Sharing Politics

While trying to score a sensory profile in my 'office' Tuesday, I was distracted from the columns of numbers by a heated conversation from the adjoining treatment room. It involved 3 pt's and 1 therapist, arguing over the coming election, all in a seriously irrational manner. The "one issue voter," "crazy partisan voter," and "completely crazy voter" were all represented. And as I groaned audibly and closed the door, I was reminded of how against my beliefs of pt. care this situation really is.

It's a common social more in the US that religion and politics should not be discussed in polite company. While I don't think that these conversations should be totally off limits, it is something to tread carefully around. Coworkers often engage in brief conversations about these topics (possibly expanding as they work together longer) but people are usually careful to ease into these discussions so that they don't strain what is a comfortable working relationship. However, I believe that despite politics and religion being important parts of an individual's occupational profile, therapists should not discuss these topics with their clients. Here's why...


While people must make their own decisions about how much information to share on these topics with coworkers, they should be very cautious about what or any information is discussed with clients. No matter how often we try to empower our clients during the therapeutic process, we still often hear, "do what you think is best, you're the expert." This is not a relationship with equal footing. You, the therapist, are billing the client for the time that you are spending together. The client is agreeing to pay for your expertise to assist them in working toward their goals. They are not paying to be proselytized, and they should never be confused into feeling that is what they are getting for their money.

Part of OT is the universal respect you must hold for your client to enable them to "Live life to its fullest." If you are disparaging his political party's beliefs, will they really believe that you hold full respect for them? If you are constantly talking about your opinions and beliefs, will they feel defensive when their views differ from your own? Some might say that they only have these type of conversations with clients who are receptive, but do you yourself instantly come down on everyone who shares an unwanted opinion? It would be difficult to assess how receptive a person forced to sit through your therapy small-talk really is, and whether they are just trying to be polite, conclude their appointment, and go on with their life.

Full disclosure: I am very immersed into politics. I make a concerted effort for my pt's to feel free to discuss that interest, but not know in what way I will be voting. I was very concerned in making sure that they would be able to vote, despite being hospitalized, as that is a critical occupation for many. (sidenote- our Care Manager on the SNF floor directed all the efforts in that direction, getting absentee ballots and representatives from the various counties to appear and verify voters. It's very doable, make sure your residents maintain their rights) Even though I consider intrusive conversations about politics to be inappropriate, I have a way to discuss the topic with those who seem interested. If they are watching election coverage, I can ask them what's happening, what's interesting them. When they express a belief, I don't contradict it, even if it's not founded in fact. I can ask about their speculations, such as, "our state voted Republican both times for Bush and Democrat both times for Clinton. Which way will we vote this time?" This is nonpartisan and doesn't ask about their own views.

If you really needed convincing that you should tread lightly involving politics and patients, consider this in your conversations: how often is the person pushing their value statements on you, extolling the virtues of their candidate, and trying to convince you to vote similarly? How would you feel if they constantly were doing that instead of listening to your instructions or doing the work they needed to do to get better? And you would stop their conversation because it would be detrimental to their progress, and you, as the therapist and 'authority figure' are responsible for helping them achieve progress. Keep it in mind and keep your opinions in check as the election season winds down.

OT Webgems- Kids and Wellness

All the jet-setting this falls has left me with less time to update, but I have still been collecting interesting web articles to share. This edition focuses on some issues in children's wellness, like nutrition, fitness, and fun.

Portion Sizes- A short discussion on how children learn to fill their plates. I was always taught "you can come back for more," but that didn't stop me from overloading my plate, especially at times like thanksgiving.

Kids and Sports- A brief report of findings on a study about kids who participate in sports. There's some notes on how the kids felt about bodies, but one of the key findings was that children with disabilities and girls in general had less access to sports. There's always room to help with Special Olympics, Challenger baseball, and able-bodied sports teams. Get out there and volunteer!

First Year Survey- A sampling of findings about the typical first year of life in a US infant.

School Lunches- while this is too late to mesh with National School Lunch Week (who knew?) here is some info for parents on learning more about school lunches. The author does make mention of one of my personal favorites- flat square pizza.

Music w/o Pain- A few brief tips from an OT on preventing repetitive strain injuries in musicians, hopefully your local school still has a music program. I have a few handouts and other information on this topic from poster presenters at various conferences- check the link relating to the 2005 AOTA conference to see exactly what I had... hopefully it is still around somewhere.

That's it for now! Enjoy a fun-filled pre-Halloween week. I know I'll be looking for costumes when they go on sale so that I have some fun stuff to practice dressing with in the clinic.

New Toy!

Found a cool new toy at the bargain outlet today... "Monster Under My Bed." Kids (4+) stick their hands underneath to try to find out what gross objects are left under the bed... like rotting orange, dirty diaper, sticky sucker, hamster. Then you see if your object matches on your bingo card, trying to get 3 in a row. If you take too long, the monster under the bed will get aggravated and pop up to reclaim what's his!



I am looking forward to using this with the kids... I have several who working on basic hand use and finger prehension. I can see that the hand therapist may steal it away to work on stereognosis. And this could be quite nice for cotreats w/ speech therapy... work on prepositions, descriptive words, colors. Lots of fun ahead!

Of course, this doesn't mean you have to spend big bucks to have great therapy... my coworkers laughed at me for making a paper bag puppet during my lunch break, but it has been the favorite toy several times now with different kids. One of my teachers at the conference last weekend said that pediatric therapy was about being goofy and selling it to the kids that they were having fun... so either a novel toy or a simple one with a silly therapist will probably work well. :)

Frustration

I haven't been able to post lately due to different time constraints... finished a big long post on hip fracture but it won't post right, something is wrong with the "continue reading" link and it is way too large to appear uncut. Very frustrated by that.

short update- went to my state association conference over the weekend, got to visit w/ some OT buddies and my teachers. Got a few bugs in my ear from the weekend... things to make our SNF better, ICU treatments, a recharge on advocacy, thoughts on early intervention. Also got an update on the status of my research paper. All these seeds and ideas... so diverse. I started listing the logical conclusion of these paths and there are 4 very different end paths, and probably no more than 2 can be carried out. I will probably start taking little steps into these different directions and see how far I can go before I have to give one up, by which time I hope to have more concrete direction in my life.

I am getting caught up on my OT reading... I am down to only 3 OT Practice magazines and 1 AJOT (to scan) on my reading list. Spent the afternoon watching "Observations Based on Sensory Integration Theory" and had quite a sense of deja vu... I may have seen (slept through?) this in peds class 2 years ago. Obviously my mind wasn't ready the first time around. But this time, at least, I saw where these simple motor activities could fit into an extended eval to get a better idea of sensory processing. Of course, the observations in the video are narrated by an SI expert... if she could arrange to narrate the evaluations in my clinic to continually guide me, that would be even better than my in head thinking of "ok... write it down and figure it out later."

Although I have had moments where I feel like I was much smarter about OT right before I graduated than now, I know that I have more confidence in what I do and a better handle on all my OT responsibilities (especially evals). I can't stay current on all the knowledge I had, even though different topics interest me a lot, since I don't use it all everyday. I am trying to feel better about the level of OT stuff that I know, as I have been responsible for job-shadow students all fall, and now have been practicing long enough to take a student. 66% of my official supervisors were new practitioners, and now that I am that professional age, I wonder if I could handle the responsibility of shaping another practitioner. I guess I am aware of the things that I don't know... which is why I really wish I had a mentor (both for rehab and peds!). That's also part of the reasoning for trying to stay up on reading, so that I don't fall behind while in veritable isolation.

quotes of the day

3.5 y.o. child w/ SPD (who rarely talks) is distracted by the stinkbugs in the clinic room.

"Goodness gracious! Look at the buggies!"
followed by...
"If my dad was here, we'd open up a can of whup-ass on those stinkbugs!"

They continue to surprise and exhaust me...

seesaw

There is such a seesaw pattern in much of life, but in this job in particular. We have busy days, slow days, few kids, many kids. Ups and downs and all arounds.

We have a speech therapist now, which is excellent. I look forward to not being responsible for all the communication boards needed in the hospital, and to getting my kiddos the treatment they have been waiting for.

The insanely busy SNF floor and acute care floors have calmed down a bit, at least for a few days. Nice to have less on my plate for the mornings since they are short and the evenings are long with kids. The elderly lady w/ thalamic stroke from this post has now landed down my hallway... she is doing considerably worse since acute care, sadly. We played cards today and I was happy that she had moments of understanding and initiating action on her own.

Laid down a VERY hard line with a pt. the other day... he has been quite uncooperative since his arrival and keeps insisting that he's independent or will be independent soon without assist. 2 weeks ago I needed to reevaluate how close he was to meeting his goals and needed to see him don shirt and pants on a Friday afternoon. "I don't need to do that, I'll do that when I go home." I basically said, "prove it." We stood w/ MAX Ax2 for 3 seconds, which was not enough time for him to pull his pants up, but was (I thought), enough time for him to realize that he needed to work on ADL tasks. Gave him a brief talk about how he needed to keep working... it didn't take. He made the COTA cry when she was trying to work with him. So, when I came back to that little mess, I said, "Mr. B, you made the other girl very upset, and I have to tell you that she's the nicest person on staff. Now you're stuck with me. You can pick which chair you sit in and where it is in the room, you can pick out which pair of pants you're wearing, but you will sit up and get dressed, and you will not get rid of me until that is done." His son was skeptical, but proud that his dad was able to do so much for himself. Saw him again today and he had a much better attitude about the whole thing, and is now a CGA w/ LE dressing.

New kid eval tomorrow... tried to do a Peabody on my fresh eval from last week and he was a total terror today. His mom about cried when I gave her the report on his behavior. She has some majorly off-base assumptions about his development as well, thought that his FMC was at normal developing range and reported that he "graduated" from speech therapy. I suspect that he "graduated" because he ran out of visits under medicaid, b/c his main statements of "I tell mom" and "you not my friend no more" were not age appropriate. He has sensory and behavioral issues (always a combo) and he will be a considerable challenge.

Get to go w/ my PT coworker to a Civitan Club meeting to explain our grant request for some new equipment and supplies. Fingers crossed for support in an expedited fashion!

Busy busy busy

been running around a lot lately... 2 weekends traveling in a row coming up, busy census at the hospital, and 6 OT practice magazines just piling up on my reading list. I also have to prep for girl scouts since I have another kid eval and will miss the meeting. I will update again... someday!

brief update note

Some updates...
After a long fought afternoon, I finally managed to get the cut links to work so I can shorten posts. The 6 subscribers from google reader will still have to deal w/ walls of text, but the rest of you got life a little easier. I don't think that I'm going to go and retro-edit the other posts, they'll be off the main page in a few weeks anyway.

Also, I think I am going to start uploading things to google documents for file sharing, since it doesn't require an account and there hasn't been any outcry from the OT Advantage community begging for files over there. (Yes, I recognize google's domination over my internet life, and I'm ok with that)

Now I just wish there was a way to make it so that when you clicked on the tag link (like "students") that it would show you the titles of the posts instead of all the relevant posts. I am somewhat of an organization freak. A free internet cookie to the one who figures out how to do that, and writes it in a way I can understand.

Case Example with Goals

A review of "recent keyword activity" leading to the blog indicates that there's a lot of people out there looking for example goals and treatments for different diagnoses. I'll try to do some posts in this direction, please don't plagiarize them for your school assignments.

Here's a walkthrough case to see the clinical reasoning behind the goals that are written, and a few example goals.


CASE: Mr. X is a 65 y.o. s/p THR on the acute orthopedic floor. He lives alone, has a tub/shower, and was previously independent with all I/ADLs. He would like to return to full independence.

SETTING BACKGROUND: Heads up- in an acute hospital, your basic joint replacement patients w/o significant comorbidities or post-op complications will leave the floor in 3-5 days. Case management will look to therapy to determine where this person will go (home, SNF, acute rehab). The lack of time for intervention means that your treatments need to cut to the point, so you can give an accurate expectation of how the client will perform in the continuing days, and whether they must have continuing care.

IMPORTANCE: Goals at this level of care have to reflect the quick pt. turnover. What are the most important things for Mr. X to learn and demonstrate before he discharges to maximize his safety and independence?

My ranking: hip precautions; basic mobility; LE dressing; advanced mobility (tub transfer, standing tolerance); home safety. Your clinical reasoning may place importance in a different order, here is my reasoning. He must know hip precautions before moving, to prevent dislocation and repeat surgery. He must be able to stand and take at least 1-2 steps so that at the very least he can get from w/c to BSC, and to facilitate dressing. We have no evidence from our brief case that this man would have any difficulty w/ UE dressing, but he cannot be independent unless ADL retraining is performed for LE dressing. He needs to be able to put on pants and shoes, or he is not going to have anything resembling independence upon discharge. At the point that he can stand up long enough to put pants on, he is probably ready to progress to advanced mobility, and I consider tub transfers to be especially important. It's better to review this in a controlled environment before the pt. goes home and decides to do it anyway. And home safety is always a good thing to work on with your patient, to try to prevent falls and maximize independence. If you, like me, do not get to leave the hospital to investigate the home, you will have to get creative with this.

GOALS
In 3-5 visits, pt. will...
1. verbalize and demo 3/3 hip precautions (we are assuming he doesn't have the extra 'no active abduction' precaution)
2. transfer to BSC w/ CGA and assistive device
3. don socks w/ sock aid independently
4. don pants w/ AE prn and CGA (I almost always use the "AE prn" phrasing since different devices work better for different people, and I have actually seen a person don pants independently w/o any device while observing hip precautions)
5. perform safe tub transfer to extended TTB w/ CGAx1
6. verbalize/demo 3-5 home safety techniques



The best way to get better at writing goals and treatment plans is to practice and get feedback from a trusted advisor- professor, supervisor, etc. The best exercise I know for this is detailed in this simple document. I have not completed an example there as this was an assignment from one of my teachers, and surely others are using it as well.

notes from the listserv

As an AOTA member, I subscribe to a couple of special interest listservs in an effort to get smarter semi-randomly. Yet, I often want to unsubscribe for one of two reasons:

1. Failure to observe internet/listserv etiquette. Perhaps I'm a spoiled person, having had internet access since I was 10, but there are some basic rules that people should observe online when their words come into my sphere. Please!!! Don't type in caps! Use a subject in your emails! Send a direct reply to the sender if your message does not contribute to the entire discussion (e.g. "thanks" or "can you send that to me too?").

2. OT Trolls. Yes, they exist. They seize on an opportunity to argue, in detail, about whether Person A is doing OT, what the difference between OT and PT is, whether the original poster was being a good OT or not... ad nauseum. I've wondered about suggesting that a new listserv be created just so that people can keep their biased partisan arguments about OT ("OT's can't walk people! That's PT!" vs "It's better to walk them than to do a stupid craft or game!") somewhere else. Perhaps I wouldn't be so irritated about this fight about the OT domain if we didn't have a practice framework that detailed an outline for therapy, or if this exact same fight didn't already happen a few months ago when the last RA motions were up for debate, or if it didn't all look suspiciously like one person stirring the pot in an effort to get more attention to their website and ideas.

An open call to stop this foolhardy "debate" if you can call it that. Functional mobility is part of the OT practice act. Enabling and Prepartory activities are part of our treatment framework. Crafts and games are at the foundation of the profession from the Reconstruction Aides. All of the arguers are right. And wrong, because limiting your practice to only one of these areas is not OT either. OT is a beautiful profession because at its core is the belief that engagement in meaningful occupation will promote health. Don't limit yourself as a practitioner, or you will limit us all, and our clients.