Week 1: Confusion vs Control

3-6 March 2015...

 

Going into the OT 3 fieldwork session, there is an overwhelming urge to plan every step of the interaction with the unknown client.

 

Once the session commences, there is a just-as-overwhelming tendency for these plans to unravel entirely.

 

 

No client entirely resembles the textbook example. There's always a few seconds of panic as I initially advance towards the client and realise that my approach will have to change entirely, as

 

1. The ancient hospital beds don't move into the upright sitting position I planned to position my client in

 

2. My client has not one diagnosis, but several, many of which are unconfirmed, inconsistent, illegible, or completely foreign to me

 

 

 

The lists I had drawn up in my head (ROM... muscle strength.. muscle tone... hand function...) have to be speedily reshuffled as I introduce myself to the client.

I haven't quite mastered the speedy reshuffle yet, as I find myself starting an assessment, then reconsidering how relevant it is to my client's phase of disease and whether the position of the client will give accurate results. I find myself consequently changing my approach, asking more questions, or starting another assessment entirely.

As I notice difficulties the client is experiencing, I imagine the functional implications, and decide to switch to a functional simulation of, for example, feeding, to see whether my hypothesis had been correct.

 

This back-and-forth alternation of assessment is understandably confusing, both to the client, and in terms of my recording of assessment findings. While I have a better overall picture of the client's level of function than I would have if I'd stuck to my list, it takes a great deal of effort to sift through and pull together all my assessment findings into a coherent report.

 

Finding the balance between structure and flexibility is going to be an issue I will have to work on over the next few weeks of fieldwork, to ensure that my assessment is quick, accurate and relevant. 

A more comprehensive understanding of my clients' diagnosis, as well as a more well-thought out, holistic assessment schedule may assist with this.

 

 

 

 

I have noticed during the course of my assessment that I am not as adept with my assessments of joint range of motion as I should be at this level. It's important that I develop a more systematic approach to range of motion testing so that my assessment findings are logical and coherent.

 

 

I have made it my mission to practice JROM testing on any of my colleagues and siblings who don't mind being my guinea pigs, so that I am sure my clients' time with me is always optimally utilised. Although it is entirely different to test the range of a person with limitations vs. a person with none, it will be easier to adapt to limitations if I have a good grasp of how to measure normal range accurately.

 

Overall, the first week of prac has already been immensely eye-opening. Functioning within a fully functional hospital (complete with doctors barging into my assessment session to deliver a 5-minute diagnosis and eyeing my home-made hand assessment kit sceptically...I must make that kit more professional-looking...) is scary, and yet exciting at the same time. From learning to write concise notes in patient files to establishing relationships with the rest of the healthcare team, this fieldwork block is going to be one rollercoaster learning curve after another.

 

I know that I can either find the pressure of fieldwork stressful and overwhelming, or I can pour in as much effort as possible and make the most of what promises to be an invaluable learning experience. May the force be with me!