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.