Busy, busy bee…

Study central around here because I have an exam with oral and written components next week…. I have to present, for ten minutes, an intervention-based session applicable to a particular case scenario I’ve been allocated to.

After the exam’s over, I have to finish writing and submit an assignment about child observation.

I shall have more to say about my Paediatrics OT subject journey after next week.

Until then – this landed in my inbox today. Check it out. I agree – health and arts are linked. After all, treating the whole person is better than just focusing on treating one part; it’s not just about the medical way of things but the social-environmental occupational etc. ways too. https://fromtheharp.co.uk/2017/10/12/a-day-out-at-parliament/

 

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Activity Scheduling and Stress Buckets

I’ve been busy lately. My current uni subject is coming to an end, and I’m also preparing for placement. I’m also balancing extra-curricular projects like MIV and LaTUCS. Not to mention going back to my hometown for work and finding time to actually relax, to spend time with my friends or boyfriend or just do personal projects for myself.

My OT course is helping, by giving me tools to explain how I feel/do things (we call these explanatory models), even as it’s stressful at times. There are life lessons I’m learning.

Like, remember to set realistic plans for the day. I might want to get something done in one day, but realistically it might take one and a half days study, or two. Case in point: last week’s assignment was more challenging to wrap my head around than I realised – giving myself a strict time pressure/deadline wasn’t helpful. I ended up feeling quite stressed. But I used my resources – I emailed my subject coordinator, knowing from past experience she’d know what to say to put my study into perspective. As well, my boyfriend came over for dinner, before we went out to a choir workshop we’d been invited to (that was the deadline). Talking things through with and being close to him really helped. It’s the little things.

I need to remember that as an overachiever (remember the impostor syndrome realisation?), given that humans have an inbuilt “negativity bias”, I’m going to be harsher on myself for not getting x, y, or z done in the time I like – even if overall I’m still travelling well. Case in point: this week’s study for the exam. I had wanted to get “this much” done yesterday, but was hampered by a bit of a slow start and felt pressured. I couldn’t seem to get going as much as I liked to, until late in the afternoon. I did manage to feel happy with the day’s work, in part because when I got into the groove I let myself go an extra hour because things were flowing, instead of stopping work at 17:00. Later that evening after chatting over Facebook with a few fellow students, I realised that my version of “not enough done today” was quite possibly different to theirs (we’ll see – we’re catching up after class today to study together).

In occupational therapy, we’ve learnt about several different models and ways of improving a person’s occupational performance and mental health. Some of these are commonsense approaches that OTs or other professionals have put a name to, or formalised.

Like the concept of Activity Scheduling, where you schedule your day so that important things get done as well as fun things. I use Google Calendar for this and have been doing so since high school. I didn’t know there was a name for it until recently though! Activity scheduling (called a “time grid” in the third principle of this article, which talks about other related stuff) can be used in a general organisational context (as just noted) or a more specific therapeutic context. For example, if someone is depressed, scheduling activities can help get things done. This is of course done in a graded manner – i.e. start off with one little thing, then build it up. More information can be found about it here. If you’re interested in it for that regard, talk about it with a trusted health professional.

Another concept is the model called, “Stress-Vulnerability Model”, first developed by Zubin and Spring (1977). It’s a model that uses symbols of a bucket/tank, rocks/etc., water and holes/taps to explain how each person has individual stress levels that are influenced by different factors – vulnerabilities, stressors and protective ones. People with more vulnerabilities generally have smaller “stress buckets”, because their vulnerabilities fill up the bucket first. When a person can’t manage their stressors, or doesn’t have enough protective resources, their stress bucket will overflow. That overflowing can mean different things for different people, but generally results in some sort of crisis – whether that be a relapse or increase in illness severity, or “just” an emotional outburst of tears or anger. Learning what one’s vulnerabilities, stressors and protective factors are can be useful, as a person can then learn how to manage those factors.

A visual description of the Stress-Vulnerability Model is below. For more information, see here (original model publication, rather wordy) and here (simpler explanation).

Very rough visual representation of the stress-vulnerability model. Stressors shown as raincloud over tank, protective factors are a tap on the tank, vulnerabilities are rocks in tank. Level of water in tank indicates level of stress.

Stress-Vulnerability link http://www.mhpod.gov.au/assets/sample_topics/combined/Risk_and_protective_factors/risk_objective_2/index.html

Meditation exercise link – smiling mind app https://smilingmind.com.au/

Interesting skills

IMG_0655

Yesterday I had an all-day skills workshop, to learn about the occupational therapy specialisation of hand therapy. This basically meant learning how to make splints. The finished lot of splints we had to make is shown in the photo above. There are two resting splints (blue) because I was the “sim-pat” (simulated patient) for the whole class demo for that one as well as having one made for me by my partner. We were paired up and each of the pair took it in turns to be the model/patient and the therapist.

The splints in the photo above were made by using a heat pan  to soften various materials in order to mould them to my shape, based on patterns provided.

IMG_0652

Heat pan

The splints we made were as follows:

  1. The “Figure 8” finger-splint
  2. The Mallet finger-splint
  3.  Hand splint*
  4. Wrist cockup splint
  5. Functional resting wrist/arm POSI splint (pan design)*

(*Not exactly its technical name, but the approximation my memory’s giving me. :/ )

The Figure-8:

IMG_0661

This sort of splint is used in two ways:

  • either as shown here, preventing hyperextension (over-straightening) of the middle knuckle of the finger (technical name: proximal interphalangeal joint [PIPJ]);
  • or flipped, so that the cross-over part of the pattern is on top, to prevent flexion (bending) of the middle knuckle (PIPJ)

The material is a thin piece of “aquaplast” a type of heat-modifiable plastic. We placed the strips into the heat pan, then waited until they had turned clear. We then lifted them out of the pan onto a tea towel nearby, quickly pressed them flat (and peeled them off the tea towel if they stuck), then moulded it to the sim-pat’s finger.

The sim-pat, our partner, was holding their hand in a loose circle, with the middle knuckle (PIPJ) slightly curled inwards (flexed). We started behind the knuckle, wrapping the middle of the strip across the sim-pat’s finger then crossed the two sides over underneath the knuckle. We then brought the sides up so that they met on top of the finger again. This involved a bit of fiddling around due to the way the sides met up. Had to make sure it wasn’t too loose or too tight.

While wearing it, you should still be able to make a fist (if using it with the crossover underneath the knuckle) or if using it with crossover on top, still be able to flex (bend) the main knuckle (metacarpo-phalangeal joint, MCPJ) and the smallest finger knuckle (distal interphalangeal joint, DIPJ).

The Mallet:

IMG_0660

This one is useful for:

  • Preventing the smallest knuckle (DIPJ) from hyperextending (over-straightening)
  • Window for fingernail preferred but can be absent if required
    • Need to be able to fully bend the middle knuckle (PIPJ) while wearing it.

We scratched out/drew a design on a flat piece of aquaplast based on a tracing of the sim-at’s finger. We then cut it out and put it in the hot water to soften. Afterwards we wrapped it around the sim-pat’s finger, ensuring that it was a snug fit without being too tight.

Hand splint/ safe position splint:

IMG_0658

This one is useful if you have:

  • Burns
  • Acute traumatic hand injury

Safe position refers to POSI = Position of Safe Immobilisation. It’s the position that is safest for immobilising a joint and has to do with angles, preventing further injury to the joint and preventing injuries to joints/tissues around the injured joint due to overcompensation.

We cut out the pattern after tracing around the person’s hand, using landmarks like the wrist, the bottom thumb joint (carpometacarpal joint, CMCJ) and thumb knuckle (MCPJ).

Wrist cockup splint:

IMG_0656

Useful for:

  • Managing arthritis
  • Wrist pain or weak wrist
  • Weakness in wrist extensors
  • Post wrist fractures

Again, we traced out a design around the person’s hand (and arm), using particular points like the borders of the wrist, the bottom thumb joint (CMCJ) and the thumb knuckle (metacarpophalangeal joint, MCPJ) Then we put it in the water to soften before cutting through the material and moulding it to the skin.

It should extend two-thirds of the way down the forearm and leave the fingers and thumb free.

Things to be aware of include:

  • Watching out for bony landmarks etc. and remoulding if necessary to avoid them so that the splint does not rub and create pressure points/sores. Applicable to all splints, but noted for this one because I’ve discovered since taking mine home that there’s a pressure point on mine!
  • Should be able to still form a fist.

We used tailorsplint to make this and I understand why the workshop facilitator loves it so much. It was easily the most pliable and flexible of the materials we used with a decent “working time” aka amount of time you can work with it in one setting before it hardens. This does mean that supports like bandages or a second pair of hands are useful when moulding it – but the second pair of hands cannot come from the patient, they must stay still! (Sounds obvious, but people will still try, because you want to help…)

Functional resting wrist POSI splint:

IMG_0659

Useful for support when wrist is affected by:

  • Arthritis
  • Neurological condition (e.g. stroke)
  • Comatose patient

We used a material called “ezeform” to make this. It was the firmest material and was a bit of a nuisance to work with because you had to soften it to cut it, but once cut the pieces would start to stick together. Also didn’t help that as this was the longest splint, you needed a lot of working space.

Landmarks used for tracing were the mark of two-thirds down the arm, the wrist, the bottom thumb joint and thumb knuckles as well as palmar creases. Due to the way this splint had to be cut, you needed to mark the inside point near the main thumb knuckle, allow another centimetre inwards then draw a “u-shape” down to the bottom thumb/hand joint (CMCJ) and up to meet the outer line of the tracing around the hand. This created the flap that my thumb curves around in the picture.

I have it on good authority that this one is comfortable, as it should be. Not only did it feel comfortable to wear personally, but when I showed it to a few friends they thought it was comfy too.

 

It was an interesting day, but I don’t think I want to make a career out of doing hand therapy (like our facilitator does). It’s a bit too fiddly for me.

Reblog from this time last year: Ouch! We’re lucky to have a good health system…..

So, it’s been over a year since I dislocated my kneecap. Phew!

It was not the most significant personal event of the year, but it was significant enough. I still have to remember to try and do knee exercises (recommended by the physio) to keep the muscles strong. In the end we decided against operating as it wasn’t clear if it’d help more than harm in the long run.

It was an experience, that’s for certain, which gave me a new perspective. Thanks again health system, doctors, nurses and other staff.

In the weeks afterwards I had to rely on people differently for a while, which was a good thing. It’s also made me slightly more spatial aware than I was, because now I’m somewhat paranoid about my knees banging into things. It still happens occasionally though.

Source: Ouch! We’re lucky to have a good health system…..

Australian Healthcare is Endangered

See these articles by thatladydoctor and drmarlenepierce. Australia has a very good healthcare system that enables healthcare for all through the use of bulk-billing and so on. But in the age of privatisation, that’s under threat. Also under threat is the value of General Practitioners and the time it takes to treat a person properly. Apparently it’s a women’s problem too!

I think they raise valid points. As a woman, I like to see a female doctor – it just makes me more comfortable. I also value being listened to (who doesn’t?) and not just treated. That takes time. Also, I don’t get sick that often and I know what to do for little things (i.e. rest, keep up fluids, use over-the-counter pharmaceuticals like cough lozenges for a sore throat or ibuprofen for a bad headache/cramps…) When I do go to the doctor’s, unless it’s for something like a uni-mandated health form, it’ll be because I need someone who is knowledgeable about something that’s been worrying me. Also they should be non-judgemental – my body, my choice and all that.

Also, as I said when sharing the first article on Facebook the other day, as an OT I’m going to be working with GPs and other health professionals to ensure my clients are cared for in the best possible way. You know what helps that? Giving health professionals the respect they/we deserve – which includes proper pay and support through not gutting systems like Medicare.

 

 

Emotional Learning

This post gets a bit lengthy because my tired brain (when writing it last night) surprised me by turning it from a uni-focused post to something a bit deeper. Firstly though – you know how on Saturday I talked about MIV? Well, the first of the 11 bullsheets has dropped. Go over here to check it out: http://us15.campaign-archive2.com/?u=76fbc0d21b849c256d862b386&id=afde62249d&e=460cb7de0c and subscribe to MIV2018‘s mailing list to keep up-to-date! (You can follow on Facebook and Twitter too!)

Now, onwards…

In class the other day, our facilitator talked about how we use ourselves as therapists to help our clients/ patients.

She talked about how an OT’s enthusiasm can provide hope by being a spark of light in someone else’s darkness – their confusion and hurt at being unable to quite get to where they want to go. We’re not doing this in a patronising way, but in a way that guides the client to see their own way. We do not enforce or coerce but empathise, collaborate with, encourage, instruct, advocate for and problem-solve with the client to instill hope and achieve our joint goals. We are not “doing to” but “working with” them. In occupational therapy, the client is the centre, after all. We enable the client to move forwards towards a future of their choosing, or one that is as close to that as possible.

The facilitator reminded us that all that we’re all different personalities, with different life experiences, and so we’ll all be different therapists, even though the class is studying the same theory. The person with a naturally bright/bubbly personality might approach a client and their situation from a slightly different angle than the approach adopted by someone who is naturally a calm, softly-spoken listener.  The best way we can practice occupational therapy is to always strive to be the best we can be.

We’d just done some role-plays of different client-therapist situations and I could see what our facilitator meant. During the role-plays, there were plenty of moments when I thought, as an observer, “Oh, I would’ve done that differently”. The facilitator’s words brought home to me the fact that I don’t have to be any sort of OT except who I am and want to be.

I’m naturally someone who empathises easily with others (even when I’m annoyed at them, depending on the person 😛 ). I also happen to be a bit of a talker. One skill I’m working on honing is learning when to “shut up and listen” and be guided by my intuition/ gut feeling. The times I’ve done that – listened to hear and not just respond, then reacted with empathy to the person’s situation – have resulted in really powerful moments for me. Moments of human connection at its best. That’s just with friends and not in the role of therapist yet, but it’s something I know I can bring into practice.

I first realised this properly last year, but I’d had insight into the feeling before then, from high school onwards, or even before that maybe? I seem to be one of those people who gets told personal things. Learning how to respond to those things is where I’ve learnt the “shut up and listen, then follow your gut” response. I like being able to have words to comfort – but when someone’s just told you something that’s visibly upsetting or frustrating, words can wait. Often words fail in those times. They need a listening ear (to get it off their chest) and then physical support, like the offer of a hug and the understanding that emotional expression is acceptable.

That brings me to another point. Human society is weird about emotions. Expressing them in public can be seen as a bit shameful – especially if it’s expressions like tears of sadness, or loud joyous laughter – except in tightly regulated situations, like at a sporting match, public performance or public memorial. I think one reason why outbursts of public mourning have become so prevalent relatively recently (though it’s been “a thing” for a few years now), aside from social media connecting people, is that it’s an acknowledgement of public emotion. It’s an acknowledgement that emotions are okay.

This is a really important thing, because there’s still so much stigma around the visibly of public – and even private – emotional expression. Like the outdated idea that men aren’t supposed to be emotional – it’s being challenged but I still see the shadow of the idea manifest in how some people, particularly men, are uncomfortable if someone starts crying in front of them. They want to “fix the problem”, a.k.a. the tears and the tears’ cause, but they sometimes don’t get that the tears have to be expressed in order for the situation to resolve. Then there’s the other end of the stereotype – the idea that women are “over-emotional”. This is, I believe, where some of the whole “special snowflake SJWs” stems from. When women become passionate, frustrated, angry, upset – others can’t deal with that. They tell us to calm down, say that we don’t make sense because we’re using our emotions, and so on. *shakes head* Not cool, people. Stop it.

Sometimes, we can’t help but get emotional, including tears. We don’t want to be told to just “calm down” – acknowledge our emotions and the reasons behind them first, please. Or you can piss off.

Some people – women AND men – are more emotionally sensitive than others. I call it being more “attuned to the emotional quality of a room”. We’re the sort of people who might get a little agitated by conflict – and therefore find it a little tricky when we have to stand up for ourselves and others. But stand up, we do, because our emotions tell us when something smells of bulls**t. We probably cry more easily than others too. We’re also the sort of people who get “over-excited” by things and accidentally embarrass other less-emotionally sensitive people by reacting just a bit too obviously to something. When that happens, we may well be told to bottle up those feelings because others can’t deal with the pure expression of ourselves. It’s a bit much for people. That can cause us/me to feel guilty about things. Is it our fault for being a bit different – or is it really the fault of society, shaping others to see our differences as abnormal? (Rhetorical question.)

I used to call myself an extrovert, though it didn’t sit quite right with me. While I do like to talk and enjoy the social environment, I also find it easy to spend hours at a time engrossed in a good book. A couple of years ago, I took one of those online quizzes about personality. I’d had to do some for a psychology subject I was taking, the Five-Factor Theorem ones. They’re interesting, but not as easy perhaps to understand as one I took for fun around the same time, a Myers-Briggs personality test. The one that splits people into Extroversion/Introversion; Intuition/Sensing; Feeling/Thinking; Judging/Perceiving groups. It’s just one test of course, which can be influenced by different factors (including your mood on the day of the test, wishful thinking/self-selection bias and things like that).

But the test showed me a few things. While I was definitely an Extrovert, it said that was a moderate preference. Of the four groups, the only one that had a distinct difference was Feeling over Thinking. That got me thinking and I realised that it did make sense in a lot of ways. Now, it’s a skill I want to cultivate further as I think it will be helpful in my future practice – I just have make sure my Extraversion takes a step back.

Just the awareness of this is helping, I think.