The more things change...

So I have been working tonight on an entry about the indecision I have right now about the future and the convoluted OT path I have taken up to now. At one point, it started to seem familiar. I felt as if I had quoted Thomas Merton before, and it turns out, I have, 3 years ago when I was equally wondering what the heck I was going to do with my life. Oh goodness... that's a sign it's time to stop thinking for a little while. :) Sudoku here I come!


Don't forget- World OT Day!

October 27 is World OT Day! Sponsored by WFOT (now on Facebook), it's a great day to proudly raise awareness about the profession. I would rock my Super OT shirt, but I have formal meetings, so I'll wear inner-OT-awesomeness instead. :)

This is the sophomore year for the OT Virtual Exchange and they have once again put together a powerhouse group of speakers for a 24 hour time frame. There is a theme of "Pay It Forward," so you should enjoy the quality talks for free and then share your OT knowledge out in the world as well! Check out the schedule here, and be prepared to tweet using the tag #ot24vx.

Linda from the great blog Daily Living Skills is also running a blog carnival to celebrate! It's been way too long since we had an OT blog carnival, I'm excited to see the entries, and I hope we can keep the energy going.


Our OT Identity

In celebration of World OT Day, we are discussing the Global Identity of Occupational Therapy. It's an interesting topic since there has been a lot of discussion about our national OT identity with the approaching Centennial. I think the best thing that I can share for this topic is my summary of two of the best AOTA sessions from the 2011 conference (and maybe from ever).

Last spring, there were two talks that best fit with the presidential address and stood out as completely awesome. One was "OT Survivor: Protecting Your Turf in a Competitive Healthcare Market" by Pam Toto and the other was "Practicing Authentic OT: Strategies for Becoming a Reflective and Reflexive Practitioner" by Debbie Amini. These ladies are both well recognized in the field. Energy was definitely palpable in both rooms, and I even got to meet (again) Suzanne Peloquin during one session. (If a Slagle lecturer shows up in your room- you know the topic is superb!) By discussing what was reviewed in these sessions, I think we can get great input into our OT Identity.

"What is occupational therapy?"

How often do we hear those words?! Yet Toto points out that each OT area has its own definition. What I do on a daily basis in the school system is nothing like what I used to do in the hospital and that would look nothing like the life of a hand therapist. Even within the hospital, my practice could vary widely from the NICU to the Neuro ICU to the orthopedic floor and so on ad nauseum. Toto said this was like blind men describing an elephant- we tend to describe our practice in a reductionist way of what we regularly do, sometimes missing the big picture of OT. This can lead to confusion from consumers, referrers, and payors. Amini points out that if we want to achieve the Centennial Vision goal of a consistent recognizable image, we much EACH take it as a personal responsibility. The "Authentic" version of OT is client centered and occupation based, with occupation as both an outcome and a treatment. Amini pointed out that this is often an espoused belief of practitioners, but not necessarily an enacted one.

A person may not even realize that they aren't enacting their beliefs until there is an additional level of reflection involved. Amini described reflection as thinking and critically examining yourself, skills, and practice. Reflexive practice takes reflection further by then comparing reflected behavior to espoused beliefs, determine any incongruence, and then act to change the behavior or the belief. This process can be done by personal journaling, mentoring, using the AOTA professional development tool, creating a portfolio, or joining a community of practice. Toto states that one of the best ways to advocate for OT is to practice consistency in areas you address, services provided, assessments and intervention approaches. In doing so, you create an image that others will remember and identify as occupational therapy.

There are perceived challenges to authentic and reflective practice. Amini includes corporate policies, reimbursement, productivity, supply cost, time, and decreased support from peers or supervisors. Toto described threats to our practice: complacency in our documentation (failing to specify our unique practice), viewing OT as a job instead of a career, moving from ADLs to preparatory/adjunctive treatments, accepting the status quo (including that laid down by the boss), and allowing any other service to be a "gatekeeper" to OT. Don't allow other professions to represent you. If your services are special and unique, NO ONE can say OT isn't needed! Remember that documentation is important. It's hard to remember that when you're writing 6 evals a day and don't think they're ever read. But think back to being in school when you learned about how each note was a legal document, the only proof of what really happened with a client. Toto discussed that it is important to use our practice framework language and reference evidence in our documentation. The most skilled part of a person's OT session may not have been the hands-on portion, but the clinical reasoning and decision making you engaged in. And speaking of clinical reasoning- don't short sell our value by saying that it's just "common sense!"

Toto discussed at length the importance of advocacy for OT. We're great at being advocates for our clients to get the best care, but more reluctant to stand up for ourselves. There are a limited number of healthcare dollars, and other groups would love to take our share. We can't be timid and "nice." As Dr. Clark said in her presidential address, if you let others take OT for granted, "it's not playing nice, it's playing dead!" Remember, there is no mysterious "they" who will advocate for you. AOTA and your state association may be able to take action on a government level to defend OT, but without your membership, they are hard pressed to do so. And they certainly won't be coming to all your referrers and coworkers and asserting the OT scope of practice. That falls to each of us. Amini reminds us (especially those AOTA members) to use the official documents as leverage during advocacy efforts.

Toto described that there are two ways to make light- you can be the candle or the mirror. When your client is successful, they need to understand who you were, what you did, and how your intervention has impacted their occupations and participation in life. Discuss and hand out goals. Hand out a business card. Make sure that you identify yourself as an Occupational Therapist and not just an OT or OTA. Have several elevator pitches for different audiences that include evidence. Most importantly, let everyone know the good that you do, so that others may receive your awesome authentic services.

I hope you find these points useful for your daily practice. The field of Occupational Therapy and our consumers will definitely benefit from authentic practitioners. Let's all strive for that in the coming week.


Dycem Product Review

The good folks over at Dycem were kind enough to send me some free samples in exchange for a review. Click through to read (and win a prize!)

Dycem products have expanded since I was in school, learning about their use. They have even made a special section on their website just for OTs. I got a few products and started trying them out in my practice and handing them out to others.

I was a little confused by the mat that had a peel off on both sides. I am 80% sure that it was just like that for easy distribution and cleanliness, not to be adhesive. (There are adhesive strips/mats as well) I tossed one of these in my utensil drawer, because the force from me closing the drawer kept knocking the silverware tray back into the depths. I put it in a few weeks ago, and despite me purposefully slamming the drawer, the tray does not move. The silverware itself keeps trying to run away, but I digress. We will also use some for either the drawer holding baggies or for where the wine glasses are.

One of the rifton chairs at school has a piece of Dycem on the seat to help keep the child from sliding. This does work, but you have to be very conscious that you are positioning the child properly and with a good pelvic tilt since it will be hard for them to readjust themselves.

I like the coaster a lot. It doesn't slide on the surface and the glass doesn't slide either. The downside is that it cannot absorb any liquid, so the glass will get pretty drippy if you have a lot of condensation. I tried to use this in the car to hold my phone (illegally) on the dashboard, but it couldn't quite hold the phone during the turns.

The pediatric mats are quite cute. However, the shape cutouts can make it difficult to get the absolute best fit for the object getting stabilized. I have used the Turtle while in the schools, stabilizing slant boards, the Ipad, blocks etc while on the wheelchair tray or tabletop. The kids seem to like it, but it can be a little distracting. I sent the hippo to my grandma because her little fat dachshund dog is so eager to get her daily food portions that she attacks them and pushes them under the toe kick for the kitchen cabinets. This is annoying for my grandma, who really shouldn't be bending over and digging under the cabinet or all across the floor for these bowls. She swapped the old mat for the dycem one and has not had a problem with the bowls moving at all. I got a text message ("from the dog") that reads- "Dear Cheryl, I like my new mat. I don't have 2 chase my food dish. It is easy for my maid 2 pick up and clean. It doesn't take up as much space. Thank u for thinking of me. love, Annie"
The jar and bottle openers are my favorites by far. The jar opener has worked on everything I could try, and my elderly patients have always liked it. It is listed at $12.75, but really high quality. It is much better than the rubber or silicone trivets/openers I've tried before. The bottle opener is a little redundant, but lets me open my adult beverages without assistance.

Keep in mind, when using any of these products, your results are much better if the surface and the product are both clean and dry. I have to keep the portable mats in boxes so that they can be transported without getting nasty. It just takes soap and water to clean. I tried to use the placemat "off label" as a trivet. I wouldn't recommend it for that. It's better than a towel, but does still transfer the heat as time goes on. I actually checked the specs and material is supposed to be OK up to 50*C, but I like my silicone trivets better for this purpose.

Things I didn't try:
- On the website, you can see small furniture disks to keep chairs from slipping. I would be interested to know whether this provides enough stabilization to someone who is really pushing back hard on the chair (like a person with Parkinson's). I suspect it would depend on the angle of the push- might be ok for a person who pushes straight backward, but most are at an angle that causes the chair to tip back.
- Also on the website, they have a picture of a sheet of Dycem on a hospital bed presumably to keep a person from sliding down the bed. Would this really work? Soft surface of sheet plus either soft hospital gown or skin? I don't know that I would try it.
- I didn't have one of those mats to try out with sit-stand transfers. It would probably work with some, but the ability to adjust the person's feet is sometimes needed. Could still be useful.

If it were me, I would expand the product features in a few ways. I think the openers and the coaster could be more accessible if there was a magnet or clip to attach to the fridge or cabinet drawer. The jar opener could probably be made into a ring only and attached to a keyring for tailgating purposes. Some products could be integrated with others to increase their function. A silverware drawer with Dycem lining on the bottom and insides would be helpful. A coaster that could somehow have a cork middle to be absorbent while still retaining the non-skid would be great. Anything that could tolerate high temperatures, microwaving, or going through the dishwasher would be helpful. And more color choices are always enjoyed.

I really don't know of an alternative better to Dycem. It just works.

Free Giveaway!
Thanks for reading this far! Please leave a comment regarding this entry or the blog in general (polite only please, no email addresses, no spam plugging fake universities, etc). Get these in by 11:59pm (EST) Sunday November 6 and I will use a random number generator to pick a winner(s) and mail you a slightly used but not damaged Dycem product. You can also get brochures and free samples here.