I am with Ron on the need for home evals. Time gets to be an issues. We have at least started a therapeutic pass with key goals to identify and a special form to fill in. Sue> Date: Wed, 10 Sep 2008 08:04:26 -0400> From: [EMAIL PROTECTED]> To: [email protected]> Subject: Re: [OTlist] OT's Role in ADL's> > When I worked in-patient rehab, I always found showering to be very> therapeutic for myself and patients. For me, because it was one of the> few places where patient's got "real world" experience. But, I also> felt that there was limitation because our facility had nice big> walk-in showers with grab rails and seats. As we now, that is NOT the> reality of most patients' homes.> > Also, as a male therapist, I made 100% sure that patients were> comfortable with bathing in front of me. There were many times when> they were not and in those cases, I made arrangements for a female> therapist to take my place. This worked out well, because it seemed> that the female therapists had male patients that were also> uncomfortable. Or, there were the occasional male patients who were> inappropriate with our therapists.> > I highly encourage OT to "demand" home evals for their patients during> the MIDDLE of the in-patient rehab stay. The home eval highlights> many environmental barriers a patient will face and doing it in the> middle of the stay allows the OT ample time to address the situations.> > > > Ron> --> Ron Carson MHS, OT> > ----- Original Message -----> From: Sue Doyle <[EMAIL PROTECTED]>> Sent: Tuesday, September 09, 2008> To: [email protected] <[email protected]>> Subj: [OTlist] OT's Role in ADL's> > > SD> Hi All,> SD> Linda on your discussion of staff not wanting to do the real> SD> bathing with patients. The Rules for the FIM measure are very> SD> clear that all bathroom (tub/shower) transfers should be performed> SD> wet and with no clothes on...that is the real thing. I also work> SD> in an inpatient rehab unit as the lead therapist. We do several> SD> real bathing sessions per day. It is an awesome place to work on> SD> many of the physical and cognitive components of self care aside> SD> from increasing their skills in bathing and comfort and safety> SD> levels prior to discharge. Bathing can be very therapeutic at all> SD> levels starting with a bed bath and then transfering to a shower> SD> or tub depending on the patients whole context etc.> SD> > >> Date: Tue, 9 Sep 2008 21:27:36 +0000> From: [EMAIL PROTECTED]> To: [email protected]> Subject: Re: [OTlist] OT's Role in ADL's> > Linda> > Coming in slightly late to this discussion. I previously worked in an in-patient rehab unit here in England and independent bathing/showering/strip washing was one of the most common goals of our patients. > > The OT would carry out an initial assessment with the patient to establish a base line and appropriate intervention, (intervention would be based on their level of function and pre morbid habits). The OT would then carry out a joint session with an assistant who would then continue with the bathing sessions from 2 - 5 times a week as required. The Ot would review the patient weekly and grade the activity increasing/decreasing demands as necessary to progress the patients rehab.> > When analysed bathing is a complex task which demands many components, and not only did our intervention often increase the patients independence in personal care but it increased skills which could be transferred to other areas of their life: a stroke patient with neglect worked on their scanning, body awareness, sequencing, perseveration...etc.> > For this reason it is a valuable and meaningful task which should be carried out early in our interventions (not just pre discharge)> > We had a great team of therapy assistants and health care assistants who would carry out our treatment plan with the patients on a frequent basis and working closely with the nursing assistants increased their understanding of OT which encouraged an enabling approach throughout the unit.> > > Kind Regards > > Lucy Simpson > > > For Quality Stationery and Greetings Cards check out this website: > www.phoenix-trading.co.uk/web/lucysimpson > Save it in your favourites for the next time you need cards. > > > --- On Tue, 9/9/08, Johnson, Arley <[EMAIL PROTECTED]> wrote:> > > From: Johnson, Arley <[EMAIL PROTECTED]>> > Subject: Re: [OTlist] OT's Role in ADL's> > To: [email protected]> > Date: Tuesday, 9 September, 2008, 5:06 PM> > Linda: I was never a big fan of performing IP baths because> > of selfish reasons, but I knew my feelings were a disservice> > to the patients. I'm sure you have discussed this with> > your staff, but it;s most likely a relevant patient goal and> > needs to happen. In my humble opinion, the only reasons that> > a real bath shouldn't occur is due to safety reasons or> > not a goal for the patient. After much discussion, I met> > patients in my time that said getting in the tub wasn't> > a goal for them and preferred their premorbid activity of> > sponge bathing. Who am I to judge? > > But, yes, we perform our bathing regimen as you described.> > But since we are ortho heavy, we tend to do bathing within> > the first 2 days of admission.> > > > Arley Johnson MS, OTR/L> > Site Manager, Rehabilitation Services, Pennsylvania> > Hospital> > Good Shepherd Penn Partners> > O: 215.829.5018> > P: 215.422.0174> > C: 215.776.4305> > > > > > > > -----Original Message-----> > From: [EMAIL PROTECTED]> > [mailto:[EMAIL PROTECTED] On Behalf Of Linda Stovall> > Sent: Tuesday, September 09, 2008 8:44 AM> > To: [email protected]> > Subject: [OTlist] OT's Role in ADL's> > > > 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]> > > > > > The information contained in this e-mail message is> > intended only for the personal and confidential use of the> > recipient(s) named above. If the reader of this message is> > not the intended recipient or an agent responsible for> > delivering it to the intended recipient, you are hereby> > notified that you have received this document in error and> > that any review, dissemination, distribution, or copying of> > this message is strictly prohibited. If you have received> > this communication in error, please notify us immediately by> > e-mail, and delete the original message.> > > > -- > > 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]> > > > -- > 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
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