New Grad Occupational Therapy and Why You Should Be Following

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OT OT OT

^^^featuring some fab OT friends at my recent bridal shower ūüôā #represent

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With internet access at the touch of a tablet screen to allied health social media accounts to online journals, there is a plethora of ways to retrieve valuable information on all things   o c c u p a t i o n a l   therapy.  The most valuable site is undoubtedly our national American Occupational Therapy Association aota.org website. This is the resource I always recommend to high school or undergraduate students curious about seeing the world through an occupational therapy lens.

AOTA MISSION STATEMENT

The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public.

Even Al Roker agrees that occupational therapy is legitimate and provides its patients from all backgrounds and abilities with limitless future opportunities.

Furthermore, AOTA provides us with invaluable insight and is easy to navigate around the website. Broken into 6 general categories,¬†the American Occupational Therapy Association website is a phenomenal resource for all things OT. Click the 6 categories listed below for detailed information and further subset categories.¬† ***For my international (non-American) blog followers, how helpful is your national website! I’m curious to know :)***

1)Practice

2)Advocacy & Policy

3)Education & Careers

4)Conference & Events

5)Publications & News

6)About Occupational Therapy

Of course I say all of this with the realization that if you have any inclination towards the occupational therapy profession, 9 times out of 10 all of y’all have perused through our national website (or through your country’s national website) prior to reading my short highlight blurb.

But……. DID YOU KNOW —-> there’s another OT online source that eagerly¬†awaits you??? Especially if you are a baby OT like me #newgrad

>>>>> New Grad Occupational Therapy<<<<

NewGradOccupationalTherapy (NGOT) exists for its readers.

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Each published article is created to help new grads become their #BESTself while providing a site that showcases passion for the profession through writing.¬†NGOT¬†can help you transition from being a fresh-faced first semester¬†OT student to a confident Level 2 fieldwork student to a brand new grad OT practitioner ready to take on the week ahead.¬† Regardless of your area of practice -pediatrics- -geriatrics/productive aging- -rehabilitation- -ergonomics/work/industry- mental health- -private practice- and loads more… there are resources and people willing and excited to connect with you on your journey.

NGOT is a source of encouragement for all whether you are a high school student nervously anticipating your first OT shadowing experience to a new grad OT to an occupational therapist who is preparing to totally switch practice settings to avoid burnout. *click here* to our dearly loved mentors and senior therapists. NGOT also invites family members of an individual who is receiving OT services or other allied health and medical professionals to come see what the profession of occupational therapy can do to enhance a multitude of lives.

For me being a Staff Writer for NewGradOccupationalTherapy keeps me mOTivated to learn more, reflect more, and be more present in the field. It¬†increases my likelihood of continuing to be proactive therapist rather than a reactive worker who just does what is asked and nothing more.¬†Now if only writing my daily documentation notes would come as quickly as writing up this post haha:) ūüôā After passing the NBCOT¬†in February while working fulltime under a temporary OT license, I was excited to accept this new position as part of the NewGradOccupationalTherapy Community after being approached in October of last year. So far, I have two published posts 6 Awesome Tips for your First OT Job and 50 Occupational Therapy Instagrams for New Grads.

 

To sum up, I invite any and all of my readers to sign up for daily content from NGOT! We can’t wait to hear from you!¬†Subscribe and¬†join the New GradOT community!

stay mOTivated,

SHANNEN M.

 

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mOTivation For the Long Term (care and inpatient rehab level 2 fieldwork)

 

12 weeks goes by even faster the second go around.

 

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My final occupational therapy Level 2¬†fieldwork was at an inpatient rehab/long term care facility just 15 minutes from Auburn University >>>war eagle, hey<<<. What are Level 1 and Level 2 fieldworks? Click here!¬†With¬†a patient caseload pretty much 3-4x older than me –they basically thought I was about 12–, this was a¬†complete contrast (or so I thought)¬†to my prior fulltime fieldwork in outpatient pediatrics where the majority of my caseload was younger than 8 years old.¬† The experiences of working separately with the two populations on opposite ends of the spectrum was truly¬†invaluable for my clinical competence and personal¬†growth.

>>>>>BASICALLY, LEVEL 2 FIELDWORK IS THE BEST (and in some ways the most challenging) PART OF OT SCHOOL.<<<<<

In this post, you will find my stream of consciousness thought process as a student in addition to a broad overview of the process of OT in this specific setting!!

In outpatient peds my full attention was given to an individual kiddo in¬†an isolated¬†treatment room (with my stellar supervisor) away from other therapists and distractions from outside those four walls. However,¬†an OT who works in an inpatient rehab/skilled nursing facility/long term care whichever way you refer to this site does not operate like this at all. A nursing home is in essence an extension of a hospital; thus, it provides 24 hour medical care in addition to rehabilitative or restorative services and so therapists must be much more cognizant of the patient’s medical needs.

runnMoreover, in¬†an outpatient setting-¬†yes you must¬†understand the medical history of the patient-¬†but these individuals are considered “medically stable” and are eligible to receive rehabilitative services without ¬†constant medical care.¬†When I was in the very fast-paced OP pediatric world I felt like I was rrrruuunnnnnnning 90 miles an hour every hour, but¬†I was able to attend to the occupational (primarily areas of occupation including ADL, education/school,¬†play) needs of the child without really worrying about how my intervention plan would affect¬†the medical status of the child.

…………………………………………..

Fast forward three months later on my first day as an OTS in the inpatient rehab/LTC setting— and these five thoughts piddled through my brain.

  1. Cute old people!! I just love them. Second thought-eeeeeek at all of this medical equipment to navigate around during therapy hmmmmm foley catheters, IVs, nasal cannulas and oxygen tanks, wheelchairs, walkers, the works. Brain immediately and silently freaks out because although I can tell these patients are resilient-they are also fragile and need a med terms refresher.
  2. Wayyyyyy slower paced than peds. Between ensuring adequate rest breaks to checking O2 sats to asking a nurse for a snack for a patient with low blood sugar to stopping briefly for medication administration, there are multiple brief interruptions in this setting and that is okay!
  3. Less documentation. Whattttt???? I don’t have daily detailed (loooovved my kiddos but pediatrics or outpatient in general equals a lot of documentation) soap notes and reassessments to write. #score
  4. Holy crap there are a ton of people in multiple professional healthcare disciplines needed to work (with goal being collaborative care) together for the health and well-being of these patients. (Also on that first day I asked myself how in the world would I learn every individual name…)
    1. Physicians to nurse practitioners to physician assistants to rehab-occupational, physical, speech- to audiologists, to¬†RNs, LPNs, and CNAs, to restorative care to social services to janitorial services, to cafeteria staff and more–each job duty with its own unique contribution and need.
    2. I have an utmost appreciation for physical therapists and speech therapists after countless awesome cotreat sessions with them.
  5. Woot woot I get my own desk. feelin da love. Really though. My coffee cup enjoyed having a place for it everyday.

PSA***MDs and DOs worked as the attending physicians over the plan of care at this facility-what a concept that there are 2 and only 2 real types of physicians in America-please for the love if you know a DO (Doctor of Osteopathic Medicine) or a DO student give them a hug because for some reason the world hasn’t caught on to them yet-admittedly, I didn’t know how awesome osteopathic physicians were either¬†until about 3 years ago*** and click here to learn more.


Where to begin-

Nursing homes get a bad rap- let me just start out with that. But this misleading perception can change if we become the change (which is undeniably difficult to do when you have the pressures of Medicare billing and productivity). ~~~~Think person-centered. Be person-centered.~~~

Patients are people first.

It’s just as important¬†to remember this as a student therapist as it will be years (many years) down the road as an advanced occupational therapy practitioner-as well as in any healthcare fields.

Their occupational identity (how the individual describes himself/herself): Teachers, Engineers, Nurses, Salesmen, Carpenters, Administrators, Counselors, Realtors, Secretaries, Welders, Church leaders, Janitors, Retail workers, Police officers, Volunteers, Grandfathers, Grandmothers, Fathers, Mothers, Sons, Daughters, you name it.

Their occupational identity (how the chart describes him/her): COPD, Parkinson’s disease, Alzheimer’s disease, Peripheral neuropathy, Diabetes, Hip replacement, Knee replacement, Cognitive decline, Low vision, OA, RA, history of cancer, Myocardial infarction, Cervical spine survey, Rotator cuff repair, Amputations, Cardiac disease, Anxiety, Depression, Schizophrenia… to name a few.

***note- I am not saying that the medical chart/patient history isn’t important!! It is¬†extremely important!! I am just emphasizing that it is also imperative to retrieve enough info on a patient’s occupational/work/life history in addition to their medical history. This extra effort is demanded¬†from OTs in order to develop an¬†occupational profile that¬†will promote client centeredness¬†from the beginning (initial evaluation) through the end (discharge). Gathering an occupational profile in this setting will enable the occupational therapist and/or occupational therapy assistant to choose treatment interventions that not only address underlying problems or weakness areas, but also are of some meaning to the patient.***

The OT PROCESS

(at least this is how it was at my site):

  1. Initial Evaluation

  2. Evaluation Write Up and Goals

  3. Intervention Plan and Implementation

  4. Progress Reports with Updated Intervention Plan and Goals

  5. Family Meeting to discuss progress

  6. Discharge

#1. Initial Evaluation-

  1. READ and comprehend the patient’s medical chart. Physician notes, nurse notes, therapy history, precautions, etc. Reason for referral. Length of prior hospital stay. Find out treatment and diagnosis code.
  2. Patient/caregiver interview and general observation. What is the patient’s occupational identity? What is the patient’s prior level of function? Any falls in the last 6 months? Behavior changes?¬†Where does the family/patient hope to discharge to after rehab? Using your clinical competence–is this potential D/C location feasible and safe? EXPLAIN IN PATIENT FRIENDLY LANGUAGE WHAT OT IS IN REFERENCE TO THAT PATIENT’S NEEDS.
  3. Have patient rate his pain verbally or nonverbally depending on cognitive status.
  4. What can the patient do now? Includes bed mobility, assessment of ADLs-toileting, feeding, grooming, bathing-, use of an assistive device, range of motion/manual muscle testing, sensory testing, visual  processing, and more.

#2. Eval Write Up and Goals

  • Varies by facility and electronic documentation system
  • Along with the initial evaluation, the Evaluation write up and goals must be written by the registered therapist
  • Short term and long term goals
  • Probably should make it a habit to make a long term bathing goal for most patients because it addresses a jillion things (functional mobility, safety, activity tolerance, dynamic sitting or standing ability, visual perceptual skills, sequencing…)

#3. Intervention Plan and Implementation

  • Be creative, client-centered, and occupation-based
  • Improve strength, endurance, and coordination in effort to reach PLOF
  • Treat underlying impairments that are hindering occupational participation
  • Think >>>>occupation as means, occupation as ends<<< (I need a new post to explain this)
  • ADL training, ADL training, ADL training!!!! In the patient’s room, in the ADL kitchen, in the rehab gym–so important
  • Co treat!!! PT and ST bring awesome cards to the table!
  • Teach modifications to activities -change the task, completely eliminate a portion of the task, provide adaptive equipment as needed
  • Compensatory strategies are always a win -joint protection, task segmentation, energy conservation…)
  • OT is all-encompassing which is probably why it is so hard to explain at times, hmmm.

I will explain each of the above pictures in a later post that dives deeper in the intervention process- ūüôā

#4/5. Progress Reports and Family meeting

  • Discuss the patient’s progress, activity tolerance, medical concerns, insurance/ Medicare days (mehhh), plans for D/C, and any needed AE fr home.

#6. Discharge

  • PT, OT, ST and other disciplines collaborate with the patient’s D/C goal in mind to determine the safest environment that is the least restrictive

Death and Dying–For me the most difficult¬†part of working in this setting can be summed up in one experience I had at mass¬†one Sunday. “We pray for those who have died this week including…” And that’s when I broke down in tears because one of the names read was one of my patients whom I did not expect to pass so soon. It is this experience and a few others that will remain with me and remind me to be kind and compassionate to even the most irritable patients because when it comes down to it-they are someone’s mom, dad, sister, brother, friend¬†before they are patients.


Halloween ———————————Rehab Style

Since Halloween was on a Monday this year, we brought the holiday spirit to the residents. As an OT to be, it’s important for me to be able to adapt to multiple contexts… so I altered my Statue of Liberty costume in order to be in appropriate attire necessary to treat patients. Summer, the speech therapy student, brightened up many patients’ days as a strawberry. The rest of the rehabilitation team -speech, occupational, and physical therapists and assistants- dressed as deviled eggs, which was quite a sight. Also, creating a caramel apple pumpkin was pretty sweet as well.

 


 

I am without a doubt grateful for my 12 weeks spent collaboratively working with my clinical instructor, speech, occupational, physical therapists and assistants, nurses, CNAs, social workers, physicians, and other disciplines. I am most thankful for the patients who have deepened my passion for the profession, increased my insight, and allowed me to be a small part of their lives-they are the reason this field continues to grow and enables us to have fulfillment in our role of being advocates, listeners, encouragers, adapters, and lifelong learners through our professional identity of occupational therapists.

As much as I love kids, my heart belongs to the patients with the old souls, the wisest stories, and the most loving hugs. I am so excited to begin my career as an occupational therapist and am so stoked to graduate December 10th!!! Cheers to the class of 2016!!

Let all you do

Be done in L O V E.

1 Corinthians 16:14

 stay mOTivated,

SHANNEN M.