Sunday, October 23, 2011

Finally… First Level 1 Fieldwork!

I had a great first fieldwork! I was out of state in a rural area which was a very different and very great experience for me. I got to see two areas I have never seen before: in-patient and long term acute care. I learned so much from so many different people!! I followed several OTs as well as a COTA, I got to watch a speech therapist (and OT helper) do a lunch group for patients with dysphasia, and I even got to attend an AMAZING in-service on transfers from the techs! My supervisors were so great! They let me do so many things hands on, which was nice because on a level 1 you are to expect observation only. I got to assist and independently perform various transfers: I did a sliding board transfer with several patients as well as some stand pivot transfers. I got to help assist patients when they were doing dynamic sitting activities or standing. It was so awesome to get hands on experience doing this – it’s just not the same when you are transferring or giving assistance to your classmate who is pretending to have left hemiparesis. When you actually feel how much or little assistance you have to provide it just clicks. I got to do PROM with a patient in a coma; I watched this countless times in my undergraduate internship before OT school and I was always bored silly, but actually being able do it and feel what a hard or soft end feel feels like was really neat. I never before realized how heavy arms can be! I got to feel what those bumps (loving my medical terminology here) from dialysis feel like… if you ever get the opportunity you should feel them. Very weird. I assisted with ADL’s and participated in helping a client dress one handed while in bed. I learned about standard wheelchairs, gait belt, and adaptive equipment. I saw a hoyer lift for the first time at the in-service! I saw this awesome, fancy piece of equipment called BTE and another one called dynovision.

The hospital had an ADL room where they did things with clients like making the bed and doing laundry. They also had a kitchen to do cooking and cleaning activities. I saw these but I think they were a little under used. One of the OT’s I observed said that they really have to be more biomechanically based instead of occupation based often because limits on time. She explained that patients used to be able to stay in-patient for months, and she would do much more occupation based activities with them and even take them out into the community, but now that they only have around 2 weeks there is just not enough time. She still did a great job being as occupation based or activity focused as she could from what I saw. The in-patient population was adult and most stroke, traumatic brain injury, hip replacements, and amputations. The long term acute patients were much more medically complex and had many co-morbid problems. It was so great meeting so many different OTs and COTAs. There were so many different personalities and they each had a unique perspective on OT that I know I will draw from as I am cultivating my own style. They were all wonderful at explaining what they were doing, how they were doing it, and why it was important. Even if the activity wasn’t occupation based they explained how it what occupations they were trying to improve by doing the activity.

The patients were equally amazing! I loved talking to them and finding out what they were like. This one man I talked to told me about his amazing career that is his now hobby that he wanted to get back to doing. It was extreme, therefore, identifiable so I can’t post it (HIPPA), but oh how I wish I could. I should have done my COPM on him because it would have been great to say well the most important thing for him is to do this extreme activity so I am going to help him do that even though I could not do that if my life depended on it. Talking to this man really put the patient in perspective for me: these are people with lives and amazing stories and I think their individuality and personality sometimes take a back seat in that they become Mr. B with a SCI vs Mr. B the man who likes extreme activities, has a wife and kids, and has a passion for Indian food.

I saw so many involved families and one particular family member of a patient who was there with their spouse from sun up to sun down- so sweet. I saw tons of family education which is so important because when the family member goes home it is all on the family. They were educated about the patient’s equipment: how to use it and where to get it for the cheapest if insurance didn’t pay for it. They discussed the patients strengths and limitations and what they could do alone vs what they needed help with. They educated them on how to help for example with transfers.

I also got to see a part of OT I have never seen before and that is the paper work side of it. I have never seen notes and documentations, which I learned can take up to 1/3 of the day. I also got to attend discharge conference meetings with doctors, nurses, PTs, OTs, and case managers. Notes and meetings are definitely not the most fun part, but they certainly gave a much more realistic picture of what a day in the life of an OT is like. I guess it can’t be all fun and games even if we are lucky enough to be in a profession where we get to play games (sometimes) for a living. One of my favorite activities was combining therapy sessions with multiple patients to play games. I would definitely want to play games if I was in a hospital. I saw Jinga, Connect Four, volleyball, pool, and checkers being utilized frequently.

I also saw some of the OTs and OT students doing a manicure days with all the patients, which I thought was so great. One patient I talked to reminded me of my mother in that she was super prissy and wanted her hair, nails, and make up done even in the hospital. She was very excited about manicure day. Other less prissy patients still enjoyed it from what I gathered because they got to get out of their rooms and do paraffin hand wax and talk to one another. I loved that they did this – such a great idea to boost morale!

The facility I was at had several OT students, most of them being level 2’s that would stay 3 months. It was really cool to talk to OT students in other programs to see what other students are learning around the country.

Two things I saw that I did not like personally were over-touching and the use of the word baby. I was only aware of this because I am not a touchy feely person and I would be horrified if someone stroked my face unnecessarily and without warning no matter how nice it was intended to be. I also find it incredibly demeaning to be called “baby” as grown person by another adult. Maybe this is just me, in fact, probably this is just me, but I think it is important to take into consideration that your patients/clients are going to be very different than you so personal space (as much as possible) and names or nicknames whatever you want to call it should be taken into consideration.

Overall, my first fieldwork experience was amazing and I feel very lucky to have had it at the facility I was at. I know seeing the things I saw during that week will influence the way I practice in the future and make me a better therapist one day because of it!

The Office and OT – trying to have some fun!

As I mentioned in my last post, I was really struggling with assignments last week. I thought if I had to look at Microsoft Word and write one more page I would just die. So to make one of my assignments fun I did a parody of The Office. I had to write a client description of an 83 year old with a stroke and left neglect for an adaptive meal prep group, so I chose to embody Phyllis from The Office complete with description of previous working history at Dunder Mifflin and Sabre and past social history of my late husband Bob Vance and new boy toy Dwight. It got out of hand… I think I even mentioned the party planning committee. I am such a dork so I thought this post and elegant picture of Phyllis was a standalone post!

PS – I will definitely write a post about meal prep group when we do it. Actually how I found my blog guru, Karen’s blog was searching OT and cooking haha.

Spreading myself too thin/ Cool things going on in OT school

Last week was the most challenging, confusing, stressful week I have had thus far in OT school. School was crazy, I was not feeling well, and I was trying to do way too many things with no time to do them. We have about ten different projects/papers/assignments going on some individual, but many are partner or group things and it was in my opinion, utter chaos. I mostly try to blog about the positive aspects of OT school that I love so much, but I really feel that to give an accurate depiction I need to write about some of the not so fun things that are happening because that is real life. As awesome as OT school is it is definitely not perfect and it surely not easy. I understand why all of the assignments are important, but when we have six different groups of people we are trying to schedule projects with who also have six other groups, I feel like we spend too much time and energy scheduling and not enough actually doing the assignments and learning. I think the quality of my work and learning suffers drastically under these conditions and I am not sure there is any good solution. I feel like the chaos sucks my time away, so I have little time to study and focus on what I am actually doing the assignments on. I know I am learning, but I just wish I had time to learn more. I do the readings, listen and participate in class, try to review notes when I can, but in the midst of everything that is going on I feel like I have little time to truly study the material and retain it. Maybe there is just no time to learn it all.

There are some positives to being this busy; we get exposed to so much! Our instructors do a great job of trying to expose us to as much as they can and they are excellent and providing resources for us. So when I do not have to time study or review a particular subject, I know that I have lectures and corresponding reading assignments I can use in the future.
And in spite of being overwhelmed, we have had some really cool things going on.

Before fieldwork we had a guest speaker and stroke advocate come in and talk to our class about his experience. It was amazing! He uses his experience to teach students and also inspire and give hope to other stroke survivors. It was fantastic to learn about stroke first hand.
We also had a unique opportunity to have a class on assistive technology with the biomedical engineer students at another university. We watched a video about these two girls with spinal muscular atrophy (I think ???) Their dad made them these awesome custom wheelchairs that completely changed their lives and accessibility. The video said he can spend up to 100 hours a month working on their chairs – what a great dad! Maybe I can find a link to this video or some other video on them (I think there have been many… maybe) and post it. We also consulted with the BME students about cases they were working on. They are crazy, intimidatingly smart in my opinion… I can barely work my IPhone and they were talking about writing code for computers to control a TV with eye blinking, which I literally could not wrap my brain around. But they valued our input because they do not have a medical or therapy background and really needed an OT perspective on what they could and should do functionally for client that would allow maximum participation. It was really neat and I hope we can do more things like this!

We also had a TBI lab like much like the SCI one we had a few weeks ago. So neat to see brain injury in practice! We had several OTs and STs doing various assessments with the guest clients and we got to talk to them and ask questions. I think brain injury is fascinating, but it also scares the heck out of me. No injury or disease is good, but few others do you have the possibility of losing who you are, what makes you, well, you. I think that scares me the most: one swift blow to the head and you can be a completely different person with a whole new, in my instructor’s words, swagger. Scary stuff.

I will try to be back to my positive self next time! I think part of my problem last week was being overwhelmed with school, but part of it was just me. I was not feeling well at all and I tried to do way too many things. In addition to my regular outside of school activities/obligations like yoga and puppy duties I also had the added stress of babysitting, making food for our department’s breast cancer awareness day, driving to Baton Rouge Friday and getting in a car wreck, and doing (well cheering on my friend that actually did) the race for the cure Saturday. Not doing a very good job of balancing my occupations while taking on too much. I need to pick and choose my commitments better because I am all about balance – OM!

Tuesday, October 18, 2011

OT and Halloween

One of my instructors sent us this link to the article “Enjoying Halloween with Sensory Challenges” so I wanted to pass it along. Neat article with great ideas. Halloween is one of my favorite holidays so I was more than happy to have it intersect with OT!

Fieldwork post coming soon – probably this weekend