Occupational therapy in a crisis
In our next guest blog on the impacts of Covid 19 in Kent and Medway, Occupational Therapist Emma Pope explains how video calls have become a powerful therapeutic tool during lockdown.
Hospital wards are busy, noisy, confusing, bright, clinical and uninviting. A far cry from the comfort of our cosy living rooms. What’s more, with PPE, our friendly smiles have been stripped from our patients when they absolutely need it the most. Doors are closed. People are sick. People are truly isolated, anchored to their chairs or beds until they can return home. This is social deprivation at its worst.
Normally, Occupational Therapy sessions involve carers, friends and family members, particularly for our patients living with dementia, in a state of delirium or acute confusion. We were able to encourage patients to participate in rehabilitation with familiar faces, voices and possessions. It is honestly one of the most magical parts of being an Occupational Therapist when a patient who has been sitting in a chair in a hospital night gown, non-communicative and frail comes alive at seeing their relatives; putting on a pair of shoes and a cardigan; brushing their hair and walking to get themselves a cuppa or hug their grandchild. That is Occupational Therapy: finding what means something to someone and using it to help them find themselves again.
Now we must be creative with how we can motivate and engage patients who are otherwise lonely and frightened. Hospital staff are the only people patients will see for days or sometimes weeks. In normal circumstances this presents its own challenges, but now we are dealing with a virus that doesn’t care. Loneliness, depression, isolation and boredom are not conducive to rehabilitation and these secondary effects from ‘no visitation‘ are too spreading like a virus.
FaceTime can be a welcome remedy: although it is not a cure it helps to solve the problem of unfamiliarity. Once patients have spoken to family their demeanour changes. They want to get out of bed. They want to have a shower and sit out in a chair to have their breakfast or lunch. They visibly lift and are a step further away from that dehumanising gown that ’restrains’ and hides them. FaceTime becomes a tool for rehabilitation.
As NHS frontline workers and more importantly as Occupational Therapists, we must all make time for FaceTime. Patients who are fighting Covid-19, deprived of the little things that help them to feel ‘well’ need us to work creatively to keep a sense of home in their minds eye. Without visitors, without a hug from their spouse or touch of a hand from a caring friend, our patients are starved of comfort and tenderness from those they need it from the most. We have a responsibility to bring that to them in a small way so that they feel connected.
Without their loved ones, vulnerable patient voices become silent; drowned by clinical vernacular. It is one of our specialist skills to promote ‘person-centred’ care and bringing patients together with their virtual visitors goes further than just providing comfort, it actively is person centred. This is more than following a professional guideline- to say that we are meeting Royal College of Occupational Therapists (RCOT) requirements. By allowing a different mode of communication in to an otherwise disempowering scenario, our patients in hospital are given opportunity to collaborate with their loved ones and communicate in a way that ensures they are listened to. Decisions about going home, what care or equipment they need, for example and any concerns can be discussed collaboratively with people they trust.
My colleagues and I have used FaceTime to facilitate family meetings for complex discharges, show relatives pieces of equipment and during joint sessions so that patients can hear a familiar voice that jointly wills them to ‘stand up’. We have been able to see if someone’s cognitive or verbal presentation is ‘normal’ for them through digital interaction. We can ask families to speak to their relatives who are confused about the time of day to wish them ‘goodnight‘. We can allow relatives to be at their most vulnerable and say ‘i love you’. What an absolute privilege to facilitate such intimacy that would normally be limited and time bound through ward visiting hours.
I have been fortunate to witness some wonderful moments with patients and their relatives through FaceTime: helping a young man to shave after a long stay on ITU so that he would look familiar to his children; facilitating a Facetime call between an elderly married couple on separate Covid-19 wards, encouraging each to return to functional independence.
The power of digital communication is not to be underestimated. Moreover, the ability to facilitate a simple conversation between relatives should not be overlooked as banal. We are using FaceTime as a means of lifting patients from the setting in which they find themselves; to remember they are a person with a story rich with ‘occupation‘ that they will be able to return to once their Covid-19 chapter ends.
This is an abridged version of Emma’s blog “make time for face time”
Emma Pope is Clinical Specialist Occupational Therapist working at the William Harvey Hospital in Ashford, Kent