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Case Study Presentation

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 .

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Case Study Presentation

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  1. Case Study Presentation Aged Care and Rehabilitation Service October 2012

  2. Aged Care and Rehabilitation Service (ACRS) • Aged Care and Rehabilitation Service: • Multidisciplinary team • Geriatric clients • 28 beds • Short and medium inpatient care

  3. Frameworks • Person-Environment-Occupational Performance (PEOP): • Highlights complexity of person-occupation-environment 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)

  4. Communication and Rapport • Fosters therapeutic relationship • Honesty • Confidentiality • Respect • Clarity • Client-centred

  5. 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)

  6. 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)

  7. Framing

  8. 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)

  9. Focussing

  10. 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)

  11. Informing

  12. 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)

  13. 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)

  14. 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)

  15. Assessments (Welch & Lowes, 2005; Wancata et al, 2006) • Home Access Visit: • Identifies barriers to home discharge • Integral aspect of discharge planning • Geriatric Depression Scale (GDS): • Assess presence of depression • Clinically valid and reliable in rehabilitation setting

  16. Identifying

  17. 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

  18. Naming

  19. 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)

  20. 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)

  21. Doing

  22. Intervention • Client-centred • Compensatory: • Equipment provision • Recommendations • Remedial: • Retraining • Practice (Christiansen et al, 2011)

  23. Intervention (Pierce, 2008; Hagsten, Svensson & Gardulf, 2006; Kortebein, Bopp, Granger, & Sullivan, 2008) • Functional task retraining: • Increases physical functioning and independence • Maximises functional recovery following hospital related debility • Group Participation: • Re-learn adaptive skills • Maintain occupational performance • Facilitate socialisation

  24. Intervention • Equipment provision in hospital: • Adjustable shower chair • Over toilet frame • Long handled reacher • Case Conference: • Weekly • Presented current care plan and goals (Koval & Cooley, 2005)

  25. Intervention • Family Meeting: • Multidisciplinary • Discharge destination • Future improvements required • Recommendations post-home visit: • Client function, intrinsic factors • Environmental modifications, extrinsic factors

  26. Intervention • Unable to achieve SMART goals • Discharged from occupational therapy • Awaiting Nursing Home Placement: • Unsafe for discharge home

  27. Reviewing

  28. 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)

  29. Service Evaluation • Challenging result • Improvements not always achieved • Duty of care • Client safety central to care (Australian Association of Occupational Therapists, 2001)

  30. Altizer, L. (2005). Hip Fractures. Orthopaedic Nursing, 24, 283-292 Australian Association of Occupational Therapists. (2001). OT Code of Ethics Australian Bureau of Statistics. (2011). Population by Age and Sex, Regions of Australia (No. 3201.0). Retrieved from http://www.abs.gov.au/ausstats/abs@. nsf/mf/3235.0 Australian Department of Health and Ageing.(2009). Extended Aged Care at Home (EACH) Packages: Information Sheet no. 4. Canberra: Author Bynon, S., Wilding, C., & Eyres, L. (2007). An innovative occupation-focussed service to minimise deconditioning in hospital: Challenges and solutions. Australian Occupational Therapy Journal, 54, 225- 227 Christiansen, C., Baum, C.M., & Bass, J.( 2011). The Person-Environment- Occupational Performance Model. In E.A.S. Duncan (Eds.) Foundations for practice in occupational therapy (5th edition pp 93-104). London: Elsevier Cole, M, & Tufano, R. (2007). Applied Theories in occupational therapy: A practical approach. Thorofare,N.J: Slack 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, 218- 224. Reference List

  31. 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 self-reported 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 & Spackman’s 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, 118–125 Koval, K.J., & Cooley, M.R. (2005). Clinical pathway after hip fracture. Disability and Rehabilitation, 27(18-19), 1053- 1060

  32. Koval, K.J., Skovron, M.L., Aharonoff, G.B., & Zuckerman, J.D. (1998). Predictors of functional recovery after hip fracture in the elderly. Clinical Orthopaedics and Related Research, 348, 22-28 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., Wei, H., & Banks, R. (2005). Clinical Value of ADL Assessments for Inpatients post-Total Hip Replacement Surgery. (Unpublished Student Research Project). University of Queensland and Mater Adults Hospital, Queensland. McCallum, J., Simons, L.A., Simons, J., & Friedlander, Y. (2005). Patterns and predictors of nursing home placement over 14 years: Dubbo study of elderly Australians. Australian Journal on Ageing, 24(3) pp 169-173 Measurement scales used in elderly care. Retrieved Oct 4, 2012 from http://www.dementia- assessment.com.au/symptoms/FIM_m anual.pdf Occupational Therapy Australia [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

  33. Pierce, S.L. (2008). Restoring Mobility. In M.Vining Radomski & C.A.Trombly Latham (Eds.) Occupational therapy for physical dysfunction (6th edition pp 817-853). Baltimore: Lippincott Williams and Wilkins Roberts, P., & Evenson, M. (2009). Settings Porividng Medical and Psychiatric Services. In E.S.Crepeau, E.S.Cohn, & B.A. Boyt Schell (Eds). Willard & spackman’s occupational therapy (11th edition pp 1074-1079). Philadelphia: Lippincott Williams & Wilkins Rogers J.C., & Holm, M.C. (2009). The Occupational Therapy Process. In E.S.Crepeau, E.S.Cohn, & B.A. Boyt Schell (Eds). Willard & spackman’s occupational therapy (11th edition pp 478-518). Philadelphia: Lippincott Williams & Wilkins Rogers, J.C. (2010). Occupational reasoning. In M. Curtin, M. Molineux, & J. Supyk- Mellson (Eds.) Occupational Therapy and Physical Dysfunction: Enabling Occupation (6th edition pp 57-65). London: Elsevier Rowland, J., Conforti, D., Basic, D., Vrantsidis, F., Hill, K., LoGiudice, D., Russell, M., Haralambous, B., Prowse, R., Harry, J., &Lucero K. (2006). A study to evaluate the Rowland Universal Dementia Assessment Scale (RUDAS) in two populations outside of the Sydney South West Area Health Service. Retrieved Oct 4, 2012 from http://www.fightdementia.org.au/comm on/files/NAT/20110303-Nat-CALD- RUDASvalidation2007.pdf Reference List

  34. Spealstra, S.L., Given, B., You, M., & Given, C.W. (2012). The Contribution Falls Have to Increasing Risk of Nursing Home Placement in Community- Dwelling Older Adults. Clinical Nursing Research 21(1) pp 24-42 Van Huet, H., Parnell, T., Mitsch, V., & Mcleod- Boyle, A. (2010). Enabling engagement in self-care occupations. In M. Curtin, M. Molineux & J. Supyk-Mellson (Eds.) Occupational Therapy and Physical Dysfunction (6th edition pp 341-355). London: Elsevier Wancata, J., Alexandrowicz, R., Marquart, B., Weiss, M. & Friedrich, F. (2006). The criterion validity of the Geriatric Depression Scale: a systematic review. Acta Psychiatrica Scandinavica , 114 (6), 398-410 retrieved from http://onlinelibrary.wiley.com/doi/10.111 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), 158-164 Reference List

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