Placement Reflection With Memory Service Health And Social Care Essay

Placement Reflection With Memory table service Health And he artificeric creationy Cargon EssayThis assay will include an introduction providing an overview of the organisation undertaken and the relevant lymph node group who access the advantage, a critical rating of three sound judgements that apply been engross within the at tennerd, one being occupational Therapy specific, a discussion and examples give outn of how chance is assessed and managed within this f atomic number 18 associationting, a discussion of the models of pull used, one noise end used with a particular client with an analysis of how the discourses were identified and prioritised, appraisal and justification of opposite potential intervention strategies, identification and evaluation of the usurpation of relevant regulation upon service prep within the practice setting, finally an evaluation of procl forecast performance as a student occupational healer, and a conclusion.The practice s wanment setting was a city-wide Memory Service situated in North Yorkshire. The Memory Service is made up of a multi-disciplinary team of mental health professionals, working alongside the Alzheimers Society. The service facilitates other(a) detection, diagnosis, and judgment of needs for older good deal with a make problem, as tumefy as giving stomach to their sharers. Group support is as easy as provided.Clients who are referred to the Memory Service are generally older adults who are experiencing archaeozoic-stages of delirium. This essay will focus on one service-user who has been referred to the service diagnosed with Alzheimers delirium, we will birdsong him gunk. The NHS website defines Alzheimers as being the most common form of aberration, which is a group of symptoms associated with a decline in mental abilities, such as storehouse and reasoning (NHS.uk, 2010) scoop is in the early/for bringfulness stage of dementia (Schneck, Reisberg, Ferris, 1982) Thi s includes gentle impairment in store and language, personality alterations, increased falling off and anxiety, although in that location is no signifi croupt deterioration in ADL and is quench competent to proceed independently, tho, it is apparent that goo is in need of round support. Moniz-Cook Wood (1997) adumbrate that psychosocial interventions are much effective in the early stages of dementia and memory serve eat up great potential to provide early interventions for the service user. exclusive is experiencing difficulties in certain areas of his occupational performance, such as wee-weeery/social isolationASSESSMENTIdentify and critically evaluate 3 Axs that are/could be used with the client group.The offset printing step toward intervention is to assess the cognitive level of the client. An example of a standardised estimation is the Mini Mental State Examination 27/30 (MMSE) Folstein et al (1975) but in Memory Service the Addenbrookes cognitive examinati on (ACE-R) is used. The ACE-R is a brief cognitive test that assesses five cognitive areas prudence/orientation, memory, oral fluency, language and visuo-spatial abilities. The total score is 100 of which pocket scored 85/100. The ACE-R is well to administer and only takes approximately 15 minutes to complete. The ACE-R results put up veer depending on the intelligence of the client and their previous education, and to a fault how literate they are.The infirmary Anxiety and Depression Scale (HAD) was used to find out if guck was nauseating or depressed. The results proved that slime was precise anxious with him scoring 9/10 anxiety, however only 2/10 for depression which is not real, in that respectfore this score was discarded. it was set offed that Max was anxious round scratch line social contact again and integrating into the communityA kitchen assessment was undertaken with Max and the occupational healer to assess and observe any adventures to Maxs public as sistance. It was highlighted that Max often left pans on the gas cooker and ended up vehement them, therefrom setting off the smoke alarm, worrying the neighbours.The un unified empirical assessment took place in Maxs kitchen at home which is a beaten(prenominal) environment and in remaining with his daily routine. Max decided to cook scrambled egg on toast as he mat comfort adequate to(p) do this. At the time the occupational therapist was excessively asking Max questions relevant to his daily routine and formulation, therefore also making it an informal interview. Although unstructured assessments dissolvenot provide the reli business leader that structured assessments domiciliate, Kielhofner (2002) mentions some(prenominal) reasons that can justify the use of unstructured assessments, such as, to add to data previously gained by a structured assessment, lack of time, unacceptability of structured assessment by a client, lack of an appropriate structured assessment.T he cast out points of carrying out a kitchen assessment are that kinda often all(prenominal) client has a certain time of the day when they may fly the coop a lot fall apart, Jack functions well well-nigh midday erst he has taken his pain medicine for arthritis and he is more able to focus on assesss. The client may also hold out that they are being assessed and may do things distinctly to how they would if they were alone.The evidence gathered from these assessments showed the occupational Therapist that Max is only slightly cognitively impaired and is understood able to function relatively well and therefore it is strategic to support Max as much as we can in his cause home.Discuss relevance of risk AX and provide examples of how risk is assessed and managed put on the line assessment and management is an important part of professional processes in occupational Therapy practice. Legislation and policies consume been utilise to betoken practice such as Alzheimers SocietyThe risk profile section of the Functional Assessment of the awe Environment (FACE) assessment and outcomes system (Clifford, 1999) is used to allow the occupational Therapist to assess and document any clinical risk that an individual may pose. FACE provides outcome data that enables a patients progress to be prolonged and also compared with other individuals. The FACE risk profile comprises of a front tab that summarises a patients contact details, and ratings of risk which are placed on a five-point scale ranging from 0=no apparent risk, through to 4= beneficial and apparent risk. The second sheet is a conlist of historical and authorized indicators of risk grouped into categories e.g. clinical symptoms indicative of risk and treatment-related indicators of risk. The third sheet comprises throw overboard text cuffes where a description of the specific risk factors, both current warning signs and risk history, can be fully describes and individualised for the patien t. The quaternary sheet comprises relapse and risk management envision which can be specified and tailored for an individual.Some specific events from Maxs past were documented neighborly isolation and exclusion. Max hardly ever left the house obscure from to do a weekly shop on a Saturday dawning time his wife died two years ago and has since been living alone. Max had very few leisure cheers apart from painting, and there was no close family support. As the course of Alzheimers progresses, the global function of individuals with Alzheimers decline. (Kuo, 2009) Max may therefore bring to pass increasingly unable to look after himself which could pose a risk in the future i.e. self-neglect?Thom and Blair (1998) describe the role of Occupational Therapy in identifying unfeigned risks to the individual through the use of functional assessment found on observation and interview. (MENTION ABOVE AX) It was observed that Max has limited mobility due to arthritis in his knees, th is poses a physical risk of falls. Max is aware of his limited mobility, however does not walk with a stick unless outside as he feels a stick inside is a hindrance. All loose rugs wear been removed and the access to Maxs house is flat. He is aware of falls taproom techniques but has requested a pendant alarm from Telecare, as he feels this is appropriate in case he has a fall at home. The furniture is placed so that Max can use this as an aid for walking from the lounge into the kitchen if he feels the need.It was also highlighted that there was a risk operating household appliances safely after the Occupational Therapist carried out a kitchen assessment with Max. It was noted that once Max had started cooking he left the pans on the hob and went off to watch idiot box because he got bored and then consequently forgot almost the pan. From the kitchen assessment the Occupational Therapist was able to intervene and reduce the potential risk by suggesting Max engage himself in an act in the kitchen whilst the food was cooking. hence Max could watch over the food but also hire a novelspaper, or do a jigsaw puzzle to keep himself entertained.Explore application of a model of practice and a therapy start that were/could be usedThe Model of Human Occupation (Kielhofner, 1995) is founded on the principle that meaningful occupation is central to our well-being and that human occupation can silk hat be understood as a dynamic system. (Duggan, 2004) This looks at physical and social environments, habituation, skills, and personal causation.As dementia is a forward- flavour disease, the physical environment may become less accessible. Dementia may also cause disorientation, making it harder for the individual to nettle their way around places they are not familiar with. Occupational Therapists focus on Occupational performance, therefore we are interested in how individuals function on a day-to-day basis with their work, leisure, domestic life, and personal care. We follow a person-centred come onA person-centred and holistic approach. A holistic approachleisure, personal care and occupation in relation to the physical, psychological, social, economical spiritual aspects of life, (Reed Sanderson, 1992) Creek, 2002.Kitwood describes Personhood promotes older wad as having the same basic rights to dignity, privacy, choice, independence fulfilment as multitude of any other age group.Social interaction will suspensor maintain well-being (Kitwood Bredin, 1992), preventing deterioration of mental function. People in a state of well-being are active occupationally engaging by constitution (Turner, 2001)..INTERVENTION PLANNINGProvide 1 intervention plan which you digest implemented and justify this with evidence and clinical reasoningFollowing Maxs assessment, an occupational strengths and needs list was drawn up for Max and from this an intervention plan was made based on Maxs desired aims, including long-term goals. Goals are ta rgets that the client hopes to reach through involvement in occupational therapy (Creek, 2002, p.129)STRENGTHSNEEDS sharpness into conditionSocially isolated although Max is very easy to get on withEnjoys drawing/painting-expresses interest in connection a topical anesthetic groupLost wife 2 years ago-feels as though he has lost his role in lifePhysically functions quite well apart from arthritic kneesBurnt PansIdentifies positive qualities kind, talkative, sense of indulgeAppears anxious about social involvementPrioritising the plan involved negotiating with Max and other members of the mental health team e.g. community support team, and making sure that Maxs goals were realistic in terms of being achieved within the 6 weeks. Cox (2007) states that symptoms of dementia can significantly disrupt a persons ability to set or meet realistic goals, therefore it is important to make sure each goal is achievable within the six weeks.By prioritising which goals Max wishes to achieve firs t this highlights the use of a person-centred approach, although risk factors moldiness be taken into consideration e.g. Maxs top priority is to be able to make an evening repast safely and independently without burning pans, this is patently a potential risk to Max and should be carried out with a member of the mental health team first.To meet the following goals, reinvigorated (specific, manageable, achievable, realistic and time specific) objectives were also readed.Long-term goal 1Max to make some of his historically favourite meals safely and independently. calendar week 1 Max and the Occupational Therapist will meet on Monday morning at Maxs house, to discuss the risks of cooking with a gas cooker and write these d avow. calendar week 2 Max and Occupational Therapist to discuss whether Max would handle some reading material in the kitchen to engage Max whilst his meal is cooking, therefore allowing Max to be occupied but also to check his food regularly to prevent burning pans and potential fire hazards.Week 3 Max and Occupational Therapist to walk to the topical anesthetic shop on Monday morning, to gather ingredients for the meal Max has chosen and Occupational Therapist to write d own basic instruction for making of the meal.Week 4 Max and Occupational Therapist to make the meal together at 5.30 pm on Tuesday, using the gas cooker and ingredients that were previously boughtDue to the temper of dementia, cognitive abilities decrease over time, the environment mustiness be qualified accordingly. People with dementia may be unable to learn new skills however old skills and habits remain deeply ingrained, and these can be used long into the diseaseBasic Living skills can be of more purposeful and value to the older person than leisure, PADL skills have been found to be important in the goals of treatment with early onset dementia as they value their independence, dignity privacy (Willard Spackman, 2001)It is important to facilitate plenty of c heers and encouragement, through positive reinforcement. It is easier for Max to complete a cooking task when it is broken down into sections, so putting out the ingredients on the worktop in the order they need to go in the pan. Achieving only one or two steps of a task may help to give Max a sense of achievement.Max has a short attention span and finds it hard to remember book of instructions, so writing down a list of short instructions on how to make his favourite meal will facilitate him in the cooking process. When making the meal for the first time the Occupational Therapist gave tactful verbal reminders and simple instructions to encourage Max.Long-term goal 2Max will find creative community based activities and social groups every week for 10 weeks.Max is a friendly and sociable person once he is around peck, and he shows a strong interest in art and has many paintings around the house. Aims of the art group to meet new nation and develop social interaction through art work.Week 1 Provide Max with information about his local neighbourhood network, easy Memory Service groups, and provide transport information so that Max can attend.Week 2 Accompany Max to attend a local art gallery, and establish a alterative relationship with him. include Max to socialise with other large number at the artistic production trend and start to build up his confidence whilst getting him to talk about his favourite interest.Week 3 Support Max to access the service for the first time attend a Memory Service dejeuner club on a Wednesday morning for two hours accompanied by the Occupational Therapist.Week 4 Max to attend a local Memory Service Open Art group for service-users once a week on Monday morning for two hours for 10 weeks.Week 5 Max to continue attending the open art group and aim to achieve a higher level of occupational performance, by marking activities.For an occupation to have any therapeutic benefit it must have purpose, value and meaning to the i ndividual (McLaughlin-Gray, 1998). For Max, this is winning part in Art based activities, in his past he was a strong artist and spent most of his free time outside painting, therefore attending a local art group with similar hatful with memory loss this is an ideal chance for Max to express his creativity and befitting more socially integrated into the community. It is important that we find out what Max wants to do and what he would enjoy, otherwise there will be secondary therapeutic benefit. This is an example of Person-centred care we look for the client to lead us into an agreement of what is good and right for them. Perrin May (2000, p.77)Research is beginning to betoken the value of providing educational and supportive memory groups for plenty in the early stages of dementia. This can be seen as a cost effective, successful intervention that provides an alternative treatment for people in the early stages of dementia (Knapp, 2006) When looking at the College of Occup ational Therapists online dementia clinical forum, there was evidence by Graff et al, 2006, for community based occupational therapy for people with dementia and their caregivers. It found that ten sessions of community occupational therapy over five weeks change the daily functioning of patients with dementia.Creative performance in groups has also been shown to reduce depression and isolation, fling the power of choice and decisions. Non-verbal therapy methods, such as painting, are able to lick the well-being of the patients positively. (Hannemann,2006)The role of the OT with general goals is in promoting occupation, health well-being taking into consideration that dementia is progressive when making intervention plans (Pedretti, 2001).Analyse how the interventions implemented were identified and prioritisedApp turn and justify other potential intervention strategiesanother(prenominal) potential intervention dodge was to install Just Checking, a web-based activity monitorin g system that provides a chart of daily living activity via the web, allowing the Occupational Therapist to track (via sensors in each room) where the individual has been, for how long, and at what time. A Just Checking system could be used for Max to establish his daily routine and activity levels during the day/night. Max states that he is anxious and sits on the sofa most of the day, Just Checking can monitor what he gets up to on a daily basis for 2-3 weeks and then the Occupational Therapist can be sure that the care plans and interventions that they put into place are based on objective information, rather than on supposition. They can be confident that the plan more closely meets Maxs needs. It may highlight that Max needs extra support which can be provided by the Community Support Team.It was suggested to Max that he try a dosset box for his daily medication, as it was noted that Max was not always lamb comparable with his medication. However, Max refused this idea as he w as happy taking his medication from the packet, and he felt that a dosset box would upset his daily routine. some other suggestion for Max could be for him to keep a diary so he can note down everything that is important like taking medication at a certain time, and attending any indispensable appointments.The Occupational Therapist also gave Max some information about a Reminiscence group that is starting in the New Year. On nearly every visit Max would get round to talk of the town about his past or photographs that he had on the wall, so it seemed like a good suggestion for Max to attend this group. When searching the Cochrane program library database, Woods et al (2005) looked at the effects of reminiscence therapy for older people with dementia and their care-givers. The results were statistically significant for cognition (at follow-up), mood (at follow-up) and on a measure of general behavioural function (at the end of the intervention period).The use of reminiscence ther apy with people with dementia has been linked with progressions in behaviour, well-being, social interaction, self-care and motive (Gibson 1994) Although there is little specific evidence for the effectiveness of reminiscence in dementia care (Carr, Jarvis and Moniz-Cook 2009) Max has expressed an interest in joining because he feels as though he would gain some therapeutic benefit being able to talk about past events with people of a similar age and with memory problems.The Cochrane review concluded that there was inconclusive evidence of the efficacy of reminiscence therapy for dementia. However, taking studies together, some significant results were identified, including improvements in mood and cognition, lessening of care giver strain and improved functional ability. No harmful effects were identified.Identify and evaluate the impact of relevant legislation, health and social policy and clinical guidelines upon service provision overallIt is important that Occupational Therap ists have a clear set of principles to work alongside when working with a person with Dementia. Also it is important to follow the Codes of Ethics and Professional Conduct (COT, 2010)The Mental Capacity propel 2005 (MCA) is underpinned by 5 guiding principles which all staff must followThese arean assumption of capacitysupporting people to make their own decisionspeople have the right to make eccentric or foolish decisionswhere someone lacks capacity staff must act in the persons best interestswhere someone lacks capacity any action we take on their behalf must generally be the least restrictive optionThe National Dementia Strategy for England (DoH, 2009a) is a five-year plan which has three main aims to ensure better knowledge, to ensure early diagnosis and to develop services. The strategy has put a focus on improving support for this large and growing group of people. It sets out a vision to raise the standards of care for people with dementia and is of great significance to Oc cupational Therapists working in the Memory Service.Occupational therapists can ensure that both the clients and their carers have a better understanding about the impact of dementia. Occupational Therapists working in the Memory Service get to see clients performing various activities that are directly or indirectly affected by memory and other cognitive functions through observation and assessment and are, therefore, able to identify early signs of cognitive impairments and raise awareness about the functional implications of memory and other cognitive impairments.In the UK, the National Service fashion model for Mental Health (DoH, 1999) has been the main guide for how services should be run. It is now being replaced by the New Horizons strategy (DoH, 2009b), which aims to promote good mental health and well-being whilst improving services for people who have mental health problems. Occupational Therapists need Includes early intervention to improve long-term outcomes, personali sed care ensuring that care is based on individuals needs and wishes, leading to recoveryNew Horizons sets out an plan across a wide range of agencies to move towards a parliamentary procedure where people understand that their mental well-being is as important as their physical health if they are to live their lives to the full. It describes some of the factors that affect well-being and some everyday strategies for preserving and boosting it.It is important that Occupational Therapists specialising in the domain of a function of dementia ensure that they have a copy of the National Service Framework for Older People and use it a guide for the minimum level of service provided.EVALUATIONAnalyse how evaluation of interventions was completedAnalyse your own performance as a student OTHaving completed this 7 week placement I feel as though I have grown in confidence and learned so around the field of Dementia. I have had the chance to observe and assess many people with different d iagnosis of dementia and every single person has been different and unique, with different goals they want to achieve and what they wish to receive out of the service. I have learned that communicating with a person with dementia can be a slow process, it is important to be able to actively listen not only to the service-user but to the carer as well as they provide so much valuable information and they are usually so much involved in the care of the service-user.Reflective practice has been identified as one of the key ways in which we can learn from our experiences. It helps to develop knowledge and skills towards becoming professional practitioners. (Jasper, 2003) It is important that as a student Occupational Therapist I learn from my experiences on placement in order to understand and develop my practice, this involves consciously view about things I am doing, actively listening and making decisions. From what I have observed I can then start the pondering process and descri be the experience and analyse it. I used Gibbss brooding cycle (Gibbs, 1988) that consists of six stages of the reflective process and asks cue questions to prompt the memory. inferenceProvide summary of key pointsEvery individual has certain strengths and weaknesses, likes and dislikes, emotions and habits, needs and preferences, and this makes them unique. People with dementia are often denied these things as their disease progresses, therefore it is important to try and maintain as best as viable the individual characteristics that makes up that person. As Occupational Therapists we need to acknowledge the uniqueness of the person and realise that even if they have dementia they are still living their life.Structure and predictability are important aspects of the environment in which people with dementia live.Summarise how the interventions improved or maintained health and well being for the individualBrooker p.44 (2007) states that It is important to and appreciate that all p eople have a unique history and personality, physical and mental health, and social and economic resources, and that these will affect their response to dementia.There is good evidence that people with dementia can learn, and respond to their environment, and through groups they can experience an improvement in the quality of life. It may not be possible to tip over the effects of dementia, but some of the major difficulties for Dementia sufferers are caused by under-stimulation, withdrawal, depression, and anxiety, and these can be reduced. This can make a real expiration to the person. Max has lost his motivation and he was anxious about difference the house and becoming socially involved again because of his memory deficits and it took some gentle persuasion to get him involved again. However, the Occupational Therapist set forth to Max what was going to happen, and what he would be doing, and reminded him when to attend the group sessions so he did not need to worry. The Art Group is a closed in(p) group, and the same people meet for a number of sessions and they get to know each other and become familiar with the routine of the group. This is good for Max as he is able to make some new friends, give way to a familiar environment each week, and start to establish a routine. The leaders of the group get to know the members and are able to plan activities according to each member. Max expressed a strong interest in watercolour painting, and the art group leader was able to arrest this. The achievement of leisure goals helped Max to sustain his self-esteem and morale.