1.    JOB DETAILS

Job Title:                                             Specialist Occupational Therapist

Responsible to:                                   Lead Therapist

Department:                                        GNCC Therapy Team

Operating Division:                             Gilmerton Neurological Care Centre (GNCC)

2.    JOB PURPOSE

• Work closely with the multi-disciplinary team and other external agencies in the provision of an Occupational Therapy service to residents with Neurological condition primarily within the residential setting (.
• Provide direct clinical care, which encompasses specialist occupational therapy assessment, treatment and management of patients with highly complex care needs in the GNCC unit.
• To support the lead Therapist in leading junior staff in a specialist area of Occupational Therapy ensuring provision of quality service to rehabilitation  patients
• As an experienced practitioner is responsible for planning, co-coordinating, delivering and evaluation of the occupational therapy service with particular reference to rehabilitation patients, and in the context of the Neurological Rehabilitation.
• Supervise junior staff and delegate work appropriately.
• Play a key role in the education and development of occupational therapy and other rehabilitation.

3.    DIMENSIONS

To work closely with the multi-disciplinary team and other external agencies in the provision of an Occupational Therapy service.

Under direction of the Lead Therapist, support the small team of staff within rehabilitation.

Supervise clinical workload of junior staff as required and provide day to day management of Therapy Assistant on the GNCC.

5.    ROLE OF DEPARTMENT

The Occupational Therapy service sits within the GNCC Therapy Services.

Responsibilities of Occupational Therapy Service:

·         To provide a high quality, effective and equitable occupational therapy service to patients with a primary stroke diagnosis and including a diverse range of clinical conditions in a wide variety of settings within hospital, community and at home.

• The Occupational Therapist will work within multi-disciplinary teams involving other health professions and community staff both statutory and voluntary to ensure the needs of the patient group are fully addressed.
• Development, implementation and management of Clinical Governance Strategy

6.    KEY RESULT AREAS

6.1 Clinical

• Act independently to assess individual patients to determine their need for Occupational Therapy intervention within a specialised area.  This will focus on patients with stroke as a primary diagnosis and can also include those with multiple pathologies and complex care needs that will include both physical and mental health conditions.
• Act independently in prioritising patient needs to ensure individual patients receive appropriate intervention and support in a timely manner, taking on the role of care co-coordinator where relevant.
• Act independently to plan, implement, evaluate and progress patient care to maximise functional independence in the areas of self maintenance productivity and leisure within a specialist area, ensuring all patient/carer needs are the focus of the care programme.
• To plan and implement client centred individual and/or group interventions, in collaboration with the patient, using graded activity to achieve the patients’ functional goals – working closely with the GNCC based activity co-coordinators.
• To monitor, evaluate and modify treatment for patients with multiple and complex needs in order to measure progress and ensure effectiveness of intervention.
• To work with patients, carers and families, to promote maximum functional independence within patient’s own environment through appropriate goal setting and use of GNCC resources.
• Manage a team caseload of patients effectively and efficiently, providing advice to others in relation to complex cases.
• Act as a highly specialist clinical resource for the occupational therapy service and the wider practitioner group within the specialty to optimise available clinical care.
• Work as part of a multi-disciplinary team to ensure effective communication and delivery of a high standard of care and support to patients and carers.
• Communicate and make recommendations to all relevant disciplines of staff to maximize patient care and promote multi-disciplinary and multi-agency working.
•  Maintain patient documentation, records and accurate statistical information to reflect care provided and meet professional standards, including computerized systems
• Incorporate additional skills gained from Continuing Professional Development into clinical practice to improve the quality of care, and disseminate these to others
• To be responsible for the efficient and effective day to day running of the OT service provision to the recovery and adaptation GNCC.
• To maintain and improve standards of care and quality of service in line with professional and local policies and to identify further areas for improvement and development.
• To work in a way that supports the integrated practice principles both with other agencies and within the multidisciplinary team.
• To apply a high level of understanding of the effect of Neurological condition, the physical disability and cognitive recommended adaptations to the client’s physical and social environment.

• To prioritise service provision in line with agreed standards

6.2 Managerial

• Manage effectively Activity/therapy assistant to maximize efficiency and achieve desired quality of care.
• Ensure all staff within GNCC specialty participates in the departmental Personal Development and E-learning to promote personal and service developments.
• Assist the Lead Therapist in the further development of the rehabilitation service in line with FSHC objectives, incorporating public involvement and integration of OT services across physical and mental health.
• Support the Lead OT to develop a specialist Occupational Therapy Service to maximise patient care and efficient use of resources.
• Participate in clinical audit to support the Occupational Therapy Service Clinical Governance strategy.
• Assist in the development of, and implement, managerial policies to promote a fair and consistent working environment.
• Liaise with a range of individuals internal and external to the organization including representing the service at appropriate meetings, to promote the role of the Occupational Therapy and ensure effective service delivery.
• Ensure that the Health and Safety policy is adhered to in designated are of responsibility.
• Under direction of Lead Therapist, assist in the collection, monitoring and interpretation of core data relevant to the service in order to contribute to service developments
• Implement relevant national and professional clinical guidelines ensuring clinical effectiveness to optimise patient care.
• Keep records of own training and development by maintaining a record of Continuing Development (CPD) activities, reviewing and reflecting on practice and performance.

6.3 Educational

• Develop, maintain and update specialist clinical knowledge and skills across a wide range of work procedures to ensure delivery of evidence-based care particularly around Neurological rehabilitation.
• Provide training and advice to Therapy staff and range of other staff regarding specialist area, ensuring the progression of integrated practice that reflects the needs of people with both physical and cognitive difficulties along with Lead OT.
• Coach and develop staff within the team to promote their professional development and clinical care.
• Support Therapy in-service and lead in-service training to promote personal development, particularly relating to Rehabilitation.
• Educate nursing, medical, other multi-disciplinary team members, educational staff and others, to promote knowledge of Occupational Therapy to enhance patient care.
• Develop full and equal partnership with patient and carers, in order to support the management of their condition to promote functional independence and enhance quality of life e.g. moving and handling issues, environmental health and safety issues.
• To be actively involved in health promotions and health prevention for the client group.
• Promote and participate in student education ensuring quality placements within designated area.
• To be a member of the relevant specialist interest groups.

6.4 Professional

• Comply with Health and Care Professions Council standards of proficiency.
• Comply with the Royal College of Occupational Therapists Code of Ethics and Professional Conduct, national/local policies and procedures.
• Respect the individuality, values, cultural and religious diversity of patients/clients and contribute to the provision of a service sensitive to these needs.
• Exhibit professional behaviours of a high ethical standard promoting ethical reasoning throughout the service.
• Independently provide evidence of CPD.

7A    EQUIPMENT & MACHINERY

Activities of Daily Living Equipment

• Dressing e.g. stocking aids, helping hands, button hooks, adapted laces,
• Feeding e.g. adapted cutlery, specialized crockery,
• Toileting e.g. raised toilet seat, toilet frames, bottom wiper, commodes, bidets,
• Kitchen e.g. kettle tippers, trolleys, adapted knives, tin openers, tap turners
• Transfer e.g. bed rails, high chairs, cushions, mattress elevators, sliding boards, rope ladders,
• Bathing e.g. bath boards, bath seats, swivel bather, shower boards, electronic bathing equipment, shower stools,
• Mobility e.g. mobilators, trolleys, delta walkers, banisters and rails, wheelchairs

Manual Handling Equipment

• Hoists, sliding boards, sliding sheets, handling belts

Splinting

• Fabricated hand splints and orthotics

Treatment/Rehabilitation

• Plinths, vari-tables

Creative

• General art equipment

IT Equipment and Systems

• Personal Computer, PowerPoint, scanner/photocopier,

Miscellaneous

·         Flipchart, easels, TV, Video

8.    ASSIGNMENT AND REVIEW OF WORK

• Clinical caseload will be generated by the specific service needs of the main clinical area – working alongside Lead Therapist in the GNCC.
• Work independently using analytical and judgmental skills to manage complex issues/problems.
• Meet monthly with Therapy team meeting to receive professional supervision
• Undertake annual performance reviews of delegated staff
• Undertake regular and update CPD review and reflect working practice, to ensure change of practice where appropriate.
• Carry out clinical audit, within the specialty, ensuring implementation of findings and closure of the audit loop.
• Carry out other non-clinical tasks as required contributing to the safe and smooth running of service.  For example, fire training, infection control training, health and safety issues.

9.    DECISIONS & JUDGEMENTS

Clinical Care

• Make decision on assessment and treatment in complex multi-pathologies of ageing processes and stroke disease, demonstrating advanced clinical reasoning skills.
• Advises relevant personnel regarding on going treatment and progress throughout the episode of care and discharge
• Complex decision regarding safety of patients returning home and support required
• Undertake risk assessments regarding patient condition and environment to ensure patient, carer and staff safety.
• Identify care package required to another service/agency to facilitate ongoing care/rehabilitation.
• Evaluate clinical effectiveness of treatment and modify the treatment plan as necessary and assists others.
• Work closely with patients who have mental health issues and may have to make immediate decisions on patient’s safety to self or others, including whether or not to involve medical staff as necessary.
• Dealing with patients who wish to self discharge during a home assessment or community treatment.
• Provide information to assist in the verification of diagnosis.

Manage Service Area

• Generate caseload; provide clinical advice and guidance to junior staff
• Deal with staff performance issues.
• Anticipation re: potential service difficulties and negotiation
• Plan service development along with Lead Occupational Therapists
• Complex judgments re. Staff competencies
• Making decision re. When to deal with issues or request assistance from senior staff.
• Manage and assist others with student placements.
• Delegations of tasks to less experienced staff. Support workers, clerical staff

Health & Safety

• Respond to changing circumstances which require immediate action to prevent harm or damage to self, patient or other individuals e.g. aggressive/challenging behaviour, falls, infection control.
• Carry out clear and concise documentation re manual handling/therapeutic handling.

10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

• Ability to adapt to the variable and unpredictable demands of both clinical and managerial workload; in addition to developing and supporting needs of a small team.
• Acting as advisor for complex mixed pathologies in particular relating to dementia and frailty.  This complexity comes from variable range of conditions encountered, requiring both a depth and breadth of specialist knowledge.
• Undertake a mentally and physically demanding job, whilst at the same time taking care to safeguard their own health and safety as well as colleagues and patients.
• Work independently without direct support of professional colleagues.
• Maintain and continually develop clinical knowledge in appropriate specialism.

11. COMMUNICATIONS AND RELATIONSHIPS

Patients

• Working in complete partnership with patient and their family/carers providing and receiving information regarding assessment, diagnosis and treatment and encourage patient centered goals to ensure compliance.
• Utilise developed motivation and persuasion skills to facilitate rehabilitation both in an individual and group setting, based on respect for choice and autonomy.
• Identifies and modifies the most appropriate communication method depending on the individual requirements e.g. hearing or visual impairments, learning difficulties, cognitive impairments, language differences, disinterest or perceptual problems.
• Demonstrate effective communication and dialogue strategies to work effectively with anxious patients during stressful and/or emotional situations.
• Patients will predominantly have complex medical problems and require the occupational therapist to have highly developed interpersonal skills:

-          As full partners, based on a positive relationship, inform and negotiate with patients in relation to care needs

-          Deal with verbal complaints

• Use advocacy skills as appropriate within the multi disciplinary team.
• Provide and receive information regarding complex and sensitive issues.

Relatives/Carers

• Intentionally develop a relationship, through dialogue with carers in order to effectively provide and receive information regarding complex and sensitive issues.
• Provide information, advice and guidance in relation to on going rehabilitation programme or patient management strategies.
• Demonstrate effective communication strategies to deal with anxious carers during stressful and/or emotional situations.
• Encourage honest dialogue re concerns / complaints, and manage effectively.

Activity/Therapy Staff

·         Communicates and provides daily support to staff.

• Provision of regular clinical and professional supervision to delegated staff.
• Carry out annual appraisal and Performance Development Plan and review with delegated staff.
• Deal with performance issues.
• Deal with conflict within the Therapy staff group.
• Coach and develop staff in specialist area.
• Assist staff with effective communication strategies to deal with difficult patients or difficult situations with other staff.
• Consult Lead Therapist for advice.
• Negotiate with Lead Therapist regarding service needs.
• Liaise with peer group to ensure service equity is maintained and resources optimized.
• Provide specialist advice to enable effective patient management.
• Pass on information (written, verbal and electronically) relating to patient discharges/handover to GNCC teams.

12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical Skills

·         Skills required to implement a variety of Occupational Therapy treatment interventions e.g. therapeutic handling; positioning hemiplegic arm for functional activities; manipulation/positioning off hand for splinting; sensory assessment and treatment.

·         Manual handling adapted to home environments

·         Exert light/moderate physical effort for several periods often in confined spaces with environment hazards e.g. animals, furniture, overcrowding, rugs, narrow doorways and other architectural feature unsuitable for disabled patients.

Physical Demands:

·         Carrying equipment to patients home

·         Therapeutic Handling of patients on a daily basis.  This may include assisting patients with significant physical, cognitive or behavioral impairment.  Patients may be very immobile, obese or unwilling to move e.g. patients who require support for lengthy periods – often from lying to sitting position, sitting to standing or transfer onto chair and back in one session.

·         Use of equipment such as hoists, walking aids, vari-table which requires manipulation, dexterity and strength, often manoeuvering within confined spaces.

·         A significant element of walking, climbing stairs, standing and working within confined and awkward spaces for the majority of the working day.

·         Driving frequently with hazards of road and parking.

·         Pushing wheelchairs

Mental Demands:

·         Responding to frequent changes in patient’s condition – this requires being alert in order to undertake a high standard of clinical reasoning involving constant re-assessment and decision making regarding clinical management.

·         Concentration required when assessing and treating patients throughout the day.

·         Constant awareness of risk, continuously risk assessing.

·         Supporting other members of staff on a daily basis as well as formal supervision.

·         Often dealing with complex cases and providing advice and support for these.

·         Dealing with staff performance issues.

·         Dealing with complaints

·         Workload priorities vary to meet service requirements Concentration and judgmental skills in unfamiliar environments.

·         Responding to unpredictable work situations, interruptions and the need to meet deadlines.

·         Often have to make quick on the spot judgments, with outcome affecting safety of self, patients and others. 

·         The negotiation required with multi-disciplinary team with regards to developing services.

·         Dealing with cognitively and perceptually impaired patients frequently on a daily basis

Emotional Demands:

·         Communicating with distressed/anxious/worried patients/relatives.

·         Impart unwelcome news regarding patients rehabilitation potential and support required by patients

·         Frequent direct exposure to distressing emotional situations and circumstances

·         Maintaining a positive outlook

·         Working with Protection Of Vulnerable Adults, Dealing with patients disclosing abuse

·         Dealing with challenging behaviours including working with  people demonstrating verbal and/or physical aggression and potential for self harm

·         Discussing sensitive issues with patients

·         Supporting other staff on a daily basis as well as formal supervision

·         Dealing with complex cases and providing advice and support for these

·         Dealing with staff performance issues, including conflict within own area

·         Balancing clinical vs non-clinical priorities

·         Dealing with complaints

Working Conditions

·         Working in close contact with patients during self care activities, who may have personal hygiene issues (dressing/toileting/feeding/bathing assessments - frequently

·         Direct exposure to body fluids (urine, faeces, vomit etc) – frequently

·         Exposure to cytoxic drugs

·         Unclean and unsafe houses often unsuitable to carry out assessments in and possible infestations.

·         Direct exposure to MRSA, C. Difficile, communicable diseases, on a daily basis.

·         Fleas and head lice

13.  KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

Training Required:

·         BSc Occupational Therapy

·         State Registration with  Health and Care Professionals Council.

Experience Required:

·         Extensive clinical post graduate experience working with older adults in physical rehabilitation fields

·         Commitment to lifelong learning

·         Knowledge of OT models of practice

·         Detailed knowledge of principles of clinical governance and its application

·         Ability to analyse professional and ethical issues

·         Policies and procedures implementation

·         Service Development

·         Excellent organizational and time management skills

·         Ability to work independently and use initiative in an isolated situation.

·         Managing staff

·         Ability to build effective working relationships

·         Ability to work as a full team member

·         Ability to work autonomously and set own priorities

·         Ability to organize and respond efficiently to complex information

·         Experience of student supervision and ability to provide appropriate learning experience/opportunities for students

Skills required

·         Able to build effective and mutual relationships based on respect for all disciplines and the rights of individuals to make choices.

·         High level of communication skills

·         Negotiation Skills

·         Supervisory skills

·         Understanding team dynamics

·         Presentation and staff development skills

·         Planning and co-ordination of treatment programmes

·         Group work skills

·         Computer literacy