This past week at fieldwork, I was assigned to work with a patient in the dementia ward. Note, I had not prepared a session for this patient, once again the patient that I had prepared for was discharged, and once again, I was flying by the seat of my pants ... but what's new. It actually turned out to be the best session that I have experienced yet. But I digress, I'll start over ...
I introduced myself to Mr. L for the first time as part of my dementia competency. He was eating breakfast and the CNA said it would be an hour before he would be done. An hour?!? So, my task (we were supposed to engage our patient in an activity) was to try to get Mr. L to feed himself a few bites of finger food. He, in recent weeks according to the CNA, has stopped feeding himself. As I approached and introduced myself, he showed no interest in me or in his breakfast. A challenge. I was talking to him, trying to find something that would jar him. This was a little difficult since I didn't know anything about him, his condition or his family. Eventually, though, I was able to coax him with hand-under-hand, to eat the rest of his pancakes and the whites of the boiled eggs he had on his plate. He did pick up his bacon and eat a bite and he picked up a piece of egg that had fallen off of his fork. Boy! I felt successful ... for about 2 minutes.
My instructor then asked me to facilitate his dressing and teeth brushing and hair brushing. Up to this point, the only thing that my patient had said was an out-of-the-blue "G#! D@!*."
Back in his room, I asked him to take his pajama bottoms off, so that we could dress in regular clothes. My instructor had taken out a pair of shorts and asked him if they were okay. With no response, I guess I thought he had no opinion. Boy was I wrong. First of all, we are told in school "don't ask you patient if they want to do something, tell them what they need to do." He let me know (without distinguishable words, except an explicative) that he was NOT going to be told what to do. New tactic ... "Help me ... " He relinquished to a degree, but I had to keep downgrading until he was mod - max (A). With much ado, he was finally dressed with his teeth and his hair brushed.
The main thing that I came away with from this experience was two-fold. Though he couldn't speak intelligibly most of the time, he definitely had feelings and opinions that couldn't be ignored. When I trying to get him to dress, he expressed, very lucidly, "I'm a man!" He did not want two women helping him to dress. I can't blame him, I wouldn't want two strange men dressing me, either.
He also knew enough to know he was having trouble. My instructor told him at one point "your having a little trouble thinking right now and we're here to help you." He nodded his head and made an "uh huh." I felt really bad for him. He knew that he should be able to do these things and was frustrated that he needed help.
After everything was over, I was very glad that my original patient was a no-show. I found a bit of my therapeutic self coming out, and I enjoyed it very much. I have been thinking about Mr. L off and on all weekend. What could be done to help improve his quality of life, make him more independent and reduce the burden on the CNAs charged to look after him? Here are 2 Youtube videos that show how OT can help patients with dementia. http://www.youtube.com/watch?v=5QNbMZtDtkw and
http://www.youtube.com/watch?v=0_WREuVAnpU
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