Week 3

A quick post this week as I am feeling very tired! You forget how tiring it is sometimes to work part time as well as being on placement and studying... It catches up with you sometimes!

So last week was my 3rd week of placement (really cannot believe how fast it goes!) and during the week I continued developing my skills further in each area I am working. I began looking into more depth on how to assess an upper limb and I now have the confidence to deliver some cognitive and mood assessments independently. 

Every patient I see, I find their presentation after stroke fascinating. For example; last week I met a patient with a severe left sided neglect. This meant they no longer had any awareness of the left side of their body and it no longer existed to them. This presented as sensory and visual neglect where the patient could only read the words on the right hand side of a page and would only eat the food on the right side of their plate! The OT will put some visual scanning activities in place for the patient to complete to work on scanning and looking over to their left side.

I have been busy planning activities for my art group which is planned to take place on 5th May! I must admit it has been fun!

Making salt dough!

This is an idea for a stroke patient who used to have a passion for baking. Unfortunately, due to the affects of their stroke, they now have a peg feed tube fitted meaning they are nil by mouth. I wanted to give them an activity to involve the process of mixing ingredients, however with the salt dough you can bake it and paint it - making decorations. This will promote use of fine motor skills, sensory input, planning and sequencing skills. I really hope that they enjoy it.

I have also been completing risk assessments and researching into the use of creative arts in stroke recovery - of which there seems to be a really good evidence base! On the topic of research - on Tuesday I used my study day to travel up to Carlisle for the student research conference. I wanted to experience what it will entail for me this time next year! And also wanted to gain some insight into other people's ideas and methods of research. I have to say, I came away that day feeling very inspired and positive about my research proposal even though I know it's going to be tough!

And finally... because being on this placement has really opened up my eyes to the effects of stroke and it is an area that is personally close to my heart, I wanted to do something to raise some money and awareness of stroke (May is Stroke month!). So I will be participating in "Step Out for Stroke" which is a sponsored walk on the 16th May for the Stroke Association! I'm looking forward to it!

Please feel free to visit my just giving page - any donation will go a long way to make a difference 

Thank you :)

https://www.justgiving.com/Victoria-Jones89

Week 2

This week has been another week bursting full of learning experiences. I have really come to the realisation of the jump up from PP1 to PP2 and I felt a little out of my depth on a couple of occasions. This a really good thing though on reflection it means that areas I need to work on and learn have been highlighted to me and I was able to recognise my own limitations and inform my educator. Further to this, I had my first supervision this week and with my educator we set out my learning objectives. My objectives this placement are more ambitious and reflect that step up in placement level.

Here are some of my learning objectives:

• Plan and implement an art based group at the residential stroke rehab centre
• Complete a competent assessment of the upper limb (with supervision)
• To be able to complete an initial assessment of a stroke patient
• To be able to develop an action/treatment plan following a mood or cognitive assessment for 3-4 patients.

Lets see if I meet my objectives by the end of placement!

Acute Stroke Unit

On my day on the ward this week I continued practicing my skills in personal care assessments and hospital bed making! I also completed a kitchen assessment under supervision with a patient who was hard of hearing which gave a whole new dimension to the assessment. It's amazing how much a simple thing like making a cup of tea can highlight and give an OT some insight into cognitive, memory, visual and perceptual issues a patient may be experiencing. I also discovered how hard it can be to work with people who have had a stroke when I met a relatively young patient on their initial assessment and the affects the stroke has had are devastating on the person and their family. It will be very interesting to follow their journey and see how much of a difference the intense therapy input makes. I also realised I felt quite out of my depth in a place surrounded by medical professionals with people who are really, very un-well. It opens your eyes to the dangers of stroke and how devastating it really can be. I have seen as an OT you have to learn to use your therapeutic use of self and be very empathetic however, you need to learn to turn this off to a certain extent as working in this environment could definitely become quite upsetting.

Residential Stroke Rehab.

I am really enjoying my days spent here and feel i'm starting to build some rapport with the patients and getting to know them more now, especially after meeting them on the ward and following their journey to this setting. I think I feel most excited about this part of my placement and have a lot of opportunity here. A discussion with the therapy staff team revealed the need to start up some activity groups to incorporate into individual's therapy. I shared my experiences of being a creative arts activity leader and am currently helping to arrange/plan some creative arts sessions which is such a great opportunity and i'm really looking forward to it. My planning consists of thinking of activities that focus on individual's physical and psychosocial needs as well as memory, cognition, planning/sequencing and sensory needs. I am also doing some research into art in stroke rehab and OT - which ties in very nicely with my proposed research project for my dissertation!

A creative weaving project I came up with using old CD's. This will address fine motor skills and coordination. It will involve the weaker upper limb, use sequencing and concentration skills and address some sensory input.

Community

During my time with the community team I have been writing notes, making phone calls to patients , completed an initial assessment under supervision and have began working on my ability to assess a person's upper limb for range of movement and sensory loss. This is helping with my anatomy knowledge and use of terms such as "flexion" and "subluxation." 

The realties of stroke have really hit me this week and the importance of stroke awareness is vital.

Image available at:

http://www.stroke.org.uk/taxonomy/term/112/all

Relaxed and ready!

Well rested and ready for placement.

I have not posted for a little while and the reason is that I have been enjoying a couple of weeks off and a well needed rest where I managed to switch myself off from uni work for a little while and be myself, do my own things and basically catch up on life. I have to say it was lovely! I also enjoyed my birthday, celebrating with my family, old friends and new friends I have made on my course.

I have just completed my first week on placement! (PP2) and as usual I have seen and learned so much over just one week. Here's what I have been doing:

My placement is based with a community stroke team however, I discussed with my educator that all my placement experience has been community so far so she has kindly liaised with her colleagues for me and has split my placement across 3 different settings; the acute stroke unit, community and residential stroke rehab. This is fantastic because I will not only get a broad range of experience. I will get to follow patients along their journey from hospital to recovery in the community or in intermediate care. Following the stroke pathway and the OT process. 

Acute Stroke Unit

If you have followed my blog or have spoken to me in person you will know that I was quite apprehensive about working in a hospital/ward setting so I felt quite nervous about being on the acute stroke unit. I spent my first day there on Thursday and I have to say... I really enjoyed it!! (I know, i'm shocked as well!) I really surprised myself actually at how comfortable I felt in that environment. I think partly down to the OT I was shadowing who was absolutely lovely and I was looked after so well and made very welcome. I have discovered that you are just applying the same principles of OT practice and what I know and have learned from community OT - just to a different setting/environment and it's all basically the same. Although in a more clinical setting, your interpersonal skills and therapeutic use of self are still as important if not more important as a lot of patients are very nervous and worried due to their stroke and also due to the unusual environment. I'd never really experienced it before but engaging in a personal care assessment with a patient made me realise just how vulnerable you are during a stay in hospital. It must be so disorientating after a life changing stroke and to have all of these strangers helping you get washed and dressed and use the toilet. It's an eye opener really! During my day on the ward I also got to complete a mood assessment and I got the opportunity to watch a CT scan which was really interesting!

Community.

It's a strange feeling really. I feel I am very familiar with the structure and process of community OT now. Which has put me in great stead for being out in the community team and in the office completing paper work. However, I am just trying to learn and get to grips with the complex neuro anatomy and terminology regarding stroke! It is very complex and I am finding it fascinating as I'm learning about the anatomy of the brain - actually seeing in practice how each side of the brain affected corresponds to how the person is physically, mentally and cognitively affected. I've seen that in the OT role within this team, as well as addressing the physical symptoms you are more than likely to be involved with assessing patients cognition and mental health state as stroke can cause a huge variety of problems within these areas. I have observed a variety of memory and cognition assessments and strategies already in my first week. These can be personalised and adapted as every individual is affected differently in these areas.

During my days in the community I went with my educator to visit a service called Think Ahead which is a fantastic charity run by stroke survivors that supports people who have had a stroke and their carers through group activities, events and talks. My educator was actually running a presentation for a group there based on memory and changes with mood after stroke. This was really inspiring as the individuals in the group seemed to get a lot of reassurance from the presentation and were able to share their experiences and strategies with others of how to deal with these problems. Being within the group and talking with others was a huge therapy in itself. Seeing this role of an OT was greatly inspiring to me as well - to think of how much you can make a difference to people's lives throughout your career path by doing such a variety of different things. It also made me realise the importance of doing all of these presentations at uni! I hope that one day I will be in a position to run a group or presentation that will help and support others in this way.

Here is a quote that I liked from the presentation from a stroke survivor with aphasia:

"We're not just legs, arms and a mouth... we are human beings with a mixture of emotions. All these feelings; self esteem, self worth, confidence, identity... They're all under attack after stroke. You can feel vulnerable, frightened and you can lose yourself. Psychological support puts you back together again - especially psychological support from someone who's been there before."

Residential Stroke Rehab

My day at stroke rehab highlighted to me the interlinking professional relationship between the OT and the physio within the intense therapy people receive during their stay there - preparing them to return home. I engaged in a kitchen assessment with a patient and also observed some physio sessions. Again I was applying what I already know of OT practice to another different environment. I was also seeing the emotional experiences the patients were going through in their transition from hospital to here and the support the OT can put into place for this.

So that has been my first week. Now I have my bearings, I am looking forward to the rest of my placement and feel I am really going to learn a lot from my experiences here!