Melissa Chieza explains how virtual emerging placements offered her both the experience and the adjustments she needed to become an OT while managing her diabetes and the global pandemic

Melissa Chieza - placementIn March 2020, I had to start shielding due to my two long term conditions, one of which is diabetes. I switched from an in-person role to a virtual emerging placement in a similar specialism in order to complete my final placement hours and become an occupational therapist. 

According to Boyle et al: “diabetics make up to 300 diabetic related decisions everyday.” This decision process occurs from the moment I wake up to the time I go to sleep; I have to consider the activities involved in my day, from looking at the nutritional labelling in the food and giving the correct amount of insulin, to any physical activity involved and the impact on my body when I need rest. By working from home, I did not have to be very restricted as I could continue to plan my routines and activities from home.

As an active member of the online OT Twitter community, I attended a webinar by another student who had organised a virtual placement, Georgia Vine and Margaret Spencer. This gave me the motivation and encouragement to carry this out myself. In the webinar, Margaret Spencer gave me Louise Kermode’s details: I made contact and she was willing to assist in this. I discussed the idea with my university placement team, and how I would meet my goals working from home. 

The placement educator Louise Kermode and I made sure to discuss reasonable adjustments that would support me in managing my health whilst working from home, which included being able to schedule regular breaks. Completing a virtual placement allowed me to observe my blood glucose patterns simply by looking at my Apple Watch through my Dexcom app, which was helpful as accessing personal devices is often discouraged in typical placement settings. If I were in a hospital environment, I may not have been able to use my Apple Watch due to infection control risks.

The positive impact on my health management during this virtual placement experience has been eye-opening, and I now feel more prepared to propose virtual working within future employment in the NHS. The virtual placement has left a lasting impression on me and I feel virtual placement should be made permanently available to future students as an alternative to offering traditional placements. 

I still needed to complete 1000 hours, and the placement was virtual, but it was also role emerging: I would be the only occupational therapist in a mental health team managed by social workers. It was my role to carry out rapid telephone assessments to ensure that the client was supported to complete meaningful activities of daily living to aid their wellbeing during coronavirus.

The disadvantage of this is that although I was the first point of contact, I missed seeing the patient going through all the steps of the OT process. Much of this related to signposting or referring onwards to other services within the community. The services adapted ways for clients to build on having more daily routine through weekly activities via zoom calls. 

I looked at it from a physical and mental health point of view when completing my assessment. It has taught me how clients feel when completing virtual assessments, as sometimes it can be difficult for clients to open up when on the telephone or virtual platforms, as some clients feel uncomfortable to disclose this information and would need more time to build a rapport. 

Working virtually on placement helps you develop skills necessary for becoming an autonomous practitioner, and it helps you to prepare for preceptorship as a newly qualified occupational therapist. My situation was instigated by the pandemic, but some elements of virtual healthcare will likely continue in the future, and provide benefits for occupational therapists when managing their own health needs. Building a therapeutic relationship over the telephone has been difficult, as I was not able to see the client’s facial expression, visual cues, or interactions to better understand verbal communication. 

As an occupational therapist in learning disabilities, I tried to counter this by establishing a rapport through helping the client feel prepared before our meeting. Before meeting the clients I send them some guidelines, especially if we are completing an observation of activities, for example, making a meal or performing a domestic task. These guidelines prepare the client and relatives, giving them knowledge on what to expect on the day, but also allowing them to think about how they want to introduce themselves to me. Then, when the assessment takes place, I spend the first 10 to 15 minutes building a therapeutic rapport with clients through a virtual platform. 

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