1. Advocates for clients who have been neglected or underrepresented in the system.
As I began to understand the huge impact insurance can have on patients’ therapy frequency and duration I became more aware of the underrepresentation that it can cause. During my outpatient rotation there was a patient who was living in a skilled nursing facility, but receiving treatment through this outpatient clinic due to insurance not covering therapy. When I first observed this patient he was very aggressive with my supervisor and appeared to be closed to suggestions/modifications that could be made for him. He had experienced a brain aneurysm that presented as a spinal cord injury diagnosis. I observed my supervisor once with this patient and the next session she told me I would be conducting the next therapy session. I was quite nervous to begin therapy with him due to his behavior from the previous session. I started the session by talking with him initially before he completed the exercises. This patient immediately took his guard down. I asked the patient questions such as: his priorities for therapy, any concerns regarding the activities of his daily routine, and what would he like to be accomplishing more independently in the skilled nursing facility. The patient immediately began to respond to my questions. In this process I realized that the patient was having a difficult time with bowel retraining. There was a lack of communication from the skilled nursing facility and the outpatient clinic. The clinic assumed that the patient was receiving the help he needed, and the nursing home assumed that the clinic would assist him in the retraining process. I then explained to the patient that bowel retraining was in our scope of practice as occupational therapists, although it might be difficult to see carryover of this skill due to this skill being executed primarily in the skilled nursing facility. I then explained that I would research education on this topic, and would identify who to contact to assist him in training on site at the facility. I collaborated with my supervisor regarding the session and we were able to get in touch with the patient’s nurse. It was a beneficial conversation with his nurse at the skilled nursing facility, because we determined the patient required a doctor’s order to allow nursing to assist in bowel retraining process. The nurse obtained the doctor's order for the patient to receive a bed side commode and begin the bowel retraining. The next therapy session I provided the patient with bowel retraining education and discussed the patient's concerns regarding the training. I also informed the patient that a doctor’s order had been placed and he should receive the bedside commode soon. He gained a sense of independence through this process. Although I do not feel that this patient was being neglected in the system; I do feel that he was being unrepresented through miscommunication of facilities. It was an eye opening experience to see the joy in the patient’s eyes after we had assisted him. I have attached the bowel retraining education that I provided to this patient.
bowel_retraining.docx
2. Fulfills commitments to the professional community.
During my time at St. Jude I attended a professional seminar regarding religion in health care. My fieldwork educator explained to me the morning prior to the seminar that she recommended for me to attend. I utilized my time efficiently to complete documentation and prepared for treatment sessions in advance in order to attend the seminar. This seminar discussed religion in healthcare, and specifically when the patients’ religion is something you as a healthcare professional are not comfortable with discussing. The knowledge I obtained from the seminiar provided the opportunity to debrief with my fieldwork educator. The seminar informed me to never fear discussions of religion, instead have an open mind to other religion viewpoints. As health care professionals we might not agree with the choices that patient's make regarding religion, but we must have an open mind that our perspective is not the only view. There were examples given by a panel of employees from St. Jude that gave perspective of religion with patients. Through attending this seminar, I fulfilled my commitment to not only the OT staff at St. Jude, but also represented the students at this facility. This seminar provided me with a wonderful professional experience that I will utilize in my future career.
3. Represents the unique perspective of occupational therapy when participating in inter-professional situations.
I presented to all therapy disciplines during my first rotation at Methodist South outpatient facility. After I collaborated with occupational therapists I was asked to present on an assessment that was new to the facility. Through this presentation I was able to discuss the purpose, administering, and scoring of the REAL assessment (the roll evaluation of activities of daily living). Although those points were crucial to the presentation, my favorite point was the opportunity to discuss an occupational therapy perspective regarding the assessment. This assessment was created by an occupational therapist, so I began the presentation providing the audience with basic knowledge of our profession. Surprisingly, there were other disciplines that had various questions related to basic knowledge and values of occupational therapy. This broadened my perspective of the importance of advocating and discussing the unique values of our profession. Before this presentation I assumed that other health care professionals understood occupational therapy, and now I will no longer make this assumption. Presenting to other disciplines provided me the possibility to give specific examples of ADLs/IADLs, client centered practice, building rapport with parents and many other situations through the case studies explained during my presentation. Below I have attached a link for the presentation on the REAL assessment.
real_presentation_.pdf
4. Assumes responsibility for professional behavior and growth, in accordance with AOTA standards.
As I read the AOTA professional behaviors it was evident that a difficult professional behavior for me to maintain occassionally is the boundary between personal and professional relationships. During my time at St. Jude my professional and personal boundary line was tested. As I began to build rapport with certain patients I found myself striving to go above and beyond for treatment plans and client centered practice. Although this is a goal for an occupational therapy practitioner there is a fine line that must be drawn. I collaborated with my educator on her strategies for boundaries with patients. My educator furthered my knowledge and explained that in some circumstances she had patients placed on other therapists’ caseload when the line of professional behavior is close to being crossed.
Through this collaboration with my educator I assumed responsibility professional behavior and growth relating to professional and personal roles with patients. I communicated openly with my educator and discussed the rapport I built with my patients, which provided constructive/professional feedback. For example, a specific patient constantly loved being surprised by new activities in occupational therapy sessions. Although this does not seem an extreme cross of professional and personal behavior I began to struggle with the idea of not being able to supply all patients with this same opportunity of new crafts and activities every session. Bringing surprises for this specific patient was a great motivating factor, however I discussed the situation with my educator and we created the only solution. We discussed with the six-year-old patient that we could not complete new crafts every session and bring surprises, but explained we could begin to bring games/activities she has not engaged in yet that we already had at the facility. This was a specific way I was able to assume responsibility for professional behavior and growth in accordance to the AOTA standards in regard to building patient rapport. I have attached links and APA references for articles that have assisted me in maintaining my professional behavior and growth through my level two fieldwork experience.
www.aota.org/-/media/corporate/files/practice/ethics/advisory/professional-boundaries-adv.pdf
developing_of_professional_behaviors_.pdf
Reference
Fidler, Gail S. “Developing a Repertoire of Professional Behaviors.” (1996). American Journal of Occuapational Therapy, Vol. 50, 583-587. doi:10.5014/ajot.50.7.583
Foster, Ann Moodey Ashe MHS, OTR/L & Foster, Loretta Jean MS, COTA/L. (2016). "Establishing Professional Boundaries: Where to Draw the Line." American Journal of Occuaptional Therapy Association. Retrieved from https://www.aota.org/-/media/corporate/files/practice/ethics/advisory/professional-boundaries-adv.pdf
5. Functions autonomously and effectively in a broad array of service models.
Through the three Level II rotations I practiced under a wide range of service models. My first rotation was at Methodist South outpatient, my seond rotation was inpatient psychosocial at Baptist Health Hospital, and lastly inpatient/outpatient pediatric at St. Jude Research Children’s Hospital. I have attached three evaluation templates I have utilized at each facility. The evaluation templates provide evidence that I functioned effectively in a broad array of service models. As I reflect over the three evaluation templates it reminds me of the growth I have experienced professionally and clinically as a future occupational therapist. At the end of each rotation I received feedback that reflected positively on my ability to function autonomously at each facility. By the end of each rotation I have held a full caseload independently. The feedback from each fieldwork educator and personal reflection are evidence that I have functioned autonomously and effectively in various service models. I have attached links to the templates utilized at each facility.
outpatient_evaluation_template_.rtf
inpatient_evaluation_template.pdf
st._jude_developmental_evaluation.docx
st._jude_pediatric_initial_evaluation_template.docx
6. Upholds the AOTA Code of Ethics in practice.
I have held the AOTA Code of Ethics as a priority during all level two fieldwork rotations. I have attached screenshots from my fieldwork educators’ evaluation regarding my performance. The two pictures indicate that both of my supervisors view my performance regarding ethics as meeting standards and exceeding standards. This provides evidence that throughout my three-month period they were able to view my priority of upholding the code of ethics and its importance as an occupational therapist. I plan to continue to hold these ethics regarding patients, colleges, and overall performance throughout my future career.
final_evaluation_completed_by_fwe-rotation_a.png
final_evaluation_completed_by_fwe-rotation_b.png
7. Serves as a role model for honesty, integrity, and morally grounded decision making.
My time at Baptist Health gave me the opportunity to serve as a role model based on honesty and integrity. This opportunity began with a patient who was admitted to the facility for substance abuse. In order for the patient to be discharged social workers were required to hold a final follow up session to confirm discharge planning. The patient expressed to the social worker she made an appointment with a short term rehab center. She stated that her appointment was in a few hours and needed to be discharged as soon as possible. When I evaluated the patient she explained to me she did not have an appointment with a rehab center. She expressed that she wanted to leave the facility and thought it would be a requirement to discharge if the facility thought she had an appointment. Hearing this information was difficult, because I wanted to have rapport with the patient. I explained to the patient that she needed to be honest with the social worker, because they would find this information out eventually. The patient was unwilling to offer this information to the social worker, so I explained that if she did not let them know I would be required to inform them into the situation. The patient, social worker, and I met and discussed the patient’s discharge planning to determine the best option for this patient. Although the patient was not honest initially, through discussion we were able to find out additional information. The patient disclosed additional social history and opened up to us, which gave us better insight into her situation. The patient stayed at the facility a few days longer and discharged to a long term rehab facility. I felt that through this encounter it was my role as an occupational therapy student to not only be a role model for this patient, but hold myself to the highest integrity and honesty by disclosing the information to the social workers. This clinical experience provided me with collaboration experience that will remain beneficial in my future career.
As I began to understand the huge impact insurance can have on patients’ therapy frequency and duration I became more aware of the underrepresentation that it can cause. During my outpatient rotation there was a patient who was living in a skilled nursing facility, but receiving treatment through this outpatient clinic due to insurance not covering therapy. When I first observed this patient he was very aggressive with my supervisor and appeared to be closed to suggestions/modifications that could be made for him. He had experienced a brain aneurysm that presented as a spinal cord injury diagnosis. I observed my supervisor once with this patient and the next session she told me I would be conducting the next therapy session. I was quite nervous to begin therapy with him due to his behavior from the previous session. I started the session by talking with him initially before he completed the exercises. This patient immediately took his guard down. I asked the patient questions such as: his priorities for therapy, any concerns regarding the activities of his daily routine, and what would he like to be accomplishing more independently in the skilled nursing facility. The patient immediately began to respond to my questions. In this process I realized that the patient was having a difficult time with bowel retraining. There was a lack of communication from the skilled nursing facility and the outpatient clinic. The clinic assumed that the patient was receiving the help he needed, and the nursing home assumed that the clinic would assist him in the retraining process. I then explained to the patient that bowel retraining was in our scope of practice as occupational therapists, although it might be difficult to see carryover of this skill due to this skill being executed primarily in the skilled nursing facility. I then explained that I would research education on this topic, and would identify who to contact to assist him in training on site at the facility. I collaborated with my supervisor regarding the session and we were able to get in touch with the patient’s nurse. It was a beneficial conversation with his nurse at the skilled nursing facility, because we determined the patient required a doctor’s order to allow nursing to assist in bowel retraining process. The nurse obtained the doctor's order for the patient to receive a bed side commode and begin the bowel retraining. The next therapy session I provided the patient with bowel retraining education and discussed the patient's concerns regarding the training. I also informed the patient that a doctor’s order had been placed and he should receive the bedside commode soon. He gained a sense of independence through this process. Although I do not feel that this patient was being neglected in the system; I do feel that he was being unrepresented through miscommunication of facilities. It was an eye opening experience to see the joy in the patient’s eyes after we had assisted him. I have attached the bowel retraining education that I provided to this patient.
bowel_retraining.docx
2. Fulfills commitments to the professional community.
During my time at St. Jude I attended a professional seminar regarding religion in health care. My fieldwork educator explained to me the morning prior to the seminar that she recommended for me to attend. I utilized my time efficiently to complete documentation and prepared for treatment sessions in advance in order to attend the seminar. This seminar discussed religion in healthcare, and specifically when the patients’ religion is something you as a healthcare professional are not comfortable with discussing. The knowledge I obtained from the seminiar provided the opportunity to debrief with my fieldwork educator. The seminar informed me to never fear discussions of religion, instead have an open mind to other religion viewpoints. As health care professionals we might not agree with the choices that patient's make regarding religion, but we must have an open mind that our perspective is not the only view. There were examples given by a panel of employees from St. Jude that gave perspective of religion with patients. Through attending this seminar, I fulfilled my commitment to not only the OT staff at St. Jude, but also represented the students at this facility. This seminar provided me with a wonderful professional experience that I will utilize in my future career.
3. Represents the unique perspective of occupational therapy when participating in inter-professional situations.
I presented to all therapy disciplines during my first rotation at Methodist South outpatient facility. After I collaborated with occupational therapists I was asked to present on an assessment that was new to the facility. Through this presentation I was able to discuss the purpose, administering, and scoring of the REAL assessment (the roll evaluation of activities of daily living). Although those points were crucial to the presentation, my favorite point was the opportunity to discuss an occupational therapy perspective regarding the assessment. This assessment was created by an occupational therapist, so I began the presentation providing the audience with basic knowledge of our profession. Surprisingly, there were other disciplines that had various questions related to basic knowledge and values of occupational therapy. This broadened my perspective of the importance of advocating and discussing the unique values of our profession. Before this presentation I assumed that other health care professionals understood occupational therapy, and now I will no longer make this assumption. Presenting to other disciplines provided me the possibility to give specific examples of ADLs/IADLs, client centered practice, building rapport with parents and many other situations through the case studies explained during my presentation. Below I have attached a link for the presentation on the REAL assessment.
real_presentation_.pdf
4. Assumes responsibility for professional behavior and growth, in accordance with AOTA standards.
As I read the AOTA professional behaviors it was evident that a difficult professional behavior for me to maintain occassionally is the boundary between personal and professional relationships. During my time at St. Jude my professional and personal boundary line was tested. As I began to build rapport with certain patients I found myself striving to go above and beyond for treatment plans and client centered practice. Although this is a goal for an occupational therapy practitioner there is a fine line that must be drawn. I collaborated with my educator on her strategies for boundaries with patients. My educator furthered my knowledge and explained that in some circumstances she had patients placed on other therapists’ caseload when the line of professional behavior is close to being crossed.
Through this collaboration with my educator I assumed responsibility professional behavior and growth relating to professional and personal roles with patients. I communicated openly with my educator and discussed the rapport I built with my patients, which provided constructive/professional feedback. For example, a specific patient constantly loved being surprised by new activities in occupational therapy sessions. Although this does not seem an extreme cross of professional and personal behavior I began to struggle with the idea of not being able to supply all patients with this same opportunity of new crafts and activities every session. Bringing surprises for this specific patient was a great motivating factor, however I discussed the situation with my educator and we created the only solution. We discussed with the six-year-old patient that we could not complete new crafts every session and bring surprises, but explained we could begin to bring games/activities she has not engaged in yet that we already had at the facility. This was a specific way I was able to assume responsibility for professional behavior and growth in accordance to the AOTA standards in regard to building patient rapport. I have attached links and APA references for articles that have assisted me in maintaining my professional behavior and growth through my level two fieldwork experience.
www.aota.org/-/media/corporate/files/practice/ethics/advisory/professional-boundaries-adv.pdf
developing_of_professional_behaviors_.pdf
Reference
Fidler, Gail S. “Developing a Repertoire of Professional Behaviors.” (1996). American Journal of Occuapational Therapy, Vol. 50, 583-587. doi:10.5014/ajot.50.7.583
Foster, Ann Moodey Ashe MHS, OTR/L & Foster, Loretta Jean MS, COTA/L. (2016). "Establishing Professional Boundaries: Where to Draw the Line." American Journal of Occuaptional Therapy Association. Retrieved from https://www.aota.org/-/media/corporate/files/practice/ethics/advisory/professional-boundaries-adv.pdf
5. Functions autonomously and effectively in a broad array of service models.
Through the three Level II rotations I practiced under a wide range of service models. My first rotation was at Methodist South outpatient, my seond rotation was inpatient psychosocial at Baptist Health Hospital, and lastly inpatient/outpatient pediatric at St. Jude Research Children’s Hospital. I have attached three evaluation templates I have utilized at each facility. The evaluation templates provide evidence that I functioned effectively in a broad array of service models. As I reflect over the three evaluation templates it reminds me of the growth I have experienced professionally and clinically as a future occupational therapist. At the end of each rotation I received feedback that reflected positively on my ability to function autonomously at each facility. By the end of each rotation I have held a full caseload independently. The feedback from each fieldwork educator and personal reflection are evidence that I have functioned autonomously and effectively in various service models. I have attached links to the templates utilized at each facility.
outpatient_evaluation_template_.rtf
inpatient_evaluation_template.pdf
st._jude_developmental_evaluation.docx
st._jude_pediatric_initial_evaluation_template.docx
6. Upholds the AOTA Code of Ethics in practice.
I have held the AOTA Code of Ethics as a priority during all level two fieldwork rotations. I have attached screenshots from my fieldwork educators’ evaluation regarding my performance. The two pictures indicate that both of my supervisors view my performance regarding ethics as meeting standards and exceeding standards. This provides evidence that throughout my three-month period they were able to view my priority of upholding the code of ethics and its importance as an occupational therapist. I plan to continue to hold these ethics regarding patients, colleges, and overall performance throughout my future career.
final_evaluation_completed_by_fwe-rotation_a.png
final_evaluation_completed_by_fwe-rotation_b.png
7. Serves as a role model for honesty, integrity, and morally grounded decision making.
My time at Baptist Health gave me the opportunity to serve as a role model based on honesty and integrity. This opportunity began with a patient who was admitted to the facility for substance abuse. In order for the patient to be discharged social workers were required to hold a final follow up session to confirm discharge planning. The patient expressed to the social worker she made an appointment with a short term rehab center. She stated that her appointment was in a few hours and needed to be discharged as soon as possible. When I evaluated the patient she explained to me she did not have an appointment with a rehab center. She expressed that she wanted to leave the facility and thought it would be a requirement to discharge if the facility thought she had an appointment. Hearing this information was difficult, because I wanted to have rapport with the patient. I explained to the patient that she needed to be honest with the social worker, because they would find this information out eventually. The patient was unwilling to offer this information to the social worker, so I explained that if she did not let them know I would be required to inform them into the situation. The patient, social worker, and I met and discussed the patient’s discharge planning to determine the best option for this patient. Although the patient was not honest initially, through discussion we were able to find out additional information. The patient disclosed additional social history and opened up to us, which gave us better insight into her situation. The patient stayed at the facility a few days longer and discharged to a long term rehab facility. I felt that through this encounter it was my role as an occupational therapy student to not only be a role model for this patient, but hold myself to the highest integrity and honesty by disclosing the information to the social workers. This clinical experience provided me with collaboration experience that will remain beneficial in my future career.