Saturday, December 19, 2009

Rounds in Forensic Psychiatry

Due to a series of fortunate events, I was able to attend the weekly rounds of the Forensic Psychiatry Unit twice during my placement. My problem-based tutorial leader happens to be on staff in that department and invited our group of students to attend. The sessions happened to be held at the hospital site where I was doing my placement. Plus my preceptor was very cool about encouraging me to take advantage of every education opportunity and she let me leave for lunch a few minutes early so that I could get to the session on time, even though the talks had nothing to do with her particular area of practice. I’m a lucky girl!

The first week I attended the guest speaker was Dr. Hy Bloom, who is both a doctor and a lawyer. His presentation was on the topic of workplace violence. Although it was an incredibly interesting topic that was very well presented, I must confess that I left the session feeling a bit disturbed. Workplace violence as a general topic was broken down into “types” based on the perpetrator’s relationship to the workplace. For instance, some have a direct relationship with the workplace as employees and commit acts of violence against coworkers who also have a direct relationship to the workplace. In other instances the perpetrator does not have a personal association with the workplace where violence is perpetrated, and the location has some kind of representative meaning to the person. And there are other types as well… which I’m sure you could look at by looking up some of the publications by Dr. Bloom! My purpose in mentioning a few examples is that each of the different types of workplace violence was illustrated in the presentation with a real life example, and it was the examples that were disturbing. So, I’d say the presentation was great for increasing my awareness of the issue and the resources that are available for further researching the topic, but because of its brevity I left the session with an uneasy feeling and many unanswered questions. Such is the nature of the lunch-time-rounds beast! We only have an hour so it seems as though we just get started when we then have to wrap it up, lol.

The second session I attended was about the assessment and management of suicidal patients and the talk was given by Dr. Larry Chad. He discussed some of the demographic risk factors for suicide and also suggested some strategies he has found successful for addressing patients where there is an overt or suspected risk of suicide. I found this talk to be much more concrete than the workplace violence topic since it focused on what to do in a given situation rather than discussing the topic more abstractly, from a big picture perspective. Don’t get me wrong… both were great! But, since I’ve signed up for a suicide prevention counseling course in the New Year I found the assessment/management topic to be more germane to my current interests.

And that was the last lunchtime rounds session of 2009! Now that my placement is over I’m not sure that I’ll get the chance to attend again… but here’s hoping! I highly recommend taking the time to attend these rounds sessions while you’re on placement if you have the opportunity. Sure, it takes up your lunch hour. But in my humble opinion it’s time well spent. And each department holds its own rounds… so maybe you’re more into pediatrics than forensics? Then check out the pediatrics department to see if they have any postings up about when they hold their rounds! There seems to be something for everyone if you just take a look to see what’s out there.

Saturday, December 12, 2009

Term One Placement = DONE!

I've just finished my first placement and it was great!

In our program, each term is divided into an academic portion followed by a clinical placement. The exception is in term five, when the clinical placement is substituted with an evidence based practice project... aka a research project akin to a mini-thesis. So, at the end of the program I'll have had a total of 5 placements in 6 terms. The earlier placements are shorter in length and our skill set is more limited so our level of participation is less than what it will be toward the end of the program when we'll be completing the longer (8-weeks for the final) placements.

So, Term One placement was 15 days over 4 weeks. We would go to "work" Monday through Thursday, and then Fridays we would rejoin our problem based learning groups at the school in order to talk about our experiences. I had my placement at a big hospital, working with the OT assigned to the Nephrology (Kidney) and Urology departments. My preceptor was great and I feel very fortunate to have had her! I have a sneaking suspicion that, more than your placement setting, a preceptor can make or break your experience.

Working primarily in Nephrology, we worked very closely with other members of the allied healthcare team, especially one of the PTs. Our clients were inpatients who are often quite ill. It was a great environment for learning about medical conditions because there are a fair number of reasons that the kidneys can malfunction (for lack of a better generic term). Many clients in that department have renal failure that is secondary to another illness; common culprits include diabetes and hypertension. So, I enjoyed reviewing medical charts to get an idea of medical history!

In terms of what occupational therapy does with clients in this setting, we are commonly referred for assessment, treatment and discharge planning around functional mobility and safe transferring. We would always conduct an initial interview and assessment that looks at a person's ability to carry out their activities of daily living, and that gets a sense of their home environment (physical and social), including any supports or equipment they use. Treatments are usually to do with getting a person mobilizing safely, so determining their needs, prescribing equipment when appropriate, and helping them learn to use it. So, for example, if a person had been ill in hospital for a while they may have lost some standing strength, endurance and/or balance. In this case we may determine that they would be helped by a rollator, so we would loan one from the OT department and get it adjusted to the person, and then train them with it's use. In this kind of case we would often have the PT accompany us as well, so that she can simultaneously do some physical training with the person (perhaps having them walk a bit or do some stairs). Assessments are generally physical and functional, but we also can do cognitive assessments if there is suspicion that there may be a deficit that makes certain activities unsafe. Examples of cognitive assessments include the Modified Mini-Mental Status and the Montreal Cognitive Assessment. Of course, if a more profound cognitive deficit is suspected and the person is 65 or older, then a referral would be made to geriatrics to do a more detailed assessment. Other assessments of function can also include Kitchen and Bathing, which can also give a lot of insight into a person's cognitive and affective status. Finally, as a part of discharge planning, home assessments are sometimes required in order to anticipate what needs a person may have upon discharge and to get the needed supports/equipment in place.

As with any accute medical floor, patients are often not in the ward for very long... either they get better and are discharged home or they get mostly better and are discharged to another level of care (such as to rehabilitation in order to improve physical condition before returning home). Because of the short duration of stay and the fact that our clients are often quite ill while they are on our ward, the OTs scope of practice is a bit narrower than what it might be in other settings. However, I will also say that it's a good thing it is! My preceptor is kept very busy because of the high number of referrals she receives.
My preceptor, as I've already mentioned, was really great. She was quick to introduce me to all of the team members on the unit and to include me in all aspects of her job. She gave me a lot of opportunities to interact with clients directly and to participate in assessments/treatments when appropriate. It was everything that I hoped for from a first training exposure to the profession!

So... do I want to work in this setting when I graduate? Maybe. There are certainly a number of benefits to being in a hospital in terms of support and resources. I also really enjoyed the direct collaboration with a whole team of allied health care professionals (such as PT, SW, Pharmacists etc...) and the fast pace makes the days fly by! Plus, because I have an interest in all things medical (having been raised by a nurse who is interested in all things medical) getting to read the charts and have that information be a part of the bigger picture when working with a client is pretty cool. However, the downside is definitely the limitations in terms of time with a client and what you're able to do with them in that time. Still, it's definitely an option I'm keeping open.

And just like that... my first term is almost done! Just one exam left to write and then it's home for the holidays for me!!