Lindsey Ward OC TH 6960

Reflective Diary Entry Paper

July 17, 2018 10:00

Factual Strand

At this point in my Level II fieldwork at Fairfield Village of Layton, a transitional rehab

unit, I am the primary occupational therapist for a client following a motor vehicle accident

(MVA). During the MVA, the client sustained multiple injuries, including: subdural hematoma,

spinal fractures, and seat belt contusions, among others. Due to injuries sustained, the client

wears a Cervical Thoracic Lumbar Sacral Orthosis (CTLSO) and is encouraged to follow spinal

precautions (no bending, lifting, or twisting) in order to allow healing. At this point in time, the

client has been at the facility for the last three weeks and demonstrates cognitive deficits in

addition to the more obvious physical injuries. Throughout treatment, I have been

communicating with the physical therapy assistant (PTA) often daily, in order for us to

understand the client’s level of cognition and how that would play a role in her independence and

discharge.

Today, the PTA advanced the client from a front wheel walker to a single point cane and

then cleared her to perform functional mobility independently within her room. The PTA did not

inform me of this, the PTA only informed me of this when I reached out and asked why a cane

was in the client’s room. At this time, I expressed my concerns regarding the client’s safety: her

short-term memory is significantly impaired, she has fallen in the bathroom twice since being

admitted, and that she does not remember to follow through with her spinal precautions. Even

after I expressed my concerns regarding the client’s cognition, the PTA continued to inform the

client, staff, and family that she was free to walk on her own utilizing the cane.
Lindsey Ward OC TH 6960

Retrospective Strand

As a student, I felt completely demeaned and betrayed. Not only was I not consulted or

included in the client’s plan of care, but even after confronting the PTA and expressing my

concerns, the PTA still felt that the client was safe enough to perform functional mobility within

her room. From my perspective, this client was not safe walking on her own, even with the use

of a cane, because she would simply not remember to use the cane. In addition, the client would

attempt to perform activities that were unsafe, often resulting in falls. I was not only

disappointed and aggravated in my interaction with the PTA, but I was extremely worried about

the client’s safety. When discussing with the PTA, the PTA felt that the client had no cognitive

deficits present. The client was able to interact and engage in a conversation, but when asked to

recall prior information from the conversation or implement more functional tasks within

ambulation, the client struggled. I realize now that the PTA was simply not seeing the same

client behaviors that I was witnessing. The PTA made the decision she did based off of what she

was observing; meaning that when the client was simply ambulating, according to the PTA, the

client appeared safe and coherent.

Substratum Strand

In order to ensure proper client care, we are supposed to work as a team; however, this

situation demonstrated the disconnect in our communication. This situation demonstrated the

different point of view that a physical therapy assistant takes from an occupational therapist.

Although I had been collaborating with this PTA almost daily, it is clear that the PTA gathered a

different understanding from the information that I was providing. Was my communication

unclear, did the PTA not understand how the cognitive deficits could become a barrier in

functional mobility? Was the PTA not aware of client’s previous falls? Was I not providing
Lindsey Ward OC TH 6960

enough detail or measurable information to support my beliefs about the client’s safety? This

situation helped me realize that objective data is critical but being first hand at experiencing a

client’s cognitive deficits may be more impactful than from information obtained from another

therapist. In addition, measurable data would have been critical to provide. By thoroughly

relating the measurable data to the client, the PTA may have had a better understanding of the

client’s abilities. The PTA may have then realized that by clearing her to walk alone would

present as a barrier to the client’s success. I also realize that I strive for client-centered practice

and I assumed this was everyone else’s approach to care; however, this is not the case in

practice.

Connective Strand

When reflecting on the previous strands, I have come to understand the differences in

practice. Each therapist has a different point of view which contributes to the observations that

stand out to us and contribute to the way that we provide client care. In order to provide care

related to a specific client characteristic, the therapist must first have a clear understanding of

that characteristic in order to then understand how it may impact performance. Personally, I have

learned that my point of view focuses on safety prior to independence. I also realize that I need

to enhance my communication skills in order to communicate a clearer picture regarding the

client’s current function and deficits in order to relate how they may impact a client’s overall

performance. In order to ensure that I will learn and grow from this experience, my action plan

will be as follows:

• Continue to engage in client-centered practice in order to ensure that the client is safe,

and the appropriate needs are being met.

Lindsey Ward OC TH 6960

• Incorporate standardized assessments into treatment in order to justify personal

observations obtained about client’s level of performance, strengths, and barriers.

• Connect the pieces. Ensure that I connect my concern with how it will impact the client’s

performance. For example, in this situation, I should have educated the PTA on how

performing functional mobility independently could lead the client to carrying out

activities of daily living independently in which she was unsafe. This client was not safe

in toileting, as she would break her spinal precautions and all of her previous falls were a

result of failed attempts at clothing management or attempting to walk to the bathroom

without a mobility device in the middle of the night.

• Ask questions. If the other therapist does not seem to have the same understanding of the

client, ask the therapist what they have seen and what is encouraging them to establish

the current plan of care for this client.

• Be open-minded. Understand that all therapists are coming from a different point of view,

the way they are understanding the situation is not wrong, just different. Their unique

point of view could enhance my level of care with this patient.

• Prepare for team meetings, clearly communicating my recommendations and the reason

behind the recommendations.