Nobody wants to be here

soooo i think that i've been having a hard time with work lately. too often many of may patents have the capacity to make me cry. and i am generally a pretty tough cookie. a while back i had two patients who i dreaded working with: 1) a man who was recovering from his second stroke and 2) a lady who was recovering from a hip fracture and a few infections she encountered with hospital stay.

1) this patient was GROUCHY with a capital "G"!!! he was NOT interested in therapy. i had the hardest time trying to educate him on the roles and goals for OT. he didn't get it and wouldn't listen.  he would tell me things like "i am not going to get better" and then the next minute, he would say "i can do everything by myself" even though i just had to help him put his jacket on. he demonstrated good potential to meet his goals to regain function and improve independence in his self care activities, but he was not interested. nor was he interested in cooperating in exercises for his hemiplegic arm. it is so important at the beginning stages of therapy immediately after a stroke to exercise and regain function in the hemi arm. he didn't care. sooooo as i tried to approach the treatment sessions, he would cover his ears and shoo me away. he called me a torturer. i tried so hard! even though i was very aware that he was like this with everyone, i couldn't help but take it personally. i think it's very common for most therapists to wish that they have that "magic touch", that they can win that grouchy patient over. i sure wished that. i think that's why i took it so personally. all i wanted to say is "look! don't treat me so rudely, I AM HERE TO HELP YOU! not tortue you!" and "hey, i am on your side!!!"

2) this patient was down right RUDE! i couldn't believe it. and unlike patient #1, i really do think it was me. when i found out that she was also canadian, i thought for sure we'd found a connection... but NOPE! apparently during my first session with her i "pushed her too hard!" her daughter approached me and let me know that her mother is very stubborn and likes to do things her way and doesn't like to be told what to do. apparently when i was educating her on proper sequencing and hand placement for transferring from chair to chair it wasn't the way she liked it. generally, one of my strategies for training in my session is to allow the patient to show me how they do things first and THEN if they are struggling and unable to complete their task OR if they are very unsafe, i will interject and offer strategies. so in this particular case, i gave her the opportunity to show me how she transfers into a chair and it wasn't safe, thus i was trying to demonstrate a safer method. she didn't like it. anyhow... i think because she is very stubborn and doesn't like me telling her what to do, she decided from then on to treat me very rudely. it was hilarious at times. until one day when i'd had enough of patient #1 and #2 and had to hide myself in the bathroom because i was so emotionally exhausted. she was funny. one minute she would tell me that all she wants to do is walk (sooooo very typical for many patients. GOSH!) AND then when i would try and encourage her to walk to the bathroom, she declined stating she was too tired. i could never win. and i almost always wanted to say: "LOOK! you don't have to be so rude!!! I AM HERE FOR YOU!" and "i am on your side!"

soooo it is so hard when you have these kinds of patients. it makes me so frustrated. i don't understand why people feel entitled or justified to behave so rudely to those individuals who are there solely for them, to help them.

and one day my boss reminded me that "nobody wants to be here!" and that hit me like a tonne of bricks! i get it. the facility i work at is generally quite clean and the staff is friendly and helpful. but i get it, who wants to be here? nobody!!! well, actually, our long term residents like it though! ha! anyhow, this was a helpful reminder for me. it's really hard to put myself in my patients shoes because i've never experienced anything like they are. especially for patient #1, it is his second stroke and he has increased weakness in his arm and also cannot swallow thin liquids safely and that has to stink! anyhow... i hope one day i will be able to keep this reminder in my mind and to be a little more understanding with future grouchy patients.

Rotator Cuff Syndrome

so i was really excited to take this rotator cuff rehab course. i learned a lot about treatment for rotator cuff syndrome and the like... here is my presentation slideshow.

april is occupational therapy month

To celebrate Occupational Therapy month at work, we posted a question each day of the week for our fellow staff members to answer regarding OT. I now pose them to you (my fellow blogreaderswhoeveryouare):

1. Besides self care, what are some other things that OT's address?
2. What are some other settings that OT's work in besides Skilled Nursing Facilities?
3. What does the term "occupation" mean in the title Occupational Therapy?
4. What are the names of all the OT's at the facility? (well, this is a bit of a tricky one. sorry.)

How did you do? Feel free to post your answers. In celebration of OT month, we were awarded with these fun t-shirts that say: "Life is great... Occupational Therapy makes it better!" Wouldn't you agree?

Functional Neuromuscular Re-Education for the Stroke Patient

I took a course a couple months back on the above mentioned title. I really love cont-ed classes. I usually leave feeling rejuvenated with some new material to work into my treatment sessions, but also further confirmation as to just how much i love my job. Here is my power point presentation on the course.

i love what i do

i came across this video and i felt inspired to clip it on the blog. it got me a tad bit emotional. i just really love what i do!!

Patience and Compassion

In part of my comany's mission statement it mentions "compassion", competency, etc. One of the reasons I am drawn to my profession is the opportunity to cultivate compassion for those I work with/serve. I have had some difficult patients lately and Friday I wanted to throw my hands up in the air and start my weekend early. I had three patients in the span of a week (with two of the the three encounters happening on Friday) get mad at me in a very child-like and irrational manner. I can be patient. I can be compassionate. It is easiest in small doses. During the last encounter, I had to take myself out of the treatment session and go sit in a small corner and take some deep breaths. While trying to have a grown-up/adult conversation with a patient who accused me of patronizing her I was unable to collect myself in the moment. This little breather/break was good for me. I believe in my company's mission statement and I want to offer the utmost compassion to every single patient, but at that moment, it was extremely hard. I think it takes moments like this (challenging patients who test our patience and compassion) to remind us of developing that patient rapport, trying to understand their narrative or life story, and why perhaps they are so upset or irrational. I have to remind myself that most of the time there is an underlying problem and to not take their behavior towards me personally. I have to think of them individually and what they are going through. This will help me to have introspection as to how to be more sensitive and delicate when working with these types of patients. I can usually do this, however, this particular Friday was just a bit too much for me. Thank goodness for the weekend and a fresh start on Monday.

Cognitive Communication Disorders

As I mentioned in a previous post, I was looking forward to attending a course on cognitive communication disorders. It was very informative and helpful. however, the instructor had to accommodate for therapists working in different settings, so there were instances when the application of material wasn't very pertinent to my setting, but useful and interesting nonetheless. I presented the information to my co-workers (see below for the power point). I went into the course with a particular patient on my mind.

Here is some background info on Mrs. R: She is in her mid 70's and has had a bilateral infarct stroke. She has severe right side neglect, anosognosia, and right visual field cut. She has delayed/slow processing speed. When we ask her where her right hand is she holds up her left hand.

Some areas of difficulty with Mrs. R:

1) SAFETY/impulsivity:
When we are practicing proper body mechanics and safety with transferring from chair to chair with the walker, she can go forward and turn (with assist) but cannot manage the walking backwards until she feels the chair behind her. In fact, when I asked her once which way was backward, she pointed forward. As she is unable to manage the backing up into the chair to sit safely, she will often attempt to sit too soon when there is no chair behind her because she is SO unaware of her spatial surroundings. Thus, she requires mod-max verbal cues so as to avoid sitting on the floor. we have tried several strategies- one being strapping her into the light gait and practicing the transfers in which we have allowed her to sit (securely) mid transfer with the hope that she will realize there is no chair and self-correct this error. However, this is still an issue for her and I am not quite sure how to solve this problem.

2) Memory Deficiencies:
I have noticed with her she still has her Implicit/Non-declarative memory when it comes to getting dressed. For example, when I ask her to put her right arm in, she puts her left arm in and is unable to without mod-max verbal/visual/tactile cues. Yet, if I hold out her tshirt or pants, she will put her arms and feet in, but wouldn't be able to describe 'how' to do it (Explicit/declarative memory).

3) Motivation:
When we approach her for therapy she is often still in bed and not dressed. It takes almost half the treatments session to convince her to get up, and often seems forced. "I don't want to get up", "I am sick", "They told me not to get up." Due to her decreased memory, she often forgets what she can do and will reply "I can't!" to almost any task, even if she just did it 2 minutes ago.

Any advice or input would be greatly appreciated on this complicated patient.