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.

A new OT in a non-traditional role.

It still seems surreal to me that I am actually writing this as a qualified occupational therapist! I have spent the past two years dreaming and hoping for this moment and at times not believing I would actually get here, but here I am.

This week marks my first week as a fully qualified and HCPC registered occupational therapist and it has fallen upon occupational therapy week so it feels even more special. I have been in my first post now for 4 weeks and I began working as a band 3 while I found my feet within the role and got to know the service users and different staff roles. 

My first role is a little different and non-traditional for an OT. I am actually titled an 'inpatient recovery practitioner' and I am working within a nursing team based within inpatient learning disability services. The role has been created to promote and enable a more 'recovery' focused model of care, which focuses very much on a person centred perspective and enables service users to make informed choices and decisions about their recovery and their care. I was very much attracted to this role as these philosophies reflect mine as an OT. This is reflected beautifully by Thew et al (2011):

"There is a strength & sense of empowerment that emerges from the fact our profession’s philosophy provides us with the knowledge and skills to follow many paths of need as indicated by those clients whom we profess to serve."

To promote a more integrated model of recovery, the role was also advertised to mental health and learning disability nurses. Although nursing staff within this role fit within the more traditional nursing role on the inpatient unit - I am essentially the odd one out! 

It has taken the past few weeks for myself and staff members to develop an understanding of my role as an OT within the setting and this is very much still a work in progress, although it is becoming clearer all of the time. I have learned that I needed to approach this role with an open mind and be open to different opportunities and experiences as we are all learning together. 

As I am based with the nursing team I am working full time on 12 hour shifts and night shifts... yep, night shifts! I have to be honest I was a little apprehensive of this at first! On the site they have a team of OTs working into the service already, so my role would not reside with them and this was hard to get my head around to begin with. Doing shift work means that no two weeks are the same, the days and nights I work are always different, which makes it difficult for me to plan any OT specific assessments or activities.

I was really worried that I was not utilising my OT skills and was working more as a nurse and from my learning as a student the risk of role blurring for OTs always in the back of my mind. We were graded on our competency on practice placements as students to specifically define the role of the OT to set us apart from other heath professionals. Now my definition has had to change to fit in with this more generic way of working...but this is not necessarily a bad or scary thing, it potentially has its negatives but it is actually a real positive. 

In relation to this Thew et al (2011) discusses that there will always be parallels and blurring of roles but in the ever-competitive nature of this world, the continued confusion of what OT can offer as a profession can lead ultimately to its failure. The profession however, needs to demonstrate it’s worth and unique contribution to the health and wellbeing of human beings well beyond the boundaries of traditional health and social care.

...In a nutshell, I have to take this opportunity and grab it with both hands and do the best I can to promote my OT skills and show how they can be valuable within the team of permanent staff within the inpatient setting. I can do that right?

From a personal perspective I have been utilising supervision and guidance from my supervisor who is an OT and this has been extremely valuable. At times I have struggled a little and felt a little lost as it is all just such a new experience. I am a new OT, it is a brand new role for OT and I am still in my transition from student to practitioner. Through supervision I have been able to reflect on my practice so far and I hadn't actually realised how much I had been using my OT skills already! It is very subtle to me because I am trained to think and practice in a certain way - but that is not how everybody thinks and I am bringing a brand new perspective to the role and I think that is really exciting.  From a professional development perspective I have enrolled on to a preceptorship programme which I will be completing with my OT supervisor and I will be attending meetings and training with the other OTs within the trust. I am also a member of the COT specialist section for learning disabilities and will be keeping my eye out for any CPD events which may be useful.

I have used a lot of theory from Role Emerging OT by Thew et al, 2011 as it was a really valuable textbook and support for me as a newly qualified OT going into a non-traditional setting. Here are some bullet points summarising some real positives that I can relate to my role:

• Opportunity to challenge yourself and create an OT role within a workplace. 
• Work independently and creatively. 
• Unique opportunity to further develop team working skills and an understanding of a diverse range of perspective of other team members. 
• In role emerging settings the heightened awareness of the benefits of occupation-focused practice seems to open up opportunities for the profession.

The role has really opened up my eyes to the nursing role within inpatient settings and how intense this can be. On placements I was never based with the ward based inpatient staff but usually with the therapy team who worked off the ward and came in and out for assessments and activities. I am working shifts and essentially practicing within a traditional role that would normally be associated with nursing staff. I am responsible for leading shifts and co-ordinating the day ahead, I can be in charge of the safe keys and money coming in and out of the unit as well as doing observations for service users. I am also named practitioner to service users just as a named nurse would be and can practice within all of these aspects of my role offering my unique OT perspective.

kronenberg, Pollard and Ramugondo (2011) highlight that our profession’s contributions towards global healthcare are being challenged by factors such as competition for limited resources, other professionals widening their practice, and pressure for generic rather than specialist workers. My role somewhat reflects this statement. However, while it is viewed as a challenge it is not necessarily a negative. If this is the way that health and social care is changing then OTs are in a perfect position to adapt to that change. We are such a diverse profession and we can use this to our advantage within new, non-traditional roles. Pollard (2011) discusses that change is not an abstract process, it is something that is resourced by the natural skills and abilities that people already possess and I feel OTs have the ideal philosophies and skills to facilitate change and adapt to new challenges and environments.

I am only just beginning my journey in this role and it is all very new. I fully acknowledge that it is going to be a challenge however, I have recognised that as an OT I have the perfect skills and abilities to rise to this challenge and can use this as an opportunity to promote the skills of the OT profession as well as learning from other staff within the MDT to ultimately integrate our skills and provide a person centred, recovery focused service for individuals within our care. 

References 

Kronenberg, F. Sakellariou, D. Pollard, N. (2011) Occupational therapies without borders, Volume 2, Towards an ecology of occupation-based practices. Edinburgh: Churchill Livingstone.

Pollard, N. (2011) ‘Occupational therapists – permanent persuaders in emerging roles?’ in Kronenberg, F. Sakellariou, D. Pollard, N. Occupational therapies without borders, Volume 2, Towards an ecology of occupation-based practices. Edinburgh: Churchill Livingstone. pp. 143-152.

Thew, M. Edwards, M. Baptiste, S. Molineux, M. (2011) Role emerging occupational therapy: maximizing occupation focused practice. Chichester: Blackwell Publishing.