Neal, funny that you mention faith. When I apologized to the patient, I told her that I was a Christian man and that I had not acted Christ-like. She mentioned that she was also a Christian.
On my last visit, which I didn't know was going to be my last, I brought a couple passages from a Bible study that I am doing. The passages were on Jesus telling us to not worry about tomorrow because we have enough to worry about today. When I asked the patient if I could read something, she said if a joking and scoffing manner; "Not the Bible"? I was sort of surprised and taken back because she had told me she was a Christian. I guess it's fortunate I had only a Bible study and not the Bible. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Neal Luther <[EMAIL PROTECTED]> Sent: Friday, October 31, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Client without goals NL> I would have done the same thing with one exception. NL> I have always found a way to discuss faith issues. I find that lack of NL> hope is related to lack of faith which is a great place to begin. When NL> I say "faith" I do mean faith in God. It is an amazing thing to realize NL> that the God of the universe who created all things created me/us with a NL> purpose. In this one simple fact is meaning and hope and it is in Him NL> that our faith should be placed. NL> When we as therapists realize this it is a great gift we give to our NL> patients to discuss these things and in fact build into the occupational NL> framework of living. The more we look into ourselves for answers the NL> emptier life is. When we turn our eyes/faith to Him and start everyday NL> with that practice the world (no matter what our circumstances) is a NL> better place. NL> Neal C. Luther,OTR/L NL> Rehab Program Coordinator NL> Advanced Home Care NL> 1-336-878-8824 xt 3205 NL> [EMAIL PROTECTED] NL> Home Care is our Business...Caring is our Specialty NL> The information contained in this electronic document from NL> Advanced Home Care is privileged and confidential information NL> intended for the sole use of [EMAIL PROTECTED] If the reader of NL> this communication is not the intended recipient, or the employee NL> or agent responsible for delivering it to the intended recipient, NL> you are hereby notified that any dissemination, distribution or NL> copying of this communication is strictly prohibited. If you have NL> received this communication in error, please immediately notify NL> the person listed above and discard the original.-----Original Message----- NL> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL> Behalf Of Mary Alice Cafiero NL> Sent: Friday, October 31, 2008 8:23 AM NL> To: [email protected] NL> Subject: Re: [OTlist] Client without goals NL> I recently had this discussion with a good friend here who does home NL> health. She had a patient that was very similar as far as not being NL> able to identify goals. Her pt had a very flat affect and didn't do NL> anything other than move from her bed to her couch during the day and NL> occasionally get up to go to the kitchen for some snack food or NL> similar that she just had to grab and eat. NL> The referral actually got to home health because the lady had a NL> shoulder arthroplasty done. However, when my friend did the NL> evaluation, this lady was able to do all of her basic ADLs and even NL> some IADLS in her home. PT was also on the case and was addressing the NL> specifics of range and exercise for the shoulder. The first thought NL> was that there were not really OT goals. My friend wasn't totally NL> comfortable with this, and I'm sure that was, at least in part, NL> because my friend does have some background working in mental health. NL> She talked with the pt who agreed to have her come back to "check" on NL> her. On the next visit, they talked about depression and how having a NL> schedule of doing things during the day can help alleviate symptoms. NL> They made a very simple plan/schedule for the pt to begin following NL> each day with just 3-5 activities scheduled throughout the day. Simple NL> things like getting dressed instead of staying in pajamas, brushing NL> her hair and teeth, making a sandwich or microwave meal for lunch, NL> stepping out into the front or backyard once or twice a day, etc. NL> On just 1-2 follow-up visits, the pt was actually doing the things NL> they scheduled and said she was feeling better and even smiled. The NL> smile was huge because during the evaluation, the pt had an absolutely NL> flat affect and showed no emotion the whole time. She was able to NL> verbalize that she could understand why getting up for activities NL> during the day made a difference in how she feels. NL> Now, of course, we don't know if she will continue to do those things NL> when no one is "checking", but I think the OT intervention was valid NL> and meaningful even though the pt could not initially verbalize goals. NL> Certainly, a recommendation was given to the HH agency and physician NL> that a pscyh referral would be a good idea. My friend did a lot of NL> education regarding depression and basic things that the pt can do NL> around her home to combat the depression. NL> What do y'all think? Was this appropriate US medical model home health NL> OT intervention? NL> Sorry for being long-winded, NL> Mary Alice NL> Mary Alice Cafiero, MSOT/L, ATP NL> [EMAIL PROTECTED] NL> 972-757-3733 NL> Fax 888-708-8683 NL> This message, including any attachments, may include confidential, NL> privileged and/or inside information. Any distribution or use of this NL> communication by anyone other than the intended recipient(s) is NL> strictly prohibited and may be unlawful. If you are not the recipient NL> of this message, please notify the sender and permanently delete the NL> message from your system. NL> On Oct 31, 2008, at 12:59 AM, FAY, Felicity wrote: >> >> Hi there, I'm a Mental Health OT from Australia and work with clients >> who find it difficult to engage and identify their goals daily. >> Sometimes just engaging with the person and building rapport for a >> couple of sessions is enough for them to feel safe to work with you on >> re-engaging and devising personal goals that require some level of >> functional ability: thereby making physical therapy more meaningful >> (?). >> >> >> Occupational dysfunction often occurs previous ability, stability) >> across many domains due to depression, poor motivation, grief (loss of >> pet) and other mental health issues, in addition to aging and loss of >> general function. A good general screen is the DASS (Depression, >> Anxiety and Stress Scale) to inform treatment, or maybe a cognitive >> screen to ascertain whether she is able to formulate appropriate goals >> due to low mood and requires more support to identify them? Perhaps >> there are some personality vulnerabilities present that compound her >> current presentation of "rejecting" (or testing) you, then wanting >> more >> input. >> >> If her goal of being "normal" is strongly held then assistance to >> manage >> depression symptoms and education re same may assist her to return >> to a >> state that is more comfortable for her? I'm not sure how your system >> works or whether there is provision for OT's to work in this way? >> >> Felicity Fay >> Mental Health Occupational Therapist >> >> -----Original Message----- >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On >> Behalf Of [EMAIL PROTECTED] >> Sent: Friday, 31 October 2008 11:31 AM >> To: [email protected] >> Subject: OTlist Digest, Vol 43, Issue 44 >> >> Send OTlist mailing list submissions to >> [email protected] >> >> To subscribe or unsubscribe via the World Wide Web, visit >> http://otnow.com/mailman/listinfo/otlist_otnow.com >> or, via email, send a message with subject or body 'help' to >> [EMAIL PROTECTED] >> >> You can reach the person managing the list at >> [EMAIL PROTECTED] >> >> When replying, please edit your Subject line so it is more specific >> than "Re: Contents of OTlist digest..." >> >> >> Today's Topics: >> >> 1. Re: D/C'd Patient For Lack of Goals (McLaughlin, Jennifer) >> 2. Re: Best Practice (Ron Carson) >> 3. Re: D/C'd Patient For Lack of Goals (Ron Carson) >> 4. Re: D/C'd Patient For Lack of Goals (Joan Riches) >> 5. Re: D/C'd Patient For Lack of Goals (Ron Carson) >> >> >> ---------------------------------------------------------------------- >> >> Message: 1 >> Date: Thu, 30 Oct 2008 11:39:15 -0400 >> From: "McLaughlin, Jennifer" <[EMAIL PROTECTED]> >> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals >> To: <[email protected]> >> Message-ID: >> <[EMAIL PROTECTED]> >> Content-Type: text/plain; charset="us-ascii" >> >> Possibly a referral for depression screening or treatment. Sounds >> fairly typical with lack of engagement and participation in daily >> occupations. If she is unable to identify goals she may need medical >> assistance to get to a place to be able to identify goals. >> Just my humble thoughts. >> Jennifer McLaughlin, OT/L >> Geriatric Rehab specialist >> The information contained in this message may be privileged and/or >> confidential and protected from disclosure. >> If the reader of this message is not the intended recipient or an >> employee or agent responsible for delivering this message to the >> intended recipient, >> you are hereby notified that any dissemination, distribution or >> copying >> of this communication is strictly prohibited. >> If you have received this communication in error, please notify us >> immediately by replying to this message and deleting the material from >> any computer. >> >> Thank you. >> >> >> >> >> ------------------------------ >> >> Message: 2 >> Date: Thu, 30 Oct 2008 20:05:12 -0400 >> From: Ron Carson <[EMAIL PROTECTED]> >> Subject: Re: [OTlist] Best Practice >> To: "[EMAIL PROTECTED]" <[email protected]> >> Message-ID: <[EMAIL PROTECTED]> >> Content-Type: text/plain; charset=utf-8 >> >> Chris, I'm going to reply, but I need to take a break ... >> >> Ron >> -- >> Ron Carson MHS, OT >> >> ----- Original Message ----- >> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> >> Sent: Wednesday, October 29, 2008 >> To: [email protected] <[email protected]> >> Subj: [OTlist] Best Practice >> >> Ron>> And, I do not think? a? therapist? can? mentally? switch? >> from? >> Ron>> component? level? to occupation? level? treatment. Maybe >> I'm >> Ron>> wrong, but I think it's one or the other. >> >> cac> But in your case study you are switching back and forth >> from >> the >> cac> component level to eventually the occupational level.? >> Standing >> cac> tolerance=component level (cardiovasular, quad strength, >> static >> cac> standing balance).? Ambulation=componet level (cardiovascular, >> quad >> cac> strength both concentric and eccentric contractions, >> dynamic >> cac> balance).? All of this was leading to the individual's >> personal >> cac> occupational goal. >> >> cac> In my case study I was switching back and forth from the >> component >> cac> level to eventually the occupational level.? Estim to the >> digit >> cac> extensors=component level (facilitation of the neural >> pathway >> to >> cac> enhance neuroplasticity which in turn leads to digit extensor >> strength >> cac> and control).? All of this leading? to the individual's >> personal >> cac> occupational goal. >> >> cac> Chris Nahrwold MS, OTR >> >> >> >> >> >> >> cac> -- >> cac> Options? >> cac> www.otnow.com/mailman/options/otlist_otnow.com >> >> cac> Archive? >> cac> www.mail-archive.com/[email protected] >> >> >> >> >> >> ------------------------------ >> >> Message: 3 >> Date: Thu, 30 Oct 2008 20:10:08 -0400 >> From: Ron Carson <[EMAIL PROTECTED]> >> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals >> To: Joan Riches <[email protected]> >> Message-ID: <[EMAIL PROTECTED]> >> Content-Type: text/plain; charset=windows-1252 >> >> Thanks Joan and Jennifer: >> >> Because the patient is on HH, she is already >> receiving a plethora of services; everything from social worker, RN, >> aide to PT. >> >> You know the question of "why" was never answered, either by the >> patient, her family or myself. When I earlier mentioned mind mapping, >> it was because of this patient. >> >> I think something psychiatrically happened to her but she refuse my >> suggestion for a psych eval. >> >> One of the things that was even odder and leads me to think that maybe >> "I" was the problem is that the patient was doing well in PT and she >> took a bathe with the assistance of the aide. But, I swear, this >> patient would NOT verbalize wanting to do anything on her own. The >> only thing she said, especially in the beginning is that she wanted to >> be "normal". >> >> Ron >> -- >> Ron Carson MHS, OT >> >> ----- Original Message ----- >> From: Joan Riches <[EMAIL PROTECTED]> >> Sent: Thursday, October 30, 2008 >> To: [email protected] <[email protected]> >> Subj: [OTlist] D/C'd Patient For Lack of Goals >> >> JR> Ron >> JR> In a case like this I think that an OT eval may be the most >> effective >> JR> part of our offering. I am left with the question, "What referrals >> have >> JR> you offered to this family?" You have gathered valuable >> information. >> JR> This is certainly an extreme case of occupational dysfunction >> due to >> JR> ......what?? >> JR> If you have read English novels you may have run across similar >> JR> descriptions of 'invalid' (emphasis on the first syllable) upper >> class >> JR> women. It is an interesting brain twig to then put the emphasis on >> the >> JR> second syllable. Thanks for all the brain twigs now and in the >> future. >> >> JR> Joan Riches B.Sc.O.T., OT(C) >> JR> Specialist in Cognitive Disability >> JR> Riches Consulting >> JR> High River, Alberta, Canada >> JR> 403 652 7928 >> >> >> JR> -----Original Message----- >> JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] >> On >> JR> Behalf Of Ron Carson >> JR> Sent: October 30, 2008 7:08 AM >> JR> To: [email protected] >> JR> Subject: [OTlist] D/C'd Patient For Lack of Goals >> >> >> JR> Yesterday, I d/c'd a patient because she is unable to verbalize >> ANY >> JR> OT-related goals. It was a very strange and difficult case and I'm >> not >> JR> 100% comfortable with the d/c, but it seemed to be the best >> choice. >> JR> I'm VERY interested to hear others' opinions. >> >> JR> I evaluated a patient last week. Without going into a lot of >> detail, >> JR> the patient has mild arthritis, recently fell and had kyphoplasty. >> She >> JR> had been very active until about 5 years ago when she >> "suddenly" >> JR> became very sedentary. There assorted history and eval findings, >> but >> JR> this is basically a women who has disengaged from life. >> She >> JR> essentially lives on her couch and that's about it. >> >> JR> When I evaled her last week, she was unable to identify ANY OT >> goals. >> JR> Against, my better judgement, I "made up" a couple goals and >> scheduled >> JR> her for only two visits. >> >> JR> At the end of my second visit, I indicated that I was d/c'ing >> the >> JR> patient for lack of goals. The patient was OK with it but the >> husband >> JR> talked and asked me to stay on. After a long conversation with >> the >> JR> patient, one in which I was apparently "mean", the patient agreed >> that >> JR> she wanted me to come back. So, I signed her up for 5x/week >> therapy. >> >> JR> On the next visit, I was told that the patient "did not like >> me" >> JR> because I was mean. I promptly apologized to her, expressed my >> concern >> JR> and methods and asked for forgiveness, which she readily gave. >> After >> JR> that, I again started talking about the patient's life and goals. >> Her >> JR> son had mentioned that the family had a pet that died and that >> was >> JR> sort of "the beginning of the end" for the patient. The son >> had >> JR> mentioned possible pet ownership which I followed up on, but >> the >> JR> patient denied wanting it. >> >> JR> I came back two more times, with each visit focused on >> identifying >> JR> goals. We did a mini life review but no matter what avenue I took, >> the >> JR> patient denied any goals. So, I reluctantly told her that in >> the >> JR> absence of goals, d/c was the only option. She agreed and said >> she >> JR> was sad because she was "starting to like me". >> >> JR> She and I agreed that my time had not been wasted but that >> continued >> JR> visits would be a waste. >> >> JR> Without doubt, this is one of the hardest and strangest cases >> I've >> JR> ever had. I've never met a person who was so unmotivated and yet >> able >> JR> to articulate the same. >> >> JR> I know all the bases are not covered in this message but it >> hopefully >> JR> provides enough information to peak everyone's interest. >> >> JR> Thanks, >> >> JR> Ron >> >> >> >> >> >> ------------------------------ >> >> Message: 4 >> Date: Thu, 30 Oct 2008 19:04:50 -0600 >> From: "Joan Riches" <[EMAIL PROTECTED]> >> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals >> To: <[email protected]> >> Message-ID: <[EMAIL PROTECTED]> >> Content-Type: text/plain; charset="us-ascii" >> >> So work at not feeling so badly, Ron. Have you never heard the saying >> 'when all else fails refer to OT'. Because with all our angst about >> not >> being appreciated lots of folks know that OT expertise means we do >> make >> a difference many times when 'the others' were stumped. Sounds like >> you >> were a sacrificial lamb in this case. The fact that you are suffering >> because you worry about not helping this woman shows what a good OT >> you >> are. >> >> Special blessings, Joan >> >> -----Original Message----- >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On >> Behalf Of Ron Carson >> Sent: October 30, 2008 6:10 PM >> To: Joan Riches >> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals >> >> >> Thanks Joan and Jennifer: >> >> Because the patient is on HH, she is already >> receiving a plethora of services; everything from social worker, RN, >> aide to PT. >> >> You know the question of "why" was never answered, either by the >> patient, her family or myself. When I earlier mentioned mind mapping, >> it was because of this patient. >> >> I think something psychiatrically happened to her but she refuse my >> suggestion for a psych eval. >> >> One of the things that was even odder and leads me to think that maybe >> "I" was the problem is that the patient was doing well in PT and she >> took a bathe with the assistance of the aide. But, I swear, this >> patient would NOT verbalize wanting to do anything on her own. The >> only thing she said, especially in the beginning is that she wanted to >> be "normal". >> >> Ron >> -- >> Ron Carson MHS, OT >> >> ----- Original Message ----- >> From: Joan Riches <[EMAIL PROTECTED]> >> Sent: Thursday, October 30, 2008 >> To: [email protected] <[email protected]> >> Subj: [OTlist] D/C'd Patient For Lack of Goals >> >> JR> Ron >> JR> In a case like this I think that an OT eval may be the most >> effective >> JR> part of our offering. I am left with the question, "What referrals >> have >> JR> you offered to this family?" You have gathered valuable >> information. >> JR> This is certainly an extreme case of occupational dysfunction >> due to >> JR> ......what?? >> JR> If you have read English novels you may have run across similar >> JR> descriptions of 'invalid' (emphasis on the first syllable) upper >> class >> JR> women. It is an interesting brain twig to then put the emphasis on >> the >> JR> second syllable. Thanks for all the brain twigs now and in the >> future. >> >> JR> Joan Riches B.Sc.O.T., OT(C) >> JR> Specialist in Cognitive Disability >> JR> Riches Consulting >> JR> High River, Alberta, Canada >> JR> 403 652 7928 >> >> >> JR> -----Original Message----- >> JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] >> On >> JR> Behalf Of Ron Carson >> JR> Sent: October 30, 2008 7:08 AM >> JR> To: [email protected] >> JR> Subject: [OTlist] D/C'd Patient For Lack of Goals >> >> >> JR> Yesterday, I d/c'd a patient because she is unable to verbalize >> ANY >> JR> OT-related goals. It was a very strange and difficult case and I'm >> not >> JR> 100% comfortable with the d/c, but it seemed to be the best >> choice. >> JR> I'm VERY interested to hear others' opinions. >> >> JR> I evaluated a patient last week. Without going into a lot of >> detail, >> JR> the patient has mild arthritis, recently fell and had kyphoplasty. >> She >> JR> had been very active until about 5 years ago when she >> "suddenly" >> JR> became very sedentary. There assorted history and eval findings, >> but >> JR> this is basically a women who has disengaged from life. >> She >> JR> essentially lives on her couch and that's about it. >> >> JR> When I evaled her last week, she was unable to identify ANY OT >> goals. >> JR> Against, my better judgement, I "made up" a couple goals and >> scheduled >> JR> her for only two visits. >> >> JR> At the end of my second visit, I indicated that I was d/c'ing >> the >> JR> patient for lack of goals. The patient was OK with it but the >> husband >> JR> talked and asked me to stay on. After a long conversation with >> the >> JR> patient, one in which I was apparently "mean", the patient agreed >> that >> JR> she wanted me to come back. So, I signed her up for 5x/week >> therapy. >> >> JR> On the next visit, I was told that the patient "did not like >> me" >> JR> because I was mean. I promptly apologized to her, expressed my >> concern >> JR> and methods and asked for forgiveness, which she readily gave. >> After >> JR> that, I again started talking about the patient's life and goals. >> Her >> JR> son had mentioned that the family had a pet that died and that >> was >> JR> sort of "the beginning of the end" for the patient. The son >> had >> JR> mentioned possible pet ownership which I followed up on, but >> the >> JR> patient denied wanting it. >> >> JR> I came back two more times, with each visit focused on >> identifying >> JR> goals. We did a mini life review but no matter what avenue I took, >> the >> JR> patient denied any goals. So, I reluctantly told her that in >> the >> JR> absence of goals, d/c was the only option. She agreed and said >> she >> JR> was sad because she was "starting to like me". >> >> JR> She and I agreed that my time had not been wasted but that >> continued >> JR> visits would be a waste. >> >> JR> Without doubt, this is one of the hardest and strangest cases >> I've >> JR> ever had. I've never met a person who was so unmotivated and yet >> able >> JR> to articulate the same. >> >> JR> I know all the bases are not covered in this message but it >> hopefully >> JR> provides enough information to peak everyone's interest. >> >> JR> Thanks, >> >> JR> Ron >> >> >> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] >> No virus found in this incoming message. >> Checked by AVG - http://www.avg.com >> Version: 8.0.175 / Virus Database: 270.8.5/1755 - Release Date: >> 10/29/2008 5:27 PM >> >> >> >> >> >> ------------------------------ >> >> Message: 5 >> Date: Thu, 30 Oct 2008 21:31:04 -0400 >> From: Ron Carson <[EMAIL PROTECTED]> >> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals >> To: Joan Riches <[email protected]> >> Message-ID: <[EMAIL PROTECTED]> >> Content-Type: text/plain; charset=windows-1252 >> >> Joan it so funny you mention sacrificial lamb, because that's >> exactly >> how I felt. It seemed that no matter what, I could not "connect" with >> the patient. But in the end, we both agreed that OT had been very >> helpful. The whole experience was just strange! >> >> I like your saying! Here's one that I made up: >> >> OT - the Other Therapy! Sort of goes hand in the hand with your >> statement! >> >> Ron >> -- >> Ron Carson MHS, OT >> >> ----- Original Message ----- >> From: Joan Riches <[EMAIL PROTECTED]> >> Sent: Thursday, October 30, 2008 >> To: [email protected] <[email protected]> >> Subj: [OTlist] D/C'd Patient For Lack of Goals >> >> JR> So work at not feeling so badly, Ron. Have you never heard the >> saying >> JR> 'when all else fails refer to OT'. Because with all our angst >> about >> not >> JR> being appreciated lots of folks know that OT expertise means we do >> make >> JR> a difference many times when 'the others' were stumped. Sounds >> like >> you >> JR> were a sacrificial lamb in this case. The fact that you are >> suffering >> JR> because you worry about not helping this woman shows what a good >> OT >> you >> JR> are. >> >> JR> Special blessings, Joan >> >> >> >> >> >> >> ------------------------------ >> >> -- >> Unsubscribe? >> [EMAIL PROTECTED] >> >> Change options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] >> >> Help? >> [EMAIL PROTECTED] >> >> >> >> End of OTlist Digest, Vol 43, Issue 44 >> ************************************** >> >> >> >> >> _____________________________________________________________________ >> >> Disclaimer: This message is intended only for the use of the >> addressee(s) named >> above and may contain privileged information. If you are not the >> intended recipient of >> this message you are hereby notified that you must not disseminate, >> copy or take any >> action based upon it. Please delete and destroy the message from >> your computer. If >> you received this message in error please notify the Healthe Group >> of Companies >> immediately. Any views expressed in this message are those of the >> individual sender, >> except where the sender specifically states them to be the views of >> the Group. >> >> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] NL> -- NL> Options? NL> www.otnow.com/mailman/options/otlist_otnow.com NL> Archive? NL> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
