OTs can blog too!😃

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Week #10!!!

Everything has to come to an end, sometime - L, Frank Baum.

And the conclusion of this blog has finally embarked upon us!

This week’s topic is: Did your client make progress. If yes, how do you know. If No, why do you think they did not. How did your client progress make you feel?

Yes and no. Most of the clients I had seen did make progress in terms of Occupational therapy, this is referring to the clients who have been discharged and therapy ran after medical intervention.

A description of function posed is that “[it] should be defined and measured by a client’s performance of life roles and the meaningful activities that are part of those roles”, Doucet & Gutman(2013). Function, the restoration of it despite impairment, is the ultimate aim of OT. It is what encompasses and provides validation for the need for our services.

In the Easter break when I was filling my missed hours, my very 1st client had stopped me in the corridor and had made amazing improvement. She is mobile and has returned to her previous tasks as a house mum and stated that the she didn’t really know how much relevance and help the tasks we did as discharge planning would have when she returned home and that she was grateful that she had that intervention to make the process of adapting while her femur fracture healed.

My midterm client had made progress in miniature steps, quite gradual. From the very 1st day that we had seen him just laying in bed to enabling him to improve his bed mobility, functional mobility with a walking frame and a few aspects of self-care and eventhough my program could not be completed with him due to an early discharge taken by the doctors, he was highly motivated to continue with rehab at home.

Interim clients that I had seen for short periods both had areas of progress or regress or where discharged SOON AFTER SURGERY AND I COULD NOT SEE THEM BEFORE DISCHARGE!

Regress however is purely due to medical complications that can’t be controlled by function maintenance regimes which I try to give to my clients such as pain management, passive mobilisation, emotional support, indirect intervention during hospital stay or encouraging forms of function regardless of how minimal.

It’s very possible that a client I had on this block had passed on due to multiple CVAs, respiratory difficulty and an increased disorientation overtime (along with aging).

Both progress and regress was mainly determined through observation of a client during activities, their amount of assistance required and by redoing assessment.

This was before this blog though and I found an amazing article by Salisbury, K. titled: 4 OT Outcome Measures You Didn’t Learn in School (check it out!). These self-report treatment effectiveness measures will definitely be put to use in determining a client’s progression.

One that I vaguely remember being mentioned in class though is the Canadian Occupational Performance Measure (COPM) – “an evidence-based outcome measure designed to capture a client’s self-perception of performance in everyday living, overtime”, COPM(1991) however an article by Donnelly, O’Neill, Bauer and Letts draws the conclusion that “The COPM is an invaluable tool to guide initial assessments and offer an occupation focused lens. Given the lifespan approach and an emphasis on screening and assessment, the challenge was finding the opportunity for readministration” which is quite realistic when considering the high turnover rate in most acute venues however, this is a tool designed by OTs for OTs🤐.

All in all, that has been the journey that I’ve travelled on this block and blog, there’s still 2 more weeks for the block, but I’m glad that the end is insight. Been some ups and many downs, but alas…the end has come-toodles!🌺✨❤️🐣

References

Donnelly, C., O’Neill, C., Bauer, M., & Letts, L. (2017). Canadian Occupational Performance Measure (COPM) in primary care: A profile of practice. American Journal of Occupational Therapy, 71, 7106265010. https://doi.org/ 10.5014/ajot.2017.020008

Doucet, B. M., Gutman, A. S. (2013). Quantifying Function: The Rest of the Measurement Story. American Journal of Occupational Therapy, 67(1).

Salisbury, K. (2017). Covalent Careers. 4 OT Outcome Measures You Didn’t Learn in School. Retrieved from: https://covalentcareers.com/resources/4-ot-outcome-measures-didnt-learn-school/?mid=ngot_readers

http://www.thecopm.ca

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Week #9

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Hi readers! So, this blog is ridiculously late, reason being the current work schedule is just as ridiculous and (I don’t know) I have mixed feelings on the topic. Which brings me to my introduction of the topic for this week: Do you feel you have grown as an OT? Explain (insert dramatic music) Have I? Haven’t I? Read on to find out…

The mixed thoughts surrounding this topic I suppose is because the professional me and personal me are at each other’s necks with very contradicting stand-points. So, to settle the playing field I’ve found an article by Chipchase, et al (2012) which identifies 6 themes upon which to measure the student’s level of preparedness which is considered to be useful in determining my level of growth. The themes highlighted are knowledge & understanding, willingness, professionalism, communication & interaction, personal attributes and skills.

From both standpoints, one cannot say that they have aced the knowledge and understanding area. According to Rodger et al, the purpose of an occupational therapy education programme is to “... produce competent generalists ...” with “... rudimentary skills, fundamental knowledge and attitudes ...” while providing those “... experiences considered crucial in preparation for beginning to practice – cited by Holland, Middleton & Uys (2012). In this field I have accepted that from time to time we all have to go back to basics, read up on the knowledge we lack, and continually build on the veryyy basic theoretical foundation we are given in lectures as cases differ from person to person. In this instance I believe I have grown by understanding that I cannot know everything, but I take measures to fill the gaps of knowledge.

Taking measures bring us to the next point of willingness where I’ve had to be professional and accept criticism knowing that it is for the enhancement of my own education and show a willingness to help, wait not help, enable a client to the best of my ability. Not to the best of Superman’s ability. My own.

Why I’m emphasising my own ability is because as I have highlighted on many occasions in this blog, this has been a taxing block for me. Over the past for weeks I have had to delve into my personal attributes and develop an acceptance, in other words acknowledging some gaps such as poor response to the challenges of prac leading to anxiety, not being as good as I was academically or stressing that I’m a good enough OT since I fade in comparison to the attributes portrayed by others. Identifying these helped me towards this concluding part of the block as I’ve learnt to show who I really am to my peers, supervisor and clients and it turns out that my client (the one who matters most in this whole situation) appreciates and values this and would choose this over other therapists. This developed a belief in my capacity as an OT, flaws and all, and helped me see that who I am and what I have to offer is enough, but I can always grow to enhance this. And wow! Can I just mention my therapeutic face staying intact with all these weird smells, awful sights of unmentionable places – and I’ve had predominantly male clients – lol, I’ve just realised that I’ve come a long way with that aspect of me.

One thing that has definitely been enhanced is my interaction skills. From being a shy almost monosyllabic high schooler, OT and especially on this block I have grown and find ease with interacting and communicating with others. Be it with a client who has deep psychosocial issues (one of my new clients who is Muslim was admitted last week and on the same day I husband experienced, heart palpitations and died the next morning. As a Muslim woman, she could not attend the burial [Wait! Whoa, therapeutic face point again, this was an intense trauma instance and I did not cry… I didn’t even cry on my #goingthroughthemost days!] and was also stuck in hospital so she could not talk to anyone to comfort her and she broke down in front of me) to everyday interactions with clients, porters, cleaning staff or other support staff at hospital for e.g. when we needed paint brushes or a screw driver along with clinicians and my supervisor. Nowadays, I find that I can talk a lot.

And last but not least, professionalism and skills. These have definitely improved as now I can actually identify the difference between treatment and assessment. I’ve become quite adaptable since I’ve had quite a few clients who are severely impacted by pain. I remember my 2nd client who required a THR surgery, when she complained about pain, I’d say okay, its fine and go to my supervisor and say I was unsuccessful but now I am able to adapt the session according to the client’s abilities and add therapeutic elements such as pain management or education to guide the client. I still lack skills in time management, and I have some delay in submissions but that has definitely improved and well I did have an issue with my email before midterms, but this point may be seen as unprofessional. However, realising that speaks to my observational skills as a professional – so that is good!

Having touched on all 6 themes, I’m sure you can now understand why the argument existed because there is now pronounced growth within this block but there is definitely growth and also grey areas… okay who am I fooling… there a dark pitfall areas that need some work. But, it’s a within the process of growth.

References

Chipchase et al. BMC Medical Education 2012, 12:112 http://www.biomedcentral.com/1472-6920/12/112

Holland, K., Middleton, L., Uys, L. (2012). South African journal of occupational therapy, 42(3), p.19.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527360/

https://mattcoaty.com/2011/07/05/student-growth/

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Week #8

Week eight!!! Finally, the last week until the supposed holiday (I say this as we’d have to work on countless assignments and study for a test – by the way I wrote a test today and I have no idea how that went, it felt like 50/50 gamble throughout the paper - as well so…resting is definitely sealing your own death note!) Okay, so back to all things prac related. This week outlined for us is to: Reflect on the multidisciplinary team and teamwork. Yayyy! How fun (not!) forgive my sarcasm. I really do understand the purpose of this blog; however, this blogging venture has not turned out to be what I hoped for. It is also excruciatingly painful to have to post after a long day of prac on topics which we have not thought of ourselves for example; OT Interventions that can improve a client’s insight into their diagnosis and treatment plan as well as rights to improve outcomes in therapy or why can’t I discuss with my client a particular topic and see how intervention is actually helping them? But, alas, such is the fate that we have been given so let us get on with it.

Let us begin by deciphering what a multidisciplinary team (hereafter referred to as MDT) approach is. Stonehouse (2014) states in an article (with reference to Chapelhow et al (2005)) that the multidisciplinary team ‘brings cross-discipline expertise to patients in a coordinated and collaborative way’. In other words, the MDT is a “group” of health professionals within a hospital that serve a common purpose – to treat and provide sufficient care and service to the health care user (HCU) – however doing so independent of the other members but ensuring tasks align with the common purpose.

The hospital which I am currently at has adapted such an approach as this is most efficient and makes use of the hospital’s resources (on a large scale, if the gloves could talk, I’m sure they’d tell a different story) and manpower sparingly. It’s implementation however I do believe requires some work though.

Since an equal team approach is not used, the doctor is able to make decisions on whether a client is to be discharged. In the 8 weeks that I have been here, only 1 doctor has considered my opinion on whether a client can be safely discharged, that too it was only after I had to prove myself over the physiotherapist (whose opinion he wished he most). In this instance, lack of communication can lead to poorly informed decisions which does not take heed of the knowledge of each health professional in both the medical and rehabilitation team could pose a threat to the health and safety of an HCU. Furthermore, readmissions are higher (as we have already seen with one of my colleagues’ clients). This communication gap along with lack of awareness for other members’ roles and responsibilities has also been identified by Borrill (1999). Not only has he (Borrill (1999)) seen a lack of communication, but he has stated that differences in jargon and lack of transparency has led to much confusion and unsuccess within an MDT.

OT requires a lot of teamwork and groupwork. My colleagues and I have been allocated a group project to refurbish the OT paediatrics room and we each know our strengths and weaknesses and do individual tasks that would contribute to this project beneficially. If the MDT could collaboratively plan once a patient arrives all the wrinkles and flaws which exist in the current system will be ironed out. I believe the greatest mountain to be overcome is the fact that not all members of the MDT treat the client holistically and as a member of the MDT which makes compliance do treatment regimes due to a number of factors be it a lack of mental capacity to understand it, other social issue affecting health or not knowing how or why certain treatments are to be administered as the patient is spoken of amongst ( sometimes they’re even absent in discussions) the professionals and not included within the didactic. In conclusion, as Stonehouse(2014) states, “there are a number of barriers that may prevent multidisciplinary teams from being successful. However, with commitment, mutual respect and awareness of every one’s unique and individual roles and skills, these barriers will be weakened and, it is to be hoped, removed altogether. Only through successful MDTs will the patients’ complex health and social care needs be met, and quality services delivered.”

After all health is not merely the absence of disease or infirmity (WHO, 1946), by working as a team and considering all aspects of the client, within the hospital context and resources with consideration for everyone’s input – ideal outcomes would be achieved.

References

Stonehouse, D. (2014). Support workers: key members of the multidisciplinary team. British Journal of healthcare assistants, 10(7), 512-514.

Chapelhow C, Crouch S, Fisher M, Walsh A (2005) Uncovering Skills For Practice: Foundations In Nursing And Health Care. Nelson Thornes, Cheltenham

Borrill C (1999) Teamworking Guide For Primary Healthcare. Health Development Agency. www.nice.org.uk/niceMedia/documents/teamworking_guide.pdf (accessed May 10, 2018)

World health organisation (1946). Definition of health. Retrieved from, https://www.google.com/amp/s/hhmslibraryteam.wordpress.com/2016/03/03/who-definition-of-health-apa-style/amp/.

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Week #7

Topic: How have I put clinical reasoning into practice?

We are well into the second half of our physical fieldwork block and now that I look back, I cannot help but wonder where all the time has flown to.

Yes, every week of prac and campus that has gone by has been gruelling – physically, emotionally and above all mentally but now as I look back on time and read through my own reflections it seems to have all gone past so fast and development both as an individual and as a student therapist has been just as fast paced.

Moving from mere assessment of clients, to treatment has been quite intense but I have been able to see how one’s mindset changes over time. How meeting a client shifts from just conducting an interview and getting to know their likes and interests to including that but also identifying the client’s strengths and key areas to work on, screening their ability in ADLs, developing aims and rationales for treatment in your head as you make observations and having OMG moments when you see patterns that you were told about in class but could not visualize until you had seen it with your clients and this had to be done all within the same hour that you used last year just to assess.

But this is how we develop as clinicians, how our thought processes develop, and this is what we term clinical reasoning which is our topic for this week and how I have applied it in intervention.

To develop your understanding; Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012) state that [clinical reasoning is the] ability to integrate and apply different types of knowledge, to weigh evidence, critically think about arguments and to reflect upon the process used to arrive at a diagnosis (in the interest of OT, its how we arrive at our aims, and treatment plans). I personally view it as an ongoing process because we cannot retrieve all the information necessary to treat from one session alone, so we are continually applying the following cycle each time we see our clients.

When meeting a client I try to build a foundation and establish rapport by conversing generally about family, their diagnosis and how they became hospitalized, their premorbid abilities and occupations as as well as his/her current abilities are established by doing a screening/observation of how the client eats, dresses, baths and toilets from which I can then ascertain what standardized assessments to prioritise. I then come home and refer back to my notes on the diagnosis in order to judge what is the best plan for my next treatment session, my aims of intervention and a suitable subprogram which incorporates what the client deems to be important and enjoyable but also what I think is realistic and necessary to ensure recovery through rehabilitation. This is then followed through in the time period that I see the client and evaluation is done on a weekly basis as I compile my findings for my case study and presentation. It isn’t always smooth sailing though since clients get discharged prematurely or a client’s medical condition may deteriorate which then forces you to skew your plan of treatment and work with what you have now ( as is the case with my current client Mr M).

As Occupational Therapists (or aspiring ones such as myself) I’ve found that as much as your clinical reasoning is something which has to be innate, almost subconscious because we want becoming functional again to be ‘fun’ as this is what sets us apart from other health professions more specifically, Physiotherapy, it is important to find a balance between not boring your client with details of why sessions are planned and implemented the way that they are - but also discuss the relevance of certain techniques and rationale behind a proposed session.

My colleagues and I have identified a problem in which clients are poorly informed in many aspects of treatment that they receive at it is of no fault to the client but rather, the clinician. By drawing some insight into why we do certain things not only does it give a client peace of mind, but I’ve noticed that it also helps with compliance to treatment regimes and therefore a better outcome. Especially in OT, where we claim to be a client-centred profession… how better to involve a client in intervention than to have them understand why such a course of intervention has been decided upon.

I definitely feel that this speaks to our own ability to critically assess and analyse the client holistically whilst involve the proverbial man of the show as much as possible because we would want the same if we were in their shoes.

So here is to putting those knowledge and skills that you have learnt in class together with the context, needs and wants of your client to treat them in a manner, different to other health professionals because OTs follow the clinical reasoning cycle with the client at the heart of it all.

By the way, I finally know Muscle strength grading of the top of my head (does an invisible little victory dance) andddd…

References

Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012). Clinical reasoning - A guide to improving teaching and practice. Australian Family Physician, 41(1-2), 18-20.

Benner P., Hughes R.G., Sutphen M., (2008). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2643/

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Week #6

My Experience of Midterms

I’m not sure what to write about as I was unable to complete my presentation for midterms and due to a whole load of difficulties, I handed my case study in late so I haven’t received feedback upon which I can speak.

If I look at everything leading up to midterms both in a personal and professional manner it all seemed so hard. Personally, everything about fieldwork was emotionally, physically and mentally draining… at some point I just felt like a mobile zombie and my supportive circle could not be there because everyone had their own through their own motions, but I’ve learnt that that is not an obstacle but rather a stepping stone to get you to seek help beyond those that are around you and preoccupied.

In the same way, I have realised that there are many gaps in my ability to assess a client therefore I’ve taken the task up to fill these, but I am doing it one step at a time because I cannot revise my entire OT2 Physical Block in a few days with all the other work I currently have. As one of my lecturers beautifully put it: “In order to get better, you have to start by owning your lack of knowledge” (Thank you @ Mrs C). I’ve taken time to go through the resources my supervisor has given us and the feedback she has given us over the weeks and also identified where I need to improve on small discrepancies.

As OT students, I think we need to understand that we are still learning and as much as we want to be perfect so that we can provide the best services and see improvement in our clients, we will never be perfect as there is always more that one can learn. We shouldn’t be so hard on ourselves and maybe by doing so, difficulties will become an opportunistic challenge to grow our knowledge and interventions.

This is the mentality which I will use in the weeks to come. We all have good days and bad days but if you look at all the critique you’ve been given, acknowledged and are working towards filling gaps in the things you do not know and seek help when you are unable to do this alone then you’re well on your way to turning those bad days into better days and becoming an OT that you can be proud of because that’s what matters most!

Below are 3 sites that I found useful with identifying my problem of anxiety, how to cope with it and also how to receive constructive criticism so that it helps you rather than stunts your growth:

Schlossberg, M. (2017). 13 signs it’s time to get help for your anxiety. Retrieved March 28, 2019, from https://www.redbookmag.com/body/mental-health/g13445934/help-for-anxiety/

Arden Coaching. (2014). Ten tips on accepting feedback gracefully. Retrieved March 26, 2019, from https://ardencoaching.com/ten-tips-accepting-feedback-gracefully/

SkillsYouNeed (n.d). Dealing with stress. [online] available at https://www.skillsyouneed.com/ps/stress-tips.html (Accessed March 25, 2019)

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Week #5

Blog topic: What are your successes and difficulties whilst on your Physical Fieldwork block?

In all honesty, this block has been the most challenging block I have experienced especially because of the dynamic factors that are out of my own control such as patient improvement/decline which affects the development of the outlined subprogram, the high turnover rate of the hospital which discharges clients as soon as they are medically cleared regardless of the fact that they may not be able to complete simple self-care tasks, the student strike which created major time constraints and had us lose 3 hospital practical days, and my own health as well has affected my performance for this block.

I've had yet another week of being ill😣 I'm actually tired of it now😑 I've been more ill and taken more medication than I have in the past 9 years and it kinda makes me upset since it prevents me from going to prac because I cannot work to prepare for my sessions, I'm afraid that I may get my clients sick as well and I cannot be completely involved in my studies because I'm in so much of pain and I lack the energy to do so. But I've given myself 1 week (I cannot completely forget about being a student in that time) but at least I have some rest. I'm trying to have a "mind over matter attitude" so that I can get out of this cycle of feeling as if I'm failing more than succeeding.

Successes have been far and few in between but at the end of the day despite not being able to make a huge impact in my clients lives, I take home the satisfaction of being 1 health professional whose job is actually to enable a client to do the things they had previously done and to see them as more than just a hospital patient or mere diagnosis. I've had small successes such as having a client who suffered a CVA, feed himself after weeks of being totally reliant on nurses, my other client with a spinal cord injury at C2 and L4 has now learnt to wash his upper body in short sitting on the side of the bed. I then asked myself if I can help clients to regain function why can't I help myself (being sick is beyond my expertise though😂)

So, I've set myself goals that I will use in conjunction with my 2 new clients goals for therapy which we will aim to achieve in April seeing as it is #OTmonth. As much as the service we provide is client-centred, I've been pouring out of an empty cup and it hasn't been working out therefore going forth I need to take time to concentrate on both myself and my clients so that by the end of April we'd find it easier to think of our successes rather than our failures.

Realistically 🙈, I have no plan of how I will achieve these goals but setting goals is step 1 to making a difference I suppose. It's almost the same as setting aims for our clients when we meet them, we identify key areas to work on and set aims and as time progresses we find a way to harness the residual strengths of the client to achieve these aims together.

Actually step 2, for me, should be to read through all of my 2nd year notes (every time my supervisor asks me about the Oxford standard scale she actually has to downgrade from verbal to slowing down her question to demonstration even 🙈 so that I can come up with a muscle strength) and then find ways to reward myself for getting through each week of Prac until I rediscover why I actually decided to study OT in the first place and that passion will then translate into all that I do for my clients and hopefully into better marks & feedback.

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Week #4 - How does culture influence intervention?

At the very heart of efforts to instill professionalism, humanism, and cultural openness and humility in medical students is the notion of justice: to treat all patients as individuals—with all the emotional, experiential, and cultural richness and depth that comprise an individual’s identity—with fairness and compassion. In much the same manner that the “habit of professionalism” develops, so does a critical consciousness of oneself and others in the world, as well as a commitment to alleviate suffering and address disparities through action. The development of this critical awareness is a central goal in multicultural education, and efforts to achieve this goal must take the form of an educational praxis, i.e., action informed by an overarching theoretical framework. (Kumagai & Lypson, 2009, p. 786-787)

As stated in the above citation, consideration for a client’s culture has become an integral part when administering services to clients and in growing as an Occupational Therapist (although the excerpt speaks to medical students, the same notion applies to all healthcare professionals).

It has been noted within my own interactions with clients, not only on my current physical block but also through the previous 2 years. I find myself having to learn to speak to my client in their own language for a better understanding, having to conduct sessions according to the way a client normally does things such as: using a facecloth to wash one’s face which is out of the ordinary for me, my previous client with the TB at his hip had asked for ‘mahewu’ when we had gone on a tuckshop trip as part of wheelchair mobilisation and I did not know what that was. This then illustrates how [I] the student therapist(ST) has to be culturally sensitive to a client’s lifestyle when implementing intervention and also be alert so as to not impose my own choices upon my client.

Culture affects all aspects of occupational therapy service and cultural context is defined within the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition (American Occupational Therapy Association [AOTA], 2008) as “customs, beliefs, activity patterns, behaviour standards, and expectations accepted by the society of which the client is a member” (AOTA, 2008, p. 645).

Whilst I do understand and definitely try to implement cultural sensitivity to accommodate a client as much as possible, I do ask myself though if the services we render (with reference to the aforementioned extract) bare consideration for every aspect of a client for I sometimes find myself having to look pass a client as being a part of a specific group be it racially, a matter of gender, age or any other difference that may exist between myself and the client in order to give the best possible service. I’ve been present when a nurse has had to change a male client’s incontinence product – and even though we are told that it shows sensitivity to an adult to call it that…the client generally understands it to be a diaper/napkin, I’ve had to go pass body space barriers in order to assist a client, sometimes clients of the Zulu culture show a stance of superiority but a need to approach them with respect for that stance but also explain that we may have to look past that for the sake of helping the client. So, I [not in my personal opinion, but from a professional stand] feel as though as much as consideration needs to be taken for a client’s culture, we also owe it to our client’s to sometimes look at them beyond just representing a specific group in order to assist a client.

This sums up how culture has influenced intervention for myself; where I see the need for doing so through experience and this is supported by literature however, I have also realised that sometimes we need to regard clients as just another fellow human being to prevent societal and cultural biases from infringing on treatment in a negative manner.

PS: I was supposed to provide a screening tool in this week’s blog post but based on feedback from my supervisor I’ve been told to try to stick to the topics which are outlined for each week of fieldwork and I intend on doing so for the remainder of the block.

Happy reading!

References

Kumagai A. K. and Lypson M. L. (2009). Beyond cultural competence: Critical consciousness, social justice and multicultural education. Academic Medicine, 84 (6), 786-787.

American Occupational Therapy Association(2013). Frequently asked questions (FAQ). How can occupational therapy strive towards culturally sensitive practices?, p.1.

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Week #3

Alas…the toughest part namely, fieldwork on Monday (which I unfortunately, could not attend because I have become ill through all the University stress we face as students) and Wednesday has passed therefore it’s safe to say…yet another week of prac has come and gone.

For week 3, I will be providing further insight into Tuberculosis of the hip (despite the fact that my client has been discharged already, all three in fact!!! So, my supervisor and I had to screen the wards AGAIN for 2 more clients) along with references and links that have been useful in developing my OT subprogram for said client using Applied Frames of Reference(AFRs). Our course guided topic for the week is: Using AFRs and approaches to guide my intervention planning which I will be reflecting on in conjunction with my subjective experience of this past week during therapeutic sessions with clients. Sheesh, there’s so much to tell!

Above, I’m hoping, is a short resource that would assist in understanding and planning your intervention in future with a client who presents with the same diagnosis. I have listed just a few approaches and one applied frame of reference since thus far I’ve had clients who required post orthopaedic rehabilitation but there are a wide range that you could choose from (just surf the net).

I vaguely remember a Confucius Law which states that: “Success depends upon previous preparation and without such previous preparation, there is sure to be failure” [This is just something from an Amazing Race episode that has stuck with me] BUT based on the last few sessions that I have planned for… all that could have gone wrong had went wrong, from uncooperative clients to finding out that my clients had been discharged, it was a complete disaster – I literally felt like crying, but I didn’t however, the stress of putting so much effort into planning ahead and not being able to implement it was what made me ill seeing as demos are next week (and the “success’ of that can be determined by how much you planned) then I was OVERTHINKING EVERYTHING and became worried that I’d fail midterms until I heard the song which I inserted in my previous post. Sung by Tom Walker the lyrics are, “We only get one life so make this life beautiful, One chance so make it worthwhile, Just be alive-the story could be glorious, Beginning to finish-long as I could say I did it”. And that was what gave me willpower, to push through being ill and having to work from 8 to 12, it helped me keep my composure when I discovered I’d have to screen again (which my supervisor says I am quite proactive in, for determining suitability of clients for OT intervention, so in my next blog I give a few pointers into what my thought processes are when screening) an that was when I found my new client, Mr M we shall call him… with fractures at the cervical and lumbar vertebrae however requested to begin rehab (always with a corset for spinal cord injuries!) and highly motivated for mobilisation.

So, I did as the song said. I didn’t wish I could go home and sleep through the day, after all we’re OTs – the ones who add meaning to life – and I had this chance to prove to my supervisor that I have been going through my theory so I adapted, like I have been when I receive a totally new client and I have to make the session activity-based…so sorry Confucius but I’m an anomaly to your law of previous prep since these are actually my better sessions, and I made do with what resources I had.

In my head, I logically and calmly went through the approaches I knew and decided to try out some preparatory techniques on the client such as trunk flexion and scapular mobilisation from the recent Neurodevelopmental(NDT) lectures we’ve had, to assist with bed mobility and eventually static sitting (keeping in mind that preventative steps-use of the corset and a graded approach needs to be used since the client had been laying for a long time).

A therapeutic opportunity then arose as Mr M desired to brush his teeth (a self-care ADL) so we had to improve to perform the task at his bedside and he was so delighted as he stated that it was as if it were a dream come true.

I undoubtedly, was overjoyed as well – I doodled too and smiled to myself (picture below) – it gave me that motivation I needed again. To see how something as simple as brushing teeth, what most take for granted, could be such an uplifting event when one’s disability infringes on function. He was then so happy to smile with his clean teeth, and we even got him to stand today, but stay tuned for my next blog as I reflect more on his progress through OT intervention.

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Grinding📚👩‍💻 with some music🎶 motivation...

New post tonight! ✨

[biancal-ot]

Week 2 of my OT3 Physical block

This week, we were required to unravel our experience whilst our practice in intervention and treatment develops within the physical fieldwork block. The topic for this week is: What does client centred mean to me? Along with this, I will provide some insight into my intervention planning and implementation by reflecting on the events during the sessions that I had with my clients (or at least the lack thereof👀).

In simple terms, this concept (to me) means doing what is beneficial for the client, within realistic & ethical boundaries, in a manner which is relevant, specific and meaningful to the client. The above image further delves into the most important factors which I consider as fundamental when determining a client centred approach for intervention.

Whilst on the topic of intervention… this week has definitely been a huge learning curve for me.

Client #1 – Requires a total hip replacement, was due for surgery last week and I had therefore planned a postoperative treatment session which incorporated early mobilisation and analysis of ADLs i.e. Toileting and toothbrushing in order to assist the client in adapting and compensating to achieve her current optimal level of independence. This session did not happen as surgery was not yet performed and the elderly client was reluctant to participate as she complained of pain and did not see the need for it before having had the operation.

Client #2 – this was an elderly CVA client whose condition was rather acute, and his medical status had progressively deteriorated in which he had now required a drip and a ventilator,  leaving him unstable for OT intervention.

Client #3 – this client has an intriguing case… he has (acute-unconfirmed) Tuberculosis of the hip which is a new phenomenon for myself (TB of the hip presents with symptomatology of pain – which will also be referred to the medial aspect of the knee, structural deformities, limping and muscle spasms – I will provide links & references within my next blog as I further develop an understanding of the condition and how OT can assist in terms of occupation-based intervention)  and he is Epileptic which gives me some good exposure in applying both Psychosocial and Physical principles for intervention.

I, however, did not prepare a session for Mr #3 as there was an expectation that Mrs #1 would have had her surgery and I could have continued my treatment plan with her but she had on gone into the theatre the morning of my prac so I had to improvise and develop a therapeutic activity session for Mr #3 which incorporated aspects of improving socialisation skills, mobilisation using crutches of his lower limbs and development of upper limb muscle strength tolerance with wheelchair mobility (this was essential as I learnt that in an acute setting deterioration is just as prominent as recovery, therefore, its best to equip a client for any possibility)

Upon receiving feedback from my supervisor, I could tell that she was concerned as I was stressed about not being able to implement my planned interventions, however, this has all only motivated me to try my best for the following week as I now have an idea of what ‘the worst day of prac looks like’ and I have my supervisors critique to guide me mostly with improving my problem list which will then assist in identifying focus areas and help with structuring and handling during my sessions.

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Week One

As an OT3 student, we've been required to set up a blog in order to reflect on our experience whilst on our physical block. This has been week 1 and surprisingly, I'M STILL ALIVE!😱😂 The adjustment will definitely take "some getting used to" with all the new illnesses that we see - which more often than not is actually some seemingly 'random' letters a doctor writes in a client's file - having to transition from assessment to treatment of clients this year, adapting to a new environment and let's not forget learning how to blog (another skill to add to our longgg list of AMAZING skills within this profession😝).

This week has however been refreshing as I was able to actually see theory (which I admittedly, didn't even know I had absorbed🙈) being put into practice and begin to see how OTs make a difference in the multidisciplinary team by thinking of ways to improve/compensate within a client's functional areas through our client-specific interventions, even before the client realises the need for it themselves.