“I’m an occupational therapist, an obscure profession if there ever was one. We are few and far between, maybe because we have chosen toserve people with disabilities. All disabilities. Not a glamorous endeavour, nor a lucrative one. And I say serve because we deem that in helping we see weakness, while in servingwe see wholeness. We’ve opted for wholeness nearly a century ago and have been at odds with the system ever since. We don’t fix people, you see: with them, we simply try to find a way tomeaning,balance, andjustice. I chose occupational therapy because it blends science and humanism, intellectual rigour and compassion.” — Rachel Thibeault (fromOccupational Therapists without Borders)1
Occupational Therapy First Year Portfolio Task
A year ago, I was in my final year at high school and studying for finals. Now, I am a first year Occupational Therapy (OT) student at the University of Witwatersrand who is getting ready for her end of year exams, scary stuff! But I can’t complain when I think back on how much I’ve learned this past year and how it has impacted me when I think about my future. At the core of it, this year has taught me that OT is not what I thought it was. Yes, I had an idea of what an OT does in terms of activities but I was not aware of what it would take to get to the same point as the OT’s who I had observed during my time job shadowing in my matric year.
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I’ve learned a lot during this first year and I now have a deeper understanding of the career path that I am pursuing- what it will demand from me, how it will influence the lives of others through me, the scope of OT and what I need to know to not only be good as an OT, but to be a great OT. It has me anxious about the mountainous path looming ahead and passionate to reach the finish line all at the same time. In talking about the mountains that I see rising ahead of me, I thought that I would reflect on the mountains that I have already crossed and how they impacted my grasp of OT and how it helped me to link the theory to the clinical uses. The first mountain was Problem Based Learning (PBL) which actually grounded me in order to prepare me for the much larger mountain: Fieldwork.
One of the first lectures that we had was on PBL’s, problem based learning. And to say that I took the concept for granted and wrote PBL’s off as time-wasters would be correct. So when I realised just how helpful and beneficial PBL groups could be, I was all in. PBL’s have taught me the importance of working as a group, time-management, designation of tasks, following certain steps in order to reach a set goal and understanding different concepts from a first-look evaluation and then comparing this to theory or researched constructs.6 This form of methodology can be defined as a teaching and learning strategy where students learn about a subject through the experience of problem solving.6 During this process students learn about thinking strategies and gain knowledge and insight into the topic. PBL teaches us to think critically rather than to draw superficial conclusions. Our first problem in PBL prepared me for what OT is, the background into OT and the professional environments of an OT.
PBL taught me that occupations are daily activities that reflect cultural values, provide structure to living, make appropriate use of an individual’s time and give meaning to their lives.8 Occupation could also be said to be ‘ordinary and familiar’,4 thus it is the nature of the occupation that gives it purpose and meaning. 4 Even Occupational Therapy was better explained to me once I had combined my new knowledge with that of our textbook: Occupational Therapy can be accomplished through the teaching, facilitation and maintenance of skills, the encouragement of engagement in “purposeful activity” 2 and in “occupation” 2 so that a person can reach his/her optimal level of function”. 3 OT is both an art and a science which uses occupation as both a means and an end in therapy, both in individual and group therapies, to enable people, families and communities in a wide range of settings. 7
This is a lot more in-depth and complicated than I ever suspected it could be. I think that I was under the impression that occupation meant ‘work’ like so many others believe. And even in knowing and understanding this, I still battle to explain it to people. I even have a friend who calls OT’s glorified housewives who love to garden!
One thing that has become clear to me, studying our Problems in PBL, sitting through our Psychology and Sociology classes and studying OT this past year- OT is very holistic. Never is a patient defined by their symptoms and OT’s tend to study every aspect of a person’s life before drawing conclusions or beginning therapy. The word ‘holistic’ has come to mean many things to me this year, but none more than that a person’s characteristics are“intimately interconnected and explicable only by reference to the whole”.9
Once I had gained the theoretical knowledge about OT, I was more than ready to start with the fieldwork part of the year. I was placed at Thambo Memorial Hospital in Boksburg for four mornings over three weeks. The patient that I was assigned to was diagnosed with deep partial thickness burns with an amputated lower left arm from the elbow. But aside from my patient I was able to observe my Fourth Year with her other patients, was able to ask her questions and even assist in certain assessments, treatments and activities. This was a completely different experience to the one that I had had when I job shadowed at the same hospital a year before. As an outsider and someone who is not aware of what OT truly meant, I merely saw the assessment of different patients at a superficial level and only really understood the treatment as games or activities that would keep the patient busy so that they did not notice that they were making use of the injured or problem area. Thankfully I now understand OT better and can see certain aspects of therapy and theory coming out in the actions of the OT’s and their patients. Being able to see therapy performed from this view and being able to interact and speak with other OT’s on a more professional level has helped to cement my plan to become an OT.
During my time at the hospital I was lucky enough to observe most of the steps in the OT process. The OT process is defined in the Practise Framework as the collaboration of the OT and the patient through the steps of evaluation, intervention and outcomes in order to achieve health and participation in life through the engagement in occupation .5
The evaluation step consists of the occupational profile and the analysis of occupational performance which help the OT determine what the patient hopes to gain during therapy, what they need to accomplish, what the patient can do and what are the barriers or supports to their health and participation in therapy. In this, I was able to speak with and fill out forms for two separate patients and also assist in the assessment of a third patient. With the occupational profile, the patient is very much the centre and all the questions are focused around them so that the appropriate goals for the end of therapy can be set.
Intervention has three parts to it: intervention plan, intervention implementation and intervention review. The plan is developed by both the OT and the patient to guide the therapy with the use of theory. Outcomes or goals are also decided upon during this stage. Implementation is the actions of the OT which will revolve around therapy as well as the support and encouragement needed to see an improved occupational performance.7 Implementation is direct towards the goals set and the OT is required to monitor and develop the patient at all times5 so that the activities are appropriate and can be adapted if they are not performing in the intended way. Finally, review is simply reflecting on the implementation and assessing the progress towards the set goals.
Outcome is the determination of success at reaching the desired goals. The results of this step will be used in planning further therapy if it is needed. This step is one of the hardest to observe in my opinion and is also very subjective. A patient may feel that he is fine and does not need any more therapy while the OT may see him as dysfunctional. To be dysfunctional is not saying that there is something socially wrong with a person or that they are overtly damaged, this is something that I have come to learn this year. Dysfunction, defined within an OT’s perspective is “when a person cannot do or is at risk for not being able to partake in occupational participation and performance”.10
In terms of my assigned patient I was unfortunately able to witness the barriers between her and my Fourth Year who was her OT which resulted in her unwillingness to participate in therapy, added to that was her de-motivation and also the selection of an inappropriate activity during therapy. My patient was French speaking and thus the OT could not effectively fill out her necessary forms, could not adequately communicate with her and had to get this information from the patient’s husband. And so the patient, who the OT thought, enjoyed cooking and cleaning chose an activity of making milkshakes. Once I spoke to the patient (since I know some French) it became clear that she does not enjoy milkshakes and only cooked and cleaned because it was culturally expected of her as a wife. This brings into play the therapeutic relationship. The therapeutic alliance between the patient and the OT develops over time11 and requires the OT to be able to communicate in an effective way such that these details are made known. Because of what happened to my Fourth Year with her miscommunication with her patient, I now understand the importance of our Dictionary assignments- to be able to communicate with any patient, no matter how rudimentary it is. Also, the selection of activities is imperative, especially for patients who are de-motivated which often occurs with burns patients or amputees. The loss of a limb or partial limb is a huge thing to deal with both physically and emotionally and burns patients are often de-motivated due to the pain of movement. Choosing the correct activity during therapy of these patients can determine whether there will be any progress in that session or not and also whether the patient will continue to be de-motivated or could possibly start to find reasons/purposes to want the therapy to succeed. This can also be accomplished through the therapeutic use of self to be able to use yourself, as an OT professional, to read the situation and adapt it, 11 whether it is during evaluation or during the intervention steps. Culture also needs to be considered when referring to patients. An OT need to take their patient’s culture into consideration and respect it. While culture may not define a person, it does indeed impact on their lives and ways of living. 12 Thus, my patient may only cook and clean because she is a wife but it is her responsibility in the home so she will need to rehabilitate to a point where she can continue with her tasks, but it may not be a good idea to use these tasks as activities since she sees them as work rather than leisure tasks.
Overall, I would definitely say that this year has been a success. My knowledge of OT and the profession has increased and I am even more certain that I want to be doing this as a career. The importance of the OT process is further defined by role of an OT which is categorised through the use of self, the therapeutic relationship, proper communication and compounded with a firm foundation of knowledge and attained skills. To reiterate what Rachel Thibeault said, “we see wholeness… We don’t fix people, you see: with them we simply try to find a way tomeaning,balance, andjustice.”1 Occupational Therapy is about the patient, it is not about us save for what we can do for others… So the goal is to learn, make mistakes, learn from them, observe and experience as much as possible so that we can do everything possible to help them.
From this end of the mountain range, I can only see the obstacles blocking the destination from my sight. And yet I am not feeling deterred. Rather, I am excited to see what the mountains will contain and what I can learn from them. The next mountain that I see is end of year exams… So I think that I am going to do this one mountain at a time and never forget what I have learned and discovered on the way so that I am prepared for every challenge that approaches me.
1 Gerber,AK. OT Without Borders. http://otwithoutborders.wordpress.com/2013/06/26/im-an-occupat/ (accessed 30 September 2014).
2 Hersch, G. I., Lamport, N. K., & Coffey, M.S. Activity Analysis: Application to Occupation, 5th ed.: SLACK Incorporated; 2005
3 Thorner, S. The Essential Skills of an Occupational Therapist. British Journal of Occupational Therapy 1991; 6(64).
4 Curtin, M., Molineux, M., & Supyk- Mellson, J. Occupational Therapy and Physical Dysfunction: Enabling Occupation, 6th ed.: Elsevier: Churchill Livingstone; 2010.
5 American Occupational Therapy Association. (2008). Occupational Therapy Practise Framework: Domain and Process (2nd Edition). American Journal of Occupational Therapy, 62, 625-683
6 Devan, D., Casteleijn, D.. Problem Based Learning 2014. Lecture presented at Khanya Building, Wits Education Campus; 2014.
7 Schell B., Gillen G. & Scaffa M. .Willard and Spackman’s Occupational Therapy. 12th ed. Baltimore MD. Lippincott, Williams & Wilkins; 2013
8 Jay J. Occupation & Activity. Lecture presented at Khanya Building, Wits Education Campus; 2014.
9 Oxforddictionaries.com. holistic: definition of holistic in Oxford dictionary (British & World English) [Internet]. 2014 [cited 1 October 2014]. Available from: http://www.oxforddictionaries.com/definition/english/holistic
10 Smith R. Intro to Occupational Dysfunction. Lecture presented at Khanya Building, Wits Education Campus; 2014.
11 Devan D. Occupational Therapy Process: PBL Post Problem Tut. Lecture presented at Khanya Building, Wits Education Campus; 2014.
12 Smith R. Cultural Diversity. Lecture presented at Khanya Building, Wits Education Campus; 2014.
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