Week 10: Touchdown

Week 10: 12-15 May...

Taking off on fieldwork ten weeks ago was the start of a terrifying, yet exhilarating journey. Navigating the ups, down, U-turns and dead ends pushed me to my maximum, but I can finally release a deep breath at having landed unscathed, yet stronger.


The first few weeks of fieldwork felt as though I was flying blind in a maze of hospital corridors, treatment principles and long lists of rules and regulations. Through trial and error, I began to slowly inch my way through understanding what was required of me for each of my clients. I feel as though I walked through the first few weeks with a perpetually confused expression on my face, asking dozens of questions as I slowly got my bearings.


Within the next few weeks, I gained some altitude, but with it came bouts of turbulence in the form of patients unexpectedly discharged, and a range of new conditions I had never worked with before.

 By this time, thankfully, I was more comfortable in the hospital environment, leaving my mind free to focus on the needs of each client. I found myself becoming more driven to research each condition, and try things that I had previously been unfamiliar with. I began to understand two things at this stage:

1. To paraphrase Shakespeare's Hamlet: There are more conditions in heaven and earth, OT student, than are mentioned in your lectures

2. Real clients don't present like textbook clients: the human body is a complicated structure- when one thing goes wrong, a whole chain of events are set off, meaning that healthcare professionals have to be exceptionally observant, a skill I still need to develop.


I also began to get a better understanding of what the OT role is within the MDT for various conditions, only realising during fieldwork that my idea of the OT role had previously been worryingly hazy.


As the final few weeks began to unfold, my flight through fieldwork began to smoothen out as I began to figure out the controls.

I began to understand the therapeutic process better, moving from assessment to drawing up aims, to application and review of intervention. For the first time, I felt more in control of my own therapy as I began to learn how to plan for the future and not just from session to session.
Once I was more comfortable with treatment planning, I found that I began to enjoy sessions with my client and develop a deeper rapport that was no longer clouded with uncertainty and nerves.

Finally, as fieldwork has drawn to a close, and  I feel relieved to be on solid ground again, I remain grateful for the opportunity we have been given to develop our skills within the real hospital environment.
This journey has been one filled with trials and shifting emotions, but also with successes and the building of new friendships and bonds.
Until I board the next fieldwork flight, I endeavour to keep my feet firmly on the ground and recuperate before the adventure starts over next semester...

Week 9: Under the Microscope

Reaching the final week of fieldwork, it's time to take to shift the lens away from my clients and on to myself, to a look back and scrutinise my development over the last 9 weeks, what skills I've developed, and what aspects I still have to work on.

Over the time I've been at hospital, I've found that I am able to assess much rapidly than previously, through having learnt how to select appropriate assessments, use observation accurately and work through assessment forms faster. This is no doubt the result of having the opportunity to be in an acute setting, where rapid assessment ensures more time available for intervention.

I've found improvements in my ability to build rapport with a client in the limited window of time, allowing them to open up more during therapy, and actively assist in the treatment process.
I've found that simply asking a client what they perceive to be their biggest problem, using listening skills and well-timed questions, often goes a long way towards building a holistic view of the client, instead of running through the set list of interview questions, in which more time is spent writing down every word the client says than actually listening.


Over time, I've found that it has become easier to select relevant therapy for the client. There are still many instances where I have to refer back to textbooks and the Internet (the saviour of students everywhere) to get a better idea of the condition and appropriate OT intervention, but slowly, my small knowledge base is expanding and I can see things starting to fall into place within the OT lobe of my brain.

It still takes me a while to sift through the assessment findings, organise them into a comprehensible whole and develop a relevant programme, but that has been slowly improving. There are times when I miss things completely, like in the case of phantom limb sensation of my current client during the sensation assessment, and have to go back and check on aspects again in subsequent sessions. Over time, I am sure that experience will be the best teacher.

Another thing I have to work on, also a difficulty related in part to limited experience, is on-the-spot grading within treatment. Often, clients change at varying degrees from one session to the next, therefore it becomes crucial that I make allowances for these changes in my grading plan. I still find it difficult to come up with adaptations rapidly within the session, meaning that until I develop this skill, a lot more thought needs to into drawing up my grading section of the session write-up.  


My time-management skills, having never been a strong talent of mine, have shown improvement, as I'm no longer rushing to scribble forms or complete activities during the last ten minutes of the day. It helps that filling in patient files takes me a lot less time now that SOAP notes are more familiar to me, and that I have a better idea of the nursing schedule, so much less time is lost waiting for bandage changes or feeding time.





Overall, I am confident that I have benefitted from fieldwork, and it has been invaluable in adding to the skills I will need to be a successful OT one day. Although there are still many weaknesses I still have to address, I can see that I have begun to develop already, and hope I will continue to do so throughout the next 18 months of my course (I pray) and the many years of practice that lie ahead.

Week 8: From Paper to Plinth

Week 8: 28 April-1 May...

Reaching the last 2 weeks of fieldwork, I'm over the moon to have two constant clients, with whom I've been able to work with for at least three sessions already.

Planning treatment sessions has become easier, now that I have a better idea of my clients, and can anticipate their reaction to treatment more accurately. I have a better idea of how to structure items to achieve the desired movements, and how high to pitch the activity. Having established a better rapport with the clients, it becomes easier to decide on appropriate activities within the treatment regimen.

Implementing treatment according to the plans I've drawn up has become easier, but there are still aspects I have to work on. The therapist must always be one step ahead of the activity, evaluating and grading as the activity unfolds. With my limited experience, I find myself becoming caught up in the present of the activity thus missing many therapeutic implications, opportunities and considerations until after the session, when I begin to critically think through and evaluate it.

I've also found that while I'm beginning to be more assertive in getting the required action from the clients, I tend to adopt a gentle, encouraging approach to prevent the breakdown of the rapport I've established. This has worked for my clients so far, but when I face more difficult clients, I will have to work hard to find the balance between  maintaining the client-centeredness of my treatment and still achieving the aims of therapy.

With my burns client on Tuesday, I had planned to do a bed-mobility activity. However, the client was in pain, had just had blood taken from her and a drip inserted. She was seated in a chair and was not willing to transfer to the bed as she was fearful of falling. Here, I faced the assertiveness dilemma once again: should I do my best to convince the client to comply with the treatment plan by explaining the importance of being able to mobilise, especially given her developing pressure sores; or should I simply respect her decision and pain, and do another activity instead?


After trying to convince the client that I would not let her fall, and could even get someone to help me just to be safe, she continued to refuse. Hence, I decided to do some upper limb mobilisation, encouraging the client to reach for food items and make use of the affected arm for bilateral hand movements during the task of eating her lunch. This way, she was still receiving therapy, but was able to remain in the chair as per her wishes. In subsequent sessions, I intend to continue with the mobility programme, as I feel it has become a priority, perhaps using incentives, such as a sweet treat, to encourage participation.


With my CVA and below-knee amputation client on Tuesday, I decided to focus on bilateral hand function in self-care, using a grooming activity.
I incorporated dynamic weight-bearing over the affected arm into my structuring to normalise muscle tone for activity participation.  The items required for the preparation and grooming task were placed to the right of the client, allowing weight-bearing to occur when she reached over to fetch the items with her left hand.

This helped to normalise muscle tone, allowing for better right arm movement during the actual activity, as she was able to hold the comb, with the help of a built-up handle, and raise it to her head. She required assistance at the elbow joint to lift her arm up to her hair, so support was provided at the elbow joint.

To prevent compensatory shoulder elevation during arm movements, a mirror was placed in front of the table at which the client was seated, allowing her to correct her own movements through visual feedback.

One aspect of structuring that could have been improved was the distance at which the client's chair was placed from the table. To allow for better posture and weight-bearing, the chair should have been closer. However, once the client had transferred herself to the chair, it was difficult to shift her forward due to her weight and the angle of her left prosthesis. The wheelchair-to-chair transfer will have to be carefully managed in the next session to ensure the client is seated the correct distance way from the table.

The best part of session was hearing from the caregiver that she has found in improvement in the client's hand function since therapy has begun. For me, this only increased my motivation to continue planning and implementing therapy that would increase the client's hand function even more.