Arley, What "limited resources" is your staff talking about? If you can get a bath bench and raised toilet seat for training as well as a sock aid, shoe horn and a table...most of the rest is just creativity. I used to set up a "kitchen" with a table, cardboard boxes, and cans of food, plates, etc borrowed from the kitchen. My boxes became the microwave (simulated in whatever position they have theirs at home..."deep" on the counter, against the wall, etc). I had patients transport their pretend plate of food from one table to another while using a walker. I used a timer and gradually increased the amount of time it took to stand at the counter while stirring soup on the stove. We practiced ways to simplify meal preparation and brainstormed easy meals for the "recovery" period of time when they may only be able to tolerate standing for a minute or two at a time. We practiced donning and doffing clothes on their bed, in a chair, in the bathroom using the toilet and sink for stability. These are the real situations they are returning home to. It would be nice for everyone to have grab bars and an assistant, but if that is not what they are returning home to, and then meet them where they are. My sessions took a lot of time and much of it was spent just talking through their home situations and brainstorming with the patient. They may not be getting the "physical action" of therapy, but through brainstorming, talking through options, then training in the physical aspect of doing the task...my units were taken care of and the patient was happy with the result. (I always explained this to the patients so they wouldn't misunderstand and think that our sessions needed to be all about exercise. I explained that I wanted them to be as independent as possible when they hit the door of their home and that much of what we would be doing is identifying potential problems and coming up with solutions ahead of time. I always explained my profession like this... "Hello Mrs. Jones. My name is Jenny and I'm your occupational therapist. Have you ever had OT before? Let me tell you a little about OT. Occupational Therapists are the problem solvers of the rehab team. We help you identify what you do to "occupy" your day and figure out if you might have any problems with those tasks. Everything from getting dressed and preparing meals to taking care of your bathroom needs and even your jobs outside the home and hobbies. Let's talk through your week. What do you do each and every day? What do you look forward to each week? Let's make a list. Now, let's talk about each of the tasks on the list. Which ones can you do right now? Which ones do you need help with? Let's prioritize what you need to be able to do to get home safely. After we figure out how you can do those tasks, we'll start on the ones that are the next priority."
It takes a bit of time but you become their friend, the patient understands the purpose of our therapy, and they will get after you if you give them an activity that doesn't relate to their goals. They will ask me, "Why do you have me doing this standing peg activity?" If I can rationalize it to them and give them a reason this will help them get to their goals then the activity is great to them. If I am just trying to do something easy because I'm brain dead from a week of paperwork and the daily grind...I am forced to re-think my priorities. I constantly point out their progress. "Did you know that at our last session you could only stand for 30 seconds to reach for 3 cans in the cabinet before you had to sit down and today you stood for 2 whole minutes while folding towels. This will really help you build your strength for making that spaghetti sauce you told me your family loves!" Make it meaningful to the patient. If you are bored watching them do the activity, they are bored too. If they don't like balloon volleyball, find something they like! I know they are tired and in pain...make them laugh, make fun of yourself, tell them stories, talk about their life, family, etc...If you aren't having fun and feeling great about your sessions at the end of the day, it is time to shake things up a bit. I love your idea about getting the therapists together. Form a "think tank" and by all means, chuck productivity out the door so you can offer better therapy in the long run. That was always the most stressful part of my job...management putting stress on me about productivity but not taking the monotonous part of the job off my shoulders (copying, filling in forms that could have been handled by a tech.) Now I'm on MY soapbox! Jenny -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
