I agree with Ron, but I bet the nursing home company in which you work
for will not like that idea much.
-----Original Message-----
From: Ron Carson <[email protected]>
To: Diane Randall <[email protected]>
Sent: Wed, Jul 1, 2009 8:31 am
Subject: Re: [OTlist] Just About To Give UP............
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 <[email protected]>
Sent: Tuesday, June 30, 2009
To: [email protected] <[email protected]>
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: [email protected] [mailto:[email protected]]on
DR> Behalf Of Ron Carson
DR> Sent: Tuesday, June 30, 2009 20:28
DR> To: [email protected]
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?
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DR> --
DR> Options?
DR> www.otnow.com/mailman/options/otlist_otnow.com
DR> Archive?
DR> www.mail-archive.com/[email protected]
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