I'd like to start a discussion on occupation-based practice. What do think it is or isn't, and how much of it do you feel you use in your practice?

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E.J. Brown

To me occupation based practice depends on your practice setting. For me in LTC it would be working with people on improving self feeding with adaptive equipment or compensatory strategies, low vision adaptations for their rooms for improved safety, etc. Unfortunately, in this setting it is very easy to get into a "routine" of treating each patient. A lot of times, these great ideas and occupation based practice gets put aside because the therapist is stretched thin in this setting having sometimes 15-20 pts to see in a day. However, I think that come October it will become easier to incorporate occupation based practice into this setting with the new 1:1 rule. The only downside I can see is the struggle to get the supplies you will need. Treating a pt 1:1 you will see many more deficits and treatable areas requiring adaptations and supplies. It has been my experience that you are told to use what is there already, which works fine in some cases but is no applicable to all. It is a balance struggle and picking your battles. I hope to use occupation-based practice a lot more when MDS 3.0 takes effect in October. I struggle on a daily basis feeling like LTC is not a skilled treatment area and that I only use a small part of my brain because you do see the same issues over and over.

 

Dear LTC-OT:

I can feel your frustration. In so many places practice is rigidly controlled by factors outside OT. But I do know that a few years ago Medicare put very stringent standards into place for nursing homes in terms of the types of activities and choices residents are to be offered. The rules are highly occupational. Unfortunately, OTs themselves may not be very much involved in the quality-of-life aspect of LTC at this time. This is where I think you need to go. Facilities are evaluated on quality of care now. Not sure how many are complying or how. Anyone out there involved in this who can tell us more?

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E.J. Brown

Having observed an Occupational Therapist in an outpatient clinic as well as completing a Level I fieldwork in the hospital setting, I feel as though occupation based care/intervention was lacking.  In the inpatient setting, ADL's were the focus, but intervention was purely limited to that aspect of occupation, which I feel could have been expanded upon throughout the client's hospital stay.  In the outpatient setting, I felt as though the Occupational Therapist was following the role of the Physical Therapist's and purely focusing on the physiological aspects of intervention, with no occupation based connection intertwined with the client's care.  The client's were mainly completing range of motion and strengthening exercises with no real function or occupation base to them.  I feel that as a future practitioner in the field of Occupational Therapy, my eyes have really been opened to this aspect of care and with this in mind, I will strive to focus on occupation based care while attempting to achieve the client's goals.  This will align their intervention and care with evidence based practice, client centered care and occupation based intervention. 

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 We should be extremely happy that we have the ability to have 1:1 sessions; this will certainly allow OTs to perform as they should. I believe that occupation-based practice is the core of the profession and has been missing from practice not entirely but from many settings. As a student whom has recently completed fieldwork experience in an outpatient and hospital setting I was able to see how the use of occupation based interventions can be beneficial.

For one client a former mechanic whom recently sustained a stroke. I was given the opportunity to choose an activity that he can work on for the session.  I chose the 5 sided box of nuts and bolts. Instructed the patient to manipulate the nuts on the bolts, on all the various levels and sides. Both in a sitting and standing position. While the activity may have been relevant to the patient I was able to identify other activities the patients was doing at this time, standing for increased periods of time, weight shifting, correcting balance. When fatigued the patients would sit and still attempt the continue to complete the task. I was able to see how invested this patient was in the session because it was very client centered and occupation based. I think this was a great learning experience for me. My supervisor at the time told me that it is a wonderful thing to think about the function behind the activity used during the treatment session. While also thinking about how else the client is benefiting from this experience. This is what I think occupation-based practice is.

 

Now I know that this cannot be the case for every patient and I think this is where the problem stems from. We will never have an unlimited amount of supplies and thus be able to do activities that are meaningful to each client. However, an attempted is warranted. Needless to say that insurance companies dictate the rules thus also limiting our abilities. But I strongly believe that any activity can have therapeutic benefits, its all about the creativity and versatility.

Lennisa,

That is definitely an excellent example of occupation-based practice and is very relevant for the challenges that the client was experiencing after the stroke.  I feel that simple activities such as this, that actually have meaning for our clients, is definitely lacking in some settings and facilities.  I feel that the activity does not have to be done in depth or very complicated, rather keeping the task simple can be more beneficial!

I am hoping that when I go on my Level II fieldwork exeperiences this spring, I will be able to provide occupation-based care and implement this practice into the setting!

 Keep up the great work!

Jodie

I see that this post initiated quite some time ago, but wondered have you gotten any positive and informative responses. I feel that as OTs we were trained to keep occupation in the forefront of therapy but do not truly understand how to implement functional activities into the treatment session. When you work in LTC you can not treat everyone in the morning for ADLS - so what do you work on if the patient is already bathed and dressed?? So what functional activities do you incorporate to work on deficits such as decreased endurance or decreased shoulder ROM?

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mat