This essay will include an debut supplying an overview of the arrangement undertaken and the relevant client group who entree the service, a critical rating of three appraisals that have been used within the service, one being Occupational Therapy particular, a treatment and illustrations given of how hazard is assessed and managed within this pattern scene, a treatment of the theoretical accounts of pattern used, one intercession program used with a peculiar client with an analysis of how the intercessions were identified and prioritised, assessment and justification of other possible intercession schemes, designation and rating of the impact of relevant statute law upon service proviso within the pattern scene, eventually an rating of ain public presentation as a pupil Occupational Therapist, and a decision.
The pattern arrangement scene was a city-wide Memory Service situated in North Yorkshire. The Memory Service is made up of a multi-disciplinary squad of mental wellness professionals, working alongside the Alzheimer ‘s Society. They facilitate early sensing, diagnosing, and appraisal of demands for older people with a memory job, every bit good as giving support to their carer ‘s. Pre and station diagnostic guidance is provided and, where needed, group support is provided.
Client ‘s who are referred to the Memory Service are by and large older grownups who are sing early-onset dementedness. This essay will concentrate on one service-user who has been referred to the service diagnosed with Alzheimer ‘s Dementia, we will name him Max. The NHS web site defines Alzheimer ‘s as being ‘the most common signifier of dementedness, which is a group of symptoms associated with a diminution in mental abilities, such as memory and concluding ‘ ( NHS.uk, 2010 ) Max is in the early/forgetfulness phase of dementedness ( Schneck, Reisberg, & A ; Ferris, 1982 ) This includes mild damage in memory and linguistic communication, personality changes, increased depression and anxiousness, although there is no important impairment in ADL and is still able to populate independently, nevertheless, it is evident that Max is in demand of some support.
Max is sing troubles in certain countries of his occupational public presentation, such as feeding,
Identify and critically measure 3 Ax ‘s that are/could be used with the client group.
The first measure toward intercession is to measure the cognitive degree of the client. An illustration of a standardized appraisal is the Mini Mental State Examination ( MMSE ) Folstein et Al ( 1975 ) / Addenbrooke ‘s cognitive scrutiny ( ACE-R ) .
Hospital Anxiety and Depression Scale ( HAD )
A kitchen appraisal was undertaken with Max and two Occupational Therapist ‘s to measure and detect any hazards to Max ‘s wellbeing. It was highlighted that Max frequently left pans on the gas cooker and ended up firing them, hence puting off the fume dismay, worrying the neighbors.
The unstructured experimental appraisal took topographic point in Max ‘s kitchen at place which is a familiar environment and in maintaining with his day-to-day modus operandi. Max decided to cook scrambled egg on toast as he felt comfy doing this. At the clip the Occupational Therapist was besides inquiring Max inquiries relevant to his day-to-day modus operandi and cookery, hence besides doing it an informal interview. Although unstructured appraisals can non supply the dependability that structured appraisals can, Kielhofner ( 2002 ) references several grounds that can warrant the usage of unstructured appraisals, such as, to add to information antecedently gained through a structured appraisal, deficiency of clip, unacceptableness of structured appraisal by a client, deficiency of an appropriate structured appraisal.
With Max holding completed both the Mini-Mental State Examination and the Hospital Anxiety and Depression graduated table and through observation and speaking, it was highlighted that Max was somewhat depressed.
Discuss relevancy of hazard AX and supply illustrations of how hazard is assessed and managed
Risk appraisal and direction is an of import portion of professional procedures in Occupational Therapy pattern. Legislation and policies have been implemented to steer pattern such as… Alzheimer ‘s Society
The hazard profile subdivision of the Functional Assessment of the Care Environment ( FACE ) appraisal and results system ( Clifford 1999 )
is used to let the Occupational Therapist to measure and document any clinical hazard that an person may hold. FACE provides outcome informations that enables a patient ‘s advancement to be followed and besides compared with other persons.
The FACE hazard profile comprises of a ‘front sheet ‘ that summarises a patient ‘s contact inside informations, evaluations of hazard, on a five-point graduated table runing from ‘0’=’no evident hazard ‘ through to ‘4’=’serious and evident hazard ‘ on assorted types of hazard. The 2nd sheet is a checklist of historical and current indexs of hazard grouped into classs e.g. ‘clinical symptoms declarative mood of hazard ‘ and ‘treatment-related indexs of hazard ‘ . The 3rd sheet comprises free text boxes where a description of the specific hazard factors, both current warning marks and hazard history, can be to the full described and individualised for the patient. The 4th sheet comprises backsliding and hazard direction program which can be specified and tailored for an single patient
Some specific events from Max ‘s yesteryear were documented:
Social isolation and exclusion. Max barely of all time left the house apart from to make a hebdomadal store on a Saturday forenoon ; his married woman died two old ages ago and has since been populating entirely. Max had really few leisure involvements apart from painting, and there was no close household support. ‘As the class of Alzheimer ‘s advancements, the planetary map of person ‘s with Alzheimer ‘s diminution ‘ . ( Kuo, 2009 ) Max may therefore go progressively unable to look after himself which could present a hazard in the hereafter i.e. self-neglect?
Thom and Blair ( 1998 ) describe the function of Occupational Therapy in placing existent hazards to the person through the usage of functional appraisal based on observation and interview. ( MENTION ABOVE AX ) It was observed that Max has limited mobility due to arthritis in his articulatio genuss, this poses a physical hazard of falls. Max is cognizant of his limited mobility, nevertheless does non walk with a stick unless outside as he feels a stick interior is a hinderance. All loose carpets have been removed and the entree to Max ‘s house is level. He is cognizant of falls bar techniques but has requested a pendent dismay from Telecare, as he feels this is appropriate in instance he has a autumn at place. The furniture is placed so that Max can utilize this as an assistance for walking from the sofa into the kitchen if he feels the demand.
It was besides highlighted that there was a hazard runing family contraptions safely ( firing pans ) which is why a kitchen appraisal was carried out to detect any possible hazards and ways of get the better ofing these.
Explore application of a theoretical account of pattern and a therapy attack that were/could be used
The Model of Human Occupation ( Kielhofner, 1995 ) is founded on the belief that meaningful business is cardinal to our wellbeing and that human business can outdo be understood as a dynamic system. ( Duggan, 2004 ) This looks at physical and societal environments, addiction, accomplishments, and personal causing.
As dementedness is a progressive disease, the physical environment may go less accessible. Dementia may besides do freak out, doing it harder for the person to do their manner around topographic points they are non familiar with.
Supply 1 intercession program which you have implemented and warrant this with grounds and clinical logical thinking
Following Max ‘s appraisal, an occupational strengths and demands list was drawn up for Max and from this an intercession program was made, including long-run ends. ‘Goals are marks that the client hopes to make through engagement in occupational therapy ‘ ( Creek, 2002, p.129 )
Insight into status
Socially isolated although Max is really easy to acquire on with
Enjoys drawing/painting-expresses involvement in fall ining a local group
Lost married woman 2 old ages ago-feels as though he has lost his function in life
Physically maps rather good apart from creaky articulatio genuss
Identifies positive qualities: sort, chatty, sense of temper
Appears low in temper
Prioritizing the program involved negociating with Max and other members of the mental wellness squad e.g. community support squad, and doing certain that Max ‘s ends were realistic in footings of being achieved within the 6 hebdomads. Cox ( 2007 ) states that ‘symptoms of dementedness can significantly interrupt a individual ‘s ability to put or run into realistic ends ‘ , therefore it is of import to do certain each end is accomplishable within the six hebdomads.
By prioritizing which ends Max wants to accomplish foremost this highlights the usage of a person-centred attack, although hazard factors must be taken into consideration e.g. Max ‘s top precedence is to be able to do an eventide repast safely and independently without firing pans, this is evidently a possible hazard to Max and should be carried out with a member of the mental wellness squad foremost.
To run into the undermentioned ends, SMART ( specific, manageable, accomplishable, realistic and clip specific ) aims were besides established.
Long-run end 1
Max will do an eventide repast mundane safely and independently.
Week 1: On the 2nd meeting, the Occupational Therapist will discourse with Max the hazards of cooking with a gas cooker
Week 2: Soap and Occupational Therapist to do an eventide repast together at 6pm utilizing the gas cooker
Week 3: Soap and Occupational Therapist to discourse Max ‘s involvements and to see if anything could be placed in the kitchen to busy Max whilst his repast is cooking, and for him so to be able to maintain look intoing the nutrient.
Long-run end 2
Max will go to a originative community based activities and societal groups on a regular footing
Max is a friendly and sociable individual once he is around people, and he shows a strong involvement in art and has many pictures around the house. Aims of the art group: to run into new people and develop societal interaction through art work. The group is planned and there is a group focal point.
Week 1: Supply Max with information about his local vicinity web and conveyance options, set up a curative relationship between Max and the Occupational Therapist.
Week 2: Support Max to entree the service for the first clip ; go to a Memory Service tiffin nine on a Wednesday forenoon for two hours accompanied by the Occupational Therapist
Week 3: Soap to go to a local Memory Service Open Art group for service-users one time a hebdomad on Monday forenoon for two hours for 10 hebdomads.
Week 4: Soap to go on go toing the unfastened art group and purpose to accomplish a higher degree of occupational public presentation, by rating activities.
Perrin and May ( 2000 ) suggest that an apprehension of the interrelatedness of business and wellbeing is of a cardinal importance, and that a ‘state of “ health ” , instead than of “ wellness ” is a more appropriate end ‘ .
Long-run end 3
Max to go to local vicinity web societal groups on a regular footing
Week 2: Attend a reminiscence group
For an business to hold any curative benefit it must hold intent, value and significance to the person ( McLaughlin-Gray, 1998 ) . For Max, this is taking portion in Art based activities, in his yesteryear he was a strong creative person and spent most of his free clip outside painting anything and everything, hence go toing a local art group with similar people with memory loss this is an ideal opportunity for Max to show his creativeness and going more socially integrated into the community. Creative activity has besides been shown to cut down depression and isolation, offering the power of pick and determinations. Nonverbal therapy methods, such as picture, are able to act upon the wellbeing of the patients positively.
Hannemann, B.T. Creativity with dementedness patients. Can creativeness and art stimulate dementedness patients positively? Gerontology. 2006 ; vol. 52 ( 1 ) , pp. 59-65.
Green-Field Library owns.
When seeking the Cochrane Library database, Reminiscence therapy for dementedness by Woods et Al ( 2005 ) looked at the effects of reminiscence therapy for older people with dementedness and their care-givers. The consequences were statistically important for knowledge ( at followup ) , temper ( at followup ) and on a step of general behavioral map ( at the terminal of the intercession period )
hypertext transfer protocol: //onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001120/frame.html
hypertext transfer protocol: //actagainstalzheimers.net/library/downloads/AltTherapies_RL2009.pdf
The function of the OT with general ends is in advancing business, wellness & A ; well-being taking into consideration that dementedness is progressive when doing intercession programs ( Pedretti, 2001 ) .
Basic Populating accomplishments can be of more purposeful and value to the older individual than leisure, PADL accomplishments have been found to be of import in the ends of intervention with early oncoming dementedness as they value their independency, self-respect & A ; privateness ( Willard & A ; Spackman, 2001 )
Analyse how the intercessions implemented were identified and prioritised
Appraise and warrant other possible intercession schemes
Another possible intercession scheme was to put in ‘Just Checking ‘ , a web-based activity monitoring system that provides a chart of day-to-day life activity via the web, leting the Occupational Therapist to track ( vis detectors in each room ) where the person has been, for how long, and at what clip.
It was suggested to Max that he seek a dosset box for his day-to-day medicine, as it noted that on occasion Max was non compliant with his medicine. However, he refused this thought as he felt he was happy with how he was get bying, and that a dosset box would upset his day-to-day modus operandi.
Identify and measure the impact of relevant statute law, wellness and societal policy and clinical guidelines upon service proviso overall
College of Occupational Therapy ( 2003 ) National Service Framework for Older Peoples. London: BAOT/COT briefing.
Department of Health ( DOH ) ( 2005 ) Mental Capacity Act. London
Analyse how rating of intercessions was completed
Analyze your ain public presentation as a pupil OT
Provide sum-up of cardinal points
Summarise how the intercessions improved or maintained wellness and good being for the person
Brooker p.44 ( 2007 ) states that ‘It is of import to and appreciate that all people have a alone history and personality, physical and mental wellness, and societal and economic resources, and that these will impact their response to dementia ‘ .