OT : work, rest and play

Life got busy, I’ve forgotten to write about placement, so here goes….

Week 5 This was a much better week than the past couple as  I had a good chance to sit down with my practice educator and discuss what I needed to do and start making plans for achieving them. The planning session made me feel quite empowered and I felt more purposeful now that I know what I’m doing and that I have a role that is more than just watching what is happening. I also got to practice my first assessment.

Week 6 This I was out and about this week visiting Community Rehab and working with the community care assistant.  The community rehab was interesting, we seemed to work with a few patients but in a lot of depth, and really saw changes happening in peoples lives. It was a big change from the hospital since I got to see people in their own setting, and the patients seemed much more confident.  I talked to them about waiting lists and how easy it was to refer clients to the service, this seems to be the biggest problem as referal seems easy from the rehab hospitals rather than acute settings.

This week I had a visit to the respiratory ward to work  with their OT’s.

It was very different to my usual ward, for some reason patients didn’t seem as ill, probably because they weren’t physically disabled and could hold a conversation. And the OT was very different, while on the stroke unit we would be looking at personal ADL’s and that would take the form of our main assessment, these OT’s did a lot more talking with their patients. Out of the whole day on the ward I only saw one kitchen practice and no dressing assessments. And two of the ladies we saw were discharged that day.

Thinking of assessments I saw that in the respiratory ward an Ocairs type of assessment would be a really useful tool, while I’m currently thinking that a MOHOST assessment might be more useful for the stroke unit.
Staff dynamics wise, the respiratory OT’s seemed to have much more of a team like relationship with the Physio’s and the nurses than on my ward. This I think was helped by the fact that the physio and the OT together did a handover with nurses in the morning, and that at lunch time the Physio’s and the OT’s ate together. Whether this meant they had a better closer working relationship than the OT’s and physio’s on my ward is hard to tell.

Best thing about the visit, was that the OT I was shadowing let me do things, nothing big just filling in forms and talking with patients but it made me feel really useful and part of her team.

Back on the stroke ward I had a talk from one of our OT’s about cognative and perceptual problems in stroke. Really interesting but I was trying to recall it a day later and failed, I was a bit anoyed with myself and am beginning to feel that I should be learning more of this  physiology stuff to impress my educator. However, need a way that is better than reading books because the books don’t seem to be working.

My placement supervisor was back from holiday so this week  felt slightly more purposeful than the last.

I spent  a couple of really interesting sessions with  my supervisor  watching her do initial assessments on patients. It was really fascinating and I really enjoyed  watching her and observing how she interacted with the patients and what she paid close attention to. It really made me think that I have a lot to learn, there seems to be so much that the OT is looking out for and the stroke patients we are working with have really diverse medical problems which means the OT has so much more to consider when planning ADL’s.

I spent an afternoon going through the Rivermead Perception Battery with another Basic grade OT, which was really good fun, but by the end of it my mind was spinning. Which made me consider whether it might be too much for some of our patients. Some of the tests in the battery also seemed to be a bit childish to me, and I wondered if it might make patients feel slightly patronised. I talked to one of the other OT’s about this who had recently carried out the Battery on one of the patients, she said that the patient had really enjoyed it, partly because he wanted to better understand his visual problems, and partly because most of the time he is stuck in the bed with not too much to do so he enjoyed the attention.

The rest of my placement time was taken up by shadowing other OT’s on washing and dressing practice, so I learnt a little  bit more about stroke dressing techniques, and the daily ins and outs of acute physical hospital OT.

I took a book out of the library about writing SOAP notes, I found it slightly helpful, but I’m generally struggling at the moment to work out what I think about the note keeping method, and the best way for OT to communicate to other MD team members.

Also this week I decided that I really didn’t like the placement handbook and notes regarding learning agreements, portfolio’s and assessments. There is too much information, so much that it is almost impossible to find the details you need, and it is written in a slightly ambiguous way so that you are not quite sure what you need to do. I’m sure the students would benefit from a one page summary of what is actually needed by way of assessment. I suspect that the handbook reflects its creator.

Waiting to see where my next placement is, hopefully will find out this week.

So waiting over, here are my results:

Professional Skills:    60%

Sociology and Social Policy:    72%

Occupational Therapy 1:     Essay    75%,  Viva 52%

I’m pleased

So, this week my educational supervisor was on holiday so I was left alone with the other members of staff. Whether I was just a little bit more used to the ward and the routine of the OT environment, or whether it was because my supervisor was away, this week went slowly, and I really had to look for things to do.

I went to the case conference where the Doctors, Nurses, OTs, Physios, Dieticians, and speech therapists all get together to evaluate each patient on the ward. I was very interesting to see the dynamics of the different disciplines, and even internal discipline dynamics (for example the consultants do all the talking, while the SHO’s write down what they say and the JHO does the filing). It was also really interesting to see what the OT’s were reporting at the case conference, and how people reacted to this, and the power OT’s have to hold back discharge if they don’t think someone will be independent in their home.

There was one consultant in particular that didn’t really seem all that interested in what the OT was saying. All he wanted to know was is the patient ready for home, if not why not and when will that be. It made me think that maybe one of my lecturers who is particularly keen on developing articulate, evidenced based OT’s, who can make a clear argument, is right. Oh course the standard of your work must be up to scratch, but it counts for nothing if you can present your cases well in the two minutes you have to talk about that patient.

I spent much more time this week considering my essay, which assessments I’ll use, and which assessments might be useful for my working life, and also the acute medical setting.

One of our patients at the moment has a visual problem that means that he can see nothing on his left hand side. The team have been discussing things that the OT’s can do to encourage him to scan for objects by turning to his left (because his brain doesn’t realise he can’t see). A bunch of perceptual tests have been mentioned, and it is really interesting to see how the team members have been tackling this gentleman’s problem. The situation is made more interesting by the fact that this gentleman has a very dry and gruff personality, and has been in hospital a number of times before and is frankly a bit pissed of about doing things that he thinks are pointless. So it will be interesting to see how willing he is to do these perceptual tests.

The team have also discussed doing more social activities with him like playing games and laying the counters on the blind side, so encourage him to scan. It was interesting to note, that some team members were much more keen on the tests rather than the games, and that others viewed the games as a test to be taken seriously. I suggested that I’d love to play games with him and that if there were a number of players then the game had more purpose and would seem more natural as an occupation. However, it appeared to me that the staff weren’t that interested in making it a little be more human. After all it is therapy not fun.

If the OT department I’m in applied MOHO theory, to this gentleman, then his motivation for occupation, his interests and roles would all be considered and it might be possible to overcome his cool personality and encourage him to scan, just by finding something that interests him. However, the problem I’ve been told with a number of MOHO assessments is that they are too long to be used in an acute setting. The also seems to be the case with CMOP as a theoretical model, an OT working in my hospital recently came into to college to lecture about her pilot study on the use of the COPM, and concluded that it just wasn’t suitable for acute settings. Humm, so still need to think a little be more about that whole thing

Our lecturer has put her back out so didn’t turn up to class today. The head of the school met us and gave us the handouts for the lecture and told us to read them and do our own research. The mood of the class plummeted, they were really angry that they would have to read around the topic themselves and wouldn’t be receiving any direct teaching on today’s subjects, cardiovascular disease, dementia, and osteoarthritis. Admittedly big subjects to cover in one day.

My feelings were that the lecture couldn’t help being ill, and I was quite happy to go to the library and do some independent study on the subjects. After all I’m sure there will be a chance to have a catch up question and answer session with the lecture, and at the end of the day we are not becoming nurses or doctors but OT’s. In my mind its more important to know about how to help someone with their occupations than it is to know the full details of their disease. Everyone’s anger, just seemed to be taking up a lot of time and effort and succeeding in doing nothing more than making them more pissed off. I don’t understand.
I remembered what one of our lecturers said last week, about responsibility for learning. It is my responsibility to get the most from the course, and therefore if I want to know something or achieve something I should use my drive and determination to get it. Oh well, I had quite a good day in the library, shame there weren’t many off us.

So today I got the marks for my presentation and assessment at the end of last term for the Social Policy and Sociology module. I was reasonably apprehensive after earlier upset over thinking I’d done well and then only just passing, so was nervous when I went to get them. However I got 72%, which was really good, better than the 52% for my viva, all I need to hope for now is a 62% in my OT 1 essay and my OCAIRS interview essay and I will be a happy lady. I got some really positive remarks and comments from the assessors plus some feedback about where I could have done better.

The rest of the class were quiet about there results so not sure how I compare. I will find out next week when I get back to college.

Apologies for the dullness of this entry for anyone reading this blog, but if I don’t write this down I’ll forget my ideas/thoughts.

Timing When is the best time to do functional assessments? Today’s lecturer expressed her opinion that if you are assessing or intervening on a selfcare issue then this should be done at a time when it is appropriate for the patient and not for the OT staff. I.e. 7 o’clock when the rest of the ward is getting up and not, 9.30 after the OT has arrived in the office at 9 and then checked her e-mail had a morning coffee etc.

Language Todays lecturer definately didn’t like the term, ‘dressing practice’ or ‘kitchen practice’ she thought this language down played the importance of these tasks and the complicated nature of the work of the OT. The OT is doing more that letting them practice. She also thought practice was a slightly patronising term, a grown adult with a stroke has had plenty of practice dressing, to call the session a practice session is to treat them as a child.