This week’s chat will be hosted by Jennifer Crow (@JenniferNCrow); HEE/NIHR Integrated Clinical Academic Doctoral Research Fellow and Clinical Specialist Occupational Therapist in Stroke.

People admitted to a Hyperacute Stroke Unit with a confirmed stroke or TIA and who are physically independent on the ward and ‘pass’ a cognitive screen, typically have a very short inpatient stay. They are thought to have made a full recovery and deemed too good for existing post-discharge stroke pathways and so are discharged home with no onward referrals except for the stroke six-month review and routine medical follow-up appointments.

These stroke survivors report unmet information needs and feeling abandoned on discharge (1, 2). Critically, hidden impairments not apparent in hospital become evident after discharge. If unaddressed these effect participation, return to work, relationships, quality of life and well-being (3-6). Even when a full clinical recovery appears to have occurred, cognitive impairment is often found (7-10). Psychological changes, particularly anxiety and depression are often reported (3, 11-15). Longitudinal studies show that problems with mood, fatigue and cognition persist, reducing participation and well being even years after a so called ‘minor’ stroke. Stroke survivors seeking support and attempting to access follow-up care describe being bounced between primary care and stroke services. There is often disagreement amongst the professional as to who should be managing ongoing mood and adjustment issues as well as fatigue and cognition (16, 17).

Join Jennifer and colleagues from the RCOT SSNP Stoke Forum (@RCOT_NP) to explore this important topic in more detail. We will be discussing the questions below and hope to learn from services where there are new and innovative practices addressing the needs of this specific stroke survivor group.

REFERENCES:

Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services – A systematic review and meta-ethnography. PLoS One. 2018;13(2):e0192533.

Crow J. A 2-week stroke review identifies unmet needs in patients discharged home from a hyperacute stroke unit. British Journal of Neuroscience Nursing. 2018;14(1):29-35.

Verbraak ME, Hoeksma AF, Lindeboom R, Kwa VI. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124-30.

Edwards DF, Hahn M, Baum C, Dromerick AW. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 2006;15(4):151-7.

Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, et al. Quality of life in patients with TIA and minor ischemic stroke. Neurology. 2015;85(22):1957-63.

Carlsson GE, Moller A, Blomstrand C. Managing an everyday life of uncertainty–a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773-82.

Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol. 2015;22(9):1288-94.

Fens M, van Heugten CM, Beusmans GH, Limburg M, Haeren R, Kaemingk A, et al. Not as transient: patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; an exploratory study. Eur J Gen Pract. 2013;19(1):11-6.

Pendlebury ST, Wadling S, Silver LE, Mehta Z, Rothwell PM. Transient cognitive impairment in TIA and minor stroke. Stroke. 2011;42(11):3116-21.

Wolf TJ, Barbee AR, White D. Executive dysfunction immediately after mild stroke. OTJR (Thorofare N J). 2011;31(1):S23-9.

Altieri M, Maestrini I, Mercurio A, Troisi P, Sgarlata E, Rea V, et al. Depression after minor stroke: prevalence and predictors. Eur J Neurol. 2012;19(3):517-21.

Terrill AL, Schwartz JK, Belagaje SR. Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors. Stroke Res Treat. 2018;2018:6187328.

Sackley CM, Mant J, McManus RJ, Humphreys G, Sharp L, Mares K, et al. Functional and emotional outcomes after transient ischemic attack: A 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):522-9.

Kellett N, Drummond AER, Palmer T, Munshi S, Lincoln NB. Impact of transient ischaemic attack and minor stroke on daily life. International Journal of Therapy and Rehabilitation. 2014;21(7):318-23.

Alenljung M, Ranada ÅL, Liedberg GM. Struggling with everyday life after mild stroke with cognitive impairments – The experiences of working age women. British Journal of Occupational Therapy. 2018;82(4):227-34.

Lim L, Mant J, Mullis R, Roland M. When is referral from primary care to specialist services appropriate for survivors of stroke? A modified RAND-appropriateness consensus study. BMC Fam Pract. 2020;21(1):66.

Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Gaps in care for patients with memory deficits after stroke: views of healthcare providers. BMC Health Serv Res. 2017;17(1):634-.

POST CHAT

Host:  @JenniferNCrow

Support on OTalk Account: @paulwilkinson94

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

Reflection logs

HCPC Standards for CPD.

• Maintain a continuous, up-to-date and accurate record of their CPD activities.
• Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
• Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
• Seek to ensure that their CPD benefits the service user.
• Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.

In the UK, there are 10-11 million people who are deaf or have a hearing loss, that is 1 in every 6 people! Over 50,000 of these are children and young people. It is estimated that by 2035 there will be 15.6 million people in the UK with hearing loss.  

Due to ableism or rather audism (discrimination against individuals who are deaf or have a hearing loss), deaf people experience inequalities in every aspect of society including education, health & social care, employment, and many more. The COVID-19 pandemic has further exposed and deepened these existing inequalities due to the lack of accessible public health information and face masks.

As Occupational Therapists, we are uniquely positioned to provide support for deaf people or people with a hearing loss to live their best lives. So as part of deaf awareness month, I would like to invite you all to a discussion where we can explore the barriers and challenges experienced by the hearing loss community and what we can do to support them.  

1. What is your understanding of and experiences of working with patients who are deaf or have hearing loss?  
2. What are the barriers and challenges that deaf people or people with hearing loss face? 
3. What are the barriers and challenges for Occupational Therapists in communicating with and supporting deaf people or people with a hearing loss? 
4. What role can occupational therapists play in tackling audism and how can we ensure our services are accessible to anyone with a hearing loss?  

Watch out for pop-up polls and random ‘Did you know?’ facts about the deaf and hearing loss community.

POST CHAT

Host:  @SusanGriffiths5

Support on OTalk Account: Rachel @OT_rach

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

Reflection logs

HCPC Standards for CPD.

• Maintain a continuous, up-to-date and accurate record of their CPD activities.
• Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
• Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
• Seek to ensure that their CPD benefits the service user.
• Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.

Hosts: Keir Harding and Dr Jenny Preston 

In our recent OTalk Research team catch up, we got chatting about the recent scandal involving the publication of a paper by a PhD researcher, with somewhat questionable ethical standards.  

As you can imagine, our collective thinking was ‘how on earth did that get past peer review?’

Those of us who have trodden the often-arduous path of publication in a peer reviewed journal know all too well how challenging this process can be. No doubt many have likely avoided the process at all costs, aware of the blackened reputation of the peer review culture.

The pitfalls are many! A reviewer with a personal bias, contradictory reviews from reviewer 1 and that renowned tricky reviewer 2 and feeling like the reviewer just didn’t get it! Were they the right person to review your topic and/or methodology? Did they give your paper the time and attention your hard crafted work truly deserved?

Though it’s not always plain sailing, it’s not always bad news either. Peer reviewers also offer supportive, constructive feedback that can often lead to an improved submission.

Data suggests that only 1.2% of manuscripts submitted to journals are accepted for publication¹. So, when you have something important to share, findings from your work that you want to disseminate and information to communicate to the wider world, only to be derailed by the peer review process, how do we get the most out of peer review, how can we prepare ourselves for it and how we can view this as a constructive experience?

Our colleague Keir Harding has spoken candidly on social media about his repeated failure to get his MSc dissertation published in a peer reviewed journal. He has had success though, with three publications in the Lancet and others in CAMH, MHRJ and most importantly BJOT.  Opinion pieces he can get published, research not so much.  

We asked Keir to join us for this month’s OTalk research to discuss the peer review culture

Reference

1. https://www.editage.com/insights/top-peer-review-challenges-for-authors-and-how-you-can-solve-them

POST CHAT

This week’s chat will be hosted by Tori Wolfendale @Tori_Doll_ here is what she has to say.  If you’re new to OTalk find out here how to join in live on twitter every Tuesday 8pm Supported by Rachel

Tori is employed as the Head of Rehabilitation and Recovery Service within a High Secure Forensic mental health service and is currently completing a Professional Doctorate in Health and Social Care – with the focus of her research being on enhancing coproduction within forensic mental health services, promoting the role of Occupational Therapy and how the profession can positively contribute to reducing restrictive interventions and in enhancing the patient “voice” within this to collaboratively identify novel practical solutions or approaches to progressing patients out of the seclusion environment.  

What is known regarding seclusion and long-term segregation from contemporary literature: 

In the United Kingdom (UK), patients are admitted to secure forensic services because they are deemed to pose a risk of violence to others and are considered a grave risk to members of the public (O’Dowd, 2022). This is linked to having a history of serious violence, risk to self and presenting with challenging behaviour (Holley et al., 2020). In addition to this, many of the individuals detained within secure services will have a complex mental health history or chronic psychiatric disorders and demonstrate a significant level of risk to themselves or others, which requires care and treatment within the secure environment (Puzzo, 2022).

The term ‘long-term segregation’ (LTS) is defined in the Mental Health Act Code of Practice (2015) as a highly restrictive intervention “which is only used when a patient is considered to present with chronically high-risk behaviours or potential of serious harm to other people that cannot be managed in a less restrictive manner”.

Whilst it has been argued that restraint and the use of seclusion and segregation are necessary for maintaining patient and staff safety, Wilson et al., (2017) propose that these approaches continue to be frequently used in contemporary practice. Furthermore, Ezeobela et al., (2014) argues that these practices have negative consequences on all stakeholders, with staff and patients reporting feelings of distress, anxiety, fear and experiencing a loss of identity, resulting in further emotional distress and social isolation. What is known from contemporary literature is the use of seclusion, LTS and restraint has been shown to have adverse effects on the therapeutic milieu, damage to patient and staff relationships and are perceived by staff to be incompatible with caring values that are a core aspect of working within any healthcare environment (Chaung and Huang, 2007). Supplementarily, there is also a growing body of literature that recognises that simply witnessing restraint or the use of restrictive interventions can have negative psychological implications for mental health patients and staff (Wilson et al., 2007; Holmes et al., 2015; Price et al., 2017). However, with austerity, underfunding, the current impact of the global pandemic and the associated staffing and resource deficits, the exponential growth in segregation across secure mental health services is becoming increasingly problematic (Chandley, 2022).  

Where does Occupational Therapy fit into this? 

One of the key political drivers within forensic services specifically, is that care providers must implement measures to enhance the experience, independent living skills and quality of life for patients with long-term conditions by ensuring that their care consists of a minimum of 25 hours of meaningful activity each week. This can pose a challenge for patients in long-term segregation as by definition, the patient is “specifically placed alone in a locked room for a period at any time of the day or night for the protection of the patient, staff or others from serious harm” (Newton-Howes, 2013, p. 422), which can significantly reduce their opportunities to engage in activities outside of their room. Additionally, the National Institute for Clinical Excellence (NICE) guidelines argues for the least restrictive measures to be used at all times and that the use of seclusion should be a last resort (NICE, 2021).  The Occupational Therapy profession contributes to this process by prescribing meaningful activity as a therapeutic tool, based on the individual’s preferences and needs. Ozkan et al., (2018) remind us that individuals who need forensic rehabilitation experience considerable participation limitations when engaging in meaningful activities, causing occupational deprivation, a sense of hopelessness and these limitations can contribute to a deterioration in mental health and wellbeing. Furthermore, the aim of Occupational Therapy in this environment is to enable the individual to experience occupational enrichment and achieve optimal functioning through engaging in meaningful activity to mitigate risk (Ozkan et al., 2018).

Questions for you to consider in preparation for the #OTalk community: 

1. What is your experience of working with patients who require the use of seclusion or long-term segregation? 
2. How do you remain client-centred throughout this process? 
3. What are the challenges or barriers to working effectively with patients who require the use of seclusion or long-term segregation? How does this influence your clinical practice? How do you overcome these? Please share any key learning outcomes. 
4. What are the positive factors when working with patients who require the use of seclusion or long-term segregation? Please share any key learning outcomes.
5. What best practices have you identified through your experience?
6. What evidence-based practice do you use to underpin your practice when working with patients who require the use of seclusion or long-term segregation?
7. What models of practice do you use to underpin your clinical practice when working with patients who require the use of seclusion or long-term segregation? How does this influence your practice? 
8. Has COVID19 had any influence on your practice when working with patients who require the use of seclusion or long-term segregation?
9. Finally … please share one specific success story – let’s use this as an opportunity to really showcase with the wider Twitter Community the fantastic work that Occupational Therapist’s complete with this complex patient group! What was this? Why was this successful? What was the impact?

POST CHAT

Host:  Tori Wolfendale @Tori_Doll_

Support on OTalk Account: Rachel @OT_rach

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

https://otalk.co.uk/reflection-logs/

HCPC Standards for CPD.

• Maintain a continuous, up-to-date and accurate record of their CPD activities.
• Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
• Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
• Seek to ensure that their CPD benefits the service user.
• Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.

This weeks OTalk is hosted by @Hannah_sercombe here is what she has to say.  If your new to OTalk find out here how to join in live on twitter every Tuesday 8pm  Supported by Helen.

‘Creative Health’ refers to creative approaches and activities which have benefits for our health and wellbeing. Activities may include visual and performing arts, crafts, film, literature as well as creative activities in nature; approaches may involve creative and innovative ways to approach health and care services, co-production, education and workforce development’.  

The past decade has seen an increasing interest in the role for Creative Health in promoting health, as well as in the prevention, management and treatment of illness across the life course, and its potential to mitigate some of the challenges facing the health, social care and wider systems (Warran et al., 2022, WHO, 2019). The All Party Parliamentary Group on Arts, Health and Wellbeing report  “Creative Health: The arts for health and wellbeing” provides a comprehensive overview of the field, documenting over 1000 studies of the arts supporting health and wellbeing (APPG, 2017). 

Based on the belief that meaningful activity engagement is essential to human flourishing, Occupational Therapists have actively engaged with this approach since the establishment of the profession.  It has been 15 years since Lord Nigel Crisp, at the time NHS Chief Executive, stated “arts and heath are, and should be firmly recognised as being integral to health, healthcare provision and healthcare environments” (DOH, 2007). Although progress has been made, the present state of the UK’s health and wellbeing cries out for more sustainable approaches to tackling health need and inequalities, OTs have a vital role to play in meeting these challenges.  

If you are an OT who implements creativity into practice, are interested in applying Creative Health to enhance your work with people, or want to find out more about how creative health can be embedded in Occupational Therapy, please join us next Tuesday at 8pm, using the hashtag #OTalk.  

We hope this chat will inform a webinar hosted in collaboration between The Royal College of Occupational Therapists and The National Centre for Creative Health between 10-1pm 31st of October 2022. This webinar will demonstrate the profession’s role in working creatively in and with the creative sector to address people’s health and care in innovative ways, showcasing several successful examples to highlight the opportunities that exist for the OT profession in and beyond statutory (NHS and Social Care) services.  

References​

APPG 2017. Creative Health:The Arts for Health and Wellbeing In: GROUP, A. P. P. (ed.). 

DOH 2007. Departmental Report. In: HEALTH, D. O. (ed.). 

WARRAN, K., BURTON, A. & FANCOURT, D. 2022. What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework [version 2; peer review: 1 approved, 1 approved with reservations]. Wellcome Open Research, 7. 

WHO 2019. What is the evidence on the role of the arts in improving health and well-being? 

POST CHAT

Host:  @Hannah_sercombe

Support on OTalk Account: Helen @HelenOTUK

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

https://otalk.co.uk/reflection-logs/

HCPC Standards for CPD.

• Maintain a continuous, up-to-date and accurate record of their CPD activities.
• Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
• Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
• Seek to ensure that their CPD benefits the service user.
• Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.