Here we are in week three

Wow, its my third week already and even though it has only been 2 days, its been one of the busiest!! Yesterday I had two clients scheduled but I found out (about an hour before my tx session) that one was being d/c'd... I didn't have a chance to say buy to her because she has already left for a doctor's appointment. I was kinda sad because she was my first client that I was treating there. My other client is doing really well, she has not been complaining of pain as much lately (she had an acute flare up of arthritis in both upper extremities). I am having such difficulty writing her daily notes though, I feel like she is so high functioning right now that I'm not really doing that much and I have to put what skilled intervention I DO in my note.
I just hate the whole business side...like i said in my last post and because even though my client is basically independent in her ADL's and we have cooked and she did fine with that, she can clean her house and has been demonstrating normal ROM in her UE and not complaining of pain....it seems that I'm not allowed to put in my notes that she is independent...because they want to keep her in the facility to make money (since Medicare will pay for 21 days they want her to stay those 21 days). It really irks me because I feel like she has the tools and skills necessary to be independent at home again..but I can't say that. it is sooo annoying. makes me wonder if it is like this every where? if not, I must find that exception!

Yesterday, I participated in my first evaluation. I feel so bad for this client, she makes me sad! She is in her 70's and fell last week and broke her left distal radius (one of the bones in your forearm) and has severe bruising on her left hip. Also she had torn her rotator cuff in her right arm a couple years ago and she has decreased range of motion and strength in that arm. AND on top of that, she has had back surgery and has severe pain from that. Its just sad bc I feel like she is in pain all of the time!
Anyways, I was responsible for filling out the eval and writing her eval note and daily tx note yesterday. And today, I saw her this morning for bathing at the sink, grooming and dressing. I was sweating so bad bc her room was hot and she is max A for pretty much everything from getting out of bed to the wheel chair, to washing her back and legs to transferring from her wheel chair to the toilet..so its a lot of work to get her up, bathed and dressed. I have my work cut out with her that's for sure!

Today I just did not have that great of a day though. Last night we had to sign the papers to officially sell my grandparents house (since my Nana died in December and it just now sold). I have been sad ever since and just holding back the tears and keeping myself from really thinking about the fact that I will never go to their house again. so I was a little emotional inside today and then when I started getting 'constructive criticism' on my daily notes I almost started crying but I held it back thankfully. I just wasn't in the mood today bc my mind was flooded with other emotions. Luckily we finished the day around 3 so I didn't have to stay a full work day.

  I've decided that tomorrow will be better!

the 'bottom line'. a rant.

I hate hate hate how everything is about the 'bottom line'  ...aka dollars and cents.
Throughout my past two years of OT school, I can't tell you how much it was drilled into us about getting the patient's occupational profile and taking time to interview them and really learn what occupations are meaningful to each individual. That is the basis of occupational therapy- being client centered and using the occupations that the client finds meaningful as the means and ends in treatment.

I'm getting frustrated already with how the whole payment system works and what is considered 'billable' and whats not, productivity demands yada yada yada...

Between all of the paperwork and stuff dealing w/ the $$, there just is no time to really get to know the patient. No time to spend more than 10-15 minutes on an Eval (apparently OTs in my facility can't bill for time spent doing evals so it doesn't count as 'productive time'), no time to develop an occupation profile- and the eval form they use don't even include a spot for the occupational profile anyways! I want to spend time with the patient before beginning treatment so that I can really tailor the sessions to what THEY want to do, not what I think they would want to do.

I find that the OT I am with pretty much has the same goals for every patient..and while self care and IADLs are VERY important..there are other things that the patient may really want to work on that she doesn't include in the goals (short or long term)....I don't feel like we ask the patient what they want to focus on enough.

Now, I know that as the OT's we are the 'experts' and are the ones who set up and grade activities for the patients needs, but I just feel like the patient should have a say in their goals and what the tx sessions focus on in general.


So basically, I just wish there was a balance between the business aspect of OT and the foundational quality of OT as being client-centered.


// end rant.

Hello, week 2

Well I'm not almost halfway through week number two. I have gotten my second patient who has arthritis in both upper extremities, every joint except her elbows.
Yesterday we did a quick eval and then I got to wrap her fingers in coband because of the edema (it is similar to an ace bandage but is thinner and more porous. You wrap it tight at the finger tips and then make the wrapping more loose as you move proximal to 'squeeze' the fluid out of her fingers. White the fingers were wrapped we had her hands on a wedge to allow gravity to help move the fluid and we also worked on some fine motor activities (peg board, putty..) to get her fingers moving to help move the fluid.
She is such a great lady, SO motivated, I think she would stay in the rehab gym alll day if we would let her. She seems to want to push her self too hard thought, esp being in the acute phase of inflammation and pain.
Today we did the shoulder arc (see pic for a similar one) to work on shoulder flexion, abduction and horizontal adduction. Then I got to do ultrasounds on both of her shoulders for the pain and then we did the shoulder arc again to see if there was a difference in pain level before/after the ultrasound. She loved the ultrasounds and said it really helped so that was great.

I also saw my other client this morning, who had a CABG and we worked on sorting and stapling packets of paper for the department, to work on hand strength and FM and then stood at the counter to make a sandwich and wash the dishes. I'm kindof getting stuck with her though because she is doing so well but still gets OT every day.

As far as documentation goes today, I had to write a daily note for my two patients and a weekly note was due today for one of them so I had to do that as well. I struggled a little with the weekly but I think my next one will be easier!

Week One: complete

Well I have officially completed my first week of fieldwork :) I feel really great about how the first week went and I'm starting to get a hand of the schedule there and get to know the other therapists too :) They are all so nice and willing to help me out so I def appreciate that!

I saw my patient today and we were going to do a ADL session in her room so she could get a shower today and I could try out the long handled sponge, and teach her about using a reacher for LB dressing but she was already dressed and didn't feel like getting a shower...which is totally understandable bc I see her at 1:00! So we headed on down to the rehab gym and did some strengthening exercises and worked on standing at a table to fold laundry. My supervisor did her eval and wrote the goals for her with are: to perform all UB dressing and bathing independently, LB dressing and bathing, using AE as needed, adhering to sternal precautions, performing simple meal prep while standing and perform laundry tasks while standing. On Monday I think I'm goin to try and get her to make something in the kitchen and try to stand for a few minutes at a time, she was complaining about her foot being swollen and numb today so the doctor was going to look at it this afternoon- hopefully its okay! Also we are going to staple papers for the department, I think she will really like doing that because its something 'productive' and useful, instead of doing hand weights, the stapler will help strengthen her hands even if she doesn't realize it!
Please let me know if you have worked with a pt with a CABG and what types of treatment activities you have done!
I think she is doing really well and I'm not sure how much longer I will be seeing her- we set goals for 4 and 8 weeks but I'm not sure she will be there for that long. 
I was glad to get more good feedback on my daily note today too- its good to know that I'm doing it right when I seemed to have difficulty in class with my notes and getting all the right info in it. Notes in 'real life' are different, we don't write SOAP notes at the facility, we just write a narrative that includes 1. what activity we did 2. why we did it (relate to d/c, goals, occupation...) 3. What the OT did (level of A, client education, family education, verbal cues...etc) and 4. How the treatment you did affected the client's performance, did they improve their skills from the beginning of the tx to the end, did they respond to your education, were they successful with the level of A provided...)
I think its a pretty easy way to write a note and not worry about what goes into each section..I still find myself jotting down quotes from the patient to put in the note (like the S part of a SOAP note).

We also saw the lady that had a CVA and she was looking much better today, I can tell such a difference in her head control in just the past couple of days. She seems to be in the 'anger' stage of recovery and she has every right to feel that way- I know I would if I were in her situation...I just hope she can work through it and face whats going on so she can really work on getting better. While she can't speak to us, she really knows what we are saying and can follow simple commands. Today we took her out on the porch to look at the flowers and then put her in the stander so she can engage her trunk muscles. She did really well with that and did well holding her head up on her own and looking out the window. I can't wait to see how much progress she makes in the next couple months.


Next week my supervisor said that I will get more exposure and practice doing the evaluations on new patients. I feel like there is a new patient admitted to the facility everyday, well multiple patients admitted every day...my supervisor did 2 evals today! The evals they do at the facility seem pretty straight forward, they don't seem to use any standardized assessments like we had used in classes. They have a form they fill out and rate the patient in areas like self care, mobility etc..and then you rate them again at time of discharge and hopefully their scores are higher at d/c than during the evaluation. I'm looking forward to doing one but I DEF need to review manual muscle testing and the rating scale.


I'm super glad its the weekend, its taking a bit to get used to this 'real world' working schedule and the weekends now have a whole new meaning! :)

day 3.

Today was great! I got to run two treatment sessions and do those patients daily notes and I found out that I will take on one of those two as 'my first patient' :)  She had a CABG and is working on getting stronger and being able to dress and bathe herself and perform the IADL's she needs to do when she gets home. Also she has to do these things while adhering to Sternal Precautions because of her surgery.
I have to take her vitals before and after each session and when I went to get her from her room and got set up to take her vitals, the BP cuff kept inflating and popping off her arm! It was a little embarrassing that I couldn't get it to stay on so I went to get my supervisor to help me! Luckily they have the electronic ones so I dont have to depend on listening to the stethoscope to find the blood pressure!  Once we got the vitals taken we headed out to the patio to fold the towels for the department since she said she is the one who does the laundry at her house. And we worked on some hand/grip strength because she had complained about her hands feeling weak after she got out of surgery. Then I had to write up her daily note! :) It was a great session and it went very smoothly :)

The other lady that I led a treatment session with was not as compliant with treatment! we worked on bilateral task- she had a hip replacement and broke her arm so it had been in a cast before this week. She is very nervous to use the arm but it is fine and ready to work! I had to keep redirecting her and keeping her on task which can be exhausting. Then we folded clothes, which is good because it is a task that just naturally facilitates the use of both arms. And we ended the session by making a peanut butter sandwich and working on opening the jar of PB and the bag of bread and using her affected arm during the activity. She complained pretty much the entire session but I just love her anyways- yesterday we saw her and when we said a phrase and it reminded her of a hymn and she just started singing. And when I took her back to her room and went to leave she said "may the blessings of the Lord be with you today"...love it!

I felt so good about my tx sessions and daily notes based on the feedback I got from my supervisor- she said she was so impressed with my notes and that I did really good leading the Tx sessions with each patient, and esp with the second lady that needed constant verbal cues.

I love that I'm getting more responsibility. I figured it would be another week or more until I got my first patient but I think I am ready to start with one, esp since the eval was done by my supervisor yesterday. :)

Level 2: Day 1

Well I have successfully completed day 1 of my first Level 2 :) I am at a Skilled Nursing Facility and it was so nice :) My supervisor is awesome, we just dove right in today and saw 3 patients in the time that I was there (She only worked a half day today so I came in at 1:00).

The first patient we saw was an elderly woman who lives at the facility due to alzheimers/dementia and she needed a resting hand splint because of contractures in the PIP joints of her L hand. She was so cute and her daughter was there visiting and saw my name tag and said that she went to Radford for her schooling! Then she was asking me how much longer I have left and I told her I will be there til Aug then to Newport News and she was just so excited because her family just moved to Roanoke from NN last year and they loved it there! =)

The second patient we saw was an elderly man who had a THA (hip replacement) that had gotten infected (eek!) and he only has 2 weeks left before he is d/c. He was soo cute :) He was telling me that he's been married twice, and has many grandchildren and then asked if i was married and if I wanted to be married and told me that I was a 'lovely young lady'!  We worked on transfers: supine-sit, sit-stand, w/c- arm chair. He is really good at doing a sliding board transfer to get from his bed to his wheelchair. we also worked on UB strengthening because he has gotten weak since being in the nursing home.

The last patient that we saw was an older woman who had a L CVA, pretty severe and has R side neglect- needs lots of cues in order to look to the right. She has some muscle tone returning in her R UE but for the most part the R side is a 0/5 (for manual muscle testing) which means there is no muscle contraction. She seemed like such a sweet lady, even though she was non-verbal and appears to had aphasia, her room was filled with balloons and mother's day cards/flowers. I can't wait to see her progress from now until she is d/c.

The facility is going through a medicare audit of all of their documentation right now so it was a big deal for me to learn their documentation procedures- I spent some time today going over old notes my supervisor had written w/ comments from the rehab manager just so I am familiar with the format and how they write notes there (everywhere is different!)

My assignment tomorrow is to write part of a daily note for a patient that we see. I don't think it will be too difficult.


(Please let me know if you have any questions about anything I write regarding fieldwork, diagnoses, abbreviations....or anything!_

let's play catch up :)

So here we are, it has been an awful long time since I have updated this blog! Since my last post lots has happened! I am now done with my time on campus..no more classroom instruction!! I will be starting my first Level 2 Fieldwork next week (!!) and will be there until the middle of August before moving to Newport News for my second Level 2 placement.

The end of the semester was so busy and stressful, as usual.  This whole semester we have been working in groups of 4 to create a business plan, I am not sure if I have mentioned this before- I think I may have briefly. My group created a Transition Program for students in the three counties around my university. I had never taken a business related class in my life so this was pretty difficult for me, never had heard of a SWOT analysis, or a Market Analysis, or a Break Even Analysis..but it all had to be done and then some. During the last week of class we had to give a 30 min presentation on our business. My group did really well on it and my professor stressed that there is such a need for the services in the area that she hoped we would take the business plan and really put it into action. hmm...we'll see about that ;)

Also, I had two skills competency checkouts for my Musculoskeletal and Neurological courses. They were the same style but different clients. We had to go in an choose a 'client' from a card, spend a few minutes reviewing the case, making a list of evaluations and treatment ideas for that client and then our professor acted as the client and we carried out an evaluation and did a treatment session, and then we had a couple of hours to write up an eval note, daily tx note, and long term/short term goals.

 For Musculoskeletal the client I had was diagnosed with Low Back Pain so that was not too challenging because it is all about client education: no bending arching or twisting, and introducing adaptive equipment to reduce the need to bend/arch/twist the back.
For Neurological, the client I was assigned had a CVA with severe L neglect (meaning she did not attend to anything to the left of mid-line, for instance if i had placed items on the left side, she would not even know they were there, even if they were placed within a normal visual field). I had to do the Letter Cancellation Test for the evaluation, and a bathing task for the tx session.

Other than written finals, those were the main assignments that kept me busy through the end of the semester.

So for my first Level 2, I am at a SNF (skilled nursing facility, aka 'nursing home') in Roanoke and I'm really excited about it. I called my supervisor the other week for the first time and she was SO NICE. She just kept telling me how much fun we will have and that she does not want me to be stressed out at all. She said she had 3 Level 2 fieldworks that were all awful and she promised herself that she would never make a student feel the way that she did. She also said that she wants me to come and be a little sponge and soak up all the information and learn as much as I can, and that if I'm too stressed, I won't be able to learn as well.  I can't wait to meet her on Tuesday :)

Since I am moving to a new area this fall for my fieldwork, a friend/classmate is also placed in Newport News - we went two weeks ago to scope out some apartments that offer short term leases and found one that we both really liked and that is affordable so that takes some of the stress off with that! Now we just need to sign the leases and get it all in order for the fall.

AND last but not least, a friend of mine from highschool, who is an Occupational Therapy student at Colorado State, just started a blog that I think you all will like so go check it out when you get a free minute: http://otbliss.blogspot.com/