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.
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.
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