National Institute for Health and Care Excellence An Occupational Therapists’ Perspective Naomi Morgan Final year occupational therapy student, Bournemouth University Student champion 2014-15 and 2015-16 Hello, my name is Naomi and I am a final year Occupational Therapy Student from Bournemouth University. I have been a student champion for 2 years and have completed 3 cascade sessions, 2 as a part of the University’s Peer Assisted Learning Scheme and 1 as a refresher to my year group. Today, I have been asked to highlight where OT may fit into some of the guidance and share with you specific examples from placements or in academic work where I have used NICE ES.

What is Occupational Therapy? I wanted to start by explaining what OT is: Essentially we look at enabling people to do the things that they want, and need to do on a daily basis. We work with adults, children, the elderly across all areas of physical and mental health as well as learning disabilities, social services, vocational services and within charitable organisations. "Occupation" refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as self-care, work or leisure (British Association and College of Occupational Therapists 2011).

Learning Disabilities Acute Neurology Spinal Cord Injuries My Placements… Paediatrics Learning Disabilities Acute Neurology Spinal Cord Injuries Community Mental Health (Next week)

Placement Experience - Falls A typical OT example – but a good one all the same. So here you can see that a home assessment is recommended in the Falls for older people guidance. OTs play a big role in getting people home from hospital and preventing hospital admissions, and much of this relates to how safe and practical, their home is to mobilise around. Home assessments are very common in the community – in physical settings, and also within all areas of OT. Home assessments go beyond looking solely at the home, the assessment will also include access to and from the property, and parking arrangements. As well as the opportunity to take a look at a patients social environment – often it is a patients social environment that can be most complex. I have completed home assessments in all of my placements so far, with the exception of SCI where geographically it would be difficult. However, arrangements were made with more local OTs to assess peoples home situation for access and mobilising around the property in a wheelchair.

Placement Experience – Stroke Keilhofner who is well known in the OT field explains that to be truly client centred we need to understand where the patient has come from – in a long term sense, but also in the short term. So, having an understanding of what the patient has been through since arriving in A&E is vital if we are going to be the client centred practitioners like we aspire to be. It is also inevitable that the patient will ask us questions that are not directly related to our area of expertise. So having access to this guidance not only gives the patient confidence in the care they are receiving, even though I was not always able to fully answer their concern, it also gave me the opportunity to learn a little more about the patients journey, the medical investigations involved in diagnosing and treating a stroke and a chance to show my PPE some wider knowledge. As it happens, OTs do have a large role to play in Stroke rehabilitation.

Placement Experience - Stroke OT Process Assessment Goal Setting Intervention (Duncan 2009) This pathway correlates nicely with the OT process where OTs tend to take the lead when screening and assessing for visual or cognitive deficits , and the assessment of upper limb dysfunction. Alongside the further MDT, goals are then set with the patients and appropriate interventions are planned. NICE leads you to specific dysfunctions…

Dissertation Which leads me quite nicely onto my dissertation topic. I have always found NICE a good place to start – to find out what is currently well evidenced and recommended in practice. This is how I chose my dissertation topic, and have referenced NICE for the exclusion of the interventions already recommended.

Dissertation Whilst on the topic of the dissertation Found under the journals and databases tab, and with the use of an open athens log in you can search a variety of databases using your search terms. I especially like how it saves all your searches and your use of any limiters which you can then email to yourself along with links to the relevant articles in your final search. It’s a great way to keep a record of how you reached your final articles.

Placement Experience – Spinal Unit Like in my previous example, I wanted to understand the patients journey whilst on placement in a spinal treatment centre but clinical guidelines were in development however, guidelines that became relevant were related to Bipolar Disorder, anxiety, depression…

Placement Experience – Spinal Unit Sadly some people acquired their SCI when attempting to take their life, had underlying MH problems, eating disorders or have become anxious or depressed since their injury. Patients can also experience post traumatic stress after a traumatic or frightening accident.

Placement Service Improvement Project This isn’t my work but a peer said she was happy for me to share this example. Whilst on placement she was asked to create a booklet of commonly used medications on the unit what they were for, likely side effects and contraindications with other drugs. She was able to use the BNF tab of NICE ES to help put this project together.

What next? Due to qualify in June 2016 Prepare for my next placement… Generalised Anxiety Disorder Depression Personality disorders Psychosis and Schizophrenia Due to qualify in June 2016 Thank you for listening, are there any questions? GAD - http://pathways.nice.org.uk/pathways/generalised-anxiety-disorder Depression - http://pathways.nice.org.uk/pathways/depression My next placement which starts on Monday is in Adult Community Mental Health so have looked at the following guidance to prepare… I am due to qualify in June of this year and am currently in the process of seeking employment in the Oxfordshire area and I’m sure that I will be referring to NICE to support my job applications.

Any Questions?