Two Fridays ago I was visiting my friend at the nursing home. I had eaten supper with her and we were sitting in her room watching game shows on mute. She always watches TV with the volume turned all the way down so game shows are a good fit. At least she can follow what is going on. Sometimes I turn up the volume enough to hear. At one point she switched the channel to a local station that showed a radar of a large rapidly moving severe thunderstorm. I told her I better head on home before it started pouring. I'm so glad I did. It was sprinkling when I got home but within 10 or 15 minutes the rain was coming in ropes (the French expression for raining cats and dogs) and the power went out. The next morning we were still without power and on my early morning drive to work, traffic lights were completely out and and trees lay across the streets. Nine days later there is still a tree laying across our street a block up. Our power was restored about 11:30 on Saturday morning but it wasn't until late Sunday evening that our internet was restored so I spent part of my Saturday afternoon at a coffee shop finishing up the week's assignments.
This semester has been calmer than last but I have a feeling it will be picking up in the month of July with tests, presentations and 32 hours of field work in a mental health context. This coming Tuesday we have a practical exam on manual muscle testing (MMT). For this test we walk into the room where one of our classmates is acting as the patient. We pick one of 32 cards that have a joint and movement on it (such as wrist extension) and we are to test the "patient's" strength. We begin by placing the patient in the proper position so the joint will be moved against gravity (elbow bent at 90˚, forearm resting on a table with back of hand facing up). If the person isn't able to move the joint through at least 50% of the range of motion, then you have them switch to a gravity-neutral position (turn forearm so the thumb is facing up with the wrist slightly flexed) to see if they have enough strength to move the joint without having to fight gravity. If they can't move the joint at all we need to know where to palpate the muscle or tendon to see if there is a trace of a contraction. Most of the 32 scenarios aren't that difficult, but I do have some studying to do tomorrow so I can be confident going into the practical on Tuesday no matter which card I draw. Elbow flexion would be the easiest choice.
Sunday, June 30, 2013
Sunday, June 16, 2013
A day of hospital OT
This past week I spent a day with an occupational therapist at one of the hospitals in the city. Four different situations give a pretty good idea of the main things OTs do in a hospital setting.
Occupational therapists help people do the things they need and want to do in their lives. The things we need to do start with our morning routine of washing and dressing. Most of us do these tasks without much thought but they can be more of a challenge for someone in an acute hospital setting. One woman we worked with wanted to wash her hair and I was introduced to waterless shower caps. We heated the cap briefly in microwave. She put it on her head, massaged it for a couple of minutes and her hair was clean -- all without leaving her chair. This particular woman wasn't really sure she had the strength to wash up at the sink but we helped her out of her chair and she used the walker to maneuver around the bed. When she finished, we helped her get situated in bed which would allow for an easier transfer when they came to take her for a procedure.
A big part of any type of therapy in the hospital is to get people moving. Everyone has had the experience of feeling weak after spending a day or two in bed. The less a person is able to move, the weaker a person becomes. That's part of why we encourage people to do everything they can for themselves even if it is as simple as brushing your teeth. Movement helps blood flow, fluid drainage and the general healing process. One young man agreed to go for a walk. He got himself out of bed on his own, donned a second gown for a bit more modesty and together with his IV pole we made two laps around the unit. That was 10 minutes of walking. We left him sitting up in a chair looking like he was a bit more ready for whatever the day held for him.
Another part of the OT's role is to evaluate whether or not someone can benefit from therapy. The therapist I was with likes it to feel like a conversation of two people getting to know each other. The questions usually focus on three big areas. One is their living situation. How many stairs are there to get into the house? Do you have to go upstairs or downstairs on a regular basis? What's the bathroom like? We also ask questions about whether or not they were having difficulty with any of their daily activities before they came to the hospital and whether or not they expect to have problems when they leave. One woman we talked with had a good set up at her home. A walk-in shower was being put in while she was at the hospital. She had people that did some of the heavier cleaning and the only real concern she had was her balance and lack of endurance. We watched her get out of her chair and walk on her own in the hall. There were a few times she seemed a bit unsteady on her feet but there was nothing she needed OT for. Instead, the therapist encouraged her to do PT while she was in the hospital and to continue once she returned home.
One of the things we have learned to do this semester is moving people's joints when they aren't able to do it themselves. This is especially helpful in the ICU when patients are unconscious or sedated. Even though they can't move themselves, it is still beneficial to move all of their joints through the full range of motion for them to ward off some stiffness and swelling. I was hoping to have the opportunity to do that but the nurse said the woman on our patient list was too sick that day.
All in all, the day gave me added motivation to keep studying since I will soon have the opportunity to use what I'm learning in real life situations.
Occupational therapists help people do the things they need and want to do in their lives. The things we need to do start with our morning routine of washing and dressing. Most of us do these tasks without much thought but they can be more of a challenge for someone in an acute hospital setting. One woman we worked with wanted to wash her hair and I was introduced to waterless shower caps. We heated the cap briefly in microwave. She put it on her head, massaged it for a couple of minutes and her hair was clean -- all without leaving her chair. This particular woman wasn't really sure she had the strength to wash up at the sink but we helped her out of her chair and she used the walker to maneuver around the bed. When she finished, we helped her get situated in bed which would allow for an easier transfer when they came to take her for a procedure.
A big part of any type of therapy in the hospital is to get people moving. Everyone has had the experience of feeling weak after spending a day or two in bed. The less a person is able to move, the weaker a person becomes. That's part of why we encourage people to do everything they can for themselves even if it is as simple as brushing your teeth. Movement helps blood flow, fluid drainage and the general healing process. One young man agreed to go for a walk. He got himself out of bed on his own, donned a second gown for a bit more modesty and together with his IV pole we made two laps around the unit. That was 10 minutes of walking. We left him sitting up in a chair looking like he was a bit more ready for whatever the day held for him.
Another part of the OT's role is to evaluate whether or not someone can benefit from therapy. The therapist I was with likes it to feel like a conversation of two people getting to know each other. The questions usually focus on three big areas. One is their living situation. How many stairs are there to get into the house? Do you have to go upstairs or downstairs on a regular basis? What's the bathroom like? We also ask questions about whether or not they were having difficulty with any of their daily activities before they came to the hospital and whether or not they expect to have problems when they leave. One woman we talked with had a good set up at her home. A walk-in shower was being put in while she was at the hospital. She had people that did some of the heavier cleaning and the only real concern she had was her balance and lack of endurance. We watched her get out of her chair and walk on her own in the hall. There were a few times she seemed a bit unsteady on her feet but there was nothing she needed OT for. Instead, the therapist encouraged her to do PT while she was in the hospital and to continue once she returned home.
One of the things we have learned to do this semester is moving people's joints when they aren't able to do it themselves. This is especially helpful in the ICU when patients are unconscious or sedated. Even though they can't move themselves, it is still beneficial to move all of their joints through the full range of motion for them to ward off some stiffness and swelling. I was hoping to have the opportunity to do that but the nurse said the woman on our patient list was too sick that day.
All in all, the day gave me added motivation to keep studying since I will soon have the opportunity to use what I'm learning in real life situations.
Sunday, June 2, 2013
A more reasonable pace
I have written before of the intensity of the past semester. It seemed I studied all day Monday through Saturday every week. This semester is different. I don't know if it is because I'm used to the pace and have found ways to work more efficiently or if there really is less work. Either way I'm grateful to feel like I can take the time to stop and see a friend while I'm out running errands.
I continue to enjoy my classes. Neuroanatomy is all about the brain and is fascinating. We have learned a lot about how the brain works in recent years but there is still much we don't understand.
Remediation is a big part of occupational therapy practice as we help people recover function they have lost through injury or disease. Two weeks ago we had a practical test on measuring range of motion in different joints. I wasn't very confident in the one I drew, and I didn't place the goniometer correctly for the first measurement. My grade was fine because my error wasn't worth many points, but I definitely learned from the experience. I won't make the same mistake again. OT Practice in Work Contexts has quite a bit of overlap with Remediation which always makes life easier for students.
The final class, OT in Mental Health Contexts, is also interesting. I recently learned that one of my 3 month rotations (known as field work) will be in a mental health context so I need to pay attention. I will get my feet wet in July with 4 days of field work at a community mental health clinic. I've had little exposure to this type of setting, but my professor thinks I should consider working in mental health. We shall see.
Now that I know where I'll be doing the final 6 months of field work, the end of my studies seems much nearer. I can begin to plan for the next step. From January - March I'll be in Fergus Falls, MN working in a smaller hospital where I can do a little bit of everything. I have been invited to stay with a couple I know there. I'll be in St. Cloud April - June and it will take some creativity to find an affordable place to stay since I don't know anyone in that area. As to what comes after that, I'll have to wait and see what jobs are available. And I'll have to pass the board exam too. Even though I have another year to go, the end is in sight!
I continue to enjoy my classes. Neuroanatomy is all about the brain and is fascinating. We have learned a lot about how the brain works in recent years but there is still much we don't understand.
Remediation is a big part of occupational therapy practice as we help people recover function they have lost through injury or disease. Two weeks ago we had a practical test on measuring range of motion in different joints. I wasn't very confident in the one I drew, and I didn't place the goniometer correctly for the first measurement. My grade was fine because my error wasn't worth many points, but I definitely learned from the experience. I won't make the same mistake again. OT Practice in Work Contexts has quite a bit of overlap with Remediation which always makes life easier for students. The final class, OT in Mental Health Contexts, is also interesting. I recently learned that one of my 3 month rotations (known as field work) will be in a mental health context so I need to pay attention. I will get my feet wet in July with 4 days of field work at a community mental health clinic. I've had little exposure to this type of setting, but my professor thinks I should consider working in mental health. We shall see.
Now that I know where I'll be doing the final 6 months of field work, the end of my studies seems much nearer. I can begin to plan for the next step. From January - March I'll be in Fergus Falls, MN working in a smaller hospital where I can do a little bit of everything. I have been invited to stay with a couple I know there. I'll be in St. Cloud April - June and it will take some creativity to find an affordable place to stay since I don't know anyone in that area. As to what comes after that, I'll have to wait and see what jobs are available. And I'll have to pass the board exam too. Even though I have another year to go, the end is in sight!
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