Growth as a OTAS

In regards to my pediatrics experience this semester, my confidence in this area of practice has really grown. Prior to this semester, I was certain that I would work with the adult population and felt it somewhat a waste of time to spend a semester learning about pediatric OT. I still feel that I will likely work with adults but this semester has provided me with the knowledge about myself that if I so desire to apply for a pediatric OT position, I could absolutely do it. When working with children on FW, I learned that I am a more dynamic person than I originally thought. I realized that my "therapist/nurturing" instincts kick in as a result of seeing vulnerability in others and has nothing to do with their age, gender, etc. I am excited to be starting FW II soon and having the opportunity to work with patients on a daily basis. I look forward to affecting people's lives in a positive way - hopefully this will be part of my legacy in this lifetime.

Ready to Dive In

Looking back to the beginning of the semester I felt comfortable going to work with children knowing I would be working with 5 & 6 year olds that were not officially referred to OT. I was a bit more nervous working with children with autism. It was uncomfortable not making that eye contact and not getting that interaction when playing with them. What I came to understand was that my reaction was just inexperience and I as realized their response to me wasn't personal, I could interact more naturally with them and treat them like other children despite not getting the usual response. I know I have the knowledge to come up with good treatment sessions but what I lack is the experience to feel confident and fluent with my skills. Each FW experience has sharpened my abilities to analyze activities and see the foundational skills required and it's not so hard anymore to come up with treatment ideas and go with the flow and change direction in the middle of a session when things don't go as planned. I'm glad we ended with kids since they are the most fickle and need the most flexibility when working with them. I don't think I could have thought on my feet if this had been my first FW experience. I still don't feel ready for FW2 but I know that it's time to get in there and do it. It's my inexperience that makes me feel unconfident and the only way to remedy that is to hold my breath and just dive in. I expect that when I come up for air I'll be swimming along nicely....for the most part.

Turning the Corner to Your Future.

Upon looking back at my 1st blog, I realized how much I have changed my thinking over the past 2 years. The language I use, the way I look & delve into the unknown is completely different. I have so much more knowledge & experience that I can pull from in every situation, whether it is at work or in my personal life. I admit, back then I did not realize how my facial reactions would affect someone else. Which, with time, I realized how I reacted to so many individuals with disabilities, not knowing the why or how they complete tasks. Now, I have so much more respect and am able to look at everyone with the same eyes. We all have tough times to get through, some have even more barriers than most. And there is no such thing as"normal"!!!!!!

I think the most interesting thing that I learned this semester is how much "stuff" a pediatric OT needs. When I first saw my supervisors trunk I was in awe. But, she needed every single item in that trunk. I really had not thought about how boring it would be, and difficult to keep a child’s attention from week to week.

After learning all of this, I will definitely be able to make sure I have different treatment plans and vary them every day to keep it more interesting for all of my patients.

At the beginning of the semester I felt like I would be kind of okay at fieldwork, but was all full of the “what if” questions. But, now I know what I can do to make every opportunity work. I have the opportunity to change people’s lives & I can make a difference with every single session. I am so much more prepared now than I was at the beginning of the semester. As my teachers and classmates are getting ready to leave each others sides, I still have butterflies, but so does anyone that is starting a new job. Suspense will keep me on my toes & I am just waiting with anticipation of starting this new aspect of my education.

While working with my pediatric supervisor this semester I got to work with a young boy with the most severe case of ADHD that I have seen personally. While I know there are kids/adults with more severe cases, this little guy showed me how my demeanor can really change a session. I had to stay calm as he was holding scissors up to my eye and his eye. But, I kept calm and with my explanation of the dangers of scissors he slowly lowered the scissors and put them down. I have not always been calm in all circumstances, but over the past 2 years I guess I have really changed how much I can control my face & demeanor. This event showed me that yes, all the work has been worth it, as well as the criticism from my classmates and teachers to get my facial expressions (acting surprised, frowning, or disgusted look) under wraps.

As I was walking down the hall today I turned the corner and found myself reminiscing about our first semester & how unsure of everything each one of us was. Will the person I am teamed up with in this class actually make it to the end of the program, or even the next class. There have been so many ups and downs while in the program & I have had so many life changing experiences occur while in this program. I feel as if had I not made it into the program when I did my life would be completely different. I have grown up so much while completing my education. I know I have always been considered more grown up for my age, but the experiences I have had in the past 2 years have given me the awakening to how I can still be “adult” while acting silly with patients to help them through their difficult times.

Life is ever changing. You never know when the next corner will change your life forever. It may lead to something that seems difficult, but just remember...the next corner could hold that glimpse of hope for change.

OTA role in assessments

Should OTA's be allowed to perform an assessment? As a professional, both OTs and OTAs are ALWAYS "assessing" their clients. We will be assessing our clients each and every session, for progress, decline and all factors influencing their performance.

In terms of a formal assessment, I think that OTAs are and should be allowed to do them, only after establishing competency in that area. As a student, I feel confident in the assessments I have learned, and feel that I should be allowed to use my knowledge in these areas just as an OT would. As an OTA, we are still under the "legal" responsibility of our supervising OT, so it is both the OT and OTAs responsibility to make sure competency is established. It is important to remember that there is a huge difference between assessing someone, and doing an evaluation.

OTA's Role in Pediatric Assessments

According to AOTA.org, "An OT initiates and directs the screening, evaluation, and re-evaluation process and analyzes and interprets the data . . . An OTA contributes to the screening, evaluation, and re-evaluation process by implementing delegated assessments and by providing verbal and written reports of observations and client capacities to the OT . . . "

My interpretation of these guidelines is that the assessment process is intended to be highly collaborative between the OT and OTA. I would imagine that if there is good rapport between these 2 clinicians, this is a mutually beneficial relationship because the workload is dispersed. However, if there is some level of dysfunction in the OT/OTA relationship, the OT may not delegate as much as much of the assessment process to the OTA. This lack of delegation could stem from the OT's lack of confidence in the OTA's abilities and dependability. If the OT feels this way, other action should be taken in order to bring the OTA up to the level at which they need to be in order to contribute. If the OTA has proven themselves to be competent and dependable, the OT would not be performing at the most efficient level possible in not delegating assessment tasks. At that point, the OTA should respectfully and constructively convey to their OT how much of an asset they would be to the assessment process.

According to ncbot.org, "The OT must initiate the evaluation. In OT practice, the term initiate is understood to mean making the first, in person, face-to-face contact with the client. After the initial contact with the client by the OT, the OTA may implement specifically delegated assessments for which service competency has been established, demonstrated, and documented. The OT is then responsible for completing the evaluation, interpreting the information provided by the OTA who completed the assessments, establishing intervention priorities, and developing the intervention plan."

It is clearly in the best interest of students in the school systems to have OT's/OTA's take full advantage of the collaborative approach to assessments afforded them by their professional guidelines. The more clinicians working together, the greater number of children will be helped in a shorter amount of time. Clinicians need to work through whatever issues may be interfering with providing the most efficient services to these children.

Getting Your Competency Up to Par!!

Everyday when a COTA is working they make decisions about how to adjust their patients care. Whether they are being challenged enough, or if the activities presented are too difficult for their current level. So, if as a COTA we are allowed to make adjustments during the treatment session why would we not be allowed to be involved in the assessment process?

Some OTs believe that COTAs should not be able to do assessments. Some think that it would take away from their jobs, while others think that COTAs don't have enough training, or the clinical reasoning skills adequate to give tests of this nature. Yes, the treatment program is put into motion considering all of the testing. Which raises another question. Would it not be better if the person implementing therapy be the one to give the assessments they are based from. Therapy would be more focused, and less time spent in communication & debate over the results of the test between the OT and OTAS. I am not saying that OTs don't need to check in and make sure everything is accurately working for the patient & COTA, but rather more people would have more client focused therapy, which could only be more beneficial.

Now, you also have to consider the experience and competence of the COTA giving the tests. All employees at a facility should be checking in with each other regularly to make sure their tests & results are proving accurate and equal to one another. If there is a problem with a COTA's skills not being up to par enough to give assessments, then perhaps that individual should take some continuing education classes to improve their knowledge and skills before assessing clients. But, if like the school I attended COTAs are being trained well enough, and have the knowledge and skill base, they should not be held back from helping to perform assessments for patients after service competency has been proven. After all, this will only give OTs more time to treat more people, and allow for more therapy planning so every patient's therapy is more client centered.

If, as a COTA you are wondering if your skills are up to par, check out this self assessment tool manual put out by the NBCOT, and the different specialty practice area resources.

Assessments: Should COTAs do them?

The question this week is "Should COTAs be allowed to do assessments especially in the pediatric setting?" According to the NCBOT Practice Act & Rules (Section .0905 Delineation of Clinical Responsibilities) and the AOTA's Standards of Practice (Standard II: Screening, Evaluation and Re-Evaluation), both documents state that OTAs contribute to the evaluation process by performing delegated assessments in which service competency has been established. So legally we CAN perform assessments but SHOULD we? If we are talking about standardized assessments, there is no reason we should not be allowed to perform them in any setting, including pediatrics. The whole design of a standardized test is to have specific protocols of administration and scoring to gather the most objective data possible. As such, it is training and experience that produces expertise in administrating a standardized assessment and not the level of education of the administrator. Pros and Cons of Tools for Doing Assessments lists various methods of assessments in the school setting, standardized assessments are one way OTAs can help gather information on a child. The direct observation in the classroom is another method that needs more skill and interpretation but that is not to say that OTAs cannot contribute in this area also, given experience and a sound collaborative relationship with the supervising OT. As with any area of practice, it is not so much whether or not an OTA SHOULD do something or not in all instances but rather in any practice setting, has service competency been established and is there proper supervision.

OTA and Assessments?

The question posed to us this week was...Should OTA's be able to give assessments? As an OTAS, I would have to agree that COTA's should be able to administer assessments. I believe our teachers have strived to teach us an array of assessments that we may use in our professional field of choice As students, we have practiced and passed competencies on several of assessments,such as ROM,MMT and The FIM.
As we go from students to professionals, we will need to successfully complete competencies from our supervisors before being allowed to run assessments. Only having OT's to administer assesssments would have far reaching consequences.SNF's and school budgets would be over loaded from hiring OT's, whose salaries are much higher then a OTA and the clients would have a much longer wait to be evaluated.

1st Pediatric FW Experience

I definitely see myself working with adults once I graduate but I was excited to explore another facet of OT. Working with seniors is something that I just naturally have a knack for and enjoy. Kids intimidate me a bit more because I don't have kids of my own and am not around them on a regular basis. I really enjoyed this first day of fieldwork. It's nice to get out of my comfort zone and realize I am able to switch gears when I need to do so. The children are so precious and it is exciting to realize that I can help sculpt their lives. When planning therapeutic interventions for older adults, you have to choose between games, crafts, exercise, function-based activity, etc. and it's always a concern whether or not they will find your choice meaningful. It is a bit easier planning activities for children because you pretty much know you're safe choosing play/fun activities. Not to say they don't need to be age-appropriate, graded properly, etc. but you know the basic direction in which to go from the beginning.
In regards to applying material learned in previous semesters, I studied ADHD a few semesters ago and I had a child on FW today that was pretty much textbook. A year ago, I would have just seen him as unruly but now I am able to understand the behavior and see the potential that lies beneath it. It is pretty cool to know that I could possibly be one of the keys to unlocking that potential.

Ped's

We did our first FW in ped’s this week. I have always worked with the geriatric population and I have thought maybe I would like to work in the pediatric field when I graduate. I’m so glad I have this opportunity to determine how I feel about this field. Our teachers have drummed into our heads Tx sessions should be fun and to have several activities planned for 1 Tx session. Oh, how right they were!! Both of my children, who are in Kindergarten and 1st grade, we did a fun assessment activity, and 3 one on one activity in a 45 minute session. Now I see how significant craft activities are going to be in this particular field. Play is children’s occupation!! Boy, will I be researching all sorts of craft ideas to keep my Tx sessions fun!! And I have to admit I enjoy planning something fun and occupational based.
I think the next couple of sessions will be difficult for me because one of my children speaks no English. I think I worry unnecessarily about the future sessions with her because it is a new situation. I get anxious when I have to go into a situation and have no experience. But I am looking forward to this challenge knowing that I will develop news skills that I will use in the future.

First Day in the School

I have to say that going into the school setting for FW this semester was the most comfortable for me. It's probably because I have so much more experience now, and the fact that I have children and I volunteered so much when they were in elementary school and know what it's like. I think it's also that children are usually so much more eager and open. My main concern was that I would have a really unruly child that I'd have to really firm with or there would be a language barrier which, thankfully I did not encounter.

Seeing the difference of writing abilities between K and 1st grades was interesting. It was surprising to me how many of the 1st graders used the quadropod grip until I read the chapter in the book that described the developmental sequence of writing grasps. The kindergarteners were mostly still in the static tripod grasp phase mostly used the "correct" grasp. The 1st graders were in the predynamic tripod phase which includes the quadropod grasp which gives them more control. They may not ever change this grasp which is still efficient but it is a stepping stone to the preferred dynamic tripod.

From experience I knew that in general, kindergarteners and 1st graders are eager to please and will find the fun in almost anything you bring them to play with. It was evident in the way all the children, even the more active ones, followed directions for the most part during the writing screen and though they got a bit rowdy during the free activities, they quickly came around when it was time to clean up. Also, you need to be very clear about how you expect them to behave when you need a certain behavior as in how to walk back to class after a session.

Over the next 2 sessions, I look forward to doing the MFun assessment and seeing where my kid falls in relation to where I think he is developmentally with his writing skills. I also look forward to seeing what ideas my classmates come up with to work on specific prewriting/writing skills.

What I found during this first session was how easy it was to go with the flow of what my kids were doing when they didn't want to do what I suggested and still get them to work on stuff I wanted to see them do. Just asking "can you make small balls out of the clay" didn't work but when he was making a spider, "make some eyes" worked.

Pediatrics

I have looked forward to pediatric FW since day 1 of this program, and we finally made it! I can't say I disliked geriatrics as much as I thought I would, but I am def. more excited for peds. I have to say that I was a little concerned in working with kids because they can be much more honest and head strong.. you never know what to expect; but these kids opened us with welcome arms, possibly because we were getting them out of classwork :)

I learned in class that when working with kids the most important thing is to make whatever you are doing FUN! Afterall, play is the primary occupation for kids. How true that is.

Since the start of the program we have been taught the importance of tailoring any activity/tx to each individual. Working with kids is no different. Each child in our group had their own unique personality. It is important to make sure you are prepared with alternatives to keep them engaged and interested.

I am looking forward to getting to know my children more, and just becoming comfortable working with kids that I do not know. I am looking forward to completing an actual assessment, and getting to put actual data with my observations.

I also learned that kids feed off of our energy, and will be the first to pick up when something is wrong. I was sick on my first day, and my energy level was running on 0. I am sure that my kids could tell, and I am ready to start again tomorrow more energized!

2 sides of the spectrum!!

As I was getting ready for fieldwork this morning I was very realistic. Since we are in the school systems, doing some writing assessments and such, I wondered if the child I would be paired with could even write yet. Are they going to be off the walls with ADHD, be scared of new people, or be very content and listen to every word I said. Well, I got a mixture of the two.

The first child I saw was in kindergarden and was very mild tempered. But, she loved to make up what she was doing. Very imaginative play. We played with play dough, and a few other things, but it struck me that she was using both hands to create everything she made. She wouldn't or couldn't manipulate the materials in one hand. I will see how this affects her as we work together. I am also very interested in her gait pattern. I noticed that when she walked down the steps she would plant both feet on one step before proceeding to the next step. However, on the way back up she took the steps one by one, as most individuals do. I would like to know more as to why she had the difference in step patterns, or if she was just playing around.

My second child I worked with today, I don't think I was as prepared for. It has been a while since I have worked with a hyperactive child with a wild imagination. No, I do not have a diagnosis on any of these children, but I believe he will be a handful either way. It was very hard to get his attention, or keep it for very long. He wanted to make his own rules to the game, instead of playing like the others, even when the rules where explained to him. But, all of this made me wonder, if like children with ADHD, he had a lot of physical activity before sitting down would he be able to concentrate better? So, I am hoping to get the chance to try this out. As we learned in class, some people crave that joint stimulation of jumping, running, and any other form of energy withdraw possible, which can help them concentrate as they sit down to do an activity.

Something that I truly learned today more than any other fieldwork, is that I am going to have to do some physical activities with some children and some quieter slower activities with others. I will be bringing a lot more activities to the site, just to better help the kids I am working with. They may not have all of the abilities that they need for school yet, but hopefully we can start them on the right direction and see where that leads. I know we won't have much time with them, but hopefully the information we get will be useful for the teachers and caregivers that want them to succeed.

If you are wondering what Occupational Therapy can do for children, or why OT's work with kids check out this video about Sylvie. This clip if very informative, and I hope you will enjoy learning what OT can do for children of all ages.

A Good Epithet

To do this bit of writing, I visited an old Episcopalian cemetary in the town where I live. The beautiful old trees, architecture, and markers dating back to Confederate War times always make me feel peaceful and philosophical. One of the things that fascinates me most about this place are some of the epithets, of which I'll share a few of my favorites:
~"Trust, honor, reverence, self control
Gave to his life a sovereign power
And made him one of God's and nature's noblemen"
~"He was a planter, and a Major in the Confederate State's Army. Brave, gentle, generous, and kind."
~"Resting now in her mother's arms
Her spirit lives with us, wherever we find beauty"
I guess one of my personal definitions of a good death is being remembered for living a good life. Reading these epithets makes me want to let go of worrying with the trivialities of life and use my energy for the things that really matter. The kinds of things that will earn a person an epithet of "brave, generous, gentle, and kind". I can think of no greater aspiration, than to leave a legacy such as these 4 words convey.

Views on dying

As a CNA, I worked with several clients who were near death or dying. I had the privilege of being with them, holding their hands, wiping their brow as they took their final breathes. And in the end, I would prepare them for viewing for the family, brushing their hair, put clean gowns on them and make the enviroment as pleasant as possible.
I did find it interesting how many of the CNA's had problems dealing with their actively dying patients, they thought it was "creepy". I thought it an honor to be with them, as my mother in-law says "God will put you where you need to be". I figured God had put me there to comfort people, even when they were dying.
I was with my mother when she died. She was surrounded by her 4 daughters, each crawling into bed with her; like we did as kids when she woke from her Sunday nap. When I die that's the way I want to go. I don't want a funeral per say, I'd like a party, I always liked parties... eat, drink, be merry and celebrate my life.

Being forgotten!

A "good death," to me, would be a party. I do NOT want people crying over a lost love, friend, or family member. Even if I died tomorrow, have some fun people!!! I know, others would think of a good death in other ways, and I have thought about that too. But, in all actuality I know a truly good death would be dying pain free, with no guilt or wanting re-do's. I would rather be alone with my thoughts. But, I grew up that way, so it is very natural to me. I might want 1 other person there just to make sure someone knows that I am dead. I could not imagine someone laying there for an hour, let alone a week or a month without anyone knowing they were dead.

I think talking about dying comes pretty natural for a lot of people, me included. But, I know it would be hard to talk about if it were someone that would be passing before they think it's "their time." But, depending on the patient, I would go either with a straight talk, or with a sugar coated. They may think their family or friends will forget them. You may want to think about having the patient do change of address letters, or postcards as part of their therapy. This way they know the people they care about know where they are, and what is happening in their life, which is huge!.

In making the decision to move to a hospice, that really just depends on the individual. If someone does not want to go, I will try everything in my power to keep them at home. But, if they do not have someone to take care of them, or are unable to hire in someone, they I would really need to push them into making that decision. And that is when straight talking can some times be the better decision. If you sugar coat things, the patient may not fully understand the benefits that would be available for them at a hospice. Then on top of dealing with yet another move, the patient is taken away from another place, and have to re-acclimate yet again! They patient may withdraw from social situations because they don't know anyone. And it will be our job to get these people to feel comfortable enough to engage in the hospice. Which, depending on the person, may be easy or hard. But, that is one reason why I became an OTAS, I have that natural ability to talk to just about anyone, as long as it is in their best interest.

And, that comes full circle. Because you will need to acclimate someone to hospice, means you will also have to get them, or their family ready, as much as possible for the inevitability that is hospice. Doing a memory book with happy times, from the patient's perspective may give the family something to look back upon when the time comes. This would be a great asset to the grieving process for the family, as well as the patient. It would give them closure on their life. They can tell their story to their family, in their own words, and they won't be forgotten. No one wants to be forgotten!!!

Althazagoraphobia-The Phobia of Being Forgotten

Dying at Home

Dealing with the end of life of a loved one is never easy. One of my grandmothers suffered a massive stroke at 98 years old and never woke from a coma. Despite being pretty healthy and independent in most things, she had often said she was ready to go since all her sisters were gone. So when the doctor said there was no hope for recovery, my family chose to stop all life sustaining measures and bring my grandmother home to die. Home hospice came in to check on her and monitor if she was in any pain and to give her a bath every few days. My family consisting of my parents, siblings, aunts, uncles, cousins, nieces, and nephews either stayed constantly or visited daily. We came from all over the U.S. We talked to her, touched her and kept telling her it was OK to let go but she held on until my cousin Stephanie, who my grandmother raised, was able to get there. It was especially hard for Steph to see our grandmother that way and she was very upset we were not doing anything for her. It really helped to have hospice there to talk to her and be an outside voice of reason.

Having my grandmother at home was a much better experience for my family. A hospital or hospice center wouldn't have allowed the comfort and space for all of us to be together. Having the support of all the family around was wonderful and the little ones were included without having to worry about restrictions or other patients.

Not all families could or would want to do this. We were comfortable taking care of my grandmother and my cousin was experienced with having to give total care and she and I kept her clean in between CNA visits. We also had a hospital bed and a large house that accommodated the 15 or so of us that were there all the time and the 10+ that came to visit daily. We also knew this was going to be for a short period of time. I imagine a hospice center would be much like a home and for those with limited support, it would be a wonderful environment for a loved one's final days.

OT and Alzheimer's Disease

Up until recently, the realm of cognitive impairment has been intimidating to me as an OTA student. We recently had an in-depth classroom lecture and video on dementia and a competency where we were graded on our interaction with a patient suffering from dementia. I received positive feedback from my teachers and was surprised at the ease I felt when working with this patient. The feedback from the teachers as well as my newfound understanding of OT's role in working with these patients has caused me to become very interested in this practice area. I sought out articles this week regarding Alzheimer's disease and found a very interesting one on a Dutch study done regarding OT's influence on the AD patient's quality of life. The study found that OT sessions drastically influenced the functional level of the patient and the coping of the caregiver. According to the study, the involvement necessary by OT staff to affect this level of change is one that very few U.S. nursing homes are able to provide. The most significant finding, in my opinion, though, is that the decrease in close attention needed by the patient at home due to the OT interventions significantly decreases the total health care bill, in essence absorbing the cost of the treatments while dramatically increasing the quality of life of patients and caregivers. Here is the link to the brief article: http://mlive.com/health/index.ssf/2009/03/occupational_therapy_sessions.html

Oh, how I hate to sew!!

I was working with a client who had met all her goals and was being discharged the following week. The COTA that was working with her suggested that we should organize her rollator because it was becoming a safety issue. I had the brilliant idea to create a "reacher bag" for her rollator so she could store her reacher, long handle shoe horn and her beloved Chapstick (the cherry flavor). I have to say "it took a village" to make this reacher bag. If it weren't for my classmates sewing skills and my teachers ideas this idea would have never gotten off the ground. I needed to modify the length of the bag and add different handles; BUT when it was done it looked great and I was very proud of myself for finishing the bag. I especially liked it's front pocket for the Chapstick. I hope that will be one of many fabrications that I will do to help keep my clients safe.

Juggling

The past two weeks I have gotten to know a new patient. She is on oxygen due to COPD, and this week had another line to deal with because she was so dehydrated. I had never dealt with trying to move someone with any lines attached. But, this week I got my first chance. I was very happy to have my teacher with me! It really was a 2 person job since she was not stable on her own. I was nervous at first, but once we got into the room, all the nerves just went away. It takes a lot of forethought for these patients to know how to move with all of the lines they are attached to. Most people aren't used to dealing with IV lines or oxygen lines. It can be very tricky and very messy if the IV line is pulled out unexpectedly. Something I hope will never be my doing! I was thinking about IV's and found these couple pics. Just imagine if you are trying to use a walker, and have 2 lines attached and can barely hold your self up using walker, let alone drag an oxygen tank and an IV drip. Everyone should do that once, just to see what it really means to juggle. This first one is just funny, and I am sure anyone in the health field will see this more than once!

Team Support

This week at FW was a lesson in support from team members. Last week when I worked with my patient I was a bit discouraged that I didn't seem to be getting along with her. It seemed everything I said irritated her. I was not looking forward to seeing this lady again. I talked to my classmate who is also working with this same patient about her experience and I was relieved that it was not only me who had difficulty with her last week. She updated me on her treatment this week and how she interacted with her and said this lady was more pleasant this week. After looking over the OT notes I talked with the COTA who has been working with her regularly. She was very encouraging and explained that my patient hadn't been feeling well last week and that was the reason for her hostility. It really helped to discuss my apprehensions with my classmate and the COTA and hear their suggestions on how to approach this lady and get a better perspective on this lady. I was much more at ease about seeing her and it helped me to feel less defensive. Though this lady is still not on friendly terms with me, I was able to be cordial and get her to participate in therapy with very little complaints.

Role play

I had an interesting experience on FW this week. My client that I have seen from the beginning was dc'd, so I got a new patient. My instructor and I went into his room, and right off the bat he was very willing to talk, articulate (as we found out he was a retired professor), and had a pleasant personality. The instructor and I talked with him for about 15 min., when we decided to do the treatment in his room so he could ice his swollen ankle. Ms. M headed back to get all my supplies that I had left in the activity room, where we had originally planned to do the session. Well, as soon as the teacher left, my client let into me! First thing he said was "do you know what I would have done if a student had come into my classroom without pencil and paper?" - and despite the fact that I told him more than once that all my supplies were a different room that we had planned to work in, he didn't take to kindly to it. Now, the original plan was for us to get to know each other and maybe play some cards for this first session; when I tried to make conversation he basically told me that socializing wasn't getting him anywhere and I needed to check the charts before I asked him these questions. When I asked him what kind of activities he liked, he basically said it didn't matter what he wanted to do, he was going to do what the therapists told him to. This went on for about 10 min. (but it seemed much longer!)

To make a long story short, I was very much caught off guard, and did not expect that. After I left I thought about what just happened? He is a man who very much likes to be in control, and I think he took on the professor/student role, since he used to be a professor. At the time it wasn't "fun", but looking back it is very interesting to see how past roles can influence someone's behavior. It was another reminder that really knowing our clients and their backgrounds can greatly influence how we approach and work with them. It was definitley a learning experience- and I have learned that the way I respond can just as well have as much effect on how the session will turn out.

The Power of Empathy

I just wanted to take this time to tell you about a rewarding and educational experience I had this week on fieldwork. I did not know who my patient would be when I got to the site this week. When I got my assignment, I went down to the patient's room with the intentions of having a brief conversation to see what she would like to work on. When I entered the room and introduced myself, the lady grew very agitated and started complaining about the disorganization of staff and did not want to work with me. There was a brief moment when I thought about accepting her rejection but instead decided that I would view this as an opportunity. The pt. obviously had alot of pent-up anger that she needed to get out as she didn't stop with the first complaint. She continued to express complaints for the next 20 min. -about the menu, the staff, her condition, etc. I stayed with her and used my empathy skills that we have reviewed so much in the classroom and it worked. It was obvious that she just needed someone to listen to her and validate her feelings. She didn't need me to fix anything, she just needed to feel my concern. After the 20 minutes of talking, it seemed the well had run dry and she treated me very differently. She was willing to do a treatment session and was very pleasant from that point on. I am sure that being a patient in any type of institution takes a psychological toll on an individual and has the potential to make them feel like their voice doesn't count. It was a lesson to me that as a therapist, you can't use your clinical skills to help a patient if you don't first use empathy and listening skills to break down the psychological barriers.

Memory Books

Doing a memory book assignment on myself has been very eye opening. It is clear how great an experience this could be doing this with an elderly client. Reminiscing with my children and husband about what they remember most about our lives together and telling them the events from my past that have stayed with me has been fun and rewarding. Looking at the old pictures brought back so many happy memories, emotions and stories. By focusing only on the positive events, the book makes me feel good about my life. I can see how an elder would have a similar experience and how important that would be if their memories were starting to fail them. Helping them to selectively remember would give them back their self identity as well as give family and friends a way to connect to the elder in a joyful way.

Changing times

Losing your friends is very difficult. All of us know this to be fact. But, how much do we think of this as a reality of every day living as we are young. The answer is not many. As I am living in a different state than where I grew up, and my life is changing every day I am thinking about this a lot lately. Yes, I have good friends here in North Carolina, but my family and childhood friends are still in Ohio. Being relocated is very difficult to handle, yet we expect our parents to up and move as soon as they can not take care of themselves. They lose touch with their friends, and before you know it, depression kicks in. Yes, senior centers have activities that you can participate in, but you are not playing, or dancing with your friends. You are participating in these activities with complete strangers.

Anything can trigger depression. Whether it is moving out of your home of 30 years, a spouse's, friends, or family members death. Or even just a change in the weather.

Here is a link that can give you some more information about depression in the elderly and seniors. I found it very helpful because it includes early warning signs, triggers, as well as action that should be taken.

Driving Seniors

This week in class we discussed the controversy of driving and aging, and the benefits of programs such as CarFit. Having these programs is a wonderful source, and as long as they are truly safe to drive, who's to stop them? The problem is knowing when they cross the line of being safe. Not only do they pose a threat to theirselves, but to other motorists as well. I think about my grandma, who until she broke her hip last year was driving locally- to and from church, the store, and nearby family. I was concerned about her driving when she did, but it gave her that last but of freedom and independence, not to mention allowed her to stay more active and involved.. who was I to oppose that? All of us who drive can relate to the amount of freedom that it gives us to have our licence and drive. I can only imagine how it must feel to have that taken away from you. There are many reasons that people can't drive, some physical some cognitive. I love the fact that many adaptations are available for the physical aspect. I don't think that given the chance my grandma would drive now. She did make the comment to my mom the other day that she would be glad when she got her car back (it has been in the shop)- we are not sure if she really thinks she could drive. She has Alzheimer's and is showing signs consistant with the mod stage.. no way would she be safe to drive. Fortunately, she has supportive family that takes her everywhere she needs to go- I thought about other people in her situation that may not have the outside support. How many people are still driving that do not have family to decide that it is not safe anymore? I think that there should be stricter laws for seniors renewing their license, and required more frequently. I found some info on the DMV websitehttp://www.dmv.com/nc/north-carolina/senior-drivers. I was surprised that they have 5 years to renew there license. A lot can change in 5 years for aging individuals! Also, they can have restrictions that allow them only to drive during day, and non rush hour times. I wonder how well these guidelines are tested and followed through?

stress on the elderly

My whole family which includes 11 girls and 2 men (my dad and my husband)just came back from a week at the beach. Unfortunately my Dad came home to a house full of WATER. It ruined the entire down stairs. It's hard to see your father look so defeated, he's 77 years old and all the furniture my parents had collected over the years is probably ruined.
I saw him just a few hours ago and he looks like he's aged over night. I was little shock at how he looked, It made my heart hurt. I have a terrible feeling of loss, the house looked just like it did when I graduated High School,(circa 1984)It was comforting,my mom's stuff is still there.
I feel have a newly found sympathy for seniors who have to move from their homes of 30 years. To pack up their wholes lives into a few boxes and to move into a place that is not their home. The stress and sadness of leaving all their things that they get comfort from, is a heavy burden to bare.

Communication Skills

I have to say, it's very uncomfortable to me to work on my communication skills. It's a bit painful to look at your faults and difficult to change a lifetime of habits. On FW though it's very clear how important these skills are in motivating clients and also negotiating with the rest of the team. With the client, getting to truly understand them by actively listening and getting them to connect with you is the key to motivating the reluctant person. If you can't connect, then negotiating with a co-worker to take over is a great way to making sure your personality conflicts are not going to hinder treatment of the client. I've seen the therapists at the SNF work together by playing to their strengths and asking each other to step in when the other has failed with a certain client. These ladies know each other well and what the other's limitations are so they work well together but I could see where being the new therapist, this could be a problem or when there is a heavy case load and there is little time for negotiating patient swaps.

I've been reading Messages: The Communication Skills Book which reiterates many of the things we've learned in class but also goes into more detail on better communication. Reading different examples of the same material has helped to clarify some of the techniques we've been taught.

Commercials

It is my belief that commercials need to be approved by a lot of people of different back grounds before they are put on the air. Otherwise they are likely to offend people of different ethnicity, origins, people with physical or mental disabilities. This rang true as soon as I saw the new Heineken can commercial. It really irked me that they put on this commercial that you don't need to have a color change marker that reacts to the cold, you have hands to feel how cold it is. So, what about the people that have no hands, whether they were born with a malformation, or if they were in an accident, or needed an amputation for another medical reason. Are the people that made this commercial not realizing how demeaning this commercial could be to someone. I am going on strike and not drinking anything Heineken, and suggesting my friends do the same! Maybe this should be a great commercial for Coors. You can tell their beer is cold before you get a nasty warm beer in your mouth, even if you don't have hands!

As I have been working with the elderly population this semester I have seen several men with ambulated legs, and one with an ambulated arm. So, this commercial really rang true. Yes, he still had one arm, but if that arm has some nerve damage as a lot of people with diabetes have over time, what then? After this commercial, I am really opening my eyes to a lot more suggestions from the tv. A lot of commercials really make growing old look horrible, which adds to the stigma that all of know too well, ageism. Ageism is the discrimination of the aged. Wrinkle cream you don't want to look old, or it's too embarrassing to buy Depends at the grocery store, so buy them online. All of these add to the stigma of getting older. But, I guess it sells items. However, this commercial is going to do the opposite in my eyes.

If you have not seen the commercial yet, I invite you to click on the link below and it will take you to U-tube to watch the horrible commercial.

Heineken commercial.

Cell Phones for Seniors

I came across a very interesting website today www.squidoo.com/cell-phones-for-seniors. It has an elaborate listing of cell phones designed specifically with the senior citizen in mind. This is another exciting example of how our society is starting to consider the older generation in areas such as product development and marketing. I believe this is a trend that is going to gain much more momentum in the near future as the baby boomers age. Below is a list of some of the features the phones offer (very OT minded in their concept!):

• One touch emergency response button (Pre-program up to 5 #'s. When the button is pressed, the phone will cycle through all 5 #'s until one is reached)


• Easy grip surface


• amplified sound


• fewer functions


• larger, well-spaced buttons


• larger screen font


• large, lighted display screens


• hearing aid compatible


• smaller, simpler packages


• "say a command" feature - can speak commands


• "read out mode" - they can have callers and text read aloud to them


• voice dialing and memo


• voice-driven menus


• health-related apps


• reminder alarms


• Medication Info. apps


• Flashing alert for incoming calls

A little goes a long way

Mealtime is important to all of us. It is often a center point for gatherings and socializing, family time, and even time to relax- not to mention vital to our wellbeing. When does it become ok to take that away from someone? I noticed on FW one day a staff member assisting someone with feeding, but while doing so, her body was completley turned away from the lady, and she was watching the T.V. in the room, only turning around to shovel another spoon of food in the client's mouth. Granted, the client did not seem to be cognitively aware, but should that matter? Shouldn't they still be treated with dignity and respect. Even something so little as turning your chair towards them, and giving them your undivided attention. How do we know what they are able to process even if they aren't able to express themselves? I can imagine having to be assisted with feeding is already degrading, but I can't imagine having someone sit there and feed me in such a way that made me feel like they were bothered and would rather be anywhere but there. I think it is so important to remember that one day that could be a loved one or even ourselves. We should always treat others like we want to be treated, no matter their physical or cognitive levels.

I found this website while searching for information about mealtime in SNF's. It is advocating for respect to our elderly population, not only at mealtime but all the time, and how important it is for society's attitude about elderly to change. I feel fortunate to be going into a field where I can make a difference in the treatment of these individuals.
http://www.barbadosadvocate.com/newsitem.asp?more=local&NewsID=259

So, this weekend I moved into a new apartment. And, for the last week or more I did not want to buy food that I was just going to have to move. In doing both of these, I have been eating different kinds of food and more fast food, which has had an interesting effect on me. Depending on the types of food I have been eating I have either been lethargic or just dazed. Now that I am in my new apartment I am feeling better and more energetic. Energetic enough to unpack all of my boxes in less than 24 hours.

With all of this happening to me, it really makes me wonder how the food at some of these senior facilities is affecting their level of energy and the amount of effort they are vs. how much energy they could be putting into their therapy.

A little while back I started keeping track of my food and how it makes me feel after I eat certain foods. And tried to find something that would help me figure out what I needed to eat, and I came upon this website What foods can affect the way I feel and increase my energy levels?

I know their are a lot of nutritionists at most of these facilities, and I know that the ones I met with really know their stuff, but it is hard to talk to them & get the information I needed in words I could understand. So, I hope this website puts things into words that others can understand the way I did.

What They Hear

We touched on a subject in class this week that has been on my mind for a while. I think most of us would be able to easily recognize abusive or negative communication of staff towards patients but there is another more prevalent and deceptively benign type of communication that takes place in facilities. Examples of this type of communication would be staff members carrying on conversations amongst themselves during tx sessions instead of interacting with the patients themselves. Another example would be staff members talking about the patient's status or performance when the pt. is sitting right there, especially if it is not positive. I recently heard one clinician telling another that something a patient with dimentia did while performing a certain task was "bizarre". The pt. was sitting right there between the 2 clinicians. In the movies, doctors always tell family members to talk to coma patients as though they can understand every word you're saying because it is unknown how much they really do hear and understand. If that is true for a coma patient, obviously it is for the geriatric patient. One of the articles I read on this topic stated: "Negative examples were given, such as talking over residents' heads and performing care of residents in a routine-like manner. " Another article said: "it is not just negative forms of communication that leave people feeling distressed; 'neutral' styles of communication can also have this effect. A neutral style of communication is defined as staff focusing on a task that needs to be completed, and lacking empathy and warmth." I believe we should view every interaction we have with a patient as an opportunity to lift their spirits. It could make all the difference in their recovery, their quality of life and our sense of purpose and personal fulfillment as therapists.
These are the 2 articles I read that support my views:
http://www.orebrolan.se/download/18.3bd692b4121b0cc24e2800013029/Encounter+staff+descriptionopn+Wadensten+mfl.pdf
http://www.nursingtimes.net/nursing-practice-clinical-research/improving-communication-skills-in-care-of-those-with-dementia/1493021.article

The Dreaded ADL

I got to work on toileting for the first time. Lucky for me, my patient is breaking me in slowly. She refused to actually use the toilet but she went through all the motions for me including handling her LB garments, which she did splendidly. She is making great progress and I believe she will be able to be D/C'd soon. While at the SNF, I ran into a patient I used to regularly talk to when I used to volunteer there and asked her how she was doing. It broke my heart to hear that she has given up on going home. She was always so cheerful and worked hard in therapy when I was a volunteer over a year ago. Her health has severely declined and she has accepted it. She is still getting OT though for toileting because it is still important to her. Toileting was one thing I always dreaded having to deal with before going out on fieldwork. Hearing how important it is to clients to be able to maintain that ability first hand now makes it a priority on my list.

Senior center tour

Last week while our teacher was at the beach relaxing, we were instructed to take a tour of a senior center in the area. I chose a facility in the next town over because I had seen their catalogs and knew it was an active senior center. I was very pleased with what I saw, the facility was fairly new,the staff was kind and inviting, they had a restaurant style kitchen and a "ballroom" located next to the kitchen and offered an array of classes.
But as I was driving home, I thought to myself "Well, there sure were alot of Mercedes in the parking lot!" I notice these things because I drive a little tiny "Scion". And the kitchen was big and shiny.. but they don't provide a "lunch program" for the needy elders in the community. And the Town has their own bus service for Seniors and the Disabled that will come right to their door and drop them off at the Senior Center for $2.00?!!
So my question was to myself was: Where do the less fortunate seniors go? If the Senior Center in their OWN town does not serve their needs, then where do the needy go? I feel a little sad that this facility is so under utilized. I can see the potential that is facility could have, a niche, they could fill.

Age really is just a number

For an assignment, I had to interview someone who was 65 or older. I went to my grandma's (who is 82), with intentions to interview her. She is in early stages of Alzheimer's and broke her hip about 8 months ago. Her sister (my great aunt) who is 78, was visiting when I got to her house. I ended up doing my interview on my great aunt, and while doing so realized the great differences between her and her sister, even though they were only 4 yrs apart in numerical age. My aunt is very active at the senior center, still driving, and completley independent. My grandmother has had a great decline in activity, and relies alot on my mother for everyday activities. Watching them side by side, it was obvious how age really is just a number; they are only 4 yrs apart, though their abilities and independence are on opposite ends of the spectrum. I wonder what it must feel like to have grown up so close together all those years, been so much alike, and then all of a sudden have so much difference? Dementia and other diseases doesn't strike at a "set" age, nor does it affect everyone. It make me think, how old would I be if I didn't know how old I was? Would I feel alot older than I actually am, or alot younger? What things in my life can I change to make a positive impact on how I age?

Senior Center Visit

As a class assignment, we had to visit a local senior center this week. My visit was very eye-opening in a good way. The center I visited was bright, with high ceilings and lots of artwork displayed very tastefully throughout. Most impressive was that there were 2 exercises classes, 4 different group games, and 3 art classes taking place just in the hour and a half I was there. The staff was upbeat and knowledgeable and the energy in the place was very high. I was almost envious and was happy to hear that younger people can take some of the classes if they pay for them. This is a good way for the center to earn extra money and the intergenerational aspect is beneficial for young and old alike. I thought it would be a good idea to buddy up with a senior who may need some assistance and take a class together.
If you've read one of my previous blogs, you know I am working with my parents to encourage them to get involved with their local senior center. Thus far, they have not gone but are starting to consider it. I asked one of the staff members at the center I visited and she said you did not have to be a local resident to attend the center. Because my local center is so nice and has such a variety of activities, my new plan of action is to ask them to accompany me to one or more of the classes the next time they come to visit me. Maybe that will be the first step in getting them involved in the center where they live. Here's a link that reinforces the positive impact of senior centers on the geriatric population:
www.helium.com/items/71524-the-benefits-of-senior-centers-in-helping-elderly-parents-find-community

Getting the best out of Therapy

So, this week my client at the location we are doing field work got another therapy added on to her schedule. Now, she has three students, plus her normal therapist working on her case. On the day I saw her She had already had 2 therapy sessions and then worked with me for an hour and a half. She was exhausted by the time our session was over, but was still as bubbly as ever.

Although a lot of clients get an exuberant amount of therapy, not all of them can handle everything they are receiving. And some clients don't receive the amount of therapy they need. But, they are required by insurance to receive whatever amount of therapy as the therapist sees fit and gets approved. And all I can hope for is that the therapist that first evaluates each person understands what kind of impact they could have on a patient's outcome. If they request too much therapy and the patient could relapse, or get denied on their next claim. If they request funding for too little therapy, their recovery is going to take longer & be more expensive for the patient in the long run. It is all a matter of really knowing your stuff. Knowing the medical system and the diagnosis that you are dealing with, as well as it's normal course.

We were lucky enough to be a part of a school that takes this seriously. Between my school and the fieldwork site, everyone wants our clients to get the best out of their therapy. And my client is getting the best of both worlds.

Not Just About the Equipment

OK. Last week I blogged about how to motivate my patient to work on ADLs and possibly discussing with her what she needs to be able to do in order to go home to motivate her to do this. After a fun craft session and getting her comfortably back in bed, I talked to her about her wanting to go home and needing to work on self-care tasks and standing tolerance. I also conspiratorially added that my instructor wanted me to work with her on those activities and she agreed. I gave her a choice of what she could work on and she chose "going to the bathroom". Not MY first choice but hey, it's not about me. I came across an OT blog about Elderly patients' perceptions about PADL interventions. It made me realize that not only giving our patients a choice of which ADLs to work on but HOW they want to be able to accomplish it is important. I won't have to worry about this with my lady who definitely lets me know her likes and dislikes but for future patients, it will be important to find out how they really want to be able to their ADLs. It may be they don't want to use adaptive equipment or do things in a different way. We need to remember not to focus just on the end result but also the process along the way.

PTSD

I was at the bank "chatting up" the loan officer when he told me about his son, a Iraq veteran who suffered from PTSD. The son went to the V.A. to seek medical attention but was turned off by what he saw. He saw the older vets sitting in the halls with amputations and drooling on themselves and he RAN out of there. His father eventually got him to go back to the V.A. but his father told me "it didn't end well".

For the rest of the day I felt so bad,I thought of all the Tx.'s I could have done with him. Maybe some leather work, something so he could get his aggression out, a journal, so he could express his feelings.

There has to be other options for families with a loved ones suffering with this disorder. So, I hit the world wide web looking for information. I found this staggering statistic "only 1 in ten vet's who enter treatment for PTSD in the V.A. actually COMPLETE the program". The military in the last few years have created programs that are directed at reducing the stigma in receiving services for mental health problems. There are many websites dedicated to our "warriors" so I have included one for you to see.

There is this new treatment for soldiers with PTSD, it's called Virtual Reality Technology, it takes the solider back to the actual "traumatic event" so they are able to work through the issues safely with a professional. I've attached an actual session of a soldier using this new technology.

I believe this is a new field that is opening for OT professionals, we need to educated our elected officals on OT and how we can change and maybe save lives of our soldiers.

http://www.pbs.org/wgbh/pages/frontline/digitalnation/virtual-worlds/health-healing/a-soldiers-therapy-session.html

http://www.realwarriors.net/

The power of motivation

Motivation. Without it, you really don't have much- or you do, but you don't really care cause you aren't interested in doing whatever it is. I find myself in these "ruts" where I don't have motivation to do this or that, and I am sure that everyone at some point in time faces this problem. For most of us it is temporary, and we soon pass out of the funk, get over it, and carry on. For some, this motivation doesn't come so easy. During my FW at the SNF, I have realized the power of motivation, and how powerful of a tool this can be as a therapist. Many of the clients are medically compromised, lonely, away from home, and just depressed. I can imagine that over time, it may be easy to lose that motivation. Once it's gone, then what? They lose interest in participating in activites, therapy, ect.. It is so important as OT practictioner to recognize this issue, and realize how we can use ourselves therapeutically and "re"motivate our clients. Sometimes it only takes rewording what you say to get them interested; instead of asking them if they want to do something, tell them you have a really fun activity to do so let's get started! Our clients will feed off of our energy, and it is our job to keep them motivated in therapy. Know your client and what they like.. be encouraging and positive. I am learning that this aspect of therapy is just as (if not more so) important as the actual activity itself. I googled ways to motivate your clients, and came across an article that introduced a new activity that can be used in therapy.... MAGIC! I have never even thought of this activity, but wow, what a great fun activity; and I think it would be a great tool to motivate clients who are bored with the same old same activities! I am excited to read more about this as a therapeutic tool, and thought I would share the link so you could use it too! http://http://www.magictherapy.com/therapists.html#BenefitsofMagicTherapy

Geriatric Drivers

I read 2 interesting articles this weekend related to the issues surrounding the geriatric community on our roadways. (1. www.jsonline.com/features/health/119156544.html, 2. www.westport-news.com/opinion/article/Should-elderly-drivers-be-retested-399215.php) The obvious conflict is the senior's right to independence vs. society's right to safety. One study rated seniors as second only to teens as a group involved in fatal car crashes. (I guess the only bright side to that statistic is that teens hold the number 1 slot and not seniors). Decreased reaction time, vision, judgement, hearing, muscle strength and flexibility, and concentration all contribute to the elderly driver's increased risk behind the wheel. One of the main problems concerning this topic is that there is no clear-cut line between when a person is safe to drive and when they are not. Lots of times, adult children are reluctant to make the call that their parents are unsafe to drive because then the responsible falls on them to figure out how to provide for their parents those things that have been lost - ability to buy groceries, participate in social situations, get to and from dr.'s appts., etc., etc., etc.. I personally believe that while a senior's independence is of utmost importance, it is trumped by the need to keep society as a whole safe on the roads. The articles list one of the current roles of OT's/OTA's as being evaluators of driving ability among the elders. So we get to help make the determination that a senior needs to be pulled off the roads. I am going to do more research into this idea (maybe for my blog next week) but these articles made me wonder about OT's role in a transport system for seniors who have lost their licenses. Public transportation such as riding a bus (independently) is out of the question for alot of seniors who have disabilities. Obviously OT's/OTA's are trained in proper transfers and the particulars of the medical conditions affecting this population. I am curious if OT clinicians are running businesses out there for this specialized purpose. I also wonder if there is any possible way insurance may cover a service of this nature? I'll do some research and try to find the answers to these questions. Maybe some of us could start our own business one day :). In the meantime, here is a website that contains more on OT's role in evaluating driving skills, in case you may want to take on this role in the future: www.aota.org/olderdriver.

video

I saw this on ABC news the other night. This is why OT is so important, we help people reach their goals.


http://abcnews.go.com/US/paralzyed-bride-jennifer-darmon-walks-aisle/story?id=13399347

new role

In my last post I wrote about my experience as a CNA working in a SNF and how I was hesitant to ever work in geriactrics again. On the tour of our FW facility I thought "Wow, what kind of place has our instructors taken us?" The facility was small, and the bedrooms held 3 clients per room and they all seemed really sick. This was a little unnerving for me because the retirement community I worked as a CNA was client paid and very upscale. Our guide, who worked as an OTA, introduces us to all the clients we passed in the hall. She knew all their names and they were so happy to see us. All these clients are in need of our services, I could see how much OT could help them be more independent.I think may be these are the types of clients that need me the most. Yahoo, that excites me I can put all my skills to work, I can instruct, educate and give SBA with min. verbal cueing. Watch out Seniors here I come!!

Doing what we like to do does wonders.

At times during the past week I have wondered what to do with elder clients. I had a plan and all of the supplies and was ready to go. Yes, I was nervous. But, I knew that my client would enjoy this activity and I was kind of excited to get going. However, as soon as I tried to find my clients file I found out that she is being discharged from therapy. Stinks, but I moved on to my next client in very little time and started from scratch on what to do with my new client with the supplies I had brought with. With some help from my supervisor I was able to get the client involved and change all of the supplies I brought into an totally different activity that not only lasted this past session, but we will be able to finish next session. And a major bonus is that the client is really looking forward to figuring out how to make a word find. I'm not sure if she realizes what it will be at this point in time, but she is excited.

It really makes a difference if a client is excited about doing an activity. It makes it that much more therapeutic. She really wants to do this for a different reason than what I am doing the activity. She is doing it for fun. I am helping her create this word find to increase her Upper body strength and increase the length of time she is able to do a task. I know through school that making tasks therapeutic has a lot to do with really making the activity something that the person enjoys. Otherwise, they are not going to want to do the activity, or be less than enthusiastic about the activity. Then I found this little diagram and it really hit home.

So, the moral of the story...Do something you like to do or it is not worth doing. And for the therapists out there, make the activities client-centered, so they get the most out of their treatment.

Finding Motivation

This week on FW was a lesson straight out of the books on the importance of meaningful activities in therapy. The OT working with my patient had been having difficulty getting this lady to participate in therapy. She had refused the OT the day before with the promise of working with her the next day. When we went to get her for her "appointment", she again refused stating she had already worked with PT and was tired. It dawned on me that she equated therapy with exercise and when I told her I had a couple of games we could play somewhere other than in the therapy room, she was willing to participate. What could have been a second refusal turned into meeting the OT's needed minutes of therapy and showing progress in activity tolerance. During the therapy session, this lady commented on some flowers outside and we incorporated making a flower arrangement for her to take to her room. She liked the decoupaged vase we used and I asked her if she'd like to make one for our next session and her grin was all I needed for an answer. I was lucky to find another activity my lady wanted to do but thinking about future sessions and how to go about working on her dressing and toileting goals is another problem. The OT mentioned she had to "trick" her into working on her ADLs. In an article entitled Motivating the Elderly Client in Long-Term Care it was stressed that giving the client a choice in activity and goals to work on goes a long way. I think reminding my lady about her goal to get home and discussing what she needs to be able to do in order to do that and then letting her decide what she wants to work on will hopefully get her to work willingly on her ADLs. We'll see how this plan works in future sessions.

Looking ahead, looking back.

In class this week we did in activity that simply involved us closing our eyes and listening to our instructor guide our minds to visualize ourself infront of a mirror at 75. I had a hard time actually seeing myself, but instead I kept seeing my grandma, who is currently 82, and in early stages of Alzheimer's. At first my mind wondered to the more obvious outer appearance changes. Of course I didn't really like what I saw, but it was just that, outer apperance. It was when I looked on the inside that this activity became more emotional for me. I continued to think of my gma, as I was thinking of how I got ready and how hard simple things were for me to do that I once did without second thought. I pictured myself with several of these physical changes that I have seen in my gma, and thought of the emotional impact it would have on me. When did these "simple" tasks become so hard? Starring into the "mirror" my "old" self kept seeing me at my current age, 26, and wondering where in the world did the time go? Did I do what I wanted with my life? What could/should I have done differently? What would I do to see my son again splashing in the waves at the beach for hours on end. WOW, where did my life go?

Everyone is going to get older, it is a part of life we must accept. That doesn't make it easy though. After this assignment, I realized that each day I am here is special, and it is up to me to make the most of it; one day, I won't have a chance to go back and do it over.

I found an interesting blog on the perspective of aging, and wanted to share http://http://coachirisblogs.com/2010/11/21/thinking-learning-laughing-crying-aging-end-of-life-reflections/

I am going to take this week to tell you about a personal mission that I have set out on within my own family. We are not very far into this semester concentrating on geriatrics and it hasn't taken much reading in the textbook or many class discussions to confirm what I already knew - that my own parents are not where they need to be. My dad retired 4 years ago and my mom has not worked since my siblings and I were young. My dad is a social person and that need was met through his work. Since he retired, he and my mom have not made (in my opinion) a successful retirement transition and it makes extremely sad. They live in a very rural area and don't seek out any outside activities. They stay at home and take care of the basics of IADL's for the house and yard but the only outings are to the grocery store, bank, and doctor's office. They are only in their sixties but their mindsets and behaviors depict a much older age. I am very concerned about this situation because I know there is so much more for them to be experiencing in life and that is becoming even more apparent to me through my studies in OT. I make small comments here and there about them needing to "get out" more but they get very uncomfortable and change the subject quickly. After we made plans for our service learning project in one of my classes I could see clearly the steps I needed to take to help my parents get out of their "rut". I think just making general statements like "you guys need to get out more" is not effective. But if I could present actual actions to take, maybe they would be less overwhelmed by the whole thing. What I have done so far is contact resources in their area. I called Social Services and local nursing homes to see what volunteer opportunities might exist. I left my phone number so they could call me if they came across an elderly person in the community who needed a ride to the doctor or something of that nature. My parents are very kind, generous people and I feel if given a specific person in need, they might act. I also discovered there's a senior center nearby with loads of activities that might appeal to them such as horseshoes, crochet class, computer classes, etc. I am having a staff member mail me their newsletter and schedule for June. I don't know how effective my efforts will be as my mother and I have already gotten into one argument about it. I am going to really tone it down a bit in my conversations with them and try to be more stealthy in my attempts like mailing the newsletter to my mom so she doesn't feel as though she is being put on the spot. Perhaps some of you have had a similar position and may have some advice for me? Below are some links to the resources I tapped into in my parents' community. I know they are of no direct use to any of you but it maps out the course I've taken so far in case any of you ever need to take similar measures. http://www.northamptonnc.com/socialserv.asp Social Services
http://www.ncdhhs.gov/aging/services/scoper.htm Senior Center
http://www.northamptonnc.com/health.asp Health Department (Office on Aging, Meals on Wheels, etc.)
http://britthaven.com/index.jsp?sec=NC&city=Jackson,%20NC Nursing Home (contacted Activities Director)
http://www.linkingseniors.com/senior_center/sc_northcarolina.htm Listing of NC Senior Centers

Getting to Know a Stranger.

I started my fieldwork today and I have to say that I was very nervous. Although I have been to two other sites, I was more comfortable with those sites because I was some what familiar with working with children, and had been to the other site before. But, I had never worked with the elder population. The only elders I have been around before were my grandparents, and unfortunately I never got to know them well before they passed away. But, now I see that my mother & father are both retired and I will probably be the one providing care to them, unless they are in a retirement community. I have 4 siblings, and each one of us has our specialties, but we are all very connected and love our parents very much. And between all of us, I know we can really take care of our parents the way they deserve.

I saw that same love in my client's eyes today. She sat quietly with her granddaughter until I entered the room, and she could not wait to tell me about her children. Immediately, I was put at ease. I have commonalities with my client that I can be even more involved and see where she draws her strength. How and when I can push her to do her best, while at the same time teaching her that she has limits. I already have so many ideas in my head about what I will be able to do with this client, and I can not wait to go back.

During our meeting my fellow classmates and I were responsible for getting as much information from our clients as possible, in a short amount of time. Well, after realizing I was going to ask a ton of questions to a perfect stranger I looked to my trusty computer to come up with some other questions that I could ask to get more pointed information about who she really is, and how I can use that information. I found so many sites that had a list of questions, but I wanted something that she and I could both use to learn about each other and this is the site that I found. Getting to Know You. It needed to be short enough to do in the time available, but long enough for my client to feel like she is getting to know me. But, the funny thing is that I did not need any of them. I was able to think on my feet and came up with questions I did not even have any idea that I would ask. It was a great experience for me, but I know that others have a hard time thinking up a conversation topic when they meet new people. So, I hope the site I attached will help someone. And I wish you good luck in your endeavors to meet new people & strike up a conversation.