1. Advocates for clients who have been neglected or underrepresented in the system. 1. During my Level II clinical rotations at an adult day center, I came across a client post-stroke (~ 4 years ago) who was complaining of pain limiting her ability to complete self care and engage in activities. The nursing staff reported difficulty with assisting her as well. Upon assessment of this client, she presented with severe contractures behind her knees, in her wrists, and elbows. After much communication with the client, family and caregivers we were finally able to schedule an appointment with her MD who proceeded to prescribe a muscle relaxer. While the muscle relaxer proved to be beneficial in some aspects, she really needed advanced, skilled therapy for contracture management. So we contacted a rehabilitation facility for a referral of skilled therapy services. Unfortunately, the rehabilitation facility deemed the client as not being appropriate for services as she would be unable to tolerate it. After relaying the news to the client and family/caregivers, I collaborated with the wellness coordinator and nursing staff to work on building the client’s tolerance and endurance so that she would become appropriate for skilled therapy services. As a whole, everyone involved including the client wanted the best care and outcome. Although it was proving to be a process, through hard work and determination we were eventually able to improve the client’s functional abilities, tolerance and endurance to receive additional services for contracture management.
2. Fulfills commitments to the professional community. 2. Recently I have been fulfilling commitments to the professional community by completing a series of questionnaires for Dr. Anita Mitchell, PhD, OTR, FAOTA who has been collecting information regarding changes in students’ beliefs about knowledge and knowing during Level II Fieldwork. There have been four stages in which I have provided insight and information for Dr. Mitchell’s research. Through the information I have provided, I hope that changes are made as necessary to provide optimal performance to future occupational therapy professionals.
3. Represents the unique perspective of occupational therapy when participating in inter-professional situations. 3. At times, it can appear that OT and PT are addressing the same underlying deficits with clients. However, the differentiation between the two professions includes the utilization of different approaches and techniques to overcome those deficits. For medically complex clients, I have had opportunities to co-treat or treat back to back with PT. During these scenarios, it can be confusing for the client so it is important to differentiate the unique viewpoint of OT to clients and other professional staff members. Oftentimes, OT's refer to looking at aspects through an OT lens meaning that we look at things holistically taking in the uniqueness of each situation to provide person-centered care. When clients and other professional staff members are able to understand the perspective of OT they gain appreciation and value behind the profession.
4. Assumes responsibility for professional behavior and growth, in accordance with AOTA standards. 4. Professional behavior is imperative for working in the health profession. As I have been challenged with many different situations while completing these last nine months of clinical rotations, I have grown and expanded on my professional behavior. I have seeked opportunities to collaborate with other professionals including speech therapists, respiratory therapists and recreational therapists in order to expand on my knowledge base, develop problem solving skills, build loyal relationships, and grow the ability to work in harmony with others. Please refer to my final comment on my very last clinical rotation of OT school.
5. Functions autonomously and effectively in a broad array of service models. 5. At the beginning of each Level II rotation, I stated to each fieldwork educator that my end goal was to function as a productive entry-level practitioner. I was concerned of not being able to uphold productivity standards and causing stress and worry to my fieldwork educators. In some cases, I required time off the clock to complete documentation but otherwise, generally speaking I was able to complete the necessary work by the end of each rotation. The most challenging rotation in achieving this goal was by far my psychosocial rotation. My psychosocial rotation was at an adult day center where my fieldwork educator had worked for nearly 45 years, since the day the facility opened. Her role at this facility included admissions, Medicaid management, USDA meal reimbursement, and group leader. I found this rotation to be challenging because it was a different role for an occupational therapist in that the majority of work she performed was behind the scenes with admissions, reimbursement aspects, state requirements, and intermittent client groups. While there were many aspects that only my fieldwork educator completed, I was able to manage certain aspects such as the admissions and Medicaid aspects while incorporating regular client centered care on a group and individual level. It was challenging to develop a personal schedule and routine but through collaboration with other professional staff members I was able to function effectively and autonomously in the end.
6. Upholds the AOTA Code of Ethics in practice. 6. A basic principle of the AOTA Code of Ethics is the principle of nonmaleficence which refers to our obligations to not cause harm to our clients. Some of the duties under this principle include avoiding the risk for potential harmful situations, addressing improper practice, and avoiding false documentation. During my Level II rotations, there were instances that I forgot to complete certain components on the evaluation. Instead of falsely documenting items that I did not assess, I went back as appropriate to assess those missed items or I would mark not observed/assessed this date. Additionally, I was terrified of having an incident so I would take all measures to ensure the safety of the client I was working with. Please refer to the evaluation comment below.
7. Serves as a role model for honesty, integrity, and morally grounded decision making. 7. Honesty, integrity and the ability to make morally grounded decisions are all skills necessary for standard professional behavior. Honesty and integrity are often times the key principles in which we build rapport with our clients as well building our interprofessional relationships. During my clinical rotations, I have upheld these characteristics by providing the best care for clients and building interprofessional relationships. If I were to be unsure of an answer, I would always respond with honesty in that I was unaware of the answer but that I would do my best to find out. In the acute care setting clients are foremost there to receive medical intervention; therefore, when clients asked about aspects related to their medical state, I would refer them to the nursing or MD staff for answers as I did not want to overstep my professional boundaries.