Week 7, Day 2…over

Today was a day of assessments.

Started with watching my OT do the KELS on a patient in adult acute who can't leave the unit (hence no CPT), I didn't much like the assessment. The pt decided to pull up her shirt/down her pants to show us fire burns.

I did two groups – very small groups today – one on “Noodle Boosters” and one on Healthy Lifestyle Habits.

Then I went to Dual Diagnosis and brought the patient to the rehab area, did the CPT on the patient.

After lunch I did an eval on a very confused lady who said her dad could hear the sound of a “pea dropping off a dog”….she later changed it to flea. LOL.

I have a HUGE list of patients to do ADMs on, I'm only a little behind on LACLS, and a tiny bit behind on MMSEs and GDS.

Gotta think about groups tomorrow, hmm. Hmmmmmmmmmmmm. Hmmmmmmmmmmmmmmmmmmmmmm.

Went to gym after work….took a “nap” which was mostly me lying there thinking about patients and who needs what in the unit.

I need to try and remember to stop at a Dollar General or something and get some cheap cards. I'm tired of patients asking for them and there not being any. I'm sure they've had cards on and off and they always get destroyed or something, but still. Costco, sell giant things of cheap playing cards, all with different color backs to keep decks separate, to stock up rehab units and stuff.

Wow, this was an almost short post, how is that possible.

Didn't get anything helpful done this afternoon, but tomorrow is a new day with new opportunities, right?

The Healthcare Cake

My recipe for “Best Patient Care”

1 cup enthusiasm
3/4th cup compassion
1/2 cup respect and dignity
1/4 cup sweetness
3 tablespoons creativity
2 tablespoons patience
4 tablespoons teamwork
2 teaspoons empathy
1 dash of passion
2 pinches of hope

Gather ingredients. Stir together in one large bowl until well-blended. Bake for 30 minutes at 350 degrees. Let cool. Share with others. Enjoy.

Week SEVEN

Did a group on stress (identification of symptoms, stress reduction) and one on relaxation. The tables in the day room – typically in one long arrangement like a feast – have been changed to more cafe style, so instead of sitting at head of table, I walked around the room. One of my patients asked if I used to be a schoolteacher and said I'd be good at it. That was really sweet I thought, since I definitely don't feel like I have any group skills.

One of my patients was in rare form today – bright and bushy tailed – one of her ideas for stress reduction was doing something fun – like catching a fish with your bare hands. And then she told us about how she did that once, lol.

I attempted two more times to do an evaluation on a man with serious aggression, but I didn't try too hard to rouse him because he gets aggressive quickly. I just needed to be able to document the attempt. I'm sure he won't get picked up, but have to keep documenting that I've tried.

I have two patients in another unit that need the KELS done – neither can or should be taken off the units for various reasons such as elopement risk so the CPT is out…so my OT suggested the KELS. She has a free spot in the morning so she'll do the first one and I can go off and do the second after…I'm sure I saw it done once in an OT school lab but it's been a long time, I've forgotten. I've now been in the Mood & Stress, Acute Adult, and Dual Diagnosis, beyond just the geriatric psych unit…so branching out, woot.

I have about 16 patients right now…not enough hours in the day to get all their short term goals met, let alone long term goals. I am hoping a few got discharged or will be discharged asap…about 5 of them apparently are all waiting placement but are otherwise stable.

Alright….tomorrow…two KELS…attempt eval again…hope there are no other evals lol…and then try to catch up on LACLS and MMSEs and ADMs….ADLs would be nice but take a lot of time so unlikely. And of course groups…..as a friend pointed out, only 58 to go….

Ummmmmmm………..maybe I'll do one on an AARP article about boosting “noodle” (brain) power…haven't done that one in a long time. And maybe a lifestyle habit one using bingo chips…asking wellness questions and if they answer yes they get a bingo chip…ie accumulation…….something along those lines. I don't hardly prepare for my groups anymore – most of them are repeats. I remember when I first started there I could not fathom just grabbing something in 2 seconds and then doing a group…but it's not that hard.

Rereading that paragraph it sounds like I don't try. I do spend a LOT of time looking up ideas/topics for groups…but in terms of sitting down and plotting it out, that hasn't been necessary…once I have the topic in mind – that is the hardest part – the rest is not hard. I've gotten books from the library on art therapy, spent hours searching the Internet, used some guided meditations, brought in my own relaxation CDs, etc. So I do try to think outside the box.

I saw the doctor today and changed medications. I'm weaning off one and starting two others…a little bit (okay a lot) more medication than I'd like. I think that when I swallowed my new pills this afternoon, I also swallowed some hope. This evening for the first time in a long time, I felt some mild energy/motivation. I got some paperwork done and cleaned out about 70+ emails…although of course have 220 to go. Not counting being about 100 Facebook msgs behind (many of which have to do with OT).  If this feeling of hope and motivation continues, I may actually get those Christmas thank you cards done this month…wow. lol.

Hey I had my midterm today. A lot of 2-s for need improvement, some 3s for good work, lol. I passed, that's all that matters. I don't think I've done any worse on this rotation than my others, this OT is just a tougher scorer!

Apparently there is an OT blogging carnival coming up…read about it today after seeing a comment about it. Will post on it later. And other stuff.

All y'all need to keep your fingers crossed that my hope, energy, and motivation, stay strong, so that I can get through this next 6 weeks with courage and grace, giving my best to my patients, my best to myself, my best to family and friends.

BLAH!!! BLAH!! BLAH!!!

Um….I've been hit by a little old lady, watched the smearing of feces, watched the spontaneous public disrobings of patients, dealt with auditory and visual hallucinations, and delusions, and aggression,
etc. I don't think I've written up my day for a while, I forget when I last did it. Seems the last few days haven't had massively big issues – just more typical stuff. Seems like there were a few things I wanted to share but my mind is blank right now. Just wanted to post so that people knew I didn't fall off the face of the earth.

Have a doc appt tomorrow afternoon – need a medication adjustment I think – feeling very zombie-ish. Makes work very very challenging as its very VERY busy – much higher census than normal – so there is VERY RARELY downtime. If you feel like a zombie, running around all day long is a very daunting task. I need to do my midterm questions by the end of this week. And start working on professional development evaluation stuff. And register for class on taking the boards/get review book. And deal with the over 300+ emails and such. And start planning trips/what happens after this final six weeks are up. I'm on month 8 of 9 months of fieldwork – my fieldwork baby is about to be born, ha ha ha. I crack me up. Anyway, it's pretty freaky to try and figure out what is next….ooooh.

Lester the Lion Kitty is soooo cute/sweet….

If anyone I see regularly has some extra decks of cards, please donate to me…..I'd like to take them to my geri unit.

Ok…hmm tomorrow's groups….maybe one on relaxation and one on boring nutrition. boo. lol. Hmm…

I guess I'm going to try and go to bed…if you've emailed me asking me to answer questions re OT school….I promise I ALWAYS answer….its just sometimes a very, very delayed answer. Like I'll probably send out my Christmas thank you cards in March….seriously. :X

Week Six.

Today was neutral. Not great, not bad. I admit every weekday morning I wake up feeling slightly nauseated and anxious as I realize I have a full workday ahead of me. I try and give myself pep thoughts, think positive, breathe deeply, try to relax, etc. But it's a yucky feeling. I know it's going to stick around probably the rest of this fieldwork as well as a while longer, as I figure out where I'm going to be settling down for work…I steel myself each time I enter the unit because I never know what to expect…

I heard my first Code 100 today….which means combative patient…..it was around 4pm and my supervisor had just left (early for the first time in like forever), so I couldn't go as a student without a supervisor around, but my heart still raced!! (Technically anyone with training who can go, should go…I've had the training…although I'm forgetting it!). It's probably my fault it happened, lol, because I saw the HELP training guy today and we chatted briefly and he mentioned there hadn't been a code in a few months. Tempted fate, oops.

Today the chaplain came in and over-ran my time….I couldn't exactly hover over her shoulder while she sang about Jesus but I did lose quite a bit of productivity. But I just hovered in another room and didn't disturb – I think the patients need that time for praise and reflection and relaxation and song and I wish she came every day. I was glad she was there, just wish her time didn't affect mine! I lost about 8-9 units because I could only run one group instead of two…I made an executive decision to run one longer group instead of two overly
short groups. Especially because the rec group had involved exercise and one of mine involved some exercise, so I crossed that one out…I did one on self-awareness…using advice…ie, what advice would you give someone younger/less experienced than you, regarding various themes like friendship, relationships, education…one person said “Don't get married at age 14 like I did”…yep, good advice. We discussed briefly at the start the importance of reflecting on the past, good and bad, and thinking about own experiences and satisfaction, and what you've learned from your experiences you'd want to share with others. There were 11 patients in the room + 1 who wandered in and out. 9/11 were my patients – two I had discharged due to lower levels and/or refusals, but they were there today. Two others slept the entire time and didn't participate so although they were at the table of my group, I didn't charge for them obviously.  I think some of the techs think of my group time as a “break” which frustrates me – if there are 16 people on the unit and 11-12 of them are in a single room with me doing a group, how about one of y'all techs stick around in the room in case a pt needs something, which is inevitable?

I guess I've come a long way that 12 people in a room with me the leader, wasn't too stressful.

One lady kept wandering around dropping her pants…not sexually, just randomly… I was in a room with a more or less bed-bound man, and this lady wandered by, and he hollered YOU KEEP YOUR CLOTHES ON! I DON'T WANT TO GO BLIND! And he explained to me she walked into his room the other day and got buck naked. AHAHAHAHAHAHA Yikes. I bet he was like noooooooooooooo!!!!!!! noooooooooooooooo!!!!! Poor lady….

Ummmmmm…….I'm way behind on lather lacing. I really don't like the LACLS….and I'm still not so hot at the single cordovan stitch. But it's a goal for pretty much all my patients so I better get crackalackin. I think my OT would have a heart attack if she realized that I have like eight more people to do it on…:X I'm pretty caught up on ADM/MMSEs….need to try and deal with some ADLs. Have two people on another unit to deal with. I'm just thinking out loud here, lol

I got a really nice e-mail from a guy from India who is also switching to OT from a computer-tech-ie oriented career. He was interested in thoughts on OT as a second career as well as cultural differences in OT…I'll have to think about what to write about it. My last supervisor was British and my current one is Australian….wow so cosmopolitan…lol. Gotta think about who else.

Ummmmmmmmmmmmmmmmm…………..ummmmmmmm……….gotta think about tomorrow's groups…..

Lester the Lion Kitty and Roger the Cowardly Kitty are messing with each other….Lester has Asperger's I'm pretty sure. No real social skills, but the desire to be social. He needs social skills training.

Ummmmmmm UMMMMMMMMMMMMMMMMMMMMM I feel like there is more to say……what what what……….oh…….an ethical thing………let's just say I'm doing an eval with a guy in his room..and then at 917 another patient comes in and tries to get into his bed and generally causes a mini ruckus that takes, oh, 5ish minutes to resolve…and then he and I finish up. And then when it's time to bill…do I count that time? Technically I was in the middle of an eval, didn't leave the room, was still with him, but was forced to deal with another patient. Do I try and glance at my watch and subtract the few minutes of chaos? If I can even remember to do so in the midst of chaos? Do I just bill for the time from start to finish and ignore a 3-5 minute interruption, even if it makes the difference between billing for one unit or two? What's most ethical/fair/feasible/realistic? These are the days of our OT lives.

Ok I'm going to stop my vegetable typing…I'm practically comatose. Hmmmmmmmmm, what does tomorrow's groups bring with probably 10ish patients and most of them with dementia? Hmmmmmmmmmmm

RIP Orange Kitty

]
Orange kitty/black kitty aka cat, my beloved La Jolla kitties….enjoying a rare inside visit while I’m home for Christmas. RIP Orange kitty!!

my poor orange kitty in california has passed away

I'm saaad

And now, a moment of modesty…and by modesty I mean "bragging"

My blog was created 4/19/2007…I'm at about 91,000 page views right now….my two-year blog anniversary is in a few months…I'll be (based on statistical trends) probably hovering at around 100,000 page views by then…and well over 1,000 blog posts.  Wow. Just sayin.

Midterm week coming up…and I survived last Thursday….

Friday was better than Thursday…the patient I was worried about was okay (ie the incident report thing). Plus, I felt better when the awesomely experienced beefy man tech admitted he practically cried too that Thursday afternoon, because things WERE so insane. He thought about quitting! So it validated my intense stress levels to know I wasn't the only one way overwhelmed. Poor guy.

Hmmmmmm, I'm trying to think of Friday, but honestly it's blurring up on me…I was kind of in a daze. I was really gun-shy about going back to that unit after Thursday's experience. Luckily we were more fully staffed and with good workers and so it wasn't so bad. Plus the hardest (for me) to handle patient, group-wise, had gone to a “real” hospital for medical reasons, so it was a little quieter. I did make a few documentation mistakes in the computer so I had to write the same note THREE TIMES – ugh, lol. My OT let me go a little early –
I left 45ish minutes early (I stayed an hour late Thursday). My OT warned me she grades low – she gives mostly a score of 2, Needs Improvement, at Mid-term, and usually a 3 at Final….yay. Low scores, just what I need to boost my confidence lol. No, I guess it's good. And I do need a lot of improvement. Although I think OVERALL – considering how crazy things are – so understaffed, her running the neuro day program and me running a currently high-census area – that I'm doing a pretty good job for the most part!!!!

My patient who scored sooo low – in way severe dementia range – scored almost three times higher – now in moderate dementia range – and was much more in it. I'm getting deja vu, I feel like I must have already written this all up? She is in a different unit…another patient came up to me and asked me something utterly outlandish…I was like….ummmmmm…..lol.

This is midterm week coming up…..week 6….six more weeks of rotation…wow. I need to start figuring out what next, SOON, huh….:x

Soon to come: My cat and the ACLS…a perfect match.

AUUUUUUUUUUUUUUUUUGHHHHHHHHHHHHHHHHHHHHHHHHHHHh

This afternoon SUCKED. SUCKED. SUCKED.

This morning I got to see the CAM done – did a group on discharge planning/leisure activities (9 in first group!!). Did a few ADM placemats. Tried to do an eval with a really nasty (ie mean) lady who refused…

Went back after lunch to do an eval etc.. AND IT WAS CHAOS AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH. AUGHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHh
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHH

The worst part of the day I can't share …let's just say an incident report was filed and it was partially my fault. My OT was really understanding though….and I learned an important lesson.

So….the census is almost double as high as normal….and this afternoon we were short a tech for whatever reason, and it was just overly busy…I coulda been like “No I can't help you…or you…or you…or you…” because none of it was billable, but it was a conscience thing. In good conscience I couldn't turn my back on these people….like the restless fall-prone guy who was getting out of bed by himself…but just needed his jacket off because he was hot…and then another lady was so restless and jumpy-out-of-her-skin because she was desperate for a sense of control and wanted her clothes…which were lost…blah blah blah…we finally found them in her OLD room…but I spent easily 30ish minutes with her…she was NOT doing well and I knew she really needed someone to give her some attention and at least a modicum of sense of control and that finding her clothes wasn't high priority, obviously, to busy nurses/techs. But I know her well enough as my patient to know she really needed this. This poor lady needs a lot more than meds to keep her from coming back – she needs a lot more coping skills/strategies. While I could have turned into a treatment, I was stressed and busy and trying to do a thousand things, so it wasn't a treatment, lol. Then I was helping a mean lady's diaper get changed, stuff like that. Then a wheelchair seat belt alarm went off and I went to the guy who had taken it off, he was cursing and tried to hit me when I went to try and re-do it so the alarm would go off. I turned it off a second to spare us all the high-pitched screech. I tried again slowly but he was still mean and angry and swiping/cursing. I had to get the insanely busy man-tech to help me. Then there is the lady spitting out her meds onto the floor next to me, the lady stopping me to ask this, the man wanting this, blah blah blah. It sounds like it wasn't a big deal, but it was REALLY stressful to see so many of my patients having issues…these people have so little control, so when the techs/nurses are too busy to listen to them or help them with low priority things (high priority being injuries, medicines, admissions, discharges, etc), that the people get upset…..and that incident I can't discuss in detail (just for self/hospital protection) REALLY stressed me out…I was sure I'd be in soooo much trouble…luckily I think it's all going to be okay…did I mention AUGH?

We have several max assist stroke patients in there now – which I'm not really able to handle by myself – I guess really they are mod/max assist x 2 – and they would ideally get some therapy for their affected extremity along with everything else – and many of them would benefit from physical therapy – but there just isn't any to offer….ugh. It's frustrating to know some of these patients aren't getting all their needs met….and time is taken up with stupid stuff like finding or ordering more gowns, finding a diaper, waiting for more towels to be brought up, trying to find a pillow (never did find an extra)… to prop against the back of a stroke patient, etc…

I finally left the area ….after having been there an extra hour+ after the final billable piece…basically doing tech duties……to me, a person with major depressive disorder and no coping skills, who is restless and getting agitated and feeling no control, needs some immediate soothing and help, even if its a low priority thing….even if its not billable or productive…but just because it is in the best interest of the patient. Oh and while trying to leave there is the cursing and gesturing man blocking the locked door, bleeding, other elopement-happy patients near the door, etc…even trying to leave was kind of an ordeal.

I went down and called a friend quickly and cried…from all the pent-up stress and from the incident….I'm still kinda shaken up but once I go in tomorrow and see everything's okay, I guess I'll be okay again….learned a sobering lesson. Sorry to be so dire and mysterious, it's not like I massacred fifty patients or anything, just safer not to go into detail.

Ummmmmmmm………..anyway……luckily the friends I am staying with are nice…my friend that I cried to went and got yummy food like guacamole and yummy ice cream, and a few other little gifts, to make me feel better!!!

Gotta steel myself and get through tomorrow…gotta figure out groups….next week is Week 6…midterm evaluation……ummmmm