Thursday at Rose Manor

I felt nervous at first, since I didn’t know which patient I would see.  After I met the patient, I learned that she had Parkinson’s.  This required me to modify the activity that I had planned to use.  As I spent time with her and became acquainted with her, I felt more at ease.  I thought about her capabilities and appropriately downgraded to allow her to participate in the activity.

I was able to successfully utilize therapeutic use of self in order to make the patient feel comfortable and meet with her on her level.  Although I felt somewhat nervous, I was able to suppress the nervousness so that it wouldn’t affect her or our time together.

I want to become more comfortable in educating.  For example, with this particular patient, I want to be sure that any kind of educational demonstration that I do is something that will specifically be accurate and helpful so that it will benefit her with respect to her particular needs related to her condition (Parkinson’s).

I learned that I can put my fears behind me and I can make a difference on my patients’ behalf.  I have very much to learn, and even though I sometimes am nervous, I can push it aside and perform my job the way I need to.

When I realized that her condition would make it hard for her to participate in the activity that I had planned, I downgraded to make it possible for her to participate.  This was successful.  Even though she didn’t have fine motor skills, she was able to participate in the activity using the finger mobility that she had in two fingers.  Plus, after we had tried one level of activity, we tried another level that was somewhat more challenging for her.  She was able to do that, and this was very rewarding for me.  Also, near the end of our activity, she smiled and made a comment indicating that she seemed to enjoy herself.  That was very rewarding.

Since I didn’t know ahead of time which patient I would meet until a few minutes before I saw her, I was only able to take a brief look at her chart.  As a result, I wasn’t able to form much of an expectation regarding my visit with her. Since I had planned an activity to work on fine motor skills, it took me by surprise to learn that my patient had Parkinson’s.  As I mentioned above, this did require me to quickly modify my plans.  But I was still pleased by what she was able to do.  She unzipped the coin purse and slid the coins out of it; I didn’t have to do those things for her.  Picking the coins up from the table was hard, and I gave her physical assistance.  I was surprised that working with buttons wasn’t as hard for her as working with coins.

Overall, I was pleased with our session, and I’m looking forward to working with her again.

Upcoming semester

I am excited  and nervous to start this semester. I have not had that much experience with the geriatric community so I am a little bit nervous but it will be great experience. I think I am scared that I will feel "bad" for them. Especially if they don't really have family around to visit with. I need to be able to deal with those feelings and have the right things to say. I look forward to having one on one time with my assigned people! I like getting to know people and hearing their stories...etc. I am also excited about doing the interviews, especially the one with a family member. I thought that the aging quiz we took was interesting. There was some stuff that we automatically assume about aging that is actually not true. I also did not know that aging starts at 30....scary! 

Silver Alert!

I'll admit, when I started this program I told myself I did not want to work in a SNF or any other type of "old person's home" but the closer and closer it gets to starting this fieldwork the more open I'm getting to it. It's not that I don't like the older population, I actually adore them, I think it's the thought of taking care of them that scares me a little. With the elder population they just seem to fragile and come with many health problems. However, I really do love the older population and I think they enjoyment of spending time with them will get rid of the fears I have about the OTA aspect of it.

 I am looking forward to getting more hands on experience and learning more about how to work with patients and utilize our skills. Since I am more resistant to working in a SNF I am hoping that I will really like it and get a great experience out of it. One thing that I learned this week was about the rights that residents have, I want to acknowledge those rights as much as possible as an OTA. If I do work in a SNF or any other type of residental home I want to make my patients feel as much at home as possible and respect their needs and freedoms to live their life to the fullest.

From generation to generation

I really can't believe it's been a year now. It's flown by and yet, at times, it feels like we've been doing this for a lot longer. We've only known each other for a year yet we've become very close very quickly. I feel as though I have learned so much and yet I know there's still so much still yet to come.

I'm really excited about this summer and working with geriatric patients. I was very close with my grandmothers before they passed and spent a lot of time visiting them in the nursing homes. Through my times with them, I learned a lot of different homes and sections, such as the dementia unit. I also got to meet and learn about many other incredible people, from spies to teachers, with amazing stories. Each person I got to know had something very interesting to teach me. I look forward from learning from folks this summer and applying to my life, after all, with age comes wisdom. This summer I hope to learn a lot more from an OTA point of view versus just an onlooker. I'm excited, and nervous, about really getting to know people and being able to work with them. I hope to make a difference in their lives and help them in a step towards recovery.
It makes me nervous, or anxious, about making plans to follow for each session. I worry that what I come up with won't work, or won't really be helpful to the patient. I really want to help these folks in their step to recovery and want to make sure my goals I set are truly following their goals. I also worry about all the paper work! I never knew it would be so much to do even though I should have realized with all the talk about documentation. It seems overwhelming, but I'm sure I'll get used to it once it all begins.
This week, I learned how quick we have to be when making our evaluations about our treatment sessions. We don't get a week to stare at our computer screens while typing a note about how the session went. Instead, we have about 15 min. to do at least one note and probably two or three.
It will be very interesting to really begin applying what we've been up to this last year to 'real people.' Instead of practicing with fellow classmates or professors, we will be in the field. It's pretty exciting to think we're really going to be taking words from a text book and using them with real life situations.

Two Sides of Aging

The best time for a kiss shows up before the kiss happens.

Something shivers in the air between his soft old lips and mine.

Thousands of kisses burn and tingle there between our skins

in the almost touching places we still share.

As long as bliss can bloom and breath can bear

As long as there are living rivers in the air.

                                                                          --Shirley Windward (88) to her husband Erv (91)

    As I enter the second year of the OTA program, I feel excited, daunted and excited again. I have always been more comfortable with older people than younger ones. They tend to have a wealth of information if you take the time to listen. In fact, part of what excites me about this semester is the prospect of learning something in my interviews that I can incorporate into my daily routine of patient care.

     The bulk of my experience with an aging population has been with people who are aging in place. Almost everyone I know over the age of 65 lives on their own or with spouses. They are active, generally happy, and have enough money to sustain a comfortable life without giving up any necessities. They are like the people from the documentary Beauty of Aging by Laurie Schur, which has an excerpt below.

     What I find to be daunting about doing fieldwork at a skilled nursing facility is these are the same people I know, only they have had their independence stripped from them because of an inability to care for themselves at home any longer. As I discovered this week, only 4.5% of the elderly population lives in a nursing facility, but 30% of this small number are lonely or depressed because their needs are not being met on a physical, spiritual, social or emotional level. Prior to entering a facility, it is important to find the closest fit possible to address all areas of care. Skillednursingfacilities.org offers a list of all of the services available and links to more than 15,000 facilities nationwide.
     As a future COTA, my job is to do my best to give the people in SNFs the dignity, respect and independence they had when they could completely care for themselves (and help those in rehab get back home). I hope I can be effective in working toward written goals while embracing all aspects of need fulfillment in the small amount of time I will be allotted with each patient.
     The second excitement I feel toward this semester is knowing that I am really beginning to practice the techniques I have learned on fellow students. I am sure it will be quite a challenge to do in a real setting. I am counting on the clients being as patient with me as I will need to be with them.
  

Summer FW with Geriatrics :-)

                          
The topics for today are feelings about being 2nd year OTA student, what are we looking forward to this Summer with our Geriatric FW & what we learned new & exciting this week.  Sooo to start it off I am beyond ecstatic to be in the 2nd year of this program!  Everyday is a journey toward a lifetime goal & am so happy, Happy, HAPPY at this point entirely :-)  For the Summer it is also very exciting to go back to RM & do FW.  It is definitely the population that I hope to work with once out of school & the experience is absolutely priceless.  I'm looking forward to the plethora of knowledge that comes in abundance while @ the FW sites.  It's like a wonderful synapses that comes together before my eyes & through my brain connecting FW with textbook readings, lab competencies & lectures that is such an awesome experience!  It was really neat just in this first week back seeing how much we all have grown & how much more there is out there to gobble up & learn to be the best COTA's possible :-)

Facing the challenges of a new semester

Thinking about this first week and the semester ahead makes me have a variety of feelings.  I feel the normal nervousness that comes with starting something new.  Having never been to Rose Manor and not being familiar with the facility, it's easy to feel slightly nervous about going there. Some of that will be gone after getting into a routine.

When I consider what is most daunting for me, I would probably list paperwork, which involves writing good treatment plans and documentation.

I look forward to learning more about seniors and working with them at Rose Manor.  I've always enjoyed working with seniors, and one of my goals has always been to work in a SNF.  In class recently, I talked about the volunteer work that I used to do in a SNF.

One interesting thing that I learned this week was about the ombudsman program in Durham County.  I had never heard of this program, and I enjoyed learning about all the ways that they advocate on behalf of seniors and help improve their situations.

I appreciate the fact that the ombudsman program promotes the rights of SNF residents and their families.  Sometimes, residents and their families don't know where to turn or what to do, and an ombudsman can provide the information and assistance that they need.  This is especially important for residents who don't have family members living in the area.  For example, when I volunteered in a SNF, I learned that there was one resident there whose only daughter lived in Texas, so there were no relatives nearby to check in on her and make sure that she was receiving appropriate care.

This week I also learned that only 4.5% of senior citizens are in SNFs.  I would have thought that this number would be much higher.  I think that it's great that so many people are able to keep a certain amount of independence by living either at home or with family.

I have a friend whose grandmother lived alone in the mountains until she was 102.  For years, her relatives encouraged her to move in with some of them.  She would always say, "I will when I become old."  She finally moved in with a daughter until her doctor told her that her daughter, who was in her late 80s, was too old to take care of her!  She then moved into a SNF.

This first week has been very interesting, and I'm looking forward to learning much more in the coming weeks.

You can find more information about the Durham County ombudsman program at this link:

http://www.co.durham.nc.us/departments/bocc/Boards/Minutes/ACHCAC/Adult_Care_Home_Comm.html

DSM-V Gender Identity Disorder Revisions...

                                            

So the word in the world is about some purposed changes to the DSM-V to come out soon.  One of these changes refers to the diagnosis in the DSM-IV-TR that "gender identity disorder" is categorically incorrect & should be changed.  The new version of the DSM will re-categorize this with the diagnosis of "gender dysphoria".  What does this all mean one may ask ... Well a brief run down of the original diagnosis description is (courtesy of the DSM-IV-TR  302.6 Gender Identity Disorder in Children & 302.85 Gender Identity Disorder in Adolescents and Adults p. 259 - 262) The 4 brief diagnostic criteria are as listed below:

• Long-standing and strong identification with another gender

• Long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex

• The diagnosis is not made if the individual also has physical intersex characteristics.

• Significant clinical discomfort or impairment at work, social situations, or other important life areas.

Work is being done now with the APA (American Psychiatric Association) and the transgender community to best research and classify this characteristic in persons who feel outside of their naturally born gender.

Conflict arises when persons with what the DSM has deemed a "disorder" do not agree that there is any disorder about themselves.  With most all situations there is always 2 sides to the coin & exceptions to everyone.  Isn't that what being an individual is all about anyway?  So for the people with a slew of letters behind there name to try and place each unique person in a category is seemingly along the lines of prejudicial.  On the flip side also to actually have a mental ailment diagnosis attached to a person is not the most politically correct thing to do - ever.  So controversy is on the horizon concerning this issue.  

Since this is a blog and I can express my first amendment right harmlessly I say (with borrowed words) "Live and let live!"  If I feel like wearing purple and pink polka dots everyday because I relate better to tropical fish please let me as an American do so without prejudice or a diagnosis. 

As always get informed to break the stigmas and hope everyone has a nice day :-)  Follow the limk below to find out about more of the purposed changes to DSM-V.  http://www.dsm5.org/Pages/Default.aspx

Everybody Look at Me!! I'm HPD

I'm surprised that they would choose to eliminate Histrionic Personality Disorder. Histrionic means dramatic or theatrical according to ClevelandClinic.org. People who exemplify HPD constantly needs to be the center of attention, dress provocatively, self-centered, make rash decisions, and are overly concerned with physical appearances. These symptoms could greatly affect the people around them and could result in an unstable environment for that person. I would think this is very prevalent in our society now-a-days with all the materialistic praise our society focuses on. However, I can see where this type of personality disorder could get out of hand and be detrimental to many people involved. People with HPD tend to manipulate others for their own selfish desires. They could also spend a lot of money caring about their appearance such as plastic surgery, shopping sprees, and physical upkeep. Some may say that there is a fine line between being spoiled and materialistic to having Histrionic Personality Disorder. Mental illness is a type of abnormal disorder that influences a person's thoughts, emotions, or behaviour and could cause harm to themselves or other people (freedictionary.com). Even though this behavior could be common and hard to diagnose I think if the condition is extreme enough it needs to be treated. Most people with Histrionic Personality Disorder could also experience depression and low self-esteem due to the fact that they are constantly seeking approval from others for their happiness. These conditions are not normal and should be addressed. I can see how HPD can overlap other disorders such as bipolar disorder, body dis-morphia disorder and borderline personal disorder but HPD addresses specific symptoms in which could hinder one's life and the life of those around them. More specific symptoms are included below: (Pubmedhealth)

Symptoms

People with this disorder are usually able to function at a high level and can be successful socially and at work.
Symptoms include:

• Acting or looking overly seductive
• Being easily influenced by others
• Being overly concerned with their looks
• Being overly dramatic and emotional
• Being overly sensitive to criticism or disapproval
• Believing that relationships are more intimate than they actually are
• Blaming failure or disappointment on others
• Constantly seeking reassurance or approval
• Having a low tolerance for frustration or delayed gratification
• Needing to be the center of attention (self-centeredness)
• Quickly changing emotions, which may seem shallow to others

Here is also a video to give a better example and differentiation of this disorder compared to others mentioned above.

 

In my opinion I think Histrionic Personality Disorder should not be eliminated from the DSM-5 because it is prevalent and detrimental to society and can be treated with therapy and medication. If it is eliminated from the DSM-5 this condition will not get recognized as problem or someone may be given the wrong diagnosis and not get the proper treatment.

References:

http://www.thefreedictionary.com/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002498/

http://my.clevelandclinic.org/disorders/personality_disorders/hic_histrionic_personality_disorder.aspx