Hi I have worked in an in-patient rehab setting and most of my patients would have goals around toileting, washing and dressing. I would carry out an initial assessment with the paitents at the appropriate time of day e.g. first thing 8.30..... it is important to try and see the patient carrying out these activities at the usual time that they would carry it out for a few reasons:
Their ability may vary at different times of the day It goes towards recreating a realistic situation. This will increase carry over and assist patient to incorporate any adaptive techniques in this situation at home long after therapy input has stopped. The ideal re the multidisciplinary team is that you communicate with eah other, and incorporate any techniques that other disciplines are using/teaching to the patient in all our interventions. E.g. if physio are working on 'normal movement' re sit - stand with a CVA patient the OT when assessing personal care should reinforce the techniques learnt in physio and ensure the patient is not using inappropriate compensatory techniques. Re - nursing, assistants often they have a different approach and work more from a 'caring' than an 'enabling' approach. This is a matter of education. I was fortunate that I had therapy assistants who, following my initial assessment would follow a treatment plan that I would devise with the patient. The assistants would 2-3x per week support the patient with their morning routine and I would review this as required and adapt plan as the patient hopefully improved. The best approach is to explore all forms of communication with your team. If all disciplines have a consistent approach then the patient is far more likely to progress and carry over the techniques/strategies that they learn during rehab. We had a communication book, weekly meetings/goal setting, and sometimes took photo's of the patients, this was very effective when wanting all staff to adhere to UL positioning in lying/sitting/standing for a CVA patient with a subluxed shoulder. One major difference for me though, being in the UK is that I do not have to 'bill' for my time... we have to keep stats re our patient contact but being the national health service I think it is easier to spend time teaching our colleagues without having to justify it too much...(that is when we are fully staffed, which sadly is not often!!!) 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 Wed, 11/2/09, Ron Carson <[email protected]> wrote: From: Ron Carson <[email protected]> Subject: Re: [OTlist] Back to basics? To: "Barbara H. Hale" <[email protected]> Date: Wednesday, 11 February, 2009, 12:39 AM Am anything but insulted. I appreciate that you are seeking information. I will ask that other list members also add their 2 cents to this discussion. Now, to answer your question. Yes, I do work in home health. I previously worked in acute care rehab and loved the patient population but hated the productivity requirements. I was a new therapist then and my approach to treatment is a lot different today. I think if I was working in rehab my approach would be as follows: Help the patient identify their occupational goals, identify what's impairing those goals, treat those areas that are treatable and that I'm trained to treat. In some ways, working with a patient 2 days post stroke can be very similar to working with a patient 2 months post stroke. Sure, some things will be different and you may have a very low level patient who is unable to verbalize goals. Of course, I also have patients who are that way. More than anything else, almost every patient you have is going to want to stand and/or walk. They will want to stand to get and put on their clothes. They want to stand to go to the bathroom and shower. So, work on these goals by starting with the lowest common denominator. Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Barbara H. Hale <[email protected]> Sent: Tuesday, February 10, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Back to basics? BHH> Hi - I hope you are not insulted by my questions. I would like to understand BHH> more fully your treatment concept for a patient that is not independent in BHH> toileting. Is your setting usually in the pts home? Do you ask the pt to BHH> take a dry run into the toilet? Do you ask the pt if they need to actually BHH> use the bathroom? Do you simulate any activities? I do not think that you BHH> are asking the pts to undress each time you enter their home. BHH> In my setting, acute rehab, what type of initial suggestion would you make BHH> to a pt a few days post CVA or Hip Fx? Lets get up and sit on the BSC? Lets BHH> get up and get into the wheelchair so we can go to the tx gym? All my BHH> sessions are not first thing in the AM when it really would make sense to do BHH> concrete care such as toileting. CNA's and Rehab Techs are often the initial BHH> contact for the day and will have already assisted the pt with their BHH> toileting. It is not considered OT when that other staff member assists BHH> them, and the other staff may do more for them without asking them to BHH> participate. I often feel that I should be training the staff for more BHH> opportunities using the skills that will be taught in tx. but that is not BHH> billable tx time. BHH> Asking a CNA for input in the level of assist needed for toileting would BHH> only make sense in a perfect world. But we are asked not to overlap BHH> PT/OT/Nursing for fear the tx will be seen as un-necessary? What the pt is BHH> able to do for themselves certainly will change as they begin to heal from BHH> their insult. By the time you see them in home tx they are more aware of BHH> what their priorities are. BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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]
