Today started out with scrubbing (whats the right word?) the ice off my car, as the rain had frozen on it. Got a little help though. 🙂

Did a bathing ADL with a pt, my OT was there as well. This pt is high functioning and was standing up to remove clothing, the way most typical people do, I think. My OT kept telling her to sit down for safety and she wouldn't. But she was pretty steady and stubborn and just set in her ways. I tend to feel like they deserve some lee-way – like if I had some health issues and some aide was taking me to a special shower room with a shower chair, hand held attachment, nothing familar, etc, I'd probably do things a little differently than I do at home, that might seem unsafe or weird to someone watching.  I dunno.

Did a geriatric depression scale scale with a lady who scored in severe depression range, no surprise. She seemed to need to talk -I spent a lot of time with her discussing coping skills and strategies, but I thought she might benefit from a chaplain (I see the chaplains come in sometimes). I asked my OT and she said go through the social worker, but the social worker (who is young and rather new) was like yeah, I didn't even think about asking the chaplains to come in for individual patients, go ahead. I think people who have worked there a while – and were trained by others there – tend to follow the same routine – while someone new and without a lot of constant supervision, just has to come up with own ideas…to me it's obvious, but I guess I have to be careful about not stepping on toes.

Speaking of the social worker, I've let her know we can contribute to the discussions on nursing home/AL/IL placement appropriateness, and so today I did the Cognitive Performance Task on a high functioning lady…took her out of the ward, my first experience doing it with my own patient. Her logic was skewed when explaining answers, and I think she “confabulated” the answer on finding the cost of a gallon of white paint….I was surprised she did rather poorly. I think she was smart enough to realize her performance on the test
was important so she was a little nervous. 

It's AMAZING how much trouble people have with setting up new medications (part of that test)…..they end up doing bizarre things like putting a few pills in a few days, seemingly at random, if they don't grasp the instructions. It's like they gamble maybe they got it right.

I gave the social worker a mini-tour of our area and walked her quickly through the 7 sub-tasks of the CPT…and gave her some papers on the level the pt was at, to share with family. Basically the social worker now knows we can be of help – she called today to ask about doing the test on another pt, and my OT was like well, guess you explained to her, and I was like yeah, maybe I created a monster! LOL. A good one. It's important, if OT is going to stay in the mental health arena, that other disciplines utilize us and know what we do!! It's a little sobering/scary though to have input…you have to be careful, safety-wise, as to what you recommend.

I interact a lot with nurses, aides, the social worker, some rec therapists, and of course patients. No speech or physical therapists work in the mental health units…which kinda sucks, because one of our patients who was walking when he got here (but weak) is no longer walking. I think if he had gotten regular PT he would have had a better chance.

I did two “creative-y” groups today…on was rather crappy, one was kinda interesting….I still have a lot of learning to do in terms of  managing groups. When I took that group class, if some one had told me I'd end up running 2 groups a day for 3 months, I would have been like ha ha!! But here I am, sucking. lol

The first group was about ambiguous direction/problem-solving……the second group was called “Transformation” and it had to do with drawing past and present and future, and discussing things to do to help ensure the future as they depicted it.

One sharp lady drew an embryo for past, a stick lady for present, and a casket for future. She cackled about it, but when I asked her what she wanted to do before the casket, she got thoughtful and had several things she wanted to work on.

Another HILARIOUS old lady said she wanted to have “quar triplets” …lots of babies.

Another lady drew a smiley face for past, sad face for present, and smiley face for future.

Another lady didn't draw anything, but verbally stated she would get better by eating right, taking vitamins, and “coming to groups”…lol. I liked that answer.

I did the MMSE on a pretty sharp guy who doesn't like the groups..and frankly he is so high level compared to most of them, that I don't blame him. He doesn't like the rec therapist at all. That almost made me happy, but not in a petty way. Let me explain…I really admire this rec therapist. She is loud and tough and really tries to get people to participate by being assertive. She is fun and good and I am “jealous” of her in the sense that I wish I had more of her strong personalit. On the other hand, some of the patients are put off by that apparently, and my quieter more lenient personality means they are more willing to do things because they don't feel I'm bullying.I know maybe some people think I'm too lenient or “soft” but I like to subscribe to the whole “more bees with honey” or whatever that expression is….flies with vinegar, I dunno. Whatev.

Ummmmmmmmmmmmmm what else. The social worker told me she likes that I seem to go above and beyond for patients, that I really care. That meant a lot to me because I do. I really, really, really care. Whether or not I do a good job or make a difference, I'm not sure sometimes, I feel I'm not very good, but I do care and I do try hard, so I'm glad that's apparent. I guess I wish I could get groups down…feel like my groups actually leave them going “Wow, that was helpful” versus leaving and going home and being like “I had to participate in the stupidest groups”….

I got exactly 20 units today…I'm less scared these days…except group is still no fun, lol. Gotta figure out how to make them FUN……and to steal a catch phrase….how to put that FUN in FUNctional.

I've got to figure out groups for tomorrow…I may do repeats…safety awareness and importance of exercise (which involves some exercise)…I think I have a whole new turn-over so it wouldn't be a repeat for anyone…hmmm…..I dunno.

This ended up being longer than I thought…I felt like I didn't have much to say but apparently, lol, I did. Just a lot going through my head. I really want each patient to leave with skills they need to be successful and not come back as a frequent flier….I want each patient to feel they have some control and that people are listening to them…I want patients to feel like their therapy is helpful and promoting success….want want want.

Jan 28, 2009 | Category: Occupational Therapy | Comments: none