Hi Linda, I've been in your shoes as a former inpatient rehab OT manager myself. I had the same issue. I made some progress, but it was a challenge. Here are my thoughts in retrospect: 1. The OT's have to really "get" occupation. If they don't, they will see this aspect of their job as demeaning and undesireable (exact terms told to me by my staff when we were discussing this issue). I fell into this mindset too early on, but once I really began to understand occuaption, I saw bathing as a very unique opportunity to provide excellent OT. As with any other intervention, it must be client centerd, so we need to repsect what the person's previous habits and routines were. This often means sponge bathing, changing the time of day we work with the client (early evening verus 6 am, etc., more on that later). 2. You as the leader must work very collaboratively with the nurse manager ( I assume you have one?) in order to make sure the nurses and aides understand the role of OT. I'll be honest, this was the biggest source of frustration in my job as OT manager. The nurse manager saw OT as an extension of her nursing staff--she demanded that we do self care with every patient every day so she could shift the nurses around and have less of them on when OT was working. Thus my staff often got stuck bathing very involved clients who really needed at least the assist of 2 people. The nurses got irritated when OT asked for assistance in these situations, and they especially didn't want to watch a patient try to do for themselves. The attitude was that if they were called in to help, they were going to get the job done. It sounds like you have less neuro than we did, so maybe this won't be such a big issue for you. 3. Here are some concrete logisitical matters we implemented: I encouraged my therapists to clearly state as they entered a room for a self care session that they were there to provide occupational therapy, rather than saying "I'm here to give you a shower". Words are powerful. In that same vein, I made sure we wrote 'occupational therapy' (spelled out) instead of "bath" on the clients schedule. I asked the one therapist who hated working early mornings and who was perpetually late anyway to alter her schedule to do evening self care sessions for pm cares as well as for those who preferred to bathe/shower in the evening. Clients loved this! This therapist worked 12-8 monday thru -thurday and a regular 7-3 on Fridays, and she also was able to work at dinner with clients working on feeding, etc. plus she did a lot of caregiver education with families during visiting hours. It was a really nice arrangment. Involve the nurses as much as possible, put everything in writing and make it so there is little effort on their parts to make it work. In my experience, if it makes their job harder, they won't help implement any new change. Getting some systems in place that give the OT's the autonomy to use their clincial reasoning and freedom to adress bathing in an occuption centered manner will really help therapist's attitudes toward this aspect of their work. Use the COPM or at leasts its questions during the OT eval so you can really tap into how important bathing is to a client, then address appropriatley. I hope this helps! Terrianne Jones, MA, OTR/L Faculty University of Minnesota Program in Occupational Therapy
--- On Tue, 9/9/08, Linda Stovall <[EMAIL PROTECTED]> wrote: From: Linda Stovall <[EMAIL PROTECTED]> Subject: [OTlist] OT's Role in ADL's To: [email protected] Date: Tuesday, September 9, 2008, 7:44 AM I am submitting a change in topic :) I am an OT with over 25 years of experience. Currently I am managing a inpatient rehab unit. Our OT's do a lot of dressing and grooming, but have a tendency to not participate in bathing of patients until close to discharge. They repeatedly state "the patient is not ready for that yet". Well, the patient is getting bathed, of course, so they ARE ready for that and I think that OT should work with nursing on the best way to facilitate the patients independence in bathing during the entire stay, not just do one bath the day or two before discharge when the patient is more independent. I guess it is a difference in theory that I see bathing as a functional task that can be used as treatment for all sorts of things (body awareness, balance, following directions, motor control, etc) and they feel that they are just assessing the level of independence prior to discharge and teaching compensation (ie do they need a tub seat or bench, etc). I think the OT should do one bath per patient per week....initially working more with nursing, then later more independently when the patient gets stronger. Can any of you tell me about your ADL programs if you work, or have ever worked, in an inpatient rehab unit?? What are your thoughts on OT's role in bathing in this situation?? Thank you for any thoughts you may have.... Linda Linda Stovall, OTR/L [EMAIL PROTECTED] Program Manager Memorial Hospital at Gulfport Comprehensive Medical Rehabilitation Program 228-867-4179 228-867-5357 (fax) 228-883-8443 (beeper) A CARF (Three-Year) Accreditation was awarded to MHG for the following programs: Inpatient Rehab - Adults, Adolescents, and Children Inpatient Rehab- Stroke Specialty -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
