Ta da

HA HA HA HA HA!!!!!!!!!!

That was AWESOME.

I've recently taught Lester the Lion Kitty to stand up for his treats….because it's cute mostly, but also because it seems to help him get it far enough in his mouth since he isn't the greatest eater with his smooshy face. ANYWAY….my friend Suzy kindly took him to the vet for me today and I met her there, since I really wanted Lester to get seen asap for his bad sinus infection or whatever. Okay, anyway again, he has to take antibiotics for a while. Of course no cat likes taking pills. But I held it up like a tiny treat and he stood up for it, I threw it in his mouth like a treat and gulp! It went down, no fuss at all! No torture! Of course I praised him to the skies with a few real treats, but was that not awesome. To have a kitty stand up for his drug! Ha ha! Ha ha!! HA HA HA HA HA!!!!!!!!!!!!!! HA HA HA HA!!!!!!!!!!!!!!!!

Okay moving on. Today was a semi stressful day…cursing angry unsteady lady causing issues and rattling other patients. I did four evals and two groups. Groups were a struggle because of two quite disruptive patients making it hard. At least I got 20 units for first time in a while. I would have had more but I ended up doing some non-billable helping.

Some of our patients are sweet and pleasant and just not suitable for OT – solely because my supervisor wants them to be at least at a 3.2 level to take them on in this unit…and that apparently pisses off some of the nurses because, I guess, they think anyone who isn't absolutely 100% insane, should get OT. It's a great thought, but with one OT running things (especially when there is no student), there has to be some kind of cut-off because otherwise it's just too much work for one person.

Relatively short post today…nothing too incredibly exciting, just difficult dealing with a few disruptive patients that have a domino effect of upsetting everyone, especially the most “cured” ones ready to go home.

I now have 7 patients…so maybe tomorrow's group will be big. Hmmm, what to do, what to do. Several of them have severe visual impairments so don't want it to be too visual. Blah blah blah, the end.

The carnival is up!!! With an update

The blog carnival went up today…time got away from me so I didn’t submit in time. I feel bad. Check it out and read all the great OT submissions at

http://e-nableot.blogspot.com/2009/03/occupational-therapy-blog-carnival_09.html

This would have been my submission:

Private Parts & Body Fluids: Things you have to learn the hard way in fieldwork

It is my belief that OT schools should have at least a class or two (maybe a panel with some fieldwork students or new grads) on some of the um, not so much fun, aspects of OT that might come up in practice. Just to be slightly less surprised when those things happen. For example, it turns out a lot of lower-functioning people, once placed on a shower chair (with the hole), often end up having a bowel movement in the shower. Nobody told me this. I had a patient with problems functioning physically and mentally, surprise me by leaving a large mess on the shower floor, at the beginning of the shower. Trying to keep him calm and safe while dealing with the mess, was a little overwhelming. That’s just one of those things you’re never told about! I just wouldn’t have thought about my patients pooping in the shower. Until it happened. Several times.

1) Hopefully by the time you have completed all your observation hours to get into OT school, you realize this, but toileting, depending on the setting, can and does take up quite a bit of time, especially in geriatric settings. You might have to help wipe. You might have to help change diapers, help change soiled clothing from accidents, deal with underwear, incontinence pads, diapers, etc. And if you ever want to think “I’m only going to sit him down for 30 seconds without anything on, surely he won’t have an accident in that 30 seconds” – you are wrong. I speak from recent experience.

2) Women’s issues – menstruation in younger women, urinary incontinence in older women – pads, pads, pads. You might be putting the pads in yourself or helping fix a mistake. I recently had to fix an urinary incontinence pad while the lady was wearing it. It had bunched up while pulling up her underwear. Because standing up/sitting down was so fatiguing for her and we had already done it multiple times, the safest option by far was just for me to fix it while it was on her. With her permission of course. But as I stood there, fixing it, I marveled at the idea that I was doing something like that. I never would have thought that was part of the job description…and/or at least thought, “that will never happen to me”. Guess what, it does.

3) Some people are private – but many are happy to whip out all their bits and do whatever they need to do. You’ll be surprised at how flexible some of those 90 year old women are when it comes to getting clean. You’re going to see it all.

4) You’ll hear every word in the world to refer to private parts. My personal recently-heard favorites are “tinklebox” and “possibles”. Be prepared! (By the way, the other day I discovered me and a geriatric patient had the same pair of Victoria’s Secret underwear…slightly traumatizing, but mostly cool).

5) You will deal with ALL BODY FLUIDS. ALL OF THEM. BE PREPARED!

A few more thoughts on the matter:

1) Gloves. Just stick gloves in your pocket or whatever you carry around all the time. Boxes of gloves have a habit of being empty right at the minute you need them most. Just always have at least a pair on you.

2) Even if it’s tempting to call someone else to deal with a mess – if it isn’t a huge mess and you can take a minute, do what you can. It may take a while for someone to get to the person, and/or they will see you as not being a team player if you never help deal with it. You can argue it’s not your job or it takes away from productivity, but any little bit of help you give will be appreciated by both patient and staff.

3) It really does get easier. If you had told me nine months ago that it would become common-place to give showers, help with toileting, deal with all manners of body fluid, adjust breasts from getting in the way of gait belts, etc – I would have said YEAH RIGHT. NEVER!!!! But it’s true, you get used to it. I don’t blink these days. And I’m not even done with fieldwork yet…so you get used to it pretty quickly, I promise.

Good luck on fieldwork!!

UPDATE: Great comment from a reader:
“I love your blog as always. It’s really too bad that you didn’t make the blog carnival. But on the gloves matter,… latex gloves are a huge issue. You want to be careful about that advice for paediatric settings (yes I use British spellings) or even non-elderly adults (ie gimps) because huge numbers of sb [spina bifida] adults/children have latex allergies.”

Is it bad if me and my geriatric patients have the same underwear?

(Updated April 2015) I wrote this post in 2009 while doing my final fieldwork rotation, in mental health, working in a locked geriatric psychiatry ward.  It’s extremely informal/just processing the day. As I read it now I cringe a little at the informality, but at the same time, it’s depicting what was going through my head at the time. I could jargonize-it all up so you would understand why I was legitimately doing what I was doing, make it sound super professional, but it wasn’t my intention at the time…just blabbering. Thinking about doing an “after” post though, using OTPF terminology, so you can see the difference between work that seems unskilled, to work that seems skilled!

=======

Today I got 19 units…so only one off from the 20 I’m supposed to have as a minimum [productivity units]. With the census low it can be difficult.

Have any of y’all heard private parts referred to as “possibles” among older generation?

I did groups today….all but one of my patients (so 4/5), plus two nursing students observing the unit for the morning, plus an extra aide doing a 1:1 with a particular patient. I always make everyone in the room participate some (ie not just patients). The first one was just a typical group, the second one was on exercise but it was extra fun because when did the actual exercise part we did a lot of silly moves like hula moves, hula hoop moves, etc…then we did the entire alphabet with our arms…like YMCA style, but from A-Z….on a lot of them we just had to do whatever we could think of, cuz who can really do a K??? lol. There was a lot of laughter and silliness, it was fun. 🙂 The nursing students afterward let me know they enjoyed it. 🙂

Oh! And after group, one of our patients who used to sing, sang us all a beautiful song. It was wonderful. 🙂 Before that, we had a singer and a chaplain who likes to sing…I get NO productivity during those times because I won’t take patients out of the only truly fun experience they’ll probably have that day so unless a patient refuses to join the group, I do other stuff.

I did a session on discharge planning…ie what to be prepared for after discharge in terms of having support systems in place, leisure activities and/or goals prepped, keeping doctor appts/taking medicines until told to stop [ so many behavioral patients start feeling better and think Oh, I’m cured, I can stop taking my meds!]…stuff like that.

Did a shower…some other grooming/random ADLs….oh…I’ve gotten better at handling intimate moments without even thinking about it…a few days ago I had to adjust a lady’s urinary incontinence pad while it was already in her underwear that she was wearing  – long story as to why but believe me it was justified – so I literally had to put my (gloved) hand into her underwear, with her permission of course, because the alternative would have been much more fatiguing for the patient. Nine months ago I would have been like WHAT?!!!!!!!! Adjusting breasts? Sticking my hand in underwear? Oh hell no. But you really do get used to it.

Three highlights of my day!!!

1) One of the nurses (who I have spent a lot of time with the last few months) doing “checks” to keep tabs on all the patients, popped her head in a room where I was standing next to a patient, guiding her to go through clothes in prep for bathing. She smiled and said “You are such a good OT, you need a raise…”

2) A patient who I had spent a lot of time with today, most of it not billable, had started slightly frustrating me because she is slow and since the time wasn’t billable [cuz it was stuff like walking her to the phone, listening to her talk about something, etc], I was a little like augh! But I hid it because I knew she needed it. And it paid off because she told me at the end of the day, “Thank you for talking to me. It helps. It’s like it’s a glowing light”  or something along those lines about light, lol. So it validated it all to me.

3) Helping a lady with grooming, adult daughter present. Lady told her daughter I was her favorite, daughter said I was kind and patient, blah blah blah…very nice!!!

These little things mean a lot to me. I spend pockets of time EVERY SINGLE DAY doubting my skills, wondering if I’m too easy on patients, wondering if I’m accomplishing real goals, wondering if I’m too nice about non-billable time/productivity by not hurrying things too much, etc etc. But then I tell myself that even with all those issues, if I give the patients a sense of control, or give them a few extra minutes, or give them a laugh…that’s good too. It’s still important. So I may not get the best productivity, but I’m still being helpful!!!! In a way that the techs/nurses don’t have the luxury of being, most of the time…they’ve got to go go go.

Oh….me and one of my patients..(GERIATRIC)….have the same pair of underwear from Victoria’s Secret!!!!!!!!!!!! I was cueing her as she prepared her clothes and I excitedly exclaimed, “Hey! I have that same pair!” [completely normal pair of underwear that has a heart pattern, nothing risque]. She said, “That’s how I will always remember you.” AHAHAHHAHAA

Yay a psychiatrist thinks I'm good

So today my OT followed me some since she only had one patient. I have been telling her about the chaos that a few of my patients have been causing, so she was interested to see. Unfortunately, although fortunately, medicines had been adjusted so things were much calmer. I still ended up with my butt patted again though.

So when my OT was sitting in on my group for first time in a long time, one of the psychiatrists walked by, came to the door and was quietly trying to get my OT's attention. She left the room with him and my heart sank. She hasn't been around much on the unit in a long time so I was like uh-oh…what could he want from her.

It TURNS OUT…the psychiatrist had pulled her out to tell her what a great student I was and how I was one of the best students he has worked with! Maybe it just means he has had crappy students, ha ha.

But it meant a lot to me that he pulled out my instructor to praise me! Especially since in a lot of ways I'm not so great, lol.

Today I was trying to deal with getting a patient to come with me for an evaluation. The patient was confused and I was patiently trying to get them to come on their own accord. A tech nearby butted in and was like firmly “We're going so this lady can ask you questions” and wheeled them down the hall. That's just not my style – my way takes a little longer, but usually has the same answer, with the patient feeling more in control….you could argue that a confused patient won't know the difference, but *I* know the difference and I don't like to be a bully. I think I'm way too sensitive though.

The other day I helped quickly with a shower on a new patient. Things were chaotic and I hadn't been able to do the eval (you can't charge stuff for a patient until after the eval) so I ended up just assisting like a tech instead of it being a billable thing. I think the nurse was a little irritated with me because I was slow about helping the patient, but that's what OT is about – sitting on your hands and letting the patient do as much as possible. I typically tell the patient, I'm here, “do what you can and let me know if you need help”…or I'll step in if it's obvious the patient needs help. But if the patient can do it and is just slow, I don't hurry the process much since then I can't accurately gauge their ability. The nurses/techs on the other hand, even if the patient can do a lot of it themselves, are typically used to whisking patients in and out as quickly as possible by having the tech/nurse do everything without waiting. I realize that with their job descriptions, a quick bathing experience is important, so we have different perspectives in mind. Just means that I have learned the OT ability of NOT helping if not necessary….not to be mean, just a different philosophy.

I wish I could do more exercise with the patients. A lot of them sit in wheelchairs all day although they can walk with assistance, and so they enter the unit walking at least a little, and then leave a few weeks later entirely in a wheelchair because they've gotten weak. I asked my OT about it and since we are treating for cognitive reasons, we can't really charge for exercise. Boo.

Um….I guess that is it. I still have a lot of decisions and stuff to deal with in the next few weeks…and I need to work on my professional development evaluations…and my study review book for taking the boards, is coming soon.

I've been cleaning out my email box…blogging blizzard really coming soon I promise.

Tomorrow will hopefully be a somewhat early day…ie 330ish…though realistically 415-430. Planning to go to a dance party tomorrow night.

A chaotic day…

Today I did a 1:1 session on healthy expression of anger. We talked about (healthy) physical, spiritual, and/or mental ways of dealing with anger. I thought it evolved to be pretty cool!!

Also did groups – one on self-awareness, one on reading of non-verbal emotion.

Also did a 1:1 using safety cards….ie determining the safe situation versus dangerous situation. Most people with dementia, even mild, do pretty poorly at figuring out the more subtle stuff. Unless there is a big ol’ fire being shown, they tend to comment on little things, like “Look at those bangs!”

You know, even with a low census, it can get really chaotic on the ward. All you need is 1-2 people
making a fuss all day long to make it a REALLY HARD DAY.

It was very hard to get productivity/units today because there were so many disruptions from
some patients having an extra hard time for various reasons.

On one hand, I want to be like FOR THE LOVE OF GOD STOP IT, AUGH YOU SUCK! as I struggle to keep my train of thought with constant disruptions…and then on the other hand, compassion kicks in as I realize these people can’t help it – whatever they are confused about and feeling is 100% real to them. Just like pain, just like emotion – it doesn’t matter what anyone else thinks – it is about what that person perceives.

So even when I am frustrated, stressed, I try to remember that. It’s clearly not an enjoyable experience to the people acting out – they are in stress/anguish themselves. I also try and remember that when another patient gets irritated with the constant disruptions and wants to discuss the disruptive patient (in general terms, not HIPAA violations). I typically just stick to something like “Yeah, seems like that person must be having a rough day”…which I’m proud of because I can be a mean gossip in normal life!! LOL

I had to step between two patients today yet again. It’s instinctive…not a “hmm do I want to risk getting hurt by stepping in between two angry patients?” But rather a “Oh crap, better get in there quick before one of them gets hurt”. Let’s see if I can make it through this entire rotation without getting hit hard…so far I’ve only been slapped and fondled! ahahahaha

Tomorrow my supervisor has a really quiet day – quietest day she’s had in the last 9 weeks or however long it’s been with me there – so she will spend a lot of time observing me on my unit. I’m nervous!

The girl in the window

Really intriguing, haunting story about a neglected little girl, Dani, rescued at age 6, with “environmental autism”….now receiving speech and OT. Article is very in-depth, also a short video to go along with it

http://www.tampabay.com/features/humaninterest/article750838.ece

Bleh…..

Well, my personal space has been violated repeatedly the last few days…sexually inappropriate behavior is a relatively common issue among older patients with dementia – it's one reason someone might end up in a psychiatric ward. I got my butt fondled recently and I've had to stave off a lot of kisses.

I've discovered that one good/bad thing about coming off really “lax” and not demanding things get done (instead just suggesting…more flies with honey than vinegar or whatever….a luxury the techs don't always have), is that I can build up friendships with them and be more of a “good guy”…so that when that person gets angry, I am more likely to be able to calm them down by being the “friend” they recognize…that's good. The bad part is, when a patient is repeatedly upset, it makes it hard to get my productivity units because I'm helping re-direct.

I've realized that while I'm not brave per se, I do stand up for patient safety at risk to myself. Two patients got upset recently and even though it looked like a blow might be imminent, I stepped in between them. Remember this is a geriatric ward so it's not as dangerous as say, two healthy strapping men about to fight.

The chaplain came in after rec therapy today and was singing to them. She was about to leave when I came in (because she isn't supposed to interfere with my time slot although I always give her extra time in my slot since I think her presence is important), and I asked her to play a little piano music for us, because I've heard her practicing in the chapel before. I think it really meant a lot to her! She ended up asking if she could stay a few minutes for my session…I said of course. There were also two nursing students in the room and a tech, so I had more non-patients than patients in there. Plus most of the patients in there weren't mine – only two of them were mine so really it wasn't worth it, productivity wise, to hold group, but since it's been a while since I've done group, I went ahead. It was on discharge planning/leisure activities. Now that I think about it there was 9 people in the room and only 2 of them were mine. AHAHAHAHA. I always make staff members, nursing students, janitors, whatever, answer questions, same as everyone else, if they enter the day room during group. Not like the entire time, just will ask them the current question to answer quickly as they come in/out….ie “what's your favorite type of exercise?” Some of the aides are particularly good about giving nice thoughtful answers with a good explanation.

Today some patients were playing with a blown up glove as a balloon, and it popped. I tried to blow up a new glove and I failed miserably, it looked like some one's hand had swelled badly instead of being a big ball. My lungs couldn't handle it.  I asked the people in the small nursing station and the social worker saved the day, blowing up a beautiful glove ball for us, LOL. 

I feel like this is a really really stupid boring blog post today. I don't have anything too exciting to share. Giving showers, evaluations, cognitive assessments, re-directing aggressive or sexually inappropriate behavior, blah blah blah….same old stuff right now. The coolest or most interesting stuff I can't share because it's too specific, HIPAA wise.

Oh, and insurance is evil. I hate to see patients leave who are SO NOT READY just because of their crappy insurance 🙁

I had my ballroom dance yesterday….getting better at foxtrot, waltz, rumba, push-pull swing…I have my final private lesson tomorrow and then a “dance check” on Thursday

Wow my cat just flipped out.I think he had a nightmare. Poor Lester.

This afternoon I was writing a list of assessments I might try on the new patient and it was MMSE, ADM, LACLS, GDS, SLUMS, CPT, MADRS, etc….and I was like hmm no wonder my non-OT readers are recently always complaining that I use too many acronyms!! I'm trying to do better on the acronym front for my non OTers.

I'm re-reading this and I sound like a snobby do-gooder who thinks she is oh so perfect. I totally have a bazillion flaws and do lots of things poorly and at times cause more problems than solutions, as is a students perogative, haha. I just prefer to focus on the good stuff I guess, so I can get through the next – and final –  month with my sanity at least partially intact. 🙂 I guess I should start working on professional development evaluation due next month….