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.

Feb 20, 2009 | Category: Occupational Therapy | Comments: 1

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