Learning By Doing

How was my experience of being on prac?

Prac, even OT in general, is not for the faint-hearted. It is difficult to say the least. Personally it challenged me in every area – physically when I was feeling unwell and just exhausted; emotionally when situations where overwhelming or just beyond what is known & familiar to me; mentally when I had to problem solve in terms of how to help my clients, or how to adapt treatment or their life situations as a whole; spiritually when a client’s beliefs where contrary to mine or when a circumstance seemed desperate & unexplainable to a client; and academically when I felt like I would never get it right.

It was a challenge, but it was also rewarding. Physically: because I got lots of exercise walking from ward to ward & to the OT department and back, as well as because it gave me the opportunity to improve my general, physical and psychological endurance; emotionally: because it pushed my boundaries & helped me to find my boundaries all at the same time, and in doing so it broadened my understanding & improved my insight; mentally: because it taught me to FIGURE IT OUT no matter how daunting the problem seemed to be; spiritually: because it strengthened my faith while reminding me to respect others & their beliefs, as well as teaching me how to consider others as a whole; and academically: because I know more now than when I first began prac & that means that learning took place and that I have grown as a future OT. My experience is one that I am very grateful for, but it is also one that was intensive and gruelling.

Reflection on the progress of my clients & how the sessions were relevant to them:

2 of my 3 clients were transferred/discharged within the last 2-3 weeks of my prac. My CVA client, Client C, was transferred to an old age home facility, and he was showing progress in terms of improvement in his mood before he was transferred. Physically he showed little improvement, largely due to the extent of his CVA and the number of times he had experienced a stroke, but also because of his previous unwillingness to try. My sessions were relevant as they incorporated mood elevating factors & ADL’s which helped get him motivated, and it was after a teeth brushing activity that I saw a positive change in his mood. The change in his mood allowed for improvement in his efforts to be seen during my physical intervention with him and this allowed for some progress, although it was just before he was scheduled to be transferred.

My GBS client, Client G, was discharged on my 2nd to last Friday of prac and she progressed immensely. On my first day of prac she had quadriplegia – she was paralysed in all 4 limbs with only movement of her neck & trunk; on the day of her discharge she made 8 cheese & tomato sandwiches independently and she walked out of the hospital without any assistance. Her progress was largely due to the characteristics of GBS, but I have no doubt that my sessions with her made a difference to the duration of her recovery and in helping her to stay encouraged and motivated. My sessions with her were relevant because I ensured that they were suitable to her stage of recovery & that each set of session aims would lead to an improvement in overall functionality.

What did I feel were my strengths & weaknesses on prac?

My strengths: Good relationships/rapport with my clients; improved time management; client-centred treatment as a focus; & an improvement in the creativity of my chosen activities. My weaknesses: Becoming too emotionally involved; my stress levels affecting the effectiveness of my treatment; not believing in myself & trusting my own decisions; doing activities that were not challenging enough; activity analysis not always being accurate enough.

There are probably a lot more faults that I could find in myself as an OT student at prac, but in the same way there are probably strengths that I have not yet discovered. As human beings we are all continually growing, learning and improving. Our strengths get stronger & and our weaknesses slowly change into strengths as we work on them. I know that there are many skills that I need to acquire and that I have a lot of growing to do, but with time, practice & opportunities like prac there is no reason for me not to be a fully capable OT, one day.

My treatment sessions of making a macramé key ring, doing an adapted sport activity & sandwich making were all well-structured and very successful in meeting the set aims of the session as well as in challenging my clients. My clients both needed minimal to no physical handling and I feel that I gave them the right amount of psychological support. The activity requirements were correct & specific to the activity and the client’s needs, and I was careful to adhere to precautions while presenting the activities in a motivating manner. I feel that these were my most successful sessions and that the improvement in my ability to implement a session well was evidently seen and felt. I managed my clients well and gave them relevant and effective treatment.

How does it feel to plan and implement intervention with my clients?

It feels great. I almost feel like I know what I’m doing! Each intervention session that I have planned and implemented has come with its own set of nerves, but it seems to be that my nerves are getting less and the quality of my sessions are getting better. Obviously there have been and will be good and ‘not so good’ sessions, but I think my ‘not so good’ sessions are now better than my used to be good sessions. My session aims are being met and my clients have been returning to the wards motivated, which is fantastic! Little bit by little bit I am becoming an Occupational Therapist, and I cannot express how much that does for my own heart and soul! I am definitely still a student and I am grateful that there are still plenty of opportunities for me to practice in the next 1½ years! Planning my sessions takes a lot of time, effort and concentration among other things and implementing them takes the same if not more, but doing therapy is good. Not only is it therapeutic for my clients, but it is therapeutic for me to see the small difference that I can make in the lives of others through a short, thought-out activity.

How did I experience putting theory learnt in class into practice? What was it like?

I have experienced it as a challenge. It has been a blessing to learn so much at practical – about new things, about how to implement our theory and about when which concepts and theory are relevant, but it has also come with lots of hard work. Digging deeper into subjects and theory that has already been taught to me is a definite necessity while at practical and it means researching, re-reading notes and applying myself to fully understand things. Being at practical has allowed me to take the information taught to me and actually use it – applying it has helped it to stick in my head and make more sense. I have then been able to look into specific areas of theory and dig deeper when my intervention plan, ethical considerations and cultural understandings required it or when a better and more in-depth understanding of an illness was needed. It has been amazing to get the opportunity to learn while doing and then to repeatedly test that learning and knowledge. Success comes with lots of hard work, commitment and effort therefore, being successful in implementing theory will require lots of hard work, commitment and effort.

Has my client been progressing and how do I feel about it?

YES! My clients have been progressing and I feel GREAT about it! Progression is not always fast and sometimes it’s not noticeable, but it is there and it is precious. It reminds me why I want to be an OT especially on the days when the workload feels like too much. I have 3 clients: a client with GBS (G); a client with Paraplegia T7 (P); and a client with a right CVA (C.).

Client G has recovered so much since I first saw her. She basically had quadriplegia – paralysis of all 4 limbs with movement only in her trunk, head and neck; she can now move all 4 limbs with some paralysis remaining in her feet and decreased muscle strength in her hands. It has been phenomenal to be a part of her recovery process!! The resident OT at my prac venue did an activity with client G and it was amazing to learn more about treatment and to see how to challenge the client just enough to encourage more recovery!

Client P has increased independence since I first saw him and he is much happier. He is independent in his BADL’s and his upper limb muscle strength is increasing with each session as well as his endurance. He is a lot more motivated than when we first began and he is super willing to participate and engage in therapy which is such a reward.

Client C has been a challenge for me. He has been depressed and has presented as more of a psychosocial client than a physical client due to him having a depressive mood. He has progressed in terms of having a more elevated/less depressive mood since doing some BADL’s and seeing a psychologist that has directly influenced his physical problems positively. AN example would be that he walked for the first time since his CVA 6 months ago. It was about +- 10 metres and he will improve but it is a fantastic start especially because he was willing to try. He is more willing to participate and is grateful for my assistance and intervention. He laughed more than 3 times on Tuesday and he smiled when I spoke to him today. His mood is rising and it is beautiful to see. I do believe an increase in his mood will make focusing on physical aspects a lot easier.

How did it feel being assessed for mid-terms? As always it felt many things to be assessed for mid-terms. It was a brand new experience for me; and doing this specific presentation, doing a treatment demo and writing up a case study were all unfamiliar and terrifying, and the relief after it was all done was extremely rewarding. It was a good learning experience and it motivated me to try harder and do better next time! Criticism is never easy to take in and learn from, even when it is constructive criticism, but I have been blessed to have a supervisor who is tactful and kind in her approach in teaching us how to be better and do more. Mid-terms reminded me that the most important thing about practical is to learn more about being a good, effective and therapeutic OT, it is not about how well I do or what marks I get – even though they are important and have to matter.

My intervention sessions have been good, but they have been very ‘soft and fluffy’ in the sense of not being challenging enough for my clients. They have almost been superficial in a sense because they have not been structured to fully meet more than one aim at a time. I am extremely grateful that this has been pointed out to me so that I can correct it and actually start MAKING A DIFFERENCE as oppose to just scratching the surface with my intervention plans and implementation. In adapting my structuring and changing my intervention principles from being general to being very specific I can change the outcome of each individual treatment session. I also realized (with the help of my supervisor :) ) that I have not been grading which has been affecting my treatment in a negative way. Grading is vital to successful treatment sessions and it also shows that the OT (student) has thought through the session(s) thoroughly in hopes of achieving each and every aim for that session.

Good activity requirements are vital to effective treatment and these need to be specific and thought out carefully rather than being general which leads to less thinking and shallow therapy.

What have been my successes and difficulties? I have felt successful in keeping my treatment client-centred and specfific to the client. I also feel relatively successful in finding the 'just right challenge' for my clients to 'stretch' them but not discourage them. I have found assessment very difficult and I have also found written hand-ins difficult to put together. I find that when I am planning a treatment session on paper I think about it too technically whereas when I am implementing I am therapeutic. It seems as though I plan it right in order to be therapeutic in the correct areas, but I battle to identify it and 'voice' it on paper until the session is done.

I feel that I have managed my clients well although my time management skills need improvement in order for me to manage my clients to the best of my ability. I have a client that is suicidal and extremely depressed and I find it very difficult to keep myself unattached and not to overstep boundaries or to overextend myself into another professional scope or field.

How does it feel to plan and implement intervention? Sometimes I feel completely overwhelmed and sometimes I feel extremely blessed and privileged to be able to even attempt making a difference. I found it extremely rewarding when my treatment plan was able to be implemented and led to an increased motivation in my client. My other client is a new client that I have just recieved, therefore my focus for him is assessment and he won't be reffered to in this post.

My client with GBS has recovered some muscle strength in her upper limb and therefore some movement in her shoulder and elbow. This has made my treatment very exciting. I have really enjoyed being able to facilitate the participation of my client in activity. On Tuesday we did making of peanut butter coated marie biscuits by me (the OT student) facilitating grasp of the knife in order for her to move the knife backward and forward to spread the peanut butter over the biscuit. In future I should consider allowing my client to use a universal cuff to illicit a greater feeling of independence during the activity.

On Friday we did a warm up ‘dance’ exercise activity to music for 15 minutes and then we played ’30 seconds’ which was very successful in challenging the patient and elevating her mood! We got her heart rate to increase and we caused energy expenditure which means her endurance was being treated without me even realising it as a very important treatment aim!

What does client centred mean to me? To me client centred means ensuring that the activity I do with my client is relevant to her - to her wants and needs, her values, her beliefs, her interests, her inner being and most importantly to her recovery.

Throughout this week I only had one client due to unforeseen circumstances that are to be expected within the hospital setting - and which give room for the growth of my ability to be flexible and able to adapt. In choosing my client's activity I looked at what she perceives to be most important to her and at what motivates her. I considered how I could improve her mood while increasing her feelings of independence while adding an element of an activity done before the onset of her illness. I looked at how I could do an activity that would be therapeutic and how I could facilitate this activity as an OT student to ensure therapeutic use of self and, therefore increase the therapeutic power of the activity and session as a whole.

I am happy with the activities that I chose although I did find it a challenge knowing when to push my client and when to allow her to stop. As an OT student I find that I can be a little bit too soft on my clients which can rob them of effective treatment. I find that I still need to work on my ability to identify the 'just right challenge' for my clients.

I also need to work on executing my structuring and handling principles more accurately. I believe my write up is generally correct, but my practical doing of it needs a lot of practice. I find it easier to write the principles than to implement them. The use of equipment that is not fully functional was a mistake on my part as I should have tested out the equipment more thoroughly than I did.