First day of final fieldwork, overrrrrrrrr

Today was my first day of my geriatric mental health fieldwork.

I met up with my supervisor around 8amish, read student manual binders for about an hour and a half until I was utterly overwhelmed, then joined a psychologist while he went and did a group in the inpatient ward that deals with stress disorders. It was an initial group and it was interesting. One lady there was complaining about how she couldn't have her makeup – she had the good point that they kept saying you should do things to make yourself feel better, but makeup would make her feel better! LOL! You aren't even allowed conditioner or face soap or anything. You get a baby Johnson's shampoo and Dial soup. Wow. Anyways, all these people were pretty high-functioning overall…able to interact, crack jokes, use words like “acrimonious”,…lol.

Even though this group was basically an initial hi, don't stop making your meds after you leave, kinda group, they all clamored to tell their stories, although sometimes indirectly, like…”What do you think it does when your mother tells you, when you're still a child, that she was molested?” Etc. They all mostly had problems with depression, anxiety, a few bipolars, a few DID (dissociative identity disorder)…honestly, considering my own background with depression/anxiety/panic attacks, and their high levels of function overall, it was a little hard for me to be present. I could see how precarious the slope is, to ending up inpatient. The psychologist kept discussing serotonin, which I wear around my neck (www.madewithmolecules.com), and I could feel it practically burning into my skin!

My OT supervisor also showed me the gero inpatient ward I'd be in – although sometimes if another ward has a low census, they temporarily combine them or something, so there were lots of young people there…including one lady who looked like an Amy Winehouse, screaming and cursing and trying to get out…my OT was just showing me around cool as a cucumber as this lady ranted and raved in the halls, not more than a few feet from us. She oddly seemed to ignore us. When it was time to leave the locked ward, the supervisor had me slip through quickly, since this lady was trying to leave. “I need to leave. I need to go to a hospital that will actually help me.”

Those were my two forays into the inpatient psych areas…the rest of the day was a combination of reading through mind-numbing huge manuals, and getting to see a few outpatient treatments with my OT, specifically a few that used assessments I'd be using – I got to see the Cognitive Performance Task – CPT – done, as well as the MMSE. The man on the MMSE scored in the moderate dementia range, answering with confidence that it was 2008, that it was Fall, etc (while also knowing it was January 5th).

For the lady who she did the CPT on – she did quite well. She scored slightly lower on the “shop” task because she “bought” a belt before checking the wallet to see how much money she had. The “phone” task was interesting as she really had to call a store and ask about a gallon of paint, which is a little flustering. I was thinking they'd have to be careful on this one not to let the patient call a big hardware chain that would make you navigate a menu to get to a person. They do account for that in the test though. Pretty interesting. The lady would think out loud, and for example on the medication task, she'd be like “Hmm…this says take as needed…normally at home I don't put those in the boxes if it says that, but I guess I could put one in a day…what do you think?” Therapist, noncomitally: “Whatever you think is best.”. Luckily she always self-corrected her mistakes, but it was a little slow-going. The only sub-task she really did poorly on was the “travel” one, following a very basic map.

There was/is a little confusion over orientation – I did get my ID badge today at least. And I was shown around some. My OT seems interesting and nice and so do her PT/ST colleagues. Here's the big scary issue. THE HOSPITAL IS A GHOST TOWN!  They're closing down wings, laying off therapists and support staff, left and right. Maybe I misunderstood, but my OT was saying they had like THIRTY OTs a few years ago, and now it's down to four OTs. Today I saw one PT, one PTA, and one ST, and then just my OT. Maybe she meant, actually, that there were like 30 therapists total, and only 4 now…hence the four therapists I met today. I'll ask for clarification. Regardless, there is no receptionist, and there are all these massive rooms/wings that are filled with AWESOME rehab equpiment, that are just dead/quiet. We stopped through the Independent Village that they boast about on their website, that has like a fake little grocery store, gas station, fake ATM, etc…it is SO COOL, it is like every OT's DREAM for functional, occupation-based treatment…and it's DEAD. Dead because it's isolated now (it was attached to the rehab area which is defunct), and it would be unsafe for a single therapist to take a patient to an isolated area, far away from any help. Seriously, a little chilling, to walk into these rooms strewn with rehab equipment. And this little village BROKE MY HEART. Such a beautiful, perfect, stunning, amazing, coolest thing I've ever seen. And yet empty. What this also means is that my OT has a lot on her plate – she runs the neuro day patient program, AND she has to do support staff functions that normally a receptionist/admin person would handle, and she is the only therapist I know of so far….today I ate lunch alone because they had a meeting through lunchtime. Not a big deal, just very different from my last two rotations. I think I'm going to have to be creative about my learning since it looks like basically I'll get to watch my OT do things a few times, then I'll be on my own from then on out…of course getting in my necessary supervisory hours, etc, but I won't be working side-by-side with any therapists.

They use the Allen's Level stuff a LOT – some of the RTI, ADM crafts, and then the CPT. Also the MMSE and ACLS. So this will be a great learning experience! I feel confident I can administer the MMSE, and the CPT is relatively straight forward once you learn some of the nuances with lower functioning patients. The ADM crafts and ACLS (leather lacing) are going to be hard for me because I have such major issues with visual perception and therefore struggle mightily to do these types of tasks.

Okay…this is my longest post in a long time. Basically, I'm feeling somewhat scared and overwhelmed, but I think that's normal for the first day/week of a fieldwork, and I think I can handle it, I just need to keep a lid on my panic!! Hey, if I do go postal, I'll be in the right place, lol.

I've gotten some sweet blog comments lately – thank you.

Jan 06, 2009 | Category: Occupational Therapy | Comments: none

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