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.
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.
3.30.2009
Product Review- Forearm Forklift
The big part of the move is over! Though the unpacking and organizing continues, the heavy lifting is done. And so follows the review for the assistive device we bought- The Forearm Forklift (as seen on TV!).
We bought our Forearm Forklift through Amazon.com, and had no trouble with payment or shipping. The straps are compact and can easily fit in a large toolbox. The basic premise is that you have 2 straps that go under your furniture, and you and a friend slip your arms into the straps to lift objects more ergonomically. That is pretty much all of the instructions that you will receive... we got one sheet of paper with back protection techniques and a few pictures of the product in use.
The straps are designed for objects that are large enough to require 2 people to carry, but they really only work well with a certain shape- either tall/long and thin. Short and squat things (non flat-screen TVs, rubbermaid tubs) don't work very well. Though there are pictures of people carrying mattresses, we had no luck with this. And though the instructions show people moving objects with their wrists in extension and hands flat against the object, we were never able to carry something with stability without grasping our hands around the edges. There was some minor pain and bruising from where the strap hits the forearm. Considering the rows of bruises I incurred on my legs from the move, they were VERY minor. They also tended to slip off our forearms and down to the wrists, which made it difficult to use.
The instructions also showed people carrying items up and down stairs, but this was particularly problematic. Our old apartment had 15 steps (no landings, thank goodness) but a very short ceiling. This is where the straps first failed, because we couldn't lift large objects very far off the ground due to the low clearance. The straps did a little better in our new place since we had fewer steps and higher clearance, but in our situation, it was easier to push things down the stairs in a controlled manner than to try to lift them.
We have 3 dressers, and to load them into the truck we carried each drawer individually and then carried the frame. Doubling the trips that took 2 people, this resulted in 20 total trips! To unload them, we tried the straps, and were able to carry fully loaded dressers using 2 people for a total of 6 trips. A definite time-saver, especially since some of the drawers were poorly made and falling apart when we tried to move them separately, causing us to take more time to adjust them later.
Using the straps increases the prep time for each object. It's hard to get used to the motion required by the strap, even if you're familiar with body mechanics. My brother and husband aren't great with body mechanics, and there were definitely times that they used inappropriate methods with or without the straps despite warnings from their resident OT. But my brother stated that he did feel that the straps kept his back from being "destroyed" during the moving process (he is a little dramatic). My husband reported that they were useful and would use again. He had an alternative way of using them, actually lifting by the straps, which he reported hurt less than grabbing sharp edges to lift.
So, overall, it wasn't a panacea, it won't force you to use proper body mechanics, and doesn't always work as you would like. But it's cheap, and for heavy stuff, it provides some extra assist and security. There were some comments on another site from people who use it regularly and get good results, fortunately, I don't have to move THAT often so it will take a little longer to get used to it. Even if the assist and security provided wasn't all I'd hoped for, it was enough to make it worth the low price. I have linked some other sources, and a couple of other products that other people referred to in those comments. I haven't fully evaluated those, but I included them in case anyone else is looking for a good moving solution.
Official Site
More Reviews from Amazon
Other Products: Shoulder Dolly and Teamstrap Moving Straps
We bought our Forearm Forklift through Amazon.com, and had no trouble with payment or shipping. The straps are compact and can easily fit in a large toolbox. The basic premise is that you have 2 straps that go under your furniture, and you and a friend slip your arms into the straps to lift objects more ergonomically. That is pretty much all of the instructions that you will receive... we got one sheet of paper with back protection techniques and a few pictures of the product in use.
The straps are designed for objects that are large enough to require 2 people to carry, but they really only work well with a certain shape- either tall/long and thin. Short and squat things (non flat-screen TVs, rubbermaid tubs) don't work very well. Though there are pictures of people carrying mattresses, we had no luck with this. And though the instructions show people moving objects with their wrists in extension and hands flat against the object, we were never able to carry something with stability without grasping our hands around the edges. There was some minor pain and bruising from where the strap hits the forearm. Considering the rows of bruises I incurred on my legs from the move, they were VERY minor. They also tended to slip off our forearms and down to the wrists, which made it difficult to use.
The instructions also showed people carrying items up and down stairs, but this was particularly problematic. Our old apartment had 15 steps (no landings, thank goodness) but a very short ceiling. This is where the straps first failed, because we couldn't lift large objects very far off the ground due to the low clearance. The straps did a little better in our new place since we had fewer steps and higher clearance, but in our situation, it was easier to push things down the stairs in a controlled manner than to try to lift them.
We have 3 dressers, and to load them into the truck we carried each drawer individually and then carried the frame. Doubling the trips that took 2 people, this resulted in 20 total trips! To unload them, we tried the straps, and were able to carry fully loaded dressers using 2 people for a total of 6 trips. A definite time-saver, especially since some of the drawers were poorly made and falling apart when we tried to move them separately, causing us to take more time to adjust them later.
Using the straps increases the prep time for each object. It's hard to get used to the motion required by the strap, even if you're familiar with body mechanics. My brother and husband aren't great with body mechanics, and there were definitely times that they used inappropriate methods with or without the straps despite warnings from their resident OT. But my brother stated that he did feel that the straps kept his back from being "destroyed" during the moving process (he is a little dramatic). My husband reported that they were useful and would use again. He had an alternative way of using them, actually lifting by the straps, which he reported hurt less than grabbing sharp edges to lift.
So, overall, it wasn't a panacea, it won't force you to use proper body mechanics, and doesn't always work as you would like. But it's cheap, and for heavy stuff, it provides some extra assist and security. There were some comments on another site from people who use it regularly and get good results, fortunately, I don't have to move THAT often so it will take a little longer to get used to it. Even if the assist and security provided wasn't all I'd hoped for, it was enough to make it worth the low price. I have linked some other sources, and a couple of other products that other people referred to in those comments. I haven't fully evaluated those, but I included them in case anyone else is looking for a good moving solution.
Official Site
More Reviews from Amazon
Other Products: Shoulder Dolly and Teamstrap Moving Straps
3.28.2009
Not mad at Obama.
I haven't really ever done a post in response to another, and not a lot on specific political events. But here is my take on the recent Obama Special Olympics comment.
First of all, let me say that yes, it was inappropriate for him to compare his lack of bowling skills to the Special Olympics. I think we all know that, and there's no need to start a flame war over that. And his comparison was quite off the mark- there's been several posts about athletes in the Special Olympics who bowl MUCH better than he does, my uncle-in-law being one of them. If anything, he should have compared himself to my friend Joanna, who regularly scores in the 20-50 pt range if not using bumpers (love you Jo!).
I read Chris's post, and he is understandably upset about the fact that someone in a leadership position would make a disparaging comment about a disability group. But I cannot condemn Obama for the comment, nor do I believe that this is revealing his "true world-view" and I also don't extrapolate this to how the administration will respond to disability issues. Why not? Because I have said stupid things too. I can think of several times that I said hurtful things to people who were my close friends because I just said the wrong thing. These statements didn't cost me those friendships because it wasn't a long term pattern and wasn't indicative of how I routinely treated them.
I don't think that this slip of the tongue, inappropriate and regrettable though it was, is evidence of the overall disability policy. The quick turnover in news cycles has turned every comment and minute action of politicians and celebrities into major news, which is great news for Jon Stewart, but a pain for those seeking sanity. At this point, I think it's more logical to wait and see how Obama acts on disability related policy than to rush to condemn him for one off comment. I would think that the recent stem cell decision fits into that column. Actions speak louder than words, or at least they should.
First of all, let me say that yes, it was inappropriate for him to compare his lack of bowling skills to the Special Olympics. I think we all know that, and there's no need to start a flame war over that. And his comparison was quite off the mark- there's been several posts about athletes in the Special Olympics who bowl MUCH better than he does, my uncle-in-law being one of them. If anything, he should have compared himself to my friend Joanna, who regularly scores in the 20-50 pt range if not using bumpers (love you Jo!).
I read Chris's post, and he is understandably upset about the fact that someone in a leadership position would make a disparaging comment about a disability group. But I cannot condemn Obama for the comment, nor do I believe that this is revealing his "true world-view" and I also don't extrapolate this to how the administration will respond to disability issues. Why not? Because I have said stupid things too. I can think of several times that I said hurtful things to people who were my close friends because I just said the wrong thing. These statements didn't cost me those friendships because it wasn't a long term pattern and wasn't indicative of how I routinely treated them.
I don't think that this slip of the tongue, inappropriate and regrettable though it was, is evidence of the overall disability policy. The quick turnover in news cycles has turned every comment and minute action of politicians and celebrities into major news, which is great news for Jon Stewart, but a pain for those seeking sanity. At this point, I think it's more logical to wait and see how Obama acts on disability related policy than to rush to condemn him for one off comment. I would think that the recent stem cell decision fits into that column. Actions speak louder than words, or at least they should.
3.27.2009
Doonesbury and Disability
Doonesbury is a comic strip that I read occasionally, waiting on an interesting storyline. Well, they just found one.
Doonesbury deals frequently with war and issues affecting soldiers, including disability. Awhile back, there was a series where B.D. lost his leg and was going through rehab, I remember an exchange where his OT was trying to get him to motor plan taking out the trash and his plan was to let the wife do it. How often does OT make it into the comics? and in a situation that is similar to what we deal with everyday, no less.
Anyway, the current storyline features Toggle, a soldier who incurred a TBI and continues to struggle with aphasia, entering a relationship with Alex Doonesbury. I don't really know the characters very well, but I am interested to see how this plays out. (Story starts 3/14/09, you can follow it here)
My only gripe is that there was a little rip on Toggle using facebook to meet people, but I think that the internet is one of the most valuable tools for a young person with a new disability. A guy that I worked with while on fieldwork was a 24 y.o. war veteran who had an SCI after returning home. His wife left him, he had to move back into his parent's house, but he was able to get online, find information about the personal/physical/emotional problems that he was dealing with, and make friends that way. It's hard to get out when you can't drive, and though he was working toward that with outpatient OT and PT, he needed to have those personal connections with other people. This was also pre-facebook times... nowadays, I have a hard time disconnecting from the internet for any length of time, it is the tool for most everything. OK, off the geek girl rant.
I think that there have been several realistic depictions of disability in comic strips. The other example that I can think of off the top of my head is when the grandfather in For Better or For Worse had a stroke. (Story starts 9/26/06, you can read month by month here) They continued to touch on issues of hospital care, rehab, caregiving, and patient frustration right up to the end of the strip when he was rehospitalized. Lynn Johnston also worked with her niece to construct the character of Shannon Lake, who has a learning disability, though I'm not sure of all the particulars since I didn't read that series all the way through.
Doonesbury deals frequently with war and issues affecting soldiers, including disability. Awhile back, there was a series where B.D. lost his leg and was going through rehab, I remember an exchange where his OT was trying to get him to motor plan taking out the trash and his plan was to let the wife do it. How often does OT make it into the comics? and in a situation that is similar to what we deal with everyday, no less.
Anyway, the current storyline features Toggle, a soldier who incurred a TBI and continues to struggle with aphasia, entering a relationship with Alex Doonesbury. I don't really know the characters very well, but I am interested to see how this plays out. (Story starts 3/14/09, you can follow it here)
My only gripe is that there was a little rip on Toggle using facebook to meet people, but I think that the internet is one of the most valuable tools for a young person with a new disability. A guy that I worked with while on fieldwork was a 24 y.o. war veteran who had an SCI after returning home. His wife left him, he had to move back into his parent's house, but he was able to get online, find information about the personal/physical/emotional problems that he was dealing with, and make friends that way. It's hard to get out when you can't drive, and though he was working toward that with outpatient OT and PT, he needed to have those personal connections with other people. This was also pre-facebook times... nowadays, I have a hard time disconnecting from the internet for any length of time, it is the tool for most everything. OK, off the geek girl rant.
I think that there have been several realistic depictions of disability in comic strips. The other example that I can think of off the top of my head is when the grandfather in For Better or For Worse had a stroke. (Story starts 9/26/06, you can read month by month here) They continued to touch on issues of hospital care, rehab, caregiving, and patient frustration right up to the end of the strip when he was rehospitalized. Lynn Johnston also worked with her niece to construct the character of Shannon Lake, who has a learning disability, though I'm not sure of all the particulars since I didn't read that series all the way through.
3.20.2009
Interesting Idea for Travelers
Traveling therapists, that is, and the kind that hop state to state as opposed to place to place within a big town. I am not a traveling therapist, though the boxes in my living room might suggest otherwise. But I was reading unclutterer and they were discussing Earth Class Mail, a virtual P.O. box that will scan your mail to your email account and then allow you to choose what to do with it- shred, send to you, archive, whatever. You can check out the prices here... I don't know how that compares to other mail forwarding options, but it sure sounds better than the cruddy service I've had at this apartment (numerous pieces lost or delayed up to 3 weeks).
Packing a moving truck today, which will be tiring, but I should also have enough info for a product review of the supposedly ergonomic Forearm Forklift (as seen on TV)!
Packing a moving truck today, which will be tiring, but I should also have enough info for a product review of the supposedly ergonomic Forearm Forklift (as seen on TV)!
3.16.2009
Mind warp
I was very confused when I woke up this morning (about 10 minutes ago). I said to myself, "ok, it's Thursday, what do you need to do?" Then I realized, it's not Thursday, I'm just not working. a little more after the click ->
I think most of the tears are over now. I am trying to get excited about my new exciting job, but first I have to get through the aggravating task of moving. Moving is very frustrating to me for all the questions it raises- How did we get so much stuff? Why are we moving here? Where is this/that/the other in our new place? How will we move again if we get any more stuff?! After seeing the apartment, I know that we have to get more lamps, as there are 3 rooms w/o overhead lighting.I am also unsure how the laundry situation will work out as our washer is approximately the size needed for a week's worth of socks. UGH.
It's also interesting that we are moving into a predominantly Jewish area, judging by the multiple synagogues, kosher eateries, and the "Kosher Assisted Living" across the street. The kosher Subway is down the street, but I think that this is the oddest restaurant that I noticed near the apartment, just for the combination of different cuisines.
Ok, got a little sidetracked from OT things, but this is bringing a change in my OT-ness too. I have 300 unread messages from the pediatric AOTA listserv that I have been putting off addressing since I know I won't be using it so much. Need to unsubscribe from that. I have to get everything ready for my license to be reviewed, since this state only reviews once a month. It's good to take a good look at the license requirements before you give your start date to your new job, FYI. I've done all I can do, now I'm just trying to facilitate other organizations doing what they need to as well. Got to change address for all my subscriptions and such. Very busy in box-town.
Have plenty to update about if I ever sit down to do it. Last week was too emotional, hopefully this week won't be too busy. Have to figure out how to transport my violets, which are fragile and blooming again.
Oh, and free giveaway- I have AJOTs from 2005, I think, to now. I will mail them wherever, if not, they're heading to the recycling center. So if you want them drop me an email with your address and I'll gladly send them to a new happy home.
I think most of the tears are over now. I am trying to get excited about my new exciting job, but first I have to get through the aggravating task of moving. Moving is very frustrating to me for all the questions it raises- How did we get so much stuff? Why are we moving here? Where is this/that/the other in our new place? How will we move again if we get any more stuff?! After seeing the apartment, I know that we have to get more lamps, as there are 3 rooms w/o overhead lighting.I am also unsure how the laundry situation will work out as our washer is approximately the size needed for a week's worth of socks. UGH.
It's also interesting that we are moving into a predominantly Jewish area, judging by the multiple synagogues, kosher eateries, and the "Kosher Assisted Living" across the street. The kosher Subway is down the street, but I think that this is the oddest restaurant that I noticed near the apartment, just for the combination of different cuisines.
Ok, got a little sidetracked from OT things, but this is bringing a change in my OT-ness too. I have 300 unread messages from the pediatric AOTA listserv that I have been putting off addressing since I know I won't be using it so much. Need to unsubscribe from that. I have to get everything ready for my license to be reviewed, since this state only reviews once a month. It's good to take a good look at the license requirements before you give your start date to your new job, FYI. I've done all I can do, now I'm just trying to facilitate other organizations doing what they need to as well. Got to change address for all my subscriptions and such. Very busy in box-town.
Have plenty to update about if I ever sit down to do it. Last week was too emotional, hopefully this week won't be too busy. Have to figure out how to transport my violets, which are fragile and blooming again.
Oh, and free giveaway- I have AJOTs from 2005, I think, to now. I will mail them wherever, if not, they're heading to the recycling center. So if you want them drop me an email with your address and I'll gladly send them to a new happy home.
3.06.2009
Chapter 2
I haven't done the late-night blogging entry since junior or senior year of college, especially since I started working and had to start going to bed at a reasonable hour. But I've had a lot of things on my mind of late and can't sleep anyway, so might as well. Go ahead and grab a snack before you click, I expect this will be a long post.
Over the past few months, I had decided to leave my current job. I had toyed with a lot of different choices for what to do next, looked pretty seriously into early intervention, also thought pretty seriously about moving back across the state to where the families are. In a serendipitous manner, many things came together to lead me to pursuing a new opportunity at a hospital in Baltimore, and that will be my new home shortly.
Like many of the children I have worked with, I struggle with transitions. My husband prodded me into completing an initial application, I was eager for an official offer, but now the emotions are in full swing. I am having a hard time adjusting to leaving, a lot harder time than I thought I would. I entered this job knowing that my time would be transient, but the attachment got well formed anyway. I've had the pleasure of working with several intelligent coworkers who have taught me some of their tricks of the trade and helped me see where my education was lacking. The group of inpatient therapists who've been working together for 20 years and more have worked hard to help me be less stressed by the job. It's taken awhile, but I feel like I have good friends that I work with, and boxing up those cards and photographs is really hurting... more than leaving high school, more than leaving OT school.
Though the decision to leave was fully my own, and did not make (most of) my coworkers happy, I believe it probably prevented some tough times for the department. Our SNF unit had a massive audit several months ago and we had all been waiting on tenterhooks for the professionals' suggestions to improve the quality and profitability of our unit. I was actually looking forward to this as I saw it as a chance for us to make some really positive OT changes. However, the powers that be have decided that it is best to shut the unit down within the year. A lot of really superb nurses and techs are out of a job and the rehab department is going to have to do some restructuring for things to stay copesetic. This all got announced the day before I gave my notice, and I think it contributed to my pregnant coworker deciding that she would leave as well. The future is still uncertain for the world of inpatient therapy... will they decide to make a very small inpatient rehab facility that can hopefully be more profitable? If not, the focus turns entirely to acute care, and it will take some major marketing before that can sustain the current employees for a full time workweek. I'm kind of sad that there's finally some change taking place and not only will I not get to be part of it, but my opinion in the matter is a moot point. All the changes are theoretical now though... no telling what will actually happen or how stressful it will be to get there.
As mentioned, my COTA coworker is leaving too. We were the entirety of the pediatric OT treatment team. Leaving the kids is literally tearing me in two. I would not have held onto this job this long if not for the kids. Pediatrics is the area I had the least skill and experience in when I started the job and it's the area that I have invested a lot of time in so that I could grow. And I do feel that I have grown as a pediatric therapist... I feel a lot more confident now in an evaluation, in spotting sensory processing problems, and in planning treatment sessions. I have spent numerous off the clock hours writing up sensory profiles (though I didn't get them all done today), reworking the computerized evaluation, and scouting the bargain stores for the perfect toys to elicit the just right challenge.
I have learned so much from the group of kids and parents that I have worked with, and have really become attached to them. I told Bob (a parent) at one point that working with his child and 2 specific others that are long-time consumers was very grounding for my life. No matter what else was happening in work, I could count on those specific 30 minute sessions to give me a routine that was often more fulfilling than the rest of the day, week, month. I have been worried sick about leaving the kids, especially since there will be a limbo time between therapists. My coworker talked about feeling territorial and resentful when an interviewee was brought in recently, because she didn't want to be replaced. I think I would feel better if I knew that there was someone starting right when I left (instead of 3 months later) and that I could talk to them and show them where everything was and present what I'd been doing with the kids and know that they would be ok, that there was someone to take care of everything after I go. I know it sounds terribly narcisstic- they will survive just fine without me and many will never remember me- but I just wish I could be assured that they would all be taken care of. In a selfish way, I also wish I could know that all the parts of the program that I have tried to build up would continue to build and not crumble. I don't want to feel like everything I did will be erased and of no consequence.
I don't worry about the adult patients in the same way. There is a revolving door on the hospital, many will be back again, and there will be a time that they don't recover. That is just something that I think you have to accept when working with that population. I do worry that with the shuttering of the transitional care unit that there will be people who get unwillingly pushed into a 'nursing home' stay and get very upset by that label. There were a lot of people who refused to go to an inpatient rehab facility or a long term community skilled facility until they had given rehab a try for a few weeks on the TCU floor. We took in a lot of joint replacement patients who would not meet requirements for an IRF, and who knows how many complications were prevented by allowing these folks with 'basic' surgeries a few extra days of supervised recovery. Enough that the orthopedic surgeons are not happy with the decision. To sum up, I worry in general about the adult patients, but their stays are so transient that I usually only worry my mind over them specifically while they are present or just recently discharged. There's no one adult who's fate will keep me up at nights, hopefully they will all be taken care of well despite the current flux.
There are other things I will miss... my COTA coworker gets more pregnant by the day, which is amusing and interesting, and I probably won't hear much about her baby. The SLP is finally getting settled into her humongus house, and I won't get a repeat visit there. Other babies are growing, my pediatric PT buddy is just coming off a honeymoon, my acute care PT buddy is growing a business and buying a house, there's a lot of personal things that I will miss. During my time here, I was able to see that when other employees left, their shadow did not remain... their names and antics were forgotten. It does hurt to know that people you've been close to will not remember you, and if they do, they will probably not care that much about the course of your life. It's normal, I know, because how could any person function if they were weighed down with the irrelevant future of every person from their past that they once were close to? That's why we facebook people we went to elementary school with, instead of writing detailed letters to them.
2 goofy things that I will miss:
- I am a number freak, always watching my car odometer and clock for palindromes and other patterns. It has always brought me a distinct feeling of success when our medical record numbers grows by a hundred thousand. I started working with people who were in the 1960000's, recently I have had a pt who had a 1999000 number. I will be really bummed if I don't see someone in the 2 millions.
- After a winter of carefully watching my step and dodging the nastiest smelling berries (?) from a tree in front of the door I use twice daily, hoping that I didn't step on one and bring the stench of vomit in on my shoes, they finally cut that darn tree down.
I know I am blessed to be leaving on my own terms, to another job, where my husband can keep his job, especially in the current economic situation. Truthfully, though I had talked of going home, it would have made it very hard to find 2 new jobs and a new place to live and go through that kind of transition in a recession. I likely would have had to be the sole provider for awhile, and I have seen the stress that has put on my coworkers. I wasn't forced to leave due to cutbacks, terrible treatment, or a need for more money, and I am thankful for that, and know that I am a little spoiled to be worried about these insignifcant things at a time when others are worried about having a job at all.
I feel that I did make the right decision, though it was very hard, and is making me do hard things like move, learn new things, and start all over in a big city. I will get some good opportunities at the new hospital, and be able to rotate to different areas every 3 months or so, which should help quell potential boredom/burnout. I will get my chance at a 'big place,' without having to move to Chicago, Atlanta, LA, etc... and see if that, which has always been something that I talked about wanting to do, is actually something that I enjoy doing. I will be able to get some more critical cases as city hospitals do get more of compared to their rural counterparts. I will get to be part of a large team of therapists who seem to be committed to personal improvement. Hopefully they are not reading this and wondering what kind of neurotic person is joining their team... I'm sure they will all find out soon enough firsthand. :-P
I do feel better now that this is all finally out in the open. I'll still be emotional, but hopefully the thoughts will slow down in my head enough for me to get to sleep. My last day at work is next week, I will follow that up by moving, acquiring a new OT license, and starting Chapter 2. Wish me luck.
Over the past few months, I had decided to leave my current job. I had toyed with a lot of different choices for what to do next, looked pretty seriously into early intervention, also thought pretty seriously about moving back across the state to where the families are. In a serendipitous manner, many things came together to lead me to pursuing a new opportunity at a hospital in Baltimore, and that will be my new home shortly.
Like many of the children I have worked with, I struggle with transitions. My husband prodded me into completing an initial application, I was eager for an official offer, but now the emotions are in full swing. I am having a hard time adjusting to leaving, a lot harder time than I thought I would. I entered this job knowing that my time would be transient, but the attachment got well formed anyway. I've had the pleasure of working with several intelligent coworkers who have taught me some of their tricks of the trade and helped me see where my education was lacking. The group of inpatient therapists who've been working together for 20 years and more have worked hard to help me be less stressed by the job. It's taken awhile, but I feel like I have good friends that I work with, and boxing up those cards and photographs is really hurting... more than leaving high school, more than leaving OT school.
Though the decision to leave was fully my own, and did not make (most of) my coworkers happy, I believe it probably prevented some tough times for the department. Our SNF unit had a massive audit several months ago and we had all been waiting on tenterhooks for the professionals' suggestions to improve the quality and profitability of our unit. I was actually looking forward to this as I saw it as a chance for us to make some really positive OT changes. However, the powers that be have decided that it is best to shut the unit down within the year. A lot of really superb nurses and techs are out of a job and the rehab department is going to have to do some restructuring for things to stay copesetic. This all got announced the day before I gave my notice, and I think it contributed to my pregnant coworker deciding that she would leave as well. The future is still uncertain for the world of inpatient therapy... will they decide to make a very small inpatient rehab facility that can hopefully be more profitable? If not, the focus turns entirely to acute care, and it will take some major marketing before that can sustain the current employees for a full time workweek. I'm kind of sad that there's finally some change taking place and not only will I not get to be part of it, but my opinion in the matter is a moot point. All the changes are theoretical now though... no telling what will actually happen or how stressful it will be to get there.
As mentioned, my COTA coworker is leaving too. We were the entirety of the pediatric OT treatment team. Leaving the kids is literally tearing me in two. I would not have held onto this job this long if not for the kids. Pediatrics is the area I had the least skill and experience in when I started the job and it's the area that I have invested a lot of time in so that I could grow. And I do feel that I have grown as a pediatric therapist... I feel a lot more confident now in an evaluation, in spotting sensory processing problems, and in planning treatment sessions. I have spent numerous off the clock hours writing up sensory profiles (though I didn't get them all done today), reworking the computerized evaluation, and scouting the bargain stores for the perfect toys to elicit the just right challenge.
I have learned so much from the group of kids and parents that I have worked with, and have really become attached to them. I told Bob (a parent) at one point that working with his child and 2 specific others that are long-time consumers was very grounding for my life. No matter what else was happening in work, I could count on those specific 30 minute sessions to give me a routine that was often more fulfilling than the rest of the day, week, month. I have been worried sick about leaving the kids, especially since there will be a limbo time between therapists. My coworker talked about feeling territorial and resentful when an interviewee was brought in recently, because she didn't want to be replaced. I think I would feel better if I knew that there was someone starting right when I left (instead of 3 months later) and that I could talk to them and show them where everything was and present what I'd been doing with the kids and know that they would be ok, that there was someone to take care of everything after I go. I know it sounds terribly narcisstic- they will survive just fine without me and many will never remember me- but I just wish I could be assured that they would all be taken care of. In a selfish way, I also wish I could know that all the parts of the program that I have tried to build up would continue to build and not crumble. I don't want to feel like everything I did will be erased and of no consequence.
I don't worry about the adult patients in the same way. There is a revolving door on the hospital, many will be back again, and there will be a time that they don't recover. That is just something that I think you have to accept when working with that population. I do worry that with the shuttering of the transitional care unit that there will be people who get unwillingly pushed into a 'nursing home' stay and get very upset by that label. There were a lot of people who refused to go to an inpatient rehab facility or a long term community skilled facility until they had given rehab a try for a few weeks on the TCU floor. We took in a lot of joint replacement patients who would not meet requirements for an IRF, and who knows how many complications were prevented by allowing these folks with 'basic' surgeries a few extra days of supervised recovery. Enough that the orthopedic surgeons are not happy with the decision. To sum up, I worry in general about the adult patients, but their stays are so transient that I usually only worry my mind over them specifically while they are present or just recently discharged. There's no one adult who's fate will keep me up at nights, hopefully they will all be taken care of well despite the current flux.
There are other things I will miss... my COTA coworker gets more pregnant by the day, which is amusing and interesting, and I probably won't hear much about her baby. The SLP is finally getting settled into her humongus house, and I won't get a repeat visit there. Other babies are growing, my pediatric PT buddy is just coming off a honeymoon, my acute care PT buddy is growing a business and buying a house, there's a lot of personal things that I will miss. During my time here, I was able to see that when other employees left, their shadow did not remain... their names and antics were forgotten. It does hurt to know that people you've been close to will not remember you, and if they do, they will probably not care that much about the course of your life. It's normal, I know, because how could any person function if they were weighed down with the irrelevant future of every person from their past that they once were close to? That's why we facebook people we went to elementary school with, instead of writing detailed letters to them.
2 goofy things that I will miss:
- I am a number freak, always watching my car odometer and clock for palindromes and other patterns. It has always brought me a distinct feeling of success when our medical record numbers grows by a hundred thousand. I started working with people who were in the 1960000's, recently I have had a pt who had a 1999000 number. I will be really bummed if I don't see someone in the 2 millions.
- After a winter of carefully watching my step and dodging the nastiest smelling berries (?) from a tree in front of the door I use twice daily, hoping that I didn't step on one and bring the stench of vomit in on my shoes, they finally cut that darn tree down.
I know I am blessed to be leaving on my own terms, to another job, where my husband can keep his job, especially in the current economic situation. Truthfully, though I had talked of going home, it would have made it very hard to find 2 new jobs and a new place to live and go through that kind of transition in a recession. I likely would have had to be the sole provider for awhile, and I have seen the stress that has put on my coworkers. I wasn't forced to leave due to cutbacks, terrible treatment, or a need for more money, and I am thankful for that, and know that I am a little spoiled to be worried about these insignifcant things at a time when others are worried about having a job at all.
I feel that I did make the right decision, though it was very hard, and is making me do hard things like move, learn new things, and start all over in a big city. I will get some good opportunities at the new hospital, and be able to rotate to different areas every 3 months or so, which should help quell potential boredom/burnout. I will get my chance at a 'big place,' without having to move to Chicago, Atlanta, LA, etc... and see if that, which has always been something that I talked about wanting to do, is actually something that I enjoy doing. I will be able to get some more critical cases as city hospitals do get more of compared to their rural counterparts. I will get to be part of a large team of therapists who seem to be committed to personal improvement. Hopefully they are not reading this and wondering what kind of neurotic person is joining their team... I'm sure they will all find out soon enough firsthand. :-P
I do feel better now that this is all finally out in the open. I'll still be emotional, but hopefully the thoughts will slow down in my head enough for me to get to sleep. My last day at work is next week, I will follow that up by moving, acquiring a new OT license, and starting Chapter 2. Wish me luck.
3.05.2009
I live in the Procrastination Station
I am up to my eyeballs in stuff to do... need to be writing up 2 sensory profiles and 2 sensory diets for Monday and Tuesday. Have to leave town this weekend, which will make that harder. Lots of other things to do, but I feel that shouldn't really be discussed until I can write a major entry here, which I have also been putting off. I have difficulty with transitions, and currently with organization. My thoughts have also been very transient, jumping to inane topics such as how death is dealt with in Dexter and Pushing Daisies, 2 shows that I like and which have nothing in common.The randomness and procrastination are possibly my coping strategies for stress, but it's making it hard to do what I have to do. Hopefully I will get all I need to done (finally) and can address some of these important issues soon. It's 4... can I get that stuff written up by 6? I hope so...
2.26.2009
Energy Crisis
Made it back from Florida alive... my husband caught a lot of stuff while we were down there and I am still dealing with some sinus stuffiness and feel like my ears are all plugged up. Between taking care of him and working an exceptionally long Tuesday, whatever brain cells made it back from vacation have been more than occupied. I have some major things to write about, but have not been formulating sentences very well. (true example: "we am canceling my membership") For someone who is internally outraged when there's confusion over your/you're or their/there/they're, it's been more than a bit frustrating. I will update soon, once this mental problem is resolved and the pile of Sensory Profiles is graded. I did at least 1 intelligent thing yesterday though... saw in the nurses notes that a man who had a knee replacement and had later had some cardiac issues had a bad night and asked the COTA not to see him that morning... he wound up in the ICU later that day. Yikes, but at least we didn't push him into it.
2.18.2009
OT WebGems- Manipulate the Brain Edition
I love brain stuff. Here's a few pieces on how that great organ works and changes, also a couple of behavioral modification pieces thrown in.
Starting off, research shows that even mild concussions can have effects years into the future, which has got to be troublesome news to anyone involved in contact sports. Go go helmet developers!
An fMRI study looked at how older and younger individuals processed negative images, and the researchers concluded that the older women were able to cope with these problems better. So hopefully one can become less stressed over time, that's what I'm hoping for anyway.
This piece has been floating around my bookmarks page for a long time (note that the subtitle discusses the election season) but it's an interesting look at irrational behavior and why humans take offense.
Researchers at Johns Hopkins found that controlled doses of carbon monoxide can prevent damage after a stroke, which makes sense after hearing about it, but who is smart enough to think this up ahead of time? Still seems to have a short window to operate, but I love seeing the new advances.
On another stroke note, here are some of the gender differences in care before and after CVA.
This was an interesting study involving deep brain stimulation in patients w/ Parkinsons, which I found fascinating.
Behavior modification is always useful, not least when used on ourselves. This article discusses how the fear of being labeled a hypocrite will lead people to make lifestyle changes. This ADVANCE piece discusses the benefit of actually accomplishing things even when they're hard. And this is a more detailed piece, also from ADVANCE about learning emotional awareness and control.
That's it for today, as my brain is currently hoping for no micro-trauma from roller-coaster riding!
Starting off, research shows that even mild concussions can have effects years into the future, which has got to be troublesome news to anyone involved in contact sports. Go go helmet developers!
An fMRI study looked at how older and younger individuals processed negative images, and the researchers concluded that the older women were able to cope with these problems better. So hopefully one can become less stressed over time, that's what I'm hoping for anyway.
This piece has been floating around my bookmarks page for a long time (note that the subtitle discusses the election season) but it's an interesting look at irrational behavior and why humans take offense.
Researchers at Johns Hopkins found that controlled doses of carbon monoxide can prevent damage after a stroke, which makes sense after hearing about it, but who is smart enough to think this up ahead of time? Still seems to have a short window to operate, but I love seeing the new advances.
On another stroke note, here are some of the gender differences in care before and after CVA.
This was an interesting study involving deep brain stimulation in patients w/ Parkinsons, which I found fascinating.
Behavior modification is always useful, not least when used on ourselves. This article discusses how the fear of being labeled a hypocrite will lead people to make lifestyle changes. This ADVANCE piece discusses the benefit of actually accomplishing things even when they're hard. And this is a more detailed piece, also from ADVANCE about learning emotional awareness and control.
That's it for today, as my brain is currently hoping for no micro-trauma from roller-coaster riding!
2.16.2009
Shoe Tying
I saw this "Rubes" cartoon and had to laugh considering the amount of time that I have spent working on other people's shoe tying skills. My little boy with dyspraxia continues to struggle... I don't even attempt it every week since I don't want breakdowns every week. I have been to this site on shoe tying, but continue to struggle. I have tried the 2 loops method, the 1 loop wrap method, and have tried teaching an alternate way to make loops (weave lace under index finger, over middle finger, under ring finger and then squeeze ring and index finger together). I also routinely do knots using wikki stix with 2 differently colored stix, but this doesn't always transfer to laces.
It's a struggle. I love the new Sketchers shoes that have the elastic laces and just slip on- little miss S has those and some velcro mary janes and I think they both rock. She has autism and is always super well dressed, but part of that is because they don't have to worry about laces.
Anybody have an absolutely FREE method for shoe tying that works?
2.15.2009
OT WebGems- Geriatric Issues
I am by nature, a total packrat in real life. I am even worse on the internet, as my bookmarks folder is now overflowing waterfall style! So here come the WebGems- with a focus on geriatric issues.
First off, some good news- TKRs do improve I/ADL function for elderly individuals! So it will be worthwhile in the end- but remember, it will HURT!!
This an ADVANCE piece on Elderspeak. It can be a hard habit to break, and usually requires me to write down all my patients' names until they're familiar to me, but I think people respond better when talked to appropriately. Different facilities have different policies... when I was on my Level II's we were on a first name basis with all the clients, to the point where one place had first names, last initial, on all the wheelchairs. At my current employment we're supposed to use Mr/Ms Last Name, but usually when I ask people what they would like to be called, they give their first names. My only confusion has been with having priests as patients... the ones that I have had (who knew each other, ironically) both asked to be called by their first names, but then I got dirty looks from people who thought I should be addressing them as Father X.
This Medline article implies that they're getting better testing for evaluating a person's driving ability. (Hope it's better than the Portoglare!) No mention of OT driving rehab or Carfit. This test is pretty extensive though, and the main problem is that they're describing it as a test for people with Alzheimer's Disease. It would be hard enough to get a person to agree to take this once, but they're certainly not going to want to keep taking it every year to satisfy that they're capable.
In other AD news, there are reports of a lot of caregiver abuse. This should add to the case for better respite programs and support systems for elderly aging in place and caregivers in general.
Romance is an issue from birth to death. This editorial reflects on falling in love after aging. And this piece is an interesting look at love in an ALF and the complications involving the family and staff.
And lastly, this editorial by an internist looks at how complicated it has become to die in a world of MPOAs, full codes, and feeding tubes.
First off, some good news- TKRs do improve I/ADL function for elderly individuals! So it will be worthwhile in the end- but remember, it will HURT!!
This an ADVANCE piece on Elderspeak. It can be a hard habit to break, and usually requires me to write down all my patients' names until they're familiar to me, but I think people respond better when talked to appropriately. Different facilities have different policies... when I was on my Level II's we were on a first name basis with all the clients, to the point where one place had first names, last initial, on all the wheelchairs. At my current employment we're supposed to use Mr/Ms Last Name, but usually when I ask people what they would like to be called, they give their first names. My only confusion has been with having priests as patients... the ones that I have had (who knew each other, ironically) both asked to be called by their first names, but then I got dirty looks from people who thought I should be addressing them as Father X.
This Medline article implies that they're getting better testing for evaluating a person's driving ability. (Hope it's better than the Portoglare!) No mention of OT driving rehab or Carfit. This test is pretty extensive though, and the main problem is that they're describing it as a test for people with Alzheimer's Disease. It would be hard enough to get a person to agree to take this once, but they're certainly not going to want to keep taking it every year to satisfy that they're capable.
In other AD news, there are reports of a lot of caregiver abuse. This should add to the case for better respite programs and support systems for elderly aging in place and caregivers in general.
Romance is an issue from birth to death. This editorial reflects on falling in love after aging. And this piece is an interesting look at love in an ALF and the complications involving the family and staff.
And lastly, this editorial by an internist looks at how complicated it has become to die in a world of MPOAs, full codes, and feeding tubes.
2.13.2009
Vacation!
If all goes according to plan, today I am boarding a flight for Florida! Hello Disney! Relaxing days of sun and fun! I have scheduled a few entries for the break, but won't be my usual speedy self at replying to emails, approving comments, etc. Supposed to be 80* on Saturday... yum!!
2.11.2009
Caution! You have computers at work!
A brief cautionary reminder
I consider myself fairly 'tech-savvy' but I feel that I am sort of on the upper age bracket of the facebook generation. To be more specific, I grew up with computers, had the internet and IM through adolescence, but was already old in techno-world once myspace and facebook came along. But this is a relevant topic for anyone living in the computer age, because I think we all take the machines for granted.
Everyone familiar w/ computers knows that emails, IMs, blog posts, etc can live (basically) forever on servers and be accessed later by other parties. Most everyone has a tale of someone seeing something they wrote that was never intended for their eyes, with embarrassing consequences. At work, they can be more than embarrassing. Any employee accessing a work computer nowadays has to sign an agreement about what can and can't be done on that computer. Most companies have filters that prevent you from accessing certain websites- our hospital has a particularly annoying filter that blocks anything with the word "store" in the title or address, which makes it really hard to print out pictures of devices for our patients. You can get in trouble for coming up against the block too often, though fortunately I haven't.
If you have access to medical records on your computer, then confidentiality agreements and especially HIPAA hold you to a certain standard for how you access that information. You will undoubtedly sign contracts that indicate that you will only access the charts which you NEED to know medical details about. And to ensure this, your facility can do an audit at any time, of any chart, they will also do this if there is a specific complaint of someone breaching the agreement. While any chart can be audited, charts belonging to other workers at the facility or VIPs are more likely to be checked. A coworker recently got written up for doing what a lot of people do- looking up records on family members. No OT orders, so no "need to know," and a violation.
Another tool that can be used is a keystroke recorder. That means that ALL your emails can be monitored and reread, that the website addresses you enter are all recorded, anything. A friend of mine who works in a non-healthcare industry recently had a problem with this and lost a job. What was the offense? Typing an offensive word, and then deleting it. That's right, no clients or bosses saw this typed on any papers or walked by the computer screen, and it was still enough to lose a job.
So be careful, because it's not just probability anymore, at least not in my world.
I consider myself fairly 'tech-savvy' but I feel that I am sort of on the upper age bracket of the facebook generation. To be more specific, I grew up with computers, had the internet and IM through adolescence, but was already old in techno-world once myspace and facebook came along. But this is a relevant topic for anyone living in the computer age, because I think we all take the machines for granted.
Everyone familiar w/ computers knows that emails, IMs, blog posts, etc can live (basically) forever on servers and be accessed later by other parties. Most everyone has a tale of someone seeing something they wrote that was never intended for their eyes, with embarrassing consequences. At work, they can be more than embarrassing. Any employee accessing a work computer nowadays has to sign an agreement about what can and can't be done on that computer. Most companies have filters that prevent you from accessing certain websites- our hospital has a particularly annoying filter that blocks anything with the word "store" in the title or address, which makes it really hard to print out pictures of devices for our patients. You can get in trouble for coming up against the block too often, though fortunately I haven't.
If you have access to medical records on your computer, then confidentiality agreements and especially HIPAA hold you to a certain standard for how you access that information. You will undoubtedly sign contracts that indicate that you will only access the charts which you NEED to know medical details about. And to ensure this, your facility can do an audit at any time, of any chart, they will also do this if there is a specific complaint of someone breaching the agreement. While any chart can be audited, charts belonging to other workers at the facility or VIPs are more likely to be checked. A coworker recently got written up for doing what a lot of people do- looking up records on family members. No OT orders, so no "need to know," and a violation.
Another tool that can be used is a keystroke recorder. That means that ALL your emails can be monitored and reread, that the website addresses you enter are all recorded, anything. A friend of mine who works in a non-healthcare industry recently had a problem with this and lost a job. What was the offense? Typing an offensive word, and then deleting it. That's right, no clients or bosses saw this typed on any papers or walked by the computer screen, and it was still enough to lose a job.
So be careful, because it's not just probability anymore, at least not in my world.
2.07.2009
ASD on TV
Thoughts on a couple of TV shows
I recently read an article about one of my favorite new TV shows, The Big Bang Theory. I have been watching this show since its premiere, partly because I am admittedly dorky, friends with others who share my dorkitude, and married to an engineer. I know those guys on the show through my interactions with my friends in college and love that the show isn't making fun of geekiness, but making it fun to be geeky! In the article that I read, they were debating about whether Sheldon has Asperger's Syndrome, and apparently there is a large following that believes it is so. If you're not familiar with the show, check out his flowchart for making friends. It's not something that I had given a lot of thought to while watching, because I just considered each character an exaggeration, and it is often thought that 'typical geeks' have several spectrum characteristics without a diagnosis. Is Sheldon diagnosable? Almost certainly. Is it purposeful? Chuck Lorre says no, and that's believable. We're all a little bit on the spectrum... I took this quiz (no endorsement, just the first one I found) and came out favoring the autistic side more than the 'neurotypical' side, which is probably no surprise to anyone who knows any of my numerous sensory issues.
Another show that I have just started watching is Dexter. He is a sociopathic killer who has a day job at the Miami police department. Dexter has severely decreased emotional responses, usually nonexistant. He likely has antisocial personality disorder, though he goes to great lengths to fit in. It has been comical for me to watch his foster father teach him how to fit in, how to pretend, how to be one of the crowd. Halfway through season 1, he has absorbed the instructions to fake social skills pretty well though he does give off some telltale signs of personality disorder that the rest of the cast conveinently ignores. I suspect he has a few additional undiagnosed issues, possibly some OCD, or his attention to detail might be significant of a spectrum disorder.
Not that I think you'll see OT on TV anytime soon, but it is interesting that we are getting a broader range of characters on shows. There was a pretty cool poster presentation at the '05 AOTA conference about disability as presented on TV and movies, you can find many of those movies here. Have you spotted any TV/movie characters that were displaying significant symptoms but not 'outed' as having a disability?
I recently read an article about one of my favorite new TV shows, The Big Bang Theory. I have been watching this show since its premiere, partly because I am admittedly dorky, friends with others who share my dorkitude, and married to an engineer. I know those guys on the show through my interactions with my friends in college and love that the show isn't making fun of geekiness, but making it fun to be geeky! In the article that I read, they were debating about whether Sheldon has Asperger's Syndrome, and apparently there is a large following that believes it is so. If you're not familiar with the show, check out his flowchart for making friends. It's not something that I had given a lot of thought to while watching, because I just considered each character an exaggeration, and it is often thought that 'typical geeks' have several spectrum characteristics without a diagnosis. Is Sheldon diagnosable? Almost certainly. Is it purposeful? Chuck Lorre says no, and that's believable. We're all a little bit on the spectrum... I took this quiz (no endorsement, just the first one I found) and came out favoring the autistic side more than the 'neurotypical' side, which is probably no surprise to anyone who knows any of my numerous sensory issues.
Another show that I have just started watching is Dexter. He is a sociopathic killer who has a day job at the Miami police department. Dexter has severely decreased emotional responses, usually nonexistant. He likely has antisocial personality disorder, though he goes to great lengths to fit in. It has been comical for me to watch his foster father teach him how to fit in, how to pretend, how to be one of the crowd. Halfway through season 1, he has absorbed the instructions to fake social skills pretty well though he does give off some telltale signs of personality disorder that the rest of the cast conveinently ignores. I suspect he has a few additional undiagnosed issues, possibly some OCD, or his attention to detail might be significant of a spectrum disorder.
Not that I think you'll see OT on TV anytime soon, but it is interesting that we are getting a broader range of characters on shows. There was a pretty cool poster presentation at the '05 AOTA conference about disability as presented on TV and movies, you can find many of those movies here. Have you spotted any TV/movie characters that were displaying significant symptoms but not 'outed' as having a disability?
2.04.2009
Smarter than I look!
Finally figured out how to join groups in OT Connections... I feel so much better now. When I clicked on the name of the (private) group on someone's page, I kept getting "you are not permitted to access this page." Had to click on "view all groups" on the right column and then go through the pages to find mine, and then click "apply to join." I'm glad I don't feel technologically impaired anymore.
Wild in the Halls
There is a not-so-well-known, not-so-good movie called Wild in the Streets for which the play on words for the title is from. In the land of that movie, my day definitely would not have happened since the elderly were shunted off into communes, but since we don't really live there, feel free to continue reading about the craziness that has been Wednesday.
Wednesday starts for our purposes when the evening nursing shift came on at 7pm. In 12 hours, Mr. L will cause enough disturbance that there will be 15 different nurses notes written about his exploits. He will be found wandering in the hallway carrying a sheet and/or the room's courtesy curtain. He will dismantle 2 bedchecks, take the bolts off a geri chair, and also climb out of a geri chair with the tray attached without a scratch. His mini-mental scores are stable, at the very lowest regions of the Moderate Cognitive Impairment range. He has been speaking very tangentially, somewhat in nursery rhymes, and has identified our president as "Muhammad." He has been very emotional and has yelled at the PT several times this week, today he was pleasant with me for 25/30 minutes while he petted his dog (not a real dog). Mr. L decided to take a walk while I was present, and I barely had time to throw a walker in front of him and couldn't get to the gait belt... had to walk side by side with my arm around his waist to keep him on his feet. He has been in this fugue of confusion since his most recent surgery- he has no history of dementia. Hopefully someone can figure out a cause and reverse this process.
Ms I is 96 and has advanced dementia with the delightful combination of severely decreased vision (macular degeneration) and decreased hearing. She is disturbed by visual hallucinations and is terribly frightened of being left alone. She has been in a geri chair by the nurses station for the better part of 2 days so that she has 'company.' She started sundowning today really badly, calling out in a cat voice about being left alone during shift change. Her new roommate has had cancer and uses a kerchief to cover her head. Roommate said to me that Ms I thought she was a man when she took off her hat, but roommate was perplexed, since Ms I wears a wig and/or kerchief too. Roommate told nurses at some point last night "either give her a tranquilizer or give me one."
New admit today... (I forget her name, I did 5 evals this afternoon and hers was the last at 415) we'll call her Mrs T who also has dementia but is oriented, sees Ms I in the hallway and during those 5 minutes that they were around each other Mrs T got at least 75% more confused. I did the home safety cards with her yesterday, she had some interesting responses. She could spot some of the simple stuff, but when I asked, "Should she take this medicine that expired 10 years ago?" she didn't really know. This lady has been in acute care and thought that she was going home for the past 3 days... hope that she adjusts ok to the SNF floor. She may have to adjust to placement, but we'll hope for the best.
Twice I had to intercept the same pt. in the hallway this morning... once he was pushing a chair out in the hallway ("to get it out of the way") without his oxygen when he should be wearing 4 liters. He has no diagnosed cognitive impairments but lacks insight into his deficits and consequences. We barely made it back to his room without falling, and he made a grab for the curtain and I thought we were going down for sure then. 20 minutes later, I walk by and he hands me a "sputum sample" on a piece of gauze. The nurses didn't want it, I certainly didn't want it... BLEH.
Bad enough to have seriously cognitively impaired patients that require constant supervision for everything... adding in those who are just overly demanding or lacking in insight has made it hard to get much done. Did manage to discharge a couple of patients today, which is fortunate, because this has been a difficult week for the nursing staff and for meaningful therapy interactions. I have some time off, followed by some more time off soon, so hopefully everything will be on the upswing.
On a totally random note, I consider myself pretty "with it" in terms of technology, in fact, I am the resident computer dork of the rehab staff. (Fun fact- I had my first website when I was 15 and still remember random pieces of HTML code) I have a facebook account and utilize other internet technologies with ease, but I am having major difficulty figuring out OT Connections. I can't seem to join groups and am not finding other people that I know are on there. Perplexing. Also, I do continue to have issues making the cut links work well on this blog, but I am working to fix that since it makes my main page look all weird.
Wednesday starts for our purposes when the evening nursing shift came on at 7pm. In 12 hours, Mr. L will cause enough disturbance that there will be 15 different nurses notes written about his exploits. He will be found wandering in the hallway carrying a sheet and/or the room's courtesy curtain. He will dismantle 2 bedchecks, take the bolts off a geri chair, and also climb out of a geri chair with the tray attached without a scratch. His mini-mental scores are stable, at the very lowest regions of the Moderate Cognitive Impairment range. He has been speaking very tangentially, somewhat in nursery rhymes, and has identified our president as "Muhammad." He has been very emotional and has yelled at the PT several times this week, today he was pleasant with me for 25/30 minutes while he petted his dog (not a real dog). Mr. L decided to take a walk while I was present, and I barely had time to throw a walker in front of him and couldn't get to the gait belt... had to walk side by side with my arm around his waist to keep him on his feet. He has been in this fugue of confusion since his most recent surgery- he has no history of dementia. Hopefully someone can figure out a cause and reverse this process.
Ms I is 96 and has advanced dementia with the delightful combination of severely decreased vision (macular degeneration) and decreased hearing. She is disturbed by visual hallucinations and is terribly frightened of being left alone. She has been in a geri chair by the nurses station for the better part of 2 days so that she has 'company.' She started sundowning today really badly, calling out in a cat voice about being left alone during shift change. Her new roommate has had cancer and uses a kerchief to cover her head. Roommate said to me that Ms I thought she was a man when she took off her hat, but roommate was perplexed, since Ms I wears a wig and/or kerchief too. Roommate told nurses at some point last night "either give her a tranquilizer or give me one."
New admit today... (I forget her name, I did 5 evals this afternoon and hers was the last at 415) we'll call her Mrs T who also has dementia but is oriented, sees Ms I in the hallway and during those 5 minutes that they were around each other Mrs T got at least 75% more confused. I did the home safety cards with her yesterday, she had some interesting responses. She could spot some of the simple stuff, but when I asked, "Should she take this medicine that expired 10 years ago?" she didn't really know. This lady has been in acute care and thought that she was going home for the past 3 days... hope that she adjusts ok to the SNF floor. She may have to adjust to placement, but we'll hope for the best.
Twice I had to intercept the same pt. in the hallway this morning... once he was pushing a chair out in the hallway ("to get it out of the way") without his oxygen when he should be wearing 4 liters. He has no diagnosed cognitive impairments but lacks insight into his deficits and consequences. We barely made it back to his room without falling, and he made a grab for the curtain and I thought we were going down for sure then. 20 minutes later, I walk by and he hands me a "sputum sample" on a piece of gauze. The nurses didn't want it, I certainly didn't want it... BLEH.
Bad enough to have seriously cognitively impaired patients that require constant supervision for everything... adding in those who are just overly demanding or lacking in insight has made it hard to get much done. Did manage to discharge a couple of patients today, which is fortunate, because this has been a difficult week for the nursing staff and for meaningful therapy interactions. I have some time off, followed by some more time off soon, so hopefully everything will be on the upswing.
On a totally random note, I consider myself pretty "with it" in terms of technology, in fact, I am the resident computer dork of the rehab staff. (Fun fact- I had my first website when I was 15 and still remember random pieces of HTML code) I have a facebook account and utilize other internet technologies with ease, but I am having major difficulty figuring out OT Connections. I can't seem to join groups and am not finding other people that I know are on there. Perplexing. Also, I do continue to have issues making the cut links work well on this blog, but I am working to fix that since it makes my main page look all weird.
2.03.2009
New Toys!
Thank you Civitan Club! Our grant went through, our fun new products have arrived and the response from the kids is overwhelmingly positive! Hooray!
First- Sensory Profile... so long overdue. Handed out 2 long and 1 short, next week will be quite busy with writeups.
Second- Ball Pit. Not a huge one, but large enough for one child. Balls plus tough foamy noodles that are nice and resistive when squeezed. Little Miss S, one of our regulars who has autism got to encounter it today. She is largely nonverbal and has difficulties w/ any purposeful expression, but one step in the ball pit and she instantly said "WHOA" with a great big grin on her face. It was super cute. We will need to make a cover for it to keep it out of sight and out of mind... does anyone have cleaning procedures for an inflatable ball pit? Hand scrubbing 500 plastic balls does not sound like a good time to me.
Third- Bolster Swing. This has been universally loved by all who have experienced it, but especially by those with low tone. Same little miss S had great posture while straddling it, and then in prone she calmed down better than she ever has from any other sensory technique. After which, she donned her shoes independently FOR THE FIRST TIME EVER in clinic. Shoe donning is usually where the session falls to bits if it hasn't already. What a sweet success. Also, the bolster can be adjusted to where it is just taller than the peanut ball, making a steamroller, which is almost as worthwhile as the swing itself.
Also, I started a book that I should have ordered a long time ago- Is it Sensory or is it Behavior? It has been worthwhile thus far and I hope to really gain from this. It is so frustrating to not know exactly how to respond to parents about different behaviors. Will share any cool tips from that one... been a little slow on the updates lately.
First- Sensory Profile... so long overdue. Handed out 2 long and 1 short, next week will be quite busy with writeups.
Second- Ball Pit. Not a huge one, but large enough for one child. Balls plus tough foamy noodles that are nice and resistive when squeezed. Little Miss S, one of our regulars who has autism got to encounter it today. She is largely nonverbal and has difficulties w/ any purposeful expression, but one step in the ball pit and she instantly said "WHOA" with a great big grin on her face. It was super cute. We will need to make a cover for it to keep it out of sight and out of mind... does anyone have cleaning procedures for an inflatable ball pit? Hand scrubbing 500 plastic balls does not sound like a good time to me.
Third- Bolster Swing. This has been universally loved by all who have experienced it, but especially by those with low tone. Same little miss S had great posture while straddling it, and then in prone she calmed down better than she ever has from any other sensory technique. After which, she donned her shoes independently FOR THE FIRST TIME EVER in clinic. Shoe donning is usually where the session falls to bits if it hasn't already. What a sweet success. Also, the bolster can be adjusted to where it is just taller than the peanut ball, making a steamroller, which is almost as worthwhile as the swing itself.
Also, I started a book that I should have ordered a long time ago- Is it Sensory or is it Behavior? It has been worthwhile thus far and I hope to really gain from this. It is so frustrating to not know exactly how to respond to parents about different behaviors. Will share any cool tips from that one... been a little slow on the updates lately.
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