Posts filed under ‘fieldwork’

Ethical Dilemma with Treating Unethical Patients

I have been struggling with an ethical dilemma ever since my Level I fieldwork assignment, where I was doing my clinical at an outpatient facility within a hospital located near one of the local jails.

Since this hospital was affiliated with the city, we often got the prisoners that needed occupational therapy at this facility.  If a prisoner is scheduled to come in for an appointment, they are accompanied by two police officers and their hands and feet are both shackled.

As part of our assessments, we typically ask our patients what their own goals are for therapy.   Unfortunately, I had one patient (who had had an ulnar nerve and tendon injury from a knife fight) tell me that his goal for therapy was “to be able to close my hand into a fist so that I can fight again.”

When I hear something like that, I think to myself, “Why do I want to treat this person?  Why do I want to help this person meet his goals?”

This question bothered my enough that I knew right away that I would never want to work with forensic patients.  As an occupational therapist, I know that we have to work with patients to meet their goals and increase their occupational well-being.  But if that involves beating up other people and doing illegal things, how can I, in good faith, treat this type of patient?

March 3, 2008 at 11:51 pm 10 comments

Hip Precautions

For one of my Level II fieldworks, I did a three-month internship in an acute orthopedic unit at an area hospital. As such, I saw predominantly hip and knee replacements, as well as several limb-lengthening patients. One day, I was looking something up on Wikipedia about something hip related and noted that there was no article on hip precautions. As occupational therapists, we’re worried about patients being able to complete their ADL‘s while being safe. I figured that I would write an article about hip precautions on Wikipedia, and it hasn’t been edited since I created it, so I’m happy it was well written. Hopefully, it was well described as well.

Here is the article:

Hip precautions refer to certain things that one should not do after having a hip replacement. Since the hip joint is very weak from surgery, doing any of these three things can greatly increase the risk of hip dislocation.

The three hip precautions are:

  • Bend
  • Cross
  • Twist

One should not bend the hip past an angle of 90 degrees (L-shaped). This is especially difficult when sitting on toilet seats, which tend to be low. Therefore, an occupational therapist will educate patients in techniques on sitting on low toilet seats, as well as telling them to obtain raised toilet seats.

Crossing refers to any time one leg crosses the other. Since it is difficult not to cross your legs when sleeping, many doctors will recommend that a patient sleep with abductor pillows, which keep the legs separated.

Twisting refers to putting a lot of weight on one leg and twisting to retrieve an object. For example, if one is cooking a light meal, they should not twist their bodies to retrieve a pot from a high shelf, rather, they should shuffle over sideways, retrieve the pot, and then shuffle back to the starting point.

I’m thinking that I should add a bit about how because of these precautions, patients with hip replacements can’t do basic ADL’s like putting socks on. After all, that is why we give them our wonderful hip kits.

March 16, 2007 at 2:52 am 12 comments


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