The Royal Brompton Hospital
Occupational Therapy Student
Handbook
(A Survival Guide to Completing Your Placement!)
Created by:
Alice Coutinho & Michelle Redler
Contributors:
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Table of Contents
The Hospital
Directions and Map
Uniform Policy
Working Hours
Supervision
Facilities
Hospital Departments and Teams (including OT team structure)
Background Knowledge
OT Theory
Anatomy and Physiology
Cardio-Respiratory Conditions
Surgeries & Interventions
Common Cardio-Respiratory Abbreviations
Working with Patients
OT Process: Assessment, Intervention and Evaluation
Documentation
International Students
The NHS
Visas and CV’s
Health Clearance and Occupational Health
Accommodation
In and Around London
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The Hospital
DIRECTIONS AND MAP
PUBLIC TRANSPORT
Tube: The hospital is a five-to-ten minute walk from South Kensington
tube station, on the District, Circle and Piccadilly lines. Transport for
London (TFL) provides an online PDF map detailing routes for the
hospital. The website also has a ‘journey planner’ function.
Buses: Buses serving the hospital are listed below.
Numbers 14, 211, 345 and 414 stop outside the Fulham wing on
Fulham Road.
Numbers 49 and 211 stop in Sydney Street.
Numbers 11, 19, 22, 211, 49 and 319 serve the King's Road.
Cycling: There are bike racks at several locations around Royal
Brompton. The Trust also provides cycle loans for staff.
Motorcycle: Motorbike parking is free at Royal Brompton, providing
your bike is registered on the car parking database. To register contact
Lisa Jenkins on extension 2266.
COMING IN BY CAR
Liftshare: Staff can join a car sharing scheme involving our hospitals and
the Royal Marsden. The online service will try to match your details with
those of a colleague so you can share your trips to and from work or
between sites. Read more on the liftshare scheme on the intranet.
Staff parking: There is only very limited parking for staff at the Brompton
site. Local street or off-street parking is expensive.
Congestion charge: Royal Brompton Hospital is within the London
congestion charge zone. The charge is £8 per day for vehicles entering
the zone and applies between 7am to 6pm Monday to Friday, excluding
bank holidays and the days between Christmas and New Year.
In certain cases NHS employees are exempt from the charge when it is
incurred in the course of their work. Read more about the charge and
exemptions.
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UNIFORM POLICY
OCCUPATIONAL THERAPY UNIFORM
The basic uniform of white tunic and bottle green trousers should be
worn. Please note international students should contact their educator if
they do not have their own uniform.
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Jewellery
Rings – No rings shall be worn apart from a wedding ring or single
plain band. Engagement rings should be removed for patient
contact. Multiple other rings are not permitted.
Earrings – These should be small and suitable.
Nose stud – One small nose stud is permitted for those with a
piercing.
Necklaces – A discreet chain is permitted but no other neck
jewellery.
Wrist jewellery is not acceptable.
Watch – No watches shall be worn during patient treatment.
Footwear – Closed shoes should be worn with preferably colour
black. Black trainers may be worn (not fashion trainers). Standard
(white) trainers are not permitted.
Socks – Predominantly dark colour /black socks are allowed but
need to be plain.
2.
Perfume/makeup
This should be minimal.
3.
Jumpers/Cardigan
A bottle green cardigan or suitable jumper is permitted but shall
not be worn on any of the wards or during patient treatments.
4.
Hair
Long hair should be tied up.
5.
Name badge/CSP Badge
Name badge and Security badge should be worn at all times during
working hours.
6.
Nails
No nail varnish is permitted. Nail length should be suitable for
patient treatments.
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7.
Travelling
Travelling or being in public places with your uniform visible is
not permitted. Occupational Therapists at Royal Brompton may be
required to conduct Home assessments in the community from time
to time. When at a client site name badge identifying the
Occupational Therapist should be available to be shown at all
times.
WORKING HOURS
Working hours are 8:30am- 4:45 pm, lunch from 12:15pm- 1:00pm.
All activities during working hours are recorded on the statistical program
OTTERS. Training will be provided during first week of placement.
SUPERVISION
All students will be allocated an ‘educator’ who will provide supervision
and guidance for the duration of their placement. Students will have
weekly supervision sessions with their educator, lasting for
approximately one hour. Supervision will include clinical discussion and
reflection plus discussion of the student’s weekly/ placement objectives.
FACILITIES
Library
Two canteens plus tuck shop
Small shop on-site
Cash machines on-site
Changing area
The Hospital
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HOSPITAL DEPARTMENTS AND TEAMS
Below is a sample of some of the other clinical departments you will find
at the hospital:
 Nutrition and dietetics
 Pharmacy
 Physiotherapy
 Nursing
 Social services
 Social work
 Speech and language therapy
 Psychology
OT DEPARTMENT STRUCTURE
Band 8a- Occupational Therapy Service Lead
1 Band 7 OT
2 Band 6 OTs- internal rotation
1 Band 5 OT- external rotation with St. Mary’s Hospital, Paddington
2 Band 3 Rehabilitation Assistants
1 Band 5 Oxygen Technician
OT Services to Cardiac Surgery Patients
For patients on the cardiac surgery wards, the majority will have had
either coronary artery bypass grafts (CABG) or valve surgery of the
mitral or aortic valve, or tricuspid valve.
Occupational Therapy offers education and advice at pre-surgery days
and as a part of a weekly programme on Princess Alexandra Ward at
Royal Brompton Hospital on resuming everyday activities following
cardiac surgery. This includes advice on:
• Returning to driving
• Returning to work
• Holidays
• Resuming sexual activity
• Stress management
• Managing emotions
Referrals may also be received for individual patients to be seen by
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Occupational Therapy for specific assessment in regard to:
• Discharge from hospital
• Management of everyday activities after surgery
• Stress management advice
OT services to Cardiology patients
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Assessment of daily activities and provision of advice on how best
to continue with these.
Provision of rehabilitation to facilitate hospital discharge.
Standardised and non-standardised cognitive assessments.
Provision of small aids and equipment.
Referrals and liaison with community and hospital services for
rehabilitation and discharge planning.
Home and access visits as appropriate.
Wheelchair loan (inpatient and outpatient).
Education including:
o lifestyle management
o energy conservation
o stress management and relaxation
Improve hand function:
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Assessment of hand function.
Provision of exercises and advice.
Equipment recommendations to improve hand function in day to
day activities.
Splinting.
Positioning while in hospital:
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Assessment for appropriate seating. Including Specialist seating
needs. Conducted jointly with Physiotherapy.
Advice on positioning in bed and in a chair.
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OT Services to Respiratory patients
Outpatients:
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Education including:
o lifestyle management
o energy conservation
o stress management and relaxation
Pulmonary Rehabilitation
Inpatients
Occupational Therapy aims to promote independence in managing daily
activities.
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Assessment of daily activities and provision of advice on how best
to continue with these.
Provision of rehabilitation to facilitate hospital discharge.
Standardised and non-standardised cognitive assessments.
Provision of small aids and equipment.
Referrals and liaison with community and hospital services for
rehabilitation and discharge planning.
Home and access visits as appropriate.
Wheelchair loan (inpatient and outpatient).
Education including:
o lifestyle management
o energy conservation
o stress management and relaxation
Improve hand function:
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Assessment of hand function.
Provision of exercises and advice.
Equipment recommendations to improve hand function in day to
day activities.
Splinting.
Positioning while in hospital:
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Assessment for appropriate seating. Including Specialist seating
needs.
Advice on positioning in bed and in a chair.
Pressure relief cushion provision.
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REFERRALS
Patients are referred to Occupational Therapy according to the
standards of referral and seen according to the priority given. These are
available in the Occupational Therapy Department.
WARDS
Cardiac patients are seen at Royal Brompton Hospital on 2
cardiology wards (York and Paul Wood), 2 cardiac surgery wards
(Princess Alexandra and Elizabeth), a private ward (Sir Reginald Wilson)
and on Adult Intensive Care (AICU). Each ward has some high
dependency beds, Princess Alexandra and Elizabeth have 5 beds, York 4
beds and Paul Wood 1 bed. Paul Wood ward has dedicated bed space for
Adult Congenital heart patients.
Respiratory inpatients are seen at Royal Brompton Hospital on 2
inpatient wards (Victoria and Foulis), a day patients ward (Lind).
Pulmonary rehabilitation patients attend a gym on-site on Victoria ward
and an off-site gym, nearby at Imperial College.
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Background Knowledge
OT THEORY
Please note, these are suggestions – other theoretical frameworks can also
be applied to the setting.
1) Frames of reference
 Biomechanical
 Compensatory
 Rehabilitative
 Learning
 Educative
 Cognitive behavioural
2) Models
 Person-Environment-Occupation Model (Law et al 1996)
 Model of Human Occupation (MOHO) (Kielhofner 2002)
 Canadian Model of Occupational Performance (CMOP)
(Townsend et al 2002)
 Adaptation through Occupation Model (Reed and Sanderson 1992)
ANATOMY AND PHYSIOLOGY
Revise the following in preparation for Cardiology and Respiratory
Placements:
1) Structures and functions of the heart
2) Systemic and Coronary Circulatory Systems
3) The Electrical Conductivity of the Heart - The Cardiac Cycle
4) Structures and functions of the Thorax
5) Process of Gaseous Exchange
6) Pulmonary Circulatory System
7) Anatomy and Physiology of Neurological System (Brain,
Transmission of impulses, Upper and Lower Motor Neurons)
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CARDIAC CONDITIONS
It will be helpful to be familiar with the following Cardiac and
Respiratory Conditions:
1) Heart Failure
2) Congenital Heart Disease
3) Coronary Heart Disease
4) Myocardial Infarction
5) Angina
6) Myocarditis / Endocarditis
8) Cerebral Vascular Accident (CVA)
RESPIRATORY CONDITIONS
1) Chronic Obstructive Pulmonary Disorder (COPD)
2) Emphysema
3) Bronchitis
4) Asthma
5) Interstitial Lung Disease
6) Bronchiectasis
7) Sarcoidosis
8) Scoliosis
9) Cystic Fibrosis
10) Type I and II Respiratory Failure
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SURGERIES AND INTERVENTIONS
It will be helpful to be familiar with the following Cardiac and
Respiratory Surgeries and Interventions:
1) Coronary Artery Bypass Graft
2) Valve Replacement Surgery
3) Ablation therapy / Cardioversion
4) Cardiac Resynchronisation Therapy (CRT)
USEFUL CARDIO-RESPIRATORY ABBREVIATIONS
(This list includes abbreviations we have come across so far, future
students should add to this list)
CPAP- Continuous positive airway pressure
ACBT- Active cycle of breathing techniques
MVR- Mitral Valve Replacement
AVR- Aortic Valve ReplacementSpO2- Saturation percentage of Oxygen
TOE- TOE
ECHO- Echocardiogram
OSA- Sleep Apnoea
SOB- Shortness of Breath
TAVI- Trans-catheter aortic valve replacement
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Working with Patients
THE OT PROCESS
1) ASSESSMENT
Cardiology/Cardiac Surgery:
 Initial Interview
 Transfer and Mobility Assessment
 Self-care Assessment
 Meal Preparation Assessment
 Home Visits if necessary
Respiratory:
Inpatients (similar to cardiology)
 Initial Interview
 Functional Assessments: e.g. Transfer and Mobility;
Bathing; Dressing; Meal Preparation
Outpatients (for Pulmonary Rehabilitation)
 Initial Interview
 Blood pressure, heart rate, oxygen saturation, spirometry
(conducted by physiotherapists), height, weight, body mass index,
fat free mass
 Incremental and endurance shuttle walk tests
 Questionnaires: St George’s Respiratory Questionnaire (SGRQ);
Hospital Anxiety and Depression Scale (HAD); Lung Information
Needs Questionnaire (LINQ); COPD Assessment Test (CAT); OT
department’s own functional ADL questionnaire
2) INTERVENTION
Cardiology/Cardiac Surgery:
 Functional ADL practise e.g. Transfer and Mobility;
Bathing; Dressing; Meal Preparation
 Equipment provision (e.g. to aid self care/ domestic ADL)
 Education (energy conservation, stress management,
relaxation)
 Referrals to community/ social services OT
 Advice/ consultation with patient/ carers/ MDT
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Respiratory:
Inpatients
 Functional ADL practise e.g. Transfer and Mobility;
Bathing; Dressing; Meal Preparation
 Equipment provision (e.g. to aid self care/ domestic ADL)
 Education (energy conservation, stress management,
relaxation)
 Referrals to community/ social services OT
 Advice/ consultation with patient/ carers/ MDT
Outpatients (for Pulmonary Rehabilitation)
 16 exercise sessions
 Education sessions: Energy Conservation*, Stress
Management*, Relaxation*, Diet, Assistive Cycle Breathing
Technique (ACBT), Inhalers, Home exercise, Anatomy and
Physiology, Medical Management, Coping with Lung
Disease, Welfare and Benefits, Benefits of Exercise, Future
Exercises, Oxygen and Ventilation, Smoking.
* particularly relevant to OT
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DOCUMENTATION
Documentation Format:
 SOAP notes (Subjective, Objective, Analysis, Plan)
The following reports are found on the InfoFlex software program
(training to be provided during first 2 weeks of placement):
 Functional Assessment Report
 Transfer Report
 Home Visit Report
 Discharge Summary Report
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International Students
THE NHS
The National Health Service or NHS is the publicly-funded
healthcare system in the UK (though the term is also used to refer to three
of the four national health services in the UK, collectively). The NHS
provides healthcare to anyone normally resident in the United Kingdom
with most services free at the point of use for the patient, though there are
charges associated with eye tests, dental care, prescriptions, and many
aspects of personal care.
The NHS provides the majority of healthcare in England, including
primary care, in-patient care, long-term healthcare, ophthalmology and
dentistry. The National Health Service Act 1946 came into effect on 5
July 1948. Private health care has continued parallel to the NHS, paid for
largely by private insurance.
The NHS is largely funded from general taxation. The UK
government department responsible for the NHS is the Department of
Health, headed by the Secretary of State for Health.
The NHS states the following as core principles of the health
service:
 That it meet the needs of everyone
 That it be free at the point of delivery
 That it be based on clinical need, not ability to pay
For more information, visit www.nhs.uk
VISAS AND CV’s
Visa
 Required for international student to work at the Royal
Brompton
 Visit the UK Border Agency website at
http://www.ukvisas.gov.uk/en/
 The ‘Youth Mobility Visa’ under Tier 5 Immigration
Applications will suit most international students
 Students may need to arrange travel to their nearest Visa
issuing office
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CV
 Updated CV must shown to the Royal Brompton’s Human
Resources Department on your first day.
HEALTH CLEARANCE AND OCCUPATIONAL HEALTH
Pre-Clearance Health Form
 Must be completed and emailed/faxed to the Royal
Brompton’s Occupational Health Department prior to
arrival.
 Ensure all regular vaccinations are up-to-date.
 YOU WILL NOT BE ABLE TO START YOUR
PLACEMENT WITHOUT CLEARANCE FROM
OCCUPATIONAL HEALTH.
Occupational Health
 Upon arrival the Royal Brompton’s Occupational health
Department will double-check your vaccinations with blood
tests.
 You will need to an Occupational health appointment during
the first week of placement.
ACCOMMODATION
The Royal Brompton has accommodation associated with the hospital
available for patient relatives or visitors, within five minutes’ walk of the
hospital buildings on South Parade.
Charges (As correct Jan 2010)
Charges are per room per night, including VAT are:
Double room (for two people) - £47.00
Single room (for one person) - £32.00
Reservations
We do ask that you make a reservation as accommodation facilities are
limited and demand is high. However we are sometimes able to deal with
accommodation requests at short notice and are usually able to find
accommodation for relatives in cases of an emergency admission.
Accommodation office: 020 7351 8044 (Monday to Friday 8am to 6pm)
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Facilities
Welcome tea and coffee
Welcome toiletry pack
Laundry room
Shared bathroom and kitchen
Reception opening hours
The accommodation reception is located on South Parade. Please go to
the Fulham wing reception and ask for directions. We are open Monday
to Friday 8am to 6pm.
Terms and conditions of stay can be found at
http://www.rbht.nhs.uk/patients/brompton/visitors/accommodation/
*If the Royal Brompton Accommodation does not meet your
needs, other short-term accommodation for international students can be
found on these websites:
www.gumtree.com
www.central-london-serviced-apartment.com
www.bookapartmentsinlondon.co.uk
www.londonservicedapartments.co.uk/
www.craigslist.com
IN AND AROUND LONDON
London is full of exciting things to do. The following list is not extensive
but may be regarded as some suggestions for new visitors:
 West End Theatre District (discount theatre tickets at TKTS booth
in Leceister Square)
 The British Museum
 The Victoria & Albert Museum
 The Science Museum
 The Natural History Museum
 The National Gallery
 The National Portrait Gallery
 The Tate Britain and The Tate Modern
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Houses of Parliament & Big Ben
Westminister Abbey
St. Paul’s Cathedral
Oxford Street, Regent Street and Bond Street Shopping
Hyde Park
Regent’s Park
Buckingham Palace
The London Eye
The countryside and seaside around London is beautiful, so don’t forget
to get on a train and get out!!
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REFERENCES
Kielhofner G (2002): Model of Human Occupation (3rd ed).
Philadelphia: Lippincott, Williams and Wilkins.
Law M et al (1996): The person-environmentoccupation model. A
transactive approach to occupational performance. Canadian Journal of
Occupational Therapy, 63, 9-23.
Reed KL, Sanderson SN (1999): Concepts of Occupational Therapy. (4th
ed). Philadelphia: Lippincott, Williams and Wilkins.
Websites
RBH website: http://www.rbht.nhs.uk/
RBH Occupational Therapy website:
http://www.rbht.nhs.uk/healthprofessionals/clinicaldepts/rehabilitation/ot/?locale=en
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