A Visit By The EMT’s.

Today the other interns and I were given three tasks to complete (Kari was not there). The first was to check on the resident with down syndrome and dementia in her room and to get her weight. This one I did. The second was to gather the “Walking Program” data and the third was to help with Henry’s doctoral thesis in the record room. I also helped with the third. I was the first intern to arrive at The Center and I assumed the other interns wouldn’t be in until later. I decided to go the the resident hall and collect the “Walking Program” data as I thought it was still early enough to catch the ladies before they went to work and I figured I could kill two birds with one stone by getting their data and getting the weight of the aforementioned resident. Unfortunately, the ladies had already left by the time I got there, so I said hello to the nurses and asked Maria (one of the nurses) if the resident had made it down to get weighed. She had not. So I borrowed the key and went and knocked on her door. Of course, she was laying in bed like always. I asked if she had eaten breakfast, no response. I told her that she needed to get weighed for the day and told her I wasn’t leaving until that happened. Eventually, Maria came down the hall and tried to coax her out of bed, but that didn’t work. I told Maria that the resident seemed to be breathing heavy. So Maria went and got her blood pressure monitor, oxygen monitor, and the resident’s medication. The resident immediately propped up in bed to take her meds and to be monitored. Maria noted that her pulse was low and then discovered that her oxygen level was below 90 percent. Maria tested her several times to see if she could get a different reading, the machine either did not read or read low. Maria then went to get another nurse. I told the resident that if she went down to the end of the hallway and got weighed that I would brush her hair, but only if she walked down to the end. She could not be weighed in the room and then get her hair brushed. Both nurses then returned and together we all three coaxed the resident out of bed and down the hall way to get weighed. We discovered she had gained a pound since the previous week. Maria then measured her oxygen again and it was still reporting low. As protocol, no one can remain at the Center who’s oxygen is less than 90. Maria called the residents brother and then informed the staff down stairs. I returned with the resident to her room to wait for the ambulance. The resident sat down on the edge of her bed and did not cover back up. I talked to her for a bit before remembering that I had promised I would brush her hair. I then asked if I could brush her hair, no response. I grabbed the comb from her nightstand and she did not stop me. I then brushed her hair. I had also promised her that I would put barrettes in. I asked if she knew where they were, no response. So I searched myself but could not find them. Eventually the nurses, the EMT’s and two other staff members returned to the room. They measured the residents blood pressure and oxygen levels, everything appeared normal and at 100 percent. The brother was then called and asked if we should take her. He decided against it. The EMT’s asked the resident if she wanted to go, but she gave no response. To my surprise though, the resident willingly allowed the EMT to measure her vitals without any resistance, which goes against her typical stubborn self! One of the staff members suggested that the resident thought the EMT was cute and she began to smile. After that she returned to her normal self and became very talkative. She even had a staff member pull out a photo from her drawer so we could all look at it. It appears that the resident responds to cute males, photos/cameras, and hair brushing. All good things to know!

Although the experience was scary, I definitely learned a lot from it.

After all of that I then went downstairs to work on the thesis in the record room. We’re almost done with it now!

Life Survey’s And Chatting.

Today I helped Henry with his dissertation. We scanned several residents life survey’s. The other interns and I got an entire drawer completed! Henry and I discussed some flaws with the survey (why the existed, potential explanations, and how to correct them when I’m a grad student). We also talked about my new minor in Quantitate Social Sciences. Afterwards, I visited with several residents seeing how their day was. I reminded a few of the ladies from the “walking program” to do aerobic steps and reminded them of how to accomplish that. I also talked with one of the residents I frequently visit. She was very talkative today, she even asked me what my name was, something she hasn’t had the opportunity to do before. It appears as if her lower dose of medication is working so far.

Alphabetized Data Sheets and Aerobic Steps.

Today I collected data again for the “Walking Program”. Kari recently began having the interns collect aerobic steps as well as we will be measuring that in addition to the physical steps each person takes a day (as counted by the pedometer). Today I collected the aerobic steps and “normal” steps from all four ladies who are participating.

During this time, I reminded one particular resident (from Wednesday the 7th) what an aerobic step meant and how to accomplish this. I had her repeat back the task and defintion as she had not remembered what it was upon first inquiry. Later on I saw her again and reminded her.

After this I paid a quick visit to a particular resident that I’ve mentioned several times (an older female with down syndrome and dementia). I visited her after her room-mate informed me that she hadn’t bathed in several days, fighting with staff, and still not leaving the room. Today she had a doctor’s appointment so it was pertinent that she got up and got dressed and ready for the day. I stopped by the room for approximately five minutes and tried to coax her out of bed by stating that she had to follow the rules and see the doctor. I also tried coaxing her by saying that I knew her mother would not be happy if she did not get up and go to the doctor. When I left her hair was combed and she was supposed to be getting dressed for the day.

After that I went downstairs to the office and filed alphabetically data sheets from December 2011-Feburary 2012.

Aerobic Steps and Backwards Chaining.

First thing I did today was help the doctoral graduate student, Henry, out with his thesis. We scanned three different residents quality of life survey’s from 2006-2009. This took approximately an hour to complete.

Afterwards, I went upstairs and assisted Kari with making a video for her presentation at the University of Houston-Clear Lake. We performed a backwards chaining task of making coffee. The steps included in this were take the cup out of the cupboard, get the carafe, pour the coffee, put the carafe back. My reward was drinking the coffee.

What is backward chaining? Backward chaining is a chaning procedure that begins with the last element in the chain and proceeds to the first element. What does this mean exactly? Well, first, the person teaching the task completes all but the last task and then uses what ever level prompting the person learning can succeed at to complete the last task by him/herself (as defined by BBB Autism Support Network) . When this is completed a number of times successfully, the person teaching then goes through all but the last two steps and again prompts for the next step in the chain. This is done until the person has successfully completed the entire task on their own.

After this I then went an taught one of the residents who is in the “Walking Program” what an aerobic step is. The first thing we did was go up to her room where I handed her tokens that Kari owed her. I then showed her a new goal sign that stated “1,000 Aerobic Steps”. This individual is to walk 1,000 aerobic steps in a day. I had her pick a spot where she would see the sign and then explained aerobic steps to her. I stated that 1,000 may sound like a lot but that it’s easy to reach, all she has to do is walk as fast as she can for ten minutes. I told her this could be done in the hallway at night or on her way to the workshop. I then had her practice walking as fast as she could in the hall way once down and then once back up and then returning to her door. After that I had her repeat back to me what an aerobic step was. I also explained to her that her pedometer would read 0 for the time being until she had accomplished her goal. I told her to not feel sad about the number but just to work on walking as fast as she could. We then returned to the workshop. While on the way there I had her repeat the definition one more time and asked her about the number 0 (if she is supposed to feel sad about it). She successfully repeated the definition back and that she was not supposed to feel bad about the number.

Data Sheets, CIRCLES, and Alzheimer’s.

As today is the second day of a new month I collected data sheets! I also put two new data sheets in for one resident who was missing data sheets for March, and one resident who just started a BIP.

Kari introduced me to CIRCLES, a “program [that] teaches social distance and levels of intimacy through the use of six colour coded concentric circles”. Although the curriculum is a little childish for our adults, it still gives some good points and a good leaping off point. A few of the residents are still a little hazy on how to act appropriately, especially with a new person, like myself. Kari gave me a few pointers on one particular resident who likes to hug me and tell me she loves me almost every time she sees me.

I also gathered data from pedometers. I got the four participants full step count from the day before, and their calories, distance, and aerobic steps from the past seven days. Aerobic steps was very interesting as they all had zeros for almost every day, only two participants had something other than a zero.

Kari also gave me an article to read (listed under the page Articles [coming soon!]).

I visited two residents that I check on every day. One had made it to the classroom while the other had not left her room. The latter later informed Rosemary that I had placed the visual prompt (reminder to go to the classroom) in her room and she did not like me. She would not take the paper from the classroom (the slip she needed to go to the workshop, a preferred place).

After Kari left, Dr. Grossett let me make copies of a book and pamphlet on Alzheimer’s (these are listed under the page Articles [coming soon!]).

I also made copies of math sheets for the teachers so that when the two aforementioned residents made it to the classroom they wouldn’t be bored.

Getting Her To The Classroom.

The goal for today was to get one particular resident who has down syndrome, depression, and possible dementia out of her room and into the classroom. Of course, she was locked out of the room again. I tried initiating conversation with her. I asked if she had visited the nurse yet to get medicine, no reply. I asked if she had plans on going to the classroom, no reply. I talked about how fun the classroom is and the latch hook rug that is waiting for her. I asked if she went at all last week, no reply. I told her I liked her hair cut, she replied thank you. I started complimenting other things while still trying to convince her to at least go take her medication or go to the class room with me. I even offered to hold her hand, she refused. Compliments seemed to work though, she would start talking to me after I paid a compliment. I tried talking to her about running because she had a medal in her room from Special Olympics, no reply. She did eventually compliment my glasses and my hair which led to brief conversations about those. Though in the end she did refuse to go anywhere and eventually told me to leave, so I did (so as to not upset her). I also talked with several residents today and discovered the reason for one resident behavior in regards to rapid eye movement. Apparently, she is legally blind due to atrophy. This particular resident only has peripheral vision. Hence, why in the lobby she did not see me but when I approached her (coming from the side) she did notice me. I also ran into another resident who is famous for going through boyfriends. She introduced me to her new boyfriend. We then had a conversation. The female resident interrupted our conversation by hugging me, stating that she loved me, and then kissing my shoulder. I immediately stepped back and said that, that behavior was inappropriate. She apologized. Her boyfriend and I continued talking, she then grabbed his hand and kissed it and asked if that was better. I redirected her by saying that, that kind of behavior was meant to be done in private as this resident has a record of touching herself and others inappropriately. She apologized and then they went to the workshop. When Kari arrived, we discussed her powerpoint that is due for her speaker series lecture. We discussed behavioral chaining and task analysis. Afterward, she discussed a lecture from TXABA on dementia.

Quarterly Reports.

Today, I assisted Kari by alphabetizing quarterly reports for the farm. After they were alphabetized, we entered their data into their charts.

The Business Side.

Kari showed me a video of a man with autism who can draw very realistic, almost photographic in nature, pictures. This led to a discussion of people first language. As defined by the TCDD, “Like other minorities, the disability community has developed preferred terminology — People First Language. More than a fad or political correctness, People First Language is an objective way of acknowledging, communicating and reporting on disabilities. It eliminates generalizations, assumptions and stereotypes by focusing on the person rather than the disability.

As the term implies, People First Language refers to the individual first and the disability second. It’s the difference in saying the autistic and a child with autism. (See the following.) While some people may not use preferred terminology, it’s important you don’t repeat negative terms that stereotype, devalue or discriminate, just as you’d avoid racial slurs and say women instead of gals.”

After this Kari showed me her C.V. so I could get a general idea of what one should look like. Then, we went over the paper work for quarterly reports. Lastly, I shredded papers. Why am I typing about shredding papers, you may ask? Although it is a very mundane task, it’s still important and still a task I completed (I like to note all tasks).

 

Karaoke: The Bright Side.

Today I went to the classroom, which was held in the auditorium. Toady was a special treat for the residents who attend class; karaoke! A fellow intern and I chatted with a few residents. One resident, who I and other interns have spent a lot of time with, was very happy to see me and smiled when she saw me. She of course, wanted to sit next to us. She is a very sweet resident and I enjoy spending time with her. The best part, was when we were watching the teacher sing and dance to a very funny rap song. I began laughing and the resident, who had been watching me, began laughing just as hard as she could. Prior to this, I had never once seen her laugh.

Upon returning to Kari’s office, I was asked to serve as an observer/secondary reporter for her “walking program” thesis. I confirmed to what level prompting the resident required when going through the process of putting on her pedometer and daily routine that involved operating/wearing the pedometer.

After this, a meeting was held with a new resident for a trial period interview. The interview as very short. Basically the Center just wanted to know what medications he was currently on, his diagnosis, and if he was violent/aggressive. After that, he was assisted with bringing his things to his new room.

 

Naturalistic Observation.

Today, Kari was unable to make it to the Center because of her fellowship. So instead, I assisted another graduate student named Karen. Karen had me do my first naturalistic observation of a resident while he was at work. Karen is working on changing a target behavior, in this case, non-compliance. This particular resident had a lot of non-compliance complaints from his social worker while at work. Karen thought the resident was potentially bored, but was unsure. Karen had done one observation on him, but needed the assistance of someone else he didn’t know to watch him so that he would “act normal”. The observation took place on a Friday when the residents were not assigned to do any contract work. The observation lasted an hour and I noted five or so instances of the resident leaving his work space and wandering to talk to someone else. There was one instance of not listening to his social worker tell him to sit down, however, I noted, that the social worker had been across the room when she informed the resident to sit. The workshop is a rather large space and very noisy, even when there is no work to be done. I believe the resident did not hear the social worker the first time due to the noise and distance between the social worker and the resident. I also noted one period of extended absence where I was unsure of where he went to. This particular resident is known for wondering off and not coming back unless fetched by his social worker. I informed Karen of this, but also said it was my belief that he had gone to the restroom as it was a period of about five to ten minutes that he was gone. Karen agreed with this. The most important information I gathered from the observation was almost at the end of the hour when the resident stated “I’m bored” to his friends, thus affirming Karen’s belief that the resident’s non-compliance was solely out of boredom, which unfortunately is not a behavior we can change.

After the observation and discussion of results, Karen and I discussed the lack of mental health care for contract workers (who develop PTSD symptoms) in Iraq and Afghanistan during the war. The reason this was brought up was because my dad was a contract worker during the war in Baghdad and in Afghanistan and now complains about flash backs and lack of sleep among other things. We found a clinic in California who stated they provided mental health care specifically for contract workers. We also read up on some court cases in various states. One judge actually stated it was not the responsibility of the health insurance provider to provide services for contract workers as “they were never in any real danger, actual or perceived”. Although comments like this infuriate me, I did find the entire research process very informative.