Occupational Therapists (or OTs) are normally employed by the NHS (National Health Service) in the United Kingdom, though many work in private or independent practice. They specialise in assessing the ability of a person to undertake activities of daily living (ADLs): basically things you do everyday.
They work with all kinds of people – adults (young and old), children and teenagers, people with physical or mental disabilities, etc. A person may need an Occupational Therapist if they are recovering from an accident, illness – they may have had a stroke or hip operation for example - have a cancer diagnosis, learning difficulties or psychological problems ranging anywhere from anxiety and depression to psychosis.
Occupational Therapists are skilled in creating a close but professional working relationship with their patients as in most cases they need to get a lot of information about the person’s life and what is important to them. They do this by looking at their home life, hobbies, social life, employment, religious or spiritual needs, etc. and assessing the impact of their illness or impairment upon it.
Once they have uncovered the areas the person is having difficulty with they will provide whatever support and advice they can. If, for example, the patient is an elderly person who has come into hospital after having a fall and during the assessment they reveal they are not coping well at home, the Occupational Therapist can practice washing and dressing and making hot drinks and snacks to help the patient get their confidence back (it is also a good chance for the OT to assess their functional ability!). Following this they may provide them with a perching stool (a height adjustable stool to allow the patient to sit at the sink or worktop), a commode so they don’t have too far to go in the night to use the toilet or an extra stair rail, for example.
However, they may recommend that the patient has home help (carers) to give them support in the short or long term or it may be that they would not be able to cope at home anymore so a move to sheltered or residential care is needed if necessary (although other avenues such as home help would be tried first where possible).
As you may guess, communication plays a vital role in Occupational Therapy. Difficult and sensitive discussions often take place and some people may be resistant to or suspicious of offers of help.
Crucial to Occupational Therapy is the ability to facilitate the person. This means rather than doing everything for the patient, it is a balancing act between assisting and allowing them to try activities, as in the example of reduced confidence above. This doesn’t mean letting someone fail, but as the emphasis is on assessment and rehabilitation, if, for example, the OT dressed the person rather than allowing them to do it in a safe and supportive environment and assisting where required, how is the patient going to see how much ability they have?
Life on the Ward:
Most Occupational Therapists work on hospital in-patient wards. You will be busy! A typical day may consist of attending board round (nursing handovers) with the other members of the multidisciplinary team (MDT) such as Physiotherapists, Social Workers, Doctors, etc. This allows you to get an update of how patients are doing and get information on anyone new.
Following this you may undertake an initial interview with a patient where you will use your communication skills to learn about their life before they came into hospital: what kind of home is it – flat, bungalow, etc. are there steps leading up to the front door; who do they live with and are they in good health – your patient may normally be a carer for their husband or wife; do they work and if so what do they do and how do they commute; who makes the meals, does the housework and shopping; do they have a wash at the sink, bath or shower independently or do they normally need help with this; what are their hobbies or social interests; have they been struggling with any household tasks before they came into hospital?
At the same time as gathering this information, you will also be able to assess the patient personally: do they remember things well or is their memory a problem? Is this new? Are they emotional or anxious and if so why? Is this normal for them? By the end of the assessment you will have a good overview of the patient’s life and along with a good knowledge of the condition that has admitted them to hospital you will be already able to start thinking about a treatment plan.
You will work very closely with the Physiotherapists as you need to know what their mobility is like and if there are any precautions you need to take, such as after a hip operation. The Physios will be interested to know what you need to work on with the patient and if you feel there are any cognitive problems they need to know about (they will be able to see if there is any cognition issues with the patient but you will be the person undertaking a full assessment of it). Sometimes it can be useful to do an assessment together as you can then discuss afterwards if a referral to a community team, social services or rehabilitation unit is needed.
It may be necessary to formally assess the patient using a rating tool to look at their memory, cognitive levels or emotions. Most require some form of training.
Once you have done your assessments, you will need to write this up in the medical notes. You will need to write neatly and legibly and give your opinion on the patient’s treatment in a non-judgemental manner. Remember that the medical notes are a legal document and will be stored for many years to come! You will need to inform the nurse looking after the patient what, if anything, you need to do as this will have an impact on the length of time the person will be staying in hospital and this allows the Doctor to plan ahead.
You may need to write a report for Social Services, outlining the assistance you think in your professional opinion the patient will need once they leave hospital or you may need to order suitable equipment, making sure it will arrive in good time. You also need to think about who will be at the patient’s home to take delivery!
There are also Occupational Therapy case notes to be written up, kept in your department, so you always have a record of the action you have taken.
As well as this, you are a vital member of the MDT (multidisciplinary team) meetings, normally chaired by a Consultant, as you can give your opinion about what the patient will need and how long it will take. You need to be professional but speak your mind as the safety of the person is priority – if you know they need a piece of equipment for example, but the Doctor wants to send them home quickly you need to be able to state this.
What skills will you need?
- A patient and caring attitude as you may be working with someone for a while if they have mental health problems, learning difficulties or are on a long-term rehabilitation unit. They may have a condition that makes them rather difficult to communicate with (or it could just be their personality sometimes!) but you need to remain friendly yet professional. However, despite being friendly you need to have good awareness of situations and your surroundings as you may be alone with an unpredictable patient or need to visit someone at home – you will need to make sure you are familiar with lone worker policies and safety precautions.
- You will need a good all-round medical knowledge though you will pick this up quickly as you work on the wards. If you don’t know what something means, ask! There’s always a Doctor, Physio or Nurse around to advise you. You don’t need to know the nitty-gritty of a condition in most cases, rather you need to in general terms what it is, what the symptoms are and what is the outcome – will they make a quick recovery, need a period of rehabilitation or is there a gradual unstoppable decline over time?
- You need to be a good team member and able to get on well with your colleagues. You may be the only Occupational Therapist working on a ward, but you can’t work in isolation: you need to know what other members of the team are doing with a patient and vice versa.
- You may be asked by the consultant on a ward round to give your opinion so you need to be able to give information concisely and with conviction.
- You need to be able to read doctors handwriting in the notes, which is a task in itself!
Occupational Therapy is a profession which is all too often overlooked. It doesn’t have the perceived ‘glamour and excitement’ of a medical or nursing role and as in many cases you are working with someone after the blue lights have long since stopped flashing, it doesn’t get the attention it deserves. When was the last time you heard it talked about in a hospital drama!? But it is a very worthwhile and satisfying career with lots of scope for working in many different specialisms.
Where can I train to be an Occupational Therapist?
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