Dancing down the hall

A social worker intern wanted to do a group today (WHAT? someone WANTING to lead a group? What is this?!).

I danced a patient down the entire long hallway today, to get that particular patient to the intern's group…a form of redirection…lol…it worked…we did a pseudo waltz/skipping kinda thing. It was fun 🙂  I wouldn't have thought of it if I hadn't just had a dance lesson, ahahahahaha

PS: I need to remember to buy peanut butter, I want it!!

A quiet day

Tommorow I have a nerve-wracking morning because I'm starting by doing the OPPM on one of my OT's patients, then I'm doing a driving screen (on paper) on her next patient. Being observed for several hours, augh!! lol Then gotta try and do a bunch with my normal patients.

I had to go to a unit today that I hear is scarier than the scariest unit (at times)…luckily it was calm at the moment…I guess I've gotten used to my relatively sedate and relatively slow-moving geriatric patients.

I hardly got any units today…I did two showers this morning, two evals in the afternoon. Oh and I watched  myofascial release today, my OT let me watch her session since I've been curious. I got to help and man, it's hard..I'm not strong!!

Tommorrow after work I have another dance lesson.

So….better pick out dance clothes, better look over the driving screen and OPPM stuff.

No group AGAIN…44 to go. Hope it works out tomorrow, I am not being productive with only 13 or so units a day (need 20)…but it just doesn't happen when census is this low…so many refusals. I think and hope tomorrow it will work.

by the way, sorry…lol

I just glanced through e-mail….I have a TON of comments and/or OT blog related e-mails to deal with….some with questions from prospective students, some from current OTs in mental health wanting to discuss some things, some from OT students with assessment questions/comments… I'm literally more than a month behind on dealing with a lot of those blog emails/comments…so please don't give up hope. I *ALWAYS* respond and it gives me hope and happiness to hear from people. 🙂

I think OTConnections is an AWESOME idea although I wish my blog would automatically show up over in my account instead of me having to copy paste! Boo! Because I'm lazy and hardly ever remember to do it!! But Penelope Moyers DID ask me to be her friend over there, so I feel special.  😉 I saw in a magazine today that singer Taylor Swift has like a million friends on MySpace. Maybe Penelope Moyers is going to be the Taylor Swift of OTConnections, befriending all! Smart move! Who doesn't love a message saying the president wants to be your friend! LOL

Hmmm…no good title springs to mind.

Did two evaluations today – one behind a mask so I'm glad the patient wasn't also hard of hearing (since my lips were covered/muffled).

Busted out the new cards/markers etc that were donated from a friend…the stuff was popular. My favorite part was when I gave this low-functioning patient two markers, a green one and pink one, she sat there and colored, and then the next time I glanced at her, she was using the pink marker as lipstick and had perfectly put it on. Good thing the markers were non-toxic and washable. My OT, upon hearing that story, told me of patients who would think the stain used in crafts was chocolate sauce and try to lick it up.

I also put some pretty pink rubber bangles on that same lady's wrist…I said Miss X, you want some pretty bracelets? She stuck out her hand in “put on bracelet” pose and I slipped them on. This particular lady isn't my patient, but she is “babied” by staff in a good way…

I did an informal family visit today….went well as we more or less agreed on proper placement for patient after discharge, and I gave the family some literature to read on her approximate cognitive level, for them to get a better feel. They were complimentary and it was a successful first family visit 🙂

I also found the MADRS (Montgomery Asberger Depression Rating Scale I think) and the Hamilton something. One of the psychiatrists had recommended them to me because he was curious as to what depression assessments we did besides the Geriatric Depression Scale. It turns out the psychiatrist didn't have copies (I printed them off the Internet) and he was happy to have them.

The MADRS is a scale that, in my understanding, is done by the health professional, but I looked at it and decided I'd rather do it in conjunction with the patient. We discussed each question together and I think it was much more helpful done as a joint process, at least from the OT perspective.

So I did the MADRS for the first time, albeit modified, and I also got to do the Rosenberg Self-Esteem Scale for the first time…

My schedule today was quiet again for most of the day…although always when it does get busy, it gets busy quickly. Sometimes I end up helping two different patients in two differently ludicrous situations, at the same time, because of their proximity to each other (ie roommates both in need)…obviously not billable time at that point, depending on what's going on, but hey, sometimes ya gotta do what you gotta do…if that involves ludicrous tasks x 2, then that's what you do, if at all possible.

I didn't get to do group yet AGAIN – only like one of my patients in the room – but I think probably tomorrow I should have 3+ finally. Gonna do discharge planning/leisure activity. Not that I miss group or anything, but my productivity is so low now that I need the units, yo! Only 46 groups to go, lol.

AFTER work, I went and had a dance lesson…basically a modern ballroom dance!! Yes, laugh all you want, I'm awkward as can be. It was actually really good – it works on poise and posture and positioning and all that good stuff. I signed up for a few more…it's a stretch for me, out of my comfort zone, but I believe it's a helpful thing…the instructor kinda got annoyed with me because I was all ADDish, my eyes darting everywhere to see the other dancers…he finally turned me around so I couldn't see anything but him. He also had to deal with my huge “trust” issues – I don't like being led backwards where I have to trust him as leader – I kept glancing back and at one point completely froze because I knew people were near, he was like TRUST ME! lol. I'm one of those people who could never just fall back trusting people to catch me, in those trust-building games you play. We worked on very basic components of foxtrot, waltz, and rumba (sp).

Okay, The END.

Census down…

Well the census dropped precipitously….all of a sudden we were down to 9, and only 5 of them are my patients…the rest are too low functioning for what our intervention is there. Because of multiple refusals and various reasons, I didn't get any productivity at all until 10am something! I ended up not having group because only two of my patients could come to group, at which point you might as well just do individual treatments…I did a lot of Mini Mental State Exams, a few leather lacing, a few ADM tile trivet tasks, and several ADLs.

I *REALLY* am starting to dislike the LACLS more and more…it frustrates almost all of my patients. And therefore frustrates me.

Tomorrow I have an informal meeting with the family of a patient that used to live alone pre-admission. My first! Let's hope it goes ok, they won't like what I have to say. 🙁

I got to spend some time – a lot of time – today – just hanging out in the ward, talking to techs, student nurses, patients, etc…there was literally nothing for me to do at times. Especially when rec therapy was going on. If rec therapy has just a small group and it's the only fun they get to have all day, I'm not taking them out of it.

But I felt guilty just sitting down. It was my first time in basically 7 weeks that I've just been able to SIT for a while. It was kinda nice although I'll try not to get used to it. 🙂 Actually, I ended up losing track of time, I was up in the unit until 3:45pm and then I was like OH MAN I forgot about notes. So I didn't get off work until 5pmish today. I guess 745 to 5pm is a normal day for a lot of people.

I only got EIGHT units today…I had several different sessions that were exactly 22 minutes…ie 1 minute short of two units…so I probably would have had at least 10 units if I had just one more minute on those units. I gotta say, ethically, IT IS SO HARD not to just rationalize the minute away and charge two units….like you're at 22 minutes and you think “I forgot to look at the watch until a few minutes into it, so I am sure it's okay…” but that's a slippery slope. Ugh. Luckily my OT had a very very busy day with 27 units, so she carried me through. There were days I had like 26 units and she had like 10, so I guess I don't feel too guilty just yet. I know I have at least one eval tomorrow, although several are being discharged…I may end up with like 3-4 patients only!! I'm gonna have to be creative to figure out what to do with them all.

You know what sucked today – is I had to clean up poo, multiple times, from the shower, and it wasn't even my patients or my issue. But two different times the techs left the shower with poop in it (a lot of low functioning patients poop in the shower, maybe because they are sat on a shower chair with a hole and it triggers toileting?), and I was like um….are y'all gonna clean it? They were like, housekeeping can do it. And I was like nuh huh. Housekeeping might not show up for hours and people need their showers…and I need to do them for ADLs/meeting goals. If it happens again I'll say something (it was a tech who isn't that familar with this unit which requires more um, dirty work than most)…but that's ridiculous…you take a patient in there and they make a mess, you clean it up. Don't make the next person do it. Not fair at all.

I am going to go look for some self-esteem/self-worth worksheets for a particular patient….and my groups tomorrow will be on discharge planning/leisure activities. Hmm, what else.

Oh…and cool thing…a friend sent me a box and I was like what is this…open it up and it was DECKS OF CARDS! CRAYONS! MARKERS! SQUISHY BALLS! Awesome stuff!! So I'm taking it in tomorrow as a donation…I am excited!

By the way, I forgot to share this awesome story from about a month ago, I had a black female pt who looked at the flimsy little comb the hospital provides, (no match for a black woman's hair) and said, “What am I supposed to use this for? To comb the hair on my tinklebox?” and then she burst out laughing and so did I.  It was pretty awesome.

Lester the Lion Kitty learns the LACLS

Lester the Lion Kitty: Prairie dog at heart

Centennial Vision Moment, Dum Dum Dum

Pt = patient, shorthand, in documentation. I keep forgetting to write out patient. Sorry.

Today was a relatively normal day, plus an extra special Centennial moment.

A friend jogged my memory about the COPM, which reminded me of the Occupational Performance Process Model (OPPM)…I remembered a case study in our book “Individuals in Context” that I really liked, as it detailed the steps of the OPPM used to help a lady with major depression after the birth of her second child, and ended up inpatient. I have a patient with severe depression so I decided to use that case study to help me use the steps. I had to do my own modified version because I have a much shorter timeline and limited resources, but it still was AWESOME, and I really felt like it was therapeutic and functional.

Today I wrote myself a skeleton of OPPM, then met with the pt. The pt and I came up with occupational performance issues (OPIs), based on me asking pointed questions about typical days, both before depression and during depression. (People with severe depression can have a hard time coming up with own ideas, concentrating, etc) We discussed importance, performance, satisfaction, of these performance issues, with some trouble, so I did not use that part, even though I know it's key if the OPPM is used properly. Since there isn't a way to follow up with pt after discharge,  I didn't worry.

We discussed patient's strengths, pt's resources, and came up with targeted outcomes and an action plan, with very simple, basic goals, that she agreed were reasonable…after lunch I put it all into the computer and typed the goals/all of it up, with extra spaces for pt to add more strengths/goals. I put one copy into the chart and gave the pt a copy. The psychiatrist showed up right as I was putting it in her chart and I showed it to him and he was like “This is GREAT! This is what OT is all about! Does OT work on the other units?” I said yes, if the doctor orders it….I forget his exact response, but it was along the lines of “You may regret telling me that”, ie he was going to start using us more often on other units.

It turns out this is a reimbursement problem for various reasons I don't fully understand, but if a doctor orders it, we do it regardless of reimbursement? I guess if we get this huge deluge of orders we'll have to narrow it down, but it was clear the psychiatrist was enthusiastic and pleased with the specific, detailed functional goals made to promote pt's success in participating in activities of daily life, after discharge.

I enjoyed the process – I spend most of my day doing things I don't find very therapeutic, as it is mostly cognitive assessments. This was one of the first times I felt like a real OT (student). I've said I don't particularly care for the rotation in general as I don't like the unpredictability…but working with people with depression/anxiety for mental health OT, is kinda cool. Too bad it's hard to find a job that lets you only work with that specific population.  ANYWAY….it was an awesome CentenniallyVisionish moment and I'm proud. Considering I didn't even use the model properly (mostly used its skeleton, missing a few ribs and a leg bone) and it was still powerful, I can only imagine its power when used right!!

Random “Stand out” moments of day:

1) Rescuing a lady in a wheelchair being pushed unwillingly by a pt wandering aimlessly. I've noticed patients with Alzheimers at the stage of wandering in the hall, will push wheelchairs, whether people are in them or not. Of course typically the pt in a wheelchair doesn't appreciate this, especially if the pt is pushing them into closed doors. Luckily typically the staff catch this early and stop it.

2) Patients being extra demanding/needy/restless/fidgety all at once – which started around my group time, lol. I didn't do anything special or different, but by 1035ish I had only 2 of my own patients left, so I stopped there at the end of the first group (on self-esteem), instead of doing another one. If this had happened earlier on in my rotation I might have felt like I did something wrong, but now I know that some days are better than others, and sometimes it seems like patients feed off each other and all end up wanting things at the same time…either they're all calm or all upset.

The rec therapy student had a flop group this afternoon too…she was frustrated and asked me advice…I told her not to feel bad because that's just the nature of it…some groups work, some don't…it might not work one day, but work a few days later…

3) A nurse and I did a rather complicated toileting ADL for a woman who requires a lot of assistance…I was proud because I did a good job with the transfer helping, yay…and also, that nurse afterward, who doesn't normally work the floor and doesn't know me, told me randomly, “You're sweet. You have a good heart, I can tell.” and then walked off.

4) Did an ADM placemat task (copying shapes/colors of a placemat, onto a blank one, using felt pieces) with a lady who did it slowly and steadily and perfectly – except for the upper right quadrant. Probably a visual impairment rather than a cognitive one.

One last thing…

an achievement…I saw on the nursing/social worker notes that often accompany a chart, that the social worker had mentioned to a particular patient's family that OT would be assessing patient for safety returning back to living alone.

Six weeks ago, the social worker didn't use OT at ALL for anything, and now she comes to me for any patient that may be making a change of living situation, asking me to do the Cognitive Performance test, etc. We talk almost daily for a few brief minutes about patient statuses…

I hadn't really thought about it because it's become a norm, but when talking to my friend tonight, I realized what a change that is from when I first started there, and I'm proud to say it's 100% because of me going to her and letting her know we can assist her. She hadn't realized. It helps her a lot to not have to make the decisions quite as blindly so she is happy to utilize OT now, and it's just become commonplace.

Talk about Centennial Vision! Woot! Alright, no more bragging…just realized how things have changed.

Week 7, Day 3…

Today was a catch-up day. A few people had been discharged, and no evals. So I made a list of all the assessments I needed to catch up on. Mostly a ton of ADM placemat tasks (a task where you have a patterned placemat and a blank placemat with felt shapes, and have them make their placemat match yours. Helps you gauge cognitive level up to a certain level…many of my patients are around a 4.4 level…don't have the form to remember what that corresponds to, but they definitely require quite a bit of cognitive assistance).

Also caught up on the geriatric depression scale and mini mental state.

My depression scale lady scored off the charts for depression 🙁 I gave her a Tangle to hold while she answered questions because she was restless. I think she liked it.

I don't tend to push patients who do poorly on placemat…like I give them a chance or two to see if they can make theirs like mine, but if it is clear they can't, I'll be like “That's a pretty pattern you're making, I like it”…no point in frustrating them in my opinion, if they are nursing home level anyway especially. One man today made a beautiful design that looked like a big flower made of hearts. Very artistic. It surprised me. I wish we had more supplies so the patients could keep what they make instead of it being taken back part – which I know isn't how it's supposed to happen, it's supposed to be used therapeutically and fully, but with this economy and understaffing, that's not possible. Let's say it's been 8 minutes and it's clear what their score is. Technically I could be like “Okay that's it and move on, since I've gotten the billable unit. But if they're enjoying the task, I'll give them the extra 5 minutes or so to play with it, before I stop them, so that it's at least SLIGHTLY therapeutic in the sense they are immersed in the activity.

I get frustrated with lack of supplies in unit – again, economy, short-staffed, and tendency of patients to destroy/lose things, makes it hard. But still – some magazines, a bunch of playing cards, a bunch of crayons and adult coloring book pages – not that hard. Anything. They have NOTHING besides TV and a few groups a day. Lucky ones get magazines or books brought to them. Some of them get restless and bored and cause nurses/techs issues because they have NOTHING TO DO.

I wonder if foam dominoes exist, so they can play without it being dangerous if someone gets angry.

Today I did one group on orientation in multiple planes – a little easy for most of them. Can I be embarassed to admit that one of the questions asked what century we are in, and none of them knew, and I was like…ummm….I THINK 21st? It's one of those things you hear but don't think about it until an embarassing moment like that where it's like I AM TOO IGNORANT TO LIVE! EGGPLANTS ARE SMARTER THAN ME! None of them were too perturbed though, lol. If they don't know the answer, they don't seem to think it shocking that I don't either…thank goodness, lol.

This one lady who wanders around really agitates some of the other patients – apparently she has smacked some of them. One patient in particular, who is my patient, gets really restless and slightly agitated when she is around him. She got really close to him several times and one time started to really get in his face. I had to PHYSICALLY maneuver my body in between hers and him, and with gentle pressure got her to move back. I didn't hurt her or be physically aggressive at all – just needed to get between them as I was worried either or both of them would hit each other.

Hmmm what else. I got my windshield replaced today – it had a massive crack – which is structurally dangerous, who knew. They came to my work, phew.

Oh…we have a patient who was very demanding and needy and needed a lot of physical assistance. I spent a long time helping her with various unrelated things before we finally got the ADM placemat task done. She got really mad at another pt in the room who was just sitting there quietly. She mentioned her higher degree and told the other pt accusingly “I bet you never even finished high school”. This was quite offensive to this other lady, who prides herself on learning, even though her learning opportunities have been limited by socioeconomic status and other issues. I told my lady that the pt was allowed to be in there and that that wasn't very nice, etc. I think she was mad about the other pt because she likes all the attention.

Some of our needier patients have left…I don't feel like I'm going to be ambushed every time I leave the nurse's station or enter the unit…although of course every time we loose a few needy patients, we quickly gain some new ones. I hope the census stays slightly lower for a while so I can catch up and breathe and do some ADLs and such. I'd love if it got REALLY low so I could do a lot more one-on-work, but the nurses/techs like it busy so they can make money, of course, lol.

I stopped and spoke to one of my patients who has been not feeling well lately. Sat with her about 5 minutes and held her hand and helped her rinse out her mouth and stuff. I try really hard to look them in the eyes, show them I'm paying attention, sit with them a few minutes, just show them I care. Sometimes I'm so busy I have to just flit around, but when I get a chance, I like to spend a minute here, a minute there, interacting with a patient, just for fun. I do like that pretty much ALL of our groups involve some laughter – no matter what it is about – I especially like it when patients make each other laugh (because of humor, not the mean kind).

Today in group a pt was describing a picture that involved a little child peering into a birds nest with eggs. The pt elaborated, saying “And then the momma bird pops up and says DONT EAT MY BABIES!” and another pt thought that was funny and went with it further. I love stuff like that. I'm trying to figure out how to do a group entirely on humor – jokes of varoius types – and relate it to life skills. Like, maybe focusing on laughter/humor as a coping skill for stress/depression. Hmm. Wonder if that would fly.

I am trying to come up with new groups and not just do old ones – most of them are too dry in my opinion. I end up feeling nervous because I know the topics are boring, and that never flies well because the patients can sense it.

Recently, a patient described a war memory. He has lost most of his words so he is rather Alice in Wonderland like when he describes things in vague terms, but it was clear in the line of duty he had seen some horrible things. He described a story and it was possible to get the gist of it. He wiped tears away. The poor man…some memories never go away.

Alright, this is way too long as normal…