To Ron and the List,
Great discussion about best practice, and I agree with Chris Nahrwold's
recent comments...very well put ...and Joan Riches comments as well (I am a
fellow Canadian..now U.S. Citizen).
According to the current criteria, in my work geriatric clients at a SNF, I
am probably guilty of "contriving" some of my back to regular functioning, and
at certain times and places and with certain clients the treatment may be more
occupationally-based or not. "To everything there is a season" Sometimes
e-stim, and weights, and cones, and pegs appear in certain sessions
unabashedly. Others involve crafts, woodwork, cooking, home evals, feeding
skills, w/c positioning, shopping excursions...etc,,etc. Each case tends to
lend itself to a different set of circumstances and client preferences. I don't
feel guilty about any of it, and my client satisfaction surveys and clinical
outcomes continue to be very good. And I always explain the what, the why, and
the how of the tasks through activity analysis and client education. Luckily I
am validated by the fact that in my facility, almost all of my 7 OT colleagues
have similar practices and
results. The work is rewarding and seems to matter to society, and is a pretty
good business.
I am not a fan of this "all or none" philosophy about OTs best
practices....creating the box in which we are to live professionally. Sometimes
I'm in that box and sometimes I am out. There is so much discussion about the
terminology and lingo and ideology and definitions and frameworks, however none
of this means anything to the clients we serve. I am more interested in
pragmatic results and common sense approaches... which I think the original OTs
who rehabilitated wounded soldiers would be more likelly to be the foundation
for best practice.
Don't forget that a lot of what might be considered "not-best-practices"
of OT out there is still really helping people. And a lot of what might be
considered bad practice is often a result of the current health care
reinbursment structure, productivity standards, staffing, facilities, resources
and corporate culture that guides practice patterns. Why do we judge people and
not consider the larger context of the processes of the system in which they
operate?
Submitted Respectfully
Brent Cheyne OTR/L
BSc.(OT) UWO '94
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