GAIN Guideline Comments
Title:
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Comment
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overall
p.18
P 20
Lack of consistency with use of capital letters in titles- Occupational Therapists some pages occupational
therapists on others
The College of Occupational Therapists (20150 Code of Ethics, Section 2:service provision 2.1 “Your practice should
be focused on enabling individuals, groups and communities “to change aspects of their person, the occupation, or
the environment, or some combination of these to enhance occupational participation”.
This document focuses on body functions but does not highlight the key role of occupational therapists to enable
participation in occupation.
Self-management should take greater prominence within the document. What are people’s aspirations? What is
important to them? What do they want to achieve in their daily life?
Would benefit with a definition of occupational therapy and physiotherapy, their roles and when roles may overlap.
Again for occupational therapy we would expect some overarching principles to be reflected within the document for
example:
Assessments
Within the assessment process occupational therapists should:
•
Consider the key impairments and occupational difficulties, as well as identifying existing strengths.
•
Discuss functional ability and observe performance within everyday tasks.
•
Consider the person’s insight into their current strengths and weaknesses and how this may affect their safety.
•
Allow sufficient time for the individual to discuss their difficulties, taking into account their stamina levels. An
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assessment may need to be completed over more than one contact.
•
Consider the person’s attitude to their diagnosis and their acceptance of aids and services.
•
Establish a list of main concerns, anticipated future needs and prioritise goals.
•
Acknowledge and address the carer and family’s needs within the assessment process. The assessment
should identify their future anticipated needs as well as immediate needs. Any plan arising from the assessment
should have clear outcomes.
•
Use a theoretical occupational therapy model to guide and underpin planned intervention.
•
Be aware of local support services available to the individual and carer and make early referrals to them.
P 25
Alongside occupational therapy assessments practitioners should be aware of or may select tools that have been
specifically designed for Malignant Spinal Cord Compression.
Drawing on the PEO model the main purpose of a home assessment is to assess whether the environment supports
or hinders occupation. Based on the occupations that the person wants or needs to do the occupational therapist may
make adaptations to the environment or recommend strategies or techniques to enable the person to continue to
safely participate in daily living.
Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. (1996) The Person-Environment-Occupation Model:
A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23
p.26
p.26
P30
p.30
This paragraph makes for confusing reading. Is this suggesting that major adaptation should be reconsidered if there
is deteriorating health?
“If it is appropriate and timely to progress with a major adaptation it is important that the occupational therapist
monitors and reviews such cases regularly to ensure the patient’s condition remains stable or that there has not been
any further deterioration which would require reassessment.”
Mobility and activities of daily living - A patient centered focus would also be of benefit when assessing ADLS and
other elements of assessment. This will support self-management and adherence to intervention.
Through assessing occupation, occupational therapists may pick up on changes in cognitive ability and recommend
further assessment. They can advise on strategies and techniques to adapt to any change. Advising carers, family
and friends how to support the person to maintain their skills and how to adapt their approach and communication.
Should there be some details here or within the document as a general point about capacity and requirements of
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p.36
p.38
p.59
assessments and what to do if lack of capacity is established.
Seating - There is no mention of seating’s role in supporting occupation (eating, drinking, other activities) and how it
could facilitate greater social interaction with family, carers, friends etc.
Bed – There could be more indication here of adaptive equipment to support bed mobility without the need for profiling
bed.
End of life considerations –include reference to Living Matters, Dying Matters A Palliative and End of Life Strategy For
Northern Ireland (2010) ?
The strategy makes use of a care model, which is made up of six steps. There are also three cross cutting elements,
which apply to each step of the model. The model can be found on p25 of the strategy.
The six steps are:
1.
Discussion and identification of needs and preferences
2.
Holistic assessment – The Northern Ireland Single Assessment Tool (NISAT) and Holistic
3.
Palliative Care Assessment Tool (NICaN) are suggested for this
4.
Planning across care settings and conditions
5.
Co-ordinate and deliver care across settings
6.
Care in the last days of life
7.
Bereavement care.
Respondents: Karin Orman , Professional Practice Manager
Paul Cooper, Professional Advisor – Long Term Conditions
College of Occupational Therapists, the professional body for occupational therapists across the UK.
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