Posted on: 12 August 2020
Sarah Mattock, Interim Head Occupational Therapist in Older Adult CMHT has reflected on her time being redeployed to St Pancras hospital during 7 April to 26 June 2020.
At the end of March 2020 I took a week of annual leave. Covid-19 had taken hold and had already impacted on my work within the older adult CMHT. I had begun to think through the implication of increased activities on the older adult wards with the staff I supervised. I had begun a skill review of the occupational therapists.
On my return I expected that some of my staff might be asked to redeploy. I was very surprised to find that my skills were needed; after all it had been 29 years since I had been on a physical health ward. Initially I declined feeling that I could be better used in supporting older adult services in the community and maybe on the wards and care homes. By the end of the day the choice was no longer mine. I was needed at St Pancras. I was given a week to get my caseload either discharged or reallocated. I was due to start on 7th April.
Travelling to St Pancras on the first day I was very anxious about my level of competency. Also some concern about whether my post would still be there on my return. Initially told I might need to do 13 hours shifts and being taught how to take basic observations felt anxiety provoking. Moving to the therapy team and being introduced to the therapists was a relief as was returning to a planned 8 hour shift. The team were a very welcoming team and willing to teach me what I needed to know at my pace. On day one I was on the Covid positive ward but as there were sufficient staff who had returned to work having had Covid-19 they were placed on this ward and I moved to another rehab ward. There was sufficient PPE and we were taught how to wear it. Although it was tiring putting new PPE on for each patient I did not feel at risk.
I realised this was an opportunity to revise and enhance my physical health skills. I was given moving and handling training and soon felt confident in using sliding sheets, hoists, the Sara-stedy and Return. Some of which I had not used before. I soon that my many years of working with older adults were an advantage especially as so many of this patient group have co-morbidities. I also had experience in areas which could assist my colleagues at SPRU for example I was able to support my colleagues when working with a patient with personality disorder and provide a teaching session with tips on management. I could also assist with mental capacity assessments particularly for discharge destination, as social workers were unable to come into the hospital and I had experience in this area.
Picture: Sarah (left) with Kricia, Physiotherapist
Although I have many years of experience many tasks felt new again and as a result took a longer for me to do and involved a lot more conscious thought. Rasmussen’s Skill, Rule and Knowledge model described by Embrey (undated) shows how novel tasks take longer to do and require more thought before the rules for those tasks are learnt and the routines become rehearsed. In time the skill becomes automatic, familiar and well-practiced and as the tasks become intuitive less conscious thought is required.
To put it another way, I initially felt like a plant that had been dug up and transplanted to a new area. Initially like the plant, there was some wilting and left unattended the plant would fail. Given water, good soil and space the plant takes root and grows. I was impressed with how patient the staff at SPRU were in explaining how things were done not just to me (on numerous occasions), but to a large number of staff who had been redeployed. Because of their care and attention I was able to grow in confidence. Although goal setting, and discharge planning were carried out differently and home visits focus on different priorities to those in mental health, it did not take long to be reminded of what was needed. The therapy team operate a buddy system with occupational therapists paired with a physiotherapist this meant that we could benefit from the skills of each other and I was always able to ask questions if needed. I was also given supervision from the band 7 in the team and from the Trust Head OT.
Picture: Sarah during her time working at SPRU
Although my preference remains working in mental and looked forward to returning to my previous role, I did begin to enjoy my time at SPRU. I was reminded how much I had previously enjoyed working with people who were rehabilitating following an amputation. I liked being able to use my skills in another setting and most of all I appreciated the support and friendship of my colleagues in the therapy team.
My three months there were challenging at times but a really positive experience.
I have worked in community mental health teams for a long while and the focus has been on integration between mental health and social services. I have felt for a long time, and it was especially emphasised during my year on the Older Persons Fellowship course (Kings College), that integration between mental and physical health is also necessary for the benefit of our patients. On one occasion on Rochester East ward at SPRU a doctor spoke about developing a care bundle on delirium; a perfect example of an area where partnership would be beneficial.
I have now returned to the older adults CMHT with the challenges that Covid-19 has brought to a community service. I have agreed with the lead occupational therapist in the therapy team at SPRU to exchange learning/teaching opportunities. It has been good to see some of my SPRU colleagues in the OT falls and frailty clinical network as we begin to share our learning in line with the new R&D strategy. I have also signed up to be a first responder and will be pleased to return to SPRU should there be a second wave.