Occupational Therapy News OTnews January 2019 | Page 21

STUDENT EDUCATION FEATURE
However, where physical health, or need for physical
rehabilitation, is a component of a person’s mental health wellbeing,
the team is often limited to ‘borrowing’ time from a physiotherapist in
a sister team, or relying on community services.
This highlights a gap in practice and knowledge within the team’s
multidisciplinary model, which cares for a very complex client group.
Physiotherapists working in dementia care can offer a unique
and important role in the management of physical conditions and in
promoting and maintaining mobility. In a care home setting, this can
have a positive impact on behavioural and psychological symptoms
of dementia and so reducing the need for pharmacological
intervention (CSP 2011).
The area of dementia as a specialist area is not as established
in physiotherapy as it is in occupational therapy. However, the
development of physiotherapy within this setting is supported by a
growth in evidence and with this there is an increasing awareness
and demand for physiotherapists in dementia care (Lam et al
2018). student placement, for reasons associated with the work setting. We
also had to think about feasibility.
Our team works with 44 care homes across a wide geographical
area. We receive a large number of complex referrals, with an aim
of establishing our interventions within 12 weeks, and student
placements for physiotherapists are only five weeks long.
Would the students have sufficient time to establish themselves
and work effectively in such a limited time span in this setting, and
would our homes be set up to support their involvement?
We also questioned who would have professional responsibility
for the students, being under long-arm supervision, and what levels
of support would need to be in place in order to reach Health and
Care Professions Council standards.
In addition, we had to consider how learning outcomes would be
met, how this could be captured and evidenced for the purposes of
marking, together with the practicalities of who would counter-sign
the patient notes.
Very often we had to remind ourselves that the ‘spirit’ of the role
Alongside this is recognition by universities of the role
physiotherapy has in dementia care, although exposure to this
specialist area as part of undergraduate training remains limited.
This suggests an expansion of practice based learning into such
areas is key to development of an expanding workforce.
Therefore, a role emerging placement seemed ideal, timely, and
an important step forwards in student experience, undergraduate
learning and service development.
The idea of trying a role emerging placement came about
organically. There was a general anecdotal feeling within the team
that our best outcomes with clients had been where there was a
broad availability of professional skills.
Many of our referrals do have elements of unmet physical
wellbeing components; aggression during manual handling, walking
with intent and deconditioning following hospital admission, resulting
in calling out behaviours and a loss of self-efficacy.
While we all felt certain that access to physiotherapy would
be of benefit, we were unsure how to explore this in the light of
commissioned services.
In discussion with the wider multidisciplinary team it became
apparent that only the occupational therapists were aware of role
emerging placements and that they were not yet standard in training
for other allied professions.
The trust therapy leads and team managers were unanimously
supportive and encouraging – key drivers being Jo Edwards and
Jayne Stride – and so we then approached the University of the
West of England (UWE), our main centre for the training of the allied
health professionals.
Once again, they were very keen to work in partnership and a
scoping meeting was arranged through Kate Stancombe, senior
lecturer and clinical co-ordinator in physiotherapy at UWE. The idea
grew quickly, with a proposed date set for a pilot placement. emerging placement is potential and exploration. The nature of role
emerging placements is not to create a whole new service, but to
explore situations and to unlock the learning potential of the setting.
Our team had to become accepting of the idea that we did not
know what the outcomes would be, but that this would still be worth
it for the knowledge gained.
Challenges
Initial concerns included the team’s capacity for providing a positive
Pre-placement preparation
In answer to some of our concerns, it was decided that we would
partner with two to three homes so that students could focus their
attention.
On our first occasion, together with the university, we decided that
homes would need a ‘Good’ or ‘Outstanding’ on their latest Care
Quality Commission inspection and that they would offer residential
dementia to nursing dementia as a service.
So that our team could also gain from the learning opportunity
we agreed that students would sit in on our weekly multidisciplinary
team referral meeting. As the ‘host team’, we wanted to learn from
the students and their professional knowledge.
We had to balance our own pre-conceived hopes against
what the students would demonstrate. Although we were used
to students, we did need a slight adjustment in our thinking about
how we supported and negotiated with role emerging placement
students. Therefore, it was important that we make opportunity for
this in our multidisciplinary team meetings.
It was thought that students may be apprehensive about taking
part in something that had never been done in that area before.
Another concern was that, as placements were marked in the
final year of study, students would not risk grades on an unknown
adventure.
Therefore, it was decided to offer the placement to those students
finishing their second year and hope for two volunteers who could
support one another.
We arranged a presentation to the cohort to introduce the
opportunity and discuss any questions or concerns. In the event,
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