Introduction to Occupational Therapy & Hospital Settings Practice Key Terminology

Key terminology used across both Introduction to Occupational Therapy Practice and Occupational Therapy in Hospital Settings at UniSA

Occupation

There are many definitions but generally, its groups of activities and everyday tasks named, organised, that have meaning and value to individuals and/or to a culture or community.

Health

A state of complete physical, mental, and social wellbeing, as well as a positive concept emphasizing social and personal resources and physical capacities.

Wellbeing

How someone feels and how being in environments or situations that match their needs can impact one’s self-esteem and sense of belonging.

What are the four main categories of wellbeing?

Physical, mental, social, and spiritual.

What are the nine categories of occupation?

Work, leisure, activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, health management, play, education, and social participation.

What is the difference between ADL and IADL?

Although both are categories of occupation, ADL is basic and everyday tasks like eating and showering whereas IADL are more complex and specific tasks to an individual like caring for others or mode of transport.

What are eight categories of ADLs?

• Bathing/showering

• Toileting/toilet hygiene

• Dressing

• Eating/swallowing

• Feeding

• Functional mobility

• Personal hygiene/grooming

• Sexual activity

What is the difference between independence and self-determination?

Independence is not depending on the existence or actions of others, not subject to external control or support whereas self-determination is a part of independence which is being able to make choices about what is done, how and when.

Why to OTs assess self-care (3 points)?

• To measure change and monitor progress

• To facilitate communication and decision making

• To evaluate programs and conduct research

When assessing self-care/ADLs of a client, what five things should you consider?

• Client needs, interests, and perceived difficulties

• Clearly define the nature and meaning of the activity for the client

• Understand the potential impact of persons’ condition on OP

• Identify contextual factors (e.g. social, personal, cultural) which may affect assessment

• Features of assessment tools

What is the difference between non-standardised and standardised assessment tools?

Non-standardised which therapists can decide on structure to cater to client needs, interests, and goals whereas standardised is standard procedure to follow which may require some training/experience depending on the tool.

When conducting a standardised assessment, what six things should you consider?

• Cultural bias of an instrument

• Requirements of a test like if there’s any specific environmental conditions and questions to be asked

• Physical focus of the assessment like is it cognitive or behavioural perspectives

• Time to conduct

• How data should be collected (either observational or interviews)

• If reassessing occurs, consider any time limitations and if its sensitive enough to one’s condition and prognosis

When conducting a non-standardised assessment, what does the therapist do?

Decide the structure of the assessment and the way it is conducted, where the client’s performance is not compared to normative data. This assessment could include an interview to gather info from the client or direct observation of the client carrying out the self-care task.

When preparing for a non-standardised or standardised assessment, what four things must be done?

• Collect everything needed for the assessment and set up the environment

• Schedule assessment with client/patient and relevant staff

• Be sensitive to persons’ needs for modesty and privacy

• Include relevant others like carers

During the assessment, what three things should be observed and analysed?

• What are the possible causes for the OP deficits?

• What else might you need to assess/think about?

• Are there any differences in what you are observing compared to what the clients or others have reported? If so, why do you think this is the case?

What are the performance criteria used to assess self-care/ADL (4 points)?

• Ability to get all supplies, set up tasks, perform, and terminate

• Ability to complete in a reasonable time and energy consumption

• Ability to perform safely

• Ability to complete activities in all appropriate environments

Interventions

Strategies/techniques/environmental adaptations when we work with a client after an assessment is completed.

When selecting interventions, what are five things to consider?

• Clients’ ability to learn

• Clients’ prognosis

• Time allocated for intervention

• Discharge plan and their environment when discharged

• Clients’ ability to follow through with new routines or techniques

What are seven common intervention techniques?

• Adaption

• Compensation

• Remediation

• Prevention

• Health promotion

• Education

• Consultation

Adapation

A type of intervention strategy which is an internal process within a person to respond to change, through repetition and practice.

Compensation and what are three examples?

A type of intervention strategy which is changing the activity and the environment to match client which may be use of adaptive techniques, routines or equipment’s/devices; environmental modifications; and use of family members/personal care attendants to assist with or carry out the self-care activities.

Remediation

A type of intervention strategy which involves changing a person's capabilities by impacting upon body functions.

Prevention

A type of intervention strategy which involves identifying and reducing risk factors through anticipatory action.

Health promotion

A type of intervention strategy which enables person to identify resources.

Education

A type of intervention strategy which involves educating ways to manage occupation.

Consultation

A type of intervention strategy which involves providing expert advice and information.

What is client-centred practice and why it’s important to OTs?

Client-centred practice is all about building a therapeutic relationship with clients on the basis of respect and partnership. Client-centred practice is pretty much the basis for OTs because it involves equal participation from both parties to negotiate, communicate, discuss and having the client as a very active contributor to their own goals with the help of an OT to make a plan centred around their goals.

What are four key aspects of the client-centred practice philosophy?

Collaboration, providing choice, involved in decision making, and clients actively contribute to their own goals.

How can we relate to clients (6 points)?

Through advocating, collaboration, empathy, encouragement, instructing, and problem-solving.

What is the difference between practice and conceptual models?

Practice are uniform frameworks that guide our practice, acting as the basis to help predict or explain a set of phenomena or behaviour whereas conceptual are more abstract and theoretical which provide a framework for understanding our client and the many factors that affect our clients.

Paradigm (concept, theory, hypothesis)

Used to describe distinct concepts, a philosophical and theoretical framework (e.g. occupational performance).

Theory (concept, theory, hypothesis)

Used to describe the principles of an art or science rather than its practice.

Model (representation, prototype)

Used to represent something physical or abstract.

What are two key conceptual models used in healthcare and OT?

International Classification of Function (ISEF) and People Environment Occupation (PEO) Model.

What are two key practice models used in healthcare and OT?

American Association of OT (AOTA) and Occupational Performance Process Model (OPPM).

What are Frames of Reference and how they are used.

A theoretical blueprint or philosophy within which programme planning may occur, depending on the situation, resources, and the therapist’s education and experience. It can be used as a conceptual lens (theory) which is determined before the client is encountered or as a tool (process/intervention) where a range of approaches is adopted, as long it is specific and meets the needs of the client.

Approaches (Method)

The practical application of a model or frame of reference on how you carry out intervention with a particular client(s) in a particular setting.

What are the seven frame of references in OT (only for this specific course)?

• Biomechanical

• Rehabilitation

• Cognitive-Behavioural

• Developmental

• Cognitive-Perceptual

• Motor Learning (re-learning)

• Sensory Intergration

What is the difference between occupational performance and occupational performance issue?

Occupational performance is the person or client performing the occupation whereas occupational performance issue is where the person or client is having difficulty or is incompetent to complete a specific occupation.

What are the seven steps in OPPM?

1. Name, validate, and prioritise occupational performance issue

2. Select potential intervention models

3. Identify body functions and environmental conditions

4. Identify strengths and resources

5. Negotiate targeted outcomes and develop action plans

6. Implement plans through occupation

7. Evaluate occupational performance outcomes

Clinical reasoning

There are multiple definitions of clinical reasoning however across all four definitions, clinical reasoning is a process used by therapists to determine an optimal and appropriate intervention(s) for a client from a holistic viewpoint based on one's experience and client's needs.

Why is clinical reasoning important in OT (5 points)?

• Allows to develop flexible treatment plans that considers the patients values, interests, and meaningful occupations.

• Helps us to balance evidence-based knowledge with client-centred practice.

• Assists us to make decisions based on our treatment context (e.g. acute setting, public, private, and community).

• Supports our ability to articulate justifications for treatment plans and recommendations.

• Allows us to engage in dynamic learning processes with other therapists.

What are the main six client resonings?

• Scientific: Diagnostic

• Scientific: Procedural

• Narrative

• Ethical

• Conditional

• Pragmatic

Scientific: Diagonostic clinical reasoning

A type of clinical reasoning which applies logical and scientific methods in decision making, may be focused on the condition and known populations statistics (e.g. People with uncontrolled diabetes have a higher risk of complications with vision).

Scientific: Procedural clinical reasoning

A type of clinical reasoning focused on following protocols designed for the relevant condition or identified concern (e.g. Educating a client following total hip replacement on precautions they need to follow when it comes to getting dressed for example).

Narrative clinical reasoning

A type of clinical reasoning used by therapists to consider the individual as an occupational being and make decisions based on client interests, roles, and occupational profile, mainly through interviewing the client. This links to the grounding theories of the profession such as the importance of meaningful engagement and client-centeredness (e.g. Prioritising certain performance skills that will assist with a client returning to a valued role such as caring for others or leisure activities).

Ethical clinical reasoning

A type of clinical reasoning used by therapists to determine what ‘should’ be done within the practice context which can include balancing client's values and wishes (often motivated by therapists) and is often seen where there is a conflict with family members' desires and/or the organisational context/limitations (e.g. Discharging a client to their home, in line with their wishes and providing support to minimise ongoing risks that may be present).

Conditional clinical reasoning

A type of clinical reasoning used by typically long-term experienced therapists which is a flexible and reflective process where therapists are able to predict and imagine different potential outcomes based on how known factors like the client's condition, environment, and context will interact.

Pragmatic clinical reasoning

A type of clinical reasoning where the environmental context and constraints are considered, which can be physical (e.g. limited resources), organisational, or socio-political (e.g. Equipment that is available under funding schemes is not a best fit however still supportive of functioning; time limited interventions due to length of stay, and prioritising intervention focus based on this).

Interactive clinical reasoning

A type of clinical reasoning where decisions are made based of the interactions with clients in order to foster a therapeutic relationship based on improving the client's wellbeing and outcomes for the client, which may be demonstrated through active listening, empathy, or motivational interviewing techniques to support the therapy process (e.g. Discussing a patient's interests while providing hand therapy exercises, asking questions about family members to further develop working relationship or incorporating humour).

Reflective practice and the benefit of it?

• The process by which practitioners reflect on their clinical reasoning, decision making, and practice outcomes and how our professional and personal lenses affect interaction with clients, which can be done in action (during) or on action (after)

• This helps identify what went well and wrong so alternative approaches can be applied to a situation or a person to achieve a more successful outcome.

What is the purpose of an OT assessment (6 points)?

1. The understand the occupations that are important to a client.

2. To identify the client's occupational performance, specifically looking at areas of current and potential difficulty.

3. To identify what environmental factors impact client's occupations.

4. To inform clinical reasoning about the factors which facilitate or constraint occupational performance for the client.

5. To inform collaborative goal setting and planning for intervention.

6. Assessment may be used later in the OT process to monitor progress.

What is OT assessment important in hospital settings?

Useful for anticipating the potential impact of changed capacity for OP, which is used as the basis for helping the client (and others) anticipate and effectively plan for changed OP after discharge.

What does a typical/general OT assessment process look like?

Client is admitted to hospital > referral to an OT > initial assessment (typically interview) > observational assessment > standardised assessment > planning for future (which could include setting goals, intervention plans, and follow-up).

What are five considerations for assessment in hospital settings?

• Time

• Location

• Access

• Patient characteristics

• Cultural responsiveness and safety

• Access to services to assess with assessment

What information might a hospital OT need to understand a clients’ OP before admission (4 points)?

• Usual routines.

• Areas of OP importance in client's life (valued occupations and responsibilities).

• Any areas of OP in which the client experienced difficulty (refer to the nine categories of occupations).

• Any strategies/supports which facilitated OP.

What information might a hospital OT need to understand a client’s OP during hospital stay (6 points)?

• How is the client managing OP within the hospital settings?

• How consistent/variable has OP been in hospital?

• Has the client's capacity or OP changed significantly from before admission?

• What have the opportunities been for OP?

• What factors might be limiting OP or underlying capacity?

• What is the client's/carers expectations/concerns for OP on discharge?

What information might a hospital OT need to understand a client’s OP after discharge (5 points)?

• Where will the client go after discharge?

• Requirements for OP (routines and responsibilities).

• Environmental barriers to successful OP.

• Resources available.

• Experience after previous DC (issues, strategies).

What are three main components of the overall OT assessment process?

• Initial assessment

• Observational assessment

• Standardised assessments

What are three important objectives of the initial assessment?

• Establishing therapeutic relationship

• Gathering information

• Determine and communicate plan

When doing an observational assessment, what should be done (2 points)?

• Assessing interaction of person, environment, and occupation factors.

• Completing functional tasks in a natural setting (ideally home environment but sometimes in a hospital setting, but will have limited access)

Standardised assessments

A systematic method of administration and scoring which generally provides quantifiable data which can compare clients over time to determine improvement and can compare client's performance against those of the general population.

ISBAR method

• A common verbal reporting method which is a mnemonic created to improve safety in the transfer of critical information.

• The mnemonic stands for Identify, Situation, Background (clinical), Assessment, and Recommendation.

When writing progress notes, what should it include (11 points)?

What happened, when, where, why (rationale), how the client/patient has responded, date of treatments, activities performed, goals achieved, problems remaining, treatment plan modification (including discharge plans), and evidence to support decisions.

What are some rules to writing clinical documentation (10 points)?

• Using black ink

• Don't use white out or scribble out mistakes instead, put a single line through any mistakes and sign and date corrections

• Don't use any jargon

• Don't use any generalities

• Don't leave any blank spaces

• must include date of service,

• Date of recording

• Signature, print name, and position

• Countersigned by therapist (if written by student)

• and always be client centred and concise.

SOAP method

• A widespread method of documentation used across multiple health disciplines which contains crucial information about a client/patient.

• The mnemonic stands for Subjective, Objective, Assessment, and Plan.