Hello Lucy:
You make good points and part of my conditions for giving people the
opportunity to make informed decisions is that they are mentally capable
of the same. Also, it is often a struggle when people only want to walk
but have no other stated goals. I generally aproach this situation as
follows:
1. I ensure patients understand occupation and it's many componets,
including:
a. Pysical
b. Mental
c. Environemtal
d. Emotional
e. Social
2. I ensure patients understand my role as an OT is to enable them to
safely and independently engage in meaningful self-care and producutive
occupations in their home. Remember, that I work in home health.
3. I consider input from family members. For example, a husband may not
want to increase his participation with tolieting, but the wife reveals
she is having difficulty managing this occupation.
4. I offer that I can come back for a 1 time followup visit. Frequenty,
patients will take this option with a sort of "well if that's what you
want" approach.
5. Patients are always told that then can call me back at anytime either
by calling my agency or calling me directly.
But, when it's all said and done, I TRY leaving the decision up to the
patient. If I've done all the above steps and the patient still declines
to start or continue OT, I generally walk away with a good feeling. I've
always maintained that when patients are unable (assuming they are
capable) of identifying occupatiional goals, there is no role for OT.
One last note on therapeutic relationship. Without question, it is my
relationship with the patient that makes or breaks patients OT goals. It
is my experience that patient's with a good therapeutic relationship do
MUCH better at reaching their goals. Conversely, those patients with a
poor therapeutic relationship tend to do much worse at reaching their
goals.
Thanks for the dialogue!!
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Lucy Simpson <[email protected]>
Sent: Saturday, April 11, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Empowering Your Patients...
LS> Ron
LS>
LS> I understand this approach and it is certainly client centred. My
LS> hesitation is that often patients have 'walking' as their goal and
LS> see this as the answer to everything..... it is sometimes only when
LS> they achieve this goal but still find they struggle with ADL's that
LS> they see the value of OT.
LS>
LS> In my experience in the acute setting I found patients can sometimes
LS> lack insight into their difficulties. They often report they will be
LS> 'fine' once they get home. We are the professional and our training
LS> gives us the ability to relate physical difficulties to the
LS> potential functional difficulties they may cause, and often cannot
LS> see the wood for the trees!!.
LS>
LS> I am sure in your eval you address the patients level of
LS> understanding/insight but sometimes it can take 2 or even 3
LS> meetings, in which you establish a therapeutic relationship, which
LS> then leads the patient to make OT goals.
LS>
LS> Currently I am working in the community and the patients that are
LS> referred to us often know exactly what they want, (it is not always
LS> what we can provide!!) so the situation you describe hardly ever
LS> arises in this setting.
LS>
LS> As ever thanks for all your great posts, I am an avid follower of
LS> this list.
LS> Kind Regards
LS> Lucy Simpson
LS> For Quality Stationery and Greetings Cards check out this website:
LS> www.phoenix-trading.co.uk/web/lucysimpson
LS> Save it in your favourites for the next time you need cards.
LS>
LS> ---
LS>
LS> --
LS> Options?
LS> www.otnow.com/mailman/options/otlist_otnow.com
LS> Archive?
LS> www.mail-archive.com/[email protected]
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/[email protected]
