• My first “Ah-Ha” moment happened when working with a patient in their 20s that was in a car accident a little over a week prior. The patient fractured their left arm, left collarbone, left ankle, and right knee and was unable to bear weight on any of their extremities. The OT worked with the PT and patient to practice transferring from the bed to the commode. This made me realize the true value of collaborative treatments and how the different lenses of the OT and PT can guide the session in a way that focuses on various goals while promoting safety, energy conservation, and maximization of independence. In addition to this, observing the OT and PT work around the patient's weight bearing precautions reminded me of how important it is that we remain attentive to our patient’s movements and ensure they do not break their precautions because this can impact their healing process. The next day, the OT completed a collaborative treatment with the PT and this patient once again. This time, the focus was on caregiver training where the patient had two family members present. The family learned how to transfer the patient safely to a wheelchair, bed, and into the shower, and they were provided with the opportunity to ask questions. Witnessing this made it clear to me how important caregiver training is because it can promote more safety and independence following discharge. Furthermore, this patient’s only option was to be discharged home due to not qualifying for an acute rehab and insurance not covering a SNF. Because of this, the patient and family would have to navigate how to care for the patient within their home. Unfortunately, their only toilet in their home is situated on the second floor and the family decided that they would have to move the patient’s room to the first floor and obtain a commode through insurance. This moment reminded me of systemic barriers related to difficulty navigating the next level of care based on insurance companies and how this can ultimately result in decreased quality care. In addition to this, it reminded me about what we have learned in previous courses about issues with accessible housing and how this can lead to decreased independence and less preferred living situations.

• Another moment that stuck with me was when the OT and I worked with a patient in their 80s with dementia. The day before meeting this patient, I had heard them vocalizing repetitively all day. Many of the staff members said they were unsure why the patient was vocalizing and implied that it was an “annoyance”. Seeing this patient with the OT made me realize how important it is to have knowledge of dementia care and its symptoms. Vocalizations, like this patient was making, often symbolize them having an unmet need. After sitting the patient up in bed, getting a nurse to provide them with pain medication for irritation to their bladder from a catheter, and providing the patient with a warm blanket, the patient’s vocalizations were quieter and they took deep breaths following instruction. As we were about to leave, the patient asked us to “stay” and “come back”. The patient then said “fill me up” and the OT provided assistance for feeding. This session made me realize how valuable it is to apply our knowledge from our courses, like the course Psychosocial Aspects of Occupation, and how important it can be to take an extra moment out of your schedule to make sure a patient’s needs are being met. This patient had hardly eaten any of their meal before another staff member took it away since they assumed the patient was not hungry. Taking an extra moment to address activities of daily living with a patient that is confused, scared, or having difficulty vocalizing concerns can truly demonstrate the patient’s level of independence and allow us to identify what their needs are. 

• The third patient that left an impression on me was a patient in their 70s admitted due to losing consciousness in their bathtub. Following this, the patient had hypothermia and it was suspected that they were in their tub for up to 24 hours until they were found after a wellness check. The patient’s baseline was independent in most selfcare tasks and transfers, however the patient realized that they were not going to be able to return home without assistance. This session stuck with me the most since it was one that the OT let me take the lead on. For this session, the patient agreed to transferring out of bed to their chair so they could eat their lunch in an upright seated position. Following this, they requested to stand up from the chair to ambulate to the bathroom using a walker. One moment when facilitating these transfers where I noticed something was not correct was when the patient tried to stand from the chair but was unable to. The previous transfers using a gait belt had gone smoothly and it took me a moment to realize that getting up from the chair was most likely more difficult than standing from the bed since the chair was situated much lower to the ground. The patient attempted twice before I directed them to stop, scoot to the edge of the chair, position one hand on the chair and one on the walker, lean forward, and then attempt to stand. This made me realize how critical following the steps we learned from our course, OT Fundamental Skills, is and how valuable it can be to stop, assess the situation, and provide the patient with appropriate steps to allow for success.

This fieldwork experience has indubitably affected my future clinical practice as an OT. This was my first time getting to witness the role of an OT in an acute care setting, and through this level I rotation, I feel that I was able to learn so much more about the importance of incorporating motivating topics into treatment sessions, listening to the patient’s needs, utilizing safe transfers following precautions, providing caregiver training and education on discharge planning, navigating insurance companies, and working with an interdisciplinary team. 

Overall, I hope to incorporate some of the knowledge that I have gained from this fieldwork experience into my future clinical practice. In particular, many of the practitioners at this site demonstrate proper advocacy for their patients and this is something that I found to be extremely valuable. Discussions between OTs, PTs, SLPs, nurses, and case managers always seemed to revolve around the best course of action for the patient, and if it did not, staff members weren’t afraid to step up and be a strong voice for their patient’s needs. Ultimately, completing my last level I rotation in this setting exposed me to an environment that was much more fast-paced, flexible, and challenging, yet exciting. In an acute care setting, sessions won’t always go as planned and it is important to be open to change at any moment. As someone who typically prefers a set routine, I found this to be challenging to navigate. However, I was able to become comfortable with this type of schedule throughout my time at this site. This experience pushed me out of my comfort zone while inspiring my desire to work in a setting like in my future practice. It made me realize how important it is to be able to adapt to patients’ needs and make modifications to our own schedules based on our co-workers’ plans of action as well. This type of intentional coordination and planning with flexibility is something I would like to carry over into my future practice and education. In addition to this, this setting taught me how critical it is to be welcoming to ideas and feedback from others and how this can, in turn, allow for successful, comprehensive care. 

Overall, I really enjoyed my time at Alta Bates, and I look forward to applying all that I have learned to my future practice to continue to expand my professional and interpersonal skills.