Jun 28 / Kimberly Breeden, Occupational Therapist, Coach, Continuing Education Instructor & Founding Partner

It's the "Moments" That Fulfill My OT Heart

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I loved Niccole’s blog last week, “Take a vacation… at Work: 6 Ways to Rest and Recharge during the Work Day”.  If you haven’t read it, I recommend it!  I loved all of the tools that she listed and I know they will help occupational therapy practitioners better cope with the many job stresses they face. 

Her blog had me reflect on my own strategies for coping with stress both on the job as well as in my personal life.  I have shared in the past my experience in corporate management and my journey back to clinical practice.  That journey has brought me to a place of professional gratification that I had not experienced earlier in my career.  It took me a long time to understand why clinical practice was so much more gratifying to me despite my success in management. It should have been obvious to me, but I missed it for years.  

The explanation for me lies in the foundations of our very own profession.  The Occupational Therapy Practice Framework: 4th Edition (OTPR-4)  frequently mentions spirituality, values and beliefs which are collectively discussed in the OTPF-4  as specific Client Factors. These factors  “influence clients’ motivation to engage in occupations and give their life or existence meaning” (AOTA, 2020).   The OTPF-4 goes on to define values as “principles, standards, or qualities considered worthwhile by the client who holds them”.  Beliefs are “something that is accepted, considered to be true, or held as an opinion”.  Spirituality is defined as “a deep experience of meaning brought about by engaging in occupations that involve the enacting of personal values and beliefs, reflection and intention within a supportive contextual environment”(AOTA, 2020, p 15). The practice framework discusses spirituality in relation to  Performance Patterns of rituals, Context in relation to environmental factors and in the ADL, IADL and Social Participation categories of occupations (AOTA, 2020).  The word "values" is found in the framework 35 times and the word "beliefs" is found 32 times.   This is no surprise as our profession has always been  unique in our focus on the mind-body-spirit connection of health and wellness. 

Values, beliefs, and spirituality are exactly what I had been overlooking in my earlier career roles.  For me, it boils down to meaning or meaningful moments.  These of course are determined by my personal beliefs, values, and spirituality.  They are individual to me, just as my clients’ beliefs, values, and spirituality are individual to them.   I have found that I can cope with the stressful situations when I can find fulfillment and purpose in my life.  In my occupational therapy life I am fulfilled by service and “meaningful moments”.  I can find purpose in my job when I feel that it improves the quality of life for my clients.  This is what was missing for me in my administrative roles.  I needed client interactions.  It really is that simple for me.  The hard stuff doesn’t seem so hard when I feel that I am making a difference in someone’s life.  If I had realized that before, I think I could have been more satisfied in management by working from the context of my own values.  I now work toward meaningful moments with every client, and I have mostly been able to create at least one moment, even if it is a small one in my visits.

I wanted to share 3 of my more significant occupational therapy “meaningful moments”.  These are the ones I reflect on when I am feeling the most discouraged or stressed in regards to changes to our profession or even my job.  For privacy purposes, I am going to be deliberately vague in my cases and omit information that may be identifiable.  

1. I was working with a client who had an orthopedic surgery and I had specific orders to provide a home exercise program.  I was not excited about doing this because I thought it left little room for me to utilize an occupation-based approach.  As I was doing this, the client shared that their acute pain was not as severe as their chronic neuropathy pain that had recently worsened.  They went on to report that they did not understand what was causing this or what to do about it.  I was able to gather more information as to how their pain was impacting occupational performance and then provide pain education during my treatment.   I was able to provide pain self-management training to utilize for their acute pain but also for the chronic pain.  After I did this their exact words were “You have truly changed my life.” They went on to tell me that they had suffered from chronic pain for years and that if they had the information that I had shared before, their quality of life could have been better.  They even went on to say, “I feel like a weight has been lifted because now I understand what is going on.  I have hope now because I know there is more that I can do to help with my pain”.   

I concluded that visit with the realization that interventions that may seem “not so glamorous” can truly impact the lives of our clients.  I also realized that I can utilize an occupation-based approach in the context of a home exercise program if I first develop an occupational profile and utilize a client-centered approach. 

2. I was working with a client who a couple of years prior experienced a brain injury that had impacted coordination of their non-dominant hand as well as executive function.  Since the accident the individual required 24 hour supervision and caregiver assistance for all IADLs and prompting to complete ADLs.  OT was referred after a recent hospitalization for respiratory complications that resulted in a functional decline. The client and family reported they wanted occupational therapy to work to improve upper extremity coordination, ADL, IADL and provide falls prevention training.  They had been instructed by a different staff member of another discipline to address upper extremity coordination by working on puzzles, clothespins and putty with the affected hand.  The client required significant cuing to participate and maintain attention to these tasks.  The client also appeared easily overwhelmed and avoided tasks that became difficult.  The family also reported concern that the client was very sedentary, seemed to not be interested in “doing anything” and was “bored”.   I completed an occupational profile, identified that the client loved music and had played a stringed instrument avidly prior to the brain injury.  I identified that the previous tasks that were recommended had no meaning to the client, required them to learn a new activity in light of impaired executive function including impaired short term memory and were tasks not usually completed with the non-dominant hand.  I asked the family if there was an instrument we could try playing the next visit.  The next visit we brought out the instrument; The client initially stated “I can’t play anymore”.  I encouraged the client that we would not try to play the instrument, we would just hold it and see if they could place their fingers of their non-dominant hand on the strings.  The client placed their non-dominant hand on the strings and automatically began to play the instrument.  Mind you, not very well and with difficulty but definitely played it!  What was the most amazing was that the client maintained attention and would keep trying even though it was hard.  The family members present began to cry.  The client said “I can’t believe it, I just played “.  They went on to say “we had no idea they could do that”.  A goal was established to provide opportunities for the client to work on chords and playing the instrument 1 time daily.   

I left that visit feeling on top of the world!  My profession had enabled me to bring meaning and quality back to someone’s life through the goal of improving coordination.  Wow!  I still get emotional over that one.  

At the next visit the family and client reported that the client was initiating playing the instrument several times a day, was more interactive with family and caregivers and was using the non-dominant hand more.  The client demonstrated the ability to effectively play 4 cords and was able to grasp the instrument with the non-dominant hand without it being placed in the hand first. That was  significant progress in just 1 week!    

3. I evaluated a client who had partial paralysis and the neurologist gave a poor prognosis for recovery as well as life expectancy.  The client was very close to their  family and most of their leisure time was spent in occupations involving family and friends.  Family members reported feeling overwhelmed and discouraged by the client’s prognosis for recovery of hemiplegia.  After the development of the occupational profile, the patient and family goals ultimately were identified and most of them involved spending time together.  We developed goals for safety with self care and self care transfers, as well as for car transfers and options for transporting the power wheelchair.  We developed goals for being able to go out to eat, use public restrooms and safely mobilize in different community settings, all activities that the patient and family could and wanted to do together.  The client and family had not considered these things to be options unless the client’s physical abilities improved.  I worked to educate everyone to options for participating in meaningful occupations using new strategies that were consistent with the client’s current physical abilities versus trying to address the “disability”.   

The family called me a year later to let me know that the client had passed away, and wanted to thank me for “giving us that last year with them”.  They went on to tell me of all the things they were able to do together and shared the “moments” they had.  I could not help but cry with them.    

My take away from this case was that OT can absolutely impact quality of life even in situations where physical recovery is not expected.  By working to focus on occupational engagement vs just physical recovery, we can bring meaning and purpose to our client’s lives.  

These are just a few of my “moments” that have given meaning to my practice as an occupational therapist.  There are so many more, and I am extremely grateful to be part of a profession that improves the lives of others.  I know it seems very simple, but for me keeping my focus on the meaning of my work helps me better cope with all of the challenges that I face as an OT practitioner.  

I hope that you are able to find meaning in your work, I realize that for me the meaningful moments came when I made them the focus of my practice.  I hope this blog has helped you to feel encouraged about being an OT practitioner as well as helping you to identify another tool that you can use to be fulfilled in your job.  

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001


Written by: Kimberly Breeden, MS, OTR, Coach, Instructor and Founding Partner
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