30 Nov 2015

My occupational therapy capstone project is complete!

I wrote mine on “Increasing Awareness and Acceptance of Children with Disabilities Using Picture Books.” My Capstone Paper

I write about the importance of awareness and acceptance of children with disabilities, and how children’s picture books can serve as a form of disability awareness, which can promote acceptance, and therefore social inclusion…which ultimately leads to increased participation in occupation, which is the whole point of occupational therapy.

In addition, I talk about how OTs should consider incorporating picture books into their practice, and also how OTs should consider writing their own children’s books! It furthers the Centennial Vision, is a form of occupational justice, utilizes our unique talents, is in alignment with the Framework-III, and also has bonuses, on the business side of things. So far only four OTs that I know of have written five children’s book that have OT in them or even disabilities at all. Karen Jacobs, famous OT of the world, has written two of them. I want to be in the top ten. 🙂 Of course books about children with disabilities exist, but not enough of them, especially high quality ones.

Business wise, selling high-quality children’s books that exist already is a way to make a few extra dollars. And selling, giving away, or recommending them, especially if they are your own books, can be a value-added service, promoting satisfaction and loyalty. They are great for marketing. And if you write your own, especially if done as an e-book, you can make some money…well assuming it’s successful. Although to warn you, children’s books are hard to write well, and illustrations are quite costly.

To learn more about the process, read my capstone manuscript…the process etc is near the end, you can find via Table of Contents.

1DobynsKarenCapstonePaper

Use the Contact Me button on my website or email me…my name karendobyns, on gmail.com, if you want to say anything, because I just switched servers and the spam is out of control. I have over 2,000 comments and I won’t see yours…I have to get it fixed. Ugh.

Anyway….I got an A on my capstone YAY and after the presentation I give in 45 minutes through GoToMeeting (I think that’s the name), I am done with all but a single reflective post worth 1 point. 🙂 Post-professional clinical doctorate of occupational therapy (OTD), here I come!


9 Nov 2015

Cadillac OT versus Reality OT

A wonderful occupational therapist/educator wrote the following forum post on our OTD forum (we are getting our post-professional clinical doctorates in OT). I asked her permission to post it because it resonated. What we learn in OT school and what we discover in the real world are two different things – but we have to remember in the real world that what we learned in OT school is still a valid and burning flame within us we must nurture and allow to grow.

 

“I remember something that one of my professors once said: “What you get in OT school is the ‘Cadillac version of OT.”  I didn’t really understand it at the time, but the idea has stuck with me and I have certainly seen it in my own career.  A lot of what we learned in school is how it should be, but not necessarily how it is currently.  But we needed to learn it that way if there is any hope of changing things going forward.  Each of us are then charged with holding on to pieces of the “Cadillac version” that fit within our practice, working to change things in practice to fit more of that in, and adapting to what we cannot change.

I try to make my teaching fit that approach.  We emphasize occupation-based practice a lot in our curriculum, and we do teach preventative care and wellness, which aren’t necessarily reimbursed or even being practiced where our students complete their fieldwork.  But some of our students have been able to fit these things into the otherwise very limited medical model at their sites, and others have the desire to find practice settings in the future that will allow them to use these skills.” – J.D. 


11 Jul 2015

Impress your Occupational Therapy Professors…

I’m writing an article for AOTA’s OT Student Pulse on the “Top Ten Ways to Impress Your Occupational Therapy Professors,” loosely based on this post that I wrote eight! years ago. I asked my OT Facebook friends, especially the OT instructors, to contribute their own thoughts. Since I can’t incorporate them all into the upcoming article, I added them here.

“…My first focus with students, and any novice or expert occupational therapist is not the knowledge, as though that is important, I have always said that one of the most important things in occupational therapy is the ability to develop rapport with the client (client in the broad sense- patient; family; system, etc.)…. as this is imperative for any other part of the occupational therapy process to work. – K.H.

“…Having had numerous relatives and me do OT and PT, .I’d like to say That K.H.’s post is dead on and should be (as Ford used to say) Job Number One for all therapists.” – J.S., Client/Caregiver

“I have students ask me all the time—“how can I be successful on fieldwork as an OT?”. I pause and say… I can teach you balance scales, manual muscle testing, G codes, vision testing, what glioblastomas are, how to identify cognitive issues vs psych issues, how to transfer people safely and how to document… What I can’t teach you is how to care, how to really see your patients, how to value each person and what they can teach you, or that you can learn from EVERY interaction ( good or bad). I cannot teach you to show up on time or early, tuck in your shirt, wear a clean shirt, brush your teeth, and to show up prepared to do your very best each day. You have to want this, you have to want this because there are people who cannot do for themselves and who need a voice. Caring— I cannot teach you to care….. if you care— there is no limit to the goodness one can do!” – S.S.

“Be one of the first to ask a question that shows you’ve done the required reading (reference the page #) and that you truly would appreciate more information. (It helps to clarify your level of understanding for the professor and probably helps at least two other students who are more hesitant to attempt this risky behavior.) Bonus points if you ask a question based on an AJOT article related to that or previous day’s assigned reading.” – L.F.

“…Always assume that your educators have the best intentions in the decisions they make” – and that these decisions are made to help shape you (and your peers) to become occupation-centred, flexible, reflexive, adaptable occupational therapists, who will be our future colleagues… and the future leaders of our profession! Whether you believe this to be true or not – coming from this standpoint when you open a discussion, ask a question or even query a grade means that you come from a position of respect and it will most likely then be responded to with respect.” – A.H.

“Demonstrate that you have an open mind and are willing to see things from different perspectives.

Get involved in your online community of practice …and not just for putting your assignments questions online and expecting someone to give you the answer. Hint. There isn’t usually one answer , it’s about showing you’ve thought about it, read around and made a clinically reasoned decision.

When reflecting. Be honest, and please reflect with purpose, to learn something.” – K.S.


“This was a good set of “ways to impress.” As I move into only my 6th year of teaching OTA students, I think it is important for students to learn to be persuasive — build a rational and compelling case for course of action when advocating for themsel
ves or others. I prefer students to be slightly skeptical about the information that they are learning yet are polite about questioning the status quo of any particular system. I hope to encourage the creation of solutions, not only the identification of problems….”- B.C.

Category: Occupational Therapy | Comments: none

28 May 2015

When intervention fails: navigating the aftermath

Failing the Consumer (Link to PDF of my paper thoroughly reviewing this article)

Have you ever felt you failed a consumer/client/patient? Have you ever felt the consumer blamed you for the failure? I recently read an article by Zaynes, Otnes, and Fischer (2014) called “The nature and implications of consumers’ experiential framings of failure in high-risk service contexts.” It wasn’t written by occupational therapists, but is quite relevant. While occupational therapists are not typically sued, I think an understanding of how consumers frame failure is an important way to avoid legal issues after a “failure,” where a consumer fails to get better, whether it’s truly your fault or an unrealistic consumer perception.

Based on interviews with people who have undergone failed fertility treatments (“high risk” of failure), the investigators found that consumers viewed treatment failure in one of four ways: 1) “failure as a route to success” 2) “failure as a mobilizing frustration” 3) “failure as a cue to re-evaluate” 4) “failure as fated” (Zayer, Otnes, & Fischer, 2014, p. 4).

Essentially, consumers came into fertility treatment with a particular view, and after failure of intervention (in an OT case, perhaps the consumer doesn’t get better after stroke treatment), the consumers navigated the failure path differently. Some understood it as just a likely possibility, some saw it as inappropriate/wrong/provider failure, some saw it as a reason to look at other possibilities, and some saw it as destiny. The most challenging group to handle after failure are those who see failure as unacceptable, and blame the provider, regardless of fairness or not.

In the case of OTs, we are pretty intuitive, and I think by the end of evaluation, especially with this knowledge in mind, we could see what “frame” the consumer operates within, and adjust our intervention accordingly. With those in that challenging group of “failure as mobilizing frustration” or failure as unacceptable, I recommend lots of clear communication as to probability, as well as extra careful documentation for future legal action. Please see the linked paper above for more information on navigating the aftermath of failure for the other three groups.

The paper linked at the top of this post is one I wrote for one of my post-professional OTD classes within the Administration and Practice Management track, exploring consumer desires. If you work in a “high-risk” arena, which can include hand therapy, catastrophic trauma, etc, I recommend you look into this article (or read my paper), to see how you can start to navigate the possibility of failure from Day 1! Good luck!

References

Zayer, L., Otnes, C., & Fischer, E. (2014). The nature and implications of consumers’ experiential framings of failure in high-risk service contexts. Journal of Service Research, 1094670514559187 doi:10.1177/1094670514559187

Category: Occupational Therapy | Comments: none

14 May 2015

Trauma, Trains, & PTSD

clevertrainart

“I don’t think there are going to be many lasting, significant effects for these folks, because most of it was just broken bones.” Said Temple University Hospital’s chief medical officer, Dr. Cushing, in this recent CNN article on the Amtrak train crash in Philadelphia, regarding the hundreds treated in local hospitals.

While I realize Dr. Cushing was referring only to acquired physical disability at the time, I couldn’t help but think about the significant mental trauma that these victims have undergone, and how a significant number of them will likely be afflicted with post-traumatic stress disorder (PTSD) because of their experience. It’s also possible that witnesses, those who have an affected friend/family member, or at-risk community members, will develop PTSD as well.

There are varying degrees of PTSD, but it can quickly or gradually lead to a decline in general function, due to fears/hypersensitivity/triggers. For example, Jan may have daily walked in a particular neighborhood as the 1:45pm train was thundering by, a sound/vibration she was used to and heard but did not allot attention to. She was always just hurrying to the 2pm pottery class she teaches three days a week. Today, though,  days after she witnessed the crash, as she hears the thundering and vibration of an oncoming train, her body tenses and her heart starts to race. Thoughts of the train derailing onto her overwhelm her with fear and freeze her to the spot for several minutes, long after the train has whistled past.

Jan is shocked and startled by how terrified she was. She is able to teach her class, but she feels shaken up and weak. In two more days, her fear of her reaction is as strong as her reaction, and at that point she stops teaching the class. Jan is a retired artist and enjoyed teaching that pottery class as it provided her a little extra income and socialization time, but it’s not worth the fear that hits her each time the train goes by.

In time, the high-pitched squeal of brakes of a truck, the vibrations of construction work under her feet, and even an advertisement depicting a train are enough for her to have flashbacks and crippling fear. Her sleep at night is filled with overturning trains, and she wakes up exhausted. Slowly, her world of walks, meeting friends, volunteering, etc, dwindles, as she’s too tired and too fearful to expose herself to possible triggers. She spends most of her time in her apartment, reading. Her lack of movement, increased social isolation, and flashback-fueled adrenaline surges have taken their toll on her. She was a valuable and productive member of society with potentially decades of independent living ahead of her, but she is falling apart. Now what?

In come the mental health professionals, such as psychologists and occupational therapists. (I’ll focus on OTs since I’m one!) Perhaps an occupational therapist starts a support group for those with PTSD related to the train crash (with such a large crash, there will likely be a need). The OT finds a time and place not too close to a train station or train rush hour. During the course of the group sessions they go over common and unique triggers, warnings of upcoming triggers, coping skills, adaptations, modifications, schedule-creation, client-unique and general community resources, needs/wants lists, exposure techniques, public awareness, and more, with the goal of focusing on increasing function/participation in everyday life again.

Slowly, Jan starts to function again in the real world. With encouragement and assistance, she does a pottery session for her group mates. She signs up to teach the pottery course again, but gets there early so she isn’t directly by the train as it passes by. She learns the train schedule around her walk times so that when she knows a train is coming shortly, she can take deep breaths and self-talk her way through it. She learns to tolerate high-pitchs squeals and earth vibrations after supervised exposure therapy. She has a friend meet her at her house several times a week for a meal. Slowly, she reintegrates into her old life, an even richer one in some ways.

To see more about how occupational therapists can help with PTSD, please click here for a two-page fact-sheet by the American Occupational Therapy Association (AOTA). It’s never too early or too late to get help.

*Train art graffitti image taken from here

My thoughts are with those affected by the traumatic Amtrak train crash in Philadelphia.

Category: Occupational Therapy | Comments: none

9 Apr 2015

It's OT Month! Celebrating the possibilities

Nothing is impossible, the word itself says ‘I’m possible’!” – Audrey Hepburn

Rockbalancing

Nothing is impossible, the word itself (1)

Don’t you think that’s a great quote for OT? I’m not saying someone with a cervical spinal cord injury should be walking, just that there are always possibilities, some of which we don’t even even know we don’t know. Occupational therapists are often blessed with knowledge that allows them to shed light on new possibilities for those facing the seemingly impossible. One of the most beautiful parts of our job. Watching faces light up with new understanding, new awareness, a sense of possibility, a sense of hope. A sense of future.

It’s April, and it’s OT Month. A month were we celebrate the possibilities and our role as OTs in their illumination.

Lately I haven’t been blogging quite as much, I’ve been posting a lot on Twitter over at https://twitter.com/msawesomenessOT and on Facebook at https://www.facebook.com/missawesomenessdotcom

You can also see them on my blog sidebar.

Speaking of impossibles, I’ve been doing a lot of rock artwork lately, and I’ve gone from stacking flat rocks (the cairns) to working on vertical rock balancing. I balanced these rocks – they’re actually only a few inches tall – on bigger rocks over at Torrey Pines State Beach in La Jolla, CA. I’m proud of it! Very challenging yet calming, meditative. Helps my swirling mind feel at peace. I never, ever would have thought it was something I could do!

 

Category: Occupational Therapy | Comments: none

9 Apr 2015

"Confined degree diversity with incredible professional diversity" within OT?

Many people get degrees (history, art, religion, technology) then have NO idea what to do after graduation…it doesn’t necessarily feed into any one profession. They have so many possibilities, but first they have to figure out what to do next.

In occupational therapy school, you know you will become an occupational therapist afterwards. It’s a "confined diversity" in that you aren’t going to sit around wondering, gee, what will I become when I graduate? That’s a great thing about clinical degrees.

And yet then your possibilities become remarkably diverse, once you’re an occupational therapist. You can work with newborns or those at the end of their life or anywhere in between. You can work with people who are completely healthy. You can work with people with physical challenges or mental health challenges, either congenital or acquired. There’s just no limit to what you can do. That’s what I love about OT. It let me go into a specific profession without any wondering, yet then opened up the skies so that I could do anything. 🙂

Just thinking out loud!

Category: Occupational Therapy | Comments: none

4 Apr 2015

Prediction of occupational performance in varying activities of daily life (ADLs)

I created this scenario to explain how, for example, assessing “Mary’s" ability to get ready in the morning (her “occupational performance”) can tell me a lot about her likely performance in making a simple meal.

Mary is a 75-year-old woman who wants to be able to independently make a simple meal, while using hip precautions, her walker, and ideally some energy conservation techniques. She is currently in inpatient rehab. If we [OTs] help her get ready in the morning, even if we haven’t seen her in the kitchen yet, we will learn valuable information. We may see she is forgetting to use- or doesn’t understand- her hip precautions. We may see that she is inefficient in her method, walking back and forth across the bathroom to get one item at a time. That she sequences tasks incorrectly, putting on makeup then realizing she hasn’t washed her face. That she is unsafe, with seemingly no awareness of fall hazards or an ability to remember to turn off her curling iron. All of these components will demonstrate to the OT that she may not be ready to safely make a meal by herself that involves anything that needs to be turned off, and that she may need items grouped together for efficiency reasons, such as keeping the peanut butter, jelly, bread, and a butter knife all in one area. She may also benefit from a written list of instructions. We haven’t even seen her in the kitchen yet, but by watching her in the bathroom, we already have information that will guide our intervention and possibly fill in some of the blanks on an assessment tool. There are many safety similarities between getting ready in the morning and making a meal, as it pertains to slippery surfaces, heated objects, sequencing, underlying skill deficits both physically and cognitively, etc.

*In this case, this fictional scenario takes place in inpatient rehab

*I’m using more laymen terms here for easier understanding, but in medical documentation I would use more professional terminology

*Born out of a discussion in one of my post-professional OTD classes, involving assessment of various occupational performance areas.

Category: Occupational Therapy | Comments: none

25 Mar 2015

Mental Health Energy Conservation

I struggle with depression and anxiety on a all-too-regular basis. I practice mental health energy conservation on a daily basis.
Throughout each day, I’m constantly doing an internal MRI-like scan of my body, figuring out how I am doing and what I can handle. I’m constantly self-talking to myself for reassurance (“okay Karen, you’ve checked the lint and you’re right here, you can start the dryer and chances are high it won’t explode into a ball of flames…” and previewing what’s coming next. I know myself pretty well and know what kind of issues are triggers for me, or where I need to have control to be okay. I know what drains me and what rejuvenates me. I’m lucky to have those skills, and I think my occupational therapy training certainly contributes to those abilities.
I have what I call an anxiety budget, similar to the fibromyalgia “spoons” theory of where you only have so many “spoons” in a day so you have to use them wisely. My goal is to get through the day without using all my anxiety coins.
For example, parallel parking downtown is a HUGE stressor for me, as is giving blood. I would try hard to NOT allow those two big stressors to be on the same day, because I know I will be at a deficit. I try to space out big stressors. I make sure if I have to see a lot of people (at a “fun” event), that I hopefully only have to do it once that day, and have time after to rejuvenate.
Somedays I assess myself when I wake up and I can tell it’s going to be a hard day, maybe I’m extra anxious. If I don’t HAVE to do my laundry that day, I won’t. I need to save all the coins I can. Or, maybe I have to for some reason, but I am aware that on a good day laundry may take me “5” coins, and for this day it may take up “15” because I’m going to be extra worried today that the dryer is going to start a fire. Another example: starting a blender always kind of scares me, even with headphones on the noise freaks me out and sometimes I get scared of electrical fires in the walls or something. So on a good day maybe I make a smoothie for 3 coins because I can tolerate the noise and won’t obsess over a fire, on a bad day I won’t touch the blender because it would cost me 15 coins and I can’t waste them on that.
It’s a constant balancing act, but my awareness is very helpful. It also allows me some compassion and grace, because I have accepted that certain things are much harder for me than others, and that it also varies by day or even hour or even minute. It also allows me to be extra aware of doing harder activities when I feel okay, and saving littler ones for challenging days. It helps me be more functional and not beat myself up so much. (Believe me, there are plenty of times I beat myself up or can’t function – it’s an art, not a science.)
Sometimes, brushing my hair or just starting self-care routines make me want to cry because they seem so hard. That’s a day I’m just going to prioritize the absolute REQUIREMENTS to be semi-functional, and maybe I don’t get a shower that day, but if I brushed my teeth and put on clothes, it’s a win.
From what I can tell (see below for more details), there isn’t much awareness -or at least it’s not called this – of the concept of mental health energy conservation. I’d love to hear from occupational therapists (e-mail, Facebook, here…) who work in mental health on their thoughts on this concept, as I know they address these challenges, maybe with a different name.
The keys are to remember that every person has unique challenges, especially as it pertains to anxiety – my parallel parking may cost me 30 coins and may only cost you 2 coins, whereas my public speaking is 5 coins in my mind and in yours its 50. I think awareness of this need for energy conservation allows for a big step in acceptance, compassion, and potentially a change in functional approaches to the day.
I’m eventually interested in working with someone to do research on this, but not anytime soon!
——-
Okay, here’s what I just posted this on one of my OTD (occupational therapy doctorate) forums…I’m trying to be okay with B grades, I know this is not very well written, but hey….it’s a little assignment and I’m practicing mental health energy conservation by not obsessing over making it perfect. It was a qualitative query I came up with along with some discussion as to why (vague paraphrase of true directions)

How do adults (18-55) with mild depression describe their energy expenditure as it relates to participation in activities of daily life? 

 My review of the literature came up with no results that specifically focused on energy expenditure in relation to mental health and activities of daily life. The majority of articles focusing on energy conservation had to do with multiple sclerosis (Blikman, et. al, 2013), cancer (Mitchell, et. al, 2014), or other physical difficulties. Other articles focused on older adults and limitations in activities of daily life in the aging process, which occasionally addressed depression (Arbesman & Mosley, 2012). Others address activity limitations and depression with chronic conditions, but do not specifically focus on mental health. While I may have missed some articles in my non-exhaustive literature search, it’s clear that this is a very specific area that has had minimal attention.

Occupational therapists and many other health professionals have knowledge and experience in dealing with energy conservation, but it’s typically based on physical needs, not mental. Mental health occupational therapists clearly recognize that people with depression have limitations in ADLs, and that even an activity as benign and simple as pouring a bowl of cereal can seem exhausting. While they certainly address these issues, I don’t know if the therapists or clients are considering this or calling this a form of energy conservation. It would be interesting to see if adults with depression describe their energy expenditure for such tasks as physical or mental, or even perceive the limitation as an energy expenditure issue in the first place.

I think the occupational therapy field would benefit from a more evidence-based approach to managing energy conservation in younger adults with mental health challenges (I chose depression but I’d also be equally interested in anxiety). If there were an assessment that was linked to the COPM, it would allow the therapist and client to get the unique viewpoint of what activities take up the most energy expenditure for that particular client (emphasis on uniqueness), and give them goals for intervention. A support group and/or energy conservation program could also be appropriate for this population.

Occupational therapy is rarely seen in most major healthcare mental health settings these days, but mental energy conservation programs for ADLs could be a new way to promote OT in mental health, and a way to help more people handle their day to day ADL participation with more awareness, compassion, and knowledge, which may in turn reduce their limitations and allow increased participation.

References

Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277–283. http://dx:doi.org/10.5014/ajot.2012.003327

Blikman, L. J., Huisstede, B. M., Kooijmans, H., Stam, H. J., Bussmann, J. B., & van Meeteren, J. (2013). Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Archives Of Physical Medicine & Rehabilitation, 94(7), 1360-1376. doi:10.1016/j.apmr.2013.01.025B

Mitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R. M., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014). Putting Evidence Into Practice: An Update of Evidence-Based Interventions for Cancer-Related Fatigue During and Following Treatment. Clinical Journal Of Oncology Nursing, 1838-58. doi:10.1188/14.CJON.S3.38-58

 


9 Mar 2015

The Amazing Breadth of Occupational Therapy!

As occupational therapists, we are so lucky to have training that allows us to to help any person of any age and with any issue, by addressing the factors that are hindering their ability to participate as fully as possible in their own life! OTs learn to analyze the spectrum of possibility and then help the supposed impossibles become possible.

Here are some of the areas we work in:

OT & Schools (children in any grade who need services for their particular issue…sensory, handwriting, fine motor, visual motor, regulation, tolerance, executive functioning…)

OT & Mental Health (of any age after mental health challenges become apparent, helping with independent living, tolerance, regulation…)

OT & Pediatrics (children of any age and any diagnosis)

OT & Acute Care (immediate care after acute issue)

OT & Inpatient rehabilitation (regaining function in a facility after hospital stay for any issue…)

OT & Outpatient (helping huge variety of issues)

OT & Vocational Rehab (for first time, back to work, or finding new work…)

OT & Driving (getting on or back on the road, safety…)

OT & Hands (trigger finger, lateral epicondylitis, accidents, burns…)

OT & Feeding (children and adults with special needs)

OT & Neurology (strokes and multiple sclerosis…..)

OT & Orthopedics (hip and knee and much more…)

OT & Chronic Disease (diabetes, lung diseases, pain syndromes…)

OT & Military (amputations, PTSD and much more…)

OT & Trauma (burns, pain management, catastrophic injuries…)

OT & Health and Wellness (joint protection, ergonomics, energy conservation, self-care, empowerment, fall prevention…)

Category: Occupational Therapy | Comments: none

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