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! 

Hoisting, wheelchairs and a more relaxed week.

Practical sessions.

I have now completed my hoisting and wheelchair practical sessions which have given me a basic understanding which will be very helpful for when I go out on placement. I am aware however, there is still a huge array of hoists and wheelchairs for me to discover along my OT adventures! It was good to actually handle the equipment and take time to familiarise myself with how it works as I was quite apprehensive to begin with - some equipment can appear quite scary.

I think for me, what I have taken most from these sessions is actually experiencing it myself! My peers and I actually had a go of being hoisted and being pushed around in a wheelchair and this really opens your eyes!

As I was being put into the hoist sling I was aware of my personal space being totally invaded. As I was hoisted up I felt my independence disappear and my anxiety kick in! It is a strange feeling being hoisted - and actually quite uncomfortable. Acting out role play in small groups revealed the importance of the therapeutic use of self and offering re-assurance.

I was pushed by one of my peers in a wheelchair within the university canteen. I went to order a piece of cake and a coffee at the now extremely tall bar! I felt so low down and could not see my choice of cake to choose. It was more difficult to communicate and to carry out the activity. Luckily the staff are so helpful and this mock situation was made a lot easier by help from peers and staff!

...But imagine if I had been on my own. The environment suddenly becomes such an obstacle in many different ways than you realise... Tight spaces, heavy doors and high surfaces - I quickly became aware that this scenario was really not just a 'piece of cake' after all.

A short video highlighting some of the environmental struggles of being a wheelchair user

Image available at: http://imgur.com/gallery/yzj4O

"How you see yourself is always more important than how others see you"

Research and re-capping.

During classes this week we handed in our research proposal questions and our requests for dissertation supervisors! Fingers crossed I should know who I have been allocated by next week. I finally decided I am going to focus on art as an occupation from an autistic adults perspective. This is of course a very rough idea and I will discuss this in further detail in future posts. In my Applied OT module we synthesised the knowledge we have learned and discussed over the past 5 weeks and presented this information to the class as learning sets. We were briefed regarding our return to this module after placement as we have a half hour assessed presentation in June. This presentation will be based on a case study I complete during PP2 and applying the relevant underpinning theory to practice (Eeekk!).

A little time to relax.

This week I have found myself with a little spare time to spend some time with friends. Beginning an intense course like this is a big decision, and meeting great people and making friends along the way is a huge bonus. 

"A piece of cake"

Preparing

This week as well as my research project I have also started to prepare for my next placement with a community stroke team. I have been liaising with my practice placement educator and discussing areas I can read and prepare some knowledge on before arriving on placement. These areas will be focused on:

• General understanding of stroke
• Different types of stroke
• Available treatments
• Symptoms
• Neuroplasiticty
• Effects on ADL's
• Supporting someone with stroke from an OT perspective
• Cognitive & emotional changes
• Communication difficulties (expressive and receptive dysphasia)

I have completed an e-learning course on stroke awareness which has given me a really good insight and a basic understanding of stroke and how complex it can be!

My first ever certificates for my CPD!

If you are a follower of my blog - you will know that from my post regarding my observational placement with a community neuro team I am very interested in stroke and it's many complexities. I feel it is good to have this small piece of experience to build upon as I did see a lot of patients with stroke during that one week and an array of different treatment strategies and assessment tools used.

I find it fascinating how complex the human brain really is - and depending on the area of the brain affected determines how the person may be affected by a stroke. 

Image available at: http://www.familyhealthonline.ca/fho/familymedicine/FM_stroke_FHc13.asp

People can be affected in many ways including:

• Cognition & memory problems
• Vision problems
• Emotional affects/depression
• Personality differences
• Loss of mobility
• Speech problems
• Swallowing problems

As an OT student and focusing on a person as an occupational being - this can have very detrimental affects on a person's participation within their daily occupations. Some examples might be:

• Work
• Driving
• Change of relationship dynamics or family roles
• Social isolation
• Independence 

I feel that OT practice in supporting individuals after stroke is a very important role and can have very positive affects and results in stroke recovery. I am looking forward into researching into the condition further and broadening my awareness of anatomy knowledge during my placement. 

Art as an occupation?

Research 

As I discussed in my previous post I am currently thinking up some research ideas to create a research proposal and continue this on through into my second year to write a research article. My ideas have been flowing this week and I have been conveying these through visual mind maps and reading various articles! I have considered my own personal passions and interests and have realised it may be important to focus on my strengths and interests throughout this research adventure as this will be a very motivating factor.

So far my interests and thoughts are based on:

• Creative arts
• Art as an occupation
• Art and creative activities as an intervention in physical OT settings
• History of craft in OT
• Long term conditions
• Autism
• Is creativity a factor as to why people choose to study OT

This then got me thinking about art as an occupation. I began reflecting - what does art mean to me?

I have always been passionate about art from as early as I can remember. My first achievement I can recall was receiving a head teachers award for a drawing I did of a daffodil in year 2 of my brand new  primary school. It made me feel accepted, and I loved the feeling of achievement this gave me as opposed to the feelings of fear and failure regarding my maths lessons! (I never did get any better at maths). 

From this, art was a leisurely activity for me as a child however, it became a vocational achievement for me throughout my school years. I subsequently did my GCSE in art (frequently told off by my teacher for my expressive mark making techniques - telling me it was wrong to blend and smudge colours together). I carried on regardless - I mean, how can any art be wrong? That was my argument...Ask the great Picasso or Willem De Kooning their opinions... I'm sure they would agree. I went on to gain a distinction in a BTEC national diploma in art and a BA (hons) in Fine Art.

Furthermore - the meaning of my discussion is this. Art and being creative for me is a very personal experience. It is or can be an expression of my feelings, how I view the world around me or a representation of how I have experienced a situation. It is an achievement for me and something I feel a confidence and a passion about.

A discussion this week with some of my peers around writing this blog highlighted that I actually don't mind writing this blog and having different people viewing it and learning about me as a person and sharing their experiences. However, I would feel anxious over someone viewing a piece of my art work - purely because it is a very personal thing to me, an achievement and a passion - and criticism may take this away from me.

So how do I use art as an occupation?

• Leisure
• Therapeutic use for myself
• Inspiration
• To learn
• To Achieve
• To support others

Within this blog you may have seen I used art within my case study for Joan Rivers as a means to express, understand and explore her life and occupations. This is a good example of how I use art to learn when I'm feeling inspired.

Therapeutic use for myself - As I have been reflecting I have realised that on many occasions I have used art as an occupation to support me to overcome a difficult situation or to deal with grief. Here is an example I would like to share with you:

This piece of art was part of a series I created to support me through the death of my Grandad. My grandad was a huge part of my life and when he passed away during my studies - It had a hard affect on me, to the point I almost quit my degree. I created this work based on the empty house and objects he had left behind, which had so much meaning when he was living there - however then seemed so empty and lost. I wanted to represent the feeling of loss and the feeling of memories and life that people can give to objects and places. 

Producing this art work really did support me and had a positive effect on my well-being. Distracting me from a difficult situation however, guiding me through the grieving process which I so needed to go through. Most importantly it helped me to focus on the positives and so many happy times I shared with my grandad.

Moreover, this is agreed within various articles I have been researching. Particularly in life threatening or long term conditions that art and creative activities can support people to feel less stressed, increased self esteem, transforming an illness experience, gaining a sense of of self, expression and building social support ( Perruza & Kinsella 2010, Reynolds & Prior 2006, Schmid 2003, Reynolds 2003).

This reflects my personal experience of art and creativity throughout my life.

Further to this I found these articles online:

It was the wish of a terminally ill lady to visit the exhibition of the works of Rembrandt.

This lady had her wish granted to visit an art exhibition she so longed to see. I feel this is amazing, as art had a huge impact upon her life and to visit an art gallery was a very important occupation for her to fulfil.

Art created by individuals with MS - 'What MS means to me"

This is a fantastic representation of how individuals with long term conditions can use art and creative techniques as a means to express their feelings and cope with the many varied challenges of MS.

Another example I can share with you is the artwork I created during the traumatic experience of my cat getting ran over and the horrific injuries she sustained:

Painting studies.

Textile and mixed media study.

On creating these pieces of art it not only helped me through a difficult time - it gained me the confidence to have my own pet portraits website, where I began taking orders and creating pet portraits for people! It opened up more occupational opportunities and made me realise the affect of pets on the health and well being of people and how much people love their pets (however, going down that route I feel would open another can of worms which I am extremely interested in).

In my experience throughout my life I get quite negative reactions from people on telling them I did a degree in fine art "what? you did a degree in colouring in?!" Is a popular reaction I get. On reading this I hope people realise how valid an occupation art is and can be. I am very proud of the achievements I have gained and the many things in my life and career that art has enabled me to gain. I was able to support adults with autism through creative arts in my job which gained me the experience and transferable skills to study OT... Which moves on to my next point. The reasons people choose to study OT. One of the reasons for me is based on the history of OT and the fact you can use creativity within OT practice. This is also found in the research by Craik et al (2003). However, based within many physical settings I have yet to use any creative techniques with people.

I feel this would be a valid occupation or intervention for people with physical conditions and I feel OT has somewhat lost it's creative roots through budgets, time constraints and a medical model focus on our profession in an attempt to promote and advocate the profession. 

I know it is important to keep a medical focus but I say bring more creative activities and occupations back! Lets go back to the roots of our awesome profession of which I am very proud to be studying.

This has been a personal reflection for me and as you can tell it is something I feel quite passionate about. I'm hoping to base my research proposal around some of these ideas and I will attend my dissertation module launch on Wednesday to explore and synthesise my ideas further.

The daffodil remains my favourite flower - Is this because it is a symbol of spring and it reminds me of sunshine? Possibly, but now on reflection I have realised why. Art is powerful stuff.

References:

Craik C. Gissane C. Douthwaite J. Phillip E. (2011) 'Factors Influencing the Career Choice of First-Year Occupational Therapy Students' British Journal of Occupational Therapy, 64(3), pp. 114-120.

Peruzza N. Kinsella A. (2010) ' Creative Arts Occupations in Therapeutic Practice: A Review of the Literature.' British Journal of Occupational therapy 73(6) pp. 261-268.

Reynolds F. Prior S. (2006) 'Creative Adventures and Flow in Art-Making: A Qualitative Study of Women Living With Cancer'. British Journal of Occupational Therapy 69(6), pp. 255- 262.

Reynolds F. (2003) 'Reclaiming a Positive Identity in Chronic Illness Through Artistic Occupation' OTJR: Occupation, Participation and Health. 23(3) pp. 118-127.

Schmid T. (2004) ' Meanings of Creativity Within Occupational Therapy Practice' Australian Occupational Therapy Journal, 51 pp. 80-88.

February

"Hello, my name is Vicky and i'm an Occupational Therapist"

Well not quite yet... but I have been refreshing my BSL signing skills during this month and learned how to sign 'occupational therapist' in a deaf awareness lecture with a lady who lost her hearing at the age of 12 due to contracting meningitis. She went on to study to be an OT and she highlighted the problems she endured during her training as her educators and lecturers often didn't have the awareness and communication abilities to support her whilst she studied. She also explained the difficulties she faces as a qualified OT. This session was really insightful and revealed the importance of being deaf aware and how loosing your hearing can affect your life and participation within occupations. A great insightful, OT session all round! The class also learned how to finger spell, which was a good little revision for me as I have already attended a beginners course in BSL. 

...Notice my cat on my lap in these photographs... she is currently recovering from recent surgery. She is deaf also and I have my own little cat gesture sign language which I do to communicate with her. Cat OT in the making!

Back to school.

I have been back at university for 3 weeks now and in that time I have completed my second assignment and started 2 new modules and endured a lot of train journeys!

I feel a little more confident this time submitting my assignment now that I have passed one previously. However, I don't really know how i've done until results day! I have really taken on board the feedback I received from my last assignment and have tried my best to improve on these areas and have read more broadly using a wider range of academic texts and journal articles, so fingers crossed!

One of the modules we have started is our scholarship and research module whereby we are to submit a research proposal in the summer! I felt very anxious over this module as I have never done a science based or research based degree before so it is all new to me! My tutor was aware of this and supported me really well during the session. We went back to basics and have been learning about the many different types of research and processes.  A lot of the words are extremely abstract at the moment to me and I feel that until I actually carry out some of the processes, I won't really understand them fully. I am trying to come up with a research question - I'm currently thinking I would like to link my knowledge of autism and my experience of art and relating it to OT. However, i've not had a lot of experience of OT with autism so that will be my job for the foreseeable future - doing lots of research into research!

We have also began some practical training sessions to finish off our intro to OT module and I attended the moving and handling session on Friday! It's good to learn the basics to transfer into practice!

We have also started another module where we have been looking at the OT process in-depth and relating this to practice placement experience we have had. This has really helped and re-enforced my understanding of the theory.

Placement update!

For my next placement I have found out I will be spending 8 weeks with a community stroke team. I am really looking forward to this to build up on my experience from the observational placement with a community neuro team and it is an area of interest for me! I also really enjoy community work however, I am a little disappointed as I feel my placements so far haven't given me a wide range of experience and I really needed a hospital placement, paediatrics or mental health. Fingers crossed for next time! The bonus is that it is in commutable distance so I won't have to move away from home for the 8 weeks.

So that has been February.

It's been a very busy month and now there is a lot of weight off my shoulders now the assignment is handed in. It has freed up time to concentrate on my new modules and research proposal! I feel March is going to be a month of lots of learning for me!

Time really does fly on this course!