By Jack Rolfe, PT, MNA, CHC, RAC-CT, Senior Compliance Partner for Utah
Jack Rolfe is also the Founder and CEO of the School of Life Foundation (http://schooloflifefoundation.org/index.html). This 501(c)3 nonprofit organization has a mission to increase high school graduation rates. The following article was published in the Saint George Health & Wellness Magazine.

The phrase “my cup runneth over” is a biblical reference to receiving an abundance of blessings in life. I believe one of the greatest blessings we can experience is peace. As my physical body grows older and my hair turns a little whiter, my mind seems to ponder more deeply on all that I have learned. Recently, I spent time pondering the following question: How can we obtain true, ongoing peace in our lives? I would say this has been on my mind due to all of the current commotion in the world. Things are unsettled politically and economically. We hear and read about natural disasters, diseases, failed family relationships, and much more. At no other time in human existence has the world been more advanced in technology, knowledge, and resources, yet we appear to be at a low level with the virtue of peace.

During my reflection on this subject, I determined that the way to spell peace is KUP. For me, this acronym is defined as follows:
K = Kindness
U = Understanding
P = Patience

For the past few weeks, my aim has been to apply KUP in my life more each day. I make a conscious effort to apply these steps in all that I do. When I slip up, I reset and try even harder. Guess what? It has been working! As I apply kindness, understanding, and patience each day, my life is filled with an abundance of peace. Does the strife in the world go away? No, it does not. Does the world around me exude more calmness, tranquility, and order? Yes, it does! Thus, I conclude that increased peace comes into the world through my efforts.

Let’s briefly examine why this happens. First, let’s look at kindness. Did you know that performing acts of kindness lowers your blood pressure, relieves depression, boosts self-esteem, and reduces social anxiety by physically changing the brain? Kindness slows the ageing process by reducing wrinkles and promoting muscle regeneration. As if that wasn’t enough, kindness increases the chances of our relationships lasting, cures stress, and makes our lives happier overall. All this evidence is found in the research of former chemist David Hamilton. In his book The Five Side Effects of Kindness, Hamilton shares the scientifically proven health benefits of kindness and how these benefits can transform your life.

Next is understanding. In his book 7 Habits of Highly Successful People, Stephen Covey explains the benefits of habit #5: “First seek to understand, then to be understood.” According to Covey, as we apply this principle in our lives, we gain true insight into the lives of others and into the circumstances that surround us. Our actions show others that we care. Thus, we build synergy and cause others to desire to understand us.

The final piece of the equation is patience. Numerous articles point to the fact that exercising patience in our lives brings about better mental and physical health, allows us to make better decisions, helps us develop compassion, and teaches us to appreciate the process of growth.

Each one of us may discover that our path to peace through kindness, understanding, and patience is achieved differently. That is okay! The key is to start down the path. So, I invite you to step back and ask yourself, “How full is my KUP?”

“Peace is not absence of conflict, it is the ability to handle conflict by peaceful means.” – Ronald Reagan

By Shelby Donahoo, M.S., OTR/L, Therapy Resource – Bandera
We all experience day-to-day (or minute-to-minute!) changes in staffing these days. Pueblo Springs in Tucson, Arizona, found themselves suddenly without a wound nurse for an indefinite time due to illness. With nursing managers working the floor, there was no one to cover this critical task.

So, DOR Josie Gorman, PT, stepped up and volunteered physical therapy to take over most of the wound care program. DNS Paulina Kareko, Josie, and ED Neil Cullen all met to discuss this as a possibility.
The team reached out to Therapy and Clinical Resources, who consulted together to determine if this was viable and considered all options, with the following questions and answers:

• Is PT qualified for this task? Yes, as verified through licensure, state practice act scope of practice, Ensign job description. Josie had also completed wound care certification training.
• How will competency be determined? With no wound care Skills Checklist in rehab, PT staff involved in wound care will complete nursing Skills Checklist, to be signed off by nursing leadership.
• What parts of the wound program will rehab take on? Dressing changes, orders, weekly rounds with MD (via telehealth at this time); nursing to continue admissions assessments, skin checks, etc.
• Can we add billable therapy wound care services to the POC? Yes, through four avenues: a) Use of Physical Agent Modalities for wound healing per Medicare guidelines for qualifying wounds (training provided); b) Adding pain management standardized assessment and goals as appropriate; c) Including functional goals in the POC pertaining to wounds: positioning, training off loading, bed mobility, therapeutic exercise to increase circulation; d) providing caregiver education and training in regard to above goals.
• What about documentation? Rehab billable tasks to remain in Optima; for non-billable tasks (weekly rounds, documentation, dressing changes), PT to document in PCC following training from nursing.
• What about cost allocation? Therapy non-billable wound care tasks to be allocated to nursing cost center.
  What about the exit strategy? PT to relinquish tasks per consistent availability of nursing management and return of wound nurse; IDT discussion bi-weekly.

Hats off to the Pueblo team for thinking out of the box and working together to support patient care! Thanks to awesome Clinical Resources Sheila Summey and Julie Uychiat for collaborating to support nursing/therapy teamwork! And thanks to Pit Crew for input and suggestions.

p.s. Yesterday, a wound-care doc reported progress on a chronic ulcer that’s been plateaued for some time, with patient expressing excitement about this gain. Estim for wounds really does work, y’all, with lots of evidence to support. ☺

By Ryan Porritt, OT, Orem Rehabilitation & Nursing, Orem, UT

Occupational Therapy (OT) used non-pharmaceutical mindfulness-based interventions (HeartMath and Acceptance and Commitment Therapy) to support a patient while the physician reduced anxiety medication that she had been on for years. The patient has several mental health diagnoses, including bipolar disorder, PTSD, generalized anxiety disorder contributing to frequent panic attacks and high levels of anxiety. Her independence and quality of life is further complicated by several physical comorbidities that exacerbate the functional impact of her anxiety. She has a history of significant trauma as measured by scoring a 9/10 on the Adverse Childhood Experience scales.

The following are the step-down dosages of clonazepam:
Staring at 1 mg 3x daily
Reduced to 0.5 mg 3x daily on Jan. 21, 2020
Reduced again to 0.5 every 12 hours on Feb. 1, 2020, to present

The OT trained the patient in several meditations to reduce the emotional struggle resulting from her anxiety in order to increase participation in value-based activities. With assistance, the patient identified three value-based activities: writing poems, quilting and facilitating a weekly bible study group for her religious congregation. After 30 years of not writing poetry, she is able to express her pain, anxiety and other emotions through regular poetry writing. She has assumed a leadership position to prepare and facilitate weekly bible study groups, and she is currently being trained to lead a resident-run quilting group in collaboration with Recreation Therapy and the Therapy Department.

While the patient still faces daily challenges resulting from anxiety, she reports the duration and frequency of panic attacks have reduced and that “I am not struggling with my emotions as much anymore.” With less medication, she reports both increased quality of life and increased participation in value-based activities. While significant progress has been noted, she will require continued skilled OT under a maintenance plan due to the complexities of her physical and mental health. As illustrated by this example, skilled therapists are in an ideal position to have a significant impact on both function and quality of life while assisting physicians to reduce medications.