2.1 Advocates for clients who have been neglected or underrepresented in the system.
I had a client during my Level II Fieldwork A rotation in acute care that had an infection in a hip that had previously been replaced. This client was a 400lb male with a history of arthritis in both hips and multiple back surgeries. The client came in to have a surgery where the infected hardware would be removed and an antibiotic spacer would be inserted. Due to the nature of the spacer, the client was non-weight bearing as well as had anterior and posterior hip precautions. The physician was pushing for the client to go home post surgery but the client reported to me that he did not feel like he could follow hip precautions at home and has little help. In my evaluation, my discharge recommendation was SNF. I continued to write in my treatment notes that the client has been max A x 2-3 for sit to stand transfers and unable to complete BSC or tub transfer. I continued to see the client and he reported the physician was still planning on discharging home. One day when I was in the room working with the client, the physician came in. He had very poor bedside manner, never made eye contact with the client, and simply told the client "he needed to be getting up into the recliner a couple of times a day". I decided this was a good chance to update the physician on the client's progress in therapy. I informed him how we are recommending SNF due to his assist levels for transfers and no help at home. Later in the day, I took a look back at the clients EMR and the physician had told case management to start the process for SNF authorization rather than home. This gave me a boost of confidence that I can still be respectful to other medical professionals while advocating for my clients at the same time.
2.2 Fulfills commitments to the professional community.
I fulfilled my commitments to the professional community by providing in-services, projects, and exposing therapist's to the most updated evidenced based practice that could be used after my rotation was over. During my Level II outpatient pediatrics rotation, I made a collective "goal bank" during my time there to simplify goal writing. This helped me to identify the deficits we were addressing with each goal. I grew much more confident in my goal-writing ability after this project. I presented this project to the OT team during my last week and they will be incorporated my example goals into their electronic medical record. From there, they will be able to pull from my example goals when writing evaluations, re-evaluations, and plan of cares. I enjoyed being able to give back to both fieldwork sites to help the therapist's be the best they can be! Please feel free to view my goal writing project below. https://docs.google.com/document/d/11ukNRRFCfkOiiKFJzxiEc42E_KCP4vnzR6M4z9GLrpg/edit?usp=sharing
2.3 Represents the unique perspective of occupational therapy when participating in inter-professional situations.
During my time in acute care, I had many opportunities to give my elevator speech on what OT is and the benefit to clients, caregivers, and medical professionals. It was not uncommon for family or other medical professionals to walk in during my treatment sessions. Many times it would be nurses and I would inform them on why I was elevating a certain UE or LE, or why I had them turned a certain way. I would also make sure to ask the patients nurse when the last time they were rotated to help prevent pressure sores. I enjoyed developing close relationships with other disciplines to best serve the patient!
2.4 Assumes responsibility for professional behavior and growth, in accordance with AOTA standards. During both of my clinical experiences, I was given the opportunity to observe new things that allowed me to grow as a future occupational therapy practitioner. During my acute care rotation, I asked if I could observe a modified barium swallow study. I was very interested to see what a MBSS was so that I could describe it to my patient's is they asked. It was very insightful being in the radiology room with the speech therapist and a radiologist. In addition to this opportunity, I was also able to observe an orthopedic surgery consisting of a total knee arthroplasty. The surgeon let me scrub in and I was able to be hands on in the surgery. I assisted the surgeon by holding the patient's leg in place while he grabbed tools he needed. It was amazing to see what the surgery consisted of with my own eyes.
2.5 Functions autonomously and effectively in a broad array of service models. The two images below are from both of my fieldwork educators on my final evaluations. By week six on each rotation, I was treating and documenting independently. Though these settings, acute care and outpatient pediatrics, are very different from each other I felt that I adapted well. I was complimented on multiple occasions that I am a fast learner. The difference between my two fieldwork settings is beneficial for me because it allowed me to grow in my creative thinking skills and adaptability. I was also consistently meeting productivity standards which differed between the two settings. Acute care was much more fast paced, however the documentation was more check-boxes and yes/no questions. In outpatient pediatrics, the documentation required more thoroughness and also more justification for services due to recent changes in insurance regarding reimbursement for pediatric OT services. Below, I have attached feedback from both of my FWE's that expressed my ability to met productivity standards and completing documentation.
2.6 Upholds the AOTA Code of Ethics in practice. During my both of my rotations, protecting my client's privacy was also on the fore-front of my mind. I feel that I upheld the American Occupational Therapy Association Code of Ethics in my practice daily. I practiced veracity, autonomy, and nonmaleficence with my clients. I upheld the principle of veracity by always letting my client's know who I was, my title, the evaluation process, and reassuring my client's understanding. To give you an example, while on my acute care rotation, evaluations are conducted daily. Each room I entered I would introduce myself, explained my role, and what our sessions would consist of. Explaining all this to the client allowed both the client and I to be on the same page. This also gave the client opportunity to ask any questions and even decide whether they want to participate or not. I upheld the principle of autonomy daily by keeping client information confidential. I made sure to always keep my laptop closed and my clipboard upside down. This ensured that any other patient's or families that may have walked passed them could not see patient's information. I also made sure to uphold HIPAA (Heath Information Portability and Accountability Act) as evidenced by not revealing any patient's information to other patients, families, or friends. There was an instance during my outpatient pediatric rotation where my grandmother was telling me about her friend's grandson that has autism. She mentioned his name and said that he gets occupational therapy but was not sure which clinic. It turned out that this child was one of my client's. However, I could not reveal that information even though she was my grandmother out of respect for the child and his family. I upheld the principle of nonmaleficence ensures no harm is done to the client. When I would perform ROM and MMT on the client, I would ensure that they would only range their extremities as far as they could go before pain. This guaranteed there would no harm done to the client. Below, I have attached feedback from my FWE that expressed my abilities to uphold the AOTA Code of Ethics in my practice.
2.7 Serves as a role model for honesty, integrity, and morally grounded decision making. During both of my fieldwork rotations, I was fortunate enough to have amazing fieldwork educators that served as role models for me. They each modeled honesty, integrity, and made morally grounded decisions. I was able to learn from both of them how important it is to maintain honestly with our client and navigate ethical dilemmas. In the acute care setting, I had many clients who were not cognitively aware of their conditions. This caused some patient's to believe they could exit their bed independently, however many times their bed alarm would go off. If I heard an alarm going off, even if it was not a patient I was currently treating, I would take the responsibility to find the room it was coming from and assist them safety back to bed. I maintained honestly by educating them on the importance of using their call button if they needed something. Below is an image of another ethical scenario I experienced during my acute care rotation. While on my outpatient pediatric rotation, there was a mother who asked me if I thought her daughter had autism. I could tell this was a touchy topic with the mother as she began to tear up. I ensured I made a morally grounded decision by telling the mother that I am unable to diagnosis that but if she has concerns she should talk to her pediatrician. I ensured the mother that a diagnosis will not change the way we treat the client. I explained to her that we will be treating the child's challenges of sensory defensiveness, sustained attention, and difficulty following commands.