Today I got 29 productivity units, my world record. I had three evals, an hour long shower ADL, and 7 people in two groups. So I had to write 20 notes!!! My OT got 20 units, so we had 49 total!!!!!!! A new record for us….lol.
Interesting day…too bad I don't feel like writing about it right now, ha ha. But some key words to remind me when I do write. Severe dementia/delirium, catatonic to not, monopolizer, remember pop not 100%
ANYWAY……..I'm tired, yo. Maybe I'll post later this weekend.
END OF WEEK FOUR! ONE THIRD THROUGH MY FINAL ROTATION! UM, I SHOULD PROBABLY START STUDYING FOR BOARDS – AND/OR FIND OUT WHEN THEY ARE – AND/OR START FIGURING OUT WHAT STATE I WANT TO LIVE IN/WORK IN………..just a thought.
A friend commented today, “I don't see what showers have to do with mental health”….ie why I “watch” people take showers.
First of all, I prefer to say I observe/assist (either with verbal prompts or hands-on physical assistance), rather than “Watch” lol. That sounds creepy. I try and be as discrete as possible, I know nobody wants to be observed… although most of these people don't seem to care at all.
Second of all, there really is a link. Showering and dressing are both activities of daily life (ADLs). ADLs are often greatly impaired in people struggling with mental health issues,
whether it's dementia or major depression or a psychotic disorder or who knows what. People struggling with mental health are not functioning at top cognitive potential, and often
struggle with basic things such as remembering to wash all body parts, sequencing correctly, safety, etc. We can get a pretty good grasp of someone's cognitive functioning level by how they shower/dress. Do they forget to wash major parts of the body? Do they not notice their t-shirt is soiled or inside out? Things like that. Plus if we do some assessments near the beginning of their stay, and then again regularly through the rest of the stay, we often – hopefully – see an improvement in function that can be concretely graded.
So…showers DO have to do with mental health. 😛
Well after speaking to switchboard operator and nursing supervisor who confirmed the outpatient area was closed, and no therapists around still by 820ish, I decided that since it was snowing, I should probably go home, instead of sitting around by myself. I almost slipped several times just walking to my car. The drive was scary. Around 830 when I was driving home carefully, I got a phone call from my supervisor, who was now at work and had just been running late. She was there to do the geriatric unit. I let her know I was on my way home although I could turn around, but she was okay with that since roads were a little iffy. Roads were scary to me a little bit, and then just walking down the hill to get into friend's house was also a little scary, I slid a few times. I feel bad that I didn't stick around longer, but I really felt certain things were closed and I didn't want to wait for roads to get any worse.
I couldn't have done anything without her there -and since outpatient is closed, she just has the ward, so I think she'll be okay (and she lives really close)…I just don't want her thinking I'm lazy!!!
I have her home phone number, but it's here at home. It never occurred to me I might be at work and need to call her at home. Now I know better.
ANYWAY….gonna go lie back down I guess. Hmm. b
Today started out with scrubbing (whats the right word?) the ice off my car, as the rain had frozen on it. Got a little help though. 🙂
Did a bathing ADL with a pt, my OT was there as well. This pt is high functioning and was standing up to remove clothing, the way most typical people do, I think. My OT kept telling her to sit down for safety and she wouldn't. But she was pretty steady and stubborn and just set in her ways. I tend to feel like they deserve some lee-way – like if I had some health issues and some aide was taking me to a special shower room with a shower chair, hand held attachment, nothing familar, etc, I'd probably do things a little differently than I do at home, that might seem unsafe or weird to someone watching. I dunno.
Did a geriatric depression scale scale with a lady who scored in severe depression range, no surprise. She seemed to need to talk -I spent a lot of time with her discussing coping skills and strategies, but I thought she might benefit from a chaplain (I see the chaplains come in sometimes). I asked my OT and she said go through the social worker, but the social worker (who is young and rather new) was like yeah, I didn't even think about asking the chaplains to come in for individual patients, go ahead. I think people who have worked there a while – and were trained by others there – tend to follow the same routine – while someone new and without a lot of constant supervision, just has to come up with own ideas…to me it's obvious, but I guess I have to be careful about not stepping on toes.
Speaking of the social worker, I've let her know we can contribute to the discussions on nursing home/AL/IL placement appropriateness, and so today I did the Cognitive Performance Task on a high functioning lady…took her out of the ward, my first experience doing it with my own patient. Her logic was skewed when explaining answers, and I think she “confabulated” the answer on finding the cost of a gallon of white paint….I was surprised she did rather poorly. I think she was smart enough to realize her performance on the test
was important so she was a little nervous.
It's AMAZING how much trouble people have with setting up new medications (part of that test)…..they end up doing bizarre things like putting a few pills in a few days, seemingly at random, if they don't grasp the instructions. It's like they gamble maybe they got it right.
I gave the social worker a mini-tour of our area and walked her quickly through the 7 sub-tasks of the CPT…and gave her some papers on the level the pt was at, to share with family. Basically the social worker now knows we can be of help – she called today to ask about doing the test on another pt, and my OT was like well, guess you explained to her, and I was like yeah, maybe I created a monster! LOL. A good one. It's important, if OT is going to stay in the mental health arena, that other disciplines utilize us and know what we do!! It's a little sobering/scary though to have input…you have to be careful, safety-wise, as to what you recommend.
I interact a lot with nurses, aides, the social worker, some rec therapists, and of course patients. No speech or physical therapists work in the mental health units…which kinda sucks, because one of our patients who was walking when he got here (but weak) is no longer walking. I think if he had gotten regular PT he would have had a better chance.
I did two “creative-y” groups today…on was rather crappy, one was kinda interesting….I still have a lot of learning to do in terms of managing groups. When I took that group class, if some one had told me I'd end up running 2 groups a day for 3 months, I would have been like ha ha!! But here I am, sucking. lol
The first group was about ambiguous direction/problem-solving……the second group was called “Transformation” and it had to do with drawing past and present and future, and discussing things to do to help ensure the future as they depicted it.
One sharp lady drew an embryo for past, a stick lady for present, and a casket for future. She cackled about it, but when I asked her what she wanted to do before the casket, she got thoughtful and had several things she wanted to work on.
Another HILARIOUS old lady said she wanted to have “quar triplets” …lots of babies.
Another lady drew a smiley face for past, sad face for present, and smiley face for future.
Another lady didn't draw anything, but verbally stated she would get better by eating right, taking vitamins, and “coming to groups”…lol. I liked that answer.
I did the MMSE on a pretty sharp guy who doesn't like the groups..and frankly he is so high level compared to most of them, that I don't blame him. He doesn't like the rec therapist at all. That almost made me happy, but not in a petty way. Let me explain…I really admire this rec therapist. She is loud and tough and really tries to get people to participate by being assertive. She is fun and good and I am “jealous” of her in the sense that I wish I had more of her strong personalit. On the other hand, some of the patients are put off by that apparently, and my quieter more lenient personality means they are more willing to do things because they don't feel I'm bullying.I know maybe some people think I'm too lenient or “soft” but I like to subscribe to the whole “more bees with honey” or whatever that expression is….flies with vinegar, I dunno. Whatev.
Ummmmmmmmmmmmmm what else. The social worker told me she likes that I seem to go above and beyond for patients, that I really care. That meant a lot to me because I do. I really, really, really care. Whether or not I do a good job or make a difference, I'm not sure sometimes, I feel I'm not very good, but I do care and I do try hard, so I'm glad that's apparent. I guess I wish I could get groups down…feel like my groups actually leave them going “Wow, that was helpful” versus leaving and going home and being like “I had to participate in the stupidest groups”….
I got exactly 20 units today…I'm less scared these days…except group is still no fun, lol. Gotta figure out how to make them FUN……and to steal a catch phrase….how to put that FUN in FUNctional.
I've got to figure out groups for tomorrow…I may do repeats…safety awareness and importance of exercise (which involves some exercise)…I think I have a whole new turn-over so it wouldn't be a repeat for anyone…hmmm…..I dunno.
This ended up being longer than I thought…I felt like I didn't have much to say but apparently, lol, I did. Just a lot going through my head. I really want each patient to leave with skills they need to be successful and not come back as a frequent flier….I want each patient to feel they have some control and that people are listening to them…I want patients to feel like their therapy is helpful and promoting success….want want want.
Four evals today….which is actually rather awesome because that + an hour of group, and bam, you got your units, lol. I had my 20 units by 11130am…although went back and did an eval afterward, so got 23…yay
One eval cancelled…heard an aide yelling for help in a bathroom…I unlocked the door as nurses came barreling in…patient had medical issues/was taken out of unit. Another one of my patients was also gone for medical issues over the weekend.
I did two groups today…with six people, my new record. I think I bored them, but I got a few ironic smiles even out of an acutely depressed patient.I didn't do my crayon group yet. Tomorrow, I think.
I'm quasi- proud of a few moments today…
One. Patient with aphasia spilled ice water on lap. I came across him in hall and saw the wetness/his cup of ice, although he didn't say anything. I told him I'd get him a towel and some water, and he started saying something. I started to move off and he got slightly agitated and clearly and loudly said WAIT! WAIT! I stood calmly in front of him for a minute, saying nothing. He just looked at me. Finally about a minute later when i sensed he was calmer, I said slowly and calmly, May I get you a towel? He nodded yes. When I got back, I said calmly, may I get you more water? He nodded yes. I'm proud I realized his agitation was coming from wanting some control and trouble processing, so I'm glad I did what I did, once I realized I was operating too fast for him. I was in a rush initially because stuff like that is a big productivity sucker – technically for stuff like that I should mention it to an aide, instead of doing it myself, because I'm solely based on billable units. But I think it's good to do it myself anyway for many reasons. It helps build a rappoire with the patients, it allows the aides/nurses to either see I'm helping them out and/or let them focus on more important stuff, and it means it gets done right away.
I went in to the activity/dining room to say hello and almost slipped because water had been spilled – there was one nurse in there on a 1:1 (ie one nurse for one patient, arms length at all times), so I let her know I'd be right back with a towel and to keep anyone from walking over there….went and got a towel. Then the lady sitting next to the spill asked for new socks because hers were wet. So I went and scanned her out new socks for her in the supply closet down the hall (not that big of a deal)..another productivity sucker, but all the patients (most of them were in there) saw I delivered on my promise. This lady has been especially hard to work with so it was good, I think. Plus I feel good I'm learning the ropes/know what's going on/can help out. I enjoy it.
On one eval I did today, the pt cried possibly four times in about 15 minutes. On another eval, you could just see the fog clouding her depressed brain…but I'm learning to go with the flow.
My friend Suzy took my cat to the vet today since he's been listless and extra sneezy. He got a steroid shot and he'll be on antibiotics. It was so helpful and kind of her to take him for me. My friend Arnie – her husband (the couple I'm staying with on this rotation) is dropping me off at work tomorrow, if we get the ice storm we're supposed to get. Hopefully we don't…ugh. But I'm lucky to have good friends.
Tomorrow night, if weather permits, we're going to a friend, Steve's, house…I wanted to go to gym…well see on weather…blah blah blah…….
Still struggling with groups! Groups, groups, groups.
I want to do some involving artwork…but am limited as we have very few supplies and a lot of items are contraband, even if we did….I spoke with a good OT friend of mine about ideas.. she pointed out I need to be careful about not being too emotionally evocative as I don't have the training or experience to necessarily handle what happens…and also that I need to remember to stay OT based, not psych based, with goals/objectives. Good point. Thinking, thinking.
This week, I have one MAIN goal.
1) Be more relaxed/calm during group!! Not dread it so much!!
Today I was “off” in the morning. I woke up pretty anxious and nauseated and decided to take an anti-anxiety med for the first time in a while. It messed with me some, I had trouble staying awake for a while lol. I did four ADM placemat tasks with people, and Joanne Cash came during rec therapy time to sing, and then my peeps disbanded. I only have 5 in OT today….1 always refuses, 1 was taken elsewhere for a meeting, 1 was willing, and two more refused this time. So no groups today…but 8/10 groups isn't bad.
I went back to the office a while to do documentation and I was still feeling off. My OT and I had our weekly meeting. Overall I'm pretty much on schedule.
Went back to the unit and was able to do a new eval with a very high functioning lady…gave a lady a shower…I finally feel pretty comfortable dealing with shower time now. And then I also did two ADM Sticker Cards…actually, it was kinda funny…I sit in on the end of a rec therapy group and we were left with four high-functioners…I wanted to do ADM sticker placemat on one of htem, but the other three were bored, and all wanted to do it. Luckily there were plenty…so I passed them out. Then they were still bored…I got the tactile dominoes (big dominoes with textures instead of numbers, for low vision) although none of us know how to play dominoes right so we ended up kinda making silly patterns, stacking them up and knocking them down, making little structures/sculptures and figuring out what they could be…just playing around and laughing. I was relaxed and comfortable because it wasn't about insurance and billing and documentation…just about having a good time with some ladies.
Apparently I probably could have billed as a group since I did have 4 people and we spent easily 20+ minutes together, interacting with each other. But the point was that it was just a nice relaxed time, which is good for me – and them. It helps me learn to chill out and calm down and it gives them some “down” time or maybe “up” time depending on how you want to say it, lol.
I ended up with only 12 units for the day since there was no group, and because I really did have an off morning which is typically when you get the most units. Next week is WEEK FOUR…time kinda flies, although not really…I've been really trying hard to bring peace to myself because it SUCKS to wake up in the mornings in dread and nausea and anxiety. I'm trying to exercise 3-4x/wk, use my special blue light to help combat SAD, repeat calming words…I really hope after another week or so, I get to the point that groups don't bother me. I think the key is to bottle that relaxed comfortable feeling I had when I wasn't worrying about having to charge insurance, and try to bring that to groups…fun and relaxed. Easier said than done, but I can try.
I went to the gym and did a half-hearted workout afterwards..then came home and apparently slept from 630 to 9pm, HARD…they tried to wake me up and I was OUT. Now my tummy is full of pizza and cookies YUM FRIDAY NIGHTS and Lester is lying next to me. I think I'm going to re-go to bed in a minute, lol. I'm so exhausted.
Gave two ladies showers today…both needed some assist….but sometimes ya gotta wonder about scoring. Like for example, one of the ladies was wearing these disposable hospital panties that tend to roll up really bad….if she had normal underwear, she probably would have been just supervision. The rolled up underwear ended up making her a min assist because it was too much for her.
Did two groups….6 in first, 5 in one. First was a Social Bingo. Second involved an 50 Noodle Boosters article from AARP…brain stimulation!
SOCIAL BINGO was interesting because it involved things like giving compliments to people sitting near you
This one lady walked around the table (she should use a walker as she holds onto furniture, but that won't happen), to give a compliment to another lady (one who has dementia and isn't really with it). With tears in her eyes she told the lady she was special and beautiful. This other lady looked up at her tremulously and said faintly “Thank you”.
I thought that was sweet.
Another compliment was made by a lady with depression to a man with dementia. She said “I love your beautiful white hair” and he said thanks, want to run your hand through it? She did, a faint smile on her lips.
One of the really flirtatious men always winks at me and sometimes I wink back and he'll say, do you have something in your eye? He always wants to marry people, I tell him I'm married. Anyway, this lady – one of our higher functioning ones – told me “I gave my heart to your boyfriend” lol.
Another man got transferred to an Assisted Living facility today – I'm not sure the facility realizes his level of need – based on our results he needs to be in a nursing home, but apparently this AL facility gives a lot of physical assistance. I hope he does okay. My guess is he'll end up frustrating the other much higher level residents, and/or getting frustrated himself. I won't be surprised if he ends up back here, although for his sake I hope not.
It's interesting to hear how nurses talk amongst themselves about doctor decisions. The nurses spend all day with patients, the docs come in for rounds maybe once a day and spend at most a few minutes with their patients…sometimes the doctors make rather poor choices, I think. I dunno.
I need to figure out two groups for tomorrow, I bettr get crackalackin. One last stupid thing though
So when I fill out times in documentation, you have to do like 0834, not 834…four digits, not three. And if you do it with three digits it will bring up a box that says HHMM and I used to think that was so cute as if it were saying HMMMM!! Fix it!! Finally I realized it was saying HHMM as in hour hour minute minute. I liked it better as the concept of Hmmm!! Oh well.