REHABILITATION FEATURE
Fears were allayed and support was given by those who
normally worked in the acute setting, although this was a unique
and challenging environment for them too.
It became apparent to those in unfamiliar surroundings that,
despite the nature or cause of the functional impairment, the
occupational therapy process remains the same. The flexible
and adaptable nature of occupational therapists meant that
our transferrable occupational therapy skill set was quickly
recognised, and everyone soon settled in to the team and role.
Unlike working in an established team, it became clear that, as
a group, we would have to create our own processes and ways of
working, including pathways and documentation.
Established processes and systems from the host trust,
Manchester University NHS Foundation Trust, were adopted
and adapted if required, but communication methods within
and external to NHS Nightingale Hospital North West had to be
established.
For many of us working within the NHS, processes and ‘red
tape’ can be a frequent obstacle; not, it appears, in the COVID-19
world.
Agreements were made with the health and social services
locality hubs across the NorthWest of England for the hospital
to use one form that was based on the Discharge to Assess
model; this meant that any request for packages of care,
adaptive equipment, community and inpatient intermediate care
rehabilitation, and short- or long-term 24-hour placement, were
made on one form.
For many, the initial challenge of clinical work was that it was
to be completed in Personal Protective Equipment (PPE). The
physical effort of wearing PPE has regularly been acknowledged
and it was no different here.
Due to the nature of the building and the glass roof the
ambient temperature would rise throughout
the course of the day, making
afternoon sessions particularly
hard work physically;
the opposite would
happen overnight as
the temperature
dropped
significantly.
A
conscious
decision
to lock the
staff toilets
in the ward
environment
was made by
the hospital
management
team, as this
would promote regular doffing of PPE and hydration, giving
welcome breaks to staff.
Communication with patients and staff members alike
presented their own challenges, whether this was due to the
physical barriers of mask and visor reducing the impact of nonverbal
communication, muffled voices in an environment that was
acoustically challenging, or to pick out your colleague in a sea of
surgical scrubs.
Wearing PPE for the first time in an unfamiliar clinical
environment can be daunting and often claustrophobic. ‘I
sometimes used grounding techniques when I entered the ward
for the first times’, was how one occupational therapist said that
they dealt with this particular challenge.
NHS Nightingale Hospital North West was originally set up
as a level one environment, with the potential to provide noninvasive
ventilation to a step-down cohort of patients. However,
it soon became apparent that the region did not require this
service.
A discharge bottleneck had developed within acute services.
Those patients who required a residential intermediate care bed,
or came from a 24-hour setting, were unable to leave the hospital
with a positive COVID-19 swab. Our role therefore evolved,
with the model of the unit moving from acute care to delivering
rehabilitation.
Undaunted, everyone pulled together, contributing ideas
and taking the lead on different areas, based on self-identified
strengths and skills.
As occupational therapists, one of the main challenges was
to identify how the setting of the temporary hospital impacted on
assessing functional independence in activities of daily living.
The physical environment itself was the first hurdle, it was
huge. The temporary shower and toilet facilities were often
inaccessible to the majority of patients and also a relatively long
distance from the bedside; in fact it was said that if you could
walk to the toilet then your mobility was definitely good enough to
get you to the shops, never mind the toilet at home.
Addressing issues such as sourcing appropriate seating and
walking aids for this new group of patients became an ongoing
task.
Promotion of a 24-hour rehabilitation approach is key to
promoting and optimising independence and creative problem
solving was required to create an environment for personal and
daily ADL assessment. Continuing this approach on the ward
also had its challenges, with ward staff made up of a mixture of
experienced hospital staff and those new to the environment,
such as airline cabin crew and students.
Despite the best efforts of the team to create a hospital
environment, the cavernous interior, the glass walls that gave no
real indication of night and day, and a giant clock, were all a nod
to its past as a railway station, and the imposing red brick walls
could easily be mistaken for those surrounding the
nearby HMP Strangeways.
OTnews July 2020 49