Jen Trinh

Reflective Diary Level II Fieldwork

Tuesday June 25th / 1:30pm Acute Care

Factual Strand: It was another day at the acute care hospital at

Intermountain medical center (IMC). Before entering into the patient’s room, I

was instructed to lead the session fully, and Lisa, my clinical instructor, would

intervene if necessary. Lisa and I entered the patient’s room where she was

found supine in the bed with family present. I introduced myself as an OT student

and began explaining her goals for therapy, which included lower body dressing,

simulated mock car transfers, toileting, and grooming/hygiene with modified

independent. The patient had orders for spinal precautions indicating no bending,

lifting, or twisting after having back surgery the day before.

I began therapy by asking the patient to verbalize understanding of her

spinal precautions. I asked her to utilize the logroll technique to get into a seated

position at the edge of the bed. She demonstrated understanding and did so with

ease. I was quite impressed with how well she was moving. She then proceeded

into a standing position in which she got up to her front wheel walker as she

maintained her spinal precautions and walked into the bathroom to complete her

next grooming and hygiene task. As she began to brush her teeth, I educated her

on helpful tips to bend at the hips during spiting and rinsing at the sink to prevent

bending and twisting of the spine. She looked at me and said, “oh yeah, that’s

what I’ve been doing” and continued with the task. I can tell that she was very

cautious with her spinal precautions. I then had her return to the edge of her bed

to work on donning and doffing sweat pants and socks with a reacher tool. I
demonstrated the tools and asked the patient to complete the task. She

performed the task effortlessly and did not need my assistance. At this point, I felt

the patient was getting pretty irritated when she sighed and said: “I know how to

get my pants and socks on and off with tools.” My next thought was to continue

working on her other goals, which were the mock car transfer and toilet

management.

After the dressing activity, Lisa could sense that the patient was on the

verge of losing interest in therapy. She intervened the session by acknowledging

the patient frustration as she redirected her. Lisa asked the patient if she had any

other concerns that might prevent her from participating in daily activities when

she returns home? The patient responded, “Oh yes, I am still trying to figure out

how to wipe after a bowel movement without breaking the spinal precautions.

Lisa then took the patient into the bathroom and educated her on different tools

and techniques to use during peri care.

Retrospective Strand: At the beginning of the session I was confident with

my treatment plan, but the more I progressed with the activities I felt like I was

losing the client’s interest and “buy-in” for therapy. I felt like I was doing well until

the moment when I did not know how to respond to the client’s remarks and

initial frustration during the dressing task. I discovered that in this situation if I had

begun therapy addressing the patient’s personal needs and concerns, then she

would have felt more comfortable with what I had planned for treatment. With my

previous fieldwork experience and working as a physical therapy aide at IMC, I

learned best by having hands-on experience and being observant of what other
therapists have done in the past. I was taught to carry out therapy sessions

based on the client’s goals in a structural manner following the treatment plans.

Therefore, I have continued with that mindset and way of thinking when working

with my clients at the hospital.

Substratum Strand: Before this incident, I have worked with six other

patients at the acute hospital with Lisa’s supervision, and her feedback to me

was that I was doing very well after each session. I continued with my treatment

plans, and to both Lisa’s understanding and mine, patients were satisfied after

our treatment sessions. It was not until this incident, where I witnessed the

patient express frustration and dissatisfaction with their therapy. Going off of

treatment plans allows me to feel more comfortable and confident in what I am

doing when working with acute care patients. I find it challenging when I have to

think “on my toes” in a hospital setting due to the lack of personal experience I

have as a therapist. I understand that I need to be more flexible when addressing

the patient’s individual needs and concerns before I carry out a specific treatment

plan. I learned that there are patient’s that will challenge my insecurities, but it is

my profession to provide them with the tools and knowledge to return home

safely and independently.

Connective Strand: The incident mentioned above has made me realized

how important it is for me, as an occupational therapist student, to develop a

habit of flexibility in therapy to address the client’s personal needs before

proceeding with their daily goals. I learned that it is crucial to be able to grade

activities at the moment, and it’s an area that I will need to improve on for future
practice. For my next level II fieldwork, I will make it a habit to discuss client-

specific scenarios with my clinical instructor and receive their instant feedback to

my responses. To do so, I will list various ways to grade activities accordingly to

meet the needs of my client so that I can provide them with “just the right

challenge” for therapy. Practicing these skills and learning from my past

mistakes, I will continue to grow as a therapist.