Hello Diane and other: Diane, I strongly believe that when a patient has no identifiable occupational goals, then they should not be seen by OT. After all, if the goal of OT is enabling people to engage in occupation and yet there are no occupational goals, then what is OT doing? More likely than not, they are doing exercises, which is wrong on two levels:
1. Does not REQUIRE the skills of a therapist 2. Is not OT Here's two patients I have today: 1. Patient is unable to care for himself because of weakness and fear of falling. We will work on standing, transfers and mobility. 2. Patient is unable to care for herself and carry out daily occupations related to her role as a wife. We will work on standing, transfers, mobility, etc. None of my interventions include focused treatment on UE, LE, strength, etc. Instead the focus is on restoring lost occupation. This is done by addressing SPECIFIC and IDENTIFIABLE problems which are preventing SPECIFIC and IDENTIFIED occupational goals. It really is a practical approach that I liken to learning to ride a bike. If a person wants to ride a bike the best way is to practice, practice, practice. Like wise, if a person wants to dress, toilet, bathe, shower, cook, clean, laundry, etc, the best approach is practice, practice, practice. I want to address some other things, but I'm off to work. Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Diane Randall <spark...@rcn.com> Sent: Tuesday, June 30, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Just About To Give UP............ DR> Hello, As a new OTA/L a week into my first job in a SNF, I have become well DR> acquainted with the UE focus of OT. But, I think the most frustrating part DR> of the process is not some much the interventions but the fact that so many DR> of my patients have really no "occupation" to look forward to when DR> discharged from rehab. It is no wonder we may be tempted to stick with just DR> UE exercises. ( besides ADL's we do in rooms) DR> Question...tell me about a typical day you spend at home? DR> Replies (paraphrased) DR> Patient A- "I just watch Soaps..my daughter does everything (cooking, DR> cleaning)" DR> Patient B- "I have not worked since I gained weight...have not left the DR> house except to come here for 2 weeks...thank god for disability." DR> Patient C- "I don't want therapy and you can't make me go". DR> patient D- " The nurses do everything for me...why should I dress myself" DR> How can we motivate patients to value "occupation" when thier goals are to DR> just get strong enough to go back to their lives which in many cases is DR> totally dependent on others. Even simple ADL's do not seem to be a goal of DR> some patients? DR> I also see in some ways why UE has become so popular in SNF's....it's easy, DR> it looks productive, and it can be done simultaneously with others. DR> Productivity expectations have created UE ther-ex focused treatment. It is DR> almost impossible to individualize OT treatment when you have 5-6 or more DR> patients seeking your attention all at one time. In addition , I have DR> noticed PT/OT /Speech seem to be in melting pot of therapy. I see speech do DR> cognitive activities I learned in school. Sometimes the only difference you DR> can really tell between an OT and PT in the gym setting is where they focus DR> patient work (above or below the belt) DR> HH is a little different..I would expect a HH agency to value occupation. I DR> mean...it is one on one therapy for gods sakes. So much can be done in that DR> setting. I would be frustrated too. We have to make a commitment to see UE DR> ther-ex as a means to an end. Strength to transfer to a toilet DR> independently-standing tolerance to create a simple meal in the kitchen from DR> a recipe chosen by the patient). But is should never be the "only" focus or DR> we have essentially become PT's..we all need to educate our patients about DR> what we do...and sadly other professionals around us. DR> -----Original Message----- DR> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on DR> Behalf Of Ron Carson DR> Sent: Tuesday, June 30, 2009 20:28 DR> To: OTlist@OTnow.com DR> Subject: [OTlist] Just About To Give UP............ DR> I am just about at the end of a very long road of trying to change my DR> profession. DR> No one seems to value occupation as an outcome. I refuse to see DR> patient's with the purpose of improving UE function so my HH agency just DR> calls other OT's who will. PT's don't appreciate occupation but it DR> encroaches on their treatment. My agency is clueless about occupation DR> and has no reason to learn about it. DR> I so value what I do and I believe that most of my patient's do as well. DR> Most of them can not articulate occupation or occupational therapy but DR> they do know that I'm there to teach them two things: DR> 1. How to take care of themselves DR> 2. How to be productive DR> I almost cried when I left my agency's staff meeting today. EVERTHING is DR> about PT, PT, PT, and how wonderful they are. There must be like 15 PT's DR> while there is only 3 OT's. It's really a sad state of affairs. I am DR> tired of going from "hero to zero". Hero with patients and zero with my DR> agency and other therapists. DR> The other day a nurse with 24 years experience told a patient that OT DR> was about small muscles and PT was about gait and large muscle groups. I DR> promptly called the nurse and explained that OT is about occupation - DR> i.e. take care of yourself and being productive. She said, that she DR> didn't know and that even after all these years she really has no idea DR> what OT does. She suggested that I call my agency and do an inservice. DR> Now can you even imagine that a home health agency needs an inservice on DR> the role of OT!! Sad state of affairs. DR> Am I the ONLY OT who experiences and feel these emotions??????????????? DR> Gosh, I hope not. But then on the other hand, maybe it's just me. Maybe DR> I just refuse to accept the way things are. Maybe I'm just a DR> self-centered egotist who is totally clueless about OT. I truly, truly DR> don't understand WHY "things" are the way they are. And more DR> importantly, what can be done, if anything, to change the direction of DR> UE physical dysfunction OT. DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/otlist@otnow.com DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
