Monday, December 6, 2010

NICU-neonatal intensive care unit

Before I went out on Peds fieldwork, we had a speaker come in and talk to us about the NICU--neonatal intensive care unit. This is basically a hospital unit dedicated to caring for ill or premature newborn infants.

Apparently this is a difficult area to get into as a new grad, which is not surprising considering the amount of knowledge and experience you need to care for these infants.

One assessment used to evaluate NICU infants is the Ballard assessment. This assessment helps you determine the baby's gestational age so you can know which kind of care it needs. Basically, you look at various systems, appearance, function and so on such as skin, lanugo, genitals, eyes and ears, tone, etc and give each area a score, sum the scores and compare the final score to a chart which tells you the baby's week of gestation. It's very interesting.

OTs in NICU assess a baby's development, calming ability, orthopedic and neurological conditions, positioning and educate staff and parents. I learned that with all the hype surrounding SIDS (sudden infant death syndrome) baby's don't get the 'tummy time' that they need and they often end up with flattened heads or developmental delays. Babies need at least 2 hours of SUPERVISED tummy time per day.

Finally, an interesting calming strategy is to try to recreate an environment for the baby that is as close to the womb as possible. Remember the womb is where the baby ate regularly, was warm, comfortable and safe. You can accomplish this by the 5 S's: swaddle the baby, sway the baby, give the baby something to suck, position the baby in sidelying and 'shhh' the baby. Apparently the little boogers like these actions and it calms them. I've certainly noticed this with my niece!

Good times with the kids

(Pom Poms)

So, as you know I LOVED working with those kids. They were all so cute and so funny and so adorable and so FUN. I had a ball!

Here is a joke one student told me. He said he made it up and he was so proud of it.

Him: What is a beaver's favorite food?
Me: I don't know, what?
Him: Steak...
Me: (silent, because I just did NOT get it, haha!)
Him: You don't get it?
Me: No, sorry! (ashamed, head down) I don't get it.
Him: You know, beavers eat wood and 'stakes' are made of wood.

I nearly fell out laughing and I think you know why.....

During another instance one student made such a hilarious statement that my supervisor and I had to turn away so she wouldn't see us laughing so hard:

We were making Christmas trees and decorating them with ornaments such as yarn, cotton balls and small pom poms (if you don't know what a pom pom is see the picture at the top of this post). This can be a sensory activity as many of the kids don't like touching glue and as a result they often don't put enough glue on the paper. When this happens, the pom poms fall off.

Boy X was gluing his pom poms to his Christmas tree but did not add enough glue. But, he was so proud of his tree that he held it up for everyone to see and his ornaments started falling off. Girl Y, trying to help him, said, "Hey, Boy X, be careful. Your balls are falling off.. Hey, did you hear me??? YOUR BALLS ARE FALLING OFF!!!!"

I nearly peed in my pants.

Individual Education Plan (IEP) meetings summary

I've had the pleasure of sitting on a few IEPs (Individual Education Plan) while on my pediatric fieldwork and I really enjoyed them.

In a nutshell, various professions in education--psychologist, occupational therapist, physical therapist, speech pathologist, special education teacher, classroom teacher, nurse, case manager, paraprofessional and any other professional, and parents all meet together to discuss the needs and goals of the child's education. Everyone gets a turn to speak and report on observations, evaluations, assessments, interventions and outcomes. They also each report on how the child is progressing and if he should remain eligible for their service over the next year.

These meetings can last for HOURS. Of course, the time flew for me because I am a student and everything is new and fascinating but I can see how over time these meetings can be frustrating if people come late or unprepared. On at least 3 occasions the parents did not show up or were so late my supervisor and I had to leave to make appointments at other schools to see our regularly scheduled kids.

I also noticed how some professionals use words that may be unfamiliar to some parents, particularly to those with certain educational backgrounds. Words such as bell curve, fine motor, adaptive equipment, pincer grasp, range of motion, etc., may be unfamiliar to some parents. As professionals we must remember to speak in layman's terms so that everyone in the meeting can participate and understand what is being said. It's also important so that parents feel comfortable enough to participate in the meeting and ask questions.

As professionals we need to be aware of what is not being said during these meetings. I noticed that some parents were very passive and only spoke when a question was asked; the professionals dictated what was to be done to their child and they went along with it. Other parents were very proactive and asked lots of questions and had a very aggressive (but not in a negative way) role in the meeting. I think that when we notice parents are passive and go along with what is being said we need to ask them for their input because what they think is important.
Additionally, it's important not to speak so negatively about the child to the parent that you make the kid sound like an idiot. In some instances, I felt badly for the parents as professionals talked about the kid as if they were slow, or stupid or amazingly abnormal. This is still someone's kid and although as the professional what you say may be the truth, it's still rather crass and insensitive to speak so poorly about the child. Every child has SOME thing they do well and at some point it's beneficial to reflect on what the child does well. Parents are an integral part of these meetings and without their cooperation and support some of these kids won't progress.

On that same note, it's important for parents to consider that professionals have appointments to make and their world does not revolve around you. Be sure to confirm the time of your appointment if you plan to attend and then, actually BE THERE at that time. If you will be late CALL THE SCHOOL and inform someone that you will be late. It's frustrating for people to sit twiddling their thumbs waiting for parents to attend the meetings because everyone has paperwork to complete, other meetings to attend and kids to see. So much time could be saved if people would communicate their whereabouts and intentions.

FAQs--OT books

So, I received a question (a really long time ago, haha) asking for suggestions on good books on occupational therapy.

Shamefully, because I'm always studying textbooks I only have two suggestions on leisure reading:

1. Treebarking by Nesta Rovina. I read this book sometime ago but it is basically a compilation of an occupational therapists experiences. I found this book incredibly interesting and I highly recommend it. It was one of the first books I could find on occupational therapy so I picked it up and read it. I thought it was a great read. I couldn't put it down.
2. Look Up for Yes by Julia Tavalaro. This is another excellent read. Ms. Tavalaro suffered several strokes that left her unable to walk or move or do anything. Everyone thought her mind was mush when in fact she was very much cognitively aware of everything that was going on around her. She was treated terribly by medical staff and professionals (emphasis on TERRIBLE) until an occupational therapist, physical therapist and speech pathologist came along and helped her. I highly recommend this book.

I'm going on another one of my international trips soon (more on that as the time approaches) and I will have more time to read so I can recommend more books then. I've found very few books specifically on occupational therapy. Rather, many books are narratives on the experience of sickness, injury or some other setback. I think books of this nature are good to read because they provide insight into the medical profession and occupational therapy.

So, thank you, Sara, for asking that question and I hope others begin to read more books in this genre!