Placement Week 2

So, this week my educational supervisor was on holiday so I was left alone with the other members of staff. Whether I was just a little bit more used to the ward and the routine of the OT environment, or whether it was because my supervisor was away, this week went slowly, and I really had to look for things to do.

I went to the case conference where the Doctors, Nurses, OTs, Physios, Dieticians, and speech therapists all get together to evaluate each patient on the ward. I was very interesting to see the dynamics of the different disciplines, and even internal discipline dynamics (for example the consultants do all the talking, while the SHO’s write down what they say and the JHO does the filing). It was also really interesting to see what the OT’s were reporting at the case conference, and how people reacted to this, and the power OT’s have to hold back discharge if they don’t think someone will be independent in their home.

There was one consultant in particular that didn’t really seem all that interested in what the OT was saying. All he wanted to know was is the patient ready for home, if not why not and when will that be. It made me think that maybe one of my lecturers who is particularly keen on developing articulate, evidenced based OT’s, who can make a clear argument, is right. Oh course the standard of your work must be up to scratch, but it counts for nothing if you can present your cases well in the two minutes you have to talk about that patient.

I spent much more time this week considering my essay, which assessments I’ll use, and which assessments might be useful for my working life, and also the acute medical setting.

One of our patients at the moment has a visual problem that means that he can see nothing on his left hand side. The team have been discussing things that the OT’s can do to encourage him to scan for objects by turning to his left (because his brain doesn’t realise he can’t see). A bunch of perceptual tests have been mentioned, and it is really interesting to see how the team members have been tackling this gentleman’s problem. The situation is made more interesting by the fact that this gentleman has a very dry and gruff personality, and has been in hospital a number of times before and is frankly a bit pissed of about doing things that he thinks are pointless. So it will be interesting to see how willing he is to do these perceptual tests.

The team have also discussed doing more social activities with him like playing games and laying the counters on the blind side, so encourage him to scan. It was interesting to note, that some team members were much more keen on the tests rather than the games, and that others viewed the games as a test to be taken seriously. I suggested that I’d love to play games with him and that if there were a number of players then the game had more purpose and would seem more natural as an occupation. However, it appeared to me that the staff weren’t that interested in making it a little be more human. After all it is therapy not fun.

If the OT department I’m in applied MOHO theory, to this gentleman, then his motivation for occupation, his interests and roles would all be considered and it might be possible to overcome his cool personality and encourage him to scan, just by finding something that interests him. However, the problem I’ve been told with a number of MOHO assessments is that they are too long to be used in an acute setting. The also seems to be the case with CMOP as a theoretical model, an OT working in my hospital recently came into to college to lecture about her pilot study on the use of the COPM, and concluded that it just wasn’t suitable for acute settings. Humm, so still need to think a little be more about that whole thing

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