Saturday, February 17, 2018

What the One Task of Toileting Taught me about Occupations

I walk into work today. A physical therapist comes up to me to inform me that they asked the physician for an occupational therapy order to assess a client’s ability to independently toilet themselves.

I think ok... there’s a few things going on in my head at the moment (which I can leave to your experience when you hear a co worker advocate for our services).

So I review the chart:

Without disclosing too much information or place identifiers to protect privacy of the client,  I will mention co morbities and conditions of their circumstances more generally than specific.

Chart review:

The client lives alone
The client is in their 50-60s
The client has a condition where they are wheelchair bound
The client has incontinence due to the use of medication to treat another medical condition ( This condition was only diagnosed in the past six months)

The reason for admission to the hospital is “non-compliance” in taking medication for recent diagnosis of their medical condition, resulting in complications of the severe symptoms of the condition

What are some thoughts that come to mind to assist the client?

Well here’s what came to my mind (at first):

They need a medication management system; assess what’s in place then go from there for what to implement for intervention. (NOPE, I WAS WRONG).

They need health literacy retraining for the importance of adherence to taking the medication...after all, this is a new diagnosis with new routines and understanding to it  (NOPE I WAS WRONG AGAIN).

So when I resolved those not being the concerns, I sat down beside my client to conduct their occupational profile interview:

The client has their own home business and takes great pride in their profession
The client is active in the community on a social level
The client has a condition that damaged the bladder many years prior
The client is modified independent in IADLs and ADLs

Here’s the barrier to their meaningful occupations:

Incontinence... consuming their time.

They would spend hours cleaning their bedding, multiple times in the night.
They would transfer to the toilet and incontinence would occur on the transition.
They would spend time cleaning the bathroom of the aftermath.
They would find minimal sleep and lots of time in the morning spent just cleaning up after them selves.... hours of time.

Not able to get out into the community
Not able to spend time with their clients
Not able to go to the grocery store
Not able to enjoy their coffee in the morning and read the newspaper (their most favorite thing to do).

So what did the client do? They  intervened with the barrier getting in the way of their most meaningful occupations; the medication causing the inconvenience. Problem resolved right?

What toileting taught me about meaningful occupations is these 3 things:

it’s not just about toileting; it’s about all the things that are impacted by that one thing. It taught me to dig deeper in what meaningful activity truly means to my client.

when reading the chart and the doctor’s interpretation of the clients “problem” on a medical level, it is our instinct in a medical model of treatment to focus on the diagnosis unintentionally... this circumstance reminds us as Occupational Therapy practitioners that we assess the occupational barriers, not the medical problem. We treat the client’s access to meaningful activity, not resolving the issue for why they are in the hospital.

I was out of my comfort zone with how to assess my client and ultimately treat them or provide intervention strategies. In finding out more about their story, their occupations of meaning, I can truly help them achieve their goals to break down occupational barriers. That’s why I firmly believe our clients are our answers to intervention. I spent over two hours with this client on eval; it was well worth the results to overcome their barriers

In closing, I hope this inspires you to face the discomfort to come in contact with something incredible.

 When did you feel out of your comfort zone with a client diagnosis or condition that you found unfamiliar?

What stories do you have about occupations teaching you something new about how to serve your clients on an elevated level?

Love, Lex

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