Hospital:

Occupational Therapists: A Day in the Life

April 23, 2019

In support of National Occupation Therapy Month, Beth Miskovsky, OTR/L, and Andrea Walk, OTR/L, MS, of Jefferson Health New Jersey’s Physical Medicine and Rehabilitation Department, share the “ins and outs” of the diverse job and what patient care may entail.

What is the purpose of occupational therapy (OT)? How does it differ from physical therapy (PT)?

Andrea: OT differs across all settings, including inpatient hospital, inpatient rehab, home care, outpatient, schools, and mental health. Our main goal is increasing overall functional independence for patients who are either recovering from injury or managing their condition. People typically need OT when they have a decreased ability to complete tasks that they were once more independent with.

Beth: PT focuses more on gait training, balance, strengthening, conditioning, and, in the outpatient setting, the spine and lower body. OT focuses on ADLs (activities of daily living), IADLs (instrumental activities of daily living), work, leisure, play and functional mobility. ADLs include getting dressed, bathing, using the toilet, grooming, and eating. IADLs are more complex tasks that aid in societal integration, such as managing finances, driving, cooking, cleaning, and shopping.

What conditions can be managed with OT?

Andrea: There’s a wide range. Because we work in outpatient and inpatient, we primarily see adult and geriatric patients. Neurological conditions, such as stroke, dementia, Multiple Sclerosis, and Parkinson’s Disease, can be managed with OT.

Beth: Recently, we’ve worked with patients recovering from hand burns and wound care is involved. Common orthopedic conditions are shoulder, elbow, and hand injuries, as well as fractures and nerve conditions like carpal tunnel and cubital tunnel.

How do you assess and improve patients’ functionality?

Beth: We really take a comprehensive look. At the first visit, we do an evaluation, which involves a social history, idea of home set-up and their prior level of functionality and daily tasks. We then test their range of motion, strength, cognitive skills (if necessary), coordination, sensation, vision, independence with ADLs and IADLs, and functional mobility (balance).

Andrea: It’s really important to find out what tasks are meaningful to them such as dressing.  After this, we’ll set a plan of care.  In the inpatient hospital setting, this plan will help with discharge recommendations.  For outpatient, we create goals and a more specific timeline target.

Beth: For a patient who has rated cooking as a top priority, we have a kitchen for them to practice in our outpatient facility.  If we don’t have a set-up for their goal, we will get creative and do anything we can to simulate that situation.  We also have the capabilities to do custom splinting.

What are your work hours and how many patients do you see daily?

Andrea: Our schedules differ. We may do 10-hour, 8-hour, or 5-hour shifts, between inpatient hospital and outpatient. Typically, we don’t do night hours in our field. Each of us will see about 10 to 12 patients in a normal, 8-hour day in inpatient; 12-15 patients in outpatient.

What happens when a patient wants to get better but doesn’t want to do the work?

Beth: As clinicians, it’s our responsibility to educate our patients, specifically on the importance of following our recommendations. They need to understand the risks that they’re faced with, if they’re not compliant. It’s really important to participate consistently and follow a home exercise program. Practice is the primary way to progress.  

What is the most rewarding aspect of the job?

Andrea: Hearing people say “thank you,” as they progress. We get to watch them become more and more independent. Doing one small task that they were unable to do a few weeks ago – that really makes them light up. There are so many things that we do and take for granted. When you can no longer take care of yourself with ease, it has a huge impact on your life.

Do you have any advice for someone going into this field?

Andrea: Know that the education is intense and you should have many observation hours to have a better understanding of OT before you commit to a program.  Also, know that OT is multi-faceted, and we have the responsibilities that aren’t well known, such as our constant communication with other health care professionals and involved patient care.

Beth: Above all else, have sympathy and empathy. Gaining back a sense of normalcy is so important, and it should never be brushed over.

To learn more about Occupational Therapy services offered at Jefferson Health in New Jersey, click here.