so I'm not such a newbie anymore. I even turn in the right direction now when getting off the elevator...
In fact, we're getting near to floor rotation time, so soon I should move on from medicine for awhile and into a new frontier. The medicine floor is sometimes a drag... I hate seeing people with multiple admissions or trying to tell people that they aren't safe to go home. However, I have seen some cool things in the past months, including one lady who had a neuro disorder so rare that they were collecting her CSF for research and a guy recently with an unknown tick-borne illness (learned a new word, Rickettsia). I have definitely had some times where I wondered whether I was smart enough to work at this hospital, but everyone makes mistakes and I am learning. Definitely taking a closer look at lab values, figuring out more about those.
I have gotten to take 2 visits into the NICU in the past couple of weeks. I work with a girl who is really experienced with feeding and so I got to see the different units and today I got to see a baby intervention in the feeder/grower area. It's interesting stuff, but unfortunately I don't get to devote a lot of time to learning this (since they're kinda paying me to do other things too) and it's such a specialized area that it seems that it would 1. take a lot of time to learn and 2. be best to learn in person from an expert as opposed to on your own.
The whole peds/NICU interest causes me internal unrest, as I really don't know what areas of OT that I want to go into. Yes, I know that I am young, but I have such broad scattered interests that I have no idea where I'm going. Early this year, I had made out different possible career tracks and things connected to each... there were at least 4 and I had programs and interests on each card that I'm not willing to give up, so the range remains broad. In similar news, I just volunteered to do my first home mod evals as an OTR/L... don't know what will come of this, if anything. don't even know if it is volunteering or consulting for money, which I will definitely have to figure out :-P
I have been stressing out the past couple of weeks, it's been busy at home and work and I have been dancing on the edge of tweak out. I have a wonderful (albeit unpaid) vacation that I am leaving for this Thursday after being at work everyday for 11 days (1 was a conference). I truly need a vacation at this point. I had planned to schedule blog posts ahead of time, but I don't know how many I will get done. The other thing that I have thought of doing on vacation is reviewing info for my next rotation (neuro or ortho & ICU) but I think I am coming up on a point where I just desperately need a break. I have been pretty devoted to reading OT stuff for about 90 minutes each day (metro ride) and I just want to move to something less taxing on my brain. I have lots of ideas right now but I think that my mental health needs me to not overwork for a week. Should be a good time with family, actually try to relax for an extended period instead of running around like a vagabond. Have to learn how to balance life.
6.24.2009
6.17.2009
Donate Bone Marrow!
You can sign up to donate your bone marrow for free (there is usually a registry fee attached). This site also allows you to donate umbilical cord blood if you're having a baby. You could save a life!!
6.16.2009
A few notes on Alzheimer's Disease
Been reading some more on Alzheimer's lately. I have HBO's "Alzheimer's Project" on my DVR but haven't gotten around to watching it yet... but here are some other notes of late.
I have been reading about the Home Environmental Skill Building Program during my metro trips, which has been interesting. I can't use it very well in the hospital environment, but it would be good in home health as long as you could justify the billing. It has had some good insights for me anyway, namely, the understanding of different priorities between OT and caregiver.
If this article about early-onset Alzheimer's doesn't scare the crap out of you, you don't worry like I do... yikes. I have a lot of word finding difficulties, so my paranoia is bumping up now.
Stumbled onto The Alzheimer's Reading Room while looking up something else, it will probably become one of my top blogs in the scrollbar. I found it because I had read about the Test Your Memory exam on a Medline press release and wanted to see what was included in the test. However, after looking at it, I think we need an adaptation for the US... don't tell my history teacher father, but I'm not sure that I remember when WWI started. I would pick the JFK assassination as a seminal date in many of the current elderly individuals' minds, however, I don't know if there is a reasoning behind the date that it shouldn't be something the person actually lived through.
Saw 2 clients w/ dementia today, one early-stage and one end-stage. Depressing. Early stage lady was faking it pretty well but had severely decreased short and long term memory. Independent w/ BADLs though, so I am recommending adult day care, hopefully that will work out well. My end stage lady was a social admission... 92 y.o. husband came in w/ a cardiac emergency and she can't care for herself. Sweet lady, but gets confused in the middle of her sentences. She was good at ADLs too though. Long term care for her. No one likes to see their mother's mind crumble.
I have been reading about the Home Environmental Skill Building Program during my metro trips, which has been interesting. I can't use it very well in the hospital environment, but it would be good in home health as long as you could justify the billing. It has had some good insights for me anyway, namely, the understanding of different priorities between OT and caregiver.
If this article about early-onset Alzheimer's doesn't scare the crap out of you, you don't worry like I do... yikes. I have a lot of word finding difficulties, so my paranoia is bumping up now.
Stumbled onto The Alzheimer's Reading Room while looking up something else, it will probably become one of my top blogs in the scrollbar. I found it because I had read about the Test Your Memory exam on a Medline press release and wanted to see what was included in the test. However, after looking at it, I think we need an adaptation for the US... don't tell my history teacher father, but I'm not sure that I remember when WWI started. I would pick the JFK assassination as a seminal date in many of the current elderly individuals' minds, however, I don't know if there is a reasoning behind the date that it shouldn't be something the person actually lived through.
Saw 2 clients w/ dementia today, one early-stage and one end-stage. Depressing. Early stage lady was faking it pretty well but had severely decreased short and long term memory. Independent w/ BADLs though, so I am recommending adult day care, hopefully that will work out well. My end stage lady was a social admission... 92 y.o. husband came in w/ a cardiac emergency and she can't care for herself. Sweet lady, but gets confused in the middle of her sentences. She was good at ADLs too though. Long term care for her. No one likes to see their mother's mind crumble.
6.11.2009
Quickie Acute Care Stories
It's hard to remember the stories from my job now since I pass in and out of peoples' lives much quicker and can zombie zone-out trying to make it through a ridiculously scheduled day. Like yesterday morning, when I found myself staring at 11 potential evals with no one to share. In the zone. Anyhow, here are some memorable moments...
3 Primary Runners for "Patient of the Day!!"
- Mr. X is 1 month s/p CVA that was not treated well at his hospital and received no rehab, now presents w/ visual deficits. He talks about his eyes dilating in and out, changes in light and dark, and not being able to see well. Finally he says, "I can only see half your face." Trying to figure out if this is a hemianopsia or other field cut, I ask which side. And his reply is, "the one with the big pimple."
- Mrs. Y is s/p fall and starting to have some memory problems, but is well tended to by her family. She says, "my daughter diagnoses me very accurately. She knew I had kidney failure while my doctor was still running blood tests." The PT asks, "is your daughter a doctor?" and she replies, "no, she uses the internet."
- Mr. Z is admitted for COPD, but apparently has no functional deficits and the shortness of breath isn't kicking in very quickly during activity. Unable to evaluate him during the morning as he had eloped out of the hospital, off the campus, and down to the gas station for a coffee and a newspaper. (independent community mobility- check!)
I just don't think you can write fiction to accurately display the craziness of the real world.
I was happy about Mr. X though because I happened to be sitting in on rounds and the PA was saying what a good vision workup OT had done with him, which made me feel good as vision is not my specialty. (Thank you Gutman and Schonfeld, I never would have remembered it without you). Later in the week, I was attending a different set of rounds and they were discussing a pt. w/ eyesight that had deteriorated due to cancer and suggested a low vision consult, and it was a good opportunity to educate the case manager, social worker, and doctor, as none of them had any idea that OT could do so much in the field. So, a few vision victories there.
Touching on the original point again, it is hard to blog after work now. The acute care life can be quite stressful and there's such pt turnover that I do mind-dump a lot. That and the use of the laptop all day makes it difficult to work on it in the evening as well. Really trying to avoid repetitive strain injuries, and it is becoming quite difficult. I do have a lot of good jotted down ideas that will get typed up eventually, but I've been restricting my blog access until I get a (for now) secret project accomplished. I am also in the midst of 7 straight weeks of full weekends- either I travel or someone traveling to me- and that leaves less time for other stuff too. Like my exercise goal, which is now back somewhere in the precontemplation phase... GIANT sigh.
Until next time- enjoy the crazy things life brings you today!
3 Primary Runners for "Patient of the Day!!"
- Mr. X is 1 month s/p CVA that was not treated well at his hospital and received no rehab, now presents w/ visual deficits. He talks about his eyes dilating in and out, changes in light and dark, and not being able to see well. Finally he says, "I can only see half your face." Trying to figure out if this is a hemianopsia or other field cut, I ask which side. And his reply is, "the one with the big pimple."
- Mrs. Y is s/p fall and starting to have some memory problems, but is well tended to by her family. She says, "my daughter diagnoses me very accurately. She knew I had kidney failure while my doctor was still running blood tests." The PT asks, "is your daughter a doctor?" and she replies, "no, she uses the internet."
- Mr. Z is admitted for COPD, but apparently has no functional deficits and the shortness of breath isn't kicking in very quickly during activity. Unable to evaluate him during the morning as he had eloped out of the hospital, off the campus, and down to the gas station for a coffee and a newspaper. (independent community mobility- check!)
I just don't think you can write fiction to accurately display the craziness of the real world.
I was happy about Mr. X though because I happened to be sitting in on rounds and the PA was saying what a good vision workup OT had done with him, which made me feel good as vision is not my specialty. (Thank you Gutman and Schonfeld, I never would have remembered it without you). Later in the week, I was attending a different set of rounds and they were discussing a pt. w/ eyesight that had deteriorated due to cancer and suggested a low vision consult, and it was a good opportunity to educate the case manager, social worker, and doctor, as none of them had any idea that OT could do so much in the field. So, a few vision victories there.
Touching on the original point again, it is hard to blog after work now. The acute care life can be quite stressful and there's such pt turnover that I do mind-dump a lot. That and the use of the laptop all day makes it difficult to work on it in the evening as well. Really trying to avoid repetitive strain injuries, and it is becoming quite difficult. I do have a lot of good jotted down ideas that will get typed up eventually, but I've been restricting my blog access until I get a (for now) secret project accomplished. I am also in the midst of 7 straight weeks of full weekends- either I travel or someone traveling to me- and that leaves less time for other stuff too. Like my exercise goal, which is now back somewhere in the precontemplation phase... GIANT sigh.
Until next time- enjoy the crazy things life brings you today!
6.05.2009
Slow on the Updates
Some busy times lately...
So for the first time in 2 or 3 weeks, I finally was able to discharge a patient on the evaluation. I have been so busy lately and working over a lot because every person I have seen has needed subacute rehab or nursing home placement, which means that they all needed goals written and follow ups done... very time and thought consuming. Wednesday we only had 7 new evals (only!) for 3 OTs, so we actually got to the follow up cards... one of the other girls said, "did you pick up? You still have cards in here" and the answer was yes, I have a full load today, but I just have too many people to actually see them all in a day. Been exhausted all week really. Sleeping on the metro instead of reading.
Trying to answer a Call for Papers for my state conference... haven't decided whether to submit for AOTA as well or not. Having a hard time following through on the requirements to write it up, very pathetic as I have no trouble writing on here, but once there's a deadline my brain is locked and procrastination sets in. I am obviously not going back to school any time soon.
I am going to Orlando in 2010 for the AOTA conference, and hopefully will get reimbursed for it from our continuing ed funds. I'm actually in a strange CE situation... I was a little panicky earlier in the year, but picked up 2 hours just applying for my new license. If I present at my state conference, that's 6 hours (have to pay to register anyway) plus a few as credit for the presentation, and my hospital is offering a stroke course for 6 hours that is super cheap for employees, so I could finish the rest of my hours right there no problem. But I am interested in the AOTA course Integrating Mental Health Into OT Practice with Older Adults... it is another 6 hours and still priced very fairly for members. I think it would be very helpful for me, but from a financial or efficiency standpoint, it doesn't make sense. I can't carryover extra CE hours in my new state, and I will have more than enough from the AOTA conference for 2010. In theory I guess I could order it and then just hold off on submitting the exam until I need it (2011?) if it is active that long. I am also holding onto 2 completed CE articles from OT practice on contemporary motor control that I hadn't submitted since I can't find my coupon.
A world with many options is simply a world filled with too many decisions...
I do have 2-3 interesting case studies I will post soon. Busy set of weekends coming up- worked last 2, had a visitor last weekend, at my parents' house for a wedding this weekend... Even though we always try to cut back to have relaxing time we always get large stretches of weeks in the summer and fall that are heavy on travel. Hope everyone is enjoying summertime before we hit triple digit heat on the East coast. :)
So for the first time in 2 or 3 weeks, I finally was able to discharge a patient on the evaluation. I have been so busy lately and working over a lot because every person I have seen has needed subacute rehab or nursing home placement, which means that they all needed goals written and follow ups done... very time and thought consuming. Wednesday we only had 7 new evals (only!) for 3 OTs, so we actually got to the follow up cards... one of the other girls said, "did you pick up? You still have cards in here" and the answer was yes, I have a full load today, but I just have too many people to actually see them all in a day. Been exhausted all week really. Sleeping on the metro instead of reading.
Trying to answer a Call for Papers for my state conference... haven't decided whether to submit for AOTA as well or not. Having a hard time following through on the requirements to write it up, very pathetic as I have no trouble writing on here, but once there's a deadline my brain is locked and procrastination sets in. I am obviously not going back to school any time soon.
I am going to Orlando in 2010 for the AOTA conference, and hopefully will get reimbursed for it from our continuing ed funds. I'm actually in a strange CE situation... I was a little panicky earlier in the year, but picked up 2 hours just applying for my new license. If I present at my state conference, that's 6 hours (have to pay to register anyway) plus a few as credit for the presentation, and my hospital is offering a stroke course for 6 hours that is super cheap for employees, so I could finish the rest of my hours right there no problem. But I am interested in the AOTA course Integrating Mental Health Into OT Practice with Older Adults... it is another 6 hours and still priced very fairly for members. I think it would be very helpful for me, but from a financial or efficiency standpoint, it doesn't make sense. I can't carryover extra CE hours in my new state, and I will have more than enough from the AOTA conference for 2010. In theory I guess I could order it and then just hold off on submitting the exam until I need it (2011?) if it is active that long. I am also holding onto 2 completed CE articles from OT practice on contemporary motor control that I hadn't submitted since I can't find my coupon.
A world with many options is simply a world filled with too many decisions...
I do have 2-3 interesting case studies I will post soon. Busy set of weekends coming up- worked last 2, had a visitor last weekend, at my parents' house for a wedding this weekend... Even though we always try to cut back to have relaxing time we always get large stretches of weeks in the summer and fall that are heavy on travel. Hope everyone is enjoying summertime before we hit triple digit heat on the East coast. :)
6.02.2009
Update on Reading Without Getting Sick
After ~2 months of efforts, I have reached my conclusions on reading on the metro train without getting carsick.
I have found that a combination of strategies allows me to read almost nonstop while on the metro.
- Choosing a front facing seat: I will take back facing seats over sideways facing... if forced into sideways seats, I turn so that I am taking up more space and oriented toward the front.
- Front Car: I try to get a seat near the front of the overall train. There isn't a big difference between car 1-2 or 2-3 but there is a major difference between front most and rear most in amount of sway.
- Don't touch anything: I avoid contact w/ the walls of the train, since they vibrate.
- Eliminate degrees of freedom: I hold the book close to me, pinning down one page w/ both hands if necessary.
- Periodic rest breaks: If I feel the train going into a turn, shaking extra, or going faster than normal, I close my eyes. I had been looking up away from the book, but closing my eyes forces me to feel when the situation has calmed down.
- Accupressure: I couldn't find my sea-bands, but when I went to the store, I remembered what i didn't like about them. The elastic does have give, and the little pressure balls can cut too tightly. However, I found psi bands, which are doubly adjustable both at the wristband and at the dial. Pretty cool, hopefully the plastic won't break.
And there you have it! I've been knocking out important articles and texts with ease.
DISCLAIMERS
1. I am not a doctor and cannot advise you on best remedies for your individual situation... go get a checkup.
2. I am not going to try these remedies while in the car. I think that cars are too bouncy, and given to too many directional shifts in both left-right and up-down (at least where I am from). It's enough for me to just not get carsick in the car, I won't be pushing it there.
3. There is one known remedy for motion sickness that I have not tried, which is eating ginger. It's not feasible for me to do that nonstop for 2 hours everyday and I hate gum of any kind more than any non-SPD person could possibly understand.
I have found that a combination of strategies allows me to read almost nonstop while on the metro.
- Choosing a front facing seat: I will take back facing seats over sideways facing... if forced into sideways seats, I turn so that I am taking up more space and oriented toward the front.
- Front Car: I try to get a seat near the front of the overall train. There isn't a big difference between car 1-2 or 2-3 but there is a major difference between front most and rear most in amount of sway.
- Don't touch anything: I avoid contact w/ the walls of the train, since they vibrate.
- Eliminate degrees of freedom: I hold the book close to me, pinning down one page w/ both hands if necessary.
- Periodic rest breaks: If I feel the train going into a turn, shaking extra, or going faster than normal, I close my eyes. I had been looking up away from the book, but closing my eyes forces me to feel when the situation has calmed down.
- Accupressure: I couldn't find my sea-bands, but when I went to the store, I remembered what i didn't like about them. The elastic does have give, and the little pressure balls can cut too tightly. However, I found psi bands, which are doubly adjustable both at the wristband and at the dial. Pretty cool, hopefully the plastic won't break.
And there you have it! I've been knocking out important articles and texts with ease.
DISCLAIMERS
1. I am not a doctor and cannot advise you on best remedies for your individual situation... go get a checkup.
2. I am not going to try these remedies while in the car. I think that cars are too bouncy, and given to too many directional shifts in both left-right and up-down (at least where I am from). It's enough for me to just not get carsick in the car, I won't be pushing it there.
3. There is one known remedy for motion sickness that I have not tried, which is eating ginger. It's not feasible for me to do that nonstop for 2 hours everyday and I hate gum of any kind more than any non-SPD person could possibly understand.
5.28.2009
Art Contest
I read about this contest on the Your Therapy Source blog and it's pretty cool... definitely a fun thing to work into a school, EI or outpatient pediatric therapy session. Most of my kids weren't using adaptive devices for our work though, just better designed products.
I am off tomorrow and excited about it! Once I get the house cleaned up for a weekend visitor, I am going to sleep and relax and update some posts. :)
I am off tomorrow and excited about it! Once I get the house cleaned up for a weekend visitor, I am going to sleep and relax and update some posts. :)
5.27.2009
OT Quotes
This little entry was gathering dust in my drafts queue, and though it's past OT month and likely past many graduations, here are some randomly collected semi-inspirational quotes. Feel free to share additional gems in the comments.
"Great leaders are almost always great simplifiers" -Colin Powell
"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm
"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium
"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf
"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb
"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning
"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips
"Everyone has a moment in history which belongs particularly to him." -A Separate Peace
"It's what you learn after you know it all that counts the most." -Phil Jackson
"The time to hesitate is through." -The Doors
"In valor, there is hope." -Police Officers Memorial
"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy
"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf
"The journey is the reward" -Greg Norman
"Stone walls do not a prison make, nor iron bars a cage." -Lovelace
"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks
"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach
"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King
"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher
(if this collection does not deserve the adjective "random," then I don't know what would)
"Great leaders are almost always great simplifiers" -Colin Powell
"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm
"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium
"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf
"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb
"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning
"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips
"Everyone has a moment in history which belongs particularly to him." -A Separate Peace
"It's what you learn after you know it all that counts the most." -Phil Jackson
"The time to hesitate is through." -The Doors
"In valor, there is hope." -Police Officers Memorial
"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy
"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf
"The journey is the reward" -Greg Norman
"Stone walls do not a prison make, nor iron bars a cage." -Lovelace
"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks
"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach
"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King
"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher
(if this collection does not deserve the adjective "random," then I don't know what would)
5.23.2009
Interesting OT Connections threads
I've been trying to spend a little more time on OT Connections, especially in the posting department as opposed to lurking. Here's some topics that I have found interesting in the past few days.
You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!
Food for Thought- a really good student project involving nursing home residents having greater control over meal time
Documentation on PDAs- a home health group is going paperless
OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there
Oncology Research Articles- I am looking for good rehab research relating to pts w/ cancer
Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread
SI for Geriatrics- some good information about bringing sensory strategies to the older adult population
Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?
You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!
Food for Thought- a really good student project involving nursing home residents having greater control over meal time
Documentation on PDAs- a home health group is going paperless
OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there
Oncology Research Articles- I am looking for good rehab research relating to pts w/ cancer
Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread
SI for Geriatrics- some good information about bringing sensory strategies to the older adult population
Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?
5.20.2009
Things I am currently thinking about...
Longer updates to come soon, I've had a couple of busy weeks and have to work this Sunday. But here's some thing's I've been thinking about.
- Contemporary Motor Control theory
- Best practices for home residing people w/ dementia
- The kid on Breaking Bad
- Reading more AJOTs
- Branching into NICU?
- A couple of interesting case studies- pt. w/ ABI and another w/ multiple complex brain issues
- Customer service
- Energy Conservation
- Changing layout on the blog?
5.09.2009
Stories
One of the amusing things about working in a field that lets you interact with lots of different people is simply the stories that you come across. It is a well known adage that to be a writer, you must read, but I think that listening to other people's original stories is the way to go- you can't make stuff like this up.
For instance, a man with COPD and schizophrenia had a vision that if he smoked more, he would get healthier. He was later admitted to the ER with persistent cough and shortness of breath.
I've had several people who've had quick reentries to the hospital, which is always lousy. I had one lady that I evaluated in my first week of real work, and I remember her because I have an aunt with the same name. Most people, in meeting someone, would be at least mildly interested by that sort of anecdote, but this lady was thoroughly not amused. She needed to go to short term rehab since she'd had compression fractures and a pacemaker placed. 2 days after she got home from rehab, she fell at home and was even less happy to see me the second time around.
One of the downsides of working in acute care is that you see SO many people that it's hard to remember all the stories. The COTA has asked me once or twice about Mrs Soandso and I'll say 'can you refresh my memory?' Even with the response, 'yeah she's the frail little lady' I am usually struggling to remember. :)
An old story from my last job that I never got around to writing up- 102 year old man was taking a mini-mental. I stick out my arm and say, "what's this on my wrist?" trying to get the response "watch." Instead he says, "oh that's some kind of growth. A mole. I big mole."
Recently evaluated a man w/ very advanced Alzheimer's and Parkinson's diseases. Per the chart review, he was basically wheelchair bound at home, largely nonverbal. Yet he somehow managed to 'take his family hostage' (though no weapon was mentioned) and he was brought to the ER in handcuffs. He was far too combatitive on day 1 for me to work with- throwing things and slapping at people. When I saw him on Day 2 he was a little more calm and the PT and I were able to get him into a chair, he was able to state his first and last names, but other than that we couldn't get him to follow any simple commands or tell us anything else. Later that day, while working with his roommate, he had decided to remove all his clothing and sheets and was requiring one person's complete attention to keep him from crawling out of the bed.
I do not envy our case managers and some of the placements that they have had to pursue recently. It is probably just 'the way things are' but it is very difficult having people with lousy home or medical situations come in, but not have rehab needs to qualify them to go elsewhere. I am trying not to get overly bummed out about that part, since I end up with a role in the drama. It also makes me think about what choices I would make in some of these situations, which is also a downer.
Though I have tried to hide it, my coworkers have figured it out (even quicker than last time) that I am a techie. We are encouraged to do point-of-care documentation and get notes in ASAP after an eval, so we all have little tablet laptops. I had been using mine as a regular laptop, but using a touchpad all day at work and then at home was making my wrists go into agony. So I resolved to figure out how to manipulate the tablet software (despite not having regular access to preferences) so that it would suit my needs, and for the most part, I have. I attempted a few evals Friday using this strategy to document in the room, and plan to hit it hard next week and make it work. Even with just trying it out on Friday, I got comments from a lot of excited coworkers who wanted to learn how to do it too. I may need to prepare a how-to guide since I don't mind sharing but definitely didn't get out on time on Friday. My current home computer is too newly purchased to talk about such things, but a tablet wouldn't be a horrible next purchase, however, the only thing I can see it really helping with is blog entries, so it's not really worth it as yet. Suppose I could eventually look into a tablet PDA, but the smaller screen would take a longer time to make work. I may also have a problem with mine at work since one section of the screen seems to have difficulty responding to my inputs... might have a dead zone.
Some of my coworkers are very resistant to the computer documentation, I am still surprised that a lot of the departments at the hospital do not do computer documentation. Everything was computerized at my last hospital, and this one is considerably larger, so I assumed they would be more 'with the times' so to speak. I remember way-back-when, first year OT school when potential research topics were brimming in my brain and I had thought of doing a project on whether therapists with computer documentation were faster, now I am glad I didn't since it is such a hot-button issue for some. Can of worms, though it would still be interesting to see the results. Anyone else use tablet computers for point-of-care documenting?
My current metro-reading strategy of reading a paragraph as the train slows down and stops at a station is going well. Since I can't seem to time the shuttle departure right (don't know if it's possible to) I am also picking up 10-20 minutes reading time there too. I am officially CAUGHT UP on all my OT Practices that had piled up during the transition time and actually eagerly awaiting new ones since I have time to read!! I am working on responses to some articles too, hopefully will be ready to post those soon.
For instance, a man with COPD and schizophrenia had a vision that if he smoked more, he would get healthier. He was later admitted to the ER with persistent cough and shortness of breath.
I've had several people who've had quick reentries to the hospital, which is always lousy. I had one lady that I evaluated in my first week of real work, and I remember her because I have an aunt with the same name. Most people, in meeting someone, would be at least mildly interested by that sort of anecdote, but this lady was thoroughly not amused. She needed to go to short term rehab since she'd had compression fractures and a pacemaker placed. 2 days after she got home from rehab, she fell at home and was even less happy to see me the second time around.
One of the downsides of working in acute care is that you see SO many people that it's hard to remember all the stories. The COTA has asked me once or twice about Mrs Soandso and I'll say 'can you refresh my memory?' Even with the response, 'yeah she's the frail little lady' I am usually struggling to remember. :)
An old story from my last job that I never got around to writing up- 102 year old man was taking a mini-mental. I stick out my arm and say, "what's this on my wrist?" trying to get the response "watch." Instead he says, "oh that's some kind of growth. A mole. I big mole."
Recently evaluated a man w/ very advanced Alzheimer's and Parkinson's diseases. Per the chart review, he was basically wheelchair bound at home, largely nonverbal. Yet he somehow managed to 'take his family hostage' (though no weapon was mentioned) and he was brought to the ER in handcuffs. He was far too combatitive on day 1 for me to work with- throwing things and slapping at people. When I saw him on Day 2 he was a little more calm and the PT and I were able to get him into a chair, he was able to state his first and last names, but other than that we couldn't get him to follow any simple commands or tell us anything else. Later that day, while working with his roommate, he had decided to remove all his clothing and sheets and was requiring one person's complete attention to keep him from crawling out of the bed.
I do not envy our case managers and some of the placements that they have had to pursue recently. It is probably just 'the way things are' but it is very difficult having people with lousy home or medical situations come in, but not have rehab needs to qualify them to go elsewhere. I am trying not to get overly bummed out about that part, since I end up with a role in the drama. It also makes me think about what choices I would make in some of these situations, which is also a downer.
Though I have tried to hide it, my coworkers have figured it out (even quicker than last time) that I am a techie. We are encouraged to do point-of-care documentation and get notes in ASAP after an eval, so we all have little tablet laptops. I had been using mine as a regular laptop, but using a touchpad all day at work and then at home was making my wrists go into agony. So I resolved to figure out how to manipulate the tablet software (despite not having regular access to preferences) so that it would suit my needs, and for the most part, I have. I attempted a few evals Friday using this strategy to document in the room, and plan to hit it hard next week and make it work. Even with just trying it out on Friday, I got comments from a lot of excited coworkers who wanted to learn how to do it too. I may need to prepare a how-to guide since I don't mind sharing but definitely didn't get out on time on Friday. My current home computer is too newly purchased to talk about such things, but a tablet wouldn't be a horrible next purchase, however, the only thing I can see it really helping with is blog entries, so it's not really worth it as yet. Suppose I could eventually look into a tablet PDA, but the smaller screen would take a longer time to make work. I may also have a problem with mine at work since one section of the screen seems to have difficulty responding to my inputs... might have a dead zone.
Some of my coworkers are very resistant to the computer documentation, I am still surprised that a lot of the departments at the hospital do not do computer documentation. Everything was computerized at my last hospital, and this one is considerably larger, so I assumed they would be more 'with the times' so to speak. I remember way-back-when, first year OT school when potential research topics were brimming in my brain and I had thought of doing a project on whether therapists with computer documentation were faster, now I am glad I didn't since it is such a hot-button issue for some. Can of worms, though it would still be interesting to see the results. Anyone else use tablet computers for point-of-care documenting?
My current metro-reading strategy of reading a paragraph as the train slows down and stops at a station is going well. Since I can't seem to time the shuttle departure right (don't know if it's possible to) I am also picking up 10-20 minutes reading time there too. I am officially CAUGHT UP on all my OT Practices that had piled up during the transition time and actually eagerly awaiting new ones since I have time to read!! I am working on responses to some articles too, hopefully will be ready to post those soon.
5.08.2009
May is Stroke Awareness Month
Read the CDC feature on stroke
Make sure your friends and family know the signs of stroke so that they can be prepared to act in an emergency.
Check out these sites for more info:
American Stroke Association (a division of the American Heart Association)
Internet Stroke Center
Make sure your friends and family know the signs of stroke so that they can be prepared to act in an emergency.
Check out these sites for more info:
American Stroke Association (a division of the American Heart Association)
Internet Stroke Center
5.05.2009
OT by PT
Addressing the problem of professional crossover.
One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.
One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.
I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.
I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'
I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.
Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.
One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.
One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.
I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.
I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'
I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.
Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.
5.03.2009
Sharing a Brain
I did not submit this card to Postsecret, but I share the sentiment...
I'm a metro girl though, not light rail.
My only complaint about the new way of commuting is that when I was driving if I left for work early in the morning and/or left work early in the afternoon, I could cut my driving time. Now the time is constant, but often longer than if I had been driving and not had traffic problems.
Other potential problems include that I have to leave by a certain time or my shuttle bus won't take me to the metro; and that it does not run on Sundays, and I work 2 of those a month. No major progress on the overcoming motion-sickness front either. Latest strategy is to read 1 paragraph at each metro stop, which is a little better.
I'm a metro girl though, not light rail.
My only complaint about the new way of commuting is that when I was driving if I left for work early in the morning and/or left work early in the afternoon, I could cut my driving time. Now the time is constant, but often longer than if I had been driving and not had traffic problems.
Other potential problems include that I have to leave by a certain time or my shuttle bus won't take me to the metro; and that it does not run on Sundays, and I work 2 of those a month. No major progress on the overcoming motion-sickness front either. Latest strategy is to read 1 paragraph at each metro stop, which is a little better.
5.02.2009
Recession Job Market
For the third part in the little mini-series on job hunting (here's the links in case you missed searching or interviewing for an OT job) I would like to address the topic of job-hunting in the midst of a recession.
The recession is not making big headlines this week, perhaps because the doomsayers have realized that we are probably not going to end up in another great depression or a post-apocalyptic nation focused solely on survival. However, it is still a topic on people's minds, especially when discussing a job search.
Occupational therapy made the headlines by landing on Time's 150 Recession-Proof Jobs list. OTRs come in at #18, and OTAs at #72. Rehab/Healthcare jobs in general were well represented on this list- PTs, PTAs, Therapy Aides, SLPs, and also RNs, LPNs, Athletic trainers, Massage and Respiratory therapists were all in the top 120.
We now interrupt this entry with a quick little note about political advocacy here. It's likely that athletic trainers have climbed their way onto the 'recession proof' list through their efforts to redefine their scope of practice on a political level. Since any individual can now be considered an "athlete," they now have a much wider base of clients to work with and places to seek employment- like outpatient rehab clinics. Recreational therapists, on the other hand, are not on this list, perhaps because they have been cut out of some Medicare legislation affecting reimbursement and their necessity to be employed in certain environments. Right now, they're trying to become a covered, required service under Medicare for additional settings. Just a little word about how you can't live as a therapist in isolation- political action is required if you'd like to continue having a job and being relevant to the rehab world. As one of my teachers said, if you don't have the time to do it, at least kick some money to the people that are working on it at your state and national associations. We now return you to your scheduled blog entry.
One thing that surprises me about the job list is that OTAs are not higher on the list, or even higher than OTs. I would think using more OTAs could be more profitable for many organizations, as long as there are not a superfluous amount of evaluations to be done as opposed to treatments. My current job is obviously one of those places since we get about 1200-1500 orders for OT/PT/SLP evals each month, so there are only 2 OTAs and 1 PTA. OT Practice recently had an article celebrating 50 years of OTA education, and the associate's degree remains a cost-effective way to get into occupational therapy.
Despite the accolades the profession has been garnering, I think that the only people who say that OT is 'recession proof' are those not currently working in healthcare. Many sites are in the midst of a soft or full-on hiring freeze. Some hospital units are closing completely, orthopedic units are trying to step up the service due to decreased elective surgeries- My old hospital was trying to see acute orthopedic surgery pts 3x for PT and 2x for OT everyday; a friend at a hospital-based SNF was trying to see subacute ortho pts 2x for PT and 1x for OT each day, which is causing their depleted staff to work overtime everyday. (Obviously the second group is salaried, keep that in mind during your job search.) PRN (as needed) nurses and therapists are seeing a dramatic cutback in use of their services, which used to be a pretty lucrative way to earn money without a full time commitment.
Though it may be callous to gripe about cutbacks on perks, that too has become the reality. Sign-on bonuses (taxed very high anyway) are getting cut. CE money is often getting cut, which is a shame, because high intesity courses that give a lot of hours are more expensive. It stands to reason that therapists might choose to stick close to home and maybe go for something based less on the knowledge they will receive and more within their price range. I don't know that it's technically fradulent to pursue CEs outside your realm of practice, but it is professionally discouraged. It wouldn't fly in my current state, since they have to preapprove everything you go to. Money for therapy supplies is likely getting slashed in budgets, so you may have to appeal to grants to get the fancy new equipment. Another cutback is in the retirement arena- matching 401K funds are dwindling. My current company still has a pension plan, which I thought had all gone kaput long ago, but they are keeping that and tossing out the matching funds.
If you work for a hospital, then at least your healthcare benefits are fairly safe. After all, they can't just deny you admission to the hospital. However, I have heard of some places charging an extra fee if your spouse's employer also offers health insurance but you chose instead to go with the hospital's plan. The wording was that the hospital couldn't afford to subsidize the rest of the county's healthcare costs. The other issue related to healthcare is that it can be hard to job-swap since a person would face up to 3 months without any benefits, especially if you have a spouse or family depending on you for coverage. If you're single with a chronic health condition (especially including pregnancy) then the issue has to be weighing into your decision as well. Related to that, it's good to pick an area that has multiple job offerings, so that you don't have to pick up and move if you want to work somewhere new. In a related situation, it would be very difficult for my husband to find a new job, so when I accepted my new position, we had to live somewhere that would be a reasonable commute for both of us. Part of the reason that we chose to move to Baltimore instead of back where our parents live is so that he could keep his job- trying to move and find 2 new jobs is stress that we're not ready for yet.
Though this post is a bit of a downer, don't be mistaken, there are OT jobs out there. You may have to take a position that isn't your dream job, but there will likely be plenty of positions available in hospitals, SNFs, and large facilities. There will probably be fewer openings in schools (these are usually limited anyway since people tend to keep those jobs when they get them) and small private practice facilities. There are also likely to be fewer openings in OT college towns since there is always a fresh supply of therapists available. But when there is a legitimate opening at any location, the current therapists will likely be stressed by trying to deal with the workload and they will want to fill their position. And if you're just starting OT school, don't be put off by the cost of the degree. Student loan debt is better to have than other types, people have used those loans for international travel and buying cars and still come out ahead. And since there will be some type of OT job available when you graduate (not necessarily a perfect one, or one that pays $100,000/year) you will be able to pay back your loans.
The jobs are out there, good luck to everyone that's looking. I have to guess that they will be a little harder to land in May or December, so you may want to start your search pre-graduation if you're expecting to get a job right after school is out. Happy hunting, everyone!
The recession is not making big headlines this week, perhaps because the doomsayers have realized that we are probably not going to end up in another great depression or a post-apocalyptic nation focused solely on survival. However, it is still a topic on people's minds, especially when discussing a job search.
Occupational therapy made the headlines by landing on Time's 150 Recession-Proof Jobs list. OTRs come in at #18, and OTAs at #72. Rehab/Healthcare jobs in general were well represented on this list- PTs, PTAs, Therapy Aides, SLPs, and also RNs, LPNs, Athletic trainers, Massage and Respiratory therapists were all in the top 120.
We now interrupt this entry with a quick little note about political advocacy here. It's likely that athletic trainers have climbed their way onto the 'recession proof' list through their efforts to redefine their scope of practice on a political level. Since any individual can now be considered an "athlete," they now have a much wider base of clients to work with and places to seek employment- like outpatient rehab clinics. Recreational therapists, on the other hand, are not on this list, perhaps because they have been cut out of some Medicare legislation affecting reimbursement and their necessity to be employed in certain environments. Right now, they're trying to become a covered, required service under Medicare for additional settings. Just a little word about how you can't live as a therapist in isolation- political action is required if you'd like to continue having a job and being relevant to the rehab world. As one of my teachers said, if you don't have the time to do it, at least kick some money to the people that are working on it at your state and national associations. We now return you to your scheduled blog entry.
One thing that surprises me about the job list is that OTAs are not higher on the list, or even higher than OTs. I would think using more OTAs could be more profitable for many organizations, as long as there are not a superfluous amount of evaluations to be done as opposed to treatments. My current job is obviously one of those places since we get about 1200-1500 orders for OT/PT/SLP evals each month, so there are only 2 OTAs and 1 PTA. OT Practice recently had an article celebrating 50 years of OTA education, and the associate's degree remains a cost-effective way to get into occupational therapy.
Despite the accolades the profession has been garnering, I think that the only people who say that OT is 'recession proof' are those not currently working in healthcare. Many sites are in the midst of a soft or full-on hiring freeze. Some hospital units are closing completely, orthopedic units are trying to step up the service due to decreased elective surgeries- My old hospital was trying to see acute orthopedic surgery pts 3x for PT and 2x for OT everyday; a friend at a hospital-based SNF was trying to see subacute ortho pts 2x for PT and 1x for OT each day, which is causing their depleted staff to work overtime everyday. (Obviously the second group is salaried, keep that in mind during your job search.) PRN (as needed) nurses and therapists are seeing a dramatic cutback in use of their services, which used to be a pretty lucrative way to earn money without a full time commitment.
Though it may be callous to gripe about cutbacks on perks, that too has become the reality. Sign-on bonuses (taxed very high anyway) are getting cut. CE money is often getting cut, which is a shame, because high intesity courses that give a lot of hours are more expensive. It stands to reason that therapists might choose to stick close to home and maybe go for something based less on the knowledge they will receive and more within their price range. I don't know that it's technically fradulent to pursue CEs outside your realm of practice, but it is professionally discouraged. It wouldn't fly in my current state, since they have to preapprove everything you go to. Money for therapy supplies is likely getting slashed in budgets, so you may have to appeal to grants to get the fancy new equipment. Another cutback is in the retirement arena- matching 401K funds are dwindling. My current company still has a pension plan, which I thought had all gone kaput long ago, but they are keeping that and tossing out the matching funds.
If you work for a hospital, then at least your healthcare benefits are fairly safe. After all, they can't just deny you admission to the hospital. However, I have heard of some places charging an extra fee if your spouse's employer also offers health insurance but you chose instead to go with the hospital's plan. The wording was that the hospital couldn't afford to subsidize the rest of the county's healthcare costs. The other issue related to healthcare is that it can be hard to job-swap since a person would face up to 3 months without any benefits, especially if you have a spouse or family depending on you for coverage. If you're single with a chronic health condition (especially including pregnancy) then the issue has to be weighing into your decision as well. Related to that, it's good to pick an area that has multiple job offerings, so that you don't have to pick up and move if you want to work somewhere new. In a related situation, it would be very difficult for my husband to find a new job, so when I accepted my new position, we had to live somewhere that would be a reasonable commute for both of us. Part of the reason that we chose to move to Baltimore instead of back where our parents live is so that he could keep his job- trying to move and find 2 new jobs is stress that we're not ready for yet.
Though this post is a bit of a downer, don't be mistaken, there are OT jobs out there. You may have to take a position that isn't your dream job, but there will likely be plenty of positions available in hospitals, SNFs, and large facilities. There will probably be fewer openings in schools (these are usually limited anyway since people tend to keep those jobs when they get them) and small private practice facilities. There are also likely to be fewer openings in OT college towns since there is always a fresh supply of therapists available. But when there is a legitimate opening at any location, the current therapists will likely be stressed by trying to deal with the workload and they will want to fill their position. And if you're just starting OT school, don't be put off by the cost of the degree. Student loan debt is better to have than other types, people have used those loans for international travel and buying cars and still come out ahead. And since there will be some type of OT job available when you graduate (not necessarily a perfect one, or one that pays $100,000/year) you will be able to pay back your loans.
The jobs are out there, good luck to everyone that's looking. I have to guess that they will be a little harder to land in May or December, so you may want to start your search pre-graduation if you're expecting to get a job right after school is out. Happy hunting, everyone!
4.30.2009
Interviewing Tips
I am not an expert about getting jobs, but I have been through a few successful interviews recently. Here are some tips that I recently wrote out for a friend. This is not comprehensive, any of these topics could be significantly expanded.
Basic Interviewing Tips- I'm not going to really cover these since most OT students have probably gone through at least one interview in their lifetime, if only the one to get into school. Wear something nice, conservative, that you are comfortable in. Bring extra copies of your resume. Learn about the company before you go. Use positive body language. Etc.
Rule #1- You are interviewing THEM as much or more than they are interviewing you. So the questioning should be a 2 way street. You have questions, you deserve to get them answered before you make a decision. Make a list- If there's anything clinical that you really liked or didn't like at your fieldworks, you can form a question to devise whether a similar situation exists at the new place. You should get information about what they offer for 401K, health insurance, days off and other benefits from the HR department, and they should get you that information before you leave that day.
Questions they will probably ask you:
- about the experience and interest you have in their population
- about your goals for professional development/ what you want to get out of the job
- your strengths/weaknesses
- might ask you to describe a situation when you overcame an obstacle at work or resolved a conflict with a coworker
(Here are some more interview questions, I'd say the ones about coworkers and goals are most likely to appear in your future)
Be honest in your appraisal of your abilities. A recent job candidate rated herself "10/10" in dealing with all types of diagnoses, therapy techniques, and practice locations- despite only having a year of experience. Also, it can be good to pause briefly before answering a question, especially if you find yourself often making foot in mouth statements. If you're nervous about how you'll react to questions and handle things on-the-spot, many college campuses have a career center that will offer to do free mock interviews or resume workshops. Check it out, you're paying for it anyway. If that's not available, have a trusted friend or adult interview you and offer constructive criticism.
Another question that will definitely come up is what you expect to be paid. (this might even be on the job application) I'd encourage you to discuss this with your professors, but there are also other good resources. Enter your state into this page on the Career InfoNet and see the wage table for your target state and compare it to the nation as a whole. You can also look for your city or metro area on the left sidebar. This gives you a good idea of the range, although I don't know anybody getting paid in that 90th percentile area. Advance also has a salary calculator, but you have to sign up to play with that. In my experience, their sample size has been too low to be truly helpful. Don't get dazzled by the money though- you're looking for the best overall place, the money will come. Also, FYI- sign on bonuses are taxed VERY high.
You should also take time to point out anything awesome on your resume or portfolio and explain how you got the honor and why it's special. For example, "I wanted you to know that I was elected to the office of Grand Poohbah of the Water Buffalo by a group of my peers to coordinate volunteer efforts in our community." Nobody knows why you were honored or what the title means until you explain it.
In the post on searching for a job, I mentioned that you should look at several sites and try to do multiple interviews in a near time frame. You'll want to keep detailed notes of what you liked and disliked about each site, what their typical day was like, anything important that they told you. Keep the names of everyone you talk to- try to get business cards as that will make it easier. And remember that you should send a follow up thank you note after the interview- email is acceptable.
If you feel like the interview went well and the facility looks promising, you can ask to have a shadow day. I strongly recommend doing that. See what a normal day is like, what the expectations are for productivity, get a feel for the balance of the caseload. Among other things, you can ask your future coworkers what they really think about everything, see what kind of people they are.
You want to take your time to consider any and all positions that are offered you, but you should be timely and polite about it- your interviewers are trying to fill their positions quickly and will appreciate your honesty. Nobody is asking you to commit to a position on the interview day, but be timely.
After all that, if you decide to accept, you'll have to pick a start date and all that. So if you come out of the initial interview feeling positive about the place, or if you are definitely living/practicing in a certain state, you will want to start investigating the licensure procedure there. Figure out the timing, how long it will take to get a license. Consider whether you need to start work right away with a temporary, or if you want to take the NBCOT exam first. I didn't want to try to balance studying and working, but it depends on what you want. All that plays into the potential start date.
Bottom line- be honest, be you, and try to find the best fit for your personality and for your skills to grow. Good luck everyone!
Basic Interviewing Tips- I'm not going to really cover these since most OT students have probably gone through at least one interview in their lifetime, if only the one to get into school. Wear something nice, conservative, that you are comfortable in. Bring extra copies of your resume. Learn about the company before you go. Use positive body language. Etc.
Rule #1- You are interviewing THEM as much or more than they are interviewing you. So the questioning should be a 2 way street. You have questions, you deserve to get them answered before you make a decision. Make a list- If there's anything clinical that you really liked or didn't like at your fieldworks, you can form a question to devise whether a similar situation exists at the new place. You should get information about what they offer for 401K, health insurance, days off and other benefits from the HR department, and they should get you that information before you leave that day.
Questions they will probably ask you:
- about the experience and interest you have in their population
- about your goals for professional development/ what you want to get out of the job
- your strengths/weaknesses
- might ask you to describe a situation when you overcame an obstacle at work or resolved a conflict with a coworker
(Here are some more interview questions, I'd say the ones about coworkers and goals are most likely to appear in your future)
Be honest in your appraisal of your abilities. A recent job candidate rated herself "10/10" in dealing with all types of diagnoses, therapy techniques, and practice locations- despite only having a year of experience. Also, it can be good to pause briefly before answering a question, especially if you find yourself often making foot in mouth statements. If you're nervous about how you'll react to questions and handle things on-the-spot, many college campuses have a career center that will offer to do free mock interviews or resume workshops. Check it out, you're paying for it anyway. If that's not available, have a trusted friend or adult interview you and offer constructive criticism.
Another question that will definitely come up is what you expect to be paid. (this might even be on the job application) I'd encourage you to discuss this with your professors, but there are also other good resources. Enter your state into this page on the Career InfoNet and see the wage table for your target state and compare it to the nation as a whole. You can also look for your city or metro area on the left sidebar. This gives you a good idea of the range, although I don't know anybody getting paid in that 90th percentile area. Advance also has a salary calculator, but you have to sign up to play with that. In my experience, their sample size has been too low to be truly helpful. Don't get dazzled by the money though- you're looking for the best overall place, the money will come. Also, FYI- sign on bonuses are taxed VERY high.
You should also take time to point out anything awesome on your resume or portfolio and explain how you got the honor and why it's special. For example, "I wanted you to know that I was elected to the office of Grand Poohbah of the Water Buffalo by a group of my peers to coordinate volunteer efforts in our community." Nobody knows why you were honored or what the title means until you explain it.
In the post on searching for a job, I mentioned that you should look at several sites and try to do multiple interviews in a near time frame. You'll want to keep detailed notes of what you liked and disliked about each site, what their typical day was like, anything important that they told you. Keep the names of everyone you talk to- try to get business cards as that will make it easier. And remember that you should send a follow up thank you note after the interview- email is acceptable.
If you feel like the interview went well and the facility looks promising, you can ask to have a shadow day. I strongly recommend doing that. See what a normal day is like, what the expectations are for productivity, get a feel for the balance of the caseload. Among other things, you can ask your future coworkers what they really think about everything, see what kind of people they are.
You want to take your time to consider any and all positions that are offered you, but you should be timely and polite about it- your interviewers are trying to fill their positions quickly and will appreciate your honesty. Nobody is asking you to commit to a position on the interview day, but be timely.
After all that, if you decide to accept, you'll have to pick a start date and all that. So if you come out of the initial interview feeling positive about the place, or if you are definitely living/practicing in a certain state, you will want to start investigating the licensure procedure there. Figure out the timing, how long it will take to get a license. Consider whether you need to start work right away with a temporary, or if you want to take the NBCOT exam first. I didn't want to try to balance studying and working, but it depends on what you want. All that plays into the potential start date.
Bottom line- be honest, be you, and try to find the best fit for your personality and for your skills to grow. Good luck everyone!
Search for an OT Job
Spring is in the air, as signified by the inch thick of pollen on my car each day. That means that there will be more folks w/ respiratory issues in the hospital and more new OTs starting their first job search!! I'm not a career counselor, but I survived my first searches, and here are some tips to hopefully make your search more fruitful.
There are a few questions which frame the whole job search, but I think most people have this under control. You should know the constraints of your search. Are you getting married or otherwise needing to stay within a certain geographical region? Do you have others to support or just need to make enough to cover your own expenses? Do you need to start work immediately or can you take some time off after graduation? Thinking about what you need can help you narrow your focus and concentrate on what's important to you.
I think it's easier looking for a job in a specific geographical area than just looking for random jobs anywhere. And while you can do a good portion of your job search from far away, thanks to the wonders of the internet, it is easier to do after you have moved and settled in the area. Not a luxury everyone has, I didn't. I haven't had very good luck searching on the internet sites that cater to all professions (i.e. Monster) but when I was seriously looking it was in a more rural region. Even now though, searching for OT jobs in Baltimore only pulls up 9 options. What I do find on sites like this is info for contracting companies, services that run nationwide.
So you can use profession-specific search engines to assist the search. If I remember correctly, I found my first job on the AOTA sponsored OT JobLink. Will this get integrated into OT Connections? Don't know, but it remains a reliable source for finding and communicating w/ employers... like monster, it allows you to upload a resume and have it be searchable or not. If you're an AOTA member (and of course you should be!) then there's no reason not to use this tool. OT Practice has nice color ads organized by region and job type and Advance always has hundreds of ads in the print magazine, you can search their listings as well. 2 other sites come up in a google search, but I haven't used either- OTJobs.com and JobsOT.com. I don't have time to give them a full trial, but I suspect that they are likely to have more national staffing companies than location specific jobs.
If you have a location in mind, it's easy to find links to the Chamber of Commerce for the different areas, you can search for hospitals or nursing homes in the area to see if they list on their website that they're hiring. Also finding local newspapers online will often let you search the help wanted ads. I get a lot of emails and mailers w/ job opportunities (that's actually how I found out about my current job), the other way to find a job is to ask your friends and acquaintences what's open in their area(Hello Facebook!). I still get emails to my school email address from classmates who have job openings at their facilities. Going to conferences big or small will also provide you with a time to network and find out about openings.
Even if you don't see an opening on a company's website, don't assume their not hiring. (Unless it's for the feds, they're pretty clear about when there's an opening) You can always call the rehab department or submit a resume without a specific opening, you will probably have more luck with this if you're willing to do prn work.
Not much to say about choosing a setting, except to keep your options open. It is very possible that you could try something different and find out that you really like it. Going into my last job, I thought that I would prefer the SNF floor over the acute care since it would be more like rehab, and I had no expectations of even participating in pediatrics at all. I didn't know the way I would appreciate those different areas. If you can find a site to give you experience in several different populations and diagnosis types, I'd say that is very valuable. It is much easier to learn to be a specialist after getting a firm grasp on being a generalist, I think.
Once you've found a few places that look promising, go ahead and set up interviews. If you can do all your interviews within the same general time frame, that will be helpful, since each place will probably want to pressure you a bit to commit or decline the opportunity quickly. Just make sure you keep good records of the benefits, daily details, and pros/cons of the different jobs so you don't get confused about what facility had what. More details on acing the interview in another post.
Anyone else have tips for finding a job? Feel free to share. One of my professors used to say that you'd be innundated w/ employment offers once you had a job, so even if prospects look bleak, remember that Job 1 could allow you to find Job 2.
There are a few questions which frame the whole job search, but I think most people have this under control. You should know the constraints of your search. Are you getting married or otherwise needing to stay within a certain geographical region? Do you have others to support or just need to make enough to cover your own expenses? Do you need to start work immediately or can you take some time off after graduation? Thinking about what you need can help you narrow your focus and concentrate on what's important to you.
I think it's easier looking for a job in a specific geographical area than just looking for random jobs anywhere. And while you can do a good portion of your job search from far away, thanks to the wonders of the internet, it is easier to do after you have moved and settled in the area. Not a luxury everyone has, I didn't. I haven't had very good luck searching on the internet sites that cater to all professions (i.e. Monster) but when I was seriously looking it was in a more rural region. Even now though, searching for OT jobs in Baltimore only pulls up 9 options. What I do find on sites like this is info for contracting companies, services that run nationwide.
So you can use profession-specific search engines to assist the search. If I remember correctly, I found my first job on the AOTA sponsored OT JobLink. Will this get integrated into OT Connections? Don't know, but it remains a reliable source for finding and communicating w/ employers... like monster, it allows you to upload a resume and have it be searchable or not. If you're an AOTA member (and of course you should be!) then there's no reason not to use this tool. OT Practice has nice color ads organized by region and job type and Advance always has hundreds of ads in the print magazine, you can search their listings as well. 2 other sites come up in a google search, but I haven't used either- OTJobs.com and JobsOT.com. I don't have time to give them a full trial, but I suspect that they are likely to have more national staffing companies than location specific jobs.
If you have a location in mind, it's easy to find links to the Chamber of Commerce for the different areas, you can search for hospitals or nursing homes in the area to see if they list on their website that they're hiring. Also finding local newspapers online will often let you search the help wanted ads. I get a lot of emails and mailers w/ job opportunities (that's actually how I found out about my current job), the other way to find a job is to ask your friends and acquaintences what's open in their area(Hello Facebook!). I still get emails to my school email address from classmates who have job openings at their facilities. Going to conferences big or small will also provide you with a time to network and find out about openings.
Even if you don't see an opening on a company's website, don't assume their not hiring. (Unless it's for the feds, they're pretty clear about when there's an opening) You can always call the rehab department or submit a resume without a specific opening, you will probably have more luck with this if you're willing to do prn work.
Not much to say about choosing a setting, except to keep your options open. It is very possible that you could try something different and find out that you really like it. Going into my last job, I thought that I would prefer the SNF floor over the acute care since it would be more like rehab, and I had no expectations of even participating in pediatrics at all. I didn't know the way I would appreciate those different areas. If you can find a site to give you experience in several different populations and diagnosis types, I'd say that is very valuable. It is much easier to learn to be a specialist after getting a firm grasp on being a generalist, I think.
Once you've found a few places that look promising, go ahead and set up interviews. If you can do all your interviews within the same general time frame, that will be helpful, since each place will probably want to pressure you a bit to commit or decline the opportunity quickly. Just make sure you keep good records of the benefits, daily details, and pros/cons of the different jobs so you don't get confused about what facility had what. More details on acing the interview in another post.
Anyone else have tips for finding a job? Feel free to share. One of my professors used to say that you'd be innundated w/ employment offers once you had a job, so even if prospects look bleak, remember that Job 1 could allow you to find Job 2.
4.28.2009
Learning to read without getting sick
I have canceled my parking pass and purchased a monthly metro pass, resulting in saving money on gas, reducing my carbon footprint, and increasing my free time in the day. A few days ago I posted about how my leisure time has been all off balance and that I would like to restore some activities, particularly reading books and my OT mags. But to do this, I would have to overcome carsickness...
OK, it's embarrassing, but true, I used to get carsick all the time. Honestly, it's probably all related to my sensory processing differences that were not identified as a child, but that's another story. I did progress in my teens to not needing Dramamine-induced sleep to make it through any trip with a curve in the road, and even was able to watch movies on the TV in our van (not a handheld) with great success. In the past few years though, I would say that I have taken a few steps backward. Fewer journeys out to rural locations for school and girl scouting events have put me out of touch with the country roads, but now at least I am able to drive when feeling ill and thus avert crisis. Never at any time was I able to overcome my vestibular problem and be able to read or operate a handheld device in a moving vehicle, and I can't even remember the last time I tried.
It never made sense to try- the risk was not worth the reward, and I could always talk to my companions. But now I have 30+ minutes of unoccupied silent time on the metro. It is a smooth ride in comparison to other transportation options. I thought that in order to make use of this time for my chosen pursuits that it would be worth it. I am not an expert on inner-ear issues or vestibular function, but it just seems that this system should be trainable. So I am trying-
Day 1- I read straight through my trip, with minimal nausea. On my return trip home, I got a nasty headache in addition to the nausea which persisted through the evening.
Day 2- I tried my husband's idea of reading in brief spurts and then looking up in the train. No discomfort during the trip, but afterwards developed low grade nausea and headache that lasted til bedtime and seemed to get worse through the day.
Neither day a success, obviously, and I am reluctant to try again in the morning as it was a very unpleasant day at work.
I have tried most every product and strategy to alleviate motion sickness in the past. I cannot find my Sea Bands. I cannot take Dramamine in the morning as I will fall asleep, can't take Bonine because it doesn't work for me. Club soda and gingerale are also ineffective. I am thoroughly disappointed by the LACK of information on the internet about anyone trying to overcome this problem and learn to read in the car, most information is on preventing motion sickness in general. The most relevant posting I could find was this monstrosity, and there wasn't even anything on metafilter. This reminds me of the internet of 1996, where it was not uncommon to not find anything on the topic you searched... you could just forget about finding obscure lyrics.
One of my new coworkers is a PT who works with people who have BPPV. (I had been informally tested for this in the past by a PTA and it was negative) But, she has a greater understanding of the inner ear than I do and believes that through some adaptation I should be able to achieve my goal. We are planning a consult for when we are not busy (ha. ha. ha.). Until we can meet and determine a plan of action, I am issuing a call for help from the internet.
I know that reading exacerbates the problem, but it is a MAIN occupation of mine. Trust me, I have heard the suggestion to do audiobooks- it is not a viable solution for me. (for 1, I want to read magazines, 2- I don't process auditory information as thoroughly, 3- reading is a treat for me which is why I want to devote more time to it). So I am taking any sensible ideas for how I can read on the metro that don't have the word "audiobook" in them. If I ever do find something that works, I will post it here, so that at least on some little corner of the internet, there will be information. I can't be the only one who wants to overcome the issue.
OK, it's embarrassing, but true, I used to get carsick all the time. Honestly, it's probably all related to my sensory processing differences that were not identified as a child, but that's another story. I did progress in my teens to not needing Dramamine-induced sleep to make it through any trip with a curve in the road, and even was able to watch movies on the TV in our van (not a handheld) with great success. In the past few years though, I would say that I have taken a few steps backward. Fewer journeys out to rural locations for school and girl scouting events have put me out of touch with the country roads, but now at least I am able to drive when feeling ill and thus avert crisis. Never at any time was I able to overcome my vestibular problem and be able to read or operate a handheld device in a moving vehicle, and I can't even remember the last time I tried.
It never made sense to try- the risk was not worth the reward, and I could always talk to my companions. But now I have 30+ minutes of unoccupied silent time on the metro. It is a smooth ride in comparison to other transportation options. I thought that in order to make use of this time for my chosen pursuits that it would be worth it. I am not an expert on inner-ear issues or vestibular function, but it just seems that this system should be trainable. So I am trying-
Day 1- I read straight through my trip, with minimal nausea. On my return trip home, I got a nasty headache in addition to the nausea which persisted through the evening.
Day 2- I tried my husband's idea of reading in brief spurts and then looking up in the train. No discomfort during the trip, but afterwards developed low grade nausea and headache that lasted til bedtime and seemed to get worse through the day.
Neither day a success, obviously, and I am reluctant to try again in the morning as it was a very unpleasant day at work.
I have tried most every product and strategy to alleviate motion sickness in the past. I cannot find my Sea Bands. I cannot take Dramamine in the morning as I will fall asleep, can't take Bonine because it doesn't work for me. Club soda and gingerale are also ineffective. I am thoroughly disappointed by the LACK of information on the internet about anyone trying to overcome this problem and learn to read in the car, most information is on preventing motion sickness in general. The most relevant posting I could find was this monstrosity, and there wasn't even anything on metafilter. This reminds me of the internet of 1996, where it was not uncommon to not find anything on the topic you searched... you could just forget about finding obscure lyrics.
One of my new coworkers is a PT who works with people who have BPPV. (I had been informally tested for this in the past by a PTA and it was negative) But, she has a greater understanding of the inner ear than I do and believes that through some adaptation I should be able to achieve my goal. We are planning a consult for when we are not busy (ha. ha. ha.). Until we can meet and determine a plan of action, I am issuing a call for help from the internet.
I know that reading exacerbates the problem, but it is a MAIN occupation of mine. Trust me, I have heard the suggestion to do audiobooks- it is not a viable solution for me. (for 1, I want to read magazines, 2- I don't process auditory information as thoroughly, 3- reading is a treat for me which is why I want to devote more time to it). So I am taking any sensible ideas for how I can read on the metro that don't have the word "audiobook" in them. If I ever do find something that works, I will post it here, so that at least on some little corner of the internet, there will be information. I can't be the only one who wants to overcome the issue.
4.26.2009
Another week down
Ok, I'm sure there are people getting sick of hearing about how I'm adjusting to work, so those people should not click on the expander for the full story. Other details coming soon, I promise.
Made it through my second full week of work. It's been an interesting transition. At this point, I still have to ask occasional "how-to" questions of the other therapists or staff (often it's "what's the code to the supply room again?") but for the most part I am on my own. Reflecting back on when I started my first job and my fieldworks, I remember there being a longer period of easing in, getting comfortable, hand holding. I know that on my first licensed day at my first job that I did not pull my fair share in comparison to the COTA- I believe that I would look up 1 pt, formulate a treatment idea, go try to see them. If it didn't work out, I had to come all the way back to the office, and either look up the pt again to try to find something else, or look up someone new and start the process over. It's nice to actually feel that I have grown as a practitioner- I think I've been a lot more useful thus far to this job than I was in my first weeks at my first job.
I know I had talked before about trying to leave on time so that I wasn't working for free... obviously I don't have that down to a science yet. I found that if I left the house early (to try to avoid traffic, etc) and started work early, I still would not be able to drag myself away early at the end of the day. There's always more to be done at the end of the day, I just try to prioritize it. Sometimes a person only has to be cleared by therapy before they can discharge home- nobody wants the hassle and fees of another night in the hospital just because their therapist had worked their 8 hours already. Just trying to balance all that- it is the life of a salaried employee, which I knew coming in.
Learning the computer system has been pretty easy, since I used one of the programs at my previous job. Now I get to tote around a laptop so that I can slide in urgent notes immediately. I am a longtime laptop user (since 2002 my primary computer has been a laptop, and they have been used A LOT) but the added usage of the touchpad is trying to aggravate my RUE into RSI symptoms. Not happy about that, and of course don't want to cut back on personal computer usage, so it is a growing issue. My work computer is a notebook w/ stylus, however, the program we use for documentation does not communicate with the stylus program that lets you write with the pen and guesses your words. This is a major design flaw and I may need to bug my techno-savvy boss into finding something that will work with that documentation program. I will also need to bug her for a mouse, and just use that while at my desk.
I need to create a checklist for work because there's so many different things to do for each pt. in the computer system. Some of it is a little redundant, but it is important to the dept for their QI projects so I need to remember to remember.
I have access to the scrubs machine now, which presents a dilemma. Obviously, it's great to have access to free scrubs whenever, and I think that the experiences I have had with getting nasty stuff on my scrubs and having to sit in a locked OT office in my underwear while I ran them through the washing machine really make me appreciate that I could just get a new clean pair at any time. Hygenically, it seems that it would be best for my pt's and everyone I come into contact with outside the hospital if I wore only hospital scrubs in the hospital and changed into something else for the commute. Economically and time wise, it makes sense not to have to wash scrubs in my incredibly small apartment washing machine. BUT- the work scrubs are ugly icky green, worn by 60% or more of the staff in all departments. So I haven't decided how to balance my need for cool cute tops with everything else, and while this is an incredibly frivolous dilemma, it does affect me.
Hard to believe, but finals week is coming up for many schools, which should bring thousands of new OTs into the burgeoning profession looking for jobs. I will try to get some interviewing/job search tips up here soon, and will really try hard to do that since I forgot about the AOTA conference (again). :( I won't forget next year though- Orlando here I come!
Made it through my second full week of work. It's been an interesting transition. At this point, I still have to ask occasional "how-to" questions of the other therapists or staff (often it's "what's the code to the supply room again?") but for the most part I am on my own. Reflecting back on when I started my first job and my fieldworks, I remember there being a longer period of easing in, getting comfortable, hand holding. I know that on my first licensed day at my first job that I did not pull my fair share in comparison to the COTA- I believe that I would look up 1 pt, formulate a treatment idea, go try to see them. If it didn't work out, I had to come all the way back to the office, and either look up the pt again to try to find something else, or look up someone new and start the process over. It's nice to actually feel that I have grown as a practitioner- I think I've been a lot more useful thus far to this job than I was in my first weeks at my first job.
I know I had talked before about trying to leave on time so that I wasn't working for free... obviously I don't have that down to a science yet. I found that if I left the house early (to try to avoid traffic, etc) and started work early, I still would not be able to drag myself away early at the end of the day. There's always more to be done at the end of the day, I just try to prioritize it. Sometimes a person only has to be cleared by therapy before they can discharge home- nobody wants the hassle and fees of another night in the hospital just because their therapist had worked their 8 hours already. Just trying to balance all that- it is the life of a salaried employee, which I knew coming in.
Learning the computer system has been pretty easy, since I used one of the programs at my previous job. Now I get to tote around a laptop so that I can slide in urgent notes immediately. I am a longtime laptop user (since 2002 my primary computer has been a laptop, and they have been used A LOT) but the added usage of the touchpad is trying to aggravate my RUE into RSI symptoms. Not happy about that, and of course don't want to cut back on personal computer usage, so it is a growing issue. My work computer is a notebook w/ stylus, however, the program we use for documentation does not communicate with the stylus program that lets you write with the pen and guesses your words. This is a major design flaw and I may need to bug my techno-savvy boss into finding something that will work with that documentation program. I will also need to bug her for a mouse, and just use that while at my desk.
I need to create a checklist for work because there's so many different things to do for each pt. in the computer system. Some of it is a little redundant, but it is important to the dept for their QI projects so I need to remember to remember.
I have access to the scrubs machine now, which presents a dilemma. Obviously, it's great to have access to free scrubs whenever, and I think that the experiences I have had with getting nasty stuff on my scrubs and having to sit in a locked OT office in my underwear while I ran them through the washing machine really make me appreciate that I could just get a new clean pair at any time. Hygenically, it seems that it would be best for my pt's and everyone I come into contact with outside the hospital if I wore only hospital scrubs in the hospital and changed into something else for the commute. Economically and time wise, it makes sense not to have to wash scrubs in my incredibly small apartment washing machine. BUT- the work scrubs are ugly icky green, worn by 60% or more of the staff in all departments. So I haven't decided how to balance my need for cool cute tops with everything else, and while this is an incredibly frivolous dilemma, it does affect me.
Hard to believe, but finals week is coming up for many schools, which should bring thousands of new OTs into the burgeoning profession looking for jobs. I will try to get some interviewing/job search tips up here soon, and will really try hard to do that since I forgot about the AOTA conference (again). :( I won't forget next year though- Orlando here I come!
4.21.2009
Still adjusting, and occupational balance is out of whack
I am continuing to adjust to my new job, and it seems to be going ok. So far I have been able to get a fair amount accomplished without working free hours (oh the bane of being salaried...) so hopefully that will continue to go well. Having some other difficulties though.
Remember those "balance your life" worksheets, with the clock face that you colored in depicting how you spent your day- leisure, work, and uh... whatever the 2 other things are? Drudgery? Self care? I don't know, I haven't had a copy since school. Anyway, I have been feeling quite out of balance lately. I think that I have a decent amount of work and leisure time, but I could probably use more sleep at night. And the added commute is eating up time that could be spent in other ways, and adding a lot of stress as well. The biggest problem though, is that I don't think my various leisure activities are balanced. For example...
My leisure activities:
- reading internet sites, newspapers, blogs
- email, facebook
- video games (animal crossing has edged out all other competitors for several months, which is itself out of balance)
- exercise
- spending time with husband
- talking to family
- making blog posts
- reading OT magazines
- reading novels
- watching TV (House, Big Bang Theory, CSI are the only current shows. Cartoons when I remember)
- travels (day trips, weddings, parties)
- puzzles (crosswords, sudoku, jigsaw)
- outdoorsy stuff (camping, canoeing... it's been so long)
This is list different than last year and the year before. I have removed activities- no more fantasy baseball as it was eating my time; no softball or girl scouts since the move since I am trying to adjust to the new city. But I am finding that some of these things are not getting done at all (exercising! OT mags! what happened?!) and that I am wishing I spent more time doing other things, but am limited in the overall time that I have. I have tried doubling up and doing 2 things at once, or being really devoted to one item for awhile, but neither have been really successful. I am afraid I will have to cut again and feel like I'm missing out.
My current plan:
I. Eliminate driving by using public transportation
(this should reduce some stress, save some money, and that cannot be bad.)
1. Figure out bus, metro, and shuttle routes (mostly done)
2. take trial runs to figure out timing
3. cancel parking pass at office
4. Benefit from extra time
A. learn to read on public transit without getting carsick
II. Make better use of time at home
(limited to ~4.5 hours between work and bed)
1. Start exercising again
2. Cut down on worthless internet time
3. Decrease days playing Animal Crossing (it's just so darn addictive!)
It's hard because I have diverse interests and I hate telling myself 'no' when I want to do something relaxing or fun. Also I am near the point of elimination on some hobbies and internet things... I feel like I just need to get rid of a lot and start from scratch. It is so easy to spot the lack of balance in another person's life, but it is hard to fix it in your own. And now it's bedtime again (sigh) so I will have to call this to a close and just try to work in these directions tomorrow so that each day gets a little better.
Remember those "balance your life" worksheets, with the clock face that you colored in depicting how you spent your day- leisure, work, and uh... whatever the 2 other things are? Drudgery? Self care? I don't know, I haven't had a copy since school. Anyway, I have been feeling quite out of balance lately. I think that I have a decent amount of work and leisure time, but I could probably use more sleep at night. And the added commute is eating up time that could be spent in other ways, and adding a lot of stress as well. The biggest problem though, is that I don't think my various leisure activities are balanced. For example...
My leisure activities:
- reading internet sites, newspapers, blogs
- email, facebook
- video games (animal crossing has edged out all other competitors for several months, which is itself out of balance)
- exercise
- spending time with husband
- talking to family
- making blog posts
- reading OT magazines
- reading novels
- watching TV (House, Big Bang Theory, CSI are the only current shows. Cartoons when I remember)
- travels (day trips, weddings, parties)
- puzzles (crosswords, sudoku, jigsaw)
- outdoorsy stuff (camping, canoeing... it's been so long)
This is list different than last year and the year before. I have removed activities- no more fantasy baseball as it was eating my time; no softball or girl scouts since the move since I am trying to adjust to the new city. But I am finding that some of these things are not getting done at all (exercising! OT mags! what happened?!) and that I am wishing I spent more time doing other things, but am limited in the overall time that I have. I have tried doubling up and doing 2 things at once, or being really devoted to one item for awhile, but neither have been really successful. I am afraid I will have to cut again and feel like I'm missing out.
My current plan:
I. Eliminate driving by using public transportation
(this should reduce some stress, save some money, and that cannot be bad.)
1. Figure out bus, metro, and shuttle routes (mostly done)
2. take trial runs to figure out timing
3. cancel parking pass at office
4. Benefit from extra time
A. learn to read on public transit without getting carsick
II. Make better use of time at home
(limited to ~4.5 hours between work and bed)
1. Start exercising again
2. Cut down on worthless internet time
3. Decrease days playing Animal Crossing (it's just so darn addictive!)
It's hard because I have diverse interests and I hate telling myself 'no' when I want to do something relaxing or fun. Also I am near the point of elimination on some hobbies and internet things... I feel like I just need to get rid of a lot and start from scratch. It is so easy to spot the lack of balance in another person's life, but it is hard to fix it in your own. And now it's bedtime again (sigh) so I will have to call this to a close and just try to work in these directions tomorrow so that each day gets a little better.
4.14.2009
Long Term Goals
This is a cross post from OT Connections, but I thought I might get quicker and more diverse responses here.
For goal writing, I was taught that your STGs should be directly related to your LTGs, and that they should all be able to be achieved in the timeframe for the facility. In acute care, therefore, a LTG could be set for only 1-2 weeks. However, my new employer says that their policy is that the LTGs are the overarching goals for the pt when they are completely rehabilitated. This would include driving independently, resuming work, being completely independent. They claim that this is how Medicare wants to see the goals, but it doesn't make sense to me. A goal of driving independently in the acute care setting is not achievable, realistic, or fitting the timetable of therapy. I don't understand why my goals for a pt. in a short term setting would have to encompass the potential months of additional therapy that the pt. should receive, especially when there is no firm discharge plan. Has anyone else heard that this is the "preferred" way of writing goals? Is anyone using these as their only LTG? Thoughts please...
For goal writing, I was taught that your STGs should be directly related to your LTGs, and that they should all be able to be achieved in the timeframe for the facility. In acute care, therefore, a LTG could be set for only 1-2 weeks. However, my new employer says that their policy is that the LTGs are the overarching goals for the pt when they are completely rehabilitated. This would include driving independently, resuming work, being completely independent. They claim that this is how Medicare wants to see the goals, but it doesn't make sense to me. A goal of driving independently in the acute care setting is not achievable, realistic, or fitting the timetable of therapy. I don't understand why my goals for a pt. in a short term setting would have to encompass the potential months of additional therapy that the pt. should receive, especially when there is no firm discharge plan. Has anyone else heard that this is the "preferred" way of writing goals? Is anyone using these as their only LTG? Thoughts please...
4.12.2009
First week done, second week coming
Made it through the first week!
It's strange going back to work after an absence, especially when you're starting all over in a new place. Spent 2 days in orientation classes, learning about 'service excellence' and the ins and outs of all the benefits and whatnot. Sat next to another Cheryl, who has the same middle initial and a very similar last name as I do, which was amusing. Part of the difference between this job's orientation and my last, besides the extra day, was at my last job, we took a 30 minute tour around the hospital. For this job, I got multiple maps of the campus and a driving tour, and my boss has been orienting me to the things inside the hospital. I hope to one day know where I am going! :)
Navigating to the job has also been a challenge, tomtom has done a good job keeping me from being hopelessly lost in the big city. I kinda got pressured into buying a month's parking pass during the first 10 minutes of orientation and didn't have enough time to research all my options. Now that I have some time to look into it, I think that I will be able to commute for the same time or less using some combination of metro/bus/hospital shuttle. That would make my environmentalist side happy, and also my "I hate driving" side. I knew from my fieldwork in Arlington that cities with good public transit programs often have kickbacks through the employer and/or the local taxes if you use the mass transit. So I hope to get that figured out and the kinks ironed out before I would have to pay for another month. (and yes, I think paying to park at your place of employment is the pits.)
I was also really cheesed off about my flexible spending account from my last employer- I knew that you had to spend that money before the end of the year... I learned that if you terminate employment, you have to spend that money within 30 days. I learned this after that time had expired. I had attributed it just to that employer, but the new employer's HR people have the same policy, so it must be some federal rule or some such. Obviously, those things can be helpful, but I've been burned 2x over on them and probably won't get another one unless I'm planning LASIK, baby birth, or some sort of elective large procedure.
I spent the other 3 days of the week getting oriented to the rehab department, getting followed around while doing evals, learning the computer system, hoping that I was calling people by the right names. I am on a team of 7 therapists for the general medicine floor, and I know a couple of the nurses and case managers now too. A PA had concerns about sending one of her pt's home, said to me, "She doesn't really need PT, but she really needs OT. I need to know whether she can be safe at home. Page me as soon as you're done." So that was nice, since we usually hear the opposite of that, and it's nice to be able to just text page all the important people if you need anything.
So tomorrow I start being a real worker, which will probably mean at least 5 evals a day and trying to follow up with other pt's as well. I've been trying to balance my evenings with my leisure activities and exercise before my husband makes it home, I'm still working that all out. One of my goals in this switch from being an hourly employee to a salaried employee is to not wind up working a million extra free hours and lose all my free time. Also, if this week is any indication, I might actually be getting better at handling mornings. Whether this is the 30 minute shift of the work schedule, or the increased commute time, or the increased time that I am awake before being expected to work, I don't know.
It's strange going back to work after an absence, especially when you're starting all over in a new place. Spent 2 days in orientation classes, learning about 'service excellence' and the ins and outs of all the benefits and whatnot. Sat next to another Cheryl, who has the same middle initial and a very similar last name as I do, which was amusing. Part of the difference between this job's orientation and my last, besides the extra day, was at my last job, we took a 30 minute tour around the hospital. For this job, I got multiple maps of the campus and a driving tour, and my boss has been orienting me to the things inside the hospital. I hope to one day know where I am going! :)
Navigating to the job has also been a challenge, tomtom has done a good job keeping me from being hopelessly lost in the big city. I kinda got pressured into buying a month's parking pass during the first 10 minutes of orientation and didn't have enough time to research all my options. Now that I have some time to look into it, I think that I will be able to commute for the same time or less using some combination of metro/bus/hospital shuttle. That would make my environmentalist side happy, and also my "I hate driving" side. I knew from my fieldwork in Arlington that cities with good public transit programs often have kickbacks through the employer and/or the local taxes if you use the mass transit. So I hope to get that figured out and the kinks ironed out before I would have to pay for another month. (and yes, I think paying to park at your place of employment is the pits.)
I was also really cheesed off about my flexible spending account from my last employer- I knew that you had to spend that money before the end of the year... I learned that if you terminate employment, you have to spend that money within 30 days. I learned this after that time had expired. I had attributed it just to that employer, but the new employer's HR people have the same policy, so it must be some federal rule or some such. Obviously, those things can be helpful, but I've been burned 2x over on them and probably won't get another one unless I'm planning LASIK, baby birth, or some sort of elective large procedure.
I spent the other 3 days of the week getting oriented to the rehab department, getting followed around while doing evals, learning the computer system, hoping that I was calling people by the right names. I am on a team of 7 therapists for the general medicine floor, and I know a couple of the nurses and case managers now too. A PA had concerns about sending one of her pt's home, said to me, "She doesn't really need PT, but she really needs OT. I need to know whether she can be safe at home. Page me as soon as you're done." So that was nice, since we usually hear the opposite of that, and it's nice to be able to just text page all the important people if you need anything.
So tomorrow I start being a real worker, which will probably mean at least 5 evals a day and trying to follow up with other pt's as well. I've been trying to balance my evenings with my leisure activities and exercise before my husband makes it home, I'm still working that all out. One of my goals in this switch from being an hourly employee to a salaried employee is to not wind up working a million extra free hours and lose all my free time. Also, if this week is any indication, I might actually be getting better at handling mornings. Whether this is the 30 minute shift of the work schedule, or the increased commute time, or the increased time that I am awake before being expected to work, I don't know.
4.05.2009
Eve of New Things
New job starts tomorrow...
2 days of orientation and then it's back to work for me. I had some goals during this transition time... packing, moving, unpacking, exercise, make lots of updates. Ended up spending more time decompressing than anything else, and the past week I pretty much ground to a dead stop on the unpacking business. But all the boxes are gone, now it's just the more mundane decisions of where the t-shirts go and whether to unpack all the books. So that just couldn't achieve a high priority for me. With the busy week up ahead, don't know if I'll find a lot of blogging time, but here are some future updates that are officially "in the works" and should be out soon.
-Video on making a fidget bag
- Beginning the Energy Conservation series
- Preparing for a job interview
- Making the most of the AOTA conference
- What to do if you don't get into OT school
Though my original plan was to spend the last week getting up at "work time" with my husband, my love of sleep won out. I was good in that I didn't sleep in to the extremes (no 1130 wake up calls) but it will still be an adjustment. OT is hard on my nocturnal temperament.
2 days of orientation and then it's back to work for me. I had some goals during this transition time... packing, moving, unpacking, exercise, make lots of updates. Ended up spending more time decompressing than anything else, and the past week I pretty much ground to a dead stop on the unpacking business. But all the boxes are gone, now it's just the more mundane decisions of where the t-shirts go and whether to unpack all the books. So that just couldn't achieve a high priority for me. With the busy week up ahead, don't know if I'll find a lot of blogging time, but here are some future updates that are officially "in the works" and should be out soon.
-Video on making a fidget bag
- Beginning the Energy Conservation series
- Preparing for a job interview
- Making the most of the AOTA conference
- What to do if you don't get into OT school
Though my original plan was to spend the last week getting up at "work time" with my husband, my love of sleep won out. I was good in that I didn't sleep in to the extremes (no 1130 wake up calls) but it will still be an adjustment. OT is hard on my nocturnal temperament.
4.02.2009
Jobsite Analysis
So I did complete my jobsite analysis long ago, and it was actually simpler than I expected. I was evaluating a worker in the microbiology lab with a diagnosis of writer's cramp. I am finally getting this written up for the blog carnival on clinical reasoning, so make sure that you check that out. If you're new to this blog, perhaps forwarded from the carnival, please be patient since I tend to write long entries :)
OK, background information, since this happened so long ago. As a hospital OT, I was asked as a courtesy to perform a worksite evaluation of a woman ("Wilma") who was having difficulty at work due to a diagnosis of writer's cramp. Before I was asked to do this, I had no experience in work hardening outside of school classes, virtually no experience in hand therapy, or any idea what life was like in the microbiology lab. I was a little bored and willing to take on a challenge, so that's how the eval fell to me. Please note- there is a significant difference between the clinical reasoning used by novice, intermediate, and experienced practitioners; that was all fleshed out in a recent OT Practice CE article. I am not claiming to have an experienced level of reasoning, I just did my best.
My first thought was shock that "writer's cramp" was an actual neurological diagnosis. I mean, I have played Operation, and have had significant pain after essay tests in college filling up Blue Books, but I had no idea that this was real. So I looked online for information on the diagnosis from reliable sites, which included eMedicine, Merck Manual Medical Library, and Medpedia. I learned that this was a focal dystonia and a repetitive strain injury (RSI) that would likely cause increased pain and decreased grip force on small objects.
Next, I went back to my OT bookshelf. I still have many of my texts, but especially those for topics that I found interesting or complex. (I have found it unfortunate how much I have already forgotten from school in topics that have been outside my realm of practice) From my book, I was able to review environmental factors that exacerbate RSIs and go through case studies involving worksite evaluations for desk workers. My book was nice in that it also came with some ready-made forms to record measurements of various workstation pieces (example- depth of chair pan, height of chair from floor). I also asked my coworker if I could review a writeup that he had done for a different person, so I could get an idea of what was expected.
I was feeling more prepared, but still didn't know what to expect in Wilma's office. What does a person in a microbiology lab do? Where to find out? My favorite source for torturing my Girl Scouts when they're doing a career badge- The O*Net. If you haven't used the O*Net before, it's a great resource that has cataloged thousands of jobs, the skills required for each, the expected salary and job outlook for each. So I was able to pull up "Biological Technician," which gave me a few brief ideas aobut what to expect.
After gathering all this information, I spent some time trying to brainstorm possible problems that Wilma might be having. Writing, obviously, but I also thought that she might have some difficulty with manipulating other small-diameter tools, keyboarding, opening or stirring containers.
The morning of the evaluation, I got my tools together- a notebook, copies of the measurement forms from my book, digital camera, tape measure, and a goniometer.
I met with Wilma at the beginning of the day since that is when the bulk of her work was done. I asked her to describe the problem, describe the pain she was having, what made it better or worse and what she had already tried to do to fix the problem. I also asked about what she had done medically- neurologist visit, MRI, EMG, etc. Then I let Wilma go ahead and start her workday, trying to see as many of her essential job functions as possible, and asking her to report anything that caused discomfort or decreased grip. I observed the tools that she interacted with, and any time I saw something that was on my list of possible pain causers or looked like it would aggravate the RSI, I asked specifically aobut that. That included vibration, twisting, squeezing, of various tools including pipettes and cotton swabs. I also took some measurements (not a full spectrum of them) related to the position of Wilma's UE to the work surfaces.
My client was quite reticent throughout the eval, and had relatively few issues. She really only complained of difficulty writing, not with any of the other tools. I knew from my education on RSIs, phyical disabilities and assistive technology that to decrease problems from a tight grip on a small object, that the person would need to change the shape of the grip or the amount of force taken to maintain the grip. I tried to include a variety of high and low tech solutions in my suggestions, and also address other issues that I felt could potentially be a problem to Wilma.
I have the summary writeup in a google document (as always, please be respectful and do not plagiarize my work). All the photos are from Sammons/Preston to give the reader a better idea of the different tools. If it had been me, I would have pushed for a label maker, because I think that would be best for efficiency sake (that and I love labelmakers anyway). I also found a $0.49 pen shaped similar to the PenAgain in a drugstore months later, so there are other options out there in the mainstream. I didn't get any follow up from this client, so I don't know what she chose to do, but I did leave the door open so that if she had any questions or problems later she could contact the department.
So that's the thought process that carried me, an inexperienced practitioner, through my first worksite eval. If anything, I think it was worth it just to get the experience and learn that I do have the foundation for a different type of practice.
OK, background information, since this happened so long ago. As a hospital OT, I was asked as a courtesy to perform a worksite evaluation of a woman ("Wilma") who was having difficulty at work due to a diagnosis of writer's cramp. Before I was asked to do this, I had no experience in work hardening outside of school classes, virtually no experience in hand therapy, or any idea what life was like in the microbiology lab. I was a little bored and willing to take on a challenge, so that's how the eval fell to me. Please note- there is a significant difference between the clinical reasoning used by novice, intermediate, and experienced practitioners; that was all fleshed out in a recent OT Practice CE article. I am not claiming to have an experienced level of reasoning, I just did my best.
My first thought was shock that "writer's cramp" was an actual neurological diagnosis. I mean, I have played Operation, and have had significant pain after essay tests in college filling up Blue Books, but I had no idea that this was real. So I looked online for information on the diagnosis from reliable sites, which included eMedicine, Merck Manual Medical Library, and Medpedia. I learned that this was a focal dystonia and a repetitive strain injury (RSI) that would likely cause increased pain and decreased grip force on small objects.
Next, I went back to my OT bookshelf. I still have many of my texts, but especially those for topics that I found interesting or complex. (I have found it unfortunate how much I have already forgotten from school in topics that have been outside my realm of practice) From my book, I was able to review environmental factors that exacerbate RSIs and go through case studies involving worksite evaluations for desk workers. My book was nice in that it also came with some ready-made forms to record measurements of various workstation pieces (example- depth of chair pan, height of chair from floor). I also asked my coworker if I could review a writeup that he had done for a different person, so I could get an idea of what was expected.
I was feeling more prepared, but still didn't know what to expect in Wilma's office. What does a person in a microbiology lab do? Where to find out? My favorite source for torturing my Girl Scouts when they're doing a career badge- The O*Net. If you haven't used the O*Net before, it's a great resource that has cataloged thousands of jobs, the skills required for each, the expected salary and job outlook for each. So I was able to pull up "Biological Technician," which gave me a few brief ideas aobut what to expect.
After gathering all this information, I spent some time trying to brainstorm possible problems that Wilma might be having. Writing, obviously, but I also thought that she might have some difficulty with manipulating other small-diameter tools, keyboarding, opening or stirring containers.
The morning of the evaluation, I got my tools together- a notebook, copies of the measurement forms from my book, digital camera, tape measure, and a goniometer.
I met with Wilma at the beginning of the day since that is when the bulk of her work was done. I asked her to describe the problem, describe the pain she was having, what made it better or worse and what she had already tried to do to fix the problem. I also asked about what she had done medically- neurologist visit, MRI, EMG, etc. Then I let Wilma go ahead and start her workday, trying to see as many of her essential job functions as possible, and asking her to report anything that caused discomfort or decreased grip. I observed the tools that she interacted with, and any time I saw something that was on my list of possible pain causers or looked like it would aggravate the RSI, I asked specifically aobut that. That included vibration, twisting, squeezing, of various tools including pipettes and cotton swabs. I also took some measurements (not a full spectrum of them) related to the position of Wilma's UE to the work surfaces.
My client was quite reticent throughout the eval, and had relatively few issues. She really only complained of difficulty writing, not with any of the other tools. I knew from my education on RSIs, phyical disabilities and assistive technology that to decrease problems from a tight grip on a small object, that the person would need to change the shape of the grip or the amount of force taken to maintain the grip. I tried to include a variety of high and low tech solutions in my suggestions, and also address other issues that I felt could potentially be a problem to Wilma.
I have the summary writeup in a google document (as always, please be respectful and do not plagiarize my work). All the photos are from Sammons/Preston to give the reader a better idea of the different tools. If it had been me, I would have pushed for a label maker, because I think that would be best for efficiency sake (that and I love labelmakers anyway). I also found a $0.49 pen shaped similar to the PenAgain in a drugstore months later, so there are other options out there in the mainstream. I didn't get any follow up from this client, so I don't know what she chose to do, but I did leave the door open so that if she had any questions or problems later she could contact the department.
So that's the thought process that carried me, an inexperienced practitioner, through my first worksite eval. If anything, I think it was worth it just to get the experience and learn that I do have the foundation for a different type of practice.
3.31.2009
a human behavior refresher
The recent moving situation has been giving my empathy organ a refresher.
Basic psych/neuro instructs that our brain forms schemas to help us understand situations. Tied in there are the motor plans for different actions and the mental maps to help navigate the environment. When these systems work perfectly, we perform actions without even thinking about it- like sitting down in a chair, touch typing, or walking to the bathroom. This is how most people spend the majority of their days, performing routine tasks without being mentally or physically challenged in the least, not devoting even 1 additional brain cell to the task.
However, the people that I see in the hospital are experiencing disruptions in these schemas. It's easy for staff to forget that their patients are not always disoriented x2, struggling to sit down, struggling with walker usage, and just generally getting confused. But this is often just a variation of a person thrown into an unfamiliar situation. Example: I moved. Everything is in a different place. Our bathrooms have a marble threshold, which I am terribly worried about breaking my toes on. Because when you wake up in the middle of the night and walk without turning the light on, you're relying on those old brain maps to get around. And my brain map does not include marble thresholds!
Another recent situation is reminiscent of what pts with joint replacement are going through. I have started exercising again, and hopefully will stick with it, or else my friend may drive out here just to kick my butt. I have been in the Contemplation stage of the Transtheoretical Model of Change for some time, but have spent the past 2 days in Action! Action is a phase that makes muscles hurt and act in different ways... and trying to motor plan simple actions like sitting down, getting out of bed, or going down stairs when your quadriceps have failed to respond in a normal manner is very difficult! So as I require 2 handholds and a dramatically increased amount of time to accomplish sitting or navigating stairs, I think of those who have had surgeons hands pulling their muscles apart and shoving in new bone parts in the last 24 hours.
So I am resolving to start my new job with a renewed sense of empathy, considering that like my pts, I will be in an unfamiliar environment and unsure of things.
Basic psych/neuro instructs that our brain forms schemas to help us understand situations. Tied in there are the motor plans for different actions and the mental maps to help navigate the environment. When these systems work perfectly, we perform actions without even thinking about it- like sitting down in a chair, touch typing, or walking to the bathroom. This is how most people spend the majority of their days, performing routine tasks without being mentally or physically challenged in the least, not devoting even 1 additional brain cell to the task.
However, the people that I see in the hospital are experiencing disruptions in these schemas. It's easy for staff to forget that their patients are not always disoriented x2, struggling to sit down, struggling with walker usage, and just generally getting confused. But this is often just a variation of a person thrown into an unfamiliar situation. Example: I moved. Everything is in a different place. Our bathrooms have a marble threshold, which I am terribly worried about breaking my toes on. Because when you wake up in the middle of the night and walk without turning the light on, you're relying on those old brain maps to get around. And my brain map does not include marble thresholds!
Another recent situation is reminiscent of what pts with joint replacement are going through. I have started exercising again, and hopefully will stick with it, or else my friend may drive out here just to kick my butt. I have been in the Contemplation stage of the Transtheoretical Model of Change for some time, but have spent the past 2 days in Action! Action is a phase that makes muscles hurt and act in different ways... and trying to motor plan simple actions like sitting down, getting out of bed, or going down stairs when your quadriceps have failed to respond in a normal manner is very difficult! So as I require 2 handholds and a dramatically increased amount of time to accomplish sitting or navigating stairs, I think of those who have had surgeons hands pulling their muscles apart and shoving in new bone parts in the last 24 hours.
So I am resolving to start my new job with a renewed sense of empathy, considering that like my pts, I will be in an unfamiliar environment and unsure of things.
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