3. īļ Demonstrate how an Occupational Therapist would
think and do in relation to using occupations for life to
maintain function during difficult life situations.
īļ Using the KAWA Model to gain a holistic picture of
the case study, aka me, sailing through grief!
AIMS OF THE PRESENTATION
4. CASE STUDY MRS JEFFERIES
INITIAL ASSESSMENT
īļ Characteristics: 41, Female, Lives alone, White, British, Home owner,
īļ Diagnosis/referral reason: Recently widowed, Reactive Anxiety/Depression
īļ Medical History: Dyslexia, Anxiety, including acute anxiety episode, Hypertension, Asthma, Allergies
īļ ADLâs: Late husband took responsibility for all bills, cars, help needed with household management
īļ Person Centred Goals : Long term âmaintain pre-grief abilities, Short term âbe proud of self and
own abilities, need to channel emotions functionally. Do lots of positive character building occupations to
build confidence, shape identity and provide meaning and purpose.
*Ethics & Code of Professional Conduct: 2.1 Duty of Care, 2.2 Welfare, 2.4. Section 3 Service Provision
3.3.2 (p.16). Section 6; 6.1 (p.33)
5. FUNCTIONAL ASSESSMENT
īļ Executive Function affected by emotional processes- short term memory affected,
planning, organising compromised
īļ Physical mobility â emotions affecting muscles in relation to anxiety and depression
īļ Home Environment compromised due to husband dying in main bedroom and
memories and prompts needed to manage bills and maintenance.
īļ Risk âloneliness and possible isolation, depression, lowered motivation
6. HOME ENVIRONMENT VISIT
īļ Home is a 2 bedroom dwelling with a large attic space and a garden within a private estate
īļ Husband died in home of a subarachnoid haematoma (massive brain bleed)
īļ Mrs Jefferies lives in a small rural community where everyone knows her and late husband and
situation, mostly supportive but raises self consciousness/awareness, friendships locally
īļ Mother, Farther & Brother live 250 miles away, Cliveâs parents live around the corner
īļ Resources in local community: village shop, hair-dressers, community centre with activities,
literary and garden society near by, local pub and restaurants within the local town, nature reserve
and beach within 10 minutes walk from home, nearest town 2 miles away, train station in town with
parking, church nearby for flower arranging,& enabling social contact
7. MY INDIVIDUALISED GRIEF
PROCESSīļ Myself and professional medic implemented the following process:
īļ Shock, Notice & Be Present; Clearance; Re-adjustment
īļ Bowlby âs Stages of Grief is what I mostly identified with: shock and numbness; yearning and searching;
despair and disorganisation; re-organisation and recovery.
īļ From the start I recognised this would be normal and my reactions would be unique to myself. I also
researched previous writings on grief and then recognised how important it was for me to view myself with an
occupational lens. This resulted in a fast processing of emotions and remaining in control, which benefitted me
enormously. Some of my friends even doubting I was dealing with my situation, which struck me was a reflection
of themselves. Actually I impressed myself and was proud of my resilience . I would also add I didnât feel a need
to recover I kept going by being kind to myself, being present with my emotions and physical state
8. SAILING THROUGH GRIEF
īļ Learning a new skill âSailing.
īļ Learning to use the tide and wind to enable me to go places rather than fighting
against them, turning potential hazards to my advantage, increasing confidence &
self efficacy. Using the elements and being in contact with nature as therapy.
īļ Sailing allowed me to use existing skills and develop new ones and go in all
different directions of my own choosing, an uncanny parallel with life.
īļ Benefits of new skills gave opportunities for matching skills and challenges,
sailing and boat maintenance, doing a boat delivery to Holland, sailing with a
disabled charity, winning first in class in Round the Island Race, completing AMPS
assessments on boats.
9. īļ Flower arranging with Cliveâs Mother, we have
the slot to remember his Grandfather in the Church
Flower Rotas
īļ Funeral Flowers
īļ Allowing for time to be structured, taking me out
of myself, doing things for others, increase in
confidence, practicing skills, creating aesthetically
colourful, control, connecting myself to others,
pleasure, relaxing, connecting with nature, local
community and wider world, exercise, photography
MEANING, PURPOSE,
CREATIVITY, RELAXATION
īļ Engaging with activities
and occupations enables
further engagement with
other activity ad
occupations
10. KAWA MODEL CONCEPTS
īļ Drift Wood âRyuboku Various attributes & resources of the individual
īļ Water â Mizu Depicts Life Flow
īļ Rocks â Iwa Negative circumstances blocking or slowing flow: can be permanent or
temporary; rocks and circumstances can be unique
īļ River Walls & Floor -Torimaki: Kawano sokuâheki & Kawano zoko Context social
and physical; includes a range of personal relationships with the living and non-living.
Have a great impact on flow in a collectivist social context.
īļ Spaces between obstructions â holistic occupational therapy occurs here including
meaning of the activity to self and community
11. MRS JEFFERIES KAWA
īļ BIRTH
īļ Phase 1 â Active, Independent
īļ Phase 2 â Married Life, IVF
īļ Phase 3 â IVF & Death of Husband, Grandma & Pet Cat
īļ Phase4 - Grief and Loss; Mental and Physical ill health
īļ Phase5 â Re-adjustment, Active, Independent
īļ END OF LIFE
12. īļ Overall Occupations in Daily Life - Routine
īļ 06:30 Wake up, Facial wash prompted by Mother gave me a routine for the
morning and a prompt to start the morning routine. Eat breakfast drink
īļ Start/continue with responsibilities after someone has died with assistance
īļ 12:00 Eat Lunch, drink
īļ Continue with death responsibilities
īļ Go to the shop, walk outside, hairdressers, flower arranging, gardening,
īļ 22:00 Watch film, Read, Stroke cat, Sleep
WATER-LIFE FLOW
13. īļ Hormone Levels
ROCKS - IWA
N E G A T I V E C I R C U M S TA N C E S B L O C K I N G L I F E F L O W
A N D C A U S E DY S F U N C T I O N / D I S A B I L I T Y
īļ Grief, death of one Cat
īļ Grief, death of Husband
īļ Grief, death of Grandma
īļ Pain Levels
īļ Dyslexia
īļ Asthma
īļ Anxiety
īļ Lives away from family
14. RIVER WALLS AND FLOOR
P H Y S I C A L & S O C I A L E N V I R O N M E N T
īļ Family, Friends, Neighbours, War
Veterans, Work Colleagues, mine &
Husbandâs
īļ Work, local community activities,
societies and associations
īļ Facebook friends
īļ Internet
īļ College of Occupational Therapists
īļ Sailing & Interest Clubs Nationally
īļ Home environments
īļ Boat in London and Isle of
Wight
īļ Cats
īļ Late Husband, Grandma
15. īļMonetary Resources, Ability to Work
īļStrength of Character & Personality, with
positive attitude, optimism
īļOccupational Therapist awareness of using
occupations and activity for health
īļBeing a woman
DRIFT WOOD
16. MRS JEFFERIES-RIVER DIAGRAM
īļ Anxiety
īļ Dyslexia
īļ Grief, death of Husband
īļ Asthma
īļ Pain Levels
īļ Hormone Levels
īļ Rocks
Walls & Floor
Family, Friends, Neighbours, War Veterans, Work
Colleagues, mine & Husbandâs
Work, local community activities, societies and
associations; Facebook friends; Internet;
College of Occupational Therapists; Sailing &
Interest Clubs Nationally; Home Environment,
Cat
Driftwood
Finances, Ability to Work,
Personality,
Occupational Therapy Skills
Water
Routine, Activities
of Daily Living,
Personal Care,
īļ Lives away from family
17. īļ Mrs Jefferies husband died suddenly, Grandma died within last year and Cat
īļ Grieving process needed to be supported; processing negative emotions
īļ Mrs Jefferies past experiences of anxiety led to Mother supporting how people are
going to react and setting expectations and encouraging Daughter to ask for help. Also
supported death responsibilities â Social, Emotional, Practical, Organisational
īļ Mrs Jefferies need for help to remain independent and maintain own home
environment. â PADLâs & ADLâs âneeded prompting
īļ Return to work on a very gradual basis, Activities daily, Learning a new activity
SPACES BETWEEN OBSTRUCTIONS
PROBLEM IDENTIFICATION
18. TREATMENT
SHORT TERM GOALS
īļ Develop abilities and implement organisational tools for supporting executive & working memory
īļ Coping with chaotic, fire fighting situation relating to finances, organising funeral, emotional aspects,
whilst developing a new routine for lifestyle
īļ Implementing Mindfulness and Flow for emotional regulation and processing
īļ Increase skill in autonomy , independence and well-being and confidence in own abilities to cope when
faced with adversity and maintain motivation
īļ Maintain social environment and financial security, making good decisions
īļ Build on success and positive experiences to counteract negative aspects of reactive depression and
anxiety by focus on occupational performance areas of tasks
19. TREATMENT
LONG TERM GOALS
īļ Maintain independence in own environment and learn strategies
īļ Increase confidence in own abilities, function and motivation
īļ Return to work within a sustainable environment for Mrs Jefferies
īļ Build resilience and develop identity and self efficacy to cope with grief and
mental health
īļ Lean a new skill to enable Mrs Jefferies to sail through grief, loss, change,
increase and maintain well-being and control
20. REFERENCES
īļ Bowlby, J. (1961). Processes of mourning. International Journal of
Psychoanalysis, 42, 317-339.
īļ College of Occupational Therapists (2010) Code of Ethics and Professional
Conduct, London
īļ Creek Jennifer (2010) The Core Concepts of Occupational Therapy: A
Dynamic Framework for Practice, Jessica Kindsley, London
īļ Iwana Michael K (2006) The Kawa Model: Culturally Relevant Occupational
Therapy, Churchill Livingstone, Elsevier