Correlation between OT and Nursing levels of ...

2016/10/24

Correlation between OT and Nursing levels of functioning of clients with intellectual disability. Presenter: Janine van der Linde Lecturer, E-learning and Occupational therapy, School of therapeutic sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

BACKGROUND Witrand Hospital Mental Health facility (1000 beds)  residence intellectually & physical disabled patients, (650)  acute & out patient psychiatric patients  physical rehabilitation Need to Determine new levels functioning: Main reasons: • Due DIP  levels changed dramatically • Services - no longer appropriate • Multi-professional team approach •  Differences assessment outcomes  conflict between the professions

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BACKGROUND OT’s  NB know level of functioning

WHY?  Implications quality of care  Play role grouping of patients for therapeutic input  Determine types of therapeutic input needed High case load  only 8 OT’s Nursing staff assist  delivery of therapeutic programs in wards Need to ensure that we are in line with what we do Problem  did not always agree on outcomes in terms of level of functioning.

Aims of Study The aim of the study  To determine if there is a correlation between the levels of functioning as measured by occupational therapists with creative ability and nursing staff using the Fairview self-help observation scale.

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Objectives

To determine level of functioning 

To determine level of functioning  Fairview selfhelp observation scale To determine

correlation between scales.

Creative ability. OBJECTIVES OF STUDY

Creative Ability OT’s mental health  Vona du Toit’s Model of Creative Ability for assessment. Creative participation assessment Why use this model/assessment ??? • Way to  Evaluate skills and ability in occupational performance areas • motivation (inner drive to participate) • action (effort put into participation). • Assessment related to participation in ADL  Self care, Social ability, Work ability, Use of free time (leisure)

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Fairview • Fairview developed 1970 as screening test  cheap easy to administer based on observations • Index of skill development • Nursing staff  Fairview scale observations to determine the patients level of functioning in months. According to 5 Domains 1. Motor dexterity 2. Self help skills 3. Communication skills 4. Social Interaction 5. Self direction Final score calculated months

Methodology •

A descriptive correlation study design

• Ethical Approval : Wits, Depth of Health NW & Hospital committee •

Assessment data from 2010 to 2012  gathered from  existing hospital database on 586 patients.

• •

Assessment instruments  Occupational therapists  (Creative participation assessment based on Vona du Toit Model of creative ability (De Witt, 1997)

1 Purposeless Unplanned Action (TONE)

•

2

3

Incidental Constructive, explorative constructive/unconstructive action (SELF DIFFERENTIATION (SELF PRESENTATION

 Nursing staff (Fairview self-help observation scale (Fourie et al., 1999)

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METHODOLOGY • • • • • • • • • • • •

Analysed information from existing database Organized in Excel worksheets * Demographic background of population  descriptive analysis  Age  Length of stay  Severity of intellectual disability  Physical disabilities involved * Functional level of patients in %  Creative Ability  Fairview Nursing scale Statistica 11  Spearman correlation test  Correlation between tests

RESULTS: Demographics Demographics Average age Average LOS Mild to moderate Intellectual disability

44 years Range 3 - 94 years 31.2 yrs longest 61 yrs 31%

Severe Intellectual disability

39%

Profound Intellectual disability •  Feeding difficulties Epilepsy

30%

Cerebral Palsy

48.5% 29%

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RESULTS: Level of Functioning – Creative Ability Average Level of Creative ability per ward 2013 4 3

3

3

3 2

2

2

2

2

2 1

1

1

1 0 Ward 3

Ward 4

2

2

Creative ability

Ward 5 (EU) 1

1 - Purposeless Unplanned Action

Ward 6

1

Ward 8 (DIP) 3

Ward 10

3

2- Incidental constructive/unconstructive

Ward 11 (PU) 2

Ward 12

2

3 - Constructive, explorative action

RESULTS: Level of Functioning – Fairview Scales Fairview Nursing Observation Scale

60

50

MONTHS

40

30

52 20

33.7

30.2 10

27.6

20.4

9.6 0 Fairview

Ward 3 20.4

Ward 4 30.2

Ward 5 9.6

13.8

17.1

6.4 Ward 6 6.4

DIP 52

Ward 10 33.7

Ward 11 27.6

Ward 12 Average 13.8 17.1

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Correlation Scatterplot of Average Fairview against Creative Ability Witrand Patient stats 30v*594c Average Fairview = -16.0791+20.906*x

•

140 120

Average Fairview

100 80 60 40 20 0 -20 -0.5

0.0

0.5

Creative Ability:Average Fairview:

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

r = 0.8116, p = 0.0000; r2 = 0.6586 Creative Ability

A spearman rank correlation test  good to excellent correlation (p = 0.84)

Conclusion & recommendation • average level of functioning Fairview  17 months • Creative ability  Self-differentiation (level 2) Similar information from different professionals Important  lessen conflict  Professions  continue to use professions specific measures  Approach to intervention more focussed

 Information used to plan detailed therapeutic program

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Acknowledgements Mrs. Mocwaledi-Senyane – Witrand Hospital CEO Dr. T. Oosthuizen – Senior Manager Clinical services Matron Annetjie de Bruin – Assistant Director Nursing Occupational Therapy department Hanlie Degenaar – Speech and language therapist Charlotte le Roux – Speech and language therapist Mariet Terblanche – Psychologist Ella Ingram – Nursing assistant Carol Elefeld – Nursing assistant Nursing Assistants involved in program

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