Date implemented:
Client’s Initials and Age: N.G. 90 years
Diagnosis and any Precautions: (1) MVA accident resulted in a distal tibia fracture of the RLE. RLE NWB.
Goal/s being addressed: (1) Pt will complete toileting with stand by assist within 1-8 sessions. & Pt will complete supine to stand/stand to
supine transfers with supervision.
Specific Objectives for this
Intervention Activities
(5)
Build rapport with Pt (i.e., how
has your day/week been, what
is your pain today, how has PT
been going, etc.).
Educate the Pt. on NWB
precautions for her RLE and
identify situations in which she
may need to adapt her transfer
or activity pattern in order to
complete the occupation while
adhering to said precautions.
 Example: when
standing, the Pt should
bring her LLE to the
center and back so that
she can adequately
balance and WB
through it while sliding
the RLE forward
This should also serve the
purpose of identifying adaptive
equipment, i.e., a hip kit.
This should be conducted within
the first 5-10 minutes of the
session.
This should be completed to
ensure Pt safety throughout the
remainder of the session, as
well as throughout the
Activity Demands (setting,
activity (list 2-3)
(5)
1. Pt will be able to
verbalize the WB
precautions for her RLE.
2. Pt will be able to walk
through (verbally) how to
transfer from sit to stand
while adhering to said
precautions.
3. Pt will be able to identify
one occupation/activity
that the precautions may
post a problem in.
To grade up: Bring along a hip kit
and explain more in depth how
Time allotted for session: 30 -45 minutes
8/19/21
Modifications (provided during the
materials, and social
activity and planned for next
requirements)
session) (5)
(5)
 Pt must be alert and Going over the WB precautions and
oriented x4. instructions for transfers with the Pt
 Therapist must utilize went well, as she had previously been
TUOS strategies to ensure given a sheet to refer to by the nursing
understanding of material staff. She also had components of the
and open the floor for hip kit already, so going over the AE
questions in an without having it in hand was fairly
approachable manner. easy. It did not go well when trying to
o Pt inquires (seeks have her provide examples of unsafe
support or situations/activities or ones in which
clarification) where the precautions would be a problem.
applicable. Next time it may be beneficial to have
o Therapist must be a drawing or cards available that the
able to clarify when client can say “yes this will be affected
presented with by WB precautions” or “no… “. This
concerns/question section could have also been more
s by Pt. motivating to the client had it involved
 Other demands for both movement and not been strictly a
parties: produce speech conversation at first. I could have also
(fluently), gesticulate, used personal examples for the safety
proper non-verbal component.
communication,
conversational routine
established, etc..
 Should take place while
the Pt is in the
received/comfortable
position.
remainder of her hospital stay.
The WB precautions will also be
important to follow upon
discharge. The addition of
having the Pt come up with
activities that may be unsafe or
need adjustment provides an
opportunity for transfer of
learning and further solidifies
the material.
Instruct the Pt that we are going
to move from lying down, to
sitting in the chair beside the
bed. Instruct the Pt to perform
each of the following transfers,
ensuring the gait belt and
walker are being used and that
the RLE is following NWB
orders: supine to sit EOB, EOB
to stand, stand pivot to sit in a
chair. Provide verbal cues as
necessary to ensure
precautions are being met and
instructions on how to perform
said transfer are being followed.
Be sure to only inform the Pt of
the current transfer i.e., “okay
we are going to sit up” sit up,
then “now let’s stand up” stand,
etc..
Note for standing with
NWBRLE: bring the LLE to the
center and back, kick the RLE
out, place one hand on the
walker and the other on the
bedrail, rock for momentum and
stand, kicking the RLE forward
as this happens
this would work. Allow the Pt to
be hands on with the materials.
To grade down: Bring along a
printed document with the
precautions and example
situations for the Pt to follow along
with/refer to.
1. Pt will complete supine  Pt must be alert and
to sit EOB transition with oriented x4 with the ability
mod A. to verbalize questions
2. Pt will complete sit to and/or problem
stand transition with mod statements.
A and use of walker.  TUOS must be used to
3. Pt will complete stand determine pain presence in
pivot transfer from EOB absence of verbal remark.
to chair with mod A and  A walker, hospital bed, gait
use of walker. belt, and chair are needed.
 The room must provide
*all while adhering to NWBRLE adequate space for
orders performing the transfer(s).
To grade this up: Complete
additional transfers (x3 as
opposed to x2) or encourage less
A (min as opposed to mod) – to do
this, allow the pt. to “fail” once and
then encourage them to try again.
To grade this down: Allow longer
rest periods between each t/f and
only have the pt. perform them
one time. If t/f does not go well,
do not proceed to the second
activity, but instead keep doing t/f
until functional activity tolerance is
met.
Walking the pt. through the current
transfer with the appropriate steps
went well, as it was a continuous
reminder that she needed to be
aware/follow her WB precautions. The
short time period between transfers
(about a minute or two to make sure
the pt. was not dizzy and was ready to
proceed) did not go well. This pt. in
particular has a low functional activity
tolerance, so next time a specific point
should be made to allow the pt. to
catch her breath and pause for a
moment with light conversation before
continuing onto the next transfer. The
only thing that was changed during this
session was that we only did one of
each transfer. To better support the
client and get more effort, I think
asking her about her future goals and
attempting to tie those into the session
would result in greater effort. The
client was engaged, but only engaged
so far as a conversation and
participation – so there was room to
really be excited to participate. I think
using a platform walker as opposed to
a standard one would also be
beneficial for this client to aide in her
standing balance.
If time, repeat each transfer
twice with the exception of
supine to sit EOB.

This is expected to take 10-15

minutes.

This activity is considered to be

preparatory for the occupation-
based task, the completion of
toileting. Each aforementioned
transfer is used in the activity
when beginning in bed – as the
Pt often does in the hospital and
will be doing upon discharge.
This also provides an
opportunity to practice and
thereby solidify the WB
precautions of the RLE.

Using a gait belt and a walker,
help the Pt (if help is needed)
walk to the bathroom from the
chair she is sitting in a the end
of the preparatory activity
(transfer practice). Provide
verbal cues as needed for the
Pt to only WB through LLE and
BUE onto the walker, as well as
step-by-step instructions for
transfers if necessary. Provide
SBA (more if needed – given
weakness of BUE is it likely Pt
will need at least min A) while
ambulating from the chair to the
bathroom. Have the Pt use the
grab bar to lower herself to the
toilet and allow her to use it if
necessary. Allow the Pt to
choose to perform peri-care
while seated or standing
 Pt must be alert and
oriented x4, and able to
1. Pt will be able to verbalize any questions,
ambulate to the needs, and/or problem
bathroom using a walker statements.
with mod A.  TUOS and clinical
2. Pt will be able to transfer judgement must be used to
on and off toilet safely determine pain,
using a walker and/or endurance, and judge the
grab bars with mod A. amount of assist provided.
3. Pt will be able to  A walker, gait belt, and
complete peri-care with toilet with grab bars (in
mod A. hospital bathroom) is
**all while adhering to NWBRLE needed.
orders  The route from the chair to
the bathroom and within
the bathroom must allow a
comfortable amount of
space for the Pt and
walker.
The Pt was able to keep WB
precautions in mind throughout the
session, so it went well to have
reviewed them prior to this activity. It
was also helpful that the chair being
used in transfer had wheels on it
already. This became useful because
the “crutch” strategy of walking I had
planned for the Pt was not optimal
given her BUE weakness and fatigue
from the previous transfers. Since we
transferred into the chair from
EOB/stand, I was able to wheel her
into the bathroom and complete the
activity as the down-grade suggested.
To better support the client next time, I
think allowing a longer break between
session activities (thereby expanding
the time frame slightly), she may have
been more successful during
ambulation and transfers. The next
 (standing with use of grab bar), To grade up: Encourage mobility session should specifically focus on
and to then wash her hands at with min A as opposed to mod A, building endurance for such activities.
the sink and resume walking to or to work on functional activity
her preferred resting area (bed tolerance as well, instruct the pt. to
or chair). Use any extra time to walk all the way to the doorway of
discuss the Pts home bathroom the room, then into the bathroom,
set up and offer suggestions of for the activity, then back to bed.
a raised toilet seat and grab
bars if not already in place. To grade down: Wheel the Pt into
the bathroom using the chair and
This occupation-based activity perform a stand pivot transfer from
should take about 10-15 chair to toilet.
minutes to complete.

I chose this activity because it

was the main occupation my
FWE and I wanted to examine
prior to discharge, in order to
determine the next step in the
Pts rehab journey. The Pt was
using a bedpan and foley upon
initial eval but began to use a
bedside commode after a
conversation on advocacy.
Since all was moving along
smoothly with the bedside
commode, the next step was an
evaluation/intervention with the
actual toilet.

S/OT name: Taylor Stamper

Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)

Support:

Feasibility and efficacy of function focused care for orthopedic trauma patients.

“To overcome challenges associated with optimizing function and physical activity among hospitalized older adults we developed Function Focused
Care for Acute Care (FFC-AC). The purpose of this study was to test the feasibility and preliminary effectiveness of this intervention. We
hypothesized that hospitalized trauma patients exposed to FFC-AC would: (1) maintain or improve function, spend more time in physical activity and
have fewer adverse events between admission and discharge; and (2) maintain or improve function, have less fear of falling, fewer depressive
symptoms, less pain, be more physically resilient and be less likely to experience adverse events at one month post discharge compared to those
exposed to FFC-Education Only (EO). FFC-AC was implemented by a Research Function Focused Care Nurse who worked on the participating
units for 20 hours a week for 16 months to implement the three components of FFC-AC. The sample included 89 older orthopedic trauma patients
the majority of whom were female (N=59, 66%), white (N= 82, 92%) and not married (N=53, 59%). At discharge and/or 30 days post discharge
participants in the treatment site showed greater improvement in function, less fear of falling and better physical resilience when compared to those
in the FFC-EO site. Future research is needed to continue to work on engaging staff in function focused care approaches and optimizing the
hospital environment and policies to support nurses in this type of care approach.”

Resnick, B., Wells, C., Galik, E., Holtzman, L., Zhu, S., Gamertsfelder, E., ... & Boltz, M. (2016). Feasibility and efficacy of function focused care for
orthopedic trauma patients. Journal of trauma nursing: the official journal of the Society of Trauma Nurses, 23(3), 144.

Reasoning: The article above supports my intervention session because it covers the feasibility and efficacy of Function Focused Care for Acute
Care (FFC-AC). FFC-AC has 3 major components: education and training, environmental and policy assessment, and ongoing training and
motivation (Resnick et al., 2016). The first two components of this are covered within the first two activities of the session (education and practice of
transfers), while the third (ongoing training and motivation) is exhibited in the occupation-based (functional) activity of toileting. The study found that
FFC-AC was feasible and beneficial to patients despite limitations, as it worked to improve clinical outcomes through the basis of early mobility and
rehabilitation (Resnick et al., 2016). Prior research recognizes that early mobility contributes to less pain, risk of delirium and adverse events
(DVTs), UTIs, and pneumonia, and no increase in falls (Resnick et al., 2016). In sum, the early mobility with a functional focus works to prevent
functional decline, thereby decreasing LOS in an acute care setting, and return older adults to their baseline independence/mobility levels in a more
efficient manner. To re-iterate the early mobility factor, the session took place post-op day 5. Considering Nancy’s age, prior independence and
mobility levels (independent & slow but functional), method of injury (trauma), and goals (to return to independent living as quickly as possible), this
intervention session aimed at early mobilization with a functional focus (toileting) was a prime fit for her. Aside from personal/patient characteristics,
FFC-AC (and therefore the intervention session) aligns with OT as it uses occupations – function – to motivate and rehabilitate patients, while
considering their environment, the task, and individual abilities (physical and psychological), while also working to prevent harm (adverse medical
occurrences like DVTS, etc.).

Total: 27 points