Deidre Morgan – Occupational Therapy and Palliative Care

The role can be really specific or it can be really varied, I think and it depends very much on the setting that you work in, whether it’s an inpatient setting or a community setting, um, but essentially for me the role of palliative care is around helping people to be as active as possible, um, in their daily life in things that they have to do so essential activities and also valued activities. It’s about um, very much about listening to what’s important for the person and then making that happen. When you’re working in an inpatient unit sometimes your time is restricted because of resources and a lot of the focus there is on getting people home. In the unit where I work we have a lot of people that will come in several times, so they’ll come in, symptoms will get under control then we’ll work at getting them home, they go home, deteriorate a bit more, come back in and we go through the same proccess again. It’s about teaching families how to cope, how to help somebody get in an out of bed or get on and off a chair, um, get on and off a toilet, so it’s about the very practical nuts and bolts stuff of everyday, everyday life. Often in an inpatient setting, people want to go home so we conduct home assessments to work out whether that’s actually feasible and doable, um, from the patients perspective, from the family’s perspective, so often times it’s, um, it can be a reality check so somebody might go home and decide that it actually is too hard and that it’s not achievable and then, um, it’s about working with them after that to what is still important and how can we work with them to achieve that so, it’s not just about being independent sometimes it’s about part indepdence, um, we often prescribe equipment for people to cope at home, um, and often times as OT’s I think we undervalue that because it looks simple, um, but it’s actually not simple and it’s actually a huge thing for a person to be able to stand indendently from a toilet, it’s huge for a carer to not have to have to lift someone physically up from the toilet. So, it’s about enabling them to engage in everyday life. So there are also things like stress management and relaxation or relaxation for stress management and anxiety and helping managing shortness of breath, um, we do a lot of work with people around, ah, fatigue and pacing and how to, um, slow yourself down so you can still do the things that you’re wanting to keep doing but taking rest breaks in between, so often at times people will go like a bullet again like they do normally and then flop at the end of the day, so it’s about teaching them that, that doesnt work now but you can try this or try that, um, and just sit down to have a shower, so just the practical things like that. I think that main thing is just about enabling independence or part independence in what’s important for the person and I think that’s the, the critical thing the other thing I was going to say is sometimes we’re involved with helping people prepare for terminal care and often times it can look like it’s just provisional, say a hospital bed or an air matress or something like that but in terms of what’s important for the person, it’s also about asking are they the type of person that likes to be in the comfort of family life so do they want to be the bed in the rumpus room, so they can be around family or are they a private person that needs space and they want the bed in their garden, the bed in their, in a room where they can look over their garden and just have some quietness and privacy so it’s about, it’s about provision of equipment within the context of that persons life and what’s important to them. You have to work close with other members of the palliative care team because patients change very very quickly and their symptoms can change from day to day or hour to hour, um, so you have to work closely so that you understand what’s happening with the patient and how the goals of care change, ah, often for allied health we’re very sessional and very part time, so it’s a pragmatic thing as well, you have to work, um, I work very closely with the physio in my unit because she’s there somedays and I’m not, we’ve got a little bit of overlap but also separate, so, we will work with each other and support each others goals for the patients. I think too, we’ll have our own perspective when we look at a patient, when we interact with them, so we need to, ah, combine all those we we get a whole picture of the patient and that includes the patient and the family because they’re part of the team as well, so, it’s vital to work together. I think it’s probably underutilised by OT’s, partly because there isn’t a lot of evidence developed by OT’s um, in palliative care so it’s not something that people automatically go to, ah, which would be good to change. As a result from a national conference this year though we’re looking at working with CareSearch to set up a forum, um, so that we can have more communication, um, as a group and talk about how we can actually create research, creative evidence, um, and have a more cohesive voice I think in the area of palliative care.

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