Acute hospital visits

I have now completed two 'shadowing' visits at the Keck Medical Centre of USC (see previous post of 22nd January- just follow this link) and was able to spend time with two of the OTs during their working day.

The first visit I spent with Lyndsay who is a permanent member of the OT team. Her caseload for the day was busy and varied and included a first evaluation with an older gentleman who had been admitted acutely with what turned out to be a stroke, a review of functional status with a younger woman post transplant, similar with an older man with stroke and an ongoing treatment session with a man in an intensive care bed following cardiac surgery and multiple complications post operatively. Two of the patients did not speak English which is not uncommon in Los Angeles. I was greatly impressed that Lyndsay was able to continue the session in Spanish! The hospital is a tertiary centre so situations like organ transplantation that would not always be part of an acute hospital OT's workload are common here.
We discussed the use and relevancy of Lifestyle Redesign in this setting. Although not always used explicitly, the Lifestyle Redesign methodology and overall philosophy forms an integral part of the practice of many of the OTs on the staff, particularly those who trained at USC where the approach developed. Once again the importance of occupational story telling/narrative came out in our discussion as an important part of intervention with patients in any of the situations described.

My second visit was with Stacey who is at the hospital part time in her one year post Masters programme residency. This work is contributing to her doctorate in OT. The project she is working on is developing the OT service for patients being admitted for bone marrow transplantation. The patients are generally admitted about a week prior to transplant day for all the preparatory work that is required. Post procedure, they remain in protective isolation for 22 days, an understandably difficult experience. The intervention being developed by Stacey has it's roots in Lifestyle Redesign and aims to help patients to cope with the emotional, physical and occupational demands of this situation in order that their final outcome will be improved, that they are ready to leave hospital on schedule and are prepared to resume their usual occupations post discharge. We spent some time with a patient who is in the first week of protective isolation and finding it difficult to cope with the isolation and boredom. The session explored some of the patient's usual occupations with a view to identifying any that could be adapted to be used in the very limiting environment of the single room. Physical exercise was one activity that this patient was keen to embark on in order to maintain strength and function. After a session that even included a game of badminton ( in a hospital room, who says OTs aren't imaginative!) the patient was left to begin developing an individualised daily 'programme', to be discussed with the OT again the following day.

In both these visits I saw the Lifestyle Redesign methodology being used as an intrinsic but not necessarily explicit way in developing interventions for individual patients. This is a contrast to the weight management group which, as appropriate to a weekly programme running for a defined length of time, uses the methodology more explicitly as the programme unfolds. The contrast and the similarities in these different situations are helping me to see the flexibility and adaptability of the approach.