Introductions...

                               

This last Thursday we met with our patients on the FW 1 site for Geriatrics.  It was a very interesting time to say the least.  First we go in and review the clients chart to be more aware of the conditions our client is ailed with.  My client suffered a R CVA not quite 90 days ago; is suffering from left neglect, confusion at times & can follow 2-3 step instructions to give a little idea of what was going on with them.  I go in to start a 45 minute session figuring a 15 minute warm up to get to introduce myself & get to know her a bit better.  It went well & I feel good about that.  I tried to use my best professional skills of therapeutic use of self to be confident, engaging & get to know the resident better as opposed to what I read in the charts.  Definitely I need to work on timing & the activities we are doing.  I gave her the choice of 3 activities to do & she wanted to do 2 of the 3.  We worked on designing a plate with 4 different brightly colored feathers & than she wanted to play rummy as her next activity.  (Left neglect was very apparent when decorating the round plate.  She pushed the plate in my direction after it was only half filled on primarily the right side.)  I’ve included below here a Youtube video demonstrating L neglect to get a better idea of how this actually appears in a person.  Once we got to playing rummy it was apparent also that it was going to take quite some time to finish the game & I didn’t want to leave the game unfinished.  The client was sometimes confused & acknowledged that some correction was needed.  The example is she tried to add a 9 to her set of 6’s.  It was interesting to see her figure through it & finally ask “is that right?”  She said a 9 can’t go upside down & that wouldn’t work.  The image I had of her from reading the chart looked similar from what I saw.  (I did see this client previously so I admit to an advantage there.  It did fill my heart to see all the progress she had made since the last time I saw her in person against the new information in the chart.)The favorite part of the session was when I asked if it would be ok if I came back next Tuesday and she smiled and said “yes.”  To me it was a sign that a semblance of rapport was built & we could go from there.  Onto next week!!! http://www.youtube.com/watch?v=ymKvS0XsM4w&feature=related

Left Arm Touch My Chin

This week I got to shadow an OT do a session on a patient who suffered from a right hemiplegia stroke several months ago. I noticed as I was observing how much patience it takes for the therapist during the session. I caught myself moving my body in the direction the patient needed to move in because the process was so slow and tedious. I realize you really have to keep a professional persona during everything because at times I'm sure it can feel like you're (the therapist) are not being heard when you tell the patient to do something and they don't do it right away.

 

Due to the fact that I was shadowing rather than actually doing the therapy session. I did not get to demonstrate any professional or clinical skills. One thing that I did do was try to ask questions and get clarification when the time was appropriate to make sure I was on track with the lingo of the session. I did observe the OT and another student who was shadowing try to scoot the patient back into her wheelchair. They were trying to grab underneath her legs and pick her up and scoot her back which was unsuccessful. The whole time I was thinking about how we do our transfers and how we learned how to scoot someone back in the chair. I asked if they have ever tried it the way we learned it and it seemed like she was unaware of what I was referring to, but they then approached her from the front and that worked. I am still curious if our method would have been successful or not or if the patient was too unstable to even try. There were a lot of things that the therapist did that I really liked; she had the patient say out loud what she wanted her to do to help reinforce movement from her arm that was spastic. For example, the patient had to touch her chin so the patient would say "left arm touch my chin."

One thing I need to work on is apply what I see to what I need to document in a SOAP note. I'm still having trouble processing the important parts of the information. I really tried during the session to keep a mental note about what I would record for my SOAP note by remembering that she did 2/5 trials of ROM flexion and extension. I'm not sure if I'm thinking accurately when it comes to trying to documenting what I see. I did learn that a lot of the things the OT observed I observed as well so I feel like I am doing better at analyzing therapy sessions like an OT.

My favorite part of the day was seeing the OT use different tactics to facilitate and decrease spasticity. She did a contract and relax method, each time she did that the patient was able to move her arm a little more in extension. Also having the patient use commands to move her arm was cool to learn too and seemed to work well.

Jumping In

                        "The time to hesitate is through." -The Doors
     Flexibility was the key to my week. The patient whose chart I reviewed was not mobile, so prior to seeing her it was determined I would work with someone else. I reviewed that patient's chart and located the room, but her bed was empty and her roommate didn't know where she was. After prompting from my instructor, I asked the people at the nursing station, who didn't know either. I looked throughout the facility and found a nurse who realized the patient was at a doctor's appointment. Strike one.
     Ms. G and I decided it would work to go back to my original patient for purposes of interview practice. When we arrived, she was already with another student and instructor. Strike two.
     I was assigned a third patient, quickly reviewed the therapy notes, and went to his room. The bed was empty. Strike three. I quickly began asking anyone who was possibly familiar with the patient, if they had an idea where he might be found. As I walked the halls an internal clock raced...tick, tick, tick: no patient, no therapy. No therapy, no paperwork. No paperwork...
     Luckily, as I rounded the corner to his room one last time, his family member wheeled him around the corner from the opposite direction.

I stopped him in the hall, introduced myself, appealed to his sense of altruism and asked if he would help me. He obliged by going to a triva game for residents. His hands were both in splints and he couldn't hold a pen, so we worked as a team with him answering the questions and me writing the answers. When he would question if one of his answers was right I would turn it around and say, "What do you think?" This seemed to make him more apt to answer with conviction and elaborate on some answers. He appears to have good cognitive abilities, with slight memory deficits for more recent trivia. I felt good about getting the opportunity to work with him in this way because we had a good rapport and I was able to make some general assessments even though I did not get to know him well.
     My time ran out quickly and I had to pass him off to one of the teachers for the remainder of the game so I could do my paperwork. Though my patient was not left unattended, I did not like the way I abruptly ended my session with him. I will definitely remember that for the future.
     This week I learned that I can roll with the punches, do not get too flustered by change, and I can jump right in an talk to a patient without hesitation.
      I didn't have many pre-formed opinions of my patient because I only reviewed his safety precautions and general goals. I wasn't affected by his physical appearance, however, which could have been shocking. He had fallen outside his home several days ago. No bones were broken, but because he was on blood thinners, the whole side of his face, both arms and both hands were completely purple. He didn't complain of much pain beyond his hands (which bore the brunt of the fall), so hopefully when I see him next week we can get him back on the road to full independence.

Failure is not the end

Going into our first day with clients in a one-on-one session, I was very nervous and very excited. I could not wait for today to begin, as well as I had no idea what I was getting myself into. It began on a complicated note because I didn't even know if my patient was still a patient at the geriatric unit we are currently having our field work at. The last OT note I saw was dated for 5/6/12 and today was 5/31/12. Fortunately, my client was there for me to attempt to work with.
Right away I struggled with being to authoritative, as I went into the room to find my client, I found him asleep in bed. I know I love my sleep, so I definitely didn't know what to do about my gentleman. Thankfully, my professors help by sending me back into the room to wake him up and begin working with him. However, I immediately ran into my second brick wall. The man refused to want to work with me. I was able to, thanks to the aide of my professor, to finally be stubborn enough to force the gentleman to talk to me for about 15 minutes. I feel as I did well in talking with the fellow and finding out things about his life and things he enjoyed doing. Of course, all the while he was lying down because he wanted nothing more than to sleep. Through this interaction, I learned that I myself need to be more stubborn about working with patients. If there asleep, wake them, if they say "no" keep trying. Even though I was unable to get the fellow up and moving around, we were able to have a little conversation. So will I can talk and carry a meaningful conversation, one that attempts to get at the focus of therapy, I need to jump right in and not doubt myself.
My favorite part was that I did fail in my attempts to work with this patient. However, I didn't allow it to affect me personally. I have learned that yes, some things will work great, and some things will fall flat on it's face. My attempts to work with this gentleman and to coax him into working with me, failed. I was able to also "attempt" to follow the OT as she attempted to work with this man as well. Again, I was proven that failure is part of the job as the man refused to work with her as well, even getting angry and stating, "I'm getting tired of this damn s**t." This proves to me that just because I failed, doesn't mean it's my fault.
His papers, history and reports, were very confusing and mixed up. Between OT, SLT, and PT, this man was completely independent to completely dependent. Some had him working on balance while sitting while others showed him mobile. It did say he would refuse meds and OT which gave me some information on what to expect as far as personality. While working with the OT, we were able to get him to walk, but that's it. He would not use his UB for ANYTHING. He even walked with his hands clenched behind his back so as not to use them.
I was surprised at how accepting I was at failing. I thought I would take it more personally as if it was my fault. But thanks to pervious fieldworks and professors I have learned that it's just part of the job and to accept it. Thankfully, I was able to do just that and was still able to learn from it as well. I can't wait for Tuesday to come so that I may try again, this time with a different patient!

2nd day!

My session with the patient was mostly talking to get to know her although, she did have to use the bathroom so I got to assess how she gets up/sits down and moves around with her walker. When I first walked came she was waiting for someone to come clean up some water on the floor in the bathroom. I thought that was great use of safety awareness and her visual skills must be pretty good! I had to use time management skills  to make sure I could find out as much information as possible with my patient before PT came, observe a PT session and write my note. I did not feel as comfortable talking to the patient with her family in the room. They kept answering for her and I did not know how to get them to let her answer. I continue to learn that I get way too anxious going into new situations. They usually are way less stressful than I imagine them to be and afterwards I think “that wasn’t that bad…why was I freaking out so much?”

My favorite part of the session was just talking to my patient. She is very sweet and reminds me of my grandma. Also, my patient’s family kept implying that because she is 88 she doesn’t like games, crafts, or activities…we will prove them wrong!

My patient looked about the same as I saw her on paper. I had seen patients at wakemed that had hip replacements so I kind of had a picture of what she would look like.  I was only really surprised by her age! I was expecting her to look much older, be more frail and not move around as well as she did…she looked really good for 88!

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!