A- Z Challenge

 

I have just signed up for the Blogging from A-Z Challenge- the idea is to blog every day in April using the next letter of the alphabet each day.

What a great idea! By April I will have been home from this study visit for a month- it will be a way to reflect on what I have learned in the light of a few weeks back home. And it will give me inspiration to continue blogging  about OT- so it's not over once the visit ends!

Hope everyone will continue to read it!

Weight Management- Physical Activity

Week 4 of 16 sessions. Chantelle, the OT leading the session, does not usually mention anything about the weigh-in that is done privately as people arrive. It is usually used as a chance to have a quick 'check in' with each participant and the print out slip is given to them for their own information with a copy retained by Chantelle for records. On this occasion every single person had lost weight and Chantelle congratulated them as a group for their efforts.
The topic this week moved away from food and food choices and habits to the subject of physical activity. In weeks 1-3, when discussing food choices, eating habits etc, the group had lots of ideas and came up with some very creative suggestions; it seemed that they could relate easily to the subject. My inpression was that talking about physical activity was much more difficult for many participants. Chantelle explained that physical activity does not only mean things like going to the gym but can include choosing things to make everyday life more active, such as using the stairs, doing a little light housework at a time you would usually lie on the couch watching TV. Barriers to physical activity included long commutes to work, fatigue, getting breathless and lack of time to fit exercise into daily routine.
The group brain stormed to try to think of things they had dome previously that they had enjoyed. It was striking that a number of people did not seem to have had any point in life when they had been physically active and it was difficult for them to see themselves becoming more active. Chantelle remained encouraging and focussed on individuals finding something that worked for them. Some had enjoyed dance exercise videos or the Wii Fit, some were staring to do a lunch time walk. Those who had already begun some form of exercise were mostly ready to increase it a little as their goal for this week, those who had not mostly chose to make a small start or to look into options that might work for them.
I felt that this session illustrated the concept in Lifestyle Redesign that occupation can create new visions of possible future selves. At present it seems that many of the group have no 'vision' of themselves as a person who had been enjoyably physically active in the past and are struggling to envision themselves in this role in future. This makes it difficult for them to make occupational choices that could promote health, and in this group, promote weight management. The process that the group sessions will take them through will help them to begin to envision new possible future selves and hopefully to feel able to make some sustainable changes.

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.