The Importance of the Therapeutic Use of Self in Engaging Jennifers Occupational Therapy - Case Study Example

CASE STUDY ON OCCUPATIONAL BEINGS IN CONTEXT [Name] [Institutional Affiliation] [Date Introduction Rheumatoid Arthritis is chronic illness that is categorised under autoimmune diseases (Goronzy. and Weyand 2001). The body has an immune system that consists a complex organisation of antibodies and systems that “search for and destroy” body invaders like infection (Hanessian 1995).  In autoimmune diseases, the antibodies and immune cells of the patient attack the tissues of the patient (Ebringer 2012). More often, this causes inflammation of body joints. In other instances, it can lead to inflammation or injury of other parts of the body. Joint in the body is a place of contact between two bones (Thibodeau et al 2013). The term arthritis refers to inflammation. An individual with rheumatoid arthritis exhibits various symptoms. They include; pain at the joints, redness of joints, swelling. Such inflammation can appear in the tissues near the joints like ligaments, muscles, and tendons (Weisman 2011). In other patients rheumatoid arthritis can damage the cartilage and ligaments thus, deforming the joints. This disease can occur at any age. People aged above 40 years are susceptible to getting the diseases. A few children have exhibited juvenile idiopathic arthritis (Films for the Humanities & Sciences, Films Media Group & Information Television Network, 2006). Rheumatoid arthritis affects people of any race and gender. However, women are more vulnerable compared to men. In the US, approximately 1.3 million people are affected by this disease (Tulchinsky & varavikova 2014). In the UK, Rheumatoid arthritis is termed as the second most prevalent form of arthritis and the most rampant inflammatory joint disorder (Espicom Business Intelligence 2008). The purpose of this essay is to identify key issues from the case study of Jennifer, a 46 year old teacher diagnosed with and outline how the health condition(s) may affect her occupational performance and lifestyle/activities and participation. The essay begins by giving a brief summary of the case study. It then discusses, under various subheadings, the causes of the Jennifer’s reduced performance in relation to the International Classification of Functioning Disability & Health (IF) and what could be done to provide her with opportunities to promote, maintain, and/or restore her health and wellbeing and why this is important. The report examines current government health and social care initiatives which would be relevant to the case study and how these would help address aspects of ill health promote health and/or restore their health and functional performance. Finally, the report looks at the importance of therapeutic use of self in engaging Jennifer’s occupational therapy. Summary of the Case Study Jennifer is 46 year old single lady. She lives in small cottage, in a village, five miles from the primary school where she works as a teacher. Five years ago she was diagnosed with rheumatoid arthritis. Recently, the symptoms have notably exacerbated. She experiences fatigue, flare ups and pain at the joint, a condition that is worrying her. Jennifer’s condition is slowly affecting her occupation as she cannot attend as regularly as she used to do. She similarly can’t enjoy her hobbies like tending the garden and going on holiday with her friends. Because of the pain and joint inflammation, Jennifer is finding it difficult to drive. The route to her cottage has steep steps and is narrow, making her movement to the cottage difficult. She is generally experiencing trouble completing her regular activities like writing and preparing meals. How the Health Condition Affects Jennifer’s Occupational Performance and Lifestyle Jennifer’s occupational performance and lifestyle are affected in a number of ways. Given her condition her optimal performance as a teacher has significantly reduced. The International Classification of Functioning Disability and Health (ICF) framework can be used to analyse how Jennifer is affected. The International Classification of Functioning Disability and Health (IF) is cognisant of the fact that disability and functioning entails concepts that are multi-dimensional(World Health Organization 2001).The concepts relate to functions and structures of the body, routine activities and how the activities limit one’s life, participation and environmental factors which affect or facilitate one’s experiences (Mpofu and Oakland 2010). Jennifer’s occupational performance and lifestyle are analysed below in relation to the ICF framework. Jennifer’s body functions and structures have been impaired due to exacerbating pain. For instance, she experiences joint pains that have hampered her movement from place to place. The pain and consequent weakening of the joints and the elbow, wrists and hands affects both her ability to work and lead her usual lifestyle. This means that in the classroom she has to stick to one place, perhaps at the front of the classroom. Movement from one place to the next to supervise the students is hindered. Writing on the interactive board is hampered because of the pain and stiffness her fingers’ joints are feeling. The fact that she can’t write on the board means her delivery in the classroom is affected as she cannot use the board to make illustrations, draw concepts, or write words for her class to see. As teacher, she is required to check, students’ work. With the state of her fingers she can’t write much thus reducing her occupational performance. In addition, limitations imposed on her body functions and structures hinder her personal activities. As examined earlier, she enjoys going on holiday with her friends. Since she is impaired, she might not enjoy sporting activities like swimming, skating and playing sports. Jennifer is likely to be left out in most of the group activities that they used to do with her family and friends. With her condition, going for holiday with her friends becomes a challenge as she is often ill and can’t do most tasks. This spreads to her inclusion in activity in the school like sports day, faculty conferences, trainings, and seminars. Jennifer is often absent making her unreliable and her attendance unpredictable. Her attendance to school activities and social events is unpredictable as she is often ill. Some of her hobbies like tending the garden form part of her lifestyle, an activity that she can’t do now. Several other hobbies are affected if they involve movement of self and other body parts. This condition affects Jennifer’s inclusion in social activities. Her life is prone to be full of boredom since she cannot enjoy her .Boredom is likely mean to provoke secondary problems like stress. As Heidenreich et al. (2009) puts it, ill-health is one of the leading causes of stress among most people. As Cartwright and Cooper (2011) notes, stress can worsen a health condition. As a member of the society Jennifer has been given the responsibility of taking care of Poppy and Max, a job she enjoys. This work entails preparing them meals, bathing them, changing them and among chores related to childcare. Due to her condition she can no longer accomplish this duty. She feels guilty though of telling her sister that she can no longer perform the duty. Her ill-health is slowly drawing her from the work that has formed part of her lifestyle for a long time. However, there is an internal conflict within her as to whether or not she should give in to the life that her conditions puts her in or not. As a member of the society, she can’t fully meet what is expected of her in term of duties and responsibilities assigned to her by other members of the society. As Hochberg (2009) indicates excessive loading on the joints is susceptible to aggravating active rheumatoid arthritis. The individual in the case study cannot persist in regular exercise activities. Proper and well-thought out exercises are recommended for diverse forms and stages of rheumatoid arthritis(Bresnihan and Dayer 2003).There are thus ,dangers of Jennifer engaging in her daily activities unless such activities have been recommended by a medical doctor. Too much writing, walking, or any form of activity that can cause loading of the muscles should be avoided as they may worsen her situation. Her participation in usual activities is limited as it may worsen her condition. Environmental factors cannot be taken for granted as they affect all other dimensions and that they need to be changed (Stamm 2005).The physical environment in which Jennifer lives consists of a multiplicity of factors that hinder Jennifer’s functioning. To begin with, the distance from her school to her cottage is a barrier. Because of this distance she has to drive all the way to school. This is a barrier to her condition. In addition, the vehicle itself is not a facilitator. She has to reach out for the belt and change the gear often, a factor that strains her elbows, wrist, and fingers. The next environmental factor is the presence of steep narrow stairs and steps up to the front door. Thus, any time she walks in and out of the cottage she has to strain the joints of the knee. The strain experienced in the jaws as she attempts to walk up and down the stairs loads the joints and makes her vulnerable to more inflammation of the joint. The other factor to consider is the interactive whiteboard. Whilst its presence makes learning in the classroom interactive and interesting, it is a hindrance. The fact that she has to write on it makes her strain her fingers and joints by moving up and down. These factors in her physical environment inhibits her ability to execute her daily activities and perform as expected in her work The social environment too has potential of being a threat to the normal functioning of a person with a disability (World Health Organization 2007). Jennifer has friends with whom she likes hanging out. She feels obliged to them and when she does not make up to go on holiday with them this bothers her. It can be a secondary source of her stress when she realises that she cannot live up to the expectations. Besides, she has a family. Her sister has given her the responsibility of taking care of Poppy and Max. Childcare of twins is exhaustive for someone who has such an illness. Cooking for the kids, buttoning them and other duties are prone to make exercise her body joints beyond the limits. What is likely to happen is that she is prone to injuring herself more. Her sister looks up to her and she is feels obliged to please, a thing that stresses her whenever she feels like she giving up. Importance of Promoting, Maintaining, and/or Restoring Health and Well-Being The first benefit of being in good health is that it helps us lead stress free lives (Heidenreich et al., 2009).This does not mean that a state of ill-health is the only cause of stress. Other major causes of stress include work, money matters, and family issues. In the USA, ill-health tops among the things that stress people the most (Shrand and Devine 2012). Ill-health derives people the opportunity to lead their usual lives and interact with other members of the society. Hobbies and social interactions are some of the things help people deal with lives stress. In their absence, people are susceptible to cave in to stress. The state of being unwell itself is enough cause for stress. In patient like Jennifer can’t wait for the pain to cease so that she can lead her usual life again. The second benefit of promoting well-being is that it helps one to stay economic stability. Ill-health and cost of treatment takes a lot money. For governments, ill-health not only deprives the nation of working population but also necessities heavy spending on medicare. In the UK for instance, a lot emphasis is given to health care since a healthy nation is a productive nation (Berkman and D'ambruoso 2006). An individual who is ill may cease to work. Failure to generate income while at the same time having to foot medical bills can land one in abject poverty. For the working population, well-being is necessary as it promotes productivity. As evident in the case study, rheumatoid arthritis negatively affects Jennifer’s performance. Her absenteeism from work is chronic as she has to attend treatment. (Green and Baker, 1991) have analysed effects of sicknesses and productivity and concluded that a healthy workforce is more productive than any other. As Ioannides (2013) notes that social interactions are central in any community. The main purpose of human beings’ actions and motifs in any society is centred at social interactions (Ioannides 2013). The community must thus find mechanisms of fostering and enhancing social interactions. When the structure is broken, either due to illness the society is culpable of diverse problems. Illness as opposed to illness deprives people the opportunity to be integrated in the social fabric that binds the society together. As noted earlier in the case study, Jennifer is unable to continue her social life due to her ill-health. Intervention Measures There are varied intervention(s) and health and social care initiatives which might be offered / promoted by occupational therapists and other members of the multidisciplinary team. The first one is to make changes in Jennifer’s physical environment. For instance, she needs to be relocated to a place near her work station. The design of the house should have a lift and should have minimal steps. This is part of the solution to her condition. At school her workload can be reduced to ensure that she doesn’t strain and that she has enough time to rest. Besides, Jennifer might need to consider alternative ways of teaching like use power point presentations to minimise the frequency of writing on the whiteboard. In terms her social environment something has to be done. Her sister should be advised to take the kids to a childcare centre to relieve her of the duties of babysitting Poppy and Max. The next intervention for Jennifer and any other patient in a similar condition is treatment. There is no known cure for rheumatoid arthritis. The aim of rheumatoid arthritis treatment is not to cure but to maximise joint function, inhibit deformity and destruction of the joints, minimise pain and reduce pain. Treatment strategies comprise of early medication intervention (Hunder 2002). This is offered in the initial stages so as to stop further inflammation and damage. At the advanced level an aggressive form of management is considered-rays are administered to cushion work disability. The important factor to note is that treatment of this illness should be customised according to the level and magnitude of the inflammation. Apart from medication, the other intervention measure is psychological support. Physical illness can cause mental illness. A patient in this state is prone to stress that comes from the physical pain, inability to lead normal life and isolation from other members of the society (Zautra 2003). The work of a psychologist in treatment is to help a patient cope with the illness and give them alternative means of living their lives to the fullest. In treatment of rheumatoid arthritis self-management is equally important. One needs to be physically active in order to keep the joints flexible. However, the principle of load demand in physical fitness ought to be kept into consideration. The load placed on the joint should not be excessive as this will damage the muscles. In addition to this, note that regular exercise will help keep the body fit. In addition, checking one’s weight and diet is inescapable as this will keep the body fit all the time. Current UK Government Health and Social Care A report by the National Audit Office (2009) found out that while progress at the national level was made in efforts to prevent and treat rheumatoid arthritis, there were limited efforts at the local level. Nevertheless efforts are made to sensitise the populations on the disease. Most patients in England do not detect the symptoms in time for treatment. That is why the British Society for Rheumatology is seeking to carry out a national audit to assess new patients with rheumatoid arthritis so that immediate treatment can be offered to them. Other interventions by the government include huge budgetary allocation to health to cater for sensitisation of the public of such a disease and cushion the cost of treatment. Besides, the national government has in place the Equality Act of 2010 where individuals with disability arising from rheumatoid arthritis are protected (Vellani 2013). These individuals have access to funds, education jobs just like any other UK citizens. Importance of a Therapeutic Relationship with the Client An effective relationship between a client and therapist makes it easy for a therapeutic work to take place (Flaskas et al. 1996) .There are three dimensions of therapeutic relationship; emotional bond and partnership, history of the participant and cognitive consensus of the objective of the tasks in the therapy (Clarkson, 2003).Lambert and Barley (2001) note whatever the relationship between the client and therapist, research has shown consistence in the outcome of such an association. Existence of a mutual relationship between the client and the therapist leads to understanding of the objective and aims of the therapy (Gilbert and Leahy, 2007).The client no longer views the tasks as ideals imposed o him by the therapy but as essential procedures that must be followed to achieve certain goals and aims. In addition, this relationship creates an emotional bond and partnership. This emotional bond is necessary for the client to be able to overcome fear. The trust generated helps the client be able to perform tasks. He/she is able to trust that the tasks created are meant for their own good and not a punishment. Termination of therapy occurs when emotional breaches are committed ( Dreeben-Irimia 2013). .Knowing the history of the client is important in therapy. From this history the therapist is able to devise methods that can suit the client and those that the client is likely to repel. Such a relationship facilitates sharing of one’s experiences and history that might help in future therapy. Conclusion In conclusion the report has identified key issues from the case study of Jennifer, a 46 year old teacher diagnosed. The essay begins by giving a brief summary of the case study. It then outlines various ways in which her condition hinders her occupational performance and lifestyle. This is majorly to the pain, swelling and inflammation of the joints her occupational performance is affected. However as noted, in reference to the International Classification of Functioning Disability and Health (ICF) her environment has certain barriers that hinder her performance and lifestyle. These factors have been analysed in two major categories; physical factors like the steep and narrow steps, distance, type of vehicle and nature of chores she does at home, the other social factors like her responsibilities to her sisters are part of the environmental factors. As illustrated, her problems are not unique and that there are possible remedies. They include treatment, therapy, and changing of the environmental factors. The report further looks at the current government health and social care initiatives which would be relevant to the case study and how these would help address aspects of ill health promote health and/or restore their health and functional performance. 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