OT 425 Ethics and Jurisprudence

Ethics is the study of how judgements are made in terms of right and wrong. Jurisprudence is the study of law, regulations, and related philosophy. It is important to have a Code of Ethics in the field of OT because it gives us consistency and a guide to lean on if we get in a tough situation. The standards of practice for OT overlaps with the Code of Ethics; this overlap, or gray area, is considered clinical reasoning where we have to use our judgment and experience to determine right and wrong. There are 7 principles in the AOTA's Code of Ethics. Beneficence is being aware of the client's well-being and looking at them holistically. Nonmaleficence is refraining from action that could cause harm to the client or others. Autonomy and confidentiality has to do with the client's freedom to choose and their right to privacy. Justice is the fair and appropriate treatment of others and complying with rules. Veracity is confidence of information to the client and strengthening the professional relationship. Fidelity is keeping commitments and promises made between the client and practitioner and staying with the client in time of need. The Ethics Commission ensures that these principles are being upheld and fairness to all individuals who may be parties in an ethics complaint.

OT 537 Case Study Take-Away

John Stoker was in a motorcycle accident in 1984 that caused internal bleeding and abdominal trauma. Complications during his surgery resulted in an incomplete spinal cord injury and blindness. He had no movement below the thoracic region and almost complete control over his right arm.  He had a trach and saliva bag and a G tube, but he still enjoyed eating some just to taste food. He passed away in 2003 from pneumonia. John was very active and healthy prior to his accident. He enjoyed riding motorcycles, fixing cars, and was a seaman in the Navy. John's aorta was clamped for too long during surgery, which lead to blood clots that caused the spinal cord injury and blindness. Prior to our discussion, I did not know that clamping the aorta for too long could cause spinal cord injury, and we talked about how blood clots could cause damage to the spinal cord and optic nerve. John saw an occupational therapist for about 3-4 months, and interventions were mainly focused on bowel and bladder control. He also wanted to gain more independence by being able to dress himself, being able to learn phone numbers to keep in touch with his family, and move around in his wheelchair without vocal cues for direction. John maintained a positive outlook after his accident and didn't let his injury stop him from doing the things he loved to do. Our discussion was really eye-opening to the causes and complications that can result in spinal cord injury.

OT 537 Neuro Note #1: Still Alice

I watched the movie Still Alice, which is based on the book Still Alice by Lisa Genova. This movie was incredibly eye-opening to the experiences a person has with early-onset Alzheimer’s disease. Alice, the main character, gave a glimpse of what it was like to be living with Alzheimer’s disease. She said it was like being able to see the words you want to say hanging right in front of you, but you just can’t reach them. Alice also said that she was mastering the art of losing, and that she wasn’t suffering, she was struggling. I feel that hearing and seeing Alice’s experiences will help me to better empathize with clients who have this disease. I was also able to see the challenges that not only Alice faced, but her family faced as well. As occupational therapists, it is important that we also include the family/care-givers in interventions to better educate and help them too. I chose to watch this movie because my grandfather was diagnosed with Alzheimer’s disease in his early 70’s, so I was interested in seeing how early-onset Alzheimer’s disease affected someone. In this movie, I saw how painful it was for Alice’s family to watch the disease progress, just as it was with my family. I watched my grandfather go through the stages of the disease like Alice did, except my grandfather’s progression was slower. Much like Alice, my grandfather was a brilliant man, and it was really hard for my family to see the intelligent man we knew revert back to an almost childlike state. Still Alice was a very insightful movie, and I feel that I learned some valuable things that will help me as an occupational therapist. I would highly recommend this movie to anyone who is looking to see Alzheimer’s disease from a patient/client’s perspective or just looking for a really good movie to watch!

Koffler, P., Lutzus, L. & James, B. (Producers) & Glatzer, R. & Westmoreland, W. (Directors).

            (2014). Still Alice [Motion picture]. United States: Sony Pictures.

OT 425 Professional Development

Acquiring skills, knowledge, and attitude going forward as an entry level practitioner is important for professional development. Being a lifelong learner is very important in occupational therapy. Lifelong learning to me means growth, gaining new perspectives, and is a choice that is very self-directed. It is very important to keep an open mind to new information, especially when it comes to technological advances and changes in health policy/regulations. Learning as an OT student is different from learning as an OT practitioner. As students, our curriculum is mapped out and our goal is more clear, which is to pass the NBCOT exam and become occupational therapists. As OT practitioners, our path is not as clear cut and it is important that we figure out how to obtain information. Finding a mentor or role model is important as OT practitioners because they can help facilitate our learning. Professional portfolios help document professional development and are important in proving and ensuring competency as OT practitioners. Professional portfolios can prove that we are continuing to learn by documenting professional development hours (PDUs), contact hours, and continuing education units (CEUs).

OT 425 Clinical Reasoning

Clinical reasoning is the thought process we use as occupational therapists to evaluate clients and determine and carry out interventions. Clinical reasoning involves thinking and how we feel, and these things are greatly shaped by our experiences. Emotion and your instinct/gut feeling play a major role in the clinical reasoning process. The clinical reasoning process is very dynamic much like the OT process and is largely dependent upon what is happening at the time. Clinical reasoning is something that is developed over time as we gain experience. Professor Lancaster gave some really helpful tips on how to build our clinical reasoning skills. It is important to build a library with the stories of clients and others because this helps develop empathy and clinical reasoning. Creating my own visual aid of the clinical reasoning process will help me envision how the process works. Asking questions like "what is the next step" and "why" will help in the intervention planning process. Seeking and paying attention to feedback during the clinical reasoning process will help in relation to professional development. Clinical reasoning can also be developed by practicing introspection and prediction through journaling. Finally, embracing the gray is important because it is a part of the process and development of my OT identity.

OT 425 Clinical Observation and Documentation

Clinical observation is very dependent on our own perspective; we may make different observations and notice different things depending on our perspective. Structured observation is a pre-determined activity, such as simulated or real cooking. It is important to learn how to hone observation skills, so you know what to look for when interacting with a client. Documentation provides a record of what we are doing, the occupational profile of the client, and outcomes. Documentation has four main parts, known as a SOAP note. The subjective involves what people report and what someone is telling me; not what I think as the clinician. Objective is what I have seen in the evaluation and the intervention. The assessment/analysis is where we as occupational therapists prove our worth by interpreting the subjective and objective, which is the whole why of OT. The plan is where we have what we have seen and heard and what we think about it, and now we determine what intervention would be best for the client. Documentation is necessary whenever an OT interacts with the client and provides justification for OT services and the distinct value of OT. Documentation is important because if we don't document it, then it didn't happen.

OT 425 The OT Process

Interaction with the client is the most powerful tool we have as occupational therapists. Therapeutic use of self and the relationships we build with clients are very important to the OT process. The OT process is very client-centered and occupation-based. Referral is the first un-official part of the process and involves getting the physicians order to obtain important information about the client. Evaluation involves screening, the occupational profile, analysis of occupational performance, and targeted outcomes. Screening is not hands-on and involves talking and observing the client. The most important part of the evaluation is the interview with the client and obtaining the occupational profile. Intervention involves the plan and implementation of intervention. It is important to remember to be careful with certain diagnoses because risk factors and precautions can vary. It is also important to monitor and reflect during intervention to determine if it is going the way you expected and making adjustments. During intervention, keeping a constant eye on when you need to re-think is important, so it is always a good idea to have a plan B. Balancing the needs of the client and involving the caregiver is vital to intervention.  Occupation can be used as both a means and an end. When helping the client to engage in occupation, so they are living life to the fullest, then occupation is being used as and end. When occupation is as intervention, then it is being used as a means. An example used in class, was someone needing to pick up copy paper to load a printer; an occupation such as doing laundry could be used as treatment/intervention to get them back to what they want to do. The caregiver plays a major role in helping the client with care, treatment, and making adjustments outside of therapy. Re-evaluation is re-analysis of occupational performance, review of targeted outcomes, and identifying action. Re-evaluation is where we determine whether to continue or discontinue therapy.

OT 425 Health Promotion, Health Literacy, and Prevention

The definition of health can mean different things to different people. Health can be the absence of disease or infirmity, exercising regularly, eating a healthy diet,  getting enough sleep, or having a social life to some people. The Institute for Healthcare Improvement is a part of the Affordable Care Act, and it has greatly influenced occupational therapy. IHI's Triple Aim pushes occupational therapists to be more involved in community-based practice, primary care, and population health. Education and training has increased in health promotion, health literacy, and prevention in all health care programs. Health promotion for occupational therapy is centered around client-centered use of occupations and alterations of context to maximize the quality of life and the pursuit of health. Prevention can be primary, secondary, or tertiary. Primary prevention is preventing disease or injury before it occurs. Secondary prevention reducing the impact of a disease or injury that has already happened and involves a lot of screening. Tertiary prevention limits the impact of an ongoing disease or injury. Health literacy is aimed at making sure clients fully understand basic health information and have the right information to make decisions. It is important that clients fully understand what is happening because it can help them navigate the healthcare system and be more open to share personal information that could affect their treatment.

OT 537 Daily Challenge #2

In today's class we learned about different brain injuries, which I found was very interesting. Acquired brain injuries can fall into two categories: traumatic brain injuries and non-traumatic brain injuries.  Traumatic brain injuries (TBI) can be caused by motor vehicle collisions, gun shot wounds, and predominantly falls. Non-traumatic brain injuries (NTBI) can be caused by stroke, tumor, or infection. TBI's are caused by a bump, blow, or jolt to the head or penetration to the brain, which disrupts normal brain function. An example of TBI we learned in class was the case of Phineas Gage. Gage had a metal rod penetrate through his jaw and come through his frontal lobe. This injury caused a complete personality change in Gage. The hard-working, kind man people had known before had turned into a childlike, rude man. He became ill and died after having many seizures, which we learned are a secondary effect of brain injury. This story was really interesting and shows how TBI can affect someone.

OT 425 OT Theories

In today's class we learned about theories used in practice. The Theory of Occupational Adaption looks at the relationship between the person, environment, and the interaction between the two. Adaption is necessary because person and environment are always changing, and it is a normal process in order to be functional. The role of the occupational therapist in the Occupational Adaption theory is to look at the person and environment to see how it is working and adapting it so occupational performance can occur.  As occupational therapists, we help the client focus on attitude and gaining new skills as part of the adaptive process. According to the OA theory, increased ability to adapt is increased ability to actively participate. Another theory we discussed was Universal Design, which is a model of practice that looks at the design of products and environments and how they can be useable by all people. This theory impacts people over the lifespan and examines ways of setting things up so the maximum amount of people are able to access it. The role of the occupational therapist according to the Universal Design theory is to advocate and educate clients.

OT 537 Daily Challenge #1

In Beatriz Abreu's ECS lecture she discusses the importance of empathy and six positive interactions with clients. She wanted to help clients with brain injuries to find balance and live fuller lives. Her first positive interaction was sharing resilience stories for motivation and inspiration. In sharing these stories, she found that clients were more motivated and hopeful. She found that a willingness to enter into the other person's emotional state and perspective is important. Each person's circumstance is unique, so it is important to understand things from their perspective. She stated that brain injuries can cause someone to become more aggressive or caring, and it is important to regulate your own interpersonal interactions. She participated in many studies that helped personalize some of the situations her clients with brain injuries would face. I feel that participating in studies related to some of the clients we may see is important because it gives us perspective and insight into their lives. She believes it is important to be able to read a client's actions and language patterns and variations. She focused on three modifiers, person, environment, and therapist, to better communicate with and understand the client. Abreu and Aimee Mullins both believe that promoting a person's hope and strength is important. In Mullins TED talk she shares a story of how her therapist's positive comments  at a young age shaped her attitude as an adult. Abreu states that teaching and using reflection and self-regulation is another positive interaction. Focusing on planning occupations and capacities with the client is important. Her final positive interaction is using creativity and imagination in therapy because occupational therapy is an art and a science. Abreu's main point was that positive empathetic interactions are very important in promoting healthier and fuller lives in clients.