This question came up for me in regards to my own work as I read through the Forum. http://Community.advanceweb.com/forums/28/ShowForum.aspx  

I found a post http://Community.advanceweb.com/forums/thread/28190.aspx written by an OT who talked about an "acute care overload." At the facility where she worked it was common to evaluate a patient and then the patient was discharged before meeting treatment goals because there wasn't even time to see the patient! The evaluation without further treatment was important even if the patient was quickly discharged in that it was a helpful determination of the patient's functional level. She was wondering if the process of writing the treatment goals could be avoided due to this fast turnaround. I am guessing because it would be faster for an overextended evaluator to eliminate a long list of goals if they would not be accomplished before discharge.

I love the answer provided by OT Tim Mancino. http://www.ot4life.com/ He says that he usually writes a goal for patient education and that actual treatment goal can begin during the evaluation. He uses handouts and he documents in the evaluation that the treatment intervention was initiated. That was a simple solution but it was quite an effective suggestion for that specific situation.

It made me think about a couple of different issues, helping patients to understand the therapy process at the initial meeting, and how to prepare for our day in regards to having some "hard copy" handouts already prepared.

It is often true that the initial period of time in acute care, home care or a skilled nursing facility can be a chaotic time for the patients. Add into this chaotic mix the evaluation from OT and often times other disciplines' evaluations. In order to reinforce patient education, the addition of handouts, a visual component of patient education, could be very helpful.

(We all know that the handouts could later be found set aside, but let us think positively!) Therefore, especially if our contact is a one-time occurrence as in an evaluation-only situation, we can leave behind with the patient the activation of the recovery process.

This brings me back to my initial question about preparing for the workday. What are the points that you want to add to each person's learning? Is there a common denominator that would be easy to disseminate when you meet with the patient? I always like to teach diaphragmatic breathing to many of my patients. I could use those instructions as a handout that could be universal. Another example of a handout that could be used for almost all new patients could be in an outpatient setting. It could be helpful to have in writing what is expected from them to achieve their goals, such as good attendance, equipment to purchase, the home exercise program or tasks to practice.

Anytime this is put in writing, it can reinforce what is said as well as make the whole new language or jargon of therapy clearer to those who may not know what we are talking about!

That one reply on the forum from Tim has me thinking about my specific work. There are several aspects to the therapeutic treatment plan that are usually new to the patient; therefore, they may not take in all of the information taught to them at the evaluation session. In a perfect world I would have a flyer or handout for each person newly evaluated as to what they may expect from the therapy and also what is expected of them.

Lymphedema treatment is not a passive process; the patient or a designated family member has to put forth effort to carry over the treatment in between visits. Therapy for the most part is an active process. Therefore, I plan to think about how to improve the learning curve for the patients as well as make each interaction with the patient as productive as possible.

I would love to hear how you approach handouts, and if you are able to use a "universal" handout. Do you print up your exercise programs for each person?

With these questions in mind, how do you prepare for your day?

I look forward to hearing back from you,

Lorraine

Unfortunately, I can count on one hand the number of fictional books I have read since college.

What is fortunate is my love of reading and learning and the craving to fully exhaust a topic of interest. (I know, there is no conclusion to this type of quest; it never ends!) I am not quite sure if this qualifies me as boring to my friends and family, but I myself am never bored!

A recent find for me that I believe to have important ramifications for the field of Occupational Therapy is a book called SPARK, by John J. Ratey, MD. (http://www.johnratey.com/site/default.aspx) I found this by accident when looking up books about Adult Attention Deficit Disorder. SPARK is a book all about the neuroscience research into the connection between exercise and the functioning of the brain. The book sites examples of how the simple act of moving the body can improve concentration, elevate mood, delay aging and my all time favorite activity, reduce one's stress!

The basic premise is that exercise is medicine!

The reasoning behind why I feel this is so important to us as OTs and COTAs is that it allows us to bring up exercise or movement of the body to patients/clients as an activity of daily living. Of course I am talking about the clients that it is appropriate for, but that is a large group. It is has been important in the areas of wellness and disease prevention, but reading this book will give you ammunition to categorize exercise as an ADL for almost everyone. Of course I am simplifying this idea, but I am of the opinion that exercise, as an activity of daily living just like brushing our teeth, is an unused resource for improving quality of life.

Different topics that are addressed in this interesting and easy to read book are case studies, learning, stress, anxiety, and depression. Do we work with any people who experience any of those challenges? He also has chapters on attention deficit, addiction, aging and hormonal changes. The book ends with suggestions for the individual reader who is inspired to work with the outlined concepts; Dr. Ratey call this the "regimen."  Also included are a glossary and an index that is quite helpful.

Obviously this is a groundbreaking book when the ideas behind it are fully utilized and lives are changed for the better.

Who do you call when you are looking for specialized advice to use with a challenging patient around a treatment technique? What do you do when you are interested in changing your niche or interested in going back to school? It is a given that people in business keep a list of others that they can call on to help them, and most importantly people who they want to help.

They call it business networking.

Do you think networking is only for the "business" population? Please think again! As you evolve through your career, who are the different peers, mentors and experts that have helped you along the way or you have been a help to them?

Do you ever get in touch with your college buddies?

Do you follow up with the other participants that you meet at continuing education conferences?

You can build a constantly growing list of interesting people. This can be so beneficial to you in many ways for your career and also your life outside of the career. You could have a group of others who share your professional enthusiasm around your work available to you just a phone call or email away. Keeping in touch can be helpful in order to seek specialized advice, join in collaboration, and to possibly work together in the future.

The reasons why it would benefit you to build a network are endless.

With an active network you will always be able to reach out and ask for what you need. Someone in your network will know the right person in the right place to help you with a project, or connect you to the perfect person who can connect you to the perfect person, and so on!

You list will include people related to the world of therapy, of course, but will also list other people you have built a relationship with or admire their work. For instance, if you meet a dentist you might refer him or her to your friend who is looking for a dentist. If you know of a great PT who specializes in vestibular work, you might refer to people to him or her. Do you see how this goes?

You can place a small amount of effort towards a plan to keep in touch with those people when you find you may have a common interest together, or those people that you meet and you really enjoyed spending time with.

There are important factors around developing your list of contacts, and it goes without saying that the essence behind it starts with the thought on your part, "How can I be of help?"

Good networking is not about getting referrals, or asking for favors. It is developing relationships that are based on a win-win premise, and the idea of thinking about how you can be of help. It is also based on the idea that the more you help someone else or serve others you get it back in return. It is also an attitude of that there is enough good to go around, so if you help others you will still succeed yourself.

Taking the time to cultivate your list of people you want to network with can only benefit your career over time. It is said that we are our own little mini business, regardless of whether we work for others or we are self-employed, and whether we plan to keep one position forever or make changes every so often. There are many ways to keep a connection, whether it is a hand written note, an email or a phone call.

Take the time to learn something about the other person or their work that will allow a true connection to develop, and remember three things:

1.   follow up,

2.   follow up,

3.   follow up!

Who can you contact today?

Until next time,

Lorraine

Why is Occupational Therapy such a great career? There is something for everyone. I was reading Wendy Spoor-Hof's OT Advance Blog dated March 13, 2008 regarding the article in Us News and World Report listing Occupational Therapy as being one of the "best careers" for this year. I would have to agree that it is definitely a best career.

In Occupational Therapy you can find the perfect niche that fits your personality and your interests. You can also match how you are working to be congruent with the different periods of your life. For example, this could be when you may want more work if you are wanting more money, or it could be the times when you want less work, when you go back to school or have a child.

For the Occupational Therapist who really thrives in the hustle and bustle of a busy hospital a position in acute care can meet a therapist's love of gaining a lot of good medical experience and honing interpersonal skills and interactions with staff, patient and family. Ongoing learning and problem solving as well as strategizing are aspects built right into the position itself.

Another choice for the person who loves the more medically based aspects of care in the area of Occupational Therapy would be the certified hand therapist. The OT can work with people that are at post operative levels and will have opportunity to interact with the doctor and the team in the OR, when splints need to be fabricated.

There are also niches for the OT who likes to see the progress over time where they would work with patients/students on a long-term basis. This could be in a school setting for special needs, or a long-term care facility. The residents can only be treated for the time specified by their insurance, but the need for therapy may reoccur over time due to the chronic nature of what it is that brought the patient to a long term facility. An example is a nursing home.

Some therapists like the idea of setting their own appointments such as in the niche of home care. They are good team players, often needing to work around others' schedules and also working together with other disciplines when the need arises to problem solve for a complicated issue.

Most people coming out of college are looking to be employed full time with benefits and the opportunity to participate in a retirement program such as a 401k or 403b. In my opinion this is the best and fastest way to gain skill and to experience the camaraderie of a team approach as well as set up your plans to save money. There could be times in one's life, when the OT wants to work part time. He or she may receive benefits based on the part time hours if they are designated as an employee. They may work as a contractor if that works better for them. As a contractor they are responsible for their own taxes and retirement saving. This choice is dependant on your personal needs as well as what type of work is available. Part time options can also include permanent part time with set days and hours or to be called into work, as you are needed.

The sky is the limit here!

Of course along with your niche you are often able to work in the population you are drawn to serve. This could include age-specific areas such as pediatrics or geriatrics, or diagnosis-specific such as oncology or orthopedic. It could be location-specific such as home care or outpatient, or task specific, such as a seating specialist. Then it could be narrowed down to outpatient-orthopedic, inpatient-pediatric spinal cord, or oncology-adult-female. The sky is the limit here as well. It takes a desire to explore options, educate yourself, and network, network, network!

There are also many Occupational Therapists who are entrepreneurs, or self-employed. This option is huge with many nuances of delivery. There is also the opportunity to teach within the field of Occupational Therapy. This could be at the college level as well as the level of clinical educator. Occupational Therapists are among the creative people who take what they have learned in college and combine it with their strengths and talents, and have made a unique niche that serves them well!

I totally agree with the Us News and World Report article that OT is one of the best careers. There can be something for everyone. Now is a great time to start the career or to reinvent the career you already have experienced for years or decades! (Am I dating myself?)

What are some unique twists of traditional OT that you have experienced in your career?

Until next time,

Lorraine

At the risk of sounding a little crazy, I would like to propose a challenge of mixing it up and changing things around.

My inspiration for this came from multiple sources. The first source was when I worked with some patients who fractured their humerus on their dominant side. Needless to say these patients had to do everything with the other hand. I mean everything; please use your imagination.

(Okay, I am talking about the ADL of toileting.)

Some people would find changing their dominance for this or anything else difficult if not nearly impossible.  This could be that we are able to do many things better with one side, or that the muscles and joints have accommodated to specific use.

Another source for my inspiration is that I have certain habits from which I feel I cannot deviate. I like my habits. This includes, of course, my eating habits, my sleeping habits, my television habits, and my time alone that I cherish. I like to be in my home, and I wonder how I would fare if I were the one forced to change the habits I rely on today.

My challenge for you is to mix it up; use different hands for different tasks when you are able, change your route to drive to work, and mix up your routine on a daily basis. Try new foods or a new hobby or exercise. I am a person who thrives on routine. I feel as though I have less stress on a routine.

As you might guess, the universe keeps changing things up. For instance when I am counting on a certain amount of hours of work and a big snowstorm changes the situation, I feel disgruntled to say the least. I would like to be able to fully enjoy the changes that pop up in this instance, like enjoying the ability to go out and shovel the snow.

I often wonder if I would be able to make the changes that we expect of our patients. Does the phrase "set in my ways" come to mind? I know I can make these changes; I did it when I went to live with my parents to help care for my mother as she was recuperating from a serious illness. Definitely I was in a different routine, and being uprooted really got me thinking about this concept of flexibility.

One of my "habits" is my morning coffee that I have assumed to be the only way to start my day. I had one morning where I got busy with a walk outside and totally forgot the coffee. I believe the walk gave me energy! Prior to this I always thought that I couldn't function in the morning without drinking my coffee.

Well, I can function without it. I drank the coffee much later, and it tasted even better than I remembered! I am now expanding my thinking around this. What else have I assumed could only be looked at one way? How can I problem solve by looking at situations in different ways? And lastly, uh, who said my way was always best? How can I be more flexible?

Deepak Chopra says that flexibility is the key to immortality. I will definitely "mix up" my routine again! I do this in the hope of making my life happier by rolling with the punches, and to also have more empathy for those whose routine has been taken from them.

Warm regards,

Lorraine

Did you ever feel at home with a group of strangers? Have you ever been in a group with people you never met before and find you share a deep commonality? It seems to me that there is a lot of that going around lately.

I recently spent a weekend in a group of thirty people at a conference in New York City to learn how to utilize the principles of restorative yoga (http://www.eastwestrehab.org/yogacourse_general_info.htm) within the confines of traditional Occupational and Physical Therapy. It is so exciting to learn new ways to make treatment better or more effective. It is absolutely exhilarating to join in the energy of the experienced instructors, Bill Gallagher PT, CMT, CYT (http://www.eastwestrehab.org/bill_bio.htm) and Richard Sabel MA, MPH, OTR, GCFP (http://www.eastwestrehab.org/Richard_bio.htm) And, of course this includes the other participants!

I felt right at home.

I am also taking a six-week course for adults with Attention Deficit Disorder, who want to feel less overwhelm. Upon introduction, it seems that everyone's story is quite similar; there is an underlying theme that could be interchanged with each person. As I read the story of one of the participants, I felt as if she had written my life story.

Again I feel at home.

What is it that draws certain people into our lives? This meeting of the minds may give us a strong connection and we can be changed in some way. That is, if we really notice the connection. We must first become aware of our feelings around the deep energy we experience or the passion we feel. Then we may be changed for good in some small way, having met a person or a group of people.

This can happen on a one to one basis. There is a member of a professional group I belong to. She will be taking over the volunteer position I held as librarian. We have been trying to meet in order for me to give her the library materials, but it never seems to work. We talk about our plans over the phone and we have discovered the amazing common interests we both share. These interests are creating a common bond between us. It now seems absolutely imperative that we get together in person and share our ideas and explore a friendship.

We never know what the start of a relationship will bring. I met my current boss at a professional training in 2003. We ran into each other a few times at a facility where we were both contractors in 2006. We kept in touch and we now work together! I would not have guessed at that time that this would be in my future, but it was. I am grateful and happy about it.

Do you ever find you experience that "right at home" feeling with new people? If so, how has the experience impacted your career in occupational therapy?

Warm Regards,

Lorraine

My mother called and told me I had to see the horror on television. It was September 11, 2001. I quickly reminded her that I don't watch upsetting things. She quickly told me I could not ignore this. She was right, and I did turn on the television.

I was always overly sensitive. I am not referring to the kind of sensitivity where one is upset by constructive or otherwise criticism, but overly sensitive to sad stories, situations or news. I had given up listening to the news years ago. I have to be alerted by family or friends when an important issue comes up that I need to know about, like when the towers were hit on 9-11. It is important to note that there are people who will always bounce back from adversity.

As an OT I work with others who are in real times of trouble. There are also times when my life is in chaos as well. It could be a challenging event, or a chronic situation that may not change, and you feel the effects of it on a daily basis.  As the professionals we need to be objective in our work and be calm in the "eye of the storm." This is important to us as professionals if it is our storm or our client's storm. It is also important to us as professionals if our level of sensitivity is high and just hearing about a challenge or sadness makes us want to cry.

Through a lot of awareness into my own make up and ways to just be with a challenge, I have made progress in this area. After all, this is the work I want to do; I need to be able to do it calmly and not let it affect me adversely. Although I have found myself close to tears with a patient, I can muster the resilience to breathe through it and come back to baseline with some tricks I have learned from those who have inspired me with their strength and inspiration.

The ability to keep bouncing back is what I want!

What do you say to yourself in times of trouble? What do you say to yourself when you are not happy with your situation or with the situation around you?

When we find ourselves in difficult circumstances we are able to help ourselves by the use of strengthening self-talk. With a better way to communicate to ourselves we are better able to transform the stress into something useful and we can become more adaptable and much more resilient.

Several years ago I taught a stress reduction class and prior to the first class the participants would fill out a questionnaire. One of the questions was around the idea of our thoughts and sayings when we are in a challenging or stressful situation. One answer from a participant that really inspired me was the phrase, "This too shall pass."  This participant said that repeating that phrase was her way of getting through her troubles.

This kind of thinking is also helpful to build resilience. It is not fluff or simply positive thinking. It is a conscious choice that can set in motion the opportunities not available when we do not think consciously or do not think at all.

Who does not need resilience in the chaotic times? Life at any time can be a time of intense change and even loss. Wouldn't it be wonderful to take the challenges and be able to bounce back from them?

Do you know anyone who may have lost his or her job, only to make the best of it? Did they look at the opportunities it afforded them, no matter how small? 

Another saying I use is, "I can handle this," or "I have choices here." I may not see the choices, I may not feel as though I can handle it, but I am directing myself into another mindset and opening up to possible choices by attracting the opposite of what is going wrong!

Listen to what you say to yourself, either aloud or silently.

Is what you are saying helping you or hindering you?

Working in home care I often had to make my own schedule while keeping in mind I had to work around the needs of the patient and the other team members who could include nursing, PT, speech and home health aides. Somehow, with a little teamwork we orchestrated a schedule that was a win-win for everyone.

Often times throughout the span of time when we are OT students and then actually practicing OTs, we are so busy that we tend to depend heavily on our calendar or electronic device that we chose to keeps our day running smoothly!

What type of device or format do you use to keep track of your appointments and your life, including your list of things you don't want to forget? I have been through all types of paper and electronic methods of keeping my work life and my personal life in running order.

Decades ago I listened to a self-study course on time management. I was a young mother who was returning to school, and I had to keep my schedule running smoothly as well as the schedule of my two little daughters. This self-study program used the Day-timer® as an example of a great system to use. It really was fantastic, and met my needs at that time!

What I first used was a little tiny book that they made which was about 3 x 5 inches. That was a size that I could fit neatly in my purse and put all the appointments that I had for myself and for my two daughters. I used the "one page per day" style, and this was good enough for me to use for volunteering, mothering, and my part time job.

As far as a "to do" list goes, I need to put it on paper and strategize the order of the items so that I could feel mentally organized for the work at hand. I even do that when I cook a large dinner for friends and family.

As the years went on and I was back to college I got a bigger sized Day-timer® that was about 4x6 inches. During those years I had to fill it with schedules and assignments and phone numbers of fellow classmates, as well as the unending schedule of activities for two little girls who took dance and music lessons and played in sports. I even upgraded to the "two page per day" style, and filled it easily.

I rarely missed a beat, or an appointment, and felt really organized. Once out of college and into working I tried different sizes of the date book to keep me on track.

There were several years of my career that I had a full time job and at the end of the day I worked with several homecare clients. I went on to use a date book that was notebook size, and huge, so I could keep track of all my homecare appointments, phone numbers, my mileage and all else that was essential to the organized, well-balanced Occupational Therapist. As time went on and I had periods of working part-time and took some time off to help with a family crisis, my needs changed and the big book was no longer necessary.

My time management system got downsized to the manageable purse size book!

I was working part-time and taking classes for Coach training, and found it was messy to find lots of room to make notations of my appointments. I had to keep looking at the date book to know what I was supposed to do at specific times. I had lots of teleclasses to attend, calls to make and work schedules to adhere to!

My mentor at that time was using a palm® and therefore I felt the necessity to use one also. Little alarms could be set to go off so I would never miss an appointment or a call! There was a place to make a strategizing task list, and best of all, it can be downloaded into the computer, and synchronized between the handheld and computer. This way I could use my schedule at the computer or anywhere.

This synchronization was very handy when I did have a computer crash! The schedule was there and waiting to be placed back onto my computer via the palm® through the beauty of the synchronization process. The palm® has been running for five years now, and is backed up daily. When I need to see my schedule on paper, I just print it out from the computer! The handiest part of this system is the little alarm that warns me of an appointment, and also the portability of the little device.

This is the system that has worked for me up until recently.

Of course as you may have guessed, my next step would be to combine my phone, computer and palm® device all into one. Choices for a smart phone include an iPhone, BlackBerry®, or Treo®. The option was a big decision for me because the perfectionist in me had to pick the very best phone for my situation. It had to be easy to use because even though I love techie stuff, it is not "intuitive" for me and many others in my generation! It had to be compatible with my main computer, and I wanted to stay with my phone provider so I can talk to my daughters for free!

I made my choice! I am still trying my new smart phone out, so I will save the rave reviews until another time.

What are your needs around documentation of your schedule, and what is your favorite item to maintain your schedule of work, home life and social life?

I would love to hear from you,

Lorraine

What I am referring to is that the notion of Activities of Daily Living encompasses so much! What is the most important activity of daily living to the patient and how will that goal impact the ultimate goal of highest level of independence? Does the insurance provider agree with what I think or the patient's wishes?

I may ramble a bit, so humor me. 

When what we want is for our patient to be at their best, and to have the best recovery, what is it we focus on? Of course I am not even hinting that we don't know how to write goals and evaluate a situation. But often times little questions keep nagging at me. How do we open a patient's frame of reference around recovery? How important is the patient's eating habits and lack of movement going to impact recovery? What is the one thing we can impact when lifelong habits are not conducive to healing?

I guess as OTs we look at the bigger picture, and the whole person. What tiny bit of information will be helpful to me as I determine what I might introduce to the plan of care? What is holding the patient back? Is it the fact that they are depressed, and therefore progress may be halted until the depression is addressed? Does she feel that if she recovers that no one will be there to care and assist anymore? Does the patient really want to recover to return to a job that makes them sick, or a life where there is not much support at home?

So much is involved in our therapy plan of care and the ADLs. It can include aspects of good nutrition, enough exercise, good choices, whole picture thinking and small picture thinking, emotional stability and emotional intelligence. What is it that makes up the whole person and their journey towards recovery or discharge? What is it that brought them to the present point and what is the role that I play in facilitating their growth?

Of course, there is one more question. How do I do all this and have it be congruent with the insurance provider?

I am a lymphedema "nerd." What that means is that I love working as a lymphedema therapist and I love reading about it, and learning more about it, and discussing the work with my peers.

My area of practice in my work as an OT is with people who have Lymphedema. Lymphedema is a chronic disease that we didn't learn about in college. It requires further continuing education to learn how to work in it, and it's an area of therapy that I was drawn to the minute I heard about it years after my graduation as an OT.

I was drawn to work with breast cancer survivors who developed lymphedema. I then went on to learn that the treatment of lymphedema covered more areas than the problem of lymphedema from breast cancer. There are many occupational and physical therapists who are quite busy with a caseload of patients who enthusiastically want to have a treatment that is so non-invasive and really helps them to live with this chronic disease!

From what I have gleaned at the many continuing education conferences I have attended, the gold standard for lymphedema is CDT, or Complex Decongestive Therapy. This is a combination of manual lymphatic drainage, compression bandaging, exercise while bandaged, compression garments and meticulous skin care.

What is lymphedema?

Lymphedema is actually an accumulation of a protein rich fluid in a body part such as an arm or leg; this protein rich lymph fluid can cause inflammation. If left untreated, the inflammation will cause fibrotic changes in the tissue.  It differs from most other occurrences of swelling by the protein rich nature of the edema.

Most people have heard of lymphedema as a side effect from cancer treatment, in particular when the treatment consists of removing lymph nodes (which will help the oncologist to stage the cancer and determine treatment options). Radiation can also increase the risk. No one knows who or why an individual will develop lymphedema.

Lymphedema that develops after cancer treatment is called secondary lymphedema. There are some guidelines to follow for patients at risk for developing secondary lymphedema from cancer treatment. It is helpful to care for the area of the body that could possibly be affected by these lifesaving cancer treatments. For instance, blood pressure cuffs are not used on arms where the lymph nodes were removed, as a precaution.

Another form of secondary lymphedema is caused by an infection called filariasis. This can occur in the tropical areas of the world caused by a mosquito born parasite; rather uncommon in the United States, the treatment would be the same.

There is also primary lymphedema, which has a genetic or congenital component. To put it in very simple terms, primary lymphedema is caused a mechanical insufficiency of the lymphatic system. Examples of possible problems are that there not enough lymph collectors in the affected area, vessels could be less functional, there could be an absence of lymph collectors or there may be other problems with the way the system functions. 

I could go on and on talking about this. There are other causes of secondary lymphedema, and there are also other diagnoses that are combination types, such as chronic venous insufficiency and a resulting lymphedema, and obesity and lymphedema. Both of those combination types can be treated with the compression bandages and compression garments.

I find this work to be exactly what I want to be doing in OT. It consists of constant ongoing learning and adaptation of the fundamental treatment principles to be helpful to the patient and his or her unique needs. The work is done individually with patients and the patient is an active participant in the therapy, or if he or she is unable a family member may be the helper. The patient will benefit greatly with "proactive" participation.

Another great aspect of treatment, also very proactive, is the use of diaphragmatic breathing, which is my most all-time favorite aspect of self-care ever!

Go ahead.

Call me a lymphedema nerd. That is okay with me.

I would love to hear from you. Are you working in an unusual area of practice that you never trained for in college?

Until next time,

Lorraine

I strive to be peaceful and non-chaotic during my working hours as much as possible, and wear a happy face during my workday. For me it is important to keep my own stress level down as much as I can. This was not always part of my life, but now I feel that for the most part I can respond to what enters my day instead of reacting to it.

There are many ways to reduce stress. My favorite is the almost comically simple act of conscious breathing or diaphragmatic breathing. As therapists we all know what it is, and many of us may have dismissed it as something we really already know how to do innately.

Who needs to be taught how to breathe? Do you know how to use it to your advantage?

Yes, we do know how to breathe, and we may refer to it as an aspect of treatment on occasion to help a client or patient to coordinate the breath with the exercise. The breathing can also be the main task to be learned. The beauty of this simple automatic act is that when utilized on a conscious basis, or non-automatically, it can be a lifesaver as well as a stress reducer. It can allow us to be with our patients or clients at our very best.

Have you ever seen a baby laying on his back and playing? He breathes with his whole body! His little baby belly puffs up on inhalation, and flattens out on an exhalation. This is the proper way we should breathe. Unfortunately we don't do this when we are under stress, or when we feel rushed. Quite often we are accustomed to holding in our abdomen to look good. It is during those times of pressure that we breathe in a shallow manner or place our breathing high in our chest.

It often has to be a conscious and deliberate effort to breathe properly. A benefit of this conscious breathing, besides keeping us alive with oxygen, is that it keeps us in the present moment. Did you ever find yourself working with a client or patient and some of your own problems drift into your mind? If you focus on your own breath, it immediately puts you in the present moment and away from the nagging thoughts of things in the future or things in the past that are not what you want to focus on.

Another important side effect of diaphragmatic breathing is that it stimulates our parasympathetic nervous system, and this in turn releases calming endorphins. This is an ultra simplified explanation of the relaxing effects of diaphragmatic breathing. Relaxation is the antithesis of the fight or flight response. The fight or flight response activates our sympathetic nervous system with the ensuing release of the stress hormones!

I could go on and on talking about this, along with the other benefits besides relaxation such as the benefit of slowing our heart rate and decreasing our blood pressure. The slow, diaphragmatic breathing also makes us feel smarter, enabling us to better focus our attention. It can help to ground us by unifying our body and our mind.

Learning this technique has helped me to be a better Occupational Therapist, because I feel more relaxed and less reactive to all that is going on around me. It didn't come naturally then or now; I practice all the time. 

I spread the word by teaching all the clients or patients I work with to "just breathe." In my opinion the possibilities are endless for the use of breathing in Activities of Daily Living.

What are your experiences with conscious breathing in your own life and with the patients you work with?

When I look back over my career and pick the times when I felt my career and work were so satisfying to me, it had to be times when I was being mentored. That process met many different values of mine. I could learn to be the best I could be in a given area, emulating someone who has similar passions and takes his or her work seriously. It would give me intellectual stimulation with ongoing learning, and also provide me with the camaraderie that ensued with the joining of the minds.

A value of mine is ongoing and lifelong learning. I love when I have someone to answer my questions, and someone who allows me to bounce ideas off of them. When I am immersed in my work and I can discuss case studies and rate a new modality or a new treatment technique, I am really in a place of flow. Flow is the name given for the state of consciousness that makes our experiences deeply fulfilling, and it is when we are totally absorbed in an experience.

When this happens the time seems to go so fast and the day is over too soon. I get a break from the routine ups and downs of my life because in this happy state of my career I can shut out all but what I am placing my attention towards.

Are you finding "flow" in your OT experience?

I have found that I need to be aware of the aspects of a situation that allow me to do my best work, such as when I have a mentor. I need to make it my business to place these things into my work.

I also know that I do my best work when I can work one-on-one with my clients or patients. I have been able to do this in my work in home care, pediatrics, and lymphedema therapy. Knowing that about myself, I can keep those characteristics in the idea of my "dream" job. So far my dream job includes having a mentor or team oriented peers to learn from, and the ability to devote most of my work time with direct one-on-one patient contact.

Of course, the compensation for the work is important, but if you have noticed it is not my number one. I enjoy good compensation, in the way that I enjoy a nice work environment, and a clean environment, with the perfect pieces of equipment. Of course that is my preference. All in all, for me personally to keep the passion going, the primary attribute of my work is to have a great mentor for ongoing learning and sharing.

What is the aspect you value most about your career? Does this value seem to resonate to other areas of your life? For example, my love of learning is an important part of my career, and resonates into my personal life.

What is it that you value most, career or personally, that is at your core of what gets you out of bed in the morning?

What was the moment when you first heard about occupational therapy? Did you always know that OT was the career for you, or did you determine this late in your college years? Once I noticed the little trail of breadcrumbs leading the way, the decision to become an occupational therapist was easy for me.

The choice was part of a whole process of little events. I had not obtained a four-year degree right out of high school. The decision I made was to go right to work. I did study off and on with some college courses and a certificate course, but never really found what I truly loved. This state of affairs never felt comfortable to me, and I always wished that I had gone to college.

When I returned to school in my early thirties, I really wanted to do something in the medical field. That was my defining factor! I had dabbled in being a chair side assistant for a dentist, but when the time felt right to go back to school, I didn't want to be a dental hygienist.  Actually, the only thing that I knew was that I wanted to get a degree and I wanted to work closely with people in some sort of medical aspect of their lives. This began a series of events that would lead me to occupational therapy.

Not knowing much about the many different types of careers one could have, I considered the fields of nursing and medical technology. Those careers were not foreign to me, so I started taking the classes that would prepare me for either one. I did know that there was a field of study called physical therapy, because my dear friend in high school became a physical therapist.

I added physical therapy to my list of possible choices.

The community college that I attended had recruiters from different four-year colleges visit to attract transfer students and as I studied the catalogues I noticed the field of occupational therapy. The next step in my journey was attending a career day event where an occupational therapist was on hand to discuss the profession and her experiences.

As I listened with focused attention, I was coming close to being sold!

My next step was to follow this occupational therapist throughout her workday. She was a homecare therapist; I was able to see firsthand how much she was able to help her patients and how important it was for them to rehabilitate in their home. No two patients were alike, and I saw varied ways that OT was a vital link in a patient's life.

By the end of that day I knew I had to look seriously at this profession. I also did some volunteering in Doylestown Hospital's Department of Occupational Therapy. This experience pushed me over the edge in regards to making an educated decision!

I was glad that I had all the appropriate courses completed in order to move forward with my studies! I also visited an open house at the college where I was interested in transferring. I took the plunge and applied to Thomas Jefferson University College of Health Professions and the rest is history for me. Little did I know that the area of study called occupational therapy could afford me so many varied experiences in my work! It also allowed me flexibility, with my choice of initially working part time, and I have never regretted this choice of health career.

Many people go into areas of study for different reasons. At the risk of sounding corny, I felt truly guided in my choice. I would love to hear from you as to what it was initially that led you to occupational therapy and then what was the defining factor that "clinched the deal" for you! 

Was it fate?

It is amazing that after all these years I keep coming back to OT. I have trained to do other types of work in addition to occupational therapy, but OT just calls to me.

Looking back, I would have to say I have been truly blessed with the opportunity to explore the profession and all the different aspects of treatment that we as occupational therapists can provide. When I am working as an OT I find that I feel passion, I feel authentic and totally in flow. I am stimulated and never bored, as there are no two patients alike; therefore, I need to think on my feet very quickly how to best work with them.

There have been many different arenas for exploration in order to allow me to decide what aspect of occupational therapy would meet my criteria for "the perfect job." As an older student going back to college, I felt as though I needed to make all the right choices and make the perfect choices.

I have explored, I have diverged, and of late I had let my therapy career sit fallow.

The exploration included many different practice areas, and many different places to practice. In just the area of pediatrics, I have been fortunate to work in specialized pediatric settings such as Easter Seals, in public schools, and preschools. I have also worked with children in the home, on an educational basis or medical basis.

One location where I was employed was set up in such a way that I would work in pediatrics during the school year, and work in an in-hospital rehab during the summer. That set up allowed me to gain valuable experience with adults. I love learning from all my peers on the rehab teams; I added yet another practice area to my repertoire.

As I verbalized my wish I that I would love to become the expert that my mentor was, she quickly stated that I was a "generalist." 

She pointed out that being a generalist was versatile and marketable.

That sounded good, except for the times when I really did want to be the expert.

Who are the experts that you admire in your area of expertise?