Wednesday, December 14, 2011

Using a cup of tea in functional assessments!

The functional assessment of making a cup of tea is common practice for many rehabilitation wards. As stated by Hannam (1997) Occupational Therapists assess an individual’s ability to make a cup of tea as a tool for evaluating readiness for safe discharge or capability for independent living. This short basic functional kitchen assessment allows the occupational therapist to assess both motor and process skills. The occupational therapist completes an activity analysis of the task and takes into account all motor and process skills the the task entails. They then observe the client making the tea and interpret the observations the made. The cup of tea is a great start point for an occupational therapist to assess a client in the kitchen due to it being (as stated above) short and basic. Even though it is basic it still has many different aspects of the task which the occupational therapist can assess.
Examples of these are:
Motor Skills
Stand at the bench safely
Mobilise around the kitchen safely
Can they reach and lift kettle, milk, containers holding tea bags and sugar.
Process Skills
Initiate and terminate the task
Search and locate items
Sequences the task appropriately

Take some time to watch this video of making a cup of tea. Pay attention to all of the steps within the video and see if you can complete your own activity analysis by breaking down this activity even more than already completed within this video.

To gain some more understanding on why occupational therapists assess clients making a cup of tea click here and visit a blog called Healing Occupational Therapy. They have posted interesting information about an occupational therapy perspective on making a cup of tea.

One thing that occupational Therapists need to be aware of is that the above video is not the only correct way to prepare a cup of tea, there are various methods of preparing a cup of tea. It can depend on people culture, beliefs, values, generation and more. This can create a challenge for all occupational therapists, as they need to ensure that they can provide the necessary equipment and demands of the alternative ways that each client prepares their tea. The most accurate functional assessments of a client are when they are within their own environment; mimicking the home environment as much as possible within the hospital setting is essential to ensure functional assessments are as correct as possible. Fair & Barnitt (1999) carried out a study to draw attention to the importance of considering cultural in the functional assessment of making a cup of tea. They concluded that differences in the methods of making a cup of tea varied between various cultures, generations of the same culture, generations of various cultures and also varied with the same person depending on who they were making the tea for. I believe that these findings are a basis that all occupational therapists need to understand; without the knowledge of why or understanding the underlying meaning for the client the Occupational therapist may interpret their observations of the client preparing tea incorrectly.

I was on my final placement of my degree; it was in an assessment, treatment and rehabilitation ward. This was my first experience of using the preparation of a cup of tea as an assessment. While on this placement I experienced many different people participate in the assessment of preparing a cup of tea, but one in particular stands out. It was a man on my case load; I wanted to complete a ‘cup of tea’ functional assessment with him as his son had said he was more confused than usual. He agreed to participate and I assisted him to the kitchen, he was confident that he was able to complete the task. I orientated him to everything in the kitchen and then allowed him to complete the task. He searched located and gathered all items required for the task without any trouble. He then used water from the unboiled kettle to pour into the mug he had gathered, searched and located the microwave in which he attempted to place his mug into. He required prompts on how to open and start the microwave as he was unable to problems solve this. He stated this was due to an unfamiliar microwave I questioned what his microwave was like at home and he was unable to explain it, he was only able to tell me that it had buttons. Once he had heated the water he added the tea bag, squeezed the teabag in his mug, placed the tea bag on the sink, located and gathered and added the milk to the tea.
I had never seen anyone prepare a cup of tea in this way. I felt unsure whether this was a deficit in his process skills or just another way to prepare tea, as it was very different to anything I had seen before and very different to the way I personally would have completed the task. I completed the assessment a couple of times and observed difficulties in problem solving each time; but attempting to use the microwave each time remained the same. I decided to liaise with his son as I wanted to ensure that he would be able to complete this task at home unassisted. His son explained his father had always used the microwave to heat his water.
From reflecting on this experience I realised that initially I was making a personal bias to the way a person should prepare a cup of tea, I am glad that I double checked that the interpretation that I was making from my observations were correct. This reflection highlighted to me the importance of being aware of my own personal assumptions and bias. This experience and also many others while on this placement taught me many different ways to preparing a cup of tea. I experienced people using tea pots, heating teapots before using them, using a cup and saucer, using just a mug, the sequence of the task also changed between each person. These variations of how to prepare tea became a challenge for me, as it became difficult at times to distinguish processing skills or methods of preparing a cup of tea. I learnt during this placement that sometimes it required two or three assessments to assess the process skills of the client as you cannot assess the first time due to new environments and different appliances.

Hersch, Lamport & Coffey (1995) states that occupational therapists should grade or adapt activities for an individual to promote successful performance. Agreeing with the statement above I believe that occupational therapists should use short basic tasks (graded activity) for the first assessment in the kitchen environment. This is to give the client the best chance to be successful within the kitchen.
Bilodeau, et al.(2011) published a research article stating that success has a positive correlation with participation in intervention. The cup of tea assessment as stated above allows occupational therapists to provide clients with an activity that is short and basic therefore giving the client the best chance of success. This success as stated by Bilodeau, et al. (2011) will increase the motivation of the client to participate in future occupational therapy intervention.

Bilodeau, A., Sampson, L., Daher, P., BĂ©langer, J., Gagnon, F., & Lussier, N. (2011, March). A participatory evaluation confirms the social relevance of a community intervention model in school success: consequences of the participation for the intervention. Global Health Promotion, 18(1), 106-109.

Fair, A., & Barnitt, R. (1999, May). Making a Cup of Tea as Part of a Culturally Sensitive Service. British Journal of Occupational Therapy, 62(5), 199-205.

Hannam, D. (1997, August). More than just a Cup of Tea: Meaning Construction in an Everyday Occupation. Journal of Occupational Science Australia, 4(2), 69-74.

Hersch, G. I., Lamport, N. K., & Coffey, M. S. (2005). Activity gradation and adaption. In Activity Analysis: Application to Occupation (5th ed., pp. 63-67). N.p.: SLACK Incorporated.

1 comment:

  1. I found the video and link very useful to see other sites with info on this topic. Also, the references you used are clearly set out, so I could look them up later!