Monday, July 23, 2012

Take care

There was an interesting conversation on the AOTA forums recently about whether or not a COTA should be 'bathing' patients in a nursing home.

Some of the conversation centered around the 'skill set' of the COTA and whether or not the COTA was being used in a nursing assistant type of role.  Then there was discussion about whether or not this was appropriate, and some people thought it might be appropriate as long as it wasn't being billed out as direct occupational therapy (unless there was some therapeutic self care training aspect to the task).

Most of these points were valid - but as is typical in online forum posts there is a real lack of detailed information so it is almost always near impossible to know if any answer provided is really the best answer for what is being 'asked.'

Something else jumped out at me though while I was reading the conversation.  Someone said,

I say not bathe the patients because that is not what they went to school to do with their time, if they are trying to get the patient to participate in the bathing then I say go for it but if it has nothing to do with the patients therapy goals then I say they shouldn't be doing it.

 It is perhaps technically true that they did not go to school so they could bathe patients.  However, it is entirely possible that one of the reasons that they got into school is because they expressed an interest in doing this kind of task.  Caring, in a broad sense, is an attribute that is often considered favorably when someone is applying for admission to a health care profession training program.  Somewhere along the line it seems that the desire to provide care got redefined along strict guidelines of goals and whether or not the patient was 'participating' in the task.  I think that is unfortunate.

That leads us to a rather large philosophical question: Is the care that is provided as occupational therapy different than the kind of care provided by other health care professions?  That is a loaded question and non-English speakers may get lost in my word-play, but of course the issue here is that in that sentence you can see that the word 'care' has accidentally taken on some meanings that perhaps need some attention.

I think the words are important.  I don't want to be care-less with my verbiage.  See, I am still engaging in word-play.

Once I told someone that 'I could care less' about whatever topic it was that we were talking about.  I will never forget the stare-down I got and reprimand that followed because that person knew that actually I cared very deeply.  Since that time I try not to 'not care,' or more accurately, 'claim to not care.'

As therapists we are paid for our care, or perhaps we are paid for the expression of our care.  Perhaps we aren't supposed to care about the pay; we are supposed to be motivated by our own intrinsic expression of compassion.  To care is to emote alongside the Other.

If I pause and think about moments of caring expression in my OT career I think immediately of Cameron and the way that his feet felt cold under my hands as I massaged them.  It was not my job to go around massaging people's feet in the hospital, but at that moment in my care for him it seemed to be the only action that made sense.  Now years after the fact, I have no idea if that session was billed.  Was I unethical?

This could all be quite different than the situation of the COTA in the nursing home.  Maybe some nursing home owner is trying to use COTAs as nursing aides when there is a staffing crunch and they are regularly asked to complete ADLs.  Maybe they are billing it out and hoping it will be paid for since a licensed professional provided the 'care.'  Or maybe it is simply a desire for compassion, and maybe even the nursing home owner pitched in and helped that day when too many staff called in sick - because the needs of the residents on that day superseded the professional role boundaries of the staff.

I guess we have a lot of opportunities every day to think about our care.  Or if we care.  Or how we care.

I suggest that if someone utters the words 'Take care' to you, accept their parting statement as a gift and opportunity to think about whether you are taking care or not.

1 comment:

Your Therapy Source Inc said...

Nice thoughtful post. I think as therapists we need to care and not just about our goals. I would like to believe many do. When I look back on my career did I provide "care" that did not quantify as direct PT? Of course not every second of every minute that I work with a client am I providing direct PT. I have changed diapers in a school setting - is that part of PT? Nope, wasn't even a goal but I do care that the child had a dirty diaper and the classroom or nurse's aide was not available. I am certainly not saying everyone has to change diapers so please no one respond that we do, just using it as an example.

We have to care about people and if you don't you may be in the wrong profession.