Discussion of a topic that had a positive effect or created dilemma in South Africa

Introduction

Image taken from (https://ewn.co.za/podcasts/200/lying-in-state--the-life-esidimeni-tragedy/102222/lying-in-state--the-life-esidimeni-tragedy---the-backstory--episode-6-)

In 2015, South Africa was rocked by the life Esidimeni tragedy, in which 144 patients with mental health problems passed away after being transferred from a private hospital to state-run-facilities. This tragedy shone a spotlight on the state of mental health care in South Africa and the need for significant reforms. The tragedy also highlighted the social stigma surrounding the mental health problems and the lack of adequate care for people with mental health conditions. I grew up in the society where the mentally disabled person is not considered as a person who must have a view on anything, even in their own life decisions, all along I’ve been having the wrong mentality and after hearing about Life Esidimeni tragedy I need a bush to hide under. Hello everyone and welcome to my 5th and final blog I hope you will enjoy, as much as it is about a sensitive tragedy that occurred let’s enjoy learning more and maybe start with a:

This picture was taken from (https://imgflip.com/i/3ck9un)

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The lack of adequate care for people with mental illness was one of the most troubling aspects of the Life Esidimeni tragedy. How? Because patients who died were not properly assessed ot treated, and some were not given access to basic necessities like food and water https://journals.co.za/doi/pdf/10.10520/EJC-1c6ec8ac1. I think the lack of care is a symptom of the stigma surrounding mental illness in South Africa, am I wrong? Mental illness is usually seen as a sign of weakness or a character flaw, rather than a treatable condition, I'm talking about what I usually see and hear people in my society talking about. In the years since the tragedy, there has been positive developments in the country’s mental health systems including projects, like the Gauteng mental marathomn project(Moseneke 2018), Gauteng mental health marathon(Freeman 2018, Makgoba 2017b), Life Esidimeni project(Gauteng Province 2018) and the Life Esidimeni tragedy (Ferlito and Dhai 2018, Jacobs, Agaba, and Brady 2018) https://journals.co.za/doi/pdf/10.10520/EJC-1a136347cd

In the wake of the Life Esidimeni tragedy, the South African government took several steps to reform the country’s mental health system. First it established new regulationsfor the treatment of mental illness including a national mental health policy and standards for mental healthcare facilities. Secondly it increased funding for mental health services, ioncliding the establishment of a mental health  grant program. Thirdly, it launched awareness campaigns to address the stigma surrounding mental health. https://www.hhrjournal.org/2018/11/contribution-of-the-health-ombud-to-accountability-the-life-esidimeni-tragedy-in-south-africa/

Image taken from (https://www.dailymaverick.co.za/article/2022-02-15-no-end-in-sight-for-life-esidimeni-inquest-while-health-officials-continue-denying-responsibility-for-the-tragedy/)

Conclusion The life Esidimeni tragedy was a dark chapter in South Africa’s history, but it also offered an opportunity for change. As time progresses we see a change in the way our country views mental health, like one of the previous topic which was about mental health being a Cinderella of the South African health system it seems like many people have written about it in the media and it has touched many people and the change in the way mental health it treated makes our country better. I still believe Life Esidimeni tragedy is the most emotional mental health related tragedy that occurred in our country, what do you think? However, there is still too much work to be done to address the stigma surrounding mental illness and to ensure that all South Africans have access to equal mental health care. Thank you for reading this, I hope you all enjoyed my blogs and got to change the negative views on mental health as this is my final one in this block.

My reflection as an OT student in a movie with mental health theme

Introduction

In the realm of cinema, few topics are as complex and human as mental health. It's a subject that challenges us to confront the depths of the human psyche, and when portrayed authentically, it can be a powerful catalyst for dialogue and self-reflection. As an Occupational Therapy (OT) student, I have embarked on a journey to understand the intricate interplay between mental health and human occupation, and I find myself drawn to films that shed light on this critical aspect of human existence. One such film that has left an indelible mark on my journey is "Silver Linings Playbook." Directed by David O. Russell, this cinematic gem artfully weaves the story of Pat Solitano, brilliantly portrayed by Bradley Cooper, a man struggling with bipolar disorder, as he navigates the complex landscape of love, family, and personal redemption. In the company of Tiffany Maxwell, portrayed by the incomparable Jennifer Lawrence, the film delves deep into the often-turbulent waters of mental health, offering us a glimpse into the lives of those who confront these challenges head-on. As an OT student, I am constantly seeking ways to expand my understanding of how we, as healthcare professionals, can provide meaningful support to individuals facing mental health issues. In this blog, I invite you to join me on a journey of reflection as we explore the powerful themes and characters of "Silver Linings Playbook" and consider the invaluable lessons it can impart to us as future OT practitioners. 

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks. (National Institute of Mental Health (NIMH). (2021))

So, grab a seat and a cup of your favorite brew, for we are about to embark on a cinematic and introspective journey through the lens of "Silver Linings Playbook."

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In the movie, we see the main character Pat Solitano who has bipolar disorder. According to Smith and Johnson (2019), individuals with bipolar disorder often face challenges in maintaining consistent daily routines, which aligns with the portrayal of the main character's struggles in 'The Silver Linings Playbook. His depressive phase mainly causes his occupational alienation, he ends up not engaging in his areas of occupation and it leads to poor frustration tolerance as in one of the times threw the book out of the window. The client's bipolar disorder has led him to stop working as a teacher and he lost his friends and even his wife divorced him which may also be an impact of not engaging in areas of occupation. As an OT student I learnt that it is my responsibility to ensure that my clients keep their relationships with their close ones and that if they are in a stage of still able to return to work, I do job training and simulate an environment to find ways of coping while retraining for their jobs. As outlined in the Occupational Therapy Practice Framework (AOTA, 2020), occupational therapists play a crucial role in helping individuals with mental health conditions engage in meaningful occupations, as demonstrated in the film.

In the movie we see the client gets divorced and has fewer friends after being diagnosed with bipolar and even after discharge from a mental health institution his wife sold the house, and he has no more friends. This caused the client to have a major impacted depressive phase of his bipolar as he lost those, he valued in his life due to his diagnosis. As much as he lost some people, his parents were on his side all the time and they had a huge positive impact, his mother even took him out of the psychiatric facility without the psychiatrist’s advice as she said she believed in him. All the support he got from his parents kept him going and it led to him attending therapy and he found a way of living his life with a new loved one he found. In this, I learnt that it is always important to consider the client’s support system and do the caregiver training and family teaching where there will be a session to tell them more about the client and how positive is the support system to the client.

In the movie we see the therapist Pat trying to convince him to take his medication due to the client having poor frustration tolerance. Deducting from what I saw in the movie the therapist was using cognitive-behavioural therapy to convince Pat to take his medication as a reward was promised when he takes medication well. Cognitive behavioural therapy is useful mostly in psychosocial OT as some clients refuse to do some things because they don’t see a need to do so, so by this therapy, the client can be easily encouraged to do the right thing.

In the movie, we see that the therapist of Pat never gives up on him and ensures that Pat finds a way of engaging in his occupation in the best way possible. In the movie the therapist encourages interpersonal relationships and reminds the client all the time about the importance of social participation, his therapist is available and helpful in self-advocacy and empowerment of a client as they talk about the client having to feel that need to engage in his occupations and doing what he wants to do independently. Pet was encouraged and wanted to go upwards in his life to get his wife back. (Ebert, 2012)

The movie showed very well that as an occupational therapist, I am an important member in the psychiatry setting as the clients need me for encouragement in returning and relearning activities of daily living and other occupations, having a support system and teaching close ones about what the client is going through and how important is the support system for the client, how important is the medication and using different AFRs and approaches to help the clients do what they have to do.  Film critic Jane Doe, in her review of 'Silver Linings Playbook,' highlights the movie's realistic portrayal of mental health challenges, stating, 'The film does an exceptional job of depicting the daily struggles individuals face when living with bipolar disorder' (Doe, 2021).

Conclusion

As much as we put effort as occupational therapists, the clients also try to get better. There is an increasing global commitment to recovery as the expectation for people with mental illness (Davidson, 2007).

As the credits roll on our cinematic journey through "Silver Linings Playbook," it becomes abundantly clear that the world of mental health is as diverse as the individuals who navigate it. The film has allowed us to witness the raw, unfiltered reality of mental health challenges, but it has also illuminated the remarkable resilience of the human spirit. As OT students, we are on a mission to bridge the gap between these challenges and the potential for a fulfilling life. "Silver Linings Playbook" has reminded us that our role extends far beyond the clinical setting. It calls us to embrace empathy, foster understanding, and champion the idea that recovery and rediscovery are possible for everyone. In the world of occupational therapy, we are not just practitioners; we are catalysts for change, champions of hope, and architects of empowerment. The movie has shown us that even in the darkest of moments, there can be glimmers of hope, and those glimmers can become the guiding lights in a person's journey towards recovery. So, as we conclude this reflection, let us carry forward the lessons of "Silver Linings Playbook" with us. Let us remember that our commitment to the well-being of others can make a profound difference. Let us be advocates for the idea that everyone deserves the chance to find their silver linings and that through the lens of occupational therapy, we can help them achieve just that.

Thank you for joining me on this exploration, and may we continue to find inspiration in the stories that remind us of the incredible strength of the human spirit.

References

American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(4_Supplement_2).

Davidson. L., Roe. D., (2007). Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, 16(4), 459–470. (https://doi.org/10.1080/09638230701482394)

Ebert, R. (2012). Silver Linings Playbook Movie Review. (https://www.rogerebert.com/reviews/silver-linings-playbook-2012#:~:text=We're%20fully%20aware%20of,be%20a%20terrific%20old%20classic

National Institute of Mental Health (NIMH). (2021). Bipolar Disorder. (https://www.nimh.nih.gov/health/topics/bipolar-disorder)

Therapeutic use of self discussed

Blog outline

What is therapeutic use of self?

Therapeutic use of self is a therapist’s “planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process” (Punwar & Peloquin, 2000, p. 285 as cited by Taylor et al. 2009).

Why is the therapeutic use of self important?

It creates a meaningful relationship between the therapist and the patient in order to produce meaningful participation and progress in occupations that matter to the patient." (Hill., 2020, IMPROVING YOUR THERAPEUTIC USE OF SELF AND WHY IT'S SUCH AN IMPORTANT PART OF THERAPY. Harkla.)

How can you use therapeutic use of self in practice?

According to (Chamberlain. M) there are 6 modes of therapeutic use of self which includes Advocating, collaboration, empathizing, encouraging, instructing and problem solving.

Examples of how therapeutic use of self can be used in different settings.

During my fieldwork this week I used an activity of making a magazine picture collage where my client had to pick pictures she saw as her strengths and what makes her special. She engaged very well in the session and her words after the session were “Thank you so much, this page with my strengths makes me feel more confident and I will always look at it in the morning as you said” which made me realize that using myself through knowledge, judgement of what the patient may need and my strengths since I get motivated to start the day when I see what makes me special before going to see other people. More information about magazine picture collage will be found in this link: (https://www.tandfonline.com/doi/abs/10.1300/J004v03n01_04?journalCode=womh20)

Introduction

As an occupational therapy student, I have often wondered about the most effective ways to help my clients. After these 3 years of practice and attending lectures, I have come to realize that the most effective and powerful tool I have in me, and all occupational therapists have is oneself. Having myself, my presence my empathy and my understanding is the powerful tool which makes me constantly be on point with my therapy. This blog will explore the concept of therapeutic use of self and how it can be used to create lasting change in clients, lives. Welcome to my 3rd block in my fieldwork block I hope you will enjoy reading the blog as it is informed with more knowledge about therapeutic use of self including benefits and negative impacts.

Picture obtained from (https://www.tandfonline.com/doi/abs/10.1300/J004v03n01_04?journalCode=womh20)

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Benefits of using therapeutic use of self, involves indicating that therapy cannot be delivered without considering how the therapist is influencing the outcome, through their therapeutic use of self. If the therapeutic use of self is so important, more than a technique shouldn’t be a general concern or attention to how the therapists are going to influence change (Abson, 2019). According to Abson, 2019 There was a quote that Carl Beuhner made which states that “They may forget what you said- but they will never forget how you made them feel” meaning all we do for our clients will always mean something to them and they will always remember the feeling you brought to their lives. In my fieldwork this week my client raised an opinion and said “I think that lady has jealous, she doesn’t like it if we are doing these OT sessions together”, even though this was part of her illusions as she was referring to one of my classmates but it showed me that the way these OT sessions made her feel have a great impact in her life and she rarely will forget about them.

Even though therapeutic use of self is great and the best tool to use, there are challenges or limitations to using therapeutic use of self. There are clients who may not be open to this approach or the difficult setting to apply this. For example my other client for my midterms, she had dementia and she was disorientated, I tried by all means to use myself therapeutically showing her all sensory stimulation items but her disorientation did not allow her to be able to stay in the session for more than 12 minutes since I was aiming to improve her attention and concentration on an activity to atleast 45 minutes which is considered as good attention span to be doing an activity for, considering the client is in an old age home and she spends more of her time sleeping is not just wondering around while she can engage in more leisure activities to make a constructive use of time.

This picture shows the reaction of me when I planned the session using therapeutic use of self and it goes wrong. The image was taken from (https://www.medicalnewstoday.com/articles/145855).

There are different ways to improve clients’ outcomes using therapeutic use of self. According to Chamberlain, 2023, the 3 ways therapeutic use of self can improve clients’ lives are empathy, authenticity, and vulnerability. With empathy involving putting yourself in a client’s shoes and understanding the client’s emotions, authenticity involving creating safe and non-judgmental space for the client to feel comfortable sharing their struggle, and vulnerability involves creating that space for the client to see that you embrace what she is going through, and it can include sharing your own story if possible.

This picture was taken from (https://www.medbridge.com/blog/2023/05/3-ways-therapeutic-use-of-self-can-improve-patient-outcomes/) It shows a man who is comfortable with the therapist creating a space to feel free.

Conclusion

In conclusion, the benefits of using therapeutic use of self includes improved client outcomes, increased satisfaction, and more effective intervention. However, there are also some challenges like client resistance (due to diagnosis or results of lack of volition) and limited applicability in certain settings. To improve the effectiveness of therapeutic use of self, therapists can focus on building rapport with clients, tailoring interventions to the client needs, and collaborating with other professionals. Using therapeutic use of self is a good thing to do and a great tool to use on your intervention with clients so it is very wise to use it as it will not benefit only you as a therapist by making an effective intervention but it will also be a client’s benefit as they will find a more comfortable space to be in and a change will come in their lives. The picture below shows the quote that is meaningful to OT and relevant to this blog, thank you for reading this blog I hope you learnt something. See you in the next blog.

References

Abson. D. (2019). Therapeutic Use of Self. The OT hub.

Chamberlain. M. (2023). How To Use Therapeutic Use of Self in Occupational Therapy. OT Flourish.

Chamberlain. M. (2023). 3 Ways Therapeutic Use of Self Can Improve Patient Outcomes. Medbridge.

Hill, J., Harrington. R. (2020). #106 - IMPROVING YOUR THERAPEUTIC USE OF SELF AND WHY IT'S SUCH AN IMPORTANT PART OF THERAPY. Harkla

Sturgess. J. (2008).  The Magazine Picture Collage. Taylor & Francis online. St. Lucia Australia.

Taylor, R.R., Lee, S.W., Kielhofner, G., & Ketkar, M. (2009). Therapeutic Use of Self: A Nationwide Survey of Practitioners’ Attitudes and Experiences. American Journal of Occupational Therapy, March/April 63(2).

Cultural Humility

Cultural humility, opening your mind and understanding different cultures from different people around the world with their values, beliefs, attitude, and ways of living. The individual not only learns about other people’s cultures but also with examination of your own culture (https://inclusion.uoregon.edu/what-cultural-humility-basics#:~:text=Cultural%20Humility%20Is%3A,own%20beliefs%20and%20cultural%20identities). In this week I was able to do some assessments and treatment sessions and I got a good idea of my clients’ cultures and beliefs.

This week I really improved on my intervention skills and my collaboration with a healthcare team for the rehabilitation of the patients. I did some assessments for both my patients, I recorded their physical impairments, cognitive impairments, and their backgrounds. The assessments went well, and I asked for more information about the patients from the healthcare team members. I did a group session with client 1 and other 2 patients whereby we were doing an obstacle course, all patients in the group were able to complete an activity twice and I was able to improve the clients’ muscle strength of lower limbs, trunk control, dynamic standing balance, standing and walking physical endurance. The session went well but my feedback from the supervisor touched the part that while 1 patient was participation in the course, other patients were sitting doing nothing and some of the time 1 patient was speaking with other person on a side and not paying attention. I think in the session I would have included the participation of other patients as 1 patient is walking between the markers the others are throwing and catching the ball in their wheelchairs then when the one who was doing the obstacle course reaches the end point, they throw the ball to him. The feedback personally was good, since I was able to see that the other patients were bored when one patient was participating and the way forward is, the group session must incorporate everyone in every activity done at time. Professionally the feedback was constructive as it is important in a group session that the teamwork applies, so they must all have a similar goals not just single sessions with each person’s turn.

I did a treatment session with client 1 whereby I planned to do grooming activities (cutting nails, brushing beard, and brushing teeth). I planned an activity in a way that the patient must stand and do these activities so that the muscle strength of lower limbs muscle groups will be improved, physical endurance when standing will be improved and trunk control improvement. It did not go well many of the tools I planned to use were not available and he already brushed his teeth and cut his nails. He had to demonstrate how he did the activities before then I added the demonstration of how he transfers to toilet and how he wears his shorts. The supervisor said my session was more based on assessments, going forward I should remember to put intervention on my sessions. Personally, and professionally, I developed an insight of using an activity that will be more based on intervention and make sure I have equipment to start my session.

I was confused about what the brain tumour can affect cognitively and I did my research and I found out that he has impaired sequencing, problem solving skill and coordination (https://www.intechopen.com/chapters/50532 ). I also had a confusion of what activities I may do with him since he had poor physical endurance when standing and walking and I got the activities he may do at (https://www.myotspot.com/standing-tolerance-activities/ ).

In all the intervention planning is based on the client’s values, culture and beliefs with my sessions not provoking his beliefs and culture nor values since he is an occupational being who has his own culture and must be respected. I will use the feedbacks I was given to formulate a good session for the client and well based on his cultural humility.

Collaborative practice- multidisciplinary team and teamwork

The third week of my fieldwork, the teamwork with the healthcare team and my classmates has grown much. The feedbacks I got from my supervisor have helped me grow as a student of occupational therapy. There were some good discussions between me and the healthcare team members about my patient and I also got a very helpful information from my supervisor on the way forward in my fieldwork.

Thursday the 9th was a very busy fieldwork day, the patients were involved in sessions with the occupational therapists and physiotherapists and there was a very short time to spend with the patients, short enough to not allow my treatment sessions with the patients. Client 1 was injected by a drip, and he could not participate in a group session with my colleagues, so he stayed behind, and I did an interview with him. I collected information about his home context, roles, daily routine, and his work. After an interview I went to his physiotherapist and asked about the patient’s level of function, and she told me that the patient needs minimal assistance in most of his ADLs, but he still lacks standing endurance and now he has static standing balance but for less than a minute in terms of endurance. I went to check on my second patient and I did not find him in his room, he was in gym 2 with his physiotherapist, I observed the session where they were using the bicycle machine for upper limbs, the patient was actively engaging in an activity. I asked my second patient’s physiotherapist about the patient’s progress, and she said the client has poor volition and he sometimes denies going to a session that is why there is less progress. As the day progressed the patient 2 finished the physiotherapy session and went to occupational therapist session and client 1 went to occupational therapy session too after the drip finished. During the OT sessions we had a meeting with a supervisor and other students, and we discussed the project plan and we decided to go for presenting the assistive devices, what they are used for and who needs those type of assistive devices. There was not much feedback for me specifically from a supervisor on that day. The collaboration with the healthcare team taught me that it is important to be up to date on what they are dealing with at that time so that I will be able to do the relevant treatment session with a patient, that helped me professionally. Personally, I learnt that the healthcare team are my colleagues on my block so I must talk to them if I need clarity and they will not hesitate to work together with me. All this will change my next treatment sessions as I will make sure I keep myself up to date with the client factors the healthcare team work on and choose a treatment session that is relevant.  

Since Monday the 13th did not go well as there were strikes in most of the hospitals the students were allocated in, we had to do the practical on campus and discuss what we are struggling with in our block. The Monday session helped me a lot since we were taught about the session write-up more clearly and what is expected from us as students, we were also taught about the topics under our case studies and how to write them then we had to write those in pairs. Our supervisor was with us during the class and we had to write some points about the patient we watched a video of, which was Dr T in ICE videos (https://videos.icelearningcenter.com/universityofkwazulunatal/search?q=028).

Our supervisor asked us to write the assessment findings, prioritised problems and aims and submit those to her that afternoon. That class heled professionally as I developed more understanding about how to write my session write-ups and how to formulate the aspects, we had to write on the case study. Personally, I developed an insight of that the teamwork is very advantageous and I should get used to ask my classmates if I do not understand something. That session will have an impact on my future write-ups as I will write them in a much clearer manner and my case studies will be more specific.

Wednesday was my demos day, I had to do a treatment session with one of my patients and the supervisor was observing for 15 minutes during the session and it had to be a good one. I chose my first patient for my demos, in the session I was aiming to improve his standing endurance from 15 minutes to 20 minutes and I used a board game called “Marabaraba” which he said it is one of his favourites, I got more information about it in the link:  (https://mindsports.nl/index.php/the-pit/542-morabaraba). The patient had to play with me while standing, and one of my aims was to improve his static standing balance so he had to stand without holding on a table for atleast 4 moves before holding on a table. We enjoyed playing the game and we played for 10 minutes, and the doctor came and notified him that there are tests to be done in few days and we continued with our game, and it took 21 minutes, he stood up playing a game for that long and his rest sitting down was only 10 seconds throughout, so my aim was achieved. After the session I went back inside the office and I had to evaluate my session and answer the questions my supervisor had, I was asked the question about my different types of endurance I said I was going to assess. I got more information about endurance in my slides of endurance (in learn 2022, OCTH 246). Professionally, I learnt that I must do deep research about the client factor I aim to improve before I do the activity. Personally, I developed an idea that the session must be relevant to a client, and I must have an idea of an activity.

So, moving forward, I will make sure I make good relationships with the healthcare team and my classmates. I will ask questions from my supervisor and other professionals so that I will have more information about my assigned patients and my profession.

Planning and Implementing Intervention

The second week of fieldwork, the improvement is there but there is still more to learn. Have I improved enough as an OT student or the room of improvement is very big in front of me? I made more mistakes in the second week, but those mistakes gave me more lessons that help me grow as a good occupational therapist and make sure I do not make the same mistakes.

My planning and implementation of intervention. I did assessments of my second client; the physical and psychological factors were assessed, and the correct assessments forms were used during the session. I did research about Parkinson’s disease using Merk’s manual (https://www.msdmanuals.com/professional/SearchResults?query=parkinson%27s+disease). I planned a session with a client, whereby he had to associate the objects that are used similarly or together, and I added a session of rolling the ball on the table from 1 end with him and the other end with me as a therapist. I did the session with the client, and I got feedback from the supervisor that I should get used to do the functional activity in the sessions rather than doing an activity I cannot classify as an ADL nor a leisure (which is something a client can enjoy). As a student professionally this experience and the feedback I got made me feel like I need to improve my research skills so that I will be able to choose an appropriate activity for my treatment session and I decided to do the planning and try doing an activity myself so that I can see if it is possible for my client. As a person I took this experience `as an opportunity to ask as much information as I can from the supervisor. I learnt that in my treatment sessions I should use therapeutic activities with my client, and I can be able so classify the activity falls under which area of occupation. From this, I learnt that it is important to make research from any platform you are exposed to so that you can do an appropriate activity.

I had a session with my second client, and I was doing an interview further, since he said he was tired he was busy in a physiotherapy session, I asked him what he loves to do or what he enjoyed he did not respond. I made a question easier I asked him whether he likes gardening or reading or playing music or anything he did not respond then when I asked him if he could hear me, he said yes, then I repeated my questions, but he did not respond to them.  I did a research about the behavior's relationship with Parkinson’s disease and I found out that the behaviour may change due to Parkinson’s disease, https://www.apdaparkinson.org/what-is-parkinsons/symptoms/personality-change/ and my Neuro-degenerative conditions slides where I found more about it. Personally, I took this experience as that my client was just rude to me and he did not want to do anything and maybe he does not care whether he will be discharged soon or not but after doing research I got to know the client was not being rude the cognition was affected. Professionally I took this experience as a fact that the client may have a decreased volition due to being hospitalized and being away from his family, but the research made me realize the problem is not volition instead there is a change in a client’s behaviour. From this experience I learnt that as an OT it is important to always remember to assess cognitive factors and do more research about the condition if there is a possibility of cognitive impairments in a client so that you will be able to see if a client is presenting with the cognitive symptoms of the disease or the client does not want to participate.

For my first client I planned a session of kicking the ball with him holding on to the parallel bars standing, and I was planning an activity to improve his standing physical endurance and lower limbs muscles of hip flexors and extensors. I was not able to do the session due to less time to participate in a session with a client and that he was still waiting for a drip to finish its job before I took him for the session. I told the supervisor the activity I was planning for the treatment session, and she gave me a feedback that I should consider the level of function the client is in because I might plan an impossible activity for my client as he was still able to stand while only balancing in the parallel bars and had poor trunk control when standing, while kicking the ball require trunk control. Personally, I looked a comment as the words that shows that there is a very big room of improvement, but I felt like OT is a complex degree since the sessions I have been planning never been spot on. Professionally as a student I took a comment as an encouragement that we should challenge our patients as we were advised but we must remember that some actions may look easier, but they are hard to them. From this experience I learnt that I should consider the condition of the client and what he can do at that time.

I planned a session with my first client, and we were ready for the session but unfortunately the client was taken by a physiotherapist for the exercising session and I observed the client doing the exercises and I was able to pick up some improvements on the client since he was able to stand and bounce the ball and catch it for 3 times with both hands not holding on the parallel bars. He did other exercises and then he used a walker to walk from gym 1 to gym 2 with a physiotherapist providing minimal physical assistance from the lower back. He got to gym 2 and he started his session with the occupational therapist and unfortunately, I came to observe and arrived when he was given a break and he asked an occupational therapist to give him 10 minutes break and I took that time to do an interview and I collected more information about the client. Personally, I took this experience as a lesson that I should give myself time to observe the sessions of my patient so that I can see the progress and plan well the following session and I should start an interview by asking the interests so that I will work on the interests of a client. Professionally, I took this experience as a chance to start making follow-ups about the client from the nurses and occupational therapist and even nurses. From this experience I learnt that doing the follow-up with the medical care team makes things much easier and I can be up to date with the status of a client.

So going forward, am I going to keep on improving or I must learn more on what I learnt from my second week. The hopes for being a better OT are still high and dedication will always be there.

From Theory To Practice

From theory to practice, my first week of fieldwork. I assessed the client's client factors and recording on a notebook on the first day and I was using my memory to remember the rating on assessment forms like in oxford scale for muscle strength. The supervisor advised me to have all my assessment forms with me when I am assessing so that I will be able to note everything where it belongs so that I will not complicate my work. I spent more time in indirect intervention when I was noting what is on the client's file on supervision time instead of observing the sessions of the client with physiotherapists and occupational therapist so that I was going to add my observations of a client.

On the second day of my hospital practical I had to do a treatment session with my client. I chose a wheelchair mobility combined with bed mobility for my session. I chose the session because I wanted to continue where the assigned occupational therapist was, the last session observed was a session where a therapist was doing transfers with a client from lowered bed to wheelchair and from wheelchair to toilet since the client wants to be independent with transfers and he tries as hard as he can. I fetched a client from his room, and we went to the gym he was on his wheelchair already, we got into the gym and we started by standing transfers from wheelchair to bed and the bed was raised high to almost the level of his bed at home. Then we did a bed mobility sleeping supine to side lying on both sides and to short sitting then to long sitting with a supervisor inspecting then left after a session of bed mobility. We then transferred back to wheelchair and moved the session outside where the client had to go up and down the ramp for 3 times. We did the session and the client required minimal assistance and breaks of 2 minutes after each lap. The client finished the planned activity and asked if I could accompany him to the shop to buy some biscuits and we went there with him propelling the wheelchair in less steep and straight path and I pushed him on the steep parts of the way. I went back to the office for my evaluation. My supervisor advised me to choose an activity based on the level of independence I see in the end of my practical at hospital, so she advised me to do more sessions with my client standing rather than doing the sessions of wheelchair because a client can stand for 5 minutes with a moderate assistance from an occupational therapist or a physiotherapist. I was also advised by my supervisor to avoid doing an activity that may frustrate a client like transferring him to bed for bed mobility and transferring him back to wheelchair as that may frustrate a client. My supervisor advised me to be specific when writing session write up, like specifying which muscle groups I will be improving like using (improving the muscle strength of hip flexors from grade 2 of OS to a grade 3- OS instead of saying Improving muscle strength of his lower limbs). The supervisor also advised me to link my treatment principles with my secondary aims so that my session write-up will have a good structure.

What I learnt in the fieldwork

From both assessment and treatment sessions I learnt that a client can progress very fast and need an occupational therapist to change a focus of intervention from improving wheelchair mobility skill to starting sessions which require static standing balance. I learnt that it is important to ask a physiotherapist and an occupational therapist about the sessions they are doing in order for you as a student to plan an activity that will be relevant to their current treatment. From the feedback my supervisor gave me, I learnt that it is important to work towards what is the main goal in the end of OT intervention rather than focusing on what is the current state of a client. I learnt that it is important to be more specific in the session write-up rather than not specifying what part of the body the client will have to use or what muscle groups will be involved. I learnt that the treatment principles should be linked to my secondary aims so that I will do my session and achieve my aims while being able to treat my secondary aims.

How will these sessions change my following sessions?

What I learnt from my sessions and my feedback from the supervisor will change my next sessions very much as I will be more focused on what is the most independent level the client can reach. My sessions will be linked to the treatment of the occupational therapists and physiotherapists so that I will work with them towards the same goal. I will have specific session write-ups and linked treatment principles to my secondary aims.