A carpenter's tool is a hammer, a photographer: camera. A Doctor: perhaps stethoscope, A painter: brush and canvas. Most of the profession has a tool that they use for their trade. As an Occupational Therapist, what would it be? I am tempted not to write them down as I always enjoy watching most OT's not knowing the tools of their trade. However, I have a commitment to remind a lot of "sleeping" OT's. Tools of practice can define the profession. So what would define OT? In the UK, I realise it is commode, raised toilet seat, perching stool, kitchen practice, relaxation, bed lever and many others. These equipment are what defines an OT sad to say. This is why a lot of other professions, or even assistants think that they know how to be an OT. Well excuuuse me. NO! Tools of OT are these:
1. Use of Self
2. Use of Environment
3. Activity Analysis
4. Use of Group
5. Teaching Learning
6. Purposeful Activity
An OT will come up with a decision because he/she unconsciously used the above list of Tools which are all very abstract which is why they get lost very easily in the depths of memory.
Wednesday, February 9, 2011
Tuesday, February 8, 2011
PRAGMATIC ASPECT OF CLINICAL REASONING
I have written in my previous blog, the 4 facets of clinical reasoning: narrative, scientific, ethical and pragmatic.
As a clinician, your clinical reasoning will always be spot on if you are able to balance these 4 aspects before you make a decision on any case. The limitation as to what you and your client can do together is dependent on the pragmatic aspect of the case.
The pragmatic aspects can be rules and regulations of the facility, protocols and guidelines, criteria of admission, target time of stay in the hospital, scope and boudarries of your profession. discussions can go on and on but in the end, the Pragmatic aspect of Clinical reasoning is the playing field that an OT can play at or the canvas that an OT can paint at.
Examples:
1. you think that a patient can benefit from a bath trasfer training because he is not yet sae with it... would you keep them in a hospital becasue they havent acheived this? Definitely not!!!! community therapy team(intermediate care, reablement, community OT can folow this up - if it is their role to do so).
2, You feel a Stroke client is not yet safe to prepare their own meals and you want to spend time doing this with the patient even if there is somebody who can do it for them. Will you do it? YES... if you are in a stroke rehab facility or neuro rehab facility. NO... if you are in an acute stroke/neuro facility. YES if you are in the community rehab team.
3. Somebody asked you to order a hospital bed for a patient. will you do it? YES...if it is a job designated for an OT to do in a county or borough that you are working at. NO.... if the borough/county's policy is that district nurses should be ordering it.
4. Can you teach a person with total hip replacement to step trasfer to and from bath while standing up? YES if safe to do so and the clent can manage (scientific) and if the client wanted to do it (narrative) and because you have and obligation to empower clients to be independent (ethical).
NO.... if the department has an agreed protocol and guideline that everybody should be transferring using a bath board.
5. can you allow a person with total hip replacement to remove his shoes by having him push the shoe off the other foot using his other foot (Leg Crossing Doffing Method).
YES - this method will not cause internal rotation to the hip joint (scientific)
- if the person wants to be independent and is willing to explore many waus of being independent (narrative)
NO - if your manager tell you not to!!!(pragmatic) "ha ha ha"
- if the there is a departmental guideline that this method is banned (pragmatic)
6. Will you order a perching stool for client to be able to wash?
YES - if client cannot sustain standing and if they cannot maintain balance or if the effort of standing is a strain to their respiratory system (Scientific)
NO - if they already have a perch stool, if they have an alternative stool, if they are fine washing whilst seated on the toilet( pragmatic)
- if they choose to just have a strip wash by the bed (narrative)
So you see. in every question and decision an OT has to make, there are always opposing anwers. Most of the decision though is affected by the pragmatic aspects of the case. Remember though that the pragmatic aspect of clinical reasoning can only be outweighed by the ETHICAL merits of the case.
As a clinician, your clinical reasoning will always be spot on if you are able to balance these 4 aspects before you make a decision on any case. The limitation as to what you and your client can do together is dependent on the pragmatic aspect of the case.
The pragmatic aspects can be rules and regulations of the facility, protocols and guidelines, criteria of admission, target time of stay in the hospital, scope and boudarries of your profession. discussions can go on and on but in the end, the Pragmatic aspect of Clinical reasoning is the playing field that an OT can play at or the canvas that an OT can paint at.
Examples:
1. you think that a patient can benefit from a bath trasfer training because he is not yet sae with it... would you keep them in a hospital becasue they havent acheived this? Definitely not!!!! community therapy team(intermediate care, reablement, community OT can folow this up - if it is their role to do so).
2, You feel a Stroke client is not yet safe to prepare their own meals and you want to spend time doing this with the patient even if there is somebody who can do it for them. Will you do it? YES... if you are in a stroke rehab facility or neuro rehab facility. NO... if you are in an acute stroke/neuro facility. YES if you are in the community rehab team.
3. Somebody asked you to order a hospital bed for a patient. will you do it? YES...if it is a job designated for an OT to do in a county or borough that you are working at. NO.... if the borough/county's policy is that district nurses should be ordering it.
4. Can you teach a person with total hip replacement to step trasfer to and from bath while standing up? YES if safe to do so and the clent can manage (scientific) and if the client wanted to do it (narrative) and because you have and obligation to empower clients to be independent (ethical).
NO.... if the department has an agreed protocol and guideline that everybody should be transferring using a bath board.
5. can you allow a person with total hip replacement to remove his shoes by having him push the shoe off the other foot using his other foot (Leg Crossing Doffing Method).
YES - this method will not cause internal rotation to the hip joint (scientific)
- if the person wants to be independent and is willing to explore many waus of being independent (narrative)
NO - if your manager tell you not to!!!(pragmatic) "ha ha ha"
- if the there is a departmental guideline that this method is banned (pragmatic)
6. Will you order a perching stool for client to be able to wash?
YES - if client cannot sustain standing and if they cannot maintain balance or if the effort of standing is a strain to their respiratory system (Scientific)
NO - if they already have a perch stool, if they have an alternative stool, if they are fine washing whilst seated on the toilet( pragmatic)
- if they choose to just have a strip wash by the bed (narrative)
So you see. in every question and decision an OT has to make, there are always opposing anwers. Most of the decision though is affected by the pragmatic aspects of the case. Remember though that the pragmatic aspect of clinical reasoning can only be outweighed by the ETHICAL merits of the case.
Tuesday, January 25, 2011
Parameters of OT assessment
We assess ADLs as OTs and after treatment or intervention, we compare progress to the initial information we obtain during initial assessment. We are very attuned to assessing independence level of the clients and we set goals generally based on this. Sometimes, an OT will come to a point where he/she cannot obtain outcome based on independence of the client. So what other parameters should we be looking for and what other aspects do we need to assess apart from level of independence of the clients? We tend to miss these other parameters and if you keep them in mind, your assessment will be more holistic and you will be able to Identify problems better which can aid in your goal setting. The parameters of assessment has an acronym of VISA.
1. Value - Level of value or importance the task is to your client
2. Independence - this is self explanatory
3. Safety - How safe is the client while he/she engages in the desired occupation?
4 Adequacy or Quality - you probably have improved the quality of performance the client engages in
more detail can be read in Willard and Spackman
1. Value - Level of value or importance the task is to your client
2. Independence - this is self explanatory
3. Safety - How safe is the client while he/she engages in the desired occupation?
4 Adequacy or Quality - you probably have improved the quality of performance the client engages in
more detail can be read in Willard and Spackman
Monday, January 24, 2011
PROMOTING OCCUPATIONAL THERAPY:USE UNIFORM TERMINOLOGY
There is a problem promoting Occupational therapy. This is because we are dealing with human occupation that is very difficult to label and quantify.
Imagine this situation, if you are an OT and you are asked by a TV advertiser to promote or endorse a product, what product would it be? Though eh? If you have a suggestion, pass it around to colleagues and it will surely stir up conversation.
A basic way of promoting OT is if we OTs talk the same talk. If we use the same words and termonologies in our daily documentation. ( Dont get me started on writing SOAP. We'll get to SOAP eventually.) Today I am just focusing and highlighting OT Uniform Terminologies. Basic. Simple.
Think of these:
Do we use uniform terminologies in our day to day documentation?
Do we use it when discussing cases with MDT?
Which Countries have a set and well defined OT uniform termonology?
Are we mandated to use it or to come up with a list?
Do you think life will be easier if all OTs use the same terminology?
Would it not be easier to talk to other professions about OT if we have the same Lingo? If we all speak as one? If we speak in uniform?
Let's look at ADLs of self maintenance tasks. What does it mean?What does it encompass?
Here's a list of Activities of Daily Living or self maintenance tasks. Hope it helps.
Grooming, Oral Hygiene, Bathing/showering, Toilet hygiene, Personal Device Care, Dressing, Feeding and eating,Medication Routine, Health Maintenence, Sicialisation, Functional Communication, Functional Mobility, Community Mobility, Emergency Response, and sexual expression.
........just a food for thought....just a food for thought.
Imagine this situation, if you are an OT and you are asked by a TV advertiser to promote or endorse a product, what product would it be? Though eh? If you have a suggestion, pass it around to colleagues and it will surely stir up conversation.
A basic way of promoting OT is if we OTs talk the same talk. If we use the same words and termonologies in our daily documentation. ( Dont get me started on writing SOAP. We'll get to SOAP eventually.) Today I am just focusing and highlighting OT Uniform Terminologies. Basic. Simple.
Think of these:
Do we use uniform terminologies in our day to day documentation?
Do we use it when discussing cases with MDT?
Which Countries have a set and well defined OT uniform termonology?
Are we mandated to use it or to come up with a list?
Do you think life will be easier if all OTs use the same terminology?
Would it not be easier to talk to other professions about OT if we have the same Lingo? If we all speak as one? If we speak in uniform?
Let's look at ADLs of self maintenance tasks. What does it mean?What does it encompass?
Here's a list of Activities of Daily Living or self maintenance tasks. Hope it helps.
Grooming, Oral Hygiene, Bathing/showering, Toilet hygiene, Personal Device Care, Dressing, Feeding and eating,Medication Routine, Health Maintenence, Sicialisation, Functional Communication, Functional Mobility, Community Mobility, Emergency Response, and sexual expression.
........just a food for thought....just a food for thought.
Sunday, January 23, 2011
REQUIREMENT FOR DISCHARING A PERSON HOME
the basic occupational requirement that a person needed to go home are:
1. he/she should be able to transfer safely from bed to toilet/commode to chair- home can be set up where the chair is close to the bed and commode so walking is not really essential for discharge from hospital. This can be improved by follow up services such as reablement team, intermediate care team or community physios etc.
2. client should have access to toiletting facility - e.g. commode if unable to walk to the toilet safely
3. client should be independent with toilet hygiene - this usually the make or break if a person is going to be independently safe at home. Unless client was incontinent prior to admission. On which case, client only needed to have regualr and frequent checks daily
4. client should have means of nourishment - either carers assist in setting up breakfast or client should have meals on wheels
5. client should'nt have any behaviour that will cause them or anybody at home any harm - this refers to cognition of the client, behaviour of wandering of psychosocial behaviours that could harm themselves or other peple in the house
6. client should have access to a sleeping facility - bed should be brought downstairs if client cannot manage stairs
these are basic requirement and could be made successfull with appropriate support either from family, carers, reablement services, intermediate care, meals on wheels
1. he/she should be able to transfer safely from bed to toilet/commode to chair- home can be set up where the chair is close to the bed and commode so walking is not really essential for discharge from hospital. This can be improved by follow up services such as reablement team, intermediate care team or community physios etc.
2. client should have access to toiletting facility - e.g. commode if unable to walk to the toilet safely
3. client should be independent with toilet hygiene - this usually the make or break if a person is going to be independently safe at home. Unless client was incontinent prior to admission. On which case, client only needed to have regualr and frequent checks daily
4. client should have means of nourishment - either carers assist in setting up breakfast or client should have meals on wheels
5. client should'nt have any behaviour that will cause them or anybody at home any harm - this refers to cognition of the client, behaviour of wandering of psychosocial behaviours that could harm themselves or other peple in the house
6. client should have access to a sleeping facility - bed should be brought downstairs if client cannot manage stairs
these are basic requirement and could be made successfull with appropriate support either from family, carers, reablement services, intermediate care, meals on wheels
OT ROLE IN HOSPITAL SETTING
You have a simple role if you are working in a hospital setting in the UK. You have to get the person out of the hospital as soon and as safe as possible. Your options are simple and few and you must decide as to which option is fastest and safest in getting the person out of the hospital.
Here are your options: You have to aim either discharge home, rehab facility, step down bed, residential or nursing home, home with support, home with intermediate care, home with reablement services, home with care package, home with family support.
In terms of Clinical reasoning, the facet that will dictate your judgement and options is the pragmatic aspects of the situation and hospital/NHS's general rule of getting people out ASAP tends to pull a lot of weight in your decision making.
Here are your options: You have to aim either discharge home, rehab facility, step down bed, residential or nursing home, home with support, home with intermediate care, home with reablement services, home with care package, home with family support.
In terms of Clinical reasoning, the facet that will dictate your judgement and options is the pragmatic aspects of the situation and hospital/NHS's general rule of getting people out ASAP tends to pull a lot of weight in your decision making.
Clinical reasoning
I have encountered many people talking about clinical reasoning. It is a well used term but not a lot of people know how to break down their clinical reasoning. Here in the UK, I have commonly come across with people or colleagues who are quick to question a clinical reasoning of another colleague when the Colleague was only asking bout the procedure how to order equipment - that is not a problem with clinical reasoning. It is a problem with procedural know how. What does Clinical reasoning actually mean? Check the books people. It's there.
facets of CLinical reasoning are these:
1. clinical aspects of the case
2. narrative(personal aspects of the case)
3. ethical aspects of the case
4. pragmatic aspects of the case
( you can find details about this in willard and spackman ---- 8th edition)
try using these four areas if you want to make a decision about your cases. I will be blogging about this in detail as we go along
facets of CLinical reasoning are these:
1. clinical aspects of the case
2. narrative(personal aspects of the case)
3. ethical aspects of the case
4. pragmatic aspects of the case
( you can find details about this in willard and spackman ---- 8th edition)
try using these four areas if you want to make a decision about your cases. I will be blogging about this in detail as we go along
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