This reflection explores my initial experiences observing home visits and developing an understanding of the importance of environmental assessment in supporting safe and effective discharge planning. It also highlights my emerging ability to articulate clinical reasoning and care planning, recognising the need to further develop depth in decision making.
This week I was able to observe two home visits for the first time. A home visit is important within Occupational therapy in order to see the patient within their own home environment and to get the full picture of how an individual is able to cope within their own home and whether any adaptations are necessary. This process also supports the discharge process to be as organised and safe as possible.
Throughout the home visits I was given the opportunity to fill in the environmental visit report which was sectioned into different parts making it easy to identify what is already in place within the home and what adaptations are necessary. For example, starting at the front entrance the front step was measured and assessed to ensure the individual was able to get up it without risk of falls. The step was only 6 inches and so no other step was necessary. This was noted in the environmental visit report. We then made our way into the kitchen and living room and observed the individual within this environment ensuring there was room/the necessary equipment for him to live as comfortably and independently as possible. All seating within these areas were measured to ensure they were high enough for the individual to be able to sit to stand and transfer easily.
Within the second home visit the patient used a zimmer frame to mobilise around the house. This meant that all aspects of the environment had to be explored in order to ensure the zimmer frame could be used appropriately. For example, the space to get around the bed with the zimmer frame had to be measured and adaptations were necessary to ensure she was able to get in and out of bed as comfortably and quickly as possible. A toilet sit to stand was also examined and therapist concluded that two drop down rails were necessary as the individual was trying to use her zimmer frame to aid her standing.
Altogether I felt observing these home visits was very informative and important for me to understand the importance of visiting the individuals house before they are discharged. It also taught me that certain aspects I would not have even know to consider are very important such as ensuring there are appropriate plugs within the bedroom for profiling beds to be plugged in etc. Another thing I learnt was that taking into consideration the material of the flooring is very important to ensure that the individual will be safe, and it is not going to hinder their recovery.
Articulating to educator what I make of appointments.
Another aspect of this placement that I have found to be a useful technique to be developing is being able to articulate my findings to my educator. This involves taking into consideration all parts of the PEOP model, the OT process and biopsychosocial aspects. Throughout the appointments I have been making sure I am taking each problem/difficulty for the individual into consideration. This has allowed me to begin to problem solve and come up with my own idea/plan of what may support the individual to meet their goals. Rather than my educator feeding back to me straight away and telling me what the action plan would be she has allowed me opportunity to consider this for myself and begin to reflect on all aspects of a patient’s care plan.
Currently, I feel as though I am able to articulate my basic findings and come up with a basic plan of what I think would benefit the patient however, I require prompts from my educator at this point to think of the more in depth/complicated scenarios. For example, I can say what I think the patient should do to improve mobility such as physio exercises or practicing sit to stand. However, when it comes to the more social aspects such as needing to refer to a social worker or them needing something put in place such as financial help, I am less able to identify this. I understand this will come with practice and I acknowledge it is only my first placement, so I am not expected to know everything and be able to put together a full care plan together without support.