Psychosocial Support For Depression and Anxiety, as Well as Stress Management and Relaxation Techniques
Occupational Therapy provides a unique contribution to the cardiac rehabilitation setting. It plays a distinct role in the interdisciplinary practice as well as in client-centered care whilst addressing cardiac disease across the continuum of care from acute care to inpatient and outpatient care and to home care on discharge. Occupational Therapists are trained in areas of prevention, modification of lifestyle, physical and psychosocial rehabilitation. OT aims to empower client-centred practice by including the client and caregiver in the decision-making process and foster effective collaboration and participation in the therapeutic process.
Occupational therapists have an active role in acute care settings and emphasize on early mobilization, monitoring, client and caregiver education, restoring function and performing evaluations to assist the necessary coordination of care and suggest discharge recommendations. Occupational therapy works in an interdisciplinary team with other health care practitioners such as doctors, nurses, physiotherapists, speech and language pathologists, social workers, and members of respiratory therapy, case management and spiritual care (Antonakoudis et al., 2006). In cases where individuals require long-term acute care such as in complications from CABG surgery, Occupational therapy provides evaluations and proposes client-centred short and long-term goals that may address ADL and IADL retraining, education that concerns safety and energy conservation strategies and cognitive impairments (Colombini et al., n.d).
In order to understand an individual’s performance strengths and limitations, an OT will use clinical reasoning skills to perform an evaluation by utilizing formal standardized assessment tools to assess the client’s ability to perform normal daily activities. OTs start with evaluation to ascertain the client’s background and current functional status and this evaluation is carried out via informal interview, observation, and with the use of the Functional Independence Measure (FIM). Besides this, OTs also offer assistance in task simplification and guidance in resuming ADLs including the prescription of adaptive equipment, in-patient educational equipment, bed mobility, graded exercises and activities, psychosocial support for depression and anxiety, and stress management and relaxation techniques. Education about promoting a healthier lifestyle is crucial in cardiac rehabilitation by modifying diets and exercising regularly to increase strength, flexibility endurance and decrease symptoms of depression and anxiety.
Education of cardiac/sternal precautions along with oedema/weight management are also essential for patients post CABG. Outpatient cardiac care follows acute inpatient cardiac care. OTs can work with other clinicians within the rehabilitation team to address the needs of the client with chronic cardiac conditions or with those recovering from acute events such as CABG surgery or a myocardial infarction (Hansen et al., 2005). OTs typically assess an individual’s capability to perform ADLs in a satisfactory manner and develop individualized treatment plans by collaboration and the establishment of goals. Education is also provided to manage conditions in the home environment as well as in the community.
Important treatment plans include therapeutic exercise training and the development of an exercise transcription to improve strength, flexibility and endurance, daily physical activity counseling as well as nutritional counselling. Management of certain conditions may be offered by Occupational therapists to ensure maintenance of health and minimizing the risk of future cardiac events which may include diabetes management, lipid management, blood pressure management, smoking cessation and psychosocial management. This will promote wellbeing and facilitate long-term commitment to lifestyle changes once discharged. Occupational therapists may also work on stress management and relaxation techniques along with making necessary adaptations for the preparation of returning to work.
Discharge planning is an interdisciplinary effort to ensure a safe home transition. The ultimate aim upon discharge for Occupational Therapy is to assist the patient return to the highest level function and independence possible. Once the client has met all the long-term goals by the anticipated date, he will be discharged home. OT provides a distinct perspective on the client’s functional status, which includes the ability to perform ADLs, IADLs, mobility and recommendations for the continuum of care such as providing adaptive equipment, home modifications or further services (Najafi & Auerbach, 2012). The new strategies proposed by the Occupational therapist will be applied to his home environment to ensure a safe transition home. These may include grab bar installations, removal of loose rugs and improvement of lighting.
Upon discharge, several key lifestyle modifications may strongly decrease the risk for recurrent myocardial infarctions and minimize the progression of cardiac disease. This may include low fat and low sodium and salt diet, smoking cessation, increased physical activity for weight loss management and resumption of normal daily routines guided by the OT (‘Centers for Disease Control and Prevention (CDC)’, n.d.). The client is still encouraged to continue building activity tolerance by higher level IADLs so that the client can perform these meaningful tasks to a satisfactory level and eventually return to work. In this case, Mr Pace will continue to practice his essential tasks until he is capable to return to his work in his grocery store. Education also focuses on fall prevention, training and emergency responses as well as caregiver education to the client’s wife or children.
Medication management and information about fitness groups will also be given to the individual upon discharge. Mr Pace must also maintain monitoring his blood pressure regularly. The client may also wish to consider home delivery services such as “Meals on Wheels” or for grocery deliveries if he is not yet able to drive. “Home help” services may also assist Mr Pace with performing heavier household tasks. Individuals who have experienced acute myocardial infarctions are at a greater risk of additional infarcts as well as the risk of developing other cardiac conditions including heart failure, arrhythmias, angina, or even stroke. Prognosis varies from one individual to another and many factors may influence this from occurring such as age and the presence or absence of risk factors. This is why it is essential for Occupational Therapists to encourage clients to continue to live an active lifestyle with safety and lifestyle modifications to ensure better precautions and promote a fulfilling life.