Running head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Occupational Analysis Nicole Quisao Touro University Nevada

OCCUPATIONAL PROFILE AND ANALYSIS Occupational Profile and Occupational Analysis Occupational Profile

Abby is a 42 year-old woman born in Brawley, California. She lives at home with her husband, two sons, one daughter, and one granddaughter. Following her total hip arthroplasty (THA), Abbys husband took the role of caregiver. Abby also receives support from her church community. Abby has experienced hip issues since she was 15 years old. She has had two hip surgeries and has been experiencing pain in her hip as a result of the surgeries. Abby began working at a keano facility 16 years ago and holds the position of shift supervision. She described keano to be similar to the game of bingo. She runs the entire department as shift supervisor. Abbys pain subsided for a number of years. However, about one year ago, Abby began to experience sharp pain in her right leg that she believed to be related to a fall. As a result, she had a right THA. Prior to the surgery, Abby was not concerned about the recovery process since she had gone through this type of surgery twice before. She anticipated discomfort; however, immediately following the surgery she noticed increased pain in her right leg at the knee. Abbys current concern relative to engagement in occupations centers around homemaking and providing for her family, maintaining independence in activities of daily life (ADLs), and maintaining her employment. She is worried that this new knee issue will inhibit her performance in occupations. The areas of occupation that are impacted by Abbys hip involvement include: ADLs, instrumental activities of daily living (IADLs), rest and sleep, work, play, leisure, and social participation.

OCCUPATIONAL PROFILE AND ANALYSIS Areas of Occupation

Activities of daily living. Abby experiences difficulty with dressing and bathing. Her husband assists in obtaining and applying clothing to her lower body. She also requires assistance during functional mobility into the shower, the car, and the bed. Abby is fearful to engage in sexual activity and usually refrains from participating in the activity. Bathing is impacted by limited mobility and pain. Abby demonstrates decreased ability to engage in grooming and hygiene as a result of pain and endurance. Abby is successful in feeding, eating, personal device care, and bowel and bladder management. Frequent breaks are taken due to decreased tolerance, endurance, and pain. Breaks typically consist of sitting. However, breaks should be brief because Abbys ability to tolerate a seated position for an extended amount of time is impacted by pain. Instrumental activities of daily living. Participation in IADLs is impacted during community mobility, home management, meal preparation, care of others, health management, and shopping. Abby attempts to complete IADLs independently each day. She initiates each activity but typically requires assistance to complete each activity. Breaks are taken due to decreased tolerance, endurance, and pain. Minimal assistance is required in safety, and emergency maintenance. Rest and sleep. Abby consistently experiences pain and discomfort during rest and sleep. She is frequently required to reposition herself in order to attempt comfortability. Abby mentioned that she lacks the appropriate amount of sleep due to these limitations. Work. Abbys ability to work has been impacted by her recent surgery. However, prior to this surgery, Abby had experienced right lower extremity pain for several years. Despite her

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limitations, Abbys employers have remained accommodating and will allow unpaid leave until she feels ready to return to work. Social participation. Abby has never been active in the community. She engages primarily with her immediate family. She feels as though she has been isolated for years as a result of her chronic pain. She does not maintain contact with many friends, but does remain in contact with select relatives via Skype. Abby engages with a variety of people at her job. However, she does not strive to initiate relationships. Contexts and Environment Cultural. Abby appreciates her work culture environment. Abby has many responsibilities associated with her position and is in charge of a large number of employees. Abbys boss is accommodating regarding the limitations caused by pain. Her job requires standing for extended periods of time, but her boss allows her to alternate between sitting and standing during most aspects of the job. Abbys employers will allow Abby to come back to work when she is ready. Personal. Abby is a 42 year old woman who lives at home with her family. She and her husband graduated from high school in California, and live a modest life together in Las Vegas, Nevada. She described her husband as extremely supportive. Her husband is adamant that he remains the sole provider of Abbys needs. Temporal. Currently, Abby is on a paid leave from work. Her employers have made it clear that Abby may return to work when she feels comfortable in the recovery process. Abby is spending more time at home to recover from her surgery while attempting to provide for her family.

OCCUPATIONAL PROFILE AND ANALYSIS

Virtual. Abbys extended family members live in in New Jersey. Prior to the surgery, Abby enjoyed calling her relatives on the phone as well as on Skype. She described how Skype has allowed her to stay in contact with her relatives. She mentioned the importance of the cell phone. Abby is often at home alone during the day. In the event of an emergency, Abby is able to utilize her cell phone to communicate with her husband. Physical. The built physical environment of her home is a contributing factor to her difficultly in participating in her occupations as it was not built to effectively accommodate her injury and pain. She lives in a multiple level home with a variety of floor textures included. The natural environment of her home provides increased natural lighting due to the many windows situated around the house. Social. Abbys social environment consists primarily of her home environment and her work environment. She has a positive relationship with her immediate supervisor, but does not maintain relationships with coworkers or patrons of the keano facility. Abby often sits during work, thus opportunity is not afforded for mobile socialization. Occupational History Abby highly values her occupation as a mother and wants to be present throughout her childrens lives. She cites personal childhood experience as an influence on her parenting style. Abby struggles to accept that her participation in motherhood is less active as a result of her recent surgery and associated pain. She used to be the primary caregiver of her children and grandchildren. However, she has recently been relying on her husband for assistance with this occupation. Abby is passionate about cooking and has always been the primary cook in her family. She has recently been ordering take-out or relying on her husband to cook. Abby still attempts to

OCCUPATIONAL PROFILE AND ANALYSIS

cook in the kitchen. However, she has to sit and take breaks as a result of the pain in her leg. She fatigues frequently and is unable to stand for extended periods of time. Abby feels useless and fears her children will no longer rely on her for basic life needs. Abbys position as keano shift supervisor falls close in priority to motherhood. She hopes to return soon as she is the major breadwinner of her family. Priorities and Desired Outcomes Abbys primary priorities include getting back into her normal routine of motherhood and employment. Overall, Abbys chief concern is to provide for her family and to be an active mother and wife. She wants get back to cooking meals for her family each evening. She also wants to regain independence in ADLs including: dressing, grooming and hygiene, and bathing. She does not want to be a burden by constantly relying on her husband. She wants to be a more active participant in her grandchildrens after school sporting activities. Abby also wants to return to work to provide her family with financial stability. These goals entail recovering from surgery and having the ability to walk and stand or sit for extended periods of time without knee pain. Abby would like to increase her endurance in order for successful participation in her daily life. Occupational Analysis The occupation observed was personal hygiene and grooming in the acute inpatient setting. Specifically, Abby brushed her teeth in a standing position at the sink in her hospital room. Abbys ability to participate in the activity is impacted by limitations resulting from total hip precautions (THP), secondary knee pain, and decreased endurance and standing tolerance. Other areas of occupation that may be affected by these limitations include: bathing, dressing, functional mobility, sexual activity, care of others, community mobility, home management,

OCCUPATIONAL PROFILE AND ANALYSIS

meal preparation, safety maintenance, shopping, rest and sleep, employment, leisure, and social participation. The following sections outline Abbys participation in personal hygiene and grooming in relation to aspects of the Occupational Therapy Practice Frameworks domain (American Occupational Therapy Association, 2008). Deficits in Body Functions Mental functions. Abby does not demonstrate deficits in mental functions. Sensory functions and pain. Abby demonstrates deficits in vestibular functions. She reports feeling nervous and unstable when she stands at the bathroom sink and does not feel safe unless she uses the counter as a support. Abby describes feeling sharp pain in her right lower extremity while standing; however she feels minimal pain in her right hip. Pain is localized to her right knee, particularly when standing at the sink for the duration of grooming and hygiene activity. Neuromusculoskeletal and movement related functions. Abby demonstrates decreased joint stability during tooth brushing, and often feels unstable when attempting to participate independently. This activity does not require much movement of the lower extremity. No deficits in joint mobility are apparent during tooth brushing. Abby exhibits decreased muscle endurance throughout the activity and cannot tolerate standing for the entire duration of the activity. Cardiovascular and respiratory functions. Abby does not demonstrate deficits in functions related to the cardiovascular and respiratory systems. Voice and speech functions. Voice and speech function deficits are not evident during Abbys occupation. Digestive, metabolic, and endocrine system functions. Digestive, metabolic, and endocrine system function deficits are not evident during Abbys occupation.

OCCUPATIONAL PROFILE AND ANALYSIS

Skin and related-structure functions. Skin and related-structure function deficits are not evident during Abbys occupation. Activity Demands Objects and their properties. Tools required for this activity include a toothbrush and a rinse cup. Abby brought her own soft-bristled tooth brush from home. She utilizes a small plastic rinse cup provided by the hospital. Materials required for this activity include water and toothpaste. Abby utilized her own toothpaste from home, and used cold sink water to rinse. Required equipment includes a sink, a faucet, and necessary plumbing. This equipment is standard in each of the hospital rooms. Additionally, to accommodate for rest breaks, Abby brings her four wheel walker into the bathroom. Space demands. A bathroom with ample space to ensure safety is required for this activity. Abby often requires intermittent breaks during the activity, thus an open space next to the sink is necessary to accommodate her four wheel walker. Proper lighting is required for Abby to be visually aware of the activity, required tools, and materials. Social demands. In the hospital setting within Abbys room, social demands are not relevant. However, in the home environment, Abby may need to share a tube of toothpaste with her family members. Sequence and timing. The sequence of steps required during the tooth brushing activity include obtaining required tools and materials, rinsing the tooth brush, applying the toothpaste to the tooth brush, brushing teeth for the appropriate amount of time, rinsing the mouth using, rinsing the toothbrush, and replacing the materials and tools back to the appropriate location within the bathroom.

OCCUPATIONAL PROFILE AND ANALYSIS

Required actions and performance skills. During the tooth brushing activity, sensory, motor, praxis, and cognitive performance skills should be considered. For example, knowledge of the sequence of steps is required in order to successfully complete the activity. Abby should be able to manipulate the toothpaste tube and tooth brush to apply the appropriate amount of toothpaste. Proper placement of the hand on the tooth brush would enable Abby to maintain the tool in her hand throughout the duration of the activity. Additionally, Abby should adjust the water to a suitable temperature. Required body functions. Mental functions related to cognitive awareness of the sequence of steps, sustained attention, memory, and execution of learned movement patterns are required to complete tooth brushing. Sensations related to vision, taste and smell, pain, temperature, and pressure are also relevant. Joint stability, muscle power, tone, and endurance are required to tolerate the activity. Additionally, deficits regarding body functions are mentioned in depth in in the Body Functions section above. Required body structures. Anatomical parts of the body that support body function during the tooth brushing activity include: eyes, oral structures, pain and temperature receptors, joints, muscles, limbs and vital organs. Performance Patterns Habits. Habits relevant to tooth brushing may include using a certain brand of toothpaste or type of tooth brush, setting a consistent water temperature from day to day, rinsing the tooth brush before applying the toothpaste, replacing the cap on the toothpaste tube at the end of the activity, or placing materials and tools into specific locations at the end of the activity. Routines. Routines relevant to the activity may include tooth brushing during certain times of the day. Abby brushes her teeth after she wakes up and as part of her bedtime routine

OCCUPATIONAL PROFILE AND ANALYSIS each evening. Additionally, Abby may follow a specific sequence of steps during each performance of the activity. Rituals. Rituals are not applicable during the tooth brushing activity.

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Roles. Abby is the mother of three children, grandmother of one grandchild, and wife to her husband. She defines these roles by engaging in homemaking and home maintenance as well as maintaining employment to provide financial stability to her family. Abby now relies on her husband for assistance with many of her occupations, or completes the occupations, such as tooth brushing, on her own modified time. Performance Skills Motor and praxis skills. Motor skills required for tooth brushing include: manipulating the toothpaste tube to open and squeeze toothpaste onto the brush, coordinating body movements to move the brush back and forth across teeth, maintaining balance while brushing teeth, and reaching to retrieve and replace tools and materials onto the bathroom counter. Praxis skilledpurposeful movements include: carrying out the appropriate sequence of motor acts as part of the overall sequence of steps and anticipating environmental changes. Sensory-perceptual skills. Sensory-perceptual skills required for tooth brushing include: positioning the body to ensure safety, visually determining appropriate amount of toothpaste to apply, visually distinguishing between toothpaste tube and other bathroom materials, locating tools and materials within the bathroom counter and cabinet, and discerning the taste of the toothpaste to ensure appropriate choice. Emotional regulation skills. Abby takes frequent rest breaks during due to decreased endurance and pain. She is able to persist throughout the duration of the activity despite becoming frustrated. She may use relaxation techniques to cope with her limitations during the

OCCUPATIONAL PROFILE AND ANALYSIS activity. These emotional regulation skills allow Abby to appropriately manage and plan for completion of the activity. Cognitive skills. Cognitive skills required during the tooth brushing activity include: selecting appropriate tools and materials, executing the sequence of steps and learned movements to complete the activity, and sustaining attention during the activity. Communication and social skills. Communication and social skills are not typically required during this activity. However, Abby should be able to initiate questions toward the therapist and communicate needs if assistance is required. Body Functions and Structures Structures of the nervous system. Not applicable.

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Eyes, ear, and related structures. The eyes are minimally relevant to this activity and are involved during application of toothpaste and intermittently while looking in the mirror. Ear related structures are not applicable. Structures involved in voice and speech. Not applicable. Structures of the cardiovascular, immunological, and respiratory systems. Not applicable. Structures related to the digestive, metabolic, and endocrine systems. Not applicable. Structures related to the genitourinary and reproductive systems. Not applicable. Structures related to movement. The primary movement-related structures involved in tooth brushing include the upper extremities, the eyes, and oral motor structures. Specifically, range of motion of the upper extremities impact the ability to complete the tooth brushing activity. Additional structures including the lower extremities limbs and muscles, trunk muscles,

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and joints provide stability during this activity. Abby often takes breaks in order to complete the tasks as a result of lower extremity knee pain and decreased standing tolerance. Skin and related structures. Not applicable. Contexts and Environments Cultural. Abby believes that she should be as independent as possible in order to provide her family with the appropriate care and support. She brushes her teeth independently and strives to maintain normal expectations related to hygiene. Personal. Abby is a 42 year old woman who has been employed by the same employer for 16 years. She graduated from high school and is the primary breadwinner of her family. She would like to return to work and to normal participation in her typical occupations once she is physically able to engage with minimal pain. Temporal. Abby currently resides in the acute hospital setting and completes her daily activities including grooming and hygiene within her hospital room. She is on a loose schedule determined by her nurses, doctors, and therapists. She receives various treatments at different times each day. She intends to return to her normal patterns of daily occupations once discharged from the facility. Virtual. Not applicable. Physical. The physical environment related to performance of tooth brushing include: the built hospital bathroom environment. The hospital bathroom includes the sink, a faucet, a toilet, and a shower. The built environment of her home should be similarly equipped d for completion tooth brushing. The natural sensory qualities of the environment should be considered and should promote efficiency of the activity.

OCCUPATIONAL PROFILE AND ANALYSIS Social. The social context and environment does not typically influence this activity.

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However, as previously mentioned, expectations in the home environment may include sharing of certain materials related to tooth brushing such as the toothpaste tube. Problem Statements The following problem statements demonstrate functional problems that Abby has experienced as a result of her right THA. 1. Client unable to complete meal preparation due to standing tolerance and R knee pain. 2. Client requires mod in LB dressing due mobility limitations secondary to THP. 3. Client unable to complete standing grooming and hygiene activities due to endurance, standing tolerance, and R knee pain. 4. Client requires Mod in bathing self due to R LE AROM and pain. 5. Client unable to attend grandchildrens sporting events due sitting tolerance secondary to R knee pain. Justification of Problem Statement Prioritization Prioritization of problem statements is centered on significance of occupations as highlighted by Abby. These occupational concerns, goals, and desired outcomes were gathered during the initial evaluation process. The first problem statement, which is related to meal preparation, would allow Abby to reestablish her primary role as mother and would address her hope to return to cooking meals for her family. Next, Abby emphasized the desire to eliminate the burden on her husband in regards to assistance with ADLs. The second problem statement would address Abbys hope to regain independence in a specific ADL. Overall, the problem statements are aimed to address Abbys desires to reestablish independence and to increase participation in meaningful activities.

OCCUPATIONAL PROFILE AND ANALYSIS References

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American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and Process (2nd ed.). Baltimore, MD: AOTA Press.