You are right. The neither like nor fully understand it. But, they do respect my autonomy enough to not fire me!! <LOL>
----- Original Message ----- From: cmnahrw...@aol.com <cmnahrw...@aol.com> Sent: Wednesday, July 01, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Just About To Give UP............ cac> I agree with Ron, but I bet the nursing home company in which you work cac> for will not like that idea much. cac> -----Original Message----- cac> From: Ron Carson <rdcar...@otnow.com> cac> To: Diane Randall <OTlist@OTnow.com> cac> Sent: Wed, Jul 1, 2009 8:31 am cac> Subject: Re: [OTlist] Just About To Give UP............ cac> Hello Diane and other: cac> Diane, I strongly believe that when a patient has no identifiable cac> occupational goals, then they should not be seen by OT. After all, if cac> the goal of OT is enabling people to engage in occupation and yet there cac> are no occupational goals, then what is OT doing? More likely than not, cac> they are doing exercises, which is wrong on two levels: cac> 1. Does not REQUIRE the skills of a therapist cac> 2. Is not OT cac> Here's two patients I have today: cac> 1. Patient is unable to care for himself because of weakness and fear of cac> falling. We will work on standing, transfers and mobility. cac> 2. Patient is unable to care for herself and carry out daily occupations cac> related to her role as a wife. We will work on standing, transfers, cac> mobility, etc. cac> None of my interventions include focused treatment on UE, LE, strength, cac> etc. Instead the focus is on restoring lost occupation. This is done by cac> addressing SPECIFIC and IDENTIFIABLE problems which are preventing cac> SPECIFIC and IDENTIFIED occupational goals. It really is a practical cac> approach that I liken to learning to ride a bike. If a person wants to cac> ride a bike the best way is to practice, practice, practice. Like wise, cac> if a person wants to dress, toilet, bathe, shower, cook, clean, laundry, cac> etc, the best approach is practice, practice, practice. cac> I want to address some other things, but I'm off to work. cac> Ron cac> ~~~ cac> Ron Carson MHS, OT cac> www.OTnow.com cac> ----- Original Message ----- cac> From: Diane Randall <spark...@rcn.com> cac> Sent: Tuesday, June 30, 2009 cac> To: OTlist@OTnow.com <OTlist@OTnow.com> cac> 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 cac> become well DR>> acquainted with the UE focus of OT. But, I think the most cac> frustrating part DR>> of the process is not some much the interventions but the fact that cac> 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 cac> 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 cac> (cooking, DR>> cleaning)" DR>> Patient B- "I have not worked since I gained weight...have not left cac> 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 cac> myself" DR>> How can we motivate patients to value "occupation" when thier goals cac> are to DR>> just get strong enough to go back to their lives which in many cac> cases is DR>> totally dependent on others. Even simple ADL's do not seem to be a cac> goal of DR>> some patients? DR>> I also see in some ways why UE has become so popular in cac> 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 cac> treatment. It is DR>> almost impossible to individualize OT treatment when you have 5-6 cac> or more DR>> patients seeking your attention all at one time. In addition , I cac> have DR>> noticed PT/OT /Speech seem to be in melting pot of therapy. I see cac> speech do DR>> cognitive activities I learned in school. Sometimes the only cac> difference you DR>> can really tell between an OT and PT in the gym setting is where cac> they focus DR>> patient work (above or below the belt) DR>> HH is a little different..I would expect a HH agency to value cac> occupation. I DR>> mean...it is one on one therapy for gods sakes. So much can be done cac> in that DR>> setting. I would be frustrated too. We have to make a commitment to cac> 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 cac> kitchen from DR>> a recipe chosen by the patient). But is should never be the "only" cac> focus or DR>> we have essentially become PT's..we all need to educate our cac> 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 cac> change my DR>> profession. DR>> No one seems to value occupation as an outcome. I refuse cac> to see DR>> patient's with the purpose of improving UE function so my HH agency cac> just DR>> calls other OT's who will. PT's don't appreciate occupation cac> but it DR>> encroaches on their treatment. My agency is clueless about cac> 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 cac> well. DR>> Most of them can not articulate occupation or occupational cac> 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. cac> EVERTHING is DR>> about PT, PT, PT, and how wonderful they are. There must be like 15 cac> PT's DR>> while there is only 3 OT's. It's really a sad state of affairs. cac> I am DR>> tired of going from "hero to zero". Hero with patients and zero cac> with my DR>> agency and other therapists. DR>> The other day a nurse with 24 years experience told a patient cac> that OT DR>> was about small muscles and PT was about gait and large muscle cac> groups. I DR>> promptly called the nurse and explained that OT is about cac> occupation - DR>> i.e. take care of yourself and being productive. She said, cac> that she DR>> didn't know and that even after all these years she really has no cac> idea DR>> what OT does. She suggested that I call my agency and do an cac> inservice. DR>> Now can you even imagine that a home health agency needs an cac> inservice on DR>> the role of OT!! Sad state of affairs. DR>> Am I the ONLY OT who experiences and feel these cac> emotions??????????????? DR>> Gosh, I hope not. But then on the other hand, maybe it's just me. cac> Maybe DR>> I just refuse to accept the way things are. Maybe I'm cac> just a DR>> self-centered egotist who is totally clueless about OT. I truly, cac> truly DR>> don't understand WHY "things" are the way they are. And cac> more DR>> importantly, what can be done, if anything, to change the cac> 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 cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
