FEATURE REHABILITATION
This obviously presented quite a challenge
for CNRT in working out a process to enable the
maintenance of essential services for the many
vulnerable patients living with complex neurological
disorders in the city of Wolverhampton.
Not knowing what the future holds, nor what
the emergent ‘new normal’ will be, continues to be
difficult.
It became clear early in the process of change
that the acknowledgement and monitoring of
the team’s emotional states was paramount.
Understandably there have been high stress levels
due to the impact of COVID-19.
The team managed admirably and promptly by
stepping into unknown territory to work in
unfamiliar environments and specialisms.
Those remaining within
‘‘
CNRT devised a means to
adapt and overcome
challenges, rapidly
developing new ways
of working to provide
a responsive and
supportive service.
Those at home have
needed to manage
anxiety regarding their
professional identity
and roles, balancing
their ability to care for their
vulnerable patients remotely,
while also juggling issues such as
childcare.
This uncertainty has certainly impacted on
morale. However, there has been a real team
effort and genuine willingness to find innovative
solutions together as a multidisciplinary team.
This is enabling CNRT to focus on its values
around empowering patients to realise their full
potential and live as they wish, while adhering to
best practice in line with the trust’s values of being
‘Safe and Effective, Kind and Caring and Exceeding
Expectation’.
A pragmatic approach, despite the novel
working practices enforced, has resulted in the
establishment of a telephone support service for the
caseload of extremely vulnerable shielding patient
groups, such as those with Motor Neurone Disease,
Huntington’s disease, brain tumour and end-stage
Parkinson’s and Multiple Sclerosis.
Conversations with communication vulnerable
patients has been difficult. Neurological conditions
can lead to issues such as dysarthria, dysphagia,
apraxia and aphasia. Many CNRT patients use
augmentative and alternative communication.
Facilitating active involvement in conversations
around occupational performance and satisfaction
can therefore be challenging for this patient group
when we cannot see them face to face.
In addition, those neurological conditions
that may lead to insight difficulties can also be
problematic over the telephone. We are used to
having our eyes and hands to assist with our clinical
assessments and interventions to gain a clearer
picture of circumstances, risk and therapeutic
requirements.
The speed and
proficiency at which staff
shifted focus onto creating
new ways to connect to
our vulnerable community
and multidisciplinary team
members in the continued
delivery of services has
been inspiring.
Without this it leads us to a feeling of conscious
incompetence over the telephone, with us
wondering what we may be missing.
We gleaned reassurance from
having an occupational therapist
available to conduct home
visits where we felt there
were such gaps.
CNRT’s occupational
therapist, Sam Bate,
was awarded the
trusts ‘Exceeding
Expectations’ award in
May 2020, in recognition
of her dedication and
commitment by being able to
complete those prioritised visits.
Thanks to her actions, CNRT
has been successful in reducing
avoidable hospital admissions and supporting
early discharge from hospital. In response to
her award Sam said: ‘Although I have found it
challenging, it has also been really rewarding to be
able to fulfil my role and think outside the box as an
occupational therapist within the team.’
There has been a rapid implementation of a
paperless/computerised documentation process,
with help from the keeping records guidance
and audit tool (RCOT 2017). This, along with
the utilisation of the video conference platform,
Microsoft Teams, has facilitated our successful
move into remote working to support social
distancing.
It has been invaluable in maintaining channels
of communication to our dispersed workforce and
in supporting the team to adapt to the enforced
changes and to share and discuss ideas.
Our chief executive, David Loughton, was
particularly impressed by the rapid adaptation of
CNRT in implementing these measures stating:
36 OTnews July 2020