opportunity to promote myself as an OT!

• Role blurring

Role blurring definitely occurs within the role and I was quite anxious about this and a little hung up on it at first. I kind of had to tell myself to relax a little, be open minded and go with the flow! I am definitely practicing within a more traditional nursing role but with a different set of skills and a different view point so where the roles do blur, I can hold on to my OT core skills and let them set me apart from the rest of the team. Although the roles and view points don't always differ too much and I do work with a great team who are very compassionate and have a person centred focus in many aspects of their work. Its about collaborating with the team to integrate our skills and provide the best service for our service users.

• Team view of OT

I was really worried about this at first and I guess it still does worry me a bit! I know that sometimes the team can have a bit of a negative impression of OT and I think this may be through a lack of understanding of what we actually do. I'm hoping that through my role I can show other professionals what OT is all about and offer an OT perspective within the team. Hopefully this will improve as time goes on and Im hoping that my role does not confuse things further!

• Shift times

Working 12 hour shifts including nights was a totally new experience for me at first and was a challenge however, it is so good from an OT perspective! I worked a night shift on christmas eve which is pretty much unheard of as an OT. Working shifts means that I literally see the service users at every time of day and see their routines, roles and occupations and how they function at all times. Doing observations on service users at different times of day enables me to engage them in 1:1 or group activities and get to know the person, their roles habits and routines and build up a therapeutic rapport. From a personal and logistical perspective the shift times mean that i skip all the busy traffic on my commute and I do get days off mid-week which is nice!

• Time constraints

• More difficult to run groups or plan OT sessions

These two link in together and reflect that I am doing mostly a traditional nursing role which means I don't get much time at all to do specific OT assessments or groups for example. Now I am settling into the role more I can see that I could fit these in at weekends and maybe in evenings and I am hoping to begin some groups that patients have asked me about such as; baking groups, art groups and a mat hatters tea party! 

I am really enjoying the role and all of the opportunities and challenges it is giving me and the chances to learn and develop as a newly qualified OT. Reflecting on my progress so far makes me feel really proud. 

References

Hirvikoski T, Mittendorfer-Rutz E, Boman M et al (2016) Premature Mortality in Autism Spectrum Disorder. The British Journal of Psychiatry 207(5): 1-7.

Rosenblatt M (2008) I Exist: The Message From Adults With Autism in England. London: The National Autistic Society.

Segers M and Rawana J (2014) What do we Know About Suicidality in Autism Spectrum Disorders? A systematic Review. Autism Research 7(4): 507-521.