Week 7, Day 3…

Today was a catch-up day. A few people had been discharged, and no evals. So I made a list of all the assessments I needed to catch up on. Mostly a ton of ADM placemat tasks (a task where you have a patterned placemat and a blank placemat with felt shapes, and have them make their placemat match yours. Helps you gauge cognitive level up to a certain level…many of my patients are around a 4.4 level…don't have the form to remember what that corresponds to, but they definitely require quite a bit of cognitive assistance).

Also caught up on the geriatric depression scale and mini mental state.

My depression scale lady scored off the charts for depression 🙁 I gave her a Tangle to hold while she answered questions because she was restless. I think she liked it.

I don't tend to push patients who do poorly on placemat…like I give them a chance or two to see if they can make theirs like mine, but if it is clear they can't, I'll be like “That's a pretty pattern you're making, I like it”…no point in frustrating them in my opinion, if they are nursing home level anyway especially. One man today made a beautiful design that looked like a big flower made of hearts. Very artistic. It surprised me. I wish we had more supplies so the patients could keep what they make instead of it being taken back part – which I know isn't how it's supposed to happen, it's supposed to be used therapeutically and fully, but with this economy and understaffing, that's not possible. Let's say it's been 8 minutes and it's clear what their score is. Technically I could be like “Okay that's it and move on, since I've gotten the billable unit. But if they're enjoying the task, I'll give them the extra 5 minutes or so to play with it, before I stop them, so that it's at least SLIGHTLY therapeutic in the sense they are immersed in the activity.

I get frustrated with lack of supplies in unit – again, economy, short-staffed, and tendency of patients to destroy/lose things, makes it hard. But still – some magazines, a bunch of playing cards, a bunch of crayons and adult coloring book pages – not that hard. Anything. They have NOTHING besides TV and a few groups a day. Lucky ones get magazines or books brought to them. Some of them get restless and bored and cause nurses/techs issues because they have NOTHING TO DO.

I wonder if foam dominoes exist, so they can play without it being dangerous if someone gets angry.

Today I did one group on orientation in multiple planes – a little easy for most of them. Can I be embarassed to admit that one of the questions asked what century we are in, and none of them knew, and I was like…ummm….I THINK 21st? It's one of those things you hear but don't think about it until an embarassing moment like that where it's like I AM TOO IGNORANT TO LIVE! EGGPLANTS ARE SMARTER THAN ME! None of them were too perturbed though, lol. If they don't know the answer, they don't seem to think it shocking that I don't either…thank goodness, lol.

This one lady who wanders around really agitates some of the other patients – apparently she has smacked some of them. One patient in particular, who is my patient, gets really restless and slightly agitated when she is around him. She got really close to him several times and one time started to really get in his face. I had to PHYSICALLY maneuver my body in between hers and him, and with gentle pressure got her to move back. I didn't hurt her or be physically aggressive at all – just needed to get between them as I was worried either or both of them would hit each other.

Hmmm what else. I got my windshield replaced today – it had a massive crack – which is structurally dangerous, who knew. They came to my work, phew.

Oh…we have a patient who was very demanding and needy and needed a lot of physical assistance. I spent a long time helping her with various unrelated things before we finally got the ADM placemat task done. She got really mad at another pt in the room who was just sitting there quietly. She mentioned her higher degree and told the other pt accusingly “I bet you never even finished high school”. This was quite offensive to this other lady, who prides herself on learning, even though her learning opportunities have been limited by socioeconomic status and other issues. I told my lady that the pt was allowed to be in there and that that wasn't very nice, etc. I think she was mad about the other pt because she likes all the attention.

Some of our needier patients have left…I don't feel like I'm going to be ambushed every time I leave the nurse's station or enter the unit…although of course every time we loose a few needy patients, we quickly gain some new ones. I hope the census stays slightly lower for a while so I can catch up and breathe and do some ADLs and such. I'd love if it got REALLY low so I could do a lot more one-on-work, but the nurses/techs like it busy so they can make money, of course, lol.

I stopped and spoke to one of my patients who has been not feeling well lately. Sat with her about 5 minutes and held her hand and helped her rinse out her mouth and stuff. I try really hard to look them in the eyes, show them I'm paying attention, sit with them a few minutes, just show them I care. Sometimes I'm so busy I have to just flit around, but when I get a chance, I like to spend a minute here, a minute there, interacting with a patient, just for fun. I do like that pretty much ALL of our groups involve some laughter – no matter what it is about – I especially like it when patients make each other laugh (because of humor, not the mean kind).

Today in group a pt was describing a picture that involved a little child peering into a birds nest with eggs. The pt elaborated, saying “And then the momma bird pops up and says DONT EAT MY BABIES!” and another pt thought that was funny and went with it further. I love stuff like that. I'm trying to figure out how to do a group entirely on humor – jokes of varoius types – and relate it to life skills. Like, maybe focusing on laughter/humor as a coping skill for stress/depression. Hmm. Wonder if that would fly.

I am trying to come up with new groups and not just do old ones – most of them are too dry in my opinion. I end up feeling nervous because I know the topics are boring, and that never flies well because the patients can sense it.

Recently, a patient described a war memory. He has lost most of his words so he is rather Alice in Wonderland like when he describes things in vague terms, but it was clear in the line of duty he had seen some horrible things. He described a story and it was possible to get the gist of it. He wiped tears away. The poor man…some memories never go away.

Alright, this is way too long as normal…

Feb 19, 2009 | Category: Occupational Therapy | Comments: none

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