Both as an undergraduate student and as a qualified Occupational Therapist working within my current role, I have maintained a passion to work with people living with dementia and their care givers. Throughout my career I have continued to seek out opportunities to contribute to my own continuous professional development in relation to dementia care. I was therefore thrilled when my application to the Alzheimer Scotland and Queen Margaret University, Edinburgh MSc Module, “Developing rights-based practice for Allied Health Professionals (AHP) working with people living with dementia, their families and carers’ was accepted. Although a bit apprehensive about being a student (again!) I was looking forward to learning more about developing an AHP rights-based approach to dementia care.
What is “rights – based practice?”
Human rights are defined as the basic rights and freedoms that belong to every person (Equality and Human Rights Commission, 2020). Underpinned in Occupational Therapy practice by both the Royal College of Occupational Therapists (2017) and the Health and Care Professions Council (2013), we as Occupational Therapists, including AHPs generally, are legally obligated to ensure these rights are adhered to in daily practice. Unfortunately, stigma still surrounds the treatment of those with dementia which in turn can restrict their human rights (Scottish Government, 2011).
Pertinent policies which underpin human rights and informed the MSc module content included, ‘Connecting People, Connecting Support, (Alzheimer Scotland, 2017) which helps to bring the importance of human rights to the forefront of my practice. Within this policy is the AHP Approach, of which one element is ‘Enhancing Daily Living’ (diagram 1), which led me to the topic on which I based my assessed presentation for the MSc module.
Right to meaningful activity in an acute setting for people with dementia
Meaningful activity is defined as “physical, social and leisure activities that are tailored to the person’s needs and preferences” (Kitwood, 1997 pg. 7).
While listening to the first-hand experiences of people living with dementia during our module, it made me consider how, and in what way, meaningful activity could be encouraged when admitted to an acute hospital setting. One carer put it perfectly recognising their loved one was only occupied when directly engaged with rehabilitation, but what about when therapy input stopped for the day?
It prompted me to reflect on my own and our team’s practice in relation to meaningful activity and question if the standardised occupational therapy process adopted in acute settings may impact on a person’s right to access meaningful activity by focusing too much on the physical function and risk/safety for discharge. Although our assessments encompass important functional activities to support health and wellbeing including independent function, I felt with the pressures of a busy setting, the importance of other areas of daily living e.g. money management, routine, hobbies suggested by Perrin (2008) as important, tended to be overlooked.
In completing a literature search related to the use of meaningful activity in acute settings, there was a paucity of high-quality research found. However, there was some research that critiqued the lack of meaningful activity in acute settings which could adversely impact the goals of rehabilitation, including wellbeing and personhood (Clisset et al 2013; Clarke et al 2018). Research also highlighted the importance of continued engagement in meaningful activities and the positive effects for the person, carers and staff both during an inpatient stay and on discharge home.
Reflecting on my practice there is scope to shift the focus from function to occupation to embed a rights-based approach by adapting our current assessments to incorporate activities that are identified as being meaningful by the person living with dementia. For example:
- Ensure “Getting to Know Me” forms are fully completed on admission and translated into assessment and ward-based routine(s) so meaningful activities can be identified. Bring items from home e.g. knitting.
- Initiating Occupational Therapy input sooner rather than when mobility allows.
- Use meaningful activities as part of therapy e.g. discussing important activities with the person prior to or during treatment e.g. football/ having favourite music on to encourage engagement and provide reassurance to support overall assessment.
Since completing this module I have fed back to the occupational therapy team and also the wider AHP and multidisciplinary team about simple alterations to practice we could make, informed by theory, that won’t reinvent the wheel, but can change the way we approach assessment and rehabilitation.
A lovely example given by my physiotherapy colleague on completion of this module was accompanying a person to the hospital shop to get her a can of Irn Bru or her “can of ginger”. This was identified by the person as something they would like to do. This allowed my colleague to review functional mobility, use of stairs and allowed assessment of handling money, decision making, way finding. Overall, however, it provided the person living with dementia a level of independence and she voiced how much she enjoyed this.
Looking to the future I am hoping to develop activity boxes that can be accessed on each ward to encourage engagement in activity both within and out with rehabilitation sessions.
Completing the MSc AHP rights-based dementia module has given me a deeper understanding of a rights-based approach and how simple changes to practice can further embed the rights of people living with dementia during rehabilitation. I would encourage all AHPs to engage in this module as dementia is everybody’s business. Although a bit daunting to go back to your student days, the knowledge and experiences you will gain for your personal learning and service development are invaluable.
My name is Emma Loftus and I am a Band 6 Occupational Therapist in Older Peoples Services within the Royal Alexandra Hospital in Paisley. My role involves assessing and implementing patient centred goals and treatment plans to maximise occupational performance and support timely discharge from hospital. @letsallbuybees
ALZHEIMER SCOTLAND., 2017 Connecting People, Connecting Support Transforming the allied health professionals contribution to supporting people living with dementia in Scotland 2017-2020. Edinburgh: Alzheimer Scotland.
CLARKE, C., STACK, C., and MARTIN, M., 2018. Lack of meaningful activity in acute physical hospital wards: Older people’s experiences. British Journal of Occupational Therapy [online]. 81(1), pg 15-23 [viewed 20 October 2020]. Available from: https://journals.sagepub.com/doi/full/10.1177/0308022617735047
CLISSETT, P., POROCK, D., HARWOOD, R. and GLADMAN, J., 2013. The challenges of achieving person centred care in acute hospitals: A qualitative study of people with dementia and their families. International Journal of Nursing Studies [online]. 50, pg. 1495-1503. [viewed 01 November 2020]. Available from: https://www.sciencedirect.com/science/article/pii/S0020748913000692?via%3Dihub
EQUALITY AND HUMAN RIGHTS COMMISSION., 2020. What are human rights? [Online] [Accessed 30 November 2020] Available from: https://www.equalityhumanrights.com/en/human-rights/what-are-human-rights
HEALTH CARE AND PROFESSIONS COUNCIL., 2013. The standards of proficiency for Occupational Therapists. London: HCPC.
KITWOOD, T., 1997 Dementia Reconsidered: the person comes first. Open University Press, Milton Keynes
PERRIN, T., MAY, H. and ANDERSON, E., 2008. Wellbeing in Dementia – An Occupational Approach for Therapists and Carers, 2nd ed. Philadeplphia: Elsevier Ltd
ROYAL COLLEGE OF OCCUPATIONAL THERAPISTS., 2015. Code of Ethics and Professional Conduct. London: RCOT.
SCOTTISH GOVERNMENT., 2011. Standards of Care for Dementia in Scotland: Action to support the change programme, Scotland’s National Dementia Strategy [online]. Edinburgh: Scottish Government [viewed 27 November 2019]. Available at:https://www.gov.scot/publications/standards-care-dementia-scotland-action-support-change-programme-scotlands-national-dementia-strategy