Growth

“Vulnerability is the birthplace of innovation, creativity and change” (Brown, B). 
I feel as though I have had to be vulnerable and have expressed many emotions throughout this block with the friends and mentors I share it with, as well as with myself. I have had to expose my areas of weakness, lack of understanding and develop in vital areas which will create an admirable therapist.

“There are no secrets to success. It is the result of preparation, hard work and learning from failure” (Powell, C). This block has taught me so much as a person and a developing therapist. As a person it has taught me to deal with criticism and accept important feedback in order to grow. As a student OT, I have realized the great impact research, clinical reasoning and client context has on the treatment you provide and sessions you plan.

Preparation and organization has been an area I lack commitment to. Although I complete the work, the lack of organization reflected in my midterms results. Organization begins with RESEARCH. This is something I did not create any time for before midterms. Since then I have learnt to enjoy reading the facts about my diagnoses and understanding each condition in depth. Researching treatment and Applied frames of reference has given me confidence in understanding the benefits I am offering the clients.

I am more of a passive learner than an active learner. I listen well in class and therefore without the NDT lectures leading up to midterms and without individual research I was guessing my way through the block and made many errors as a result. I discovered the importance of active learning in this degree through this.

Through understanding treatment principles according to my frame of reference choice and preparing problem lists to formulate a subprogramme, I have finally grasped the concept of treatment. This is definitely a reason I feel I have grown as an OT.

According to (Greenwood, Beth) these are the qualities which make a good OT. I will elaborate on how I have grown in these areas.

Communication and Listening

“Interpersonal skills and ability to communicate with your patients are vitally important. First, you must listen to your patients, who can explain how they feel or what their symptoms are. You must be able to put complex terms in simple language, especially when working with a child or an adult with a cognitive problem”. I feel I have developed in my interpersonal skills to communicate with my patients. I have learnt about the importance of using an adult tone and body language when communicating with an aphasic client and I have learnt to be proactive and asking my patients questions about their concerns which are vital to gain context to formulate a problem list whilst assessing them.

Organization and Problem-Solving

“Much of OT work involves solving problems, according to OT Career Path. An OT needs organizational skills to manage her own daily activities and schedule as well”. As a student OT I have come to terms with the fact that organization is the key to successful sessions. Even having a note written for reminders during the session, a notebook, pen and forms readily available allows for a more productive day. Organization in terms of researching and planning treatment also falls into this section. I have improved greatly in this area compared to the start of the fieldwork block and will continue to grow through its value. Time management is also vital. I have definitely learnt to treat faster and use my time more wisely. Through this I have grown in my confidence and handling of patients during treatment sessions.

Compassionate Care

“Compassion, empathy and patience are necessary skills for an OT and are often driven by a desire to help others. A patient who has suffered an injury or illness may be grieving for her lost skills or the life activities she once enjoyed”. As students I feel we are sometimes so stressed about our cases that we tend to forget that these are real people whose lives have been impacted and they are dealing with many emotional stressors as a result. I do my best to develop therapeutic relationships with my clients so that they feel we have developed a safe, trustworthy relationship. I have learnt to show compassion for their struggles and develop aims alongside them.

I believe I have improved as an OT, but I also know there is a lot of growing to still be done. This will come with experience and feedback from others as well as myself, as I develop through researching and improving in my skills.

References:

1. Greenwood, Beth. "Qualities of a Good Occupational Therapist." Work - Chron.com, http://work.chron.com/qualities-good-occupational-therapist-26306.html. Accessed 24 April 2019.

2.  Gibbs, M. 5 Powerful Quote’s from Brene Brown’s Ted Talk. http://empowerlounge.com/5-powerful-quotes-from-brene-browns-tedtalk-about-shame/

3.  Powell, C. Failure Quotes: Brainy Quotes. https://www.brainyquote.com/topics/failure

Team Work

Every Multidisciplinary team is composed of different professionals, possessing a variety of skills necessary to produce safe and effective care.

This includes:

·        general practitioners;

·        practice nurses;

·        allied health professionals such as physiotherapists, occupational therapists, dieticians, psychologists, social workers, podiatrists and Aboriginal Health Workers;

·         health educators - such as diabetes educators - providing promotion and prevention clinics and other activities.

Multidisciplinary teams convey many benefits to both the patients and the health professionals working on the team. These include improved health outcomes and enhanced satisfaction for clients, and the more efficient use of resources and enhanced job satisfaction for team members.

What makes healthcare teams so different from those in other types of organisation is that team members have differing allegiances, not only to the team but also to their professional groups. History and professionalism play their part in making questions of authority and responsibility in the health service team much more complex. Clarity about authority and accountability in health care teams is essential.

To ensure optimal functioning of the team and effective patient outcomes, the roles of the multidisciplinary team members in care planning and delivery must be clearly negotiated and defined.

This requires:

·         respect and trust between team members;

·         the best use of the skill within the team;

·         agreed clinical governance structures;

·         agreed systems and protocols for communication and interaction between team members.

I feel as though the Entabeni rehab and multidisciplinary team have made an effort to show interest in us as students joining their team. They offer us advice, communicate with us about changes and time slot conveniences and have adapted to us being in their environment twice a week. We are blessed with the staff the rehab has.

This week I performed a self-care grooming and LL dressing treatment sessions with Ms. Thobeka. The client also improved in her transfer abilities this week , as she was able to transfer from the wheelchair to the bed safely but with supervision. However, she required help to transfer back to the wheelchair. The client performed LL dressing and undressing with moderate assistance in a sufficient time. The client was required to weight bear on the subluxated affected right arm during grooming (Face washing and teeth brushing). I have seen great improvement in the client’s dynamic sitting balance (Trunk control). I have performed NDT techniques to improve her Trunk control each prac day.

Mrs Pillay is being discharged on Friday. This client’s dynamic standing balance was my main focus of treatment in these last few weeks. In my session I learnt the importance of ensuring the client is weightbearing on the affected leg and not neglecting it. This was tricky to focus on when also assisting the client with the co-ordination peg board activity. The client was asked to lift her left heel to ensure weightbearing in the last 6 minutes of the activity and the student therapist focused more on knee extension than the second half of the activity which was an easier task. Through this activity the student noted the importance of adaptation to meet the aims and the importance of multitasking as a therapist for all aspects of the sessions requirements.

 Unfortunately my client was unwell with stomach problems on Wednesday and I therefore didn't get to perform my last treatment session with her.

Mrs Mabongo is my new T6/7 SCI client. We performed a shuffling activity today as the client struggled in this area when she was assessed. This is important for mobilization to get into positions for therapy, as well as for her transfer she performs at the moment with a transfer board. The client understood the new techniques taught to her and great improvement was noted by the end of the session through repetition. The client did not understand the initial game for the pegboard despite multiple demonstrations and it was therefore downgraded to just removal of the pegs. The activity required trunk rotation of the left and right side to improve trunk control. It also incorporated weighted cuffs. My supervisor noted it wasn’t necessary. I agreed with this feedback as the only step of the activity it may have improved MS for is the elevation and reach the client was required to perform when removing the pegs. The client's heavy flaccid LL's provided enough resistance to increase MS of the UL's.

References:

1. Health One NSW. (2014). Multidisciplinary Team Care. https://www.health.nsw.gov.au/

healthone/Pages/multidisciplinary-team-care.aspx

2. Jenkins, V. (2001). Multidisciplinart Teamwork: The good, bad and everything in between. https://qualitysafety.bmj.com/content/10/2/65

Clinical Reasoning

It is important to study clinical thinking and reasoning as students becoming OT professionals, because it promotes the recognition and development of the transition from novels towards mastery and practise towards coherent decision making. 

Professional reasoning is an all-encompassing concept of logical thought which guides practise and action. It includes utilization of modes of reasoning, such as: narrative, diagnostic, scientific, conditional and ethical types of reasoning.

Clinical reasoning is a component of professional reasoning that uses logical thinking to plan, direct, provide, influence and reflect on patient care. 

Reasoning enables professionals to better understand and utilize the best evidence, as well as to allow them to maintain their intuitive processes to stimulate innervation. When reflected on professionally it can help bring to life potential biases in our own professional decision making. 

I will be reflecting on my own clinical reasoning according to the clinical reasoning cycle:

Consider the patient situation: The interview process to gather cultural, environmental, socio economic and client-based interests, values and spirituality is essential to establish a patient-therapist relationship with client centred treatment goals. 

As I develop into a therapist, I am discovering the importance of this with my patients. A session which has not considered culture or context may even be written off as untherapeutic and ineffective.

Collect cues/ info.: This has to date been my weakest point as a student. I have been so focused on getting the jobs done that I have been unsuccessful at researching, gaining knowledge and interpreting facts which provide evidence to support my points. This forms the base of treatment as all treatment performed should be objective. I have since downloaded Trombly from my phone onto my laptop and have been reading chapters such as CVA. Gaining knowledge from this chapter made me realise the importance of building a foundation in research.

Process information: I need to improve in my ability to interpret, discriminate, relate and predict data. This will come with practise and gained knowledge to ensure an expert thought process.

Identify problems/ Issues: I am able to discover the problems my client is faced with; however, my integration requires improvement. I also need to synthesize facts to make a definitive diagnosis including co-morbidities.

Establish goals: I am learning to prioritize my patient specific goals appropriately. This co-insides with identifying the most important problems. I therefore need to put effort into planning my short term, medium term and long term aims.

Take action: This refers to the choice of approaches and frame of reference one establishes for their client. This skill will develop into second nature over the next two years. A well thought-through subprogramme is necessary to prioritize goals.

Evaluate outcomes: I feel as though my research base leading to midterms was poor and this is important in order to evaluate how the client performed and how the therapist performed. This base will now help develop my skill in analysing how the sessions could have been improved

Reflect on process and new learning: My supervisor discussed that my blogging reflections show increased insight. I need to implement this into the real world and learn to accept criticism and feedback with less emotion. Criticism is essential for students to improve as therapists and develop their clinical reasoning. I also need to become less nervous when the supervisor asks me questions. I sometimes start thinking of detailed and complicated answers when she is mainly wanting the simple, obvious response. E.g. “What do you need to assess with Pt X with regards to her cognitive problems in reading”. I started to think of specific reading disorders and go off on a tangent when I know very well already at the beginning of my session with the client that cognition and perception using MOCA is what is needed

I am feeling more confident in my activity choices; however, I need to ensure I do not over structure an activity and that I think carefully about context. My client managed reasonably well on the rough terrain and learnt how to propel herself slowly down a gradual incline. She was also able to get over a medium sized bump. The client’s endurance is one of her prioritized problems for wheelchair mobility. On Monday I learnt a lot about my client’s decreased orientation to basic colours, shapes and numbers through my Geostacks activity, which was structured to improve dynamic sitting balance.

I structured my sandwich making activity to include trunk rotation towards the affected right side by including a table behind the client towards her right. This encouraged balance reactions and improvement of posture awareness when returning to meal preparation. The activity was also structured to incorporate bilateral hand functioning and walking. 

In my make up activity with my client I could have stabilized her at the hip (Key point of control) for a greater trunk rotation as the items were placed relatively close to her on the affected right side. I learnt about the importance of spontaneous cognition. Instead of answering my own question I should be asking and waiting for client response. ‘Why she chose the eye shadow colour’.

In conclusion, I will develop my knowledge of NDT components and normal movement patterns and continue to research in order to develop my clinical reasoning skills.

References:

1. Ferguson, R. (2014). Clinical and Professional Reasoning in OT. https://www.youtube.com/watch?

2. Isaac Asimov (1982). “Isaac Asimov's Science Fiction Magazine”

3. (2018). clinical reasoning | nursing student clinical documents -clinical reasoning cycle. Retrieved from Pinterest on the 02/04/19