Case Study Presentation Aged Care and Rehabilitation Service October 2012 Aged Care and Rehabilitation Service (ACRS) Aged Care and Rehabilitation Service: Multidisciplinary team Geriatric clients 28 beds Short and medium inpatient care Frameworks Person-Environment-Occupational
Performance (PEOP): Highlights complexity of person-occupationenvironment relationships Occupational performance as outcome Client central to care plan Client-Centred Frame of Reference (FOR): Client needs direct planning and intervention (Christiansen, Baum, & Bass, 2011; Parker, 2012; Cole, & Tufano 2007; Parker, 2011) Communication and Rapport Fosters therapeutic relationship
Honesty Confidentiality Respect Clarity Client-centred Pseudonym: Ms Pamela Watson Member of aged demographic Fractured pre-existing hip replacement Left hemi-arthroplasty Deconditioned Bilateral Odema Urinary precautions Higher risk of nursing home placement
Extended Aged Care at Home Package (EACH) (ABS, 2011; Spealstra, Given, You, & Given, 2012; McCallum, Simons, Simons, & Friedlander, 2005; Koval, Skovron, Aharonoff, & Zuckerman, 1998, Australian Associated of Occupational Therapists, 2001; Altizer, 2005; Australian Department of Health and Ageing, 2009) Function Pre-morbid: Independent with all Activities of Daily Living (ADLs) Assistance with showering Admission: Maximum assistance with ADLs Current:
Minimal assistance with ADLs (Bynon, Wilding, & Eyres, 2007; Van Huet, Parnell, Mitsch, & Mcleod-Boyle, 2011) Framing Framing Automatic referral Responded to in timely manner Comprehensive client evaluation Occupational Therapy Code of Ethics Little Company of Mary (Little Company of Mary Health Care Ltd, 2007; Australian Association of Occupational Therapists, 2001; Roberts, & Evenson, 2009) Focussing Focussing Acquired
client 3.5 weeks into Occupational Therapy Practice process (OT Process) Handover provided Gather current function and further deficits Minimum standards for information gathering Maintained confidentiality (Occupational Therapy Australia, 2010; Australian Association of Occupational Therapists, 2001) Informing Informing Integral to Occupational Therapy Practice Process Determine effect of intrinsic and extrinsic factors on occupational performance PEOP and client centred FOR guided assessment process
(Hocking, 2010; Roberts & Evenson, 2009; Welch & Lowes, 2005; Liu et al, 2005; Christiansen, Baum, & Bass, 2011; Parker, 20122; Cole, & Tufano 2007; Parker, 2011) Assessments Functional Independence Measure (FIM) Assess physical and cognitive function level of assistance required for care Measures patient progress and rehabilitation outcomes Responsive to change Initial: Develop occupational profile Fosters therapeutic relationship (Glenny, Stolee, Husted, Thomspon, & Berg, 2010; Henry & Kramer, 2009; Haidet & Paterniti, 2003; Rogers, 2009; Rogers, & Holm, 2009) Assessments
Rowland Universal Dementia Assessment Scale (RUDAS): Valid screening tool for cognitive impairment Culturally diverse Applicable to range of settings and diagnoses ADL assessments: Bed mobility Shower Toileting Meal preparation
(Unsworth, 2011; Rowland et al, 2006 Measurement scales used in elderly care, N.d; Liu et al, 2005) Assessments Home Access Identifies barriers to home discharge Integral aspect of discharge planning Geriatric Visit: Depression Scale (GDS): Assess presence of depression Clinically valid and reliable in rehabilitation setting (Welch & Lowes, 2005; Wancata et al, 2006)
Identifying Occupational Issues Unable to transfer in/out of bed independently Unable to maintain stamina to perform light meal tasks Unable to dress lower limb independently Unable to perform self-care tasks with minimal assistance Naming SMART Goals By the end of 6 weeks, Ms Watson will be able to independently transfer in and out of bed within the ACRS setting utilising her own physical strength and endurance. Ms Watson will practice transfers daily
and a weekly follow up discussion will be utilised to identify progress. By the end of 6 weeks, Ms Watson will be able to independently make a cup of tea in the ADL kitchen utilising the toaster, tap and condiments. Ms Watson will practice making tea weekly and weekly functional observation will be utilised to measure progress (Occupational Therapy Australia, 2010) SMART Goals By the end of 6 weeks, Ms Watson will be able to independently dress the lower limb within the rehab setting utilising her own physical strength and flexibility. Ms Watson will practice daily, reducing the nursing assistance provided. Functional observation and review will be utilised to measure progress
By the end of 6 weeks, Ms Watson will be able to independently transfer on and off the toilet using an over toilet frame in her rehab room. Ms Watson will receive less nursing assistance daily and functional observation and review will be utilised to measure progress (Occupational Therapy Australia, 2010) Doing Intervention Client-centred Compensatory: Equipment provision Recommendations Remedial:
Retraining Practice (Christiansen et al, 2011) Intervention Functional Increases physical functioning and independence Maximises functional recovery following hospital related debility Group task retraining: Participation:
Re-learn adaptive skills Maintain occupational performance Facilitate socialisation (Pierce, 2008; Hagsten, Svensson & Gardulf, 2006; Kortebein, Bopp, Granger, & Sullivan, 2008) Intervention Equipment Adjustable shower chair Over toilet frame Long handled reacher Case provision in hospital:
Conference: Weekly Presented current care plan and goals (Koval & Cooley, 2005) Intervention Family Meeting: Multidisciplinary Discharge destination Future improvements required Recommendations
post-home visit: Client function, intrinsic factors Environmental modifications, extrinsic factors Intervention Unable to achieve SMART goals Discharged Awaiting from occupational therapy Nursing Home Placement: Unsafe for discharge home Reviewing
Service Evaluation Integral to professional reflection and development Functional review Observation FIM (Duncan, 2011; Glenny, Stolee, Husted, Thomspon, & Berg, 2010 ; Australian Association of Occupational Therapists, 2001) Service Evaluation Challenging result Improvements not always achieved Duty of care Client safety central to care (Australian Association of Occupational Therapists, 2001) Reference List
24, Christiansen, C., Baum, C.M., & Bass, J.( Altizer, L. (2005). Hip Fractures. Orthopaedic Nursing, 283-292 2011). The Person-EnvironmentOccupational Australian Association of Occupational Therapists. (2001). OT Code of Ethics Model.ofInAustralia E.A.S. Duncan Australian Bureau of Statistics. (2011). Population by AgePerformance and Sex, Regions (No.
3201.0). (Eds.) Foundations for practice in Retrieved from http://www.abs.gov.au/ausstats/[email protected] nsf/mf/3235.0 occupational therapy (5th edition pp 93-104). Australian Department of Health and Ageing.(2009). Extended Aged Care at Home (EACH) London: Elsevier Packages: Information Sheet no. 4. Canberra: Author Cole, M, & Tufano, R. (2007). Applied Theories Bynon, S., Wilding, C., & Eyres, L. (2007). An innovative occupation-focussed service to minimise in occupational therapy: A practical deconditioning in hospital: Challenges and solutions. Australian Occupational Therapy Journal, 54, approach. Thorofare,N.J: Slack 225- 227 Eyres, L., & Unsworth, C.A. (2005).
Occupational therapy in acute hospitals: The effectiveness of a pilot program to maintain occupational performance in older clients. Australian Occupational Therapy Journal, 52, 218224. Reference List Glenny, C., Stolee, P., Husted, J.,Thompson, M., & Berg, K. Comparison of the responsiveness of the FIM and interRAI Post Acute Care Assessment Instrument in Rehabilitation of older
adults. Archives of Physical Medicine and Rehabilitation, 91, 1038-1043 Hagsten, B., Svensson, O., & Gardulf, A. (2006). Health-related quality of life and selfreported ability concerning ADL and IADL after hip fracture. Acta Orthopaedica, 77(1), 114-119 Haidet, P., & Paterniti, D.A. (2003). Building a history rather than taking one. Archives of Internal Medicine, 163, 1134-1140
Henry, A.D., & Kramer, J.M. (2009). The interview process in occupational therapy. In E.B. Crepeau, E.S. Cohen, & B.A. Boyt Schell (Eds.), Willard & Spackmans Occupational therapy (11th edition pp. 342-358). Baltimore, MD: Lippincott William & Wilkins. Hocking, M. (2010). Process of assessment and evaluation. In M. Curtin, M. Molineux & J. Supyk-Mellson (Eds.) Occupational Therapy and Physical Dysfunction (6th edition pp 81-93). London: Elsevier Kortebein, P., Bopp, M.M., Granger, C.V., & Sullivan, D.H. (2008). Outcomes of inpatient Rehabilitation for older adults with debility. American Journal of Physical Medicine and Rehabilitation,87, 118125
Koval, K.J., & Cooley, M.R. (2005). Clinical pathway after hip fracture. Disability and Rehabilitation, 27(18-19), 1053- 1060 Reference List McCallum, Koval, K.J.,J., Skovron, Simons,M.L., L.A.,Aharonoff, Simons, J., G.B., & & Friedlander, Zuckerman, Y.
J.D. (2005). (1998). Patterns Predictors and of predictors functional of recoveryhome nursing after placement hip fracture inover 14the years: elderly. Dubbo Clinical study Orthopaedics of elderly and Australians. Related Australian Research, Journal
348, on 22-28 Ageing, 24(3) pp 169-173 Little Company of Mary Health Care Ltd. (2007). Philosophy: the philosophy of the health, community and aged care service which is a ministry of the Sisters of the Little Company of Mary Liu, S., Kuo, J.,scales Measurement Wei, H., used & Banks, in elderly R. care. (2005). Retrieved Clinical Value Oct of 4, ADL 2012Assessments from
http://www.dementiafor Inpatients postTotal Hip assessment.com.au/symptoms/FIM_m Replacement Surgery. (Unpublished anual.pdf Student Research Project). University of Queensland and MaterAustralia Adults Hospital, Queensland. Occupational Therapy [OTA]. (2010). Australian Minimum Competency Standards for New Graduate Occupational Therapists. Parker, D.M. (2011). The client-centred frame of reference. In E.A.S. Duncan (Eds.),Foundations for practice in occupational therapy (5th edition pp 140-152). London: Elsevier
Reference List Rogers,S.L. Pierce, J.C.(2008). (2010).Restoring Occupational Mobility. reasoning. In InM.Vining M. Radomski Curtin, M. & Molineux, C.A.Trombly & J. SupykLathamMellson (Eds.) Occupational
D.,M. Basic, (2009). D.,Settings Vrantsidis, F., Porividng Hill, K.,Medical LoGiudice, andD., Psychiatric Russell, M., Haralambous, Services. In B., E.S.Crepeau, Prowse, R., Harry, E.S.Cohn, J., & &Lucero B.A. K. Boyt (2006). Schell A study
(Eds). to evaluate Willard & the spackmans Rowlandoccupational Universal Dementia therapy (11th editionScale Assessment pp 1074-1079). (RUDAS) inPhiladelphia: two populations Lippincott outside Williams of the &Sydney WilkinsSouth West Area Health Service. Retrieved OctM.C. 4, 2012 fromThe http://www.fightdementia.org.au/comm
on/files/NAT/20110303Rogers J.C., & Holm, (2009). Occupational Therapy Process. In E.S.Crepeau, E.S.Cohn, Nat-CALDRUDASvalidation2007.pdf & B.A. Boyt Schell (Eds). Willard & spackmans occupational therapy (11th edition pp 478518). Philadelphia: Lippincott Williams & Wilkins Reference List Wancata, J., Alexandrowicz, R., Marquart, B., Spealstra, S.L., Given, B., You, M., & Given, C.W. (2012).
The Contribution Falls Have to M. &Older Friedrich, F. (2006). The criterion Increasing Risk of Nursing Home Placement in Community-Weiss, Dwelling Adults. Clinical Nursing validity of the Geriatric Depression Scale: a Research 21(1) pp 24-42 systematic review. Acta Psychiatrica Van Huet, H., Parnell, T., Mitsch, V., & Mcleod- Boyle, A. (2010). Enabling engagement in self-care , 114 (6),Therapy
398-410and retrieved from occupations. In M. Curtin, M. Molineux & J. Supyk-MellsonScandinavica (Eds.) Occupational Physical http://onlinelibrary.wiley.com/doi/10.111 Dysfunction (6th edition pp 341-355). London: Elsevier 1/j.1532-5415.2005.53461.x/full Welch, S., & Lowes, J. (2005). Home assessment visits within the acute setting: A discussion and literature review. British Journal of Occupational Therapy, 68(4), 158164
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