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This posting was in a ward in the Dementia setting in Waterford Residential Care Centre. This was where I was primarily based and worked with my Host Supervisor on a daily basis.

I also completed my project here which was a case study on one individual and featured trialling out different activities and objects that bring the most movement, engagement, and enjoyment on any given day. To monitor this, I created my own informal observation tool which is displayed below.

I also worked with all the other residents on the ward either on a 1:1 or group setting. Activities ranged from kicking/throwing a ball around, to dancing along to music, or passive stretching for those with limited mobility.

This was by far the most enjoyable, meaningful, yet difficult aspect of my placement overall as Dementia is a very difficult and cruel disease, although there were moments where you could witness the people as their true, happy selves.

I also had the pleasure of working alongside the nurses and the relatives of each of the residents to learn more of their interests in order to elicit further engagement and enjoyment. It was also important to connect with the relatives and support them in their struggles by suggesting different activities to try during their visits or to try out counselling. This portion of work resulted in myself and my supervisor creating a support pack for families of residents, which is displayed below.

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Another posting I was assigned involved working with individuals at a community level, who were using the services in the Primary Care Setting. I operated between the Primary Care Centres in Waterford City, Tramore, and Dungarvan. Clients were referred to me by the Occupational Therapists and we worked collaboratively to help improve each person's motivation, routine, and goal setting. I would create a programme or come up with a routine for each person, and offer advice from an Exercise and Health perspective, and the OT would offer their own advice from a therapeutic standpoint.

In other scenarios, I also worked with clients in an informal, public setting by Lone Working in public parks. Here, I would meet people at certain times and either go for a walk or we would use the outdoor gym equipment. The nature of the sessions would depend on the weather and the mood of the person on the day. However, the outcome was always the same - the concept of having an appointment and having someone waiting for you, helped with their motivation to be present for each session, and over time, it helped form a habit and a routine.

The sessions lasted for eight weeks and over the course of these, I would implement anything the clients needed on an individual basis according to certain factors that would arise or any changing goals. An example of this was that one client mentioned that she would like to improve balance and mobility, and restore full range of motion in an injured shoulder, but has hated the format of any previous programmes received and found it difficult to adhere to. Therefore I created a new programme with very basic and quick movements that can be done while watching TV, waiting for the kettle to boil, or waiting for the bus. I also created it in a format that she requested, with one exercise per page and very large font.

I also took the responsibility to check in on everyone's previous injuries each week, and would recommend them certain stretches that would help, or to visit their GP or physio if I thought it necessary.

At times, it was necessary to adjust my expectations or ideas for certain clients, as it took a while to adjust to taking mental health into consideration, mainly motivation and desire.

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Dpt. of Psychiatry Waterford University Hospital

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Dpt. of Psychiatry Waterford University Hospital

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My work in the Dpt. of Psychiatry (D.O.P) began in the last portion of my placement and featured a four week fun movement group. I incorporated it into an existing self-care group with the advice and permission of the OT there, in order to work around workplace politics, which is also a large portion of the job. I also learned that I needed to make it a gentle movement group to avoid the need for an IPAQ or doctor's permission, and to avoid clashing with other existing groups.

Following this, I created and implemented a fun group that consisted of four different activities across the four weeks. The clinical reasoning behind this was to ensure different people had the opportunity to participate each week depending on mood and preferences, and that it would offer a change of energy each week from low to high, i.e Week one - Fitness Bingo, week two - yoga, week three - dance party, week four - Fitness Bingo (repeated upon request).

One thing I had to take into account was that as this is a psychiatric unit and I was acting as an external worker, I did not know any of these people or their diagnoses. Therefore, I had to learn to adapt a lot to suit the different moods and abilities of everyone that entered the room and improvise where necessary.

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This was a very small portion of my placement, but quite impactful. I had the opportunity to visit and participate in the Kickstart to Recovery Soccer Group facilitated by an FAI coach and the OTs in the rehabilitation setting. This group has been active for quite some time and has seen the same individuals participate for a while, so most of them have bonded well and have learned a lot about patience and team work. It is essentially a five aside game each week, but the social aspect and the fact that there is an official coach facilitating means they all respect and support each other, no matter what team they are on. The initiative is clearly very successful and it was a pleasure to meet everyone there and witness its impacts.

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This is an example extract of an intervention I completed as part of my case study in the Dementia setting. The man that my case study is centred around has a diagnosis of Lewy Body Dementia which has elements of Parkinson's Disease, meaning there is both cognitive and motor decline present. This made it very difficult to choose activities and implement them, as both needed to be considered. With Dementia, individuals can change behaviours and moods from minute to minute so at times it may be impossible to achieve anything, other times it might only last for one minute, and at best, you can be lucky to capture engagement for 20 minutes. There is also an increase in the quantity of sleep making it difficult to plan interventions, as they may be sleeping at the chosen times. Lastly, there is the element of sensory stimulation - individuals can be over-stimulated or under-stimulated due to over or under-baring visuals, noises, smells, or touch. If one is over-stimulated, they may act out and display sadness or frustration, and if they are under-stimulated they may not engage or may sleep very frequently. Because of this, there was regular decision-making in whether to wake them for stimulation and social engagement, or let them sleep for extra rest.

Taking all this into consideration, I had to choose certain activities that were appropriate for all of the above, but also based on the current literature and advice from my supervisor from a therapeutic perspective.

As shown, some activities were as simple as trying to fold socks. From a therapeutic standpoint, the observation here was if the person understood the request and further, was able to make the connection and to physically carry it out. Also observed was level of social engagement, activity engagement, length of engagement, and level of eye contact. From an exercise perspective, I would observe how well their fine motor skills in their hands and fingers have been maintained and for how long they can physically withstand the movement for. Other activities included dancing to music, passive stretches of the arms and legs, throwing and catching a ball, and assisted walking which focused on gait quality and ability to initiate movement as a consequence of his Parkinsonism.

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This is an extract from the Family Resource Pack I created with my supervisor to offer families of residents in the Dementia setting who are struggling with visiting and connecting with their loved ones. Most of these activities were trialled by myself and my supervisor with multiple residents on both an individual and a group setting.

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This is an extract from the Family Resource Pack on counselling services and groups for relatives of the residents on the Dementia setting who are struggling to cope with complex emotions and a new way of living, and grieving the person they knew before the onset of the disease.

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This is an extract of the Family Resource Pack which summarises one type of Dementia in simple terms that is easy for an overwhelmed relative to understand and come to grips with. It contains a summary explanation, different forms, symptoms, and resources. This was completed for all the common types of Dementia, including Alzheimer's, Lewy Body, and Frontotemporal.

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This Warm-Up routine is one of the handouts I created in the Primary Care setting for OTs to offer existing and future clients who are interested in adding movement into their routine in a gentle way. It can all be completed at home and requires no equipment, and exercises can be picked at random to complete at different times throughout the day. I suggested that clients use association and pick one exercise to do during certain household tasks, for example Hip Circles while the kettle boils or Heel Kicks while brushing your teeth.

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This Circuit routine is one of the handouts I created in the Primary Care setting that can be completed at home with objects around the house. I advised it be offered to those who are looking to start with the basics to introduce exercise into their routine, or for those who are looking to build confidence and technique before joining a gym setting.

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This Balance routine is one of the handouts I created in the Primary Care setting. It is to offer those looking to improve their balance or core strength an opportunity to do so at home with the ease of only four movements. Adaptations of completing them seated are also included.

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This Cool-Down routine is one of the handouts I created in the Primary Care Setting for those looking to improve flexibility or who are unsure of what to do after a bout of exercise. It is also beneficial for those with limited range of motion or mobility.

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Community Setting - Individualised Programmes

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Community Setting - Individualised Programmes

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This is an extract from the adapted programme I created for my client in the community setting, as stated above. She stated that previous programmes were difficult to follow, understand, and adhere to. She requested a larger format with one movement per page, and wanted to learn more on balance and mobility. The feedback on this was great and she found her motivation spike once she received this.

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This is the template I created for my Fitness Bingo group in the Dpt. of Psychiatry. I chose this as it is a fun activity that brought a lot of light and laughter to a dull, clinical setting, and the movements are very gentle. Some are silly which brought laughter, and others are more compassionate like "Compliment your neighbour" which I chose due to the setting and context of the cohort. Others like "Shake it Out" allowed them to physically release any negative feelings, stress or tension from their body. Additionally, the concept of getting Bingo added a slight competitive nature which targeted certain people in the unit, and helped keep engagement across the 30 minutes. I also created duplicates so that two people in the group would have the same Bingo card to ensure everyone had a chance to win and be celebrated. I also gave everyone the opportunity to pick out an activity to the group to ensure inclusivity.

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This poster was used for my second group session in the Dpt. of Psychiatry, and offered a more calm energy compared with the first session. I achieved my goal of targeting a whole new group of people for this session, and it allowed them to become more grounded and in the present. This context elicited a lot of feelings and emotions in some participating, and led to a deep, lengthy discussion. To keep the focus on the movement, I encouraged everyone to continue with the movements while we listened to everyone speak their mind. Everyone was very patient, compassionate, and respectful, and even though Yoga is a stereotypical quiet and peaceful activity, these people needed to be heard in this moment so I made sure they had the space and felt safe to do so. I was supported by my supervisor and the other OT of the unit to address any issues or topics out of my scope, and we worked on the spot as a team to keep everyone calm and on track.

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This is the poster I created for my third session in the Dpt. of Psychiatry which was a Dance Party. I chose this next to contrast with the slow energy of the previous session and, again, to engage with new people with a universal activity that is more free-flowing. For this session, I was advised by my supervisor that it may be difficult to encourage some people to engage and interact due to nerves or lack of confidence which I had not anticipated. To work around this I made sure everyone was aware that they were not under any pressure and could leave if they wish. I started with a gentle warm-up and slowly incorporated dance moves with the help of my supervisor to help everyone feel more comfortable and lighten up. It ended with some slower music to calm and cool down and was a success.

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As a whole, all of the tasks I completed and people I worked with was new for me as I have never experienced anything like this before. I learned a lot from multiple different OTs in multiple different settings, mainly, how to consider mental health factors while working with clients in this setting and designing a programme or group with those considerations in mind.

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What can sometimes be neglected is personal wellbeing in the workplace, particularly in the mental health services. This is an emotional and sensitive environment, and completely new to me from a professional standpoint. My supervisor would check in with me every day to ensure I was doing ok with all of the challenges, new skills and information, work-college-life balance, and emotions that come with the job. She would encourage, listen, advise, and teach techniques to separate and protect while dealing with people.

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Management and Expectations of Workload across different Teams

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Management and Expectations of Workload across different Teams

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As I had multiple different postings with multiple different OTs and projects, I had to learn to separate each of them and manage the workload accordingly. I had to learn to be a part of a large multidisciplinary team and to stand back and learn and observe, while also being independent and showing initiative. I found it difficult to transition from a college student to a professional colleague, as this was how I was viewed and treated. I found myself being very passive at times, as I felt I should have been just because I was a student. However, I learned later that the opposite was respectfully expected of me and I had to gain confidence in being more assertive.

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I also had the pleasure of meeting and making connections with multiple different OTs across Waterford and Wexford, and attend large meetings. This resulted in me being invited to a meeting with Integrated Exercise Practitioners (IEPs) of the Exercise Effect in Wexford. They were beginning to work with an OT in another Dementia Ward and I was able to witness others working in the same setting as I had just entered into. It was interesting to observe others in the same field in action in a professional setting.

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The concept of Lone Working was completely new to me, and I had to learn a lot on setting and reiterating boundaries to clients. The context where I worked with clients in an informal, public setting, meant that sometimes boundaries could become blurred. However, it is important to always maintain a professional dynamic, particularly when working in the mental health services. This was tricky for me as I had the fear of triggering something with certain clients, as I never know what their diagnosis or history is. It is difficult to maintain sensitivity and professionalism without crossing a line.

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New Ways of Communicating in a Dementia Setting

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New Ways of Communicating in a Dementia Setting

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In the Dementia setting, the majority of individuals cannot communicate verbally. Others can but it may be difficult to understand or make sense of as the conversation can drift very easily. In order to communicate non-verbally, I had to learn a lot about OT and sensory stimulation. I learned the skill of eliciting sensory stimulation, and that sometimes to initiate engagement or focus, targeting other senses like touch can help. I also had to learn to speak more clearly and concisely, as it can be difficult to process a lot of information at once with Dementia, particularly if there are other stimuli present. For example, if there is music or a TV playing in the background, it is important to switch it off or turn it down so it is easier for the person to focus on you. It is also important to read body language as this is the main way of communicating consent, enjoyment, or preferences. All of these new skills took a while to get the hang of and put into action. Particularly engaging through touch, as it needs to be the right amount and level of pressure. It also requires confidence to do this assertively, particularly if you are just getting to know the person and are not used to this method of communication.

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Creating Relationships in a Dementia Setting

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Creating Relationships in a Dementia Setting

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The biggest personal development across this placement experience for me was learning to hold space for family members and the residents when in distress, and offering support where appropriate. To do this, I learned about the different Dementia types and the impact it has on the residents. I learned how to create trust and meaningful relationships, and how to incorporate gentle movement into the therapeutic programmes. With this came confidence in clinical reasoning during individual and group interventions, for example how to respond to a distressed person with Dementia.

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Finding Success in Smaller Movements with Dementia

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Finding Success in Smaller Movements with Dementia

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The combination of older age, cognitive decline, and physical decline in the Dementia setting meant completely stripping back standards and expectations going into this placement. I had to acutely observe, and reassess my plans and expectations around what I was going to do and what I expected the residents to do. Rather than creating a circuit programme and expecting them to abide by it each week, I wanted my work to be more impactful and realistic. This is how I thought of my Trial & Error Case Study, to test out different activities tailored to the person, and assess their effectiveness from a movement and therapeutic perspective. I learned to find success in smaller movements like intentionally turning their head to look someone in the eye, or intentionally tapping their feet to music or clapping their hands. The intention behind the movement demonstrated that they were in the present and aware of their environment, and knew how to respond to it accordingly. Requesting certain stereotypical exercises would not work in this cohort as the activity needs to be meaningful to them, relate to everyday life, and be easy to understand and follow. For example, instead of asking them to squat, ask if they would pick something up off the floor. Learning to readjust the perspective and wording of the intervention but still observe their movements behind the scenes was a huge development for me.

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Learning to Assist and Empower with Dementia rather than Taking Over

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Learning to Assist and Empower with Dementia rather than Taking Over

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With Dementia, it can be difficult to complete the most basic of tasks that other people would take for granted, for example zipping up a jumper. This can be the most challenging and frustrating thing to do for someone with Dementia if it takes some time to complete. In this instance, I learned the skill of guiding and empowering rather than taking over and completing the task for them, which can be an automatic response in order to help as much as possible. This is to promote and maintain as much independence as possible, but also to respect that they are still adults who have lived a full and meaningful life and should not be "babied". It also allowed me to observe their fine motor skills in a variety of tasks.

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Again, learning to reassess and adjust expectations of clients and what I ask of them was the biggest takeaway. This did not only apply to the Dementia setting, but also in the Community setting. As this placement was in the mental health services, motivation was the largest barrier for clients for exercising. As I was creating tailored programmes for people, I of course had to take into account other factors in their life, and their mental health struggles was the largest one and how it was affecting other commitments and priorities in their lives. Therefore, I could not just prescribe and expect someone to do a home programme for 30 minutes three days per week, as it would be too overwhelming for them. Instead, I created small and simple routines that they can pick and choose exercises from as they please. Starting out with baby steps and doing these exercises with them weekly provided them with a starting point and allowed them to slowly begin doing them in their own time throughout the week. This is where I found success in these clients - when they would report that they did one or two exercises on their own across the week. This made them feel accomplished and more likely to adhere and increase the quantity and frequency.

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Learning to Maintain rather than Progress

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Learning to Maintain rather than Progress

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Typically in this field, the aim is to help clients progress to a certain goal and consistently increase their level of fitness. However, in this situation, this is not applicable at all. There are no specific exercise goals to reach and it is not always possible to increase levels of activity. The main goal here is to continuously initiate movement and maintain as many physical functions as possible, for as long as possible. This is why I had the clinical reasoning of folding socks with them, or creating passive movements and assisted walking. The activity may only last a few minutes, be very basic, and seem unrelated to physical activity and exercise on the surface, but it was effective. This was a difficult concept to adjust to, as we are taught the complete opposite for the general population, and I have only worked with the general population in previous positions. It allowed me to change my perspective around movement and individual needs.

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My contributions to the Dementia setting include the creation of the Family Resource Pack to offer existing and future family members of residents more resources and suggestions to support them in their new journey. I believe I helped bring some more joy and laughter to the resident's lives and allowed them the freedom to move more, particularly for those in wheelchairs who can walk with assistance, or obtain movement passively. I have offered tips and suggestions on how to increase the amount of mobility for most residents with ease, and encouraged nurses to do so when time permits. This was probably the most meaningful contribution, as the man I surrounded my case study on was very under-stimulated as staff and family were very unsure on how to communicate with him. The bond and connection I have formed with him through sensory and movement stimulation has encouraged everyone to engage with him more, and others who are similar, and this is evident in his recent behaviours. He is more "chatty" and cracks jokes with everyone around him when his mood is particularly good, and is more open to trying out different activities.

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In the community, the handouts and resources I created have been left for future clients to avail of, and will be beneficial for OTs to refer to during sessions. All other programmes I created for clients have also been left with the OTs to offer clients. I also believe the consistency of my work with these clients has helped them to form a habit and a routine around exercise. The support and knowledge offered to them each week has reported to be effective, as they believe they are more organised and ready to adhere to the best of their abilities. The overall feedback demonstrated that the small but impactful contributions have made a difference to a few people, as they have all stated that they intend to maintain their sessions in their own time from now on.

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My work completed in the D.O.P was very short but impressionable. The fluctuation of energy from high to low allowed people to experience movement on different levels. Also, the inclusion of laughter seemed to alter the atmosphere of the setting after each session, as most seemed more at ease and comfortable, no matter how long it may have lasted for them thereafter. The brief moment of forgetting any clinical-related thoughts or emotions, and letting go to have fun sparked some new and insightful feelings in some participants. They seemed to be relieved slightly of any tension they held onto, and

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It was reported by staff that any resources I created were hugely helpful, and that it felt more like working with a colleague than a student, which is great feedback around professional skills and mannerisms.

I thoroughly enjoyed my work during this placement and found it incredibly valuable and meaningful to work in the mental health services. The concept of combining mental health, occupational therapy, and movement was a fantastic challenge to achieve that I hope to apply further in the near future, and to continuously improve upon.

The knowledge and skills I have gained and the relationships I have built will stay with me forever, and I can only hope that the mark I have left in each setting will help future clients and residents.

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A day that stood out to me the most was our recent Farm Visit for the residents in the Dementia setting. Although this was more for therapeutic than movement purposes, it was by far the most memorable day across the last 13 weeks. We had visits from chicks, guinea pigs, piglets, goats, and bunnies, and the residents had the best time. It brought out a compassionate side in most, and brought a lot of sillyness and laughter to their day.
Other standout moments would be those where I had the opportunity to engage and connect with the residents in a deeper level. Those moments where you see the sparkle in their eye and get a glimpse of who they are deep down, despite their current situation. I believe when you see the residents for who they are and respect the long lives they have lived, it becomes less like work and more like forming a bond. As I developed a close relationship with the individual in my case study, these standout moments where he would flash a smile, crack a joke at you, or even when he would become upset, became very powerful and poignant and it will be very difficult to leave.