Every setting has its own complex rules and regulations, but it seems that the Skilled Nursing Facilities (SNF) get more than their fair share. Payment for therapy services rendered is dependent upon meeting a set number of minutes in a pt's week (starting on their admission). To be even more complicated, I have heard that the first week's payment actually is a prospective payment for the second week... I cannot go into that as it is far too dizzying. At any rate, a pt. must be seen for at least 15 minutes to count as a 'day' of therapy. In addition to meeting a certain number of minutes of therapy per 7 days, there are also requirements of how many 'days' of therapy a person needs.
blah blah blah paperwork.
So here's where the holidays wreak havoc. If pt. X is admitted on Wednesday the 27th (and is evaluated and treated that day, not a given), they will need 4 more 'days' of treatment for most levels. So between Saturday, Sunday, and Labor Day, this pt. will have to be seen by at least one therapy, and will likely have to make up extra time during the regular work week. So for any pt. that is in their first 14 days, there is a crush to get extra time. Also, this is why most SNFs require therapists to work weekends and many holidays. Kind of a bummer.
Another bummer from the 'days' side of things has been happening a lot at my place recently. A person cannot be discharged from the hospital and admitted to the SNF floor w/o a doctor's order. So even if all the plans have been made through case management and the SNF admission planner, if no one writes an order, the pt. sits and languishes in hospital bed limbo. Also, the therapist's wobble and wait for word on whether the pt. will come that day, night, or the next. You can wait around, have a pt. show up at 4:55 and wind up working over. Or you can wait around for naught since they won't show til 8:30. Regardless of whether they are evaluated or not, treated or not, that still starts their week and leaves only 6 more days to work. And if you just happen to have a person who is too sick to participate 1 or 2 days... it just makes it all harder.
I gave my best today to try to be extra motivating to my lil' ladies down my hallway... especially since I shant be helping the rest of the team again until Tuesday (which also starts new peds sched). I am taking an extended weekend to go home and decrease my loneliness by visiting w/ friends and family. I have been doing fair with my goals... 2 social activities this week and 1 trip to the rec center, a finished jigsaw puzzle, another load of laundry, and a nice long phone call with a friend. But the townhouse gets quiet. So posts might be less frequent than planned this weekend, but at least I'll be having fun. :)
PS- funny note: Laughed a lot the other day as an MD stalled out his manual-transmission sports car while trying to key in the password to the MD lot on a teeny tiny slope. I don't drive a stick very well, but I also didn't drop BIG BUCKS on a fancy schmancy sports car. :-P
8.23.2008
Pondering the future
In the same way that working with elderly clients can make you a little morbid, it can also have you question your future. Specifically- what kind of old lady am I going to be? Cranky in the morning, but that's a given. Are my popping knees going to deteriorate badly enough for me to need replacements? Will I be a regarded as a whiny wuss during my rehab by a bunch of young punks? Will I get osteoporosis and become the new record holder for most fractures? Will my rehab from whatever afflicts me go slow, and require me to toil away at a long term SNF for months on end when all I want to do is go home? Will my family offer me physical assistance or leave me to languish alone? Will my body decay before my mind, or vice versa?
I don't worry about this stuff too often (although the knee replacement issue does eat at the back of my mind) but it is interesting to contemplate. I try to adapt my approach to different age groups. I can be a real dictator for the under-60 joint replacements, but do try to show my kinder, gentler side to the 85+ crowd. Not that I'm not nice to everyone, but I'm more likely to let an older pt. say, "I'm too tired" and have it be enough to call off a treatment. I try to impress more on the older clients that they can refuse treatment, that they can take rest breaks, because more often than not they feel obligated to participate as much as physically possible, and really do need the rest. For those of you who haven't worked in a SNF or other environment with the elderly, you've probably never contemplated the physical exercise and strain of sitting up in a chair for the morning. I know with the 85+ crowd that the physically/mentally straining activities need to be in the morning, before sitting up too long tires them out. If I do anything in the afternoon, I usually preface it with "I only need a few minutes" or "we just need to do 1 thing today" or "we will do this and go back to bed." Please don't send me emails about how I'm simplifying this too much or patronizing my clients... this is just a description of the typical response for the age group, not your overly active grandma.
I also ponder my near future a good deal. I have a habit of throwing myself into whatever I'm currently doing, which sometimes makes it hard to plan farther ahead. I've been investing a lot of time into pediatric and sensory stuff, even though that wasn't an area that I thought I'd ever go into before I started this job. I don't want to leave this knowledge behind and start from scratch on my next job, but I don't know what exactly I want to do on my next job. Or the rest of my life. This is part of why I went into OT as a student- because there are lots of options and you can completely change your daily job life without needing more education. But, I don't want to keep starting from scratch bouncing into different settings. I've often thought that my next job should be back into that demanding world of inpatient rehab, but that can really be stressful. I don't have the experience at this point to go to a top-shelf place, and also don't know if I could take the pressure. I feel a responsibility to myself and a lot of different people to do great things, go great places, live up to potential. Probably more of my 'great things' that I actually end up doing will be pretty mundane and in small places, and deep down I know that's ok too and that no one will be disappointed. Still... need some good career goals.
I don't worry about this stuff too often (although the knee replacement issue does eat at the back of my mind) but it is interesting to contemplate. I try to adapt my approach to different age groups. I can be a real dictator for the under-60 joint replacements, but do try to show my kinder, gentler side to the 85+ crowd. Not that I'm not nice to everyone, but I'm more likely to let an older pt. say, "I'm too tired" and have it be enough to call off a treatment. I try to impress more on the older clients that they can refuse treatment, that they can take rest breaks, because more often than not they feel obligated to participate as much as physically possible, and really do need the rest. For those of you who haven't worked in a SNF or other environment with the elderly, you've probably never contemplated the physical exercise and strain of sitting up in a chair for the morning. I know with the 85+ crowd that the physically/mentally straining activities need to be in the morning, before sitting up too long tires them out. If I do anything in the afternoon, I usually preface it with "I only need a few minutes" or "we just need to do 1 thing today" or "we will do this and go back to bed." Please don't send me emails about how I'm simplifying this too much or patronizing my clients... this is just a description of the typical response for the age group, not your overly active grandma.
I also ponder my near future a good deal. I have a habit of throwing myself into whatever I'm currently doing, which sometimes makes it hard to plan farther ahead. I've been investing a lot of time into pediatric and sensory stuff, even though that wasn't an area that I thought I'd ever go into before I started this job. I don't want to leave this knowledge behind and start from scratch on my next job, but I don't know what exactly I want to do on my next job. Or the rest of my life. This is part of why I went into OT as a student- because there are lots of options and you can completely change your daily job life without needing more education. But, I don't want to keep starting from scratch bouncing into different settings. I've often thought that my next job should be back into that demanding world of inpatient rehab, but that can really be stressful. I don't have the experience at this point to go to a top-shelf place, and also don't know if I could take the pressure. I feel a responsibility to myself and a lot of different people to do great things, go great places, live up to potential. Probably more of my 'great things' that I actually end up doing will be pretty mundane and in small places, and deep down I know that's ok too and that no one will be disappointed. Still... need some good career goals.
8.22.2008
Things that make you go ugh!
Life is never without irony. So, the day after I write up a nice thing on paperwork and goal writing, I discover that I had totally neglected to write goals for a child that I had seen for the eval and an additional session to do the Peabody. I rarely delay documentation and really don't know what I was thinking this time, but it had to be done today since he is on the COTA's schedule next. Must have some kind of treatment plan to begin the collaboration.
In other, crappier, news, we have had more ICU patients than usual. One of them had been doing pretty well and went into a coma. He died yesterday. One had gotten better, moved to the regular unit and even down to the transitional care unit. A few hours after his transfer to the SNF floor, he developed some additional cardiac problems and wound up back in ICU. One has been undergoing very limited treatment, mostly PROM, w/o much progress for 2 weeks or more. One was an outpatient who developed CHF and respiratory failure- her future is bleak.
One of the reasons I went into OT was because I didn't want to be dealing with life and death emergencies. I like my patients to get better, go home, stay out of the hospital. Unfortunately, in the hospital and/or SNF setting, that is not always the case. It's a little morbid, but fairly common, for hospital staff (therapy included) to be regular checkers of the local obituaries. And no matter how uncomfortable it makes us as therapists, there are moments that we do endanger our patients- not knowingly, but still. Several months ago, when I had the patient fall, we didn't know it at the time, but she had developed A-fib and was going into renal failure. She left the SNF floor for ICU no more than a day after we had the fall.
Sometimes the only thing standing between you and disaster is an experienced coworker. There's been a number of times when the rehab aide has taken a look at a patient and advised to lay off, or noticed diaphoresis early... she's probably stopped a lot of falls and other problems just from experience and observation skills. Mad props to her- and attention students- don't rule anybody out as a potential teacher. There are a lot times when your masters/doctorate degree doesn't mean a thing next to someone's experienced observations or practical skills they've developed over time. Make friends with these people, they will save you from being an idiot time an again.
One happy ICU story to mix in with all this sad stuff. Mrs. P was a middle age woman admitted w/ anoxic BI. When we first eval'd her, she was quite flat and making slow progress. Then she got bumped into ICU and was unresponsive for several days. Then... we got orders to resume therapy as she moved out to the regular floor. She was showing good memory, emotion, and moving so much better. It was as if she came out of the coma doing much better than when she went in. She's home now, and hopefully continuing to improve. If not, I guess I'll see it in the paper...
In other, crappier, news, we have had more ICU patients than usual. One of them had been doing pretty well and went into a coma. He died yesterday. One had gotten better, moved to the regular unit and even down to the transitional care unit. A few hours after his transfer to the SNF floor, he developed some additional cardiac problems and wound up back in ICU. One has been undergoing very limited treatment, mostly PROM, w/o much progress for 2 weeks or more. One was an outpatient who developed CHF and respiratory failure- her future is bleak.
One of the reasons I went into OT was because I didn't want to be dealing with life and death emergencies. I like my patients to get better, go home, stay out of the hospital. Unfortunately, in the hospital and/or SNF setting, that is not always the case. It's a little morbid, but fairly common, for hospital staff (therapy included) to be regular checkers of the local obituaries. And no matter how uncomfortable it makes us as therapists, there are moments that we do endanger our patients- not knowingly, but still. Several months ago, when I had the patient fall, we didn't know it at the time, but she had developed A-fib and was going into renal failure. She left the SNF floor for ICU no more than a day after we had the fall.
Sometimes the only thing standing between you and disaster is an experienced coworker. There's been a number of times when the rehab aide has taken a look at a patient and advised to lay off, or noticed diaphoresis early... she's probably stopped a lot of falls and other problems just from experience and observation skills. Mad props to her- and attention students- don't rule anybody out as a potential teacher. There are a lot times when your masters/doctorate degree doesn't mean a thing next to someone's experienced observations or practical skills they've developed over time. Make friends with these people, they will save you from being an idiot time an again.
One happy ICU story to mix in with all this sad stuff. Mrs. P was a middle age woman admitted w/ anoxic BI. When we first eval'd her, she was quite flat and making slow progress. Then she got bumped into ICU and was unresponsive for several days. Then... we got orders to resume therapy as she moved out to the regular floor. She was showing good memory, emotion, and moving so much better. It was as if she came out of the coma doing much better than when she went in. She's home now, and hopefully continuing to improve. If not, I guess I'll see it in the paper...
8.20.2008
Writing Goals
This blog was started with interests in helping students and also in describing my current OT life, so this entry should be an interesting mix. My husband left for an extended trip to Europe today, and I was trying to make a list of things to do while he's away and realized it would be a good time to offer some instruction on goal writing. Some of this information is taken from my notes on the required documentation book from my first year (long since sold, so I can't check on anything else in it).
There are a few basic types of goals, but most of what I write are restorative, modification, or new skill goals. If you are writing a goal with the intent to maintain something in a client's life, or prevent something from happening, you're on shaky ground (ie- may not be reimbursed by insurance or covered in scope of practice). If you've got a grant for a special program focusing on preventive care or health promotion, more power to you, but most people want evidence that the goal has been achieved within a reasonable time frame and primarily due to your OT intervention before they pay you.
When starting at a new setting or when out on fieldwork, focusing on writing good goals can be a little overwhelming. A note to the fieldwork students- every supervisor has different expectations for documentation (also, they have every right to be demanding, as their name goes on it too). A good supervisor will tell you though that as you start being 'a real OT/A' that you will develop your own style of documentation that still retains the basic needs (hopefully!). This can be easier to do if you have a framework to go off of. I used the SMART model in school, here are a few more:
Another problem that fieldwork students often have is knowing what issues to write a goal about. As a rule, if you want to work as an OT practitioner, you need some occupation-based goals. It simply cannot be all about ROM, strengthening, or mobility in your wording, and should not be in your approach. With my hospital patients, I try to have 2 ADL goals, 1 mobility goal, 1 exercise goal, 1 home safety goal. (That's the baseline, I add and subtract based on pt ability) In the few hand evals that I did, I would have a ROM goal, strength goal, HEP goal, and 1-2 specific occupation goals. (the CHT at my site often uses "pt. will identify x# new daily tasks she is capable of performing w/ RUE") With the kids, it is all very different due to their needs, but there is often a sensory goal, 1-2 school readiness goals, parent program goal.
Examples- these are all based off of my life, and written while watching softball, so they aren't exactly what you would want in your setting, but it should give a reasonable idea.
One thing about goals that I need some HELP in!! Does anyone know the legality of whether you can write a goal for a child that directly relates to their MRDD Waiver Program family goal? Since the family is financially reimbursed for meeting the goal, it seems like shaky ground. Anyone have information on this?
There are a few basic types of goals, but most of what I write are restorative, modification, or new skill goals. If you are writing a goal with the intent to maintain something in a client's life, or prevent something from happening, you're on shaky ground (ie- may not be reimbursed by insurance or covered in scope of practice). If you've got a grant for a special program focusing on preventive care or health promotion, more power to you, but most people want evidence that the goal has been achieved within a reasonable time frame and primarily due to your OT intervention before they pay you.
When starting at a new setting or when out on fieldwork, focusing on writing good goals can be a little overwhelming. A note to the fieldwork students- every supervisor has different expectations for documentation (also, they have every right to be demanding, as their name goes on it too). A good supervisor will tell you though that as you start being 'a real OT/A' that you will develop your own style of documentation that still retains the basic needs (hopefully!). This can be easier to do if you have a framework to go off of. I used the SMART model in school, here are a few more:
- SMART: Significant, Measurable, Achievable, Relates to person, Time based
- ABCD: Audience, Behavior, Condition, Degree
- FEAST: Function, Expectation, Action, Specific conditions, Timeline
- RHUMBA: Relevant, How long, Understandable, Measurable, Behavioral, Achievable
Another problem that fieldwork students often have is knowing what issues to write a goal about. As a rule, if you want to work as an OT practitioner, you need some occupation-based goals. It simply cannot be all about ROM, strengthening, or mobility in your wording, and should not be in your approach. With my hospital patients, I try to have 2 ADL goals, 1 mobility goal, 1 exercise goal, 1 home safety goal. (That's the baseline, I add and subtract based on pt ability) In the few hand evals that I did, I would have a ROM goal, strength goal, HEP goal, and 1-2 specific occupation goals. (the CHT at my site often uses "pt. will identify x# new daily tasks she is capable of performing w/ RUE") With the kids, it is all very different due to their needs, but there is often a sensory goal, 1-2 school readiness goals, parent program goal.
Examples- these are all based off of my life, and written while watching softball, so they aren't exactly what you would want in your setting, but it should give a reasonable idea.
- To demonstrate increased leisure participation, Cheryl will attend activities with friends 1x/week for 3 weeks.
- In 3 weeks, Cheryl will complete 10 crossword puzzles at modified independent level with use of google.
- Cheryl will complete 80%+ of her exercise program at the wellness center 3 days/week.
- Cheryl will play fewer than 50 computer games per week to decrease c/o wrist pain.
One thing about goals that I need some HELP in!! Does anyone know the legality of whether you can write a goal for a child that directly relates to their MRDD Waiver Program family goal? Since the family is financially reimbursed for meeting the goal, it seems like shaky ground. Anyone have information on this?
8.05.2008
Brief recap
Last week:
-Mondays are not Fundays... especially when only 2 people are left to manage inpatient and outpatient... 1 COTA, 1 OT... 2 outpatient schedules... plenty of hospital evaluations.
-Tuesday was also shorthanded and always unfun. We usually split patients not by the amount of time required to treat, but just by the number of patients, which can lead to some major discrepancies on these days.
-Wednesdays are also not fun due to routinely scheduled staffing shortages. Made it through and then got a visit from my parents! First time they have been out to my new place. The rest of the week (parts not devoted to work) was devoted to tourist-type fun and awesome restaurants.
This week:
Another shorthanded Monday with 5 evals and treatments of adults and 5 kids as well. Worked through lunch to make a social skills worksheet identifying "potential friends" for a kid w/ Aspergers. Will post that later...
Today I had some extra clerical work but was unwilling to stay and do it after an 11 hour Monday.
I've been a very involved Olympics fan for a long time... I'd 1994 is the first games that I remember, though I do remember the 92 Dream Team somewhat. Really hate that I have to go to bed before fun stuff happens (Men's gymnastics bronze!!) and need to get better w/ the DVR. I've highlighted all the fun events I want to see (approx 2200) and will not have a lot of computer time devoted to non-Olympic pursuits for awhile. :) Husband is leaving for overseas multi-week job placement soon, so I'll have a considerable amount of time to dedicate to different projects. Part of that will be uploading various files to share with the online community. Other OT-related projects include preparing for my annual review, calling and scheduling parents for the school year, and looking at the feasibility of doing a research study at my facility.
-Mondays are not Fundays... especially when only 2 people are left to manage inpatient and outpatient... 1 COTA, 1 OT... 2 outpatient schedules... plenty of hospital evaluations.
-Tuesday was also shorthanded and always unfun. We usually split patients not by the amount of time required to treat, but just by the number of patients, which can lead to some major discrepancies on these days.
-Wednesdays are also not fun due to routinely scheduled staffing shortages. Made it through and then got a visit from my parents! First time they have been out to my new place. The rest of the week (parts not devoted to work) was devoted to tourist-type fun and awesome restaurants.
This week:
Another shorthanded Monday with 5 evals and treatments of adults and 5 kids as well. Worked through lunch to make a social skills worksheet identifying "potential friends" for a kid w/ Aspergers. Will post that later...
Today I had some extra clerical work but was unwilling to stay and do it after an 11 hour Monday.
I've been a very involved Olympics fan for a long time... I'd 1994 is the first games that I remember, though I do remember the 92 Dream Team somewhat. Really hate that I have to go to bed before fun stuff happens (Men's gymnastics bronze!!) and need to get better w/ the DVR. I've highlighted all the fun events I want to see (approx 2200) and will not have a lot of computer time devoted to non-Olympic pursuits for awhile. :) Husband is leaving for overseas multi-week job placement soon, so I'll have a considerable amount of time to dedicate to different projects. Part of that will be uploading various files to share with the online community. Other OT-related projects include preparing for my annual review, calling and scheduling parents for the school year, and looking at the feasibility of doing a research study at my facility.
8.03.2008
Girl Scout Camp Postmortem
It is with considerable relief that I can finally sit down to type again of this week. Thanks to the beauty of scheduled posts, I could assure that my devoted readers (ha!) never missed me during my long and hard-fought days of work and scout camp. I was working with older girls, entering 5th-8th grades, on the theory that they would be more self-directed and require less help throughout everything. HA! There was a lot that I had forgotten about teenage girls, and between the age range and the sheer number of girls (15) we had some considerable struggles. But we persevered, earned our badges, and made it through the week. During the times when I wasn't leading a rowdy band of scouts, I also saw a bunch of kids and inpatients, as is par for the work course. Had to plan out the new school year schedule... it has 3 afternoon/evenings of kids, 2 eval spots, and 17 30-minute slots. Party. Also, I will be starting work a little later to avoid the dreaded 10-12 hour days that I was working. Hopefully I can work this so that I will also be able to be a scout leader (for most of my camp kids) on Tuesday nights, but it is too far to tell if that will work out.
Arm pain is back... I am now fairly certain that it is referred pain from my neck that is controlled by how I am sleeping at night. I am now trying a memory foam traveler's neck pillow to see if it will force me to sleep on my back w/o flexing my neck.
Had some interesting kids this week. Little Mr. Q is 4 y.o. but not in preschool, b/c mom can't afford it. I Peabody'd him, showing 10-month delays in object manipulation (ball use) and Visual Motor Integration. He jumps at a ball when you throw it to him, and thus, usually does not catch it. He also cuts with extreme forearm supination, which is the skill that tipped off the MD. I will be interested to see what the PT comes up with on Monday, and also need to tell Mom that Ollie's Bargain Outlet (one of my haunts) is carrying Pre-K instruction packs for $20.
Another child, Lil Mr. P, is an interesting story indeed. He was referred w/ a CP diagnosis, w/o his caregivers knowing it, and really does not match CP at all. I actually called the MD to make sure that he had written the dx correctly. What he does certainly have is dyspraxia, though the caregiver regarded me with extreme suspicion when I mentioned this and recommended Sensational Kids for further reading. (I like to refer to this book as I find it very informational and know that it is both at the local library and relatively inexpensive online.) Caregiver stated that he had an appt w/ a developmental pediatrician and that she would not make any more OT/PT appts until she had talked to him, b/c she doesn't think he needs therapy. Hopefully he will reiterate that Mr. P is not developing along the typical timeline and that he will need continued therapy, b/c he really can benefit.
That's about it for now... my parents are visiting later this week. I picked up the 2 headed crayons, but the RoseArt version, as they were only $2. I will also be making a list of projects to work on during the 3 weeks that my husband heads overseas for work. This really should include writing up some SPD stuff so that I can synthesize more of it in my brain, but also needs to have some tangible work for me to do. I'm thinking working out more, puzzles, artsy things. If I don't force myself to have a list, then I will just sit on the couch and do nothing.
Arm pain is back... I am now fairly certain that it is referred pain from my neck that is controlled by how I am sleeping at night. I am now trying a memory foam traveler's neck pillow to see if it will force me to sleep on my back w/o flexing my neck.
Had some interesting kids this week. Little Mr. Q is 4 y.o. but not in preschool, b/c mom can't afford it. I Peabody'd him, showing 10-month delays in object manipulation (ball use) and Visual Motor Integration. He jumps at a ball when you throw it to him, and thus, usually does not catch it. He also cuts with extreme forearm supination, which is the skill that tipped off the MD. I will be interested to see what the PT comes up with on Monday, and also need to tell Mom that Ollie's Bargain Outlet (one of my haunts) is carrying Pre-K instruction packs for $20.
Another child, Lil Mr. P, is an interesting story indeed. He was referred w/ a CP diagnosis, w/o his caregivers knowing it, and really does not match CP at all. I actually called the MD to make sure that he had written the dx correctly. What he does certainly have is dyspraxia, though the caregiver regarded me with extreme suspicion when I mentioned this and recommended Sensational Kids for further reading. (I like to refer to this book as I find it very informational and know that it is both at the local library and relatively inexpensive online.) Caregiver stated that he had an appt w/ a developmental pediatrician and that she would not make any more OT/PT appts until she had talked to him, b/c she doesn't think he needs therapy. Hopefully he will reiterate that Mr. P is not developing along the typical timeline and that he will need continued therapy, b/c he really can benefit.
That's about it for now... my parents are visiting later this week. I picked up the 2 headed crayons, but the RoseArt version, as they were only $2. I will also be making a list of projects to work on during the 3 weeks that my husband heads overseas for work. This really should include writing up some SPD stuff so that I can synthesize more of it in my brain, but also needs to have some tangible work for me to do. I'm thinking working out more, puzzles, artsy things. If I don't force myself to have a list, then I will just sit on the couch and do nothing.
7.30.2008
Products I <3
When reading some of Karen's posts about peds friendly products, I thought about some of the things I've been using and like too. I've included a lot of pictures of crayola products, not because they pay me (or send me free samples), but because they seem to be on the edge of developing the kind of tools that are great for the kids.
Pipsqueeks Markers: these are becoming more and more mainstream and I love the fact that someone bought these for our facility before I started working there. The small size is so much easier to elicit proper grip with, and the colors are quite cute.
Heads n Tails: These are similar to the Handwriting w/o Tears crayons that facilitate in-hand manipulation
Twistables: I included the Slick Stix here
because they require very little pressure to create vibrant color. The twist factor also continually elicits fine motor work w/o breaking out rote twistable manipulatives (nuts and bolts)
Stetero Grips: Put your thumb on the star and get a great grip. Doesn't get much simpler than that, I plan to send several kids back to school w/ these.
Tactile Stim Pencil Grips: I personally love these- be they foamy, bumpy, squishy- anything but sticky. I found terrific mini mechanical pencils w/ grips already on them at KMart and use them for all my Alert Program kids. Fatten up your favorite writing implement and give yourself something to touch.
Wikki Stix- made to work on handwriting, but I love using these to teach shoe tying. The stickiness is great to build up a tactile defensive person's tolerance for unpleasant stimuli.
Pipsqueeks Markers: these are becoming more and more mainstream and I love the fact that someone bought these for our facility before I started working there. The small size is so much easier to elicit proper grip with, and the colors are quite cute.
Heads n Tails: These are similar to the Handwriting w/o Tears crayons that facilitate in-hand manipulation
Twistables: I included the Slick Stix here
because they require very little pressure to create vibrant color. The twist factor also continually elicits fine motor work w/o breaking out rote twistable manipulatives (nuts and bolts)
Stetero Grips: Put your thumb on the star and get a great grip. Doesn't get much simpler than that, I plan to send several kids back to school w/ these.
Tactile Stim Pencil Grips: I personally love these- be they foamy, bumpy, squishy- anything but sticky. I found terrific mini mechanical pencils w/ grips already on them at KMart and use them for all my Alert Program kids. Fatten up your favorite writing implement and give yourself something to touch.
Wikki Stix- made to work on handwriting, but I love using these to teach shoe tying. The stickiness is great to build up a tactile defensive person's tolerance for unpleasant stimuli.
7.28.2008
Here's to you, Mrs. K
My Mrs. B is off to acute rehab. Despite the PTA's view that "it won't make any difference," I think that she is capable of great recovery. This week, she was able to don her bra independently using a clothespin to hold it to her pants, participate in the modified pilates for neuromuscular reeducation, and complete a shower with more ease. We did the resistive clothespins on her second to last day, and she was able to independently seek and manipulate all but the hardest pins, a drastic improvement from Day 1 (which I did get to see). I got to say goodbye and give her a hug, and she was so appreciative of me... it was so sad because I formed a strong bond with this strong lady. In retrospect, she reminds me very much of a patient I worked very closely with at the end of my rehab fieldwork- Mrs. S. They are different in diagnosis (Mrs. S had a FOOSH which resulted in a R wrist ORIF and R hip replacement) but both have a great drive to get better. Even though the healing takes longer, since they were both in their 80s, I believe that they both did quite well with rehab, and do miss their special personalities. Thinking about it also makes me wish I was back in the intensive rehab world again, and makes me worry about whether I have the chops for that anyway.
Sadly enough, as my dad would say there's always an object lesson. Mrs B was the patient who alerted me to how my changed pediatric schedule and personal focus has affected the inpatient environment. I was able to work with her less often than I wanted due to my peds schedule and the responsibilities that come when working on a small staff. I was only in inpatient all day 2 out of my 4 workdays, and one of those was often spent entrenched in acute care evaluations. Not only was I working less w/ Mrs B, I was also working less with the patients down "my" hallway. The division of hallways was setup about a year ago, and obviously is still in play, though my peds schedule has had a strange effect on it. Since I was not around to constantly direct care for "my" patients, they got fewer ADLs and less personalized care from the rest of the staff. I found weekly updates hard to complete, and little attention was paid to the altered treatment plans.
I feel terrible about the decreased level of care that I feel these people have gotten, but it's hard to understand how others' complacency let it get to this point. I will have to spend the next month (until school starts) advocating louder for their needs and paying greater attention to their treatments and developments, even if I never get to see them. Who knows what effect the school year schedule will have... I've been adding kids left and right since June and will have to make spots available somewhere, while still carrying a full hospital caseload.
I hope I can get all this worked out... I am trying to worry about it less so that I have more mental peace. But good luck Mrs B- may those at the county rehab recognize your special light and help you achieve all that is possible.
I used too many abbreviations today, here are some explanations if you're unfamiliar with any of them: PTA- physical therapy assistant; FOOSH- fall on outstretched hand; ORIF- open reduction internal fixation operation.
Sadly enough, as my dad would say there's always an object lesson. Mrs B was the patient who alerted me to how my changed pediatric schedule and personal focus has affected the inpatient environment. I was able to work with her less often than I wanted due to my peds schedule and the responsibilities that come when working on a small staff. I was only in inpatient all day 2 out of my 4 workdays, and one of those was often spent entrenched in acute care evaluations. Not only was I working less w/ Mrs B, I was also working less with the patients down "my" hallway. The division of hallways was setup about a year ago, and obviously is still in play, though my peds schedule has had a strange effect on it. Since I was not around to constantly direct care for "my" patients, they got fewer ADLs and less personalized care from the rest of the staff. I found weekly updates hard to complete, and little attention was paid to the altered treatment plans.
I feel terrible about the decreased level of care that I feel these people have gotten, but it's hard to understand how others' complacency let it get to this point. I will have to spend the next month (until school starts) advocating louder for their needs and paying greater attention to their treatments and developments, even if I never get to see them. Who knows what effect the school year schedule will have... I've been adding kids left and right since June and will have to make spots available somewhere, while still carrying a full hospital caseload.
I hope I can get all this worked out... I am trying to worry about it less so that I have more mental peace. But good luck Mrs B- may those at the county rehab recognize your special light and help you achieve all that is possible.
I used too many abbreviations today, here are some explanations if you're unfamiliar with any of them: PTA- physical therapy assistant; FOOSH- fall on outstretched hand; ORIF- open reduction internal fixation operation.
7.26.2008
Parental Ratings
There are times when I really worry about the choices parents make and how they affect their children. Usually, this is associated in my mind with parents dragging sick kids to therapy, or skipping therapy, or over-therapying. But this time, I got to witness some parental slack outside of the therapist-client relationship for a change. I was at the movies today, watching The Dark Knight. This movie is rated PG-13 (though I really don't know how it escaped an R rating). In case you are living under a rock, this is not your grandpa's Batman, and this is a very intense movie (for proof, see the nail marks on my husband's arm). I would hate to give any part of the movie away, but even in the previews, you can see that there are hostage situations, often with one person holding a weapon in the face of an innocent. Harsh. Brutal. Violent. Intense.
During a particularly graphic scene, my attention was diverted by the people in front of me, who exited briefly and returned. A mother, escorting her two children, ages 5-7. Seriously. These children will be like my peers who saw IT when they were little and still live in fear of clowns. Please... be the parent and let your kids act their age.
During a particularly graphic scene, my attention was diverted by the people in front of me, who exited briefly and returned. A mother, escorting her two children, ages 5-7. Seriously. These children will be like my peers who saw IT when they were little and still live in fear of clowns. Please... be the parent and let your kids act their age.
7.24.2008
Pilates power!
Admittedly, I have been very terrible about keeping up with Pilates since starting the videos w/ my OT buddies during first year. I have done perhaps 2 10 minute sessions since last year, which is pretty pathetic. But I finally got to use some techniques w/ one of my stroke pts- Mrs. K. I had her doing an adapted mermaid while seated EOB. Really trying to bring back some normative movement in her RUE, as the natural flow is gone. It was hard for her, but she is such a trooper, really willing to work. Hopefully I can continue to incorporate these exercises for relevant treatments. :)
7.22.2008
Busy times
Been pretty busy recently and only going to get moreso... GS evening camp is next week. I'll have to try to eat work early, wolf down dinner, and put on my happy face til 9pm. This is, of course, if I can get prepared. I have to spend this week making a sample of all the crafts, since it will take me that long to produce a decent craft. My fine motor is lacking... maybe I should have gone the PT route, though my gross motor skills aren't the best at other times. :-/
My favorite stroke pt, Mrs K, is now on the fast track to go to acute rehab from our SNF floor. I will miss her a lot, and really regret that my peds/acute care schedule has kept me from working with her more. I hope that her OTs and PTs at rehab can help her motivate and rehabilitate. (that should be a slogan!)
I have gotten the go-ahead to turn my handout on preventing occupational deprivation into a newspaper article, just need to add a summary paragraph.
Saw 9 kids yesterday w/ 1 no show. It was good to see my coworkers' kids last week to get a good reminder of typical development. I always rejoice in the minor progresses that the kids make, but it's nice to remember what we're shooting for. I need to get a better grasp of development, but not in the way that everyone suggests (Having kids!).
My favorite stroke pt, Mrs K, is now on the fast track to go to acute rehab from our SNF floor. I will miss her a lot, and really regret that my peds/acute care schedule has kept me from working with her more. I hope that her OTs and PTs at rehab can help her motivate and rehabilitate. (that should be a slogan!)
I have gotten the go-ahead to turn my handout on preventing occupational deprivation into a newspaper article, just need to add a summary paragraph.
Saw 9 kids yesterday w/ 1 no show. It was good to see my coworkers' kids last week to get a good reminder of typical development. I always rejoice in the minor progresses that the kids make, but it's nice to remember what we're shooting for. I need to get a better grasp of development, but not in the way that everyone suggests (Having kids!).
7.10.2008
Stroke Season
One of my OT coworkers always says that as the heat goes up, the stroke rate goes up too. I evaluated 4 stroke patients yesterday. One was my friend from acute care who transferred to the SNF floor. Hopefully, I will get to continue to work with her and continue our partnership. I have a lot of cool treatment ideas for her right now and am working on a list to share w/ the COTA to get her more comfortable working with CVA pts.
Another lady came in and only speech therapy had been ordered on admission, but I got a referral the next day. She was a little defensive about me showing up to see her, but we took a nice walk and discovered that though she'd been having trouble reading (a major barrier to her preferred leisure activities) she could still recognize symbols and was about 70% on reading basic words. I picked her up solely to educate her on low vision techniques that would make it easier for her to read (fonts, more space between words, high contrast).
Had a very unfortunate gentleman in his early 60's who had a bilateral cerebellar infarct with a 1-sided thalamus infarct as well. This man had just started a new job, so it can be assumed that he was a reasonably active individual PTA. Unfortunately, his current assests are moderate head control, moderate ability to hold sitting balance, and movement in his L elbow and hand. No current speech production, questionable ability to understand others, and a mix of flaccidity and extensor tone in different extremities.
Last guy came in with minimal involvement- some slurred speech, decreased endurance, and slight proprioceptive and sensory deficits. He will go home soon, but there is some question to the future. The PT tried to allude to this with him by saying, "This might be considered a wake-up call" but there is little hope of him changing the behaviors that caused the stroke to start with- obesity, HTN, no exercise, no checkups with doctors, etc. People can change after such events, my dad did after his heart attack and now starts the day with 30-45 minutes of cardio exercise and a cup of oatmeal. But in order to change, you've got to answer the phone on that wake-up call. Here's hoping that this guy does so that I don't see him in 2 months in worse condition.
Title LGT the American Heart Association.
Another lady came in and only speech therapy had been ordered on admission, but I got a referral the next day. She was a little defensive about me showing up to see her, but we took a nice walk and discovered that though she'd been having trouble reading (a major barrier to her preferred leisure activities) she could still recognize symbols and was about 70% on reading basic words. I picked her up solely to educate her on low vision techniques that would make it easier for her to read (fonts, more space between words, high contrast).
Had a very unfortunate gentleman in his early 60's who had a bilateral cerebellar infarct with a 1-sided thalamus infarct as well. This man had just started a new job, so it can be assumed that he was a reasonably active individual PTA. Unfortunately, his current assests are moderate head control, moderate ability to hold sitting balance, and movement in his L elbow and hand. No current speech production, questionable ability to understand others, and a mix of flaccidity and extensor tone in different extremities.
Last guy came in with minimal involvement- some slurred speech, decreased endurance, and slight proprioceptive and sensory deficits. He will go home soon, but there is some question to the future. The PT tried to allude to this with him by saying, "This might be considered a wake-up call" but there is little hope of him changing the behaviors that caused the stroke to start with- obesity, HTN, no exercise, no checkups with doctors, etc. People can change after such events, my dad did after his heart attack and now starts the day with 30-45 minutes of cardio exercise and a cup of oatmeal. But in order to change, you've got to answer the phone on that wake-up call. Here's hoping that this guy does so that I don't see him in 2 months in worse condition.
Title LGT the American Heart Association.
7.08.2008
Being the therapist that inspires
I have pride today. Couple of days where I've been able to delve into projects and treatments and feeling quite good about it all. I've had some successes and am happy about it, so here's some notes on the whole business.
I've been working with a L MCA stroke patient and got to spend an hour with her today even though she is on acute care. Our acute care patients get short sessions too often, especially when we are overloaded elsewhere. But this little lady was willing to work and has good potential (I wish that the MDs would take our advice and send her to rehab instead of SNF, but that's a different story). We took steps, we did FMC exercises, we did self-ROM, and we opened 4 of the easy level clothespins 2x each. Those closepins were difficult for both of us, but she felt the taste of success and showed decreased depressive behaviors, so that was good. When I came back for her afternoon session, she said to her visitors, "That's my therapist! She's going to get me better!" BIG SMILE. She'll get herself better, but I will take the compliment. :)
My 5 year old from the post on Failures was back yesterday with his mom. We worked on some activities to challenge his balance, which wasn't difficult since his center of gravity is in his head. We worked on the swing (he does have independent reciprocal swinging motion!) and eventually progressed to catching and throwing a ball while swinging. I made big goofy faces about how strong his throws were and he giggled and kept going instead of saying "I can't" which is his favorite word set.
And I've been doing some good work on projects the past 2 days. Raided the speech therapy room (we are currently -2.5 STs) and borrowed a stack of books to explore. Among my finds was the Adolescent Test Of Problem Solving, which will be used on my 13 y.o. coming in on Monday, and a book on communication problems w/ pediatric TBI. The big ticket item though was the manual and installation disks (floppys!) for communication board software. I made the IT guy come install it ASAP as we get calls fairly frequently for communication boards for people in the hospital. It will take some getting used to, as it was designed for Windows 3.1, but I hope to persevere soon! Apparently, you can download a free trial of their new software here.
I've been working with a L MCA stroke patient and got to spend an hour with her today even though she is on acute care. Our acute care patients get short sessions too often, especially when we are overloaded elsewhere. But this little lady was willing to work and has good potential (I wish that the MDs would take our advice and send her to rehab instead of SNF, but that's a different story). We took steps, we did FMC exercises, we did self-ROM, and we opened 4 of the easy level clothespins 2x each. Those closepins were difficult for both of us, but she felt the taste of success and showed decreased depressive behaviors, so that was good. When I came back for her afternoon session, she said to her visitors, "That's my therapist! She's going to get me better!" BIG SMILE. She'll get herself better, but I will take the compliment. :)My 5 year old from the post on Failures was back yesterday with his mom. We worked on some activities to challenge his balance, which wasn't difficult since his center of gravity is in his head. We worked on the swing (he does have independent reciprocal swinging motion!) and eventually progressed to catching and throwing a ball while swinging. I made big goofy faces about how strong his throws were and he giggled and kept going instead of saying "I can't" which is his favorite word set.
And I've been doing some good work on projects the past 2 days. Raided the speech therapy room (we are currently -2.5 STs) and borrowed a stack of books to explore. Among my finds was the Adolescent Test Of Problem Solving, which will be used on my 13 y.o. coming in on Monday, and a book on communication problems w/ pediatric TBI. The big ticket item though was the manual and installation disks (floppys!) for communication board software. I made the IT guy come install it ASAP as we get calls fairly frequently for communication boards for people in the hospital. It will take some getting used to, as it was designed for Windows 3.1, but I hope to persevere soon! Apparently, you can download a free trial of their new software here.
7.05.2008
Books books, they're good for your head
Continuing education money is a perk that you cannot expect at a job, but if you do have it, it is quite enjoyable! We are trying to use up a portion of this money before the budget is reevaluated so that we can keep this great perk for years to come. So, my great SPD course earlier in the year was gratis, and now, I'm getting some great books to add to my library. The only downside with buying educational materials w/o a course is that you get no credit from NBCOT or your state association for the hours you're trying to better yourself. Not that I know of, anyway.
Sharing Time!! (books linked to their stores)
Autism: A Comprehensive Occupational Therapy Approach
This book is a lesson on why you should not sell your textbooks. I had accidentally left this on my half.com inventory, and then I wound up working in peds. Seriously, you never know what you're going to do with life and those books do come in handy. (Being an AOTA member will save you mucho dolores on this one)
Teaching Motor Skills to Children with Cerebral Palsy
This book was written for parents and professionals, and was quite economical. It does have a PT focus, so there's more information about gross motor skills than any UE activity. It does have good pictures of stretching and I'm hoping to learn more about the general progression of kids w/ CP. Also, I am going to trade w/ my PT buddy to read her new book about treatment ideas for kids w/ Autism.
Stroke Rehabilitation: A function-based approach
This is a textbook, and upon my scanning of it today, it has lots of evidenced based reports and good ideas for OT stroke treatment. I find both stroke and SCI to be areas that I would love to know more about, and I do see a fair number of CVA pts nowadays. I don't want to focus all my work on peds, and I'm hoping that this will be a helpful resource.
Observations Based on Sensory Integration Theory
This video/manual set came highly
recommended by Delanah Honaker when I went to her course on SPD. It was out of my price range when paying out of pocket, but this is what I think CE money is really for. Since I lack the luxary of a pediatric fieldwork experience, mentor, rubber wall to bounce ideas off of, I am hoping to get some good learning from this so that I can improve my practice and understand SI in practice better.
Sharing Time!! (books linked to their stores)
Autism: A Comprehensive Occupational Therapy Approach
This book is a lesson on why you should not sell your textbooks. I had accidentally left this on my half.com inventory, and then I wound up working in peds. Seriously, you never know what you're going to do with life and those books do come in handy. (Being an AOTA member will save you mucho dolores on this one)
Teaching Motor Skills to Children with Cerebral Palsy
This book was written for parents and professionals, and was quite economical. It does have a PT focus, so there's more information about gross motor skills than any UE activity. It does have good pictures of stretching and I'm hoping to learn more about the general progression of kids w/ CP. Also, I am going to trade w/ my PT buddy to read her new book about treatment ideas for kids w/ Autism.
Stroke Rehabilitation: A function-based approach
This is a textbook, and upon my scanning of it today, it has lots of evidenced based reports and good ideas for OT stroke treatment. I find both stroke and SCI to be areas that I would love to know more about, and I do see a fair number of CVA pts nowadays. I don't want to focus all my work on peds, and I'm hoping that this will be a helpful resource.
Observations Based on Sensory Integration Theory
This video/manual set came highly
recommended by Delanah Honaker when I went to her course on SPD. It was out of my price range when paying out of pocket, but this is what I think CE money is really for. Since I lack the luxary of a pediatric fieldwork experience, mentor, rubber wall to bounce ideas off of, I am hoping to get some good learning from this so that I can improve my practice and understand SI in practice better.
7.03.2008
Updates
A couple of no-topic updates :)
- First off, I am adding new links to the right. I have some good links for parents that I have stumbled upon and some new Autism-related links.
- Secondly, I had some great talks recently with patients and family members about preventing occupational deprivation in the elderly. I am planning to make a handout to post on OT Advantage.
- Third, my husband has helped me conquer some occupational deprivation of my own, and took a day off work to pack cranky-morning-me off for an awesome canoeing trip. I used to spend my whole summer on the water, but OT school KILLED that, and it was great to get back to something I really love to do.
- And finally, I had several questions from Melody in an earlier post and I realized that I could shed some more light on my situation.
1. I work in a small hospital which houses a SNF floor and several acute care floors, with a freestanding outpatient clinic where I see the pediatrics. I have a handful of OT/OTA coworkers.
2. I do NOT have kids. (This is actually a sore subject when asked in person, as a patient or a coworker speculates at least 1x/week that I am pregnant. No hard feelings for the online ask, but people who see me in person should note the complete lack of baby bump.) Actually, after my first neuro class in OT school, I don't know that I could make it through a pregnancy, as I am incredibly predisposed to worrying over everything. I am involved with activities that are typically reserved for parents (girl scouts, VBS), but it is because I believe in spending the extra time I have trying to give back now and then to organizations that were meaningful to me.
2b. As for the job I will have when/if I have kids, it's hard to say, as my goals for the near future aren't so clear. Adult rehab can be very physically exhausting, and a salaried job can be exceptionally time consuming in the day to day. I know of a lot of therapists who got into school system practice to schedule more time with their own kids. There's advantages to both sides, but I'd say that what OT parents are really looking for in a job is: flexible hours and good insurance. By flex hours, I mean that you can take days off without giving lots of notice, get vacation time (especially if you get school holidays), and know that you won't be asked to work a lot of weekends. I could be wrong- anyone in this situation can comment with their real thoughts.
And 3. I don't teach ASL, though I did take a semester in college and worked with a child (in a non-OT way) on baby signs. I know some basics for working with my speech limited kids (colors, OT-related actions). I would love to be totally fluent or at least generally better, but there is no way to do so without a lot of time devoted to practice.
- First off, I am adding new links to the right. I have some good links for parents that I have stumbled upon and some new Autism-related links.
- Secondly, I had some great talks recently with patients and family members about preventing occupational deprivation in the elderly. I am planning to make a handout to post on OT Advantage.
- Third, my husband has helped me conquer some occupational deprivation of my own, and took a day off work to pack cranky-morning-me off for an awesome canoeing trip. I used to spend my whole summer on the water, but OT school KILLED that, and it was great to get back to something I really love to do.
- And finally, I had several questions from Melody in an earlier post and I realized that I could shed some more light on my situation.
Just wondering about two things outs of curiosity. 1. do you work in a school based/clinic/hospital setting? and 2. How do you feel working with children when you have child/ren of your own?Answers!
I'm considering either peds or acute physical when I'm graduating but Im planning a family as well and my mum rechons working with adults would be more of a relief.
Whats it like for you.
PS do you teach sign language?
1. I work in a small hospital which houses a SNF floor and several acute care floors, with a freestanding outpatient clinic where I see the pediatrics. I have a handful of OT/OTA coworkers.
2. I do NOT have kids. (This is actually a sore subject when asked in person, as a patient or a coworker speculates at least 1x/week that I am pregnant. No hard feelings for the online ask, but people who see me in person should note the complete lack of baby bump.) Actually, after my first neuro class in OT school, I don't know that I could make it through a pregnancy, as I am incredibly predisposed to worrying over everything. I am involved with activities that are typically reserved for parents (girl scouts, VBS), but it is because I believe in spending the extra time I have trying to give back now and then to organizations that were meaningful to me.
2b. As for the job I will have when/if I have kids, it's hard to say, as my goals for the near future aren't so clear. Adult rehab can be very physically exhausting, and a salaried job can be exceptionally time consuming in the day to day. I know of a lot of therapists who got into school system practice to schedule more time with their own kids. There's advantages to both sides, but I'd say that what OT parents are really looking for in a job is: flexible hours and good insurance. By flex hours, I mean that you can take days off without giving lots of notice, get vacation time (especially if you get school holidays), and know that you won't be asked to work a lot of weekends. I could be wrong- anyone in this situation can comment with their real thoughts.
And 3. I don't teach ASL, though I did take a semester in college and worked with a child (in a non-OT way) on baby signs. I know some basics for working with my speech limited kids (colors, OT-related actions). I would love to be totally fluent or at least generally better, but there is no way to do so without a lot of time devoted to practice.
6.30.2008
Kennedy Center Show
LGT a recent show at the Kennedy Center on disability. Seems like it would have been cool to go to, had I 1) known about it and 2) not been working all day Saturday. Ironically, the review was buried in the depths of the Washington Post site, which certainly won't help it draw attention. More thoughts at a later date, as I am behind in my work for the girl scouts...
6.28.2008
The long week is over...
It's been a long week, but it is finally over. And, thanks to a 5-hour day today, I am actually caught up on *everything*! All the minutes for Monday are done, and suggestions for treatments left for my coworker. Emails have been answered. All the weekly notes, all the COTA cosigning... DONE. Couldn't bring myself to do it yesterday at 430 since I was so tired, but it is all actually done now. I still have a few things to do this weekend- particularly, writing up treatment goals relevant to the Alert Program- and I will have a few calls to make on Monday, but work is remarkably on target right now.
I'm feeling some peace with finishing everything today. I know that I won't be caught up for long, but it is a good feeling nonetheless. Perhaps I'm getting better at leaving work behind. I follow a job advice columnist from the Washington Post, and her latest entry is relevant to that feeling when I was getting so overwhelmed at work. Do your best while you're there, and don't worry about it when you've left it behind. There will be days when we won't get enough minutes for patients to meet their RUG levels, or all the evals don't get done, or a paper is left unfinished, but it will be OK anyway. Have yourself a peaceful easy feeling about the coming work week.
I'm feeling some peace with finishing everything today. I know that I won't be caught up for long, but it is a good feeling nonetheless. Perhaps I'm getting better at leaving work behind. I follow a job advice columnist from the Washington Post, and her latest entry is relevant to that feeling when I was getting so overwhelmed at work. Do your best while you're there, and don't worry about it when you've left it behind. There will be days when we won't get enough minutes for patients to meet their RUG levels, or all the evals don't get done, or a paper is left unfinished, but it will be OK anyway. Have yourself a peaceful easy feeling about the coming work week.
6.26.2008
Merging back in...
I am still alive...
Vacation was wonderful. Things that are tough: 1. trying to merge back into work after vacation 2. being shorthanded this week due to others' vacations 3. trying to leave work early each night so that I can drive 30 minutes to instruct 2 year olds in vacation Bible school. So, I've been getting home at 9 and quite tired all week.
A few quick positives from the week:
Vacation was wonderful. Things that are tough: 1. trying to merge back into work after vacation 2. being shorthanded this week due to others' vacations 3. trying to leave work early each night so that I can drive 30 minutes to instruct 2 year olds in vacation Bible school. So, I've been getting home at 9 and quite tired all week.
A few quick positives from the week:
- My new peds schedule does let me leave on time, a joy not felt for many months.
- Our SNF and acute floors are discharging several patients this week
- My six 2 y.o.'s are learning sign language and social behaviors!
- A member of a community organization (not sure if I can name it or not) stopped by ask what pediatric equipment we wanted for our outpatient clinic so that they could donate it. (AWESOME!!)
- After the false starts with younger children and the Alert Program, I have two older kids who I will be trying this approach with over the summer. One is an 11 y.o. girl with a lot of anxiety-related oral stimulation behaviors, and the other is a 13 y.o. boy with Asperger's and some difficulties with sensory regulation.
6.20.2008
How to get into OT school
Many OT programs require applications, interviews, and/or test scores for admission, and do not accept all applicants. Here is a brief walk-through of things to do to better your chances of acceptance. For the purposes of this entry, we will assume that the prospective student has already done intelligent things to determine if OT is the right career path, and has decided upon a specific university.
- Read Carefully- Upon admission to a college, you should get a guide with information about all the different majors offered and brief descriptions of classes. This guide is akin to a school's contract with you. This will have the information you need about prerequisite classes and general education requirements that you will need to graduate. In many cases, you will need to finish your liberal arts/general ed classes before starting in the OT curriculum. Also be sure to carefully examine the admissions packet from your OT school at least a semester in advance of when you would apply. This gives you a chance to pick up anything you would be missing prior to your application.
- Schedule Smart- The college adviser... an appointed watchdog to make sure you graduate on time and according to plan. Warning- if you believe that is the adviser's job, you are likely to have problems. I won't say that all advisers are overworked and ill-informed, but those types of people do exist. College advisers have to sort schedules for hundreds or thousands of people each semester, and they most likely won't have the extensive contact with you to be familiar with your detailed career aspirations. So if it's important to you to apply to OT school in a specific year, finish your coursework on time, or take the required classes, you need to be your own advocate. Use the program guides to sketch out a framework of what classes you will need each year, where you have space for electives, etc. Your adviser may be able to help you in making sure that your planning reflects the university schedule (ie, if you Chemistry before Physiology, but they are both only offered in fall semester, you will need to do chem early).
- Make Contact- contact faculty at your OT program. Be friendly. Let them know that you're out in the world and interested in their program. They'll be familiar with you when you apply, and can also help you if you get confused during the admissions process. If you can, make friends with a current student or recent grad. They can give you inside information about what to expect from the program that can be invaluable. In my program, we pass on a "buddy CD" of study guides and notes from classes year to year.
- Volunteer- Get to work at a local center that provides OT. Job shadow OTs, and remember, these people will be your future references. At these times, always dress and act professionally. Be courteous and curious. Take an active role and try to help out where you can (be aware, this will not be in direct patient care). Volunteering in other fields is also a great idea and shows commitment to helping others.
- Review Your Resume- Make sure your resume contains information about your skills and your volunteer and work experiences. You should include anything that could be related to a career in healthcare- babysitting, coaching, and tutoring are all great to include, especially if those experiences gave you exposure to kids with special needs. Do you have a CNA or rehab aide job? Have you done any detailed volunteering projects through scouting or another organization? It's great to include an activity that shows long term commitment and dedication to a cause, as well as any unique interests. Have a friend or parent review to check spellings and make sure that your resume reflects all your relevant abilities.
- Boost Your Awareness- If you want to be an OT, you need to know about OT. Review the AOTA website as well as your program's OT website. Get a general grasp of the different settings that OTs work in, the clients OTs see, and some basic treatment ideas. Your job shadowing is a great time to gather this information. Look at your program's website and see if you can find what interests your future faculty have. You should expect some general questions about OT, disability, and your reason for choosing OT as a career in an interview. No one expects you to know everything, but they will expect you to be familiar with the basic concepts of your future profession.
6.14.2008
Wish upon a star
I'm now at that momentous 1-year-since-graduation mark. Still close enough to remember being a student (which is why I try to post tips and helpful things) but also wanting to be a full-fledged totally-awesome practitioner. I've always been a little critical on myself, and don't like to just sit back and relax, as I'm afraid of waking up one day and finding that I'm actually terrible at what I do. So though I recognize that it's way too early to be a 100% awesome OT, I know that there are things that I should be doing more of to be my best. So, as a 'year in review,' here's a list of things that I would like to be doing more or generally better at.
- Transfers/Independently Ambulating New Pts- Since I left my rehab fieldwork, my transfer skills have seriously declined. I always doubted my general strength and body mechanics, but I used to be able to do a DEP transfer alone (and had to, as there was no support staff!). Now I've grown lax, since there are helpful nurses/techs, rehab aides, and PT staff abounding. I often hold off on my evals if I can tag team w/ PT, which is not a totally bad thing but I should have more confidence in getting pts up on my own. I have gotten a lot better about that, but do try to play it safe when possible.
- Stroke Treatments- compared to my fieldwork, we get absolutely zero CVAs, so I haven't had a chance to really hone my treatment skills for this diagnosis. This would include the following:
- Scapular mobilizations
- Neuro-reeducation
- Motor control theory- my husband was swift enough to spy an old textbook w/ pictures of Brunnstrum and Rood movement methods at a yard sale. I haven't had a chance to review this, and I know that I don't have a solid practice base in old principles of motor recovery or the new motor control theory, and really need to.
- Time Management- this has improved greatly since fieldwork, but I still find myself struggling to get everything done in a day
- Pediatric Goal Writing- admitted bad habit: I often delay writing my pediatric pt's goals and have a hard time making them SMART, as they say. Sensory goals are especially challenging and I've been trying to get some advice on that.
- Occupation-Based Sessions for Adults- I am good at incorporating BADLs into treatment, but I should be getting my adults to do some more fun things.
- Laying Down the Law- it seems that a lot of my pediatric pt's parents do things that make my life a lot harder, such as no-show'ing, leaving the waiting room while the child is in therapy, etc. I need to be better at drawing the line with people when necessary.
- Explaining OT to Adults- I know, this should be second nature and part of my eval spiel, but I do get in a hurry. Sometimes it seems like there's no way to make people care about what we do, no matter what is offered.
- Sensory-based treatments- I would really like to have a better plan about conducting these during pediatric sessions so that things go smoothly more often. I have some materials to help, but I need time to review everything and make changes.
- Turning it all off- I need to get better at compartmentalizing work away from the rest of my life. I also need to de-stress better, do more ME time things. I get in a habit of just relaxing and watching tv, but I need to work out more, get back into pilates, read books for fun, spend time with friends.
6.12.2008
30 Days in a Wheelchair
I have been a fan of Morgan Spurlock's for awhile, though not rabid enough to catch every show or appearance. But I was interested to see the episode of 30 days that had football player Ray Crockett spend 30 days in a wheelchair. I was interested to see how this would play out. I have read several articles from different members of the disabled online community that were outraged by disability simulation experiences held in schools or other groups. But I feel that this show made a good effort to stray away from the stereotypical simulation experience. For one thing, Ray's experience lasted a full month, which is at least 29 days longer than the average. This gave him a longer time to feel the effects of his situation on himself and his family, and gave him time to grow.
Another key point was that Ray was part of a community of legitimate wheelchair users. He played wheelchair rugby (with some of the most famous and skilled American players), worked with people at a rehab center, and had support from a counselor that has been a quadriplegic for several years. We weren't left with only Ray's opinions of what being in a wheelchair was like for him, and neither was he. Ray turned a corner after meeting the rugby team, and started lifting weights in his own gym again. I'm paraphrasing here, but he basically said that he had thought that since he was in a chair, he was supposed to be frail. If he hadn't met people living vibrant lives, he would have felt confined and isolated, and portrayed a very biased picture of what living in a wheelchair is like.
I liked Murderball, and I liked this show too. I thought it was very telling when Ray was sharing videos of his rugby sessions with his family and trying to correct some of their misconceptions about quadriplegics and disability in general. My mom has always had lots of friends in our community that have different disabilities, so I had a lot of experiences growing up with people who walked or talked differently, and I like to think that I learned to treat people equally and with respect at all times. But some people don't have those kind of experiences in their everyday life (or rather, haven't YET), and I feel that shows that are done well can provide a window into another world for those people. A window that allows someone to think: "huh. that person drives a car, goes to work, and spends time with his family just like I do. Maybe we're not so different after all."
Here's some of my random thoughts I had while watching the episode. There are videos of portions of the episode online here if you missed it.
Another key point was that Ray was part of a community of legitimate wheelchair users. He played wheelchair rugby (with some of the most famous and skilled American players), worked with people at a rehab center, and had support from a counselor that has been a quadriplegic for several years. We weren't left with only Ray's opinions of what being in a wheelchair was like for him, and neither was he. Ray turned a corner after meeting the rugby team, and started lifting weights in his own gym again. I'm paraphrasing here, but he basically said that he had thought that since he was in a chair, he was supposed to be frail. If he hadn't met people living vibrant lives, he would have felt confined and isolated, and portrayed a very biased picture of what living in a wheelchair is like.
I liked Murderball, and I liked this show too. I thought it was very telling when Ray was sharing videos of his rugby sessions with his family and trying to correct some of their misconceptions about quadriplegics and disability in general. My mom has always had lots of friends in our community that have different disabilities, so I had a lot of experiences growing up with people who walked or talked differently, and I like to think that I learned to treat people equally and with respect at all times. But some people don't have those kind of experiences in their everyday life (or rather, haven't YET), and I feel that shows that are done well can provide a window into another world for those people. A window that allows someone to think: "huh. that person drives a car, goes to work, and spends time with his family just like I do. Maybe we're not so different after all."
Here's some of my random thoughts I had while watching the episode. There are videos of portions of the episode online here if you missed it.
- One of the first people Ray gets to meet is Kenny the OT!! I was very excited.
- The doctor talked to Ray about the risk for blood clots from being in a wheelchair, but didn't even give him a stinking pair of drugstore knockoff TED hose?
- I found it both interesting and ironic that they chose a football player to be in a wheelchair, as they walk the line between athlete and injury everyday
- The family has a very nice home that was obviously built with no thought to universal design. 5 steps to enter the house, sunken and raised rooms throughout, sunken shower, steps to the backyard... I wish they had time to touch on that concept, but it's only a 60 minute show.
- Ray was lucky enough to have the cash to plunk down a bunch of ramps all over his poorly designed house, but if he's seriously interested in keeping his buddies from the show close, he better look into making the house visitable
- I liked watching Ray playing basketball with his kids, it also demonstrates that he was an exceptionally strong person before the show. I played basketball for years and years, and hurt my ankle late in high school, keeping me from ankle plantar flexion but not from standing. I couldn't even shoot a form shot. Try sitting down on the court next time you're playing and see how much arm strength it really takes to push a ball over 10' in the air.
- Woo! Justin Dart! I met him :)
- After all the growing that Ray had done, he still admits that he would want to help the girl in rehab do her BADL and mobility tasks.
- As the girl was 'graduating' from rehab, they did touch on how close the staff and patients can become when working so closely for so long. It's an odd relationship though, which I may have to go more in-depth in another time.
Respect for OT from... an MD!!
I was working with one of the ladies on orthopedics, introducing her to the AE for lower body dressing. She was struggling, as she has some cognitive deficits, but we were plugging along. A knock on the door, and I saw young Dr. McDreamy (not his real name, but it might as well be. Another pt. stated that if he got any closer to her, she was going to reach up and give him "a great big kiss!"). I said to my pt, "ok, let's take a break so you can talk to your doctor," and he interrupts me, saying- "No, no, you keep going! You're doing the important work! I'll come back later." I was flabbergasted... this is not how the therapist-doctor-patient relationship usually works. Made me feel pretty awesome and just added another checkmark to my opinion of Dr. McDreamy.
Semi-unrelated, but people should consider asking hospital employees for opinions of physicians when making choices. We see the doctors more often than patients usually do, and see how they treat multiple people. We know which surgeons are good at which surgeries, which ones have had multiple revisions, how they treat their patients. Something to think about when choosing your next physician.
Semi-unrelated, but people should consider asking hospital employees for opinions of physicians when making choices. We see the doctors more often than patients usually do, and see how they treat multiple people. We know which surgeons are good at which surgeries, which ones have had multiple revisions, how they treat their patients. Something to think about when choosing your next physician.
6.11.2008
Surveys
The AOTA listservs that I subscribe to frequently feature online surveys from research students. Please take time to contribute to any that are appropriate to your situation. I make no claims supporting any university or project, this is just a friendly pass-along of info with wording direct from the author when available.
" Contribute to OT research aimed at improving Level II FW education. Must be 1-3 years post graduation and had a Level II fieldwork in rehab. Click on the link below for 33 question survey. 5
participants chosen will each win $50.00. Approved Doc project of Rosalyn Lipsitt, Temple U."
"You are invited to participate in a survey for OTs in the physdys field. I am investigating treatment media choices of practicing OTs and what is influencing these choices. It doesn’t matter if you are a new grad or a veteran; I want to hear from you! You can find the survey at this site:" (I am not sure that this one is working 100% properly)
" Please follow the link below to participate in an online survey about occupational therapy and LOW VISION rehabilitation."
"I am a post-professional master's student and Virginia Commonwealth University attempting to complete my thesis research. If you are an OT who is NDT-trained (formerly NDT-Certified) in Adult Hemiplegia, please take a few minutes to click on the following link and complete a brief survey"
"The Westchester Institute for Human Development in New York is conducting a survey to determine what consumers know about the newborn screening process. Our goal is to improve consumer education on newborn screening. If you are 18 years of age or older, please visit http://wihd.org and take our anonymous online survey, which will take approximately 5-10 minutes of your time. It is in the upper right corner of the page."
" Contribute to OT research aimed at improving Level II FW education. Must be 1-3 years post graduation and had a Level II fieldwork in rehab. Click on the link below for 33 question survey. 5
participants chosen will each win $50.00. Approved Doc project of Rosalyn Lipsitt, Temple U."
"You are invited to participate in a survey for OTs in the physdys field. I am investigating treatment media choices of practicing OTs and what is influencing these choices. It doesn’t matter if you are a new grad or a veteran; I want to hear from you! You can find the survey at this site:" (I am not sure that this one is working 100% properly)
" Please follow the link below to participate in an online survey about occupational therapy and LOW VISION rehabilitation."
"I am a post-professional master's student and Virginia Commonwealth University attempting to complete my thesis research. If you are an OT who is NDT-trained (formerly NDT-Certified) in Adult Hemiplegia, please take a few minutes to click on the following link and complete a brief survey"
"The Westchester Institute for Human Development in New York is conducting a survey to determine what consumers know about the newborn screening process. Our goal is to improve consumer education on newborn screening. If you are 18 years of age or older, please visit http://wihd.org and take our anonymous online survey, which will take approximately 5-10 minutes of your time. It is in the upper right corner of the page."
6.09.2008
It begins...
Today was Day #1 of the new summer schedule. The new plan has me in outpatient Mondays from 815-?; Wednesdays 8-830 (only because this is literally the only time the family can come); and Fridays from 8-130. I spent a good portion of this time confused, as I couldn't remember who was coming when or where I was supposed to be. My first pt (an eval) canceled (for the 3rd time) so I ran across the street to evaluate some orthos. Then I had to run back to give a Peabody, had several peds to see, worked through lunch and didn't notice that my 1230 hadn't shown up until 1 o'clock. Also had an extended power outage in there that scared a child and destroyed one of my evals. Had a surprise videotaped session, and closed w/ a peds eval. Finally finished up the outpatients at 330 and had time to run back across the street and eval a lady on the observation unit before my brain was totally shot. Between the heat and lack of sleep, I developed a pounding headache and was quite ready for the day to end.
I've had a hard time sleeping on Sunday nights, likely due to the stress and anxiety of seeing the peds. Hopefully, the new schedule will get me out of work earlier so that I can stop working random 11.5 hour days. I spoke to 2 more parents today about starting OT for their kids, so the caseload is definitely growing. I can't tell if this will make things overall better or worse for the sleep situation. Part of the stress (ironically) is my impending vacation. I will be taking next week off to be a beach bum, thus leaving my colleagues shorthanded all week. When I return, another inpatient OT will be taking her week off, making week 2 of short staff and (almost assuredly) short tempers. To make matters extra fun, I have to work that Saturday and have an evening commitment every day that week. Vacation should not be this stressful! I need to learn to just turn it all off in my head, or I'm not going to be able to enjoy my vacation because of the stressors that are following it.
Here's hoping I can finally get some rest.
I've had a hard time sleeping on Sunday nights, likely due to the stress and anxiety of seeing the peds. Hopefully, the new schedule will get me out of work earlier so that I can stop working random 11.5 hour days. I spoke to 2 more parents today about starting OT for their kids, so the caseload is definitely growing. I can't tell if this will make things overall better or worse for the sleep situation. Part of the stress (ironically) is my impending vacation. I will be taking next week off to be a beach bum, thus leaving my colleagues shorthanded all week. When I return, another inpatient OT will be taking her week off, making week 2 of short staff and (almost assuredly) short tempers. To make matters extra fun, I have to work that Saturday and have an evening commitment every day that week. Vacation should not be this stressful! I need to learn to just turn it all off in my head, or I'm not going to be able to enjoy my vacation because of the stressors that are following it.
Here's hoping I can finally get some rest.
6.02.2008
Deadlines
I remember the euphoric feelings when my school semesters and fieldworks were over... at last, no more papers, no more due dates, no more deadlines hanging over me. How untrue. After missing work on Friday due to general misery, I had a large stack of paperwork that needed to be done last week waiting for me this morning. Co-signing COTA notes, weekly progress notes, and I didn't even begin to address the mounting discharges. And then, I arrive home, only to have a Sensory Profile School Companion that must be written up tonight, as I have put it off for 2 weeks and I am seeing the patient again tomorrow. I was really not excited about that as the teacher rated the child as overresponsive in EVERY area measured, so I had to add in a bunch of disclaimers and my usual tidy 1-page summary became a 3 page monstrosity.
So, the homework still exists. But I am a little excited to see this child again as he has dyspraxia (by my diagnosis- is that good enough?) and I will be testing him on our fancy Balance Master machine with assist of PT. The Balance Master is like a WiiFit for professionals who want statistical output. I haven't used it yet, and hope that he will be cooperative and that it will be fun and revealing.
So, the homework still exists. But I am a little excited to see this child again as he has dyspraxia (by my diagnosis- is that good enough?) and I will be testing him on our fancy Balance Master machine with assist of PT. The Balance Master is like a WiiFit for professionals who want statistical output. I haven't used it yet, and hope that he will be cooperative and that it will be fun and revealing.
Subscribe to:
Posts (Atom)