50 noodle boosters

http://www.aarp.org/health/healthyliving/brain_health/articles/noodle_boosters.html

Um, no………

Looking for ideas for senior groups by searching for fun groups in general …this Christian teen site had a weird idea of “fun”….yay vomit.

Milk Chug

This is fun, but ultimately disgusting. It is a good idea to get permission from the parents of students competing, as it will likely result in vomiting. So why is it on this list? Well, it really is a fun competition to do during a service. Have four or five students volunteer to compete during a youth service or activity. At the start of service give each student a gallon of milk. Throughout the service the students chug the milk to see who can finish the entire jug first. It is a good idea to have garbage cans on hand.

While all of these games can be fun, do you have more ideas you’d like to share. E-mail your ideas to your Christian Teens Guide. I’ll put them together in more articles to share with other youth groups!

Week 3, Day 3 – Geriatric Inpatient

Today was Discharge planning groups, a few evals, etc. Got 19 units (20+ is ideal). Since I'm only in Week 3 I think it's ok.

Four short stories.

1) Geriatric Depression Scale with severely depressed lady. She has had some SI – suicidal ideations – and poignantly explained the problem that “my body wants to live, but my brain wants to die”….

2) Our guy we d/ced from OT for being too low level – brain injury issues – very adamantly and clearly wanted me to come over to him today (I was across the table from him, talking to another patient)- I tentatively did so – and he promptly pointed to my half-open pants zipper. His aide died laughing and I was like AHAHAHAHA noooooooooo. I thanked him of course and fixed myself up!!

3) Newest sentence creation during MMSE: “I want to be your friend forever”.

4) Discussing leisure activities during group, and new learning opportunities. Lady states she wants to learn to write more like doctors….I was like (thinking) hmm, working on making your handwriting MORE illegible, great idea. And yes, she literally meant the handwriting.

Okay…I'm back to being behind on things big time…online and off…I still haven't done Christmas cards to Norwegian friends/family, written thank you cards from Christmas, written some 3 or 4 month old blog entries (oopsies), and then of course I'm almost 200 emails behind. Maybe it's time to break it down and make some short term goals. For now I gotta go figure out what to do for group tomorrow. Love ya my blogging peeps

Week 3, Day 2, Geriatric Inpatient Psych, Level II OT fieldwork

So I don’t feel like blogging tonight. Maybe it’s because I just found out that Karen the Rooster is DEAD. My friends Paul & Angela who owned Karen the rooster (he started out life as a girl, or okay, he was supposed to be a girl, SURPRISE), anyway, they KILLED HIM so that a friend could EAT HIM.

But really, that’s just a disturbing blip in the radar, not necessarily the reason I don’t want to blog. But I know if I don’t, by tomorrow the new day will erase today and I’ll have lost all my stories of the day.

Let’s say. Today I got 20 productivity units and wrote um, at least 15 notes. 2 evals, 4 cogs, 1 ADL, 8 group notes, etc.

Abbreviations I’m about to use a thousand times explained quick and dirty and possibly slightly wrongly:

MMSE, Mini Mental State Exam: common questionnaire for dementia
ACL: Allen’s Cognitive Levels, used to determine how much cognitive assistance a person needs
LACLS: a leather lacing task to test cognitive levels, related to ACL

My supervisor had an empty morning so was with me 8am-11am.

First: did MMSE/LACLS on a man who is very low level, just to confirm he is too low level for OT (at least for our purposes in this particular ward, nobody is too low level for OT), with documented proof, so we can discharge him.
Second: Gave a newly-frequent-flier lady a shower. My first time. I stood in the shower with her – her on a shower chair – and was in charge of the hand held attachment. She is graded
on her bathing/dressing using cognitive levels. For example she perseverated on certain areas and forgot to deal with others until cued. Man, elderly diabetics tend to have really scary feet.
Third: Did an eval. Lady slow to process, very depressed. Didn’t particularly care but was cooperative.
Fourth: Watched my OT run a group on self-care using a Self-Care modified Bingo.
Fifth: Ran my group on importance of exercise as important component to healthy lifestyle – not in those words. Did chair exercises.
Sixth: Oh lordie, I’m forgetting.

We discharged one lady because she would ALWAYS sleep – and then an hour later, I go up and she is sitting there, bored in the hallway, wanting something to read. guess if she is awake again tomorrow, we’ll re-instate her.

I did another eval on a lady who, apparently, pre-hospital, would try to get the plastic off food by using a lighter, lol. She apparently told this one aide
who she finds particularly pushy, “Go away, you bitch”…….which isn’t so bad. I mean, in the sense that sometimes they REALLY curse you out. One curse word is like, nothing, lol.

Some of these ladies seem pretty calm and cooperative and high-functioning and I’m like, hmm, do they really belong here?And then I stick around on the ward and start to hear them scream and cry and I’m like um, yes, I guess so, lol. Although truthfully I think a stay in a psychiatric ward could make someone a little crazy get a little more crazy. The change in routine, the loss of control, it’s not cool!!!

I asked one lady during exercise group what she did for exercise and she said “breathe”. Loved that answer.

Ok I guess this got long. I ended up at work 745 to 445, 20 minute lunch……..documentation took longer than I expected so I left 30 minutes late. I guess I’ll eventually learn how to handle it all.

Okay I’m going to go back to reading the year of living biblically now. and ignoring all the thank you notes, and 160+ emails, and 40+ Facebook msgs, that I’m behind on, lol. Oopsie doopsies. Maybe tomorrow.

Joke as reward for getting this far:
What kind of key doesn’t open a door?
a MON key

:O

Today started out as a bummer as always because I didn't want to start the week. But the day got better.

I did a chart review, then an evaluation with supervision…we did the LACLS on a lady with SI “suicidal ideations” and she got frustrated with the lacing task (after the 2nd demonstration of the whipstitch) and she said “Please don't make me upset” in a wavering voice, so we stopped. By then we had her score anyways.

My OT ran groups today – I've told her several times I still feel the need to observe how she handles problem behaviors. She did one on roles/self-awareness, and one on logical thinking/sequencing, through a functional task – ie planning dream vacations.

The paranoid schizophrenic lady was not in a good mood this morning but then a switch flipped and she was pleasant and I was able to do an ADM placemat with her and she did a horrible job but enjoyed the process. I think she would definitely enjoy little arts and crafts activities.

Another man who is low functioning compared to the rest of the unit, and has aphasia, was having a rough day today. He can normally feed himself after set-up, but today he kept his eyes closed most of the time, kept using an imaginary fork instead of the real one, missing his plate, missing his mouth, etc. The aide was sitting with him and I was observing because I was going to do a few things with him. Finally the aide was like, he isn't normally like this, I guess I'm going to have to feed him. I was like how about I take over, so I could do a feeding ADL unit with him by helping him feed himself. That's an intimate act when you're providing a lot of help.  Later on, he put his head down on the table and wept. He cries a lot. I felt so sorry for him. I rubbed his back awhile. While being mindful of his arms in case he decided to fling his arms out in anger, as he tends to get agitated.

On another man, I did the ADM tile trivet task, and he didn't particularly have interest in it, but he described his approach as that of a job. Pretty good attitude and insight for someone who functions at a relatively low level.

Hmmm…one thing I'm encountering is how to make it clear OT is awesome…at times. I don't feel particularly awesome sitting there watching someone place tiles. And the aide who was watching was like, not impressed, thinking, OTs make so much more money and they just sit there and watch a person place tiles? I showed her some of the paperwork/explanations of the ACL/ADM because I *promise* you she was thinking OTs had the easiest job in the world. And maybe sometimes we do. I think aides have a much harder job than therapists…paid very little to deal with a lot of crap, literally and figuratively.

And the same for rec therapy – I try to explain to the rec therapy students, when they asked, about OT groups etc, and they seem to think I'm basically doing the same thing as them. And maybe I kind of am – there is some overlap at times – but OT has much more of a focus on functional outcome….I dunno. It's not that I want to feel superior to aides or rec therapy students because they all serve vital functions and I admire them – but OT is ideally much much much more than the little bits they see me doing, and I hate for them to get their opinion of OT by watching me sit by a dude placing tiles.

Okay, I can't think of anything else to say now. Oh yeah, it snowed a lot of the morning. Only four more days left of Week 3…lol

"Sometimes I think I'm the Lord himself"

One last little story from Friday.

One of my men with dementia who is very self confident (I think to hide insecurity though), seemed MORE so than normal during group Friday…he would say confidently, I can do anything, I can do everything, I am unique because I pick things up so fast….sometimes I think I am the Lord himself”. It was interesting because I was having him do a placemat copy and he did a HORRENDOUS job but seemed to think it was perfect. I didn't ruin his illusion, lol.

That seemed like a slight escalation in behavior so I let the nurse know he was being rather grandiose at a higher level than before. That was before lunch. After lunch, I came back, and he had had a mini outburst, ranting and preaching to another patient, and had to be sedated. Guess he'll still be there Monday, lol.

About to start Week 3

Friday I only got 14 units instead of 20. I got 12 in the morning but only two in the afternoon!

I went back in the afternoon thinking I'd fill up, but two people were leaving, a few I had already seen in the morning or had an issue, one was heavily sedated, one was a paranoid schizophrenic who was having issues, and three were heavily asleep. I feel like waking up a strange lady to say, hey, I have some questions about depression for you, is kinda counter-productive. Yeah, if it's a depressed person sleeping the day away, that's one thing. But if it's a 92 year old taking an afternoon nap, I hate to disturb the person. Anyway.

The paranoid schizophrenic (look at my poor, poor use of person first language) was sitting in the hallway in a disheveled gown and as I'd walk by she would look at me until I got near, then she'd very blatantly snap her head away. At one point, having exhausted other options, I tried to talk to her (since she is one of our OT patients) and she snapped “I don't want to talk to you”. I said “Okay, just checking in” and kept walking, lol. Her behavior was odd enough that it wasn't her being irritable, it was her having active symptoms, so I wasn't going to mess with her.

Joanne Cash (Johnny Cash's sister) came in to sing again. She does gospelly stuff. One of my men with dementia came in and was like Wow, is that a wig!? (she has black and white crazy hair). She said no, it's all mine, do you want to feel it? Or something along those lines. He ran his hands all through her hair and commented “That's more than a handful.” After she was done singing, he asked again if he could touch her hair. She said no, once was enough. LOL. She was pretty cool in how she dealt with him. It's really nice of her to sing to them. I like watching the patients sing and immerse themselves into the experience.

I did group afterward – 4 in first group, 5 in second. One was on compensating for memory deficits….

Me: What would you do if somebody gave you a phone number and you didn't have a pen? (thinking they'd say repeat it a lot)
Lady: I'd say call back or tell me later after I get a pen!
Me: ::asks same question to man in wheelchair::
Him: “I'd say, go get me a pen so I can write that down!”

AHAHAHAHAHA

The second was supposed to be on anger management, but I made a split-second decision to do it on support systems/discharge planning instead, based on the group and that multiple patients in it were leaving that day.

The shining moment of the day, though, had to do with a one-on-one session.
That morning, I spoke with a man who was leaving that day after being there about a week. He said he was feeling anxious and he didn't know why really. We discussed how change can be scary, even if it's good change, because it means a change in routine, and some unknown factors. He acknowledged he was going to have a new room at his old nursing home and how that was a little disconcerting as well, etc. I think he hadn't been able to fully “get” his anxiety considering it's supposedly a good thing to leave a hospital, until we talked. We also spoke a little about relaxation – deep breaths, calming the mind etc, and he mentioned he wanted to try yoga. ANYWAY, I wasn't sure if what I had just done was billable or not since all we did was chat, but my OT confirmed it was, as long as the outcome is measurable, ie, identify 1-2 coping strategies for anxiety. So….I haven't been fond of what I've been doing in the ward (seems like I do very little therapeutically, mostly just evals and/or confirmatory diagnostic tools), BUT, one-on-one discussions of how to cope with anxiety, depression, etc, is right up my alley, so that might be the one thing that helps me like the rotation.

The way I know (or at least strongly suspect) I actually made a difference for him? He was in my group on discharge planning a few hours later. He basically said word for word what we had discussed earlier about change being hard whether it was good or bad, but he had made it his “own” words.

ANYWAY…those were the highlights of Friday.

I had a fun weekend – details later – but I was bummed tonight knowing I have the start of a new week tomorrow! Oh well, I guess I'll get through Week 3. I'm going to try and go to the gym 4 out of the 5 days, wish me luck.

Lester is curled up next to me with his little tongue protruding, sooo cute.

physical holds – HELP training

Today I learned how to get out of someone choking me from either front or back, how to get out of someone grabbing me by my arms on either side, or both hands, how to get away/block someone hitting/kicking/coming at me, how to get past a patient to the door, how to come up behind a patient, restrain them with crossed arms, then take them down to the floor, etc. We used HELP – human empowerment and learning principles, or something. It focuses on trying to verbally de-escalate a crisis situation, but if that doesn't work, using physical holds that put you out of harm's way while also not doing damage to the patient.

It was really cool. We heard some crazy stories about a code that involved a man smeared in feces (they had to take him down regardless and all got covered in poo), stuff like that. Overall it was awesome…considering we were in training 730am to 415pm, it went pretty fast.

We were checked off on everything – we all took turns being both patients/staff in all of the holds, so we all took each other down. Pretty cool. The holds work around maximum leverage more so than strength. It was good basic self-defense stuff to learn although it was “clean” – ie no fighting back, just getting out of the way and calming/restraining patient safely.

Tomorrow I probably hold two groups and then do evals, etc. Almost end of week 2, 10 weeks to go. It was a beautiful, beautiful thing to have two days without worries about group…only 100 groups to go…2 a day, 5 days a week, x 10!!!!!!! :O

Umm

yo!! yay!!!!!!!

i just checked blogger (I normally just email the blog posts) and I've had 1,027 posts now!! I think 1,000+ posts on OT deserves a PRIZE! Like a million dollars!! Or a roll of duct tape.Or a machete to chop off my fingers so I can't keep rambling. Well I still could, just slower.
 
Just sayin'.

Note to Cookie Gimp: Yep, it was you I was talking about the other day!!