Julie Bray, Occupational Therapy Team Lead, Belfast Health and Social Care Trust
Since March, I have been redeployed to the MIH COVID-19 Unit. As clichéd as it may sound, no pandemic workday has been the same or predictable. The work has been totally different from my usual role.
Before coronavirus, I was Team Lead to staff working across acute medical, surgical, respiratory, and rehabilitation/stroke inpatient wards, and the Emergency Department, whilst carrying an outpatient caseload. Over the past three months, my days have switched from treating patients with hand injuries to working with patients struck down by COVID-19, whilst continuing to supervise and support the OT team at MIH.
When our hospital was identified as the COVID-19 response centre for the Belfast Health & Social Care Trust, our staff reacted and adapted swiftly, dealing with vacancies, shielding and redeployments of services. Their response was superb, and they rose to the new challenges with enthusiasm and optimism, as we strived to adapt our service provision and skills to meet our new clients’ needs. As occupational therapists, our core skills are care and treatment provision to promote all aspects of independence and wellbeing through occupation, aspects which have proven to be vital in recovering from the virus.
Coronavirus has totally changed the structure and routine of my daily working life. As a team, we were unsure what the situation would mean, and many colleagues felt overwhelmed with the change it would bring. As Team Lead, I felt it was my job to encourage and support my team, ensuring they felt calm and confident, whatever happened.
Fundamentally, our OT role of providing functional assessment and rehabilitation has continued. What has changed is the structure, routine and look of our working day. Our identifying uniforms have been replaced by scrubs and a layer of PPE which, on a positive note, has led to the formation of new friendships with the laundry staff who are working above and beyond to support us. Bathrooms we usually use to complete PADLs in, we now shower in before and after shifts. We’ve learned about clean zones, donning and doffing areas, fit masks, and it has forced us to be more thoughtful about the prescription of equipment for use on wards due to the implications of the new infection control restrictions.
Seven-day working has been the biggest upheaval personally and for many staff like me with young families. With a four-year-old son whose school, day care and normal routine totally halted overnight, and my husband also working fulltime, it has been a major challenge balancing shift work with my family life. However, my occupational therapy skills have come in useful helping my son transition to our new lifestyle and structure.
My daily occupational therapy work still centres around educating and supporting staff with their caseloads and working with the MDT to help our patients maximise their health and function to facilitate hospital discharge. As an accredited Hand Therapist, I have found my clinical skills in upper limb therapy have been invaluable in devising graded rehabilitation programmes for the COVID client group in regaining the ability to self-feed and self-care again.
The respiratory aspect of the virus has been a challenge for all of us, and I am so grateful to work with so many clinically excellent staff who have readily and willingly educated and advised me throughout.
Whilst no two patients are ever the same, their rehab journey typically begins with them being bed ridden, deconditioned, and extremely fatigued. Many have a range of co-morbidities that slow and impinge upon their recovery. Some have long standing cognitive impairments whilst some have deliriums.
As an OT, I consider the patient’s occupational roles and identity central to their treatment goals. They may be returning to work, family life, and a range of daily activities. Starting with assessment of function and the provision of specialist seating and pressure care, the restoration of sitting and standing balance are fundamental in the progress from hoisting, and to being able to stand, step and walk again. Then we build on activity tolerance and lastly increased independent participation in personal and domestic ADLs. All to get them well enough to be discharged home where their recovery journey can continue with our community-based rehab schemes.
Patients recovering from COVID-19 are presenting with vast rehabilitation needs and recovery is difficult. The Royal College of Occupational Therapists is leading the way on the need for COVID-specific rehabilitation which is helping us as OTs ensure we continue to promote the importance of personalised and occupationally-focused rehab
COVID-19 has been a steep learning curve for everyone in the health service. We learn something new and face different challenges every day. We focus on the positives and use our expertise to help those afflicted by the virus get back to their normal selves. My new workday has been challenging and daunting but also hugely rewarding.