Role-Emerging Physiotherapy Placements in Dementia Care; a Service Improvement.

Purpose

Physiotherapy role-emerging placements can occur at sites where there is minimal or no physiotherapy service or established physiotherapy role. Lack of physiotherapy provision has been identified in care home settings, and this lack impacts on the quality of care in managing complex physical and mental health conditions such as dementia.

The Care Home Liaison team uses a multi-disciplinary model to develop interventions to support individuals living with dementia to have positive lived experiences of the care home setting. However, where physical health is a component of the individual's mental well-being, the team is limited to over-stretched community physiotherapy services.

This gap in knowledge and practice highlights the unique role physiotherapy could offer in managing such a complex client group. Physiotherapists working in dementia care offer an important role in the management of physical conditions, together with promoting and maintaining mobility and function. This has a positive impact on the behavioural and psychological symptoms of dementia and so reduces the use of pharmacological interventions.

Role-emerging placements can highlight the value and impact physiotherapy has, and allows students to develop skills and experience in increasingly diverse, complex and evolving workplaces.

Lack of physiotherapy provision has been identified in care home settings,
and this lack impacts on the quality of care in managing complex physical and mental health conditions such as dementia.
Role-emerging placements can highlight the value and impact physiotherapy has,
and allows students to develop skills and experience in increasingly diverse, complex and evolving workplaces.

Approach

  • The Occupational Therapist from the Care Home Liaison team and the Physiotherapist from the linked Community Mental Health team collaborated with the local university, The University of the West of England (UWE), to set up a pilot placement.
  • Collaboration and advice were sourced from occupational therapy colleagues, as role-emerging placements are well established in under-graduate OT training. Guidance and support were also provided by the CSP and the HCPC.
  • A presentation was delivered to the second-year physiotherapy cohort to introduce the opportunity of a role-emerging placement in dementia care.
  • A selection process was introduced by the university, identifying the most suitable students. Two students were selected, offering peer support.
  • Students were supported by an operational supervisor, and a qualified clinician provided 'long-arm' supervision
  • Questionnaires were used to collect feedback from students, staff and care home managers, which were then thematically analysed.

Outcomes

The physiotherapy role-emerging placement promoted the impact and value of physiotherapy in this care setting, and how physiotherapy is responding to the challenges of caring for more complex presentations.

It was recognised that the nature of role-emerging placements allowed for the development of core transferable skills including autonomous working, developing a professional identity and self-directed learning, as well as key specialist skills and knowledge. In addition, it allowed the unlocking of the learning potential in a new setting and a deeper learning through interpretation of experience and construction of knowledge.

Role-emerging placements in physiotherapy offer developmental opportunities in new settings and an important role in managing very complex client groups. It identifies a gap in knowledge and practice, and how placement opportunities are evolving in response. 

Cost and savings

There were no direct costs or savings accounted from the project, having completed it within our job roles.

However, it did offer the opportunity for the clinician to supervise two students rather than one. The two students offered each other peer support and worked autonomously. It therefore created an extra placement without extra educator time.

Implications

The success of this pilot has led to the integration of role-emerging placements into the physiotherapy undergraduate training programme at UWE, together with potential for the model to be further rolled out to other physiotherapy undergraduate programmes.

Top three learning points

  1. The value and impact of expanding physiotherapy placements into different areas of practice and using innovative models of learning.
  2. The interest and enthusiasm of students for this opportunity contributed significantly to its success.
  3. The less tangible benefits of the placement for students, service users and the care homes included working autonomously within a less structured framework and offering rich learning experiences.

Fund acknowledgements

We would like to thank the University of the West of England and Avon and Wiltshire Mental Health Partnership NHS Trust for the resources and time allowed to complete this project. Also, to the Care Homes involved, Osbourne Court and The Meadows, for their support, resources and time for enabling this project to go ahead and be successfully completed.

Additional notes

This work was presented in poster format at Physiotherapy UK 2019, the National Association of Educators in Practice (NAEP) in May 2019 and is to be presented at the International OT Congress in September 2021. 

Please see the attached Innovations poster below. 

For further information about this work please contact Nansi Felton

 

Reference(s):

Corse, D and Felton, N (2019) Role-Emerging Placement; a service initiative, OT News, 27 (1): 20-22.

CSP and Dementia Action Alliance (2011) Physiotherapy Works; Dementia Care, www.csp.org.uk/system/files/csp_physioworks_2011_dementia_0.pdf.

Fieldhouse, J and Fedden, T (2009) Exploring the learning process on the role-emerging practice placement; a qualitative study, British Journal of Occupational Therapy 72(7): 302-307.