Questions from Soap Notes

1
Questions from Soap Notes

• OT 665

2
OT 665 Credit Hours

• From the website
• OT 665 Geriatric Rehabilitation for Health
  Professionals (3)
• From the website - course catalogue
• OT 665. Geriatric Rehabilitation for Health
  Professionals.--Rehabilitation of elderly from
  perspective of functional impact of age-related
  changes, evaluation and remediation of functional
  limitations, and personal and environmental
  adaptations to promote continuing autonomy.
  Prerequisites OT 611, 624, and 625. 3 hours.
  (Also GER 665)
• From my syllabus
• CREDIT HOURS 3
• From Miss Elaine
• Hi Em,
•  
• According to the spring semester schedule that
  was distributed to faculty/staff/students -
  (student's schedules were put in their mailboxes)
•  
• OT-665  Geriatric Rehabilitation in Rehab
•              Call - 0564
•              Credit hrs - 3
•  
• If you need anything else, let me know
• Elaine

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Questions about Cognition

• OT 665

OT 665
4
Questions

• What sensory stimulating activities are
  appropriate to use with patients with Alzheimers
  who seem cognitively impaired?

5
Questions

• Also because we do not know what areas of the
  brain have been affected by her TIAs, I wonder
  if some of her visual problems may in fact be due
  to the TIA?

6
Questions

• The therapeutic activity we provided lasted for
  the majority of the hour. It was very
  frustrating working with (our support team
  friend) because she has no long or short term
  recollection.
• She would not even acknowledge directions being
  given to her during the activity.
• I would like to know how I could reach her in
  some way because I want to feel as if my work is
  rewarding by her showing some kind of progress.

7
Questions

• (Our Support Team Friend) does not recognize
  herself or family members in pictures, but would
  it be helpful to look through family albums if
  the names were printed below the picture?

8
Questions

• Is it practical to expect a person with mid- to
  late-stage Alzheimers Disease, like our care
  team friend, to remember someone new in their
  life when the memory is facilitated by repetition
  of names and the wearing of name tags?

9
Questions

• What activities can be used with the client to
  stimulate socialization and cognition without
  getting into therapeutic interventions?

10
Questions about Engagement in Activity

• OT 665

OT 665
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Questions

• Our pt. refuses to interact with the group
  activities and she is content on staying in her
  room and in her bed. If you ask her to go she
  refuses.
• What is another approach to take to try to get
  our pt. to engage in the daily activities?

12
Questions

• How can we help (our support team friend) learn
  to initiate her own engagement in an activity?

13
Questions

• The clients was happy to see us when we arrived.
  She looks forward to us visiting her every week.
  I feel as though she gets most of her joy from
  conversations with others. She started a
  conversation the second I identified myself as
  one of the students.
• Question
• How can I encourage our client to become active
  in activities?

14
Questions

• Should we continue to play dominos with her since
  she has expressed an interest in it, or should we
  try a different game with her?

15
Questions

• If she did not enjoy baking cookies the first
  time, is it worth another try with a modified
  approach?
• I think she enjoyed eating them.

16
Questions

• What are inexpensive things we can use to engage
  (our support team friend)

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Questions about The Support Team Friends
Interactions with the Team

• OT 665

OT 665
18
Questions

• Does K really enjoy my company and how will I see
  the results.

19
Questions

• What are ways to get (our support team friend) to
  interact with us more?

20
Questions about Mobility and Safety

• OT 665

21
Questions

• Is it ok to help the client go to the bathroom if
  she has to go, or should the team members and I
  call for a nurse?
• On the prior visit, the client requested
  assistance by the other team member and me in
  wheeling over to the bathroom because she had to
  go.
• Is this near crossing over the care-team/client
  boundaries and liability?

22
Questions

• Her daughter wants us to encourage walking and
  mobility in client.
• Are we supposed to help her or call a nurse? How
  do we go about this topic?

23
Questions

• Our elder is very frail, weak, and unstable on
  her feet.
• Should we attempt transferring her because she
  requires max assist?
• Or call for assistance?

24
Questions

• I have been surprised at her level of function as
  compared to her daughters description. She
  appears to enjoy our visits and the opportunity
  to talk with us. I do worry about her decreasing
  level of mobility. She has become very weak from
  osteoporosis. It has been exciting, however, to
  create ways to keep her engaged cognitively.
• Question
• Would a therapist be able to increase mobility in
  a client such as this or would they just maintain
  it?
• What would be some ways to increase mobility,
  such as transfers, besides standing activities?

25
Questions

• What activities can be utilized to increase an
  elders endurance without causing over exhaustion?

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Questions about Working with the Family

• OT 665

OT 665
27
Questions

• Right now, our main issue is getting to talk with
  Ks daughter, the primary caregiver, when she is
  not running out the door.
• I have corresponded with her via e-mail once,
  before we began for scheduling.

28
Questions and Comments about The Support
Team/Group Process

• OT 665

OT 665
29
Questions

• What are some tactics to reduce stress within a
  group?

30
Questions

• What is our purpose here? I do not mean this
  rudely. I just want to know why am I driving an
  hour, one way, to hear myself talk for three more
  hours, then 40 45 minutes home.

31
Comments

• I feel that sometimes this class does overwhelm
  me with the support team.
• It does feel like we are free sitters at times
  for the families.
• I feel the class would benefit from guest
  speakers that work in the geriatric field (home
  health or nursing home).
• With my limited experience, I believe that
  educating people on how to talk to their
  geriatric patients is very important.
• I feel it would be beneficial for our class to
  have a discussion on how to help our geriatric
  patients maintain their dignity.

32
Comments

• Im not necessarily glad that other teams are
  having the same problems engaging their support
  person in activities, but it does make me feel
  better to know that the other teams are having
  the same difficulties that we are.
• I think it is good for us to see that not all
  activities will be tolerated by other people and
  requires us to be a bit more creative about what
  we do.
• Im going out on a limb to see if K will enjoy
  decorating clay pots in hopes that during another
  session we can plant flowers and extend the
  activity over two sessions.
• We really havent been able to determine exactly
  what she likes and doesnt like to do (other than
  watch Ryan Seacrest on American Idol), so its
  experimentation for us as to what activities work
  and dont work.
• At least Im able to try out activities that
  might be useful in the future with another
  client.

33
One Question Unrelated to the Support Team (and
yet still worthwhile to discuss) and Mostly
Comments

• I feel that Our Support Team Friend has a vital
  support person in her husband.
• Without this source of support she would be
  dependent in all tasks.
• Since we are not providing treatment as OTs
  for her I feel that her time is not being spent
  wisely during our visits.
• We as care team members find ourselves just
  coming up with activities to fill the time slot
  mandated for the week instead of positively
  approaching the visits so as to benefit her
  therapeutically.
• It is hard for me personally to approach a visit
  with a positive thought process because I am
  limited by lack of certification and lack of
  will to help the patient.
• This may be unfortunate but I think it is the
  nature of the disease that grips our
  patient-decreased cognition/dementia, which turns
  my best attempts to engage the patient into pure
  passage of time.
• I feel that my lack of patience with the
  individuals of this population (Alzheimers) is
  difficult to overcome.
• Question
• What is the purpose of the diversity activity as
  a part of this class?
• I find it difficult to determine if I need more
  cultural diversity after attending two long
  workshops (one last semester, one this
  semester) on cultural diversity outside of my
  regular class time.

34
Support Team Stories

• OT 665

OT 665
35
Support Team Story 1

• On Being a Gracious Receiver
• by Betty McCulloch, R.N.
• Support Teams are regularly formed by co-workers
  for co-workers at The 1917 Clinic (named after
  its original street address). Betty McCulloch, RN
  and Director of Clinical Trials Research, tells
  her personal story of when her mother came to her
  home to live her last few months. When Kelly
  first mentioned the Support Team idea to me, I
  was uncomfortable with having folks do for me
  things that I was capable of doing for myself,
  and I worried that folks who report directly to
  me might feel some pressure to participate. After
  Kelly's reassurances I agreed to the formation of
  a Support Team, and I will be forever grateful
  for the support provided to me. Let me give you
  some examples of the things they did.
• "From The Support Team Network,
  www.SupportTeam.org."

36
Support Team Story 1

• The daily phone calls or visits met a need for
  socialization that I didn't realize I had. And,
  it kept me in contact with folks whom I'm used to
  interacting with on a daily basis. I was
  surprised and still can't really explain how
  important it was to continue to feel "included"
  at work, even though I didn't want to have to
  think about the work that I wasn't getting done.
  Crazy, but true.
• Some provided goodies to eat, and that saved me
  some cooking time so that I could spend a little
  more time relaxing - something I really needed to
  do. Instead of cooking, I worked in my yard - and
  that was a real treat!
• "From The Support Team Network,
  www.SupportTeam.org."

37
Support Team Story 1

• Although I made a couple of suggestions about
  what my mother might like to eat, some also
  brought food items that they had heard me say
  over the years that I really enjoy - like sweets
  and or pimento cheese spread. I was amazed and
  very touched that anyone would remember those
  things.
• Some helped get spur-of-the-moment prescriptions
  that it would have otherwise been logistically
  tedious and downright expensive to get.
• Some brought my car from the repair shop so that
  I didn't have to rent a car and hire a sitter in
  order to accomplish that.
• And last but not least, they said such sweet
  things about my mother.
• "From The Support Team Network,
  www.SupportTeam.org."

38
Support Team Story 1

• Having been single for many years, and having
  looked after my mother and her affairs for over
  15 years, I'm used to doing everything for myself
  and my mother. So I could have taken care of all
  the things that were so lovingly done for us.
• But I've learned, now, how wonderful it feels to
  be "taken care of." And to receive those
  expressions of caring, and the prayers, at a time
  when I was grieving over my mother's
  deteriorating health was simply a tremendous
  feeling. I've returned to work after 3 weeks
  feeling completely refreshed, and that feeling is
  in large part a result of having a Support Team.
• I've wracked my brain to figure out how to
  reciprocate the many kindnesses we received and
  continue to receive from our Support Team, but
  nothing adequate comes to mind.
• However, I'm really looking forward to
  participating in the next Support Team that is
  developed, and to attending the August training
  session for Support Teams!
• "From The Support Team Network,
  www.SupportTeam.org."

39
Support Team Story 2

• Sacred Moments
• by Malcolm Marler
• It was a sacred moment. Ten care team members sat
  around a table with donuts, orange juice, and
  coffee and remembered. This team represented a
  small Catholic parish, St. Joseph's, in the west
  end of Birmingham. They ranged in age from young
  adults to senior adults. Their Care Team Friend,
  Ruth, had died of Alzheimer's disease and cancer
  just three weeks earlier.
• "From The Support Team Network,
  www.SupportTeam.org."

40
Support Team Story 2

• Practical Needs
• They remembered the things they had done for
  their Friend and her husband. One man in his
  thirties talked about his role on the team had
  been cleaning their Friend's house regularly. "I
  thought it would be more awkward than it was," he
  said with misty eyes. "But I was just glad to
  help." Another talked about the yard work and
  laughed about Al, the Care Team Friend's spouse,
  who is so committed to helping others that he
  would be cutting a neighbor's grass while his own
  was being taken care of by a team member! They
  had learned that it was still important for him
  to help others, despite his burden of being a
  caregiver. The team had freed him up to do what
  he loved.
• "From The Support Team Network,
  www.SupportTeam.org."

41
Support Team Story 2

• Emotional Needs
• Many of the team members had delivered dinner
  regularly, and just as importantly, sat down at
  the kitchen table to eat with Al so he wouldn't
  have to be alone. At least two of the women made
  friends with the hospice aide who did most of the
  personal care for Ruth. They went beyond the role
  of most care teams and showed up to assist her in
  bathing their Care Team Friend. "Because it
  needed to be done," they said matter-of-factly.
• "From The Support Team Network,
  www.SupportTeam.org."
•  

42
Support Team Story 2

• Spiritual Needs
• They remembered saying the rosary and praying
  together on several occasions. Others called
  regularly, visited, and listened often. One team
  member talked about how this experience had
  changed her. "My prayer life is different now. I
  take time to thank God for my blessings." Another
  said she had learned how to put her faith into
  action. Most were present at the wake and the
  funeral. Each agreed they had been the ones
  blessed in the whole experience. Each one had
  been changed, and yet all were grieving in their
  own way while supporting one another.
• "From The Support Team Network,
  www.SupportTeam.org."

43
Support Team Story 2

• Looking ahead
• And then their attention turned to what they
  would do next.
• They understood that a spouse does not lose the
  love of his life after more than sixty years of
  marriage and be fine after three weeks. They
  committed to be present with him in the weeks and
  months to come for as long as it will take.
  Special attention would be given during the
  upcoming holidays.
• "From The Support Team Network,
  www.SupportTeam.org."

44
Support Team Story 2

• They agreed they wanted to take on another
  assignment in a couple of months, maybe someone
  elderly in their parish or community. Al has
  mentioned he will probably end up joining their
  team in the coming year. And they will then turn
  to someone new who has a need, and the love of
  God will be shared again.
• This was Christian community at its best. And
  then I remembered. This is why we have Care
  Teams.
• Malcolm Marler
• "From The Support Team Network,
  www.SupportTeam.org."

45
Family Perspective

• by Al Germann
• The following article appeared in the One Voice
  Catholic newspaper as a letter to the editor,
  Birmingham, AL, August 21, 1998. Your
  article entitled "Support Team Offers
  Unconditional Love, Support, To Those In Need" in
  last week's edition of One Voice traces the
  history of the Support Team Network.
• I would like to elaborate a bit on the
  "unconditional love and support" given. My family
  is the recipient of that unconditional love and
  I can tell you that this TEAM makes all the
  difference in the world. There really is no word
  that I can think of to describe the feelings of
  gratitude and the love that we experience from
  these parishioners.
• These ladies and gentleman are for the most part,
  young to middle aged couples or persons who have
  jobs, families, and homes to care for. Yet they
  come together each Sunday to pray and to discern
  together as a small faith community how they can
  assist their "Support Team Friend." Therein is
  born that unconditional love which reaches beyond
  themselves, busy though they are.
• "From The Support Team Network,
  www.SupportTeam.org."

46
Family Perspective

• One paragraph in the article stands out and
  needs to be emphasized "The family being helped
  is overwhelmed by the outpouring of love and
  support from the Team. The Team members, in turn,
  knowing they are putting their faith into action
  by demonstrating God's love through compassion,
  adds a purpose to their own existence. One of the
  best aspects of being on a Support Team is
  becoming an extended family member to the ones
  you are helping."
• After the doctor explains that your loved one has
  only weeks to live and after the tears and
  emotions comes the inevitable question "What are
  we to do now?"
• Only because the Support Team Network was already
  taking shape at St. Joseph's could we even think
  of bringing our terminally ill wife/mother home
  to die. Therein lies the benefit of the Support
  Team Network.
• You cannot measure unconditional love and service
  in quantity of hours of service rather this
  SERVICE makes the impossible become possible and
  so we are caring for "Mom" at home!
• "From The Support Team Network,
  www.SupportTeam.org."

47
Family Perspective

• No, I'm not overlooking Hospice Care and the
  professional care they provide. They are but
  another facet of unconditional love and service.
• Thank God for this small faith community that has
  been born at St. Joseph's and has thrived in
  reaching out to others, while molding themselves
  into a family, such as Pope John Paul II has
  envisioned in RENEW 2000. Last week this
  "unbelievable" Team came together at our house
  and said the Rosary with us.
• I will not mention names they would not allow
  that. But I will publicly acknowledge the huge
  debt gratitude that our family owes this Team of
  loving/caring people. God Bless them all!
• One final advantage this Team has afforded I can
  still carry out my "deacon" duties, both in
  Church and in the community. Thank God for that!
• Forever in debt to the parishioners of St.
  Joseph's I am,
• (Deacon) Al Germann
• Birmingham
• Editor's Note Ruth Germann died at home on
  Wednesday, October 21, 1998. His Support Team
  continues to minister to him during his grief.
• "From The Support Team Network,
  www.SupportTeam.org."

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Questions to Ask Yourself

• OT 665

OT 665
49
Questions to Ask Yourself

• The Tony Robbins Approach to Support Team
  Survival
• (ask how can I, not why is it)
• 1. How can I make what I am doing on the support
  team helpful to the family?
• 2. When I help the family, how can I find out if
  my doing that is also helping my support team
  friend?
• 3. How can I make this this support team
  experience into a positive and worthwhile
  learning experience for me?
• 4. How can I make a meaningful connection with my
  support team friend - one that does not include
  active doing?

http//www.personalpower.com/index.php?acntGHTZZ0
1H
50
Questions to Ask Yourself

• The Tony Robbins Approach to Support Team
  Survival
• (ask how can I, not why is it
• 5. How can I find ways in which my support team
  friend is likeable, or loveable to me?
• 6. How can I bring joy to a person with cognitive
  (or psychosocial or sensorimotor) deficits such
  as my support team friend?
• 7. How can I build a rapport with someone as
  challenging as my support team friend?
• 8. How can I create and maintain a positive
  attitude about this support team experience?

http//www.personalpower.com/index.php?acntGHTZZ0
1H
51
Questions to Ask Yourself

• The Tony Robbins Approach to Support Team
  Survival
• (ask how can I, not why is it
• 9. how can I use some of my special gifts or
  interests to help my support team friend?

http//www.personalpower.com/index.php?acntGHTZZ0
1H
52
Questions and Answers

• ?