My occupational therapy internship: then and now!

Introduction:

My name is Sarah MacFarlane and I was the one of the Occupational Therapy Interns with Alzheimer Scotland in 2018. I am a Canadian who found herself across the pond to do the MSc (Pre Reg.) Occupational Therapy program at Queen Margaret University (QMU), Edinburgh, when I was lucky enough to undertake this opportunity between my first and second year of the two year program.

When I was asked to write this blog and reflect on my past experience as an occupational therapy intern, I will admit I felt a bit like a child star participating in a “where are they now” documentary!  Thankfully, the place where I am now is not one that is gossip magazine worthy, but rather one that I can say I am in now directly because of my internship and my experience there.

Where am I now?

First off, this Canadian is still in Scotland! After two amazing years on the MSc (Pre-Reg.) occupational therapy program filled with four practice placements all around Scotland, including the Alzheimer Scotland internship, I was not quite ready to leave. I wanted to stay and contribute to the healthcare system that educated me so patiently and work in a country that welcomed me with open arms. The internship in particular shed such a bright light on the amazing work Scotland is doing for and with people living with dementia. I was offered opportunities to really get to know people living with dementia in Scotland, and people who were passionate about making change and being a voice for dementia. All of this is of course in addition to my love of Scotland’s architecture, scenery and food! For example, here is a travel picture of a pre-lockdown adventure on the Isle of Skye to give us all hope for an adventurous future, post lockdown.

I am now working full time as a Band 5 Occupational Therapist within an Adult Community Mental Health Team. Although I am not working with older adults, I work everyday with people who are living with an “invisible disability”. This term was first brought to my attention during my work with the Scottish Dementia Working Group (SDWG) through the internship, when one of it’s members said dementia was a barrier to him engaging and gaining appropriate support – that his illness and disability was not visible when people looked at him. I value that experience and knowledge everyday at work, and what unique barriers come with this when a person is trying to engage in meaningful occupations.

How did the internship prepare me for the world of work?

The internship allowed me to explore the space between being a student and being in the “real world” as a practicing therapist. It allowed for a safe space to grow, while at the same time pushing me to explore a new area and role for occupational therapy internships. There are so many ways to consider this question, but I will say that the internship prepared me for the world of work in 3 main ways:

1. Importance of having both independent and team working skills.

A skill that many take for granted I believe is the ability to work when there is not an immediate team around you, motivating you and guiding you. Although this role was very supportive and I worked as part of a team throughout the entire summer, I imagine it to be like many role-emerging occupational therapy posts in that it required a lot of initiative, leadership, creativity, time management and passion for the project you were working on. It instilled a confidence and comfort in independent working that I value so much as a practicing occupational therapist now.

2. Seeing and appreciating the value of unique occupations.

            As humans, it is easy to start to stereotype populations or groups and have certain expectations for those individuals. I believe this internship came at such a critical point in my occupational therapy training as it shattered some of the stereotypes I will admit to having had, and allowed me to see the value in unique occupations no matter the age, diagnosis, perceived barriers or societal expectations. A good example was when one woman said during a “blether” with the SDWG, that just because she was old, doesn’t mean she wants to play bingo. Not that there is anything at all wrong with bingo, however I believe this does go to show that we need to think outside of some of the perceived beliefs around what occupations people value, which in this case was going to the pub. Cheers!

A great place to further see what occupations people within the SDWG valued, is through the project we worked on, called The Roots to Occupation.  Check it out here

3. The importance of project development and connecting policy to people.

            The projects I worked on as an intern and the policy development I was exposed to at Alzheimer Scotland prepared me for the world of work where I am currently having to adapt and enhance services offered to patients that are in line with lockdown restrictions, develop new groups, and work on all of the other aspects that come with the “paperwork” side of the role. I was able to see the direct impact that policy can have on people with dementia, but also the impact and voice people with dementia can have with policy.

So, although I am a few years out of the internship now, I can proudly say that once an occupational therapy intern, always an occupational therapy intern.

Contributor

Sarah MacFarlane, Occupational Therapist

Twitter Handle: SMacFarlane_OT

Occupational Therapy Student Placement at Alzheimer Scotland

Abi writes about her placement which finished at the end of October……..

I can’t believe that it has been 8 weeks already! I am sad to say this is my final day on placement with Alzheimer Scotland. I have really enjoyed this placement and feel that I have been given many opportunities to expand my knowledge of dementia, hear the lived experience of people living with dementia and those who support them, meet with organisations such as the Scottish Dementia Working Group (SDWG) and the National Dementia Carers Action Network (NDCAN), attend multiple virtual events and provide individualized advice to people living with dementia and their carers.

In my previous blog I had mentioned that “there was so much more I still wanted to learn about and explore within the field of dementia, especially in relation to how Occupational Therapy can support people living with dementia and their carers within the community”. Comparing what I knew at the beginning of this placement to now, I feel my knowledge and understanding of this has increased significantly. From the requests received from the Dementia Advisors and Dementia Link Workers to the many questions I was asked during the carers groups I attended, it is clear that Occupational Therapy has a vital role in dementia.

During this placement I was lucky enough to work alongside a fellow Occupational Therapy student as well as two Physiotherapy students. This offered me the chance to engage in peer-assisted learning, something I had not been able to do before, experience what it is like to work as part of a wider, multidisciplinary team and gave me the opportunity to learn about the role other professions play in supporting people living with dementia and those who support them.

The three main learning goals I set myself at the beginning of this placement were as follows:

  • To further expand my own and others (including other Allied Health Professionals) awareness of the current issues faced by people living with dementia and their carers
  • To promote the role of an Occupational Therapist within dementia care, mainly using social media platforms and my attendance at carer support groups
  • To provide those living with dementia and their carers with up to date and evidence-based information around ways of participating and engaging in meaningful activities, wellbeing for carers, tips for getting out and about during Covid-19 and lots more

I can safely say through creation of many flyers, posters, videos, resource packs and the Activity Series (which was shared across social media using the AHPDementia accounts) as well as having the opportunity to speak with AHPs and other professionals working within this field and providing individualized advice, I have been able to meet all three of these learning goals.

Graphical user interface, website

Description automatically generatedBefore I finish, I would just like to take this opportunity to say a big thank all those that made this placement possible and to recognise all the amazing work everyone Alzheimer Scotland does providing, what I would deem, a vital service to people living with dementia and those who support them.

All the best,

Abi Allan, 4th Year Occupational Therapy Student, Queen Margret University, Edinburgh

Look out for fellow Occupational Therapy student, Gemma’s Blog coming soon.

Summer success for online resource supporting people with dementia

In March 2020, Lab4Living, in collaboration with allied heath professionals from Alzheimer Scotland, launched Connecting People, Connecting Support, an online resource to support people with dementia and their families. The website hosts a range of interactive research-informed resources that promote quality of life.

The website was designed in response to the COVID-19 pandemic, which prevented people with dementia accessing day centres and resources in person. It was felt that the opportunity for individuals to interact and engage in meaningful activity at home was more important than ever.

The online recourse grew over time with two new topics being added every week in response to feedback, what was currently happening regarding COVID-19 and even the weather. Topics released on a Tuesday focused on helping individuals to manage the practical challenges that living with dementia brings and the Friday topics shared creative and expressive activities.

Lab4Living Research Assistant and Designer, Helen Fisher, said “The strength of the resource can be found in its contributors. Not only are the resources based on over 10 years of research by Professor Claire Craig and Alzheimer Scotland, but we also had 10 specialist contributors, ranging from poets to dietitians to artists.”

Since its launch, the website has received over 5000 visitors and 35,000 page views.

One user commented, “I sat down and I must have been at it for 2 hours… I actually enjoyed doing it, I actually liked quite a lot of it. You’ve got to set yourself time to do it. Having something like this is really good.”

Following a webinar about the website in which 268 people attended, a healthcare professional provided the following feedback: “I think the scope of the piece of work is vast. I work in a specialist dementia team and can see so many ways we can use the resource in the future.” An occupational therapist also added: “I have found the resource to be incredibly helpful; as well as signposting people living with dementia and their family to the website, I have used some of the materials with patients. This includes the drinking challenge template, which we used within our team to support an individual to increase her fluid intake.”

It was also noted by a regular website visitor that “Carers don’t have the energy to search for things online, so having this all in one place is great. People feel like they’ve won the lottery when they see the website!”

Not only has positive feedback been received from people with dementia, carers, family members and professionals, the Royal College of Occupational Therapists have endorsed the website, recommending it as a targeted digital occupational therapy tool

(This blog was originally posted in September and we had permission to share here too. Thank you)

Physiotherapy student placement at Alzheimer Scotland

Physiotherapy Students, Edinburgh Napier University

Who, What, Why and When

Who   What have we learned about working with people living with dementia?

In our eight weeks with Alzheimer Scotland we have met many people living well dementia and carers who are helping them to live well with the condition. The best thing we have heard from this placement was “if you have met one person with dementia, then you’ve met one person with dementia.” That was proven to be true every day when we listened and learned about how the different types of the disease had impacted people’s lives in different ways through various symptoms, differing ages of onset and rates of progression. Through this we have been able to gain a better understanding of how support for a person living with dementia must be specific to their individual needs.

What kind of things have we done to show how physiotherapists can help people live with dementia?

To help people understand what it is that Physiotherapists and Physiotherapy as a whole can do for people with dementia, we created an animated video, outlining the main roles and input Physiotherapists can have. When discussing Physiotherapy and other AHP’s with link worker and carer groups it appeared they were unaware of the extent to which Physiotherapy can be involved in a person’s dementia journey.

To help people better understand what Physiotherapist’s can offer:

  • We promoted dementia friendly exercise sheets via social media using photos and videos to help others visualise the exercises
  • Created falls advice and going out after covid-19 lockdown advice leaflets to allow people easy access to this information
  • Raised awareness of Physiotherapy’s role in dementia care by creating an AHP youtube channel that has all our exercises videos and our “What can physiotherapy do for a person living with dementia”
  • Created a checklist to help Physiotherapy services become more dementia aware
  • We gave one to one advice to carers and people living with dementia
  • We hosted online exercise classes, in which we led a group through the dementia friendly exercise sheets
  • We wrote blogs to document our journey through this placement and show people what we have been up to
  • Attended Carer and Link worker groups to ask and answer questions people had about Physiotherapy and give advice
  • We researched and then created dementia friendly activity posters, highlighting the benefits of each activity for those living with dementia

We hoped by completing these projects throughout our time at Alzheimer Scotland we would have created more awareness about what Physiotherapy can offer and help promote future areas of development within the service.

Why were the things we did important?

We chose to focus most of our time during this placement on encouraging people living with dementia to increase their physical activity levels to build muscle strength and improve balance. This is important to help people keep as much of their independence for as long as possible. We were able to use dementia friendly exercise sheets that had already been developed and we chose to make short videos to accompany these since we were unable to meet people and demonstrate these in person. We also felt it was essential to promote these exercises during the Alzheimer Scotland link worker and carer groups as well as on social media to reach as many people as possible. We felt it was important during our time with Alzheimer Scotland to make people aware of what a physiotherapist can do to support them. We listened to what concerns people living with dementia and their carers had,  such as how to increase physical activity? what types of exercises to do?  as well as hints and tips around falls prevention. We regularly use the phrases “any movement is good movement” and “make it fun”! Engagement seems to be a challenge in increasing activity levels for people living with dementia so including music, balloons and other fun things like catching bubbles can always help.

When should someone with dementia contact a Physiotherapist?

This is a questioned we have been asked many times by a range of different people, it is also a difficult question to answer as it often differs between people. However, a Physiotherapist may be able to help you with your mobility, strength, balance, injuries, pelvic health, maintaining function and independence, confidence in walking, back pain and more.

So, if you notice a change or decline in your movement, function or independence it is time to contact a Physiotherapist.

Prevention is also a key area of Physiotherapy therefore completing simple and functional exercises can help you stay strong and mobile. These exercise sheets below have been designed to be simple but beneficial for improving strength and balance. You can also check out the AHP Dementia YouTube channel for videos of us completing these exercises.

Dementia friendly exercises for strength and flexibility here

Dementia friendly exercises for strength and balance here

YouTube Channel:

https://www.youtube.com/channel/UCvl9tSghsjCGq4mIuiCag-w

See our video – Click Here

We have had a great eight weeks with Alzheimer Scotland and have learned so many new things from all the people we have been lucky enough to meet. Thank you to everyone who has been involved with us and supported us, it has been an experience we will not forget.

Thanks for having us!

Toni and Steff

Toni
Steff

Demystifying Delirium

#AHPDementia webinar series

On Wednesday 26th August 2020 we hosted a webinar on delirium, as part of the AHP dementia webinar series.  During the session we explored:

  • What Delirium is, and how it presents
  • How to be a delirium detective
  • The AHP role
  • A delirium case study

And some top tips on how to support people to manage delirium

You can listen again here: https://www.alzscot.org/our-work/transforming-health-care/allied-health-professionals-and-dementia/allied-health/our-ahp/innovation-improvement-and-research

During the webinar we were asked some interesting questions, and are pleased to be able to answer these for you below.

Question: Does Delirium affect a certain part of the brain?

Answer: Although the exact pathology of delirium is not fully understood, research has suggested changes in cerebrum and the blood brain barrier.  It is thought this is due to changes in the levels of chemicals that carry signals around the brain called neurotransmitters.  It may therefore be that delirium causes widespread changes in the brains ability to work rather than affecting one particular area.  The paper by Maldonado (2017) explores this in more detail.

https://onlinelibrary.wiley.com/doi/10.1002/gps.4823

Question: I’m an OT – How can I best support the newly qualified nursing staff on the ward to promote the “Action on Delirium” we’ve discussed today?

Answer: iHub and SIGN have produced a range of resources including infographs and patient information leaflets that can be useful to share with colleagues in raising awareness of delirium.  NES have also produced a Learnpro module on the subject which can staff can undertake as part of the professional development.  But often the most productive way to get the message across is to raise the topic during case discussions.

Question: Do you have 24 hour provision of AHPs in your hospitals. If not how do you support quality 24/7 delirium care?

Answer:  Physiotherapists often provide a respiratory on-call service, however 24 hour AHP cover is rare, and we do not have this for rehabilitation within the hospitals we work in. To truly provide a 24/7 AHP service would require significant investment and ongoing funding. However delirium identification and management is part of everyone’s role. As allied health professionals, part of our role is consultancy; sharing our knowledge and practical advice with all of the people we work with.  Raising awareness of delirium, developing strategies to manage it during multi-disciplinary team meetings, developing and delivering education sessions and sharing resources such as this webinar will help to provide effective care within the wider health and social care team throughout the day and night.

It was great to hear your reflections on what you currently do to manage delirium

‘I encourage hydration and have an awareness of falls risk.’

‘Already use photos of staff faces on the outside of PPE and have done since the start of the pandemic’.

‘Use 4AT routinely.  If the patient scores 4 or above I will ask an ACP or doctor to complete the TIME bundle.’

‘I am an occupational therapist and regularly use SQiD, however I was not aware it was ‘a thing’

And thank you for all of your feedback on the webinar itself:

‘Good reminder about non pharmalogical management of delirium and the importance of education.’

‘It was very informative, straight to the point – no medical jargon and the hour was enough time to learn thank you really enjoyed and learnt from this.’

‘Felt today’s presentation was quite hospital based… suggestions for community based delirium would have been useful.’

‘Content was excellent and focus on AHP contribution was excellent, practical support and it was very helpful.’

Take away thoughts

AHPs have a key role to play in risk reduction, identification, management and rehabilitation for people with delirium and dementia.  Important ways in which we can support people in hospital or in the community include:

  • Encouraging people to get up and dressed during the day
  • Ensuring they are hydrated and well nourished
  • Supporting carers to recognise sudden changes in presentation
  • Establishing routines
  • Promoting sleep and rest   

Remember SQiDIs the person more confused than normal?

If yes, think Delirium!

Contributor

Claire Craig, team lead phyiotherapist,

@ClaireCraig_PT

#withPHYSIOyouCAN

Gillian McMillan, Specialist Dietitian in Mental Health         

#withDietitiansyouCAN

Christine Steel, AHP Dementia Consultant

@christineahp