Day 7/60, Geriatric Mental Health, Level II OT fieldwork student

Yesterday. I don't remember much, that's why I should blog each night while it's fresh. I do remember doing a CPT with someone who scored pretty low. On the medicine subtask, I was like augh! One of the pills says “this is as needed, not to exceed 8 in 24 hours” and she was like hmmm….I guess I'll put a few in each. On all the medications, she made some mistakes. Glad her daughter helps her still.

What else. Oh yeah, the big event of the day. I was doing group and one member with dementia was monpolizing things big time – I kept trying to redirect him, tell him to stop, but he is hard of hearing and adamant, so it's a bad combo. Another member, who has had multiple strokes and is not very physically functional and has trouble speaking, got really angry at this monopolizing member, and started yelling, banging the table, and cursing, etc, telling him to shut up. Some nurses/aides came in and calmed down the angry guy. The monopolozing guy kept apologizing but kept talking at the same time about his rough life. They kept trying to get monopolizing guy to be quiet so that angry guy would clam down. One of the aides said something along the lines of “Stop talking sir, we've all had a rough life, we don't want to hear it.” I was like UM. Not to say I have a better way of dealing with it, but that doesn't seem like something you say to people in a psych hospital or who are getting therapy!! Angry guy left and so did another little lady with dementia who always dissapears during such events. So group was a bust more or less. Oh well. It kind of freaked me out when he was getting so angry. Good thing I have behavioral training tomorrow, lol.

I checked in with the angry guy later, he had calmed down, he was angry about the monopilizing (how many ways can I spell this wrong in one post?) not only for himself but also for my sake. I think I'll learn some assertiveness over the next few months, since I'm supposed to be doing two groups a day!!!!! Augh!!!!!!!!

Do you know the scenes in the movie Superstar where Mary Katherine Gallagher is like flirting with a stop sign/flagpole/tree? I think Lester is flirting with a table pole. He just stuck his nose against it.

Today and yesterday my OT has been more with me, watching me do evals to point out stuff, helping me with the single cordovan stitch on ACLS (I still freeze but I'm almost there!!)…we started out the morning with bathing I've never seen shower ADLs before. There is a special bathroom with a shower chair, hand held shower attachment, etc.

My OT basically holds the shower attachment to minimize how wet she gets, and then the person gets scored via ACL scoring and FIM scores for their bathing and undressing/dressing. You think, how do you score a person on bathing?!! But think about all the tiny steps involved in bathing – soaping up hidden areas, remembering a washcloth, being safe, washing off soup, using enough soup, etc.

I did a few MMSEs, a few ADM placemats ….

You learn to just nod and go along with things. Like on the MMSE when you ask orientation questions and they tell you it's February, Fall, Thursday, etc, you just keep going with the poker face…Today's MMSE sentence by a lady with COPD who was very gravvelly sounding: “I wish I had a cigarette”. I added some exclamation points to that one for her 😉

I'm still a little conflicted sometimes regarding “getting the productivity units” versus whether I think the person is genuinely going to benefit from my intervention. Also, because I all too familiarly know the overwhelming desire to crawl back into bed with depression/anxiety, I feel bad for the ones who want to go back to bed because the nurses/aides/doctors want them up out of bed as much as possible. I know in reality it's best for them to stay up, not be isolated, etc, but I really “feel” their desire to just be alone/go to bed!! One lady today was having an anxiety attack and begged me to stay with her  (I had gone in to chek to see if she would come to group, she was in bed crying). In retrospect I wish really bad I had stayed with her and worked on some relaxation techniques, but my other patients were waiting for group to start, so I couldn't. Ugh!

Tomorrow morning and Thursday morning I have behavioral health related training – I don't know how long it will last but I'm hoping a long time – anything to keep me out of the ward!

It's only day 7…I sincerely hope I'll eventually get the hang of things to the point I no longer dread each day. I'm really quite a passive person even in all my activity – I'd much prefer to be a zombie rather than do things like literally JOG to the ward for an eval (my supervisor has long legs!!!). She LOVES her productivity units with a passion, lol. She has the sin of productivity gluttony. She never stops for a break, and I think she's had an actual 30 minute lunch like once.

Today she had to go off premises for a while and it was like time for lunch and she was going to be back in say 45 minutes, and she wanted to make sure I had plenty to do, and I was like yeah and rattled off a bunch of stuff, and then I was thinking…if I'm lucky I've been taking a 20 minute lunch, and there is no such thing as a “break” for her. So I did take like 20 minutes for lunch and felt guilty lol.

I guess it sounds like the above is complaining, but it's more a combination of sharing/awe. She's certainly energetic. I just have my winter zombie blues so her level of energy is pretty amazing to me. Oh and today I got off on time!! Wow!!!!!!!

Okay, this is really long…oh well, I don't care. If you got this far, you are way too nice.

New (to me) OT blog :)

http://e-nableot.blogspot.com/

Check it out, she's a smartie pants! In a good way. 🙂 AND, she is nice!!!

Augh

Yesterday was less crazy than Friday and she supervised me more, but it was still rough as it involved a flare-up between two of my group members. More on that later.
I went to bed at 9pm, I had all I could tolerate in the waking world. Right now it's 7am, I need to leave in 5 minutes, I'm anxious and nauseated. The thought of another long day….I'm hoping if I blog out my thoughts for the extra 5 mins I have, it will help.

It also doesn't help Lester hasn't been feeling so good, he's been acting extra oddly which always worries me.

ANYWAY.

Today we start out with ADLs – we are giving one lady, one man, a shower. Then I'm doing the CPT on one of my OT's neuro patients (since I'm learning it). Then I have two groups for an hour. There is at least one eval to do today maybe more if any orders came overnight. And then ACLS and MMSE on 3 people, ADMs and/or GDS on others. We'll see how
much of that gets done.

Ok, I better go start defrosting the car. Send calming thoughts my way.

Week 1 down…day in a gero psych ward.

Inpatient Geriatric Psych Ward: Census: 6
Today I did:
Two 25-minute groups of 4-5 patients: 8 notes
Two evaluations: 2 notes
One ADM Placemat/Geriatric Depression Scale: 1 note
One ADM: 1 note –
One ACLS: 1 note –
Total: 13 notes.

Productivity units: 17 (20 is ideal minimum).

My supervisor also had her neuro day patients, so we actually got 32 units for the day since my productivity goes under her. I also semi helped do the travel task of the CPT, and a cooking task of scrambling eggs, with a neuro patient, to gain some experience with both the CPT and using cooking for treatment. My OT was present/helped with this as it was her patient. My OT does do fine motor tasks with patients like pegboards etc, but is otherwise the most occupation-based therapist I’ve seen – she does a lot of cooking tasks, making the bed, dressing, typing, etc.

My OT kept getting called away when joining me, so I did most things by myself. She was present as an observer/SLIGHT participant for my groups, and did the cordovan stitch for an ACLS. The rest? All me.

She signed those 13 notes at the end of the day – made a few suggestions and a few small changes, but not much.

I got there at 7:45am, left at 5:30pm as she signed my last note. I had a 15 minute lunch – ie heated up the lunch, ate it as quickly as I could. No other real breaks – maybe 2 minutes here and there.

In other words: on the last day of my FIRST week, I basically carried a full caseload by myself. Of course I bounced off ideas on my supervisor, asked questions, etc, but I’d say that’s a lot to do on week 1!!

Topics of my two Life Skills groups: First: identifying safety hazards around the house, how to remove them. 2nd: Somewhat of a stretch, but self-awareness – thinking about happy moments of the past and laughter, and what about the situation made it so happy, and what people could do now to help promote a positive mental state, ie be with friends, garden, etc.

One of my favorite moments of day:
Male patient with severe dementia: I don’t remember. I’m 88, you see.
Me: You don’t look a day over 87!
Patient: ::genuinely laughs:::

Also, one of my patients who was psychotic kept hearing things in his head…including calypso music! You try interpreting the word “calypso” from someone with dysarthria!!

Oh! And want to hear something funny???!! Apparently Johnny Cash’s sister, Joanne Cash, performs for the patients, ie mini concerts (meaning a microphone/CD, into the little room), which is so sweet. But I saw the lady downstairs beforehand and she has such funky hair (a la Cruella DeVil), I was like WHO is that. Well I found out soon, when the rec therapist brought her in. She was awesome. She sang a lot of gospel. Isn’t that the nicest thing? I think that is so wonderful and the patients loved it.

Week 1 down, 11 to go. I think I can handle it…

Sorry this is so disjointed…

OOOH! SEX QUESTION!

Did I get your attention?

What do you do when a very old man with dementia is inappropriate towards women, expecting sexual favors (confusing them with his passed wife, at times)? Honestly my instinct is to recommend paying someone to cuddle with him since that's probably the only thing he can really handle anyway, but I know that's not exactly kosher and I'm not sure how you'd do it…”Excuse me, Escort Services? Yes, I'd like to use y'all, but not for any home runs, ya know what I'm saying?”

I wonder how many escorts specialize in geriatric services…ie cuddling and minor intimacy. Hmm. Yo Escort Services who have Google Alerts: Think about it!!! Geriatric Specialties!! You're welcome.

I was asked by the man's daughter how to handle this situation, and I told her I'd look into it and get back to her. Anybody have good ideas?!! I might post this on the OT mental health listserv, but first I should probably check some literature and the archives too, as I know this is a relatively common issue….the whole retrogenesis thing I guess.

Okay I'm jumping in the shower and heading to bed! Those of you who just started a new fieldwork (apparently January 5th was a big start day), I/we would LOVE to hear from y'all if you have anything to share, whether good, bad, stories, facts, thoughts, whatev.

Health promotion for OTs

A recent e-mail that made me happy…I changed her name/location. I gave her some tips but if anybody wants to chime in, please feel free.

AOTA! Check it out!!

My name is “Jane Doe” and I regularly read your blog! I wanted to say that I love the blog as it opened up my eyes to OT and I learned a lot about the profession. Your blog is one of the reasons I am applying to OT school because it gave me a perspective of OT from a student's view! I am actually in the process of applying to a master of OT program in “Doeland”(I am from “Dooda”) and I was wondering if you can give me some tips.

I have to submit an essay discussing OT as part of my application and it's due this Friday! and I am freaking out…one of the question is to describe a trend in health care and how OT is positioned to play a leadership role. I was thinking of maybe discussing the switch in healthcare to health promotion and disease prevention but I am a little unclear on how OTs can play a role in this.

If you can give me any tips I would really appreciate it!

Thanks and keep up the great work on the BLOG!

Check out otadvocacy.com! I c/ped her comment

Haha, good luck, you'll do great! That dang ACLS has always tripped me up (according to my score, I shouldn't be allowed to operate home appliances).

Anyway, I should introduce myself- my name's Alece and I'm 2nd year MOT student at the University of Washington (in Seattle). I've been reading your blog for a long time now (since April 2008) and admire your dedication.

I am very interested in political advocacy at the state level, and for my Master's Project I've just launched a blog about OT advocacy in WA State- you might enjoy checking it out: www.otadvocacy.com

Day 4 of Geriatric OT Mental Health Level II Fieldwork

Today I did the chart review and subsequent evaluation, MMSE, and ACLS! ON a man with severe dementia.I also wrote it all up. All by myself!  I also wrote up the 8 group notes (four people, 2 groups)…although my OT ran the groups. Tomorrow, I run the groups! Augh!!

I watched a cooking task this morning – a lady who had to make scrambled eggs – and it's a miracle she didn't burn herself, she was sooo unsafe. It was my OT's neuro patient, but she wanted me to watch because I could potentially bring patients down to the kitchen for cooking tasks.

I am very proud of myself because today I went and hung out with our four patients (about to be six) + some other random patients, in a big room, for a little while, before group…instead of cowering in the nurse's area.

The first group was on discharge planning/importance of support systems. The second group was on identifying leisure activities/why they are important.

I really like watching Margaret run groups because I learn a lot about dealing with problem behaviors. I tend to be too nice – doh.

I don't necessary feel like I've been thrown to the sharks, but at least the dolphins. It's only the end of week 1 and I've done two LACLS, like 5 MMSE, lots of chart reviews, and 1.25 evals, as well as written up at least 2 evals, several cog notes, and lots of group notes. I know it's my last rotation and I've already had 6 months, but it's a very different setting!
 I'm starting to finally grasp the paperwork and how the system runs – I have to understand the big picture and the step-by-step process, in order to be able to problem-solve.

My favorite quote of the day was when I asked the man with severe dementia why he was here, and he said “You tell me and then we'll both know!”

3 days down

Who knew Baby Jesus had hypotonia!

Day 3 over!

So…I struggled last night and this morning with dread over going to work. I'm a creature of habit, I don't like unpredictability, I don't like not feeling competent, blah blah. But I swallowed it!! My OT had a packed schedule with her neuro day program, so she sent me to the gero inpatient ward to do a chart review, and then I came back. I practiced the LACLS and made myself a cheat sheet of what to say and did some other reading, while she saw her patients.

She had this one patient in a wheelchair attempt to take his jacket off one-armed (since his other arm had no function from a stroke), by using a pulling/shaking method, and WOW, it was hard to watch. He was struggling and getting frustrated and she was skilfully helping him, but after about a minute I was (internally) like OH PLEASE FOR THE LOVE OF GOD LET ME HELP. And you know, my OT training teaches me that its important for him to do it by himself independently, and then my “gimp” perspective taught to me over the year from my “gimp” friend, makes me wonder, Why?? If it doesn't really bother him to get help getting his jacket off, why bother frustrating him so much doing it one-handed?  It was painful to watch him struggle!! My OT, btw, has awesome knowledge and skills. She has done a ton of continuing education and loves alternative therapies and is very smart and talented at OT-osity.

Then when it was time for the eval I did the chart review on, she had to do something really quick, so I went up to start. I wheeled the lady to her room – she had severe depression/anxiety – and she cried a lot. And when asked why she was there, her answer was “My stupid husband brought me here thinking it was an emergency room”. I feel so sorry for these people who just feel utterly betrayed and lost. She kept saying she just couldn't stand to be alone anymore, and crying. I just wanted to throw my clipboard of evaluation questions down and give her a hug!! I started asking questions and then my OT came in and finished up, then I did the MMSE with her – her short term memory was horrid, so she scored pretty badly. The doctors LOVE the MMSE and so when I went to turn it in (they do most of their stuff via paper charts!!), they had me give it directly to the doctor who had that lady's chart, and he was really nice. He apparently worked with the people who developed the MMSE so he gave me some cool information on it, and pointed out it's a great tool to use repeatedly (ie every few days), to determine whether a person has delirium versus dementia. Oh. And her sentence creation? Was “Love is God's greatest gift”.

I think of everything, the sentence people write on the MMSE, is most revealing. Breaks my heart. Think about it. You ask them, off-guard, to write you a sentence, about anything, and that which is most important to them, is what flows out of their fingers. The lonely lady craves love. The euphoric lady is, uh, euphoric (Euphoric Lady is Euphoric, Sarah), and the lady with circular logic/dementia just wants to be understood.
Lady with dementia: “Please understand”
Lady with euphoria: “I am a happy person and I love everyone”
Lady with fear of being alone: “Love is God's greatest gift”

I also got to give the LACLS for the first time, to an older hearing impaired man. I did the running stitch and whipstitch, then my OT took over for the single cordovan stitch, I'm not quite there yet (but probably will be tomorrow)!! Poor man could not untwist the lace for the life of him.

The coolest part of the day was unfortunately not directly related to my rotation. I joined the psychologist for his group in the stress disorders unit (I was with him Monday morning as well). I LOVE that unit because most of them aren't that dangerous or unpredictable, or at least less aggressive. You have a lot of sad people there, but not people ranting and raving and screaming and tearing off their clothes. It's subdued. The group was very small. One of them discussed some very painful memories, the other one was just very very sad and quiet. One lady kept picking at her clothes as if not sure what to do, I wanted to give her a Tangle toy to hold onto! I contributed a tiny bit to this session. I REALLY REALLY REALLY would like to work with this population of people debilitated by depression/anxiety. I have so many ideas for things I would do with these people. I realized that this morning that when I enter the gero inpatient psych ward, I'm scared and/or saddened, and don't feel like I have much to offer besides compassion…but when I am with these people with depression/anxiety, my soul shouts and sings with ideas of things to do.  I'm thinking that maybe, when the gero ward is quiet, if my OT is busy, that I would be allowed to do some non-billable work in the stress disorder unit….doing a lot of activities that focus on soul-searching through (mildly) creative outlets.
You know how Care Bears are like CARE BEAR POWER or whatever, and then like their stomach shines with this huge light that focuses on the person/thing, and changes it? I want to be like SEROTONIN POWER and have my necklace burst into this spotlight and infuse them with happy chemicals and thoughts.

Ok….my posts have gotten back to being really really long, but it helps me to spill it out. Tomorrow I may do an evaluation, MMSE, and LACLS with supervision…ie the whole tamale!! And maybe some ADLs…

After work I hit the Curves gym and have been hanging out with my friend I'm living with!! Lester the Lion Kitty is curled up next to me. I just talked to Brooke who is at John Hopkins and she loves it so far (although she's only been in orientation but it's obviously an awesome place). Also talked to another good friend for a catch-up chat and that was also awesome. Now I'm going to hang out some more and go to bed. YAY for being ridiculously overdetailed.

Day 2 of Gero Mental Health Fieldwork

So the first few hours of today weren't so cool, but it ended better.

Last night I took an anti anxiety pill to help rid of my jangles, and went to bed early. I woke up about an hour later because I had this really bad dream where my beloved Lester the Lion kitty was eaten by a dog. I cried!! I've had a lot of dreams lately where I'm just really uneasy and scared. I guess just reflecting all the changes I've had lately in my life! Anyway. The problem with that pill is that it helps at the time, but when I wake up in the morning, I feel rather sad and broken. So that's not cool. I woke up this morning and I was like, I'm not sure I can handle this. I'm not sure I can do this fieldwork (or any new fieldwork). Rough. I consoled myself with the knowledge that if I do break down, I'm in the perfect place. LOL.

Went to work, and it turns out there was orientation issues, and that I was supposed to have gone to the main campus Monday morning, and I need to go right that moment. I volunteer to look up directions on Google Map, but my OT wants to draw me a map to go the back roads as it is easier. It looks pretty straight-forward so I agree to try her way. Unfortunately one of the roads had an issue and I had to get directions in a Walgreens, but I did eventually get there, in the rain.

The fieldwork coordinator there (not just for OT, she has 500+ students) was quite kind as apparently the mistakes were on both sides, not just mine. She let me get my TB test there instead of finding the health department, and we're working on the CPR card thing. Of all the stuff stolen from my car that night in October, I never thought my CPR card would end up causing me more grief than all my financial cards!!

I went back to my hospital using yet another way – I had now gotten directions from 3 different people and all of them had said something that wasn't quite right, lol.

The rest of the day was a combination of interesting, a little scary, busy, and slightly confidence-increasing.

We did a group with 3 old ladies – one we had evaluated, two that would be evaluated later in the day. One lady, let's call her Jane, kept insisting “I'm not crazy!” and she was rather euphoric and motor-mouthed and restless. The other two ladies were rather quiet. Euphoric Jane cracked me up, she kept talking about how much she loves belly-dancing. One of the quiet ones, when asked about things she values, said “My kids and my clothes”. The first group was on self-awareness, by answering questions about valued things/events, and the second one was using big pictures and discussing emotions displayed in the pictures (ie happy child, sad person, etc).

The lady that was so agitated yesterday – screaming and cursing – was mild mannered today.

Later on we did several evaluations.

1) A lady who talked/processed sooooo slowly and was very Alice in Wonderland, using circular answers “That is the answer to which the answer is asked”, kinda stuff. She could not remember the state she was in at all, or county, or town. She scored in moderate dementia range using the mental status MMSE questions. She did poorly on the leather lacing assessment. She also didn't handle imitating a placemat very well. This is one of the confidence boosters today – realizing the ADM craft placemat wasn't so hard and I wouldn't have to struggle to learn it.
I was the one who gave the MMSE with my supervisor sitting next to me. Pretty cool. Her “sentence” that she had to write (without any suggestions on what to write) was “Please understand”. It kinda gave me chills – considering the way she spoke so slowly and circular-ly.

2) The euphoric lady. She was living alone up until this hospitalization. Hard to imagine her being safe. Euphoria is hilarious. Her sentence was “I am a very happy person and I love everyone”. I did her MMSE as well.

3) This was awesome. We went back to do the evaluation on one of our earlier pleasant quiet ladies, and she was NOT in a good mood. She kept saying SHUT UP and NO. My OT was trying nicely to get her to participate – and she was having none of it. She finally said “If you don't go away I'll throw my coffee in your face!”. My OT didn't flinch, she stayed calm.

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I did a few mini chart reviews – learned that the Axis I diagnosis is what we have to use – did my two MMSEs – and learned how to enter in the info/notes for a group therapy session, into the computer. They still mostly use paper charts and their computer system is like DINOSAUR DOSsey, with like, using the function keys and arrows to get around, a TOTAL pain in the butt. It doesn't even word wrap!! Shockingly old school.

I need to practice the ACLS some more…that single cordovan stitch is going to be the death of me. And I'm not the only one. I know lots of other students who struggle with it.

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It's really interesting to me to see how people can be logical and smart in some ways, and then utterly incompetent in other ways, in these settings…the brain is so complicated!!! Spoken like a true neuroscience major.

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ANYWAY….this was a little disjointed, but whatev. I wrote it with lots of distractions. After work I went to the gym. I think physical exercise at the gym is going to be my saving grace for getting through this fieldwork with my mental health intact. That and wonderful friends. And SEROTONIN! Come on you little serotonies!! Work harder!! Be fruitful and multiply and stuff!

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