:O

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

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

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

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

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

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

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

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

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

"Sometimes I think I'm the Lord himself"

One last little story from Friday.

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

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

About to start Week 3

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

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

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

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

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

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

AHAHAHAHAHA

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

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

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

ANYWAY…those were the highlights of Friday.

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

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

physical holds – HELP training

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

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

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

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

Umm

yo!! yay!!!!!!!

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

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

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…