Running head: JANES OCCUPATIONAL PROFILE ANALYSIS

Janes Occupational Profile & Analysis Corinne Trenholm Touro University, Nevada

JANES OCCUPATIONAL PROFILE ANALYSIS

Occupational Profile The following occupational profile was completed through a personal interview utilizing the Occupational Therapy Practice Framework (2008) to guide questions and discussion. Jane is a 71 year old female who lives with her husband. Her two children live out of town with their spouses and her grandchildren. She has several friends in town that she only sees when Jane is well enough to go to dinner or out to the casinos. Jane is recovering from a total left knee revision surgery performed three days ago. She is in an acute care setting at St. Rose hospital. She had total left knee replacement surgery about two years ago due to osteoarthritis and this is her sixth surgery on her left knee due to infection. Previous surgeries have consisted of wash outs and antibiotic block placements. Jane has been unable to participate in many activities she enjoys including painting and traveling the last two years due to pain and recovering from multiple surgeries. She also had total right knee surgery a few months before her initial left knee surgery. This impacts her ability to weight bear for long periods of time on her right lower extremity causing difficulty with activities that require standing and/or mobility. Jane lives on the seventh floor in an apartment complex. She has elevator access which is a few steps from her front door. Jane and her husband have been retired for over eleven years. Before her surgeries they traveled all over the county and enjoyed visiting her children and grandchildren out of state. She also rode her bike seven miles every day with her husband, liked going out to dinner, and enjoyed gambling on the weekends. Janes top priority is to get rid of the infection in her knee. She is worried that if the infection doesnt go away and comes back again, she will have to have her left leg amputated. Jane expressed that she hasnt had a life the past two years and is eager to be able to paint, ride her bike, and travel. She also wants to be able to cook, clean, shop, and do things with her husband. She feels that she hasnt been able to

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fulfill her role as a wife. In the hospital setting Jane would like to bathe in the shower instead of her bed and practice transfers, walking, and dressing.

Occupational Analysis The following occupational analysis was completed through a chart review, observations, and personal interview. The Occupational Therapy Practice Framework (2008) served as a guide to complete this analysis. Body Function Deficits Jane has difficulty walking and standing due to left knee surgery, left knee precautions, and her inability to bear weight for long periods of time on her right lower extremity. She has decreased muscle strength and endurance in both lower extremities. Jane has hypertension which she controls with medication. Jane suffers from asthma and uses an inhaler when needed. Jane underwent a mastectomy due to breast cancer and had her spleen removed due to a tumor. Jane has a large incision that has been stitched on the front of her left knee. Her left knee is swollen, red, and painful. She has an IV in her right hand for fluids and a PICC line in her right arm for antibiotics. Jane requires corrective lenses for visual acuity. Jane is going through emotional pain and stress. She is concerned that her surgeon may have to amputate her left leg and feels helpless. She hasnt been able to engage in any meaningful activities the past two years which has caused depression. Janes pain keeps her from sleeping well. Lack of sleep also contributes to decreased energy and mood. Janes knee pain is a 7/10 and with medication it only goes down to a 6/10. Activity Demands

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Objects and their properties. Jane expressed the desire to bathe in the shower. In order for Jane to bathe independently she requires the use of adaptive and durable medical equipment. In order to sit at edge of bed, she requires the use of hand rails on her bed to transfer from supine to sitting. Jane uses a front wheel walker to transfer to and from sit to stand and to walk to and from the bathroom. Her walker has been adjusted for her height and has padded handgrips to ensure safety and help with weight bearing. The hospital shower is a walk in shower which makes it easy for Jane to transfer. The shower also contains non-slip shower treads for added safety during standing and transfers. While showering, Jane requires the use of a back supported shower chair and a long handled sponge. The back support allows Jane to lean back when needed while providing safety. The long-handled sponge allows Jane to reach her lower extremities and back. Jane also requires a handheld showerhead in order to rinse desired areas. The handheld showerhead also enables Jane to keep her IV and PICC line dry as well as her knee. Jane needs appropriate coverings over her IV, PICC line, and knee. Jane is able to use the soap, washcloths, and towels provided by the hospital. Space demands. Janes hospital room and bathroom have adequate space that enables her to complete her showering routine. The hospital room, bathroom, and shower contain enough space for her OT to be present with her during this activity. She is able to manipulate her walker to and from her bed and in and out of the bathroom. The shower has ample room for a shower chair. The shower also has enough space for Jane to manipulate her walker with the shower chair present when transferring to and from the shower chair. Social demand. Jane is in a private room which provides privacy during showering; however, due to needing moderate assistance during transfers and minimal assistance during mobility, Jane requires her OT to be present during these activities. Jane also requires assistance

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with covering her IV, PICC line, and knee and assisting with positioning the IV pole outside the shower curtain. Jane requires setup of clean clothes and bathing accessories. Although Jane is able to bathe independently once seated, she requires the OT to help transfer her walker before and after her shower and assist with lower body dressing and undressing. Jane is respectful, polite, and is able to appropriately communicate with her OT during this activity. Sequence and timing. Jane understands and is able to sequence the needed steps to complete her shower routine. Prior to getting out of bed, Jane inspects her IV and PICC line in relation to the IV pole and her body. She is able to move to the edge of her bed and stand using her front wheel walker while maneuvering around her room and bathroom keeping cognizant of her IV pole and lines. Janes therapist moves the pole while Jane walks. Although Jane understands that she must retrieve her clean clothes, towels, soap, and long handled sponge, her therapist obtains and sets up these items prior to starting the activity due to decreased endurance, standing tolerance, weight bearing precautions, and safety. She undresses her upper body while seated on the toilet and asks for assistance with undressing her lower body. Once undressed, she is able to transfer to the shower and onto her shower chair. She is able to ask for assistance to remove her walker prior to showering. Jane can turn on and adjust the temperature of the water. Jane uses a handheld showerhead to rinse her body and hair prior to using soap. She is able to keep her IV, PICC line, and knee fairly dry. After cleaning her body and hair, she rinses herself with water. Once her shower routine is complete, Jane turns off the water and asks for assistance to recover her towel and help cover her body while transferring from the shower. She uses the toilet and her walker while drying her body. Jane is able to dress her upper body and asks for assistance with her lower body. Once dressed, Jane transfers back to her hospital bed or chair.

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Required actions and performance skills. In order to complete this activity Jane needs to grab and maintain a grasp on the bed rails and walker for transfers and mobility. She needs to support her upper body and trunk with her arms using her walker and bear about 75% of her lower body weight on her right lower extremity when walking and standing. In order to walk, Jane needs to be able to move her legs, keeping her left leg straight, in front of her body while coordinating her arms to move her walker. She needs to be able to sit and stand, keeping her left leg straight, using her walker as support. Jane needs to be oriented during this activity and sequence activities to compensate for her lack of endurance and strength. She needs to be cognizant of her IV, PICC line, and IV pole in relation to her body and be attentive of her activity tolerance. Jane needs to maintain emotional regulation when working with her OT. Jane requires her corrective lenses which enable her to see and be safe during transfers and mobility. Body functions and body structures. In order to shower Jane utilizes many body functions and structures. Like stated above, Jane needs to be conscious during this activity using cognition skills to sequence and plan. She relies on the muscles and joints in her upper extremities including her shoulders, arms, wrists, and fingers for transferring and mobilizing with a walker. She also utilizes the joints and muscles in her upper extremities to manipulate materials in the shower and during dressing. Janes overall muscle tone and back and core muscles enable her to maintain a standing and sitting posture. The muscles in her lower body and the joints in her hips, ankles, feet, and right leg enable Jane to stand, sit, and walk. Jane relies on her reflexes to help her right if she becomes off balance. Jane uses eye-hand/foot coordination and bilateral integration during all aspects of this activity. Jane uses her visual, auditory, and tactile systems to help her transfer, mobilize, execute manipulation, and effectively communicate with her OT. Jane uses expressive language to ask for assistance when needed and

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coordinate teamwork tasks. Because Jane has adequate respiratory and cardiovascular functions she is able to complete this activity. Performance Patterns Related to the Task Habits. Due to Janes multiple surgeries and having been through the recovery process several times, she has learned habits that help her shower safely and with some degree of independence. She automatically inspects her PICC and IV lines in relation to her body. She instinctively uses her walker for transfers and mobility and always keeps her left leg and knee straight during these activities. She knows her tolerance level and spontaneously sits during activities that require more endurance, strength, and coordination such as dressing. Jane intuitively asks for help when needed. Jane unconsciously accesses and uses adaptive and durable medical equipment such as the shower chair, handheld showerhead, and long handled sponge while showering. Routines. Throughout retirement Jane has maintained a routine to shower and groom in the morning even if she is going to stay home. Due to showering being a daily routine for Jane, its important to allow her to engage in this activity in the hospital setting. Not only will this help Janes psychological well-being, it will help her regain skills such as increased endurance and strength to complete this activity when she returns home. Rituals. Jane prays multiple times a day. She feels that if she continues to have faith and maintains a positive attitude she can recover from this infection. She feels that keeping a routine, such as showering in the morning, and staying active will help her recover. Jane explains that showering rejuvenates her, makes her feel clean and vibrant, and lifts her spirits. Roles. Janes husband has the responsibility of all household tasks including shopping, cleaning, and cooking, which used to be Janes roles as a wife. She also feels guilty because the

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leisure activities they enjoyed doing together as husband and wife have ceased due to her illness. Jane wants nothing more than to make her husband happy. By keeping herself groomed and bathed she feels that her husband will respects her and see her as his beautiful wife and not a morbid woman. She also feels that after she has showered and completed her grooming routine including applying makeup, she has more confidence. This makes her feel like the strong woman she has always strived to be. Relation of the Context Jane recalls that since her childhood her mother has instilled the importance of good hygiene and grooming. Being 71 years old now, Jane continues to take pride in her looks and maintains the same expectations to be well groomed and dressed at home and in the community. At home, Janes bathroom has a walk in shower. During her initial knee surgeries her husband obtained approval from their apartment complex to install a handheld shower head. They were also prescribed a three in one commode, long handled sponge, and front wheel walker that Jane uses during showers. Janes husband is very supportive and helps with her shower routine. He sets up needed materials, provides standby assistance during transfers and mobility, and helps with dressing and undressing. Janes environment enables her to complete this desired occupation. Problem List Adhering to the guidelines from Gateley & Borcherding (2012) the following problem statements are prioritized from greatest to least. These problem statements are prioritized according to Janes wants and needs and the goals and interventions that can be carried out in the hospital setting by an occupational therapist.

JANES OCCUPATIONAL PROFILE ANALYSIS

1)

Client requires Mod (A) showering 2 inability to transfer sit stand secondary to L knee precautions & endurance & strength in R LE.

2) 3)

Client requires Mod (A) to dress and undress lower body 2 L knee precautions. Client requires Min (A) to walk bed bathroom during showering routine 2 L knee precautions & endurance & strength in R LE.

4)

Client requires Max (A) to obtain & set up dressing & showering materials 2 L knee precautions & endurance & strength in R LE.

5)

Client is unable to sleep > 3 hr. nightly 2 L knee pain.

While interviewing Jane she discussed that she would like to shower and practice transfers, walking, and dressing. The first two problem statements can be translated into long and short term goals that address the four areas that Jane would like to work on; thus making them the top two priority statements. Due to Jane only needing minimal assistance to walk, this problem statement falls third in priority. This problem can be incorporated in goals and interventions that will be addressed with the first two problem statements and therefore doesnt warrant top priority. Although Jane requires maximum assistance to set up her dressing and showering materials, this task is prioritized fourth due to safety precautions. Until Jane has progressed in therapy by increasing strength, endurance, and being able to bear more weight on her left leg, this activity should be completed by her OT or husband. This is a problem/concern that can be addressed later in therapy. Although pain is impacting Janes ability to sleep which influences her mood and activity level, this problem statement falls last on the problem statement priority list. This problems falls last as Janes OT is able to recommend techniques such as positioning and meditation that can be discussed during the course of her therapy sessions. This therefore doesnt warrant the need for goals or interventions. Janes doctors are also aware of her pain and are monitoring and manipulating her pain medications to address her concern.

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The above problem statements identify the occupations that have been impacted by Janes condition. Prioritizing the problem statements allow Jane and her OT to focus on identified occupations and problems that are most important to Jane (Gateley & Borcherding, 2012). Through intervention planning the OT is able to engage Jane in occupations that are meaningful to her such as taking a shower while working on contributing factors such as decreased strength and endurance. Using a desired occupation as the focus on intervention motivates Jane to participate in therapy while restoring needed skills to engage in all areas of occupation. Conclusion Through an occupational profile, analysis, and development of problems statements, an OT is able to gather and interpret valuable information about their client. This information enables an OT to identify their clients wants, interests, strengths, needs, and priorities. By identifying these factors an OT develops appropriate, client-centered goals and interventions that facilitate engagement in desired and meaningful occupations that enhance ones life.

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References American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and Process (2nd ed.). Baltimore, MD: AOTA Press. Gateley, C., & Borcherding, S. (2012). Documentation manual for occupational therapy: Writing SOAP notes. (3rd ed., pp. 37-43). Thorofare, NJ: SLACK Incorporated.