Career Story: Visiting Nurse And Occupational Therapist

Visiting Nurse And Occupational Therapist

Job Title: Occupational Therapist

Type of Company: I work for a visiting nurse association in Lowell, Massachusetts. The agency employs nurses, physical and occupational therapists, medical social workers and speech therapists. We provide medical, hospice and rehab services in the patient's home.

Education: BS, Occupational Therapy, Tufts University

Previous Experience: I worked for a small rehabilitation hospital in western Massachusetts, then in a nursing home and later worked as a clinical supervisor in a hospital rehab facility, before moving again and becoming a visiting nurse.

Job Tasks: I have worked in home care for about 18 years. On a typical day, I drive to patients' homes after a set up a general schedule which may be very flexible.

I receive information about a patient, which includes a name, diagnosis, address, relevant recent medical information and doctor's orders regarding treatment -- though, often, this is left up to me. I call the patient and go to see them in their home.

I look at how they move, how much strength they have, whether they have problems seeing or hearing or feeling; I look at how steady they are when they walk or get up. I ask a lot of questions... about how they do things, how they feel, how they perceive their own conditions. I ask about their family and friends to see if they have any help around.

I think about the diagnosis they have, for example, a stroke, partial blindness, a broken arm or leg, a joint replacement, back pain, anxiety or depression, dizziness, heart or lung problems and how that affects what the person can do or not do for themselves. Occupational Therapy is geared to look at a person ability to do things or function and make the treatment specific for that individual. For example, in home care as an Occupational therapist , I often to start with the basics, can a person take care of themselves at home, can they bathe?, can they dress?, can they make a meal, get a drink, walk or move in their home without falling, If they can but it is difficult and needs to be made better, I look at how they are doing those activities to see if a different way to do it is better, or does using a piece of equipment make it easier or safer.

I may use an exercise, teach a new way of doing something, teach the use of a piece of equipment, such as a walker or bath seat or a long handled device to reach things on the floor or their feet. I often have to be inventive as each person is very individual and a commercially made piece of equipment may not suit an individual and need to be changed to make it work for them.

I very much need to be able to understand a person's point of view or the way they learn and look at things, I could go into a home and make all kinds of suggestions and a person might not choose any one of them unless I make it meaningful for them. I need to understand what motivates them to change in order to make any of the teaching or exercise I do make a difference.

I will always set goals for a person from the beginning and then change those goals as needed. For some individuals, it is very important to be able to be independent getting dressed and for some, they would rather have some one else do it for them.

I can also adapt an exercise to make it more meaningful or interesting and still achieve the desired result of better range of motion or strength by changing an existing activity, for example, I might add weights to a persons arms while they put cups away in the cabinet, or place items of interest on the visual side that they need to pay more attention to in the case of a visually perceptually impaired stroke patient.

I generally see about 5 -7 patients a day, for 2 - 3 times a week, sometimes for a week or two or sometimes for a month or two, depending on the need. I also need to be able to write a relevant progress note on each visit I do as well as specifics of an evaluation. Because I work in the medical field, we are ultimately paid by the medical insurances which our patients carry. More and more the insurance reviewers want to see that what I do is justified enough for them to pay the bill. I need to include what, how much, how far, what the patients response was, toward what goal is this activity relevant to, what can someone still not be able to do, etc, So I need to be able to write in an understandable and interesting fashion.

I love working in home care as an Occupational Therapist because the home is where we all start. For many years while I worked in a hospital or rehab setting, the occupational therapists would be trying to recreate the individuals setting at home to practice the skills the person would need to return home. In the home, the setting is already there and will tell a great deal about how a person functions and takes care of themselves: what is important and not important to them.

The years I spent working in hospitals and rehab's was absolutely necessary for me to work in home care because I need to know a lot about various diagnoses and conditions, as I could be asked to treat a back injury, a brain injury or a weakness due to heart or lung problems. I need to understand a great deal of psychology to understand motivation and emotional reactions to disability and even family relations.

Home care is also a job in which a therapist needs to be very independent. I get excellent support from my co-workers and supervisors but I enter a home alone and work alone most of the day. I can call for support if I need it but I have to be able to structure my time and work with people independently.

I love the flex ability of my job as an occupational therapist in home care and I love to help people. Ultimately the satisfaction of having made a difference to someone's wellbeing is what makes doing my job worthwhile.

Best and Worst Parts of the Job: The worst part of this job is working with a patient who's rude or unpleasant; the second worst thing is working in a dirty or unclean home. Teaching has to be handled carefully to avoid giving offense to people, especially those who are dirty.

The best part of my job is having someone make it clear that what I've done for them or taught them has really made a difference in their lives. I have been told that "you have been the most help to me" or "I finally understand what the doctor's been trying to tell me." Those things feel great.

Job Tips:
1. Try out as many areas of occupational therapy as you can to see what fits best. OTR's (registered occupational therapists) work in many different settings. Some work in school systems, with children in their homes or in patient settings; some work in psychology. Some OTR's work in hospitals or nursing homes, and some work with young people or young adults. You have a whole lot of options.

2. Keep an open mind, always ask questions. No matter what you think you know, there is always much more that you don't know!

3. Avoid being judgmental or leaping to conclusions, which can limit what you can learn from someone.

4. Be confident about what you do know, but don't try to force your view on someone else. Your intentions may be good, but it may make you less effective as a teacher or therapist.

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