Running head: OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Michelle Wilson
Occupational Analysis and Intervention Plan
Touro University Nevada

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Occupational Profile
Who is the client?
The patient is a 70-year-old male, married with a family of four grown children. Two of
his daughters live in the Las Vegas area, one son lives in California, and another son lives in
Boston. It has been seven years since the patient previously retired at age 63 from working as a
driver in Chicago, Illinois. After retirement, the patient and his partner moved from the Chicago
area to Las Vegas, ultimately to escape the cold and live in a warmer climate. The patients
partner is extremely helpful and takes care of the cooking, household demands, and anything else
the patient may be unable to complete independently. The two daughters living in Las Vegas
visit the couple at home at least three times per week to assist with household demands. In
addition to the help of their two daughters, the patient also has a personal care attendant (PCA)
that comes by the house three times per week to assist with showering and dressing.
Why is the client seeking services, and what are the clients current concerns relative to
engaging in occupations and in daily life activities?
The patient was admitted to acute rehabilitation at Spring Valley Hospital to receive
dialysis treatment. Dialysis treatment is used to remove waste, salt, and extra water from the
body of individuals suffering from chronic renal failure whose kidneys are unable to perform at a
healthy functioning level. It also assists in maintaining normal blood pressure and keeping safe
levels of chemicals in the blood (National Kidney Foundation, 2015). The patient was diagnosed
with diabetes mellitus stage 2 in his mid-forties and undergoes dialysis treatment secondary to
chronic renal failure when needed. His doctor runs blood tests often to identify and decide when
dialysis treatment is needed. The patient will stay at the hospital anywhere between one to two
weeks, until blood levels return to a healthy level and the doctor approves the patient for

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discharge. During this time, dialysis will take place three times per week for four hours each
session.
Some of the most common symptoms from dialysis experienced by this patient include
low blood pressure, nausea, weakness, and fatigue. The patient will receive occupational therapy
services to address weakness and fatigue, which may further cause secondary symptoms
including decreased range of motion and decreased strength. All symptoms listed will further
affect the patients ability to be independent in activities of daily living (ADLs) and instrumental
activities of daily living (IADLs).
Currently, the patient has a PCA at home to assist with showering and dressing, however,
he would like to be modified independent using adaptive equipment while showering and
dressing. Due to dialysis treatment, the patient has been experiencing increased weakness
further causing decreased strength and range of motion in all extremities. The patient would like
to work on various strengthening activities with the occupational therapist, education on adaptive
equipment, and increasing competence with a front wheel walker (FWW) to complete functional
ambulation in order to increase independence in ADLs and IADLs.
In what occupations does the client feel successful, and what barriers are affecting his or
her success?
Currently, the patient feels successful in his ability to live at home with his wife and seek
medical treatment elsewhere when needed. For most ADLs, the patients previous level of
functioning was modified independent, utilizing adaptive equipment as well as more time for
activity completion than most. The patient is able to use a FWW to ambulate to the toilet when
needed and complete all toileting tasks without further assistance. However, directly following
dialysis treatment, the patients weakness and fatigue level increase immensely, affecting his
ability to be modified independent with toileting. This is also the case with dressing, bathing,

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and completing functional mobility using a FWW. The patient hopes that through occupational
therapy treatment, his weakness will be addressed and he will return to his prior level of
functioning as modified independent to complete ADLs.
In terms of IADLs, the patient receives needed assistance from his wife to complete
home management, health management, medication routine management, meal preparation and
cleanup, as well as shopping. Previously, the patient assisted his wife with meal preparation, but
currently fatigues too quickly and is unable to stand for more than five minutes before needing to
rest and sit down. In terms of leisure activities, after retirement the patient and his wife became
extremely interested in travel and began traveling to new locations every chance they would get.
The patient no longer partakes in traveling even though his doctor informed him that it was
possible to get set up with dialysis treatment anywhere he wanted to travel to. This not only
affects his leisure interests, but also social participation. The patient no longer travels to visit his
children and grandchildren due to fear of requiring dialysis treatment when on vacation.
What aspects of his or her environments or contexts does the client see as supporting
engagement in desired occupations and what aspects are inhibiting engagement?
Seven years ago when the patient and his wife moved from Chicago to Las Vegas, they
made sure to purchase a home that would accommodate their needs. They purchased a three
bedroom, single story home with no stairs indoors or outdoors. Their bedroom contains a
bathroom that has a walk in shower containing grab bars and a shower chair, providing
assistance if needed for weakness or fatigue after dialysis treatment. The patient views his home
environment as a supportive location and believes that achieving modified independence in
ADLs and IADLs is possible. With high levels of fatigue, the patient unfortunately does not feel
that traveling, either by plane or car is achievable.

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What is the clients occupational history?

The patient grew up in Chicago and pursued a career for a company based out of Seattle,
Washington. He drove the company car throughout the Chicago suburbs assisting their clients
with various needs. In his early thirties, the patient met and married his partner in Chicago,
Illinois and has been married for almost 40 years. After retirement, he and his wife moved to
Las Vegas because the weather was much more appealing, and soon after their daughters
followed and moved to Las Vegas as well.
Following retirement, the patient pursued leisure interests in traveling, golf, playing
poker with friends, and attending various shows and events of interest in Las Vegas. Although
the patient no longer travels due to weakness secondary to dialysis treatment, his partner
continues to travel in her spare time without his attendance. Additionally, the patient has one
granddaughter that lives in the Las Vegas area that he loves getting to spend time with. She is
eight-years-old and enjoys assisting her grandparents in the kitchen with meal preparation
activities, playing games, and watching her favorite television shows.
What are the clients values and interests?
Raising a family of four children, the patient values the importance of family
connectedness by creating and providing a supportive network his family can rely on. He values
his daughters for the support they offer through various household demands at his home. While
the patient requires assistance from a PCA to complete showering and dressing, he values the
opportunity to be as independent as possible and does not want to impede on his partners
happiness and well-being by relying on her for assistance for said tasks.
The patient is interested in maintaining a close network with his family throughout
dialysis treatment. While he no longer participates in traveling, he communicates with his two

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sons living in different states through weekly phone calls to catch up and stay connected. The
patient enjoys any social participation activity that may arise and stays connected with friends
through golf, poker, and attending various events in Las Vegas.
What are the clients daily life roles?
Currently, the patients roles around the home include taking care of financial
management and other non-laborious activities. He values the role of taking part in home
management activities and feels as though he is an asset and provides meaningful contributions
around the home. He has been married to his partner for nearly 40 years and it is extremely
important to him to provide support and offer equal contributions in his relationship.
Additionally, the patient is a father to four grown children and grandfather to one little girl.
Being a role model to his children and grandchild is crucial for his happiness and well-being.
What are the clients patterns of engagement in occupations, and how have they changed
over time?
The patient is retired and previously filled his spare time, before chronic renal failure
with golfing, traveling, and spending time with family. On a day-to-day basis, the patient wakes
up in the morning, showers with assistance from his PCA or partner when needed, completes
grooming activities with modified independence, and dons and doffs clothing. His partner
completes meal preparation activities due to his inability to attend to tasks for longer than five
minutes. Previously, he and his partner would complete meal preparation activities together. In
the past, the patient would go on multiple vacations with his partner and family. Since requiring
dialysis treatment, he no longer pursues traveling. However, the patients doctor has educated
him on the ability to be set up with dialysis treatment in any city he would travel to. The patient
feels that it would take away from his vacation and not be worth pursuing traveling if requiring
dialysis treatment.

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What are the clients priorities and desired targeted?

The patient is most concerned with returning to his prior level of functioning before being
admitted to the hospital, that being modified independent in showering, grooming, dressing, and
functional ambulation with a FWW. The patient would like to participate and contribute to meal
preparation activities for his family like he used to in the past. Cooking in the home was a great
opportunity to bond and communicate with his partner about life each day. He feels that taking
part in this activity provided strength and support in their relationship. Feeling empowered
through a strong marriage enhances the patients quality of life and well-being. It is very
important that the patient be able to participate in activities with his eight-year-old granddaughter
and keep up with her energy level without becoming fatigued extremely quickly. The patient
values the importance of family and wants to continue to be a strong role model for his
granddaughter as well as children.
Occupational Analysis
Briefly discuss the context/setting of occupational therapy services
Occupational therapy services took place on the acute rehabilitation floor at Spring
Valley Hospital. Session would take place in both the occupational therapy gym as well as the
patients hospital room for completion of ADLs such as showering, dressing, grooming, and
eating. In the rehabilitation gym the patient completed exercises to increase strength,
coordination, and flexibility in his upper extremities using dumbbells, the arm bike, theraband,
and over-the-head arm pulleys. The acute rehabilitation floor was designed to accommodate
durable medical equipment (DME), providing the patient more than enough room to navigate
with his FWW and wheelchair if needed. In the bathroom in his hospital room, it is large enough

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to navigate with DME as well. The shower has grab bars and a shower chair supporting his
assistance level of being modified independent in showering.
Briefly discuss or describe the activity observed and your clients performance during this
activity.
The patient participated in a shower evaluation with the occupational therapist to address
the level of assistance needed in order to be successful in this activity. Due to dialysis, the
patient was much weaker than usual and experiencing fatigue in a standing position. He doffed
his hospital gown in a wheelchair with minimal assistance from the occupational therapist.
Bending over to take off his socks was too difficult as well and he requested help, requiring total
assistance. The patient was able to stand in order to pull down his pants and undergarments, but
lost his balance momentarily due to light headedness, requiring contact guard assistance from the
occupational therapist, and reached back for the wheelchair arm rests for support. The
occupational therapist then used plastic to cover both dialysis ports, one located on the inside of
his left arm, the other on the right side of his chest. In order to transfer from the wheelchair to
the shower chair, the patient required minimal assistance for steadying and guiding of the hips to
the chair during a stand pivot transfer. Privacy was then given to the patient and he completed
shampooing and washing his body with modified independence, using grab bars and a shower
chair for support.
Once the patient was finished with washing his body and hair, he turned off the water
independently and called to let the therapist know he was finished. The therapist handed the
patient a towel as well as placed one on the floor outside of the shower to ensure safety and he
independently dried off his body. He was then able to transfer from the shower chair back to the
wheelchair using minimal assistance once again during a stand pivot transfer. After the shower,
he requested oxygen due to increased fatigue and shortness of breath, both side effects of dialysis

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treatment. Due to fatigue, the patient required moderate assistance for donning his shirt,
undergarments, and pants.
Identify key observations from the performance of the occupation or activity.
When observing the patient during the shower activity, I noticed that although he was
using a wheelchair, he was capable of standing up but preferred to use the wheelchair for
transferring due to increased fatigue level after dialysis. It would be important to pay close
attention to his functional ambulation and transferring abilities at a time other than the morning
after receiving dialysis because his weakness may be more impacted at this time.
I had the opportunity to observe the occupational therapist with this patient once before
the shower activity and the progress he had made was very apparent. Previously he denied a
shower due feelings of increased weakness and low blood pressure, but this session he was
excited to shower and was fully engaged in the process. His goal for himself upon discharge is
to be able to shower with modified independence.
Consider your clients diagnosis and why he/she is seeking OT services. Comment on what
domains of the OTPF are most significantly impacting your clients ability to successfully
engage in occupations based on your observations.
The patient has been admitted to Spring Valley Hospital to receive dialysis treatment
secondary to chronic renal failure. He is seeking occupational therapy services to increase
strength and endurance during the duration of dialysis treatment. This treatment is exhausting
for him and causes high levels of fatigue. It is important to keep him actively engaged in
occupational therapy services throughout his hospital stay to prevent further weakness, fatigue,
decreased strength, and decreased range of motion.
Currently the patient is having the most difficulty engaging in showering, dressing, and
functional mobility (American Occupational Therapy Association, 2014). All three of these

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occupations are challenging for the client to engage in with modified independence due to a
variety of reasons. The patient has expressed having a tough time adapting nightly routines to
the hospital setting, further affecting his sleep patterns at night and increasing fatigue levels
during the day. The dialysis treatment has also decreased his muscle power, muscle endurance,
and joint mobility in the left upper extremity due to location of the dialysis port. Additionally,
the patients cardiovascular system has been affected by dialysis causing low blood pressure, a
common symptom of the treatment.
Problem List
1. Pt. unable to complete ADLs & IADLs Mod I for more than x5 min due to activity
tolerance 2 weakness & pain.
2. Pt. requires Min A dressing 2 ROM & strength in (B) UE secondary to dialysis
treatment.
3. Pt. requires Min A t/f WC S/C for steadying & guiding hips 2 strength (B) LE.
4. Pt. unable to complete fine motor tasks (L) hand 2 weakness in fingers secondary to
previous elbow surgery.
5. Pt. unable to complete leisure activity of traveling I due to activity tolerance 2
weakness & pain & fear of requiring treatment on vacation.
Ultimately, increasing the patients activity tolerance through energy conservation and
compensatory techniques is the most important problem to address. It is very important for the
patient not to rely heavily on his partner for completion in ADLs and IADLs because he does not
want to be a burden. He stated that his goal upon discharge is to be modified independent
utilizing adaptive equipment such as a shower chair and grab bars during showering. By
increasing activity tolerance, the patient will be able to complete required activities in a

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reasonable amount of time ensuring success. The second most important problem to address is
completing interventions to increase range of motion (ROM) and strength in the patients upper
extremities. Dialysis will continue to further fatigue the patient causing muscle weakening and
decreased ROM. If not addressed, this will further impair the patients ability to be independent
not only in dressing, but additional ADLs as well. Next, it is important to educate the patient on
safe transfer techniques to and from the shower. While he does have a PCA for assistance with
showering and dressing at home, it will increase his ability to complete these tasks in a safe
manner and prevent further injury from occurring. The next area to address is the patients
inability to complete fine motor tasks with his left hand. While this is an important area for
occupational therapy to address, the patient expressed that he has had decreased fine motor
ability for a few years since undergoing elbow surgery and it is not a priority of his to address.
Lastly, the patient expressed a previous interest in traveling, but no longer partakes in this
leisure activity due to fear of requiring treatment on vacation. From an occupational therapy
standpoint, it is important to address this matter because it was a meaningful occupation that took
up much of the patients free time before dialysis. The doctor expressed traveling being a
possibility due to dialysis treatment offered in numerous hospitals. This was placed last on the
problem list because it does not need to be the primary problem being addressed during the
patients hospital stay. It is something that can be addressed through conversation during
therapy sessions while focusing on other problem areas.
Intervention Plan & Outcomes
1. LTG
STG
Intervention

Pt. will complete ADLs & IADLs Mod I x15 min within 2 weeks.
Within 1 week, pt. will complete ADLs & IADLs CGA standing x10
min.
The patient will complete a meal preparation activity with his partner in the
occupational therapy rehabilitation kitchen while standing. The
occupational therapist will educate the patient and encourage incorporating

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rest breaks.

Intervention
Reasoning

STG
Intervention

Intervention
Reasoning

Outcome: Participation
As stated earlier in the text, the patient used to assist his partner with meal
preparation activities. Since undergoing dialysis treatment and having
increased fatigue, he no longer participates in this activity. By increasing
the patients activity tolerance and educating on the importance of rest
breaks, he will be able to participate in this desired occupation once again.
Common non-pharmacological treatments for patients experiencing pain
and fatigue are often provided by physical and occupational therapists and
usually include training in exercise programs, use of adaptive equipment,
and splinting (Murphy, Lyden, Smith, Dong, & Koliba, 2010). While these
interventions are important for active participation in meaningful
occupations, they often do not address the bigger picture of how their
symptoms are affecting participation in daily occupational demands. This
article emphasizes the importance of activity pacing; a strategy taught by
occupational therapists to gradually increase activity periods between
alternating rest breaks. Participants included in this study reported that
fatigue no longer impacted their daily life and through the education and
implementation of rest breaks, participation in meaningful occupations
increased immensely (Murphy et al., 2010).
This patient will be educated on the importance of incorporating rest breaks
during participation in meaningful activities such as meal preparation, to
increase his ability to participate for longer periods of time.
Pt. will gather & t/f shower necessities hospital room bathroom within
10 min using FWW CGA within 1 week.
While standing in the hospital room, the patient will use his reacher to pick
up items needed for showering (i.e. clothing, towels, comb, etc.) and place
them into the basket to bring to the bathroom.
Outcome: Participation
Energy conservation through the use of adaptive equipment increases an
individuals ability to participate in meaningful occupations. A study done
by Mathiowetz, Matuska, and Murphy observed the effects of energy
conservation through the use of adaptive equipment with individuals
diagnosed with multiple sclerosis (MS) due to high levels of fatigue
experienced later in the day (2001). Patients reported having significantly
less fatigue impact, increased self-efficacy, and an overall increased quality
of life (Mathiowetz et al., 2001). Although the patient in this intervention
is not diagnosed with MS, his diagnosis of chronic renal failure is similar
to MS in that he fatigues extremely easily, further limiting his participation
in meaningful occupations. By educating on energy conservation
techniques through the use of adaptive equipment, he will be able to
participate more fully in the daily demands presented to him.

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2. LTG
STG
Intervention

Intervention
Reasoning

STG
Intervention

Intervention
Reasoning

13

Pt. will complete dressing Mod I using AE within 2 weeks.

Pt. will fasten 4 buttons within 3 min using button hook no more than 3
VC within 1 week.
The patient will make a beaded bracelet to give to his granddaughter the
next time she comes to visit at the hospital. The patient mentioned loving
getting to spend time with his eight-year-old granddaughter and worries
that he will no longer be able to keep up with her energy level due to his
increased fatigue and weakness.
Outcome: Role competence
Often times, individuals requiring dialysis treatment not only go through
physical fatigue, but mental fatigue as well. Common negative
psychosocial consequences experienced include decrease or loss of selfesteem, and feelings of worthlessness (Mariotti & Rocha de Carvalho,
2011). It is crucial to address psychosocial aspects from an occupational
therapy standpoint. Through gradually strengthening his self-esteem, the
patient will discover that he can improve his overall quality of life by
continuing fulfill past roles through meaningful occupations with his social
group. The occupational therapist can address psychosocial aspects by
encouraging the patient to continue to participate in previous roles, such as
being a grandfather. In addition to socialization through role competence,
the importance of increasing fine motor skills for dressing will be
addressed as well.
Within 1 week, pt. will don & doff socks using sock aid & reacher with no
more than 3 VC.
With the assistance of the occupational therapist, the patient will educate
and instruct partner on use of the sock aid and reacher and talk him through
using it to put on and take off socks.
Outcome: Participation
In the past when the patient is extremely fatigued and the PCA is not at the
home to assist with dressing, the partner has to assist the patient with
ADLs. It is extremely important that the partner understand how to utilize
the patients adaptive equipment if she finds herself needing to assist him.
Being a caregiver places many demands on an individual and is not an easy
task to fulfill. It is extremely important to include the caregiver in the
therapy process and provide them with the necessary education needed to
successfully care for their loved one at home. According to DiZazzoMiller, Samuel, Barnas, and Welker, by not providing caregivers with
adequate support, they are at high risk for physical injuries, caregiver
stress, and burnout (2014). In a study done by DiZazzo et al., incorporating
caregivers in a family education program can increase caregiver knowledge
and decrease possibility of further injury to both the patient and caregiver.
Although this study focused primarily on individuals caring for loved ones
diagnosed with dementia, the importance of caregiver education can
transfer individuals caring for loved ones of a variety of diagnoses. The

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occupational therapist will assist this patient in completing education on

compensatory strategies to his loved one to ensure successful participation
in ADLs.
Precautions and/or contraindications for the client or intervention plan
After the patient receives one four hour session of dialysis treatment, he is extremely
weak and fatigued. When not at the hospital, he utilizes a FWW to ambulate throughout his
home in order to complete ADLs and IADLs, however, with increased weakness, the patient
utilizes a wheelchair to ensure safety while maneuvering throughout the hospital. Additionally,
due to the location of the dialysis ports being in the patients left arm and chest, he is advised to
not sleep on the left side or in prone position, to avoid further damage from occurring. Also, he
should not lift heavy objects with the left arm containing the port, to avoid over straining. As
stated above, one of the patients goals during the therapy process is to be more independent in
dressing. He has been educated on the benefits of wearing loose-fitted clothing to not only
provide more space for the dialysis hook ups, but also offering to him a more manageable way to
dress even if feeling overly fatigued. Lastly, the patient is participating with multiple therapists
as well as many disciplines during his stay in the hospital. It is the interdisciplinary teams job to
communicate and understand the occupational therapy rehabilitation goals during his hospital
stay (Reed, 2014).
Frequency and duration of intervention plan
The patient was admitted to Spring Valley Hospital to receive dialysis treatment and
therapy services in an acute rehabilitation setting. In this setting, patients are required to receive
at least three hours of therapy a day on average five to six days per week (Pendleton & SchultzKrohn, 2013). Dialysis can vary depending on each individual and their kidney functioning
ability. Treatment will continue until blood tests are cleared by the doctor for discharge. This

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patients estimated length of stay is two weeks, receiving dialysis three times per week for four
hours each session. He will be receiving occupational therapy services to address further fatigue
secondary to dialysis treatment.
For one of the identified intervention ideas, provide one example of grading up and one
example of grading down
For the intervention requiring the patient to complete a meal preparation activity with his
partner in the occupational therapy rehabilitation kitchen standing for ten minutes while
incorporating rest breaks, it is very possible that this may be too difficult or too easy for the
patient depending on the day and his fatigue level. It is important for the occupational therapist
to be prepared to either increase or decrease activity demands to avoid frustration as well as
ensure motivation in therapy. To lessen the difficulty if needed, the patient will complete the
meal preparation activity with his partner while seated. On the other hand, if the task appears to
be too easy for the patient, he can complete the meal preparation activity with his partner while
standing for ten minutes, without taking any rest breaks.
Identify and discuss the primary framework utilized for this intervention plan. Explain
how the framework guided intervention planning and goal setting.
Due to this patient experiencing weakness after dialysis treatment, the occupational
therapy team is going to be educating on energy conservation and compensatory strategies using
adaptive techniques through the rehabilitation frame of reference. The patient has been
diagnosed with chronic renal failure secondary to diabetes. While his fatigue level temporarily
increases immensely following dialysis treatment, his overall physical endurance has continued
to decline due to years of receiving said treatment. This frame of reference focuses on
identifying the patients strengths and utilizing them to restore overall independence through
compensatory strategies. The patient is a key member in the rehabilitation team and the therapist

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must be creative in creating interventions using a compensatory approach (Gillen, 2014). The
two long term goals that will be addressed in this patients intervention plan include increasing
activity tolerance utilizing energy conservation techniques and second to achieve modified
independence in dressing with adaptive equipment. Energy conservation as well as adaptive
equipment very much falls under the scope of the rehabilitation frame of reference.
While the rehabilitation frame of reference is primarily guiding this intervention plan, the
model of human occupation (MOHO) will also be directing this intervention. It is crucial to
identify the patients interests and what is going to motivate them to participate and achieve
intervention goals. The MOHO model is unique in that it is occupation based and hones in on
what motivates the patient to achieve optimal performance in meaningful occupations (Pendleton
& Schultz-Krohn, 2013). The therapy team is striving to incorporate the patients family in the
intervention process because he mentioned family being an extremely important part of his life.
Discuss how /caregiver training and education will be addressed in the intervention plan
Although the patient has a PCA to assist with showering and dressing three times a week,
it is important to educate the patients partner on the various compensatory strategies that are
being taught in the intervention process. His partner makes frequent visits to the hospital and
wishes to be actively engaged in the therapy process. The therapist will incorporate the patients
partner in various intervention activities when possible including meal preparation and adaptive
equipment education.
In addition to taking part in the therapy process at Spring Valley Hospital, it is important
to educate the patients partner on how to ensure safety at home. It is essential upon discharge
that the patient will be returning home to a safe environment in which supports his condition.
Home modifications are something the partner can complete while the patient is still admitted to

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the hospital. These include placing kitchen or bathroom items in easy to reach locations to avoid
further fatigue, placing chairs around the home providing easy access for rest breaks when
needed, and adapting the patients bathroom with a shower chair and grab bars to ensure safety.
Discuss how the clients response to the interventions will be monitored and assessed
towards progress of goals.
The patients progress will be assessed through skilled observation of activity by the
occupational therapist. Each activity will be broken down by task performance to identify if and
where progress is being made, and if progress is not being achieved, exactly what portion of the
activity the patient is struggling with. The MOHO model will be one of two frameworks that
will be guiding this intervention. Before identifying the patients goals and creating
interventions, the occupational therapist will complete the Canadian Occupational Performance
Measure (COPM), an assessment which is primarily guided by the Canadian Model of
Occupational Performance. The COPM is a performance based outcome measure, given to the
patient in the form of a semi-structured interview periodically throughout treatment (COPM,
2015). This assessment is unique in that it is client-centered, requiring the patient to identify the
barriers that are restricting occupational engagement in meaningful occupations.
In addition to the COPM, the occupational therapist will complete the FIM assessment
upon initial evaluation as well as at the time of discharge. The FIM assessment measures a
patients independence level and identifies the level of assistance needed to carry out ADLs
(Rigby, Lowe, Letts, & Stewart, 2008). By completing this assessment upon initial evaluation as
well as at discharge, the occupational therapist can identify whether goals are suitable for the
patient, how much assistance will be needed upon discharge, and whether progress has been
achieved during the patients hospital stay.

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References
American Occupational Therapy Association (2014). Occupational therapy practice framework:
Domain and Process (3rd ed.). Baltimore, MD: AOTA Press.
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American Occupational Therapy Association. (2014). Occupational therapy practice framework:
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COPM. (2015). The COPM is an individualized, client-centered outcome measure. Retrieved
from http://www.thecopm.ca/
National Kidney Foundation. (2015). Dialysis. Retrieved from
https://www.kidney.org/atoz/content/dialysisinfo
DiZazzo-Miller, R., Samuel, P. S., Barnas, J. M. (2014). Addressing everyday challenges:
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Journal of Occupational Therapy, 68, 212-220.
http://dx.doi.org/10.5014/ajot.2014.009829
Gillen, G. (2014). Motor function and occupational performance. In Schell, B.A., Gillen, G., and
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Mariotti, M. C., & Rocha de Carvalho, J. G. (2011). Improving quality of life in hemodialysis:
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Mathiowetz, V., Matuska, K. M. & Murphy, M. E. (2001). Efficacy of an energy conservation

course for persons with multiple sclerosis. Archives of physical medicine and
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Murphy, S. L., Lyden, A. K., Smith, D. M., Dong, Q., & Koliba, J. F. (2010). Research scholars
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