This week at fieldwork I finally got the opportunity to ask Jen some questions about documentation.  Jen walked me through the aspects of the evals and explained to me how she created STGs after reading the complete eval.  I feel that I definitly benefited from Jen’s descriptions and examples because I was then able to work on the STGs on the case study for Kim’s class.  I also helped Jen do prolonged stretch on a patient that had a CVA several years ago.  The patient’s left side is affected preventing her from moving her arm and leg so her positioning is a constant concern for therapy and nursing.  The patient has what seemed to me like high tone in the muscles on the right side of her neck.  She has posturing devices in her wheelchair to help keep a good position but she still seems to lean alot to the left keeping her head tilted to the right.  I felt the patients shoulders and neck as Jen provided stretch, the muscles spasmed as the were being lengthened.

progress note:  I have only 7 hours left to complete my level 1 fieldwork.  I have had such a great learning experience.  I plan to return to finish my hours Tuesday and Thursday of next week.

I have had a good week at fieldwork this week.  Jen allowed me to work with the patients I usually do.  I have encountered a new aspect of the CVA recovery process too.  the patient that i have been so fortunate to watch progress every week has hit a plateau.  after being excused from therapy for 4 days due to a skin grafting surgery the patient returned to therapy tired and frustrated.  jen explained to me that this happens with all cva patients and that he was fortunate to make such a great recovery.  I have seen quite a few cva patients progress to max potential in therapy treatments from my work experience but i don’t think that i have ever seen such a vast improvment as i have seen in this patient.  jen also allowed me to come observe a prom and splinting treatment this week.  i was able to provide some of the prom and feel the contractures of the upper extremities.  the patient had contratures of both UE and his right LE.  because of his condition his positioning was a constant concern for therapy and nursing.  he is at risk for skin break down and worsening of his existing contractures so a log is kept to track his position in bed.  the patient is also legally deaf so communicating with him was very difficult, luckly he was a very pleasant man and didn’t mind me observing or working with him.

progress note:  I am seeing this experience coming to an end and feel like i will miss everyone at my facility.  I feel like i have learned so much and my desire to be a part of this profession is even greater.  I plan to return next week to finish my fieldwork hours.

This week at my Level 1 Fieldwork I had the opportunity to follow a different COTA/L.  My supervisor Jen had to travel this week to another facility because case load was low at BHCC and a facility in Lancaster needed help.  The OTA that I observed this week was also named Jen.  She is also a very good therapist.  Her caseload is somewhat different than my supervisor’s in the fact that she treats more LTC patients than Jen does.  I observed alot of self care tasks and purposeful simulation activities.  Jen’s schedule this week didn’t allow for much time for me to come observe so I didn’t complete 10 hours, but I plan to make up for the shortage this coming week.  I also had the chance to meet the regional manager on Tuesday.  Her name is Chris Stotts and she also started her OT career at Zane State.  She later obtained her masters degree at Findlay of Ohio and had great things to say about the Zane State program.  I was glad to hear what a great reputation the Zane State OTA program has and was excited to talk to her about the opportunities we will all have after graduation.

Progress note:  I had another good week at fieldwork.  Although I didn’t reach the expected 10 hours this week, I plan to make them up this week and possibly observe all day Memorial day.

I had a slow week at fieldwork.  I could only attend one day this week but I had alot of fun while I was there.  I worked with the patient with a left side cva that I usually work with.  He is making vast improvements everyday.  This week I worked with the patient to complete fine motor tasks, upper body strengthening, and Jen let me help to sit the patient on an exercise ball to help improve his balance. I also helped a LTC patient complete dowel exercises and saw a activity new to me, the patient uses a wooden knife to cut wooden pieces of fruit connected by velcro.  The activity was something new for the patient and she really enjoyed it.  This week I had my first experience with a highly irritated patient.  Both PT and OT were working with the patient at the same time to try to get their minutes, Jen said that she is usually short tempered and doesn’t want to stay in therapy for the whole session.  The patient became irritated and anxious so both therapists agreed that if the patient let her therapists walk her to her room that she could be done for the day.  The patient seemed to be happy with the plan so the therapists set her up for her walk.  As the therapists began to help the patient stand she became very combative and started hitting the PT on her arms.  The patient was already in the standing position so she was at risk to fall.  I was asked to follow with the wheelchair so I was behind them watching the situation unfold.  As the patient continued to hit the therapists her feet began to slide out from underneath her.  I had to quickly push the wheelchair under the patient as far as I could and then grab her gait belt to help pull her back to her chair.  It was a unnerving experience but it helped me to practice reacting more quickly.

progress note:

I have experienced a lot thus far at my fieldwork site.  I am really trying to take in as much as I can and ask questions to better understand treatment and goals.  I will return to observe this week Tuesday and Thursday.

I had another good week at my fieldwork site.  I again got to participate in therapy treatments, most in depth with the treatment of the left side CVA patient I have been working with regularly.  This week Jen instructed me to chose a challenging activity for the patient but to use my best judgement to make it one that he could still complete.  I thought this assignment was extremely helpful and helped me to understand some of the decisions I will be making as a therapist.  The activity I chose for the patient to attempt to complete was a fine motor peg board that he had been unable to fill with pegs two weeks ago.  I tried to think if the progress he had made in the last couple weeks was enough to enable him to complete the task.  The patient required very few verbal cues and one rest break but completed the activity.  I was very excited and commended the patient for his accomplishment.  This week I also helped to carry out the OT month celebration that Jen and I planned.  We had alot of fun helping the patients make their ice cream treats, but I think that the patients enjoyed it much more than what we did.  We directed a group exercising session after the residents finished eating.  Jen said that the activities director told her that we had a bigger turn out for our event then what she does for her activities.  I am having a great time observing Jen.

S:  “I am enjoying this experience and feel like I am learning something new everyday.”

O:  Student observed OT treatment Tuesday and Thursday.  Student participated in several different treatment activities; including ADL’s, finemotor, grossmotor, self feeding, and UB strengthening.  Student planned and participated in directing a large group activity to celebrate OT month.

A:  Student becoming more confident in directing therapeutic activities and seems to be more oriented with room set up. 

P:  Student will continue to observe OT treatment with planned return to the facility for Tuesday, Thursday, and Friday of following week.

I have had another exciting week at fieldwork.  Jen allowed me to work with the same CVA patient I worked with last week.  Jen continues to work with the patient on improving fine motor skills and ROM.  The patient was moved from dumbell exercises to a weighted dowel rod.  I helped Jen and a PTA in walking the patient, testing a wheeled walker, and experimenting with surface changes like linoleum to carpeting.  Jen also allowed me to work with one of her long term care patients to work on fine motor, upper body strengthening, and ROM.  Jen challenges me to try to think of new routines for some of the patients I work with daily.  I had also been asked to try to think of a facility wide activity to celebrate OT month.  I am so excited to say that the therapists chose to use my idea of an ice cream social to promote the awareness and importance of OT in the facility. We made posters to announce the event that will take place next Thursday.  Patients and other staff will join us in the largest activity/dining room in the facility to participate in activities and make their favorite ice cream treats.

Progress note:  I have completed 31 hours of the required 100 this week.  I have began to feel more confident in participating in therapy sessions.  I have scheduled myself to return next Thursday and Friday to continue my observation.

I had alot of fun the second week of my fieldwork.  Jen, my supervisor, let me help with the therapy session of a CVA patient.  The patient suffered a left CVA and has right side weakness and neglect.  After reading the patient’s chart, I saw the great improvements the patient has made.  His right arm was completely flaccid on date of evaluation and in the short time he has participated in therapy he has regained most feeling and movement.  Jen explained to me that CVA patients have “windows of opportunity”, or times the patient can be more likely to regain movement in the affected arm and hand.  The patient is very motivated to return home and was happy to let me sit in on his treatment.  Jen set the patient up with a fine motor peg board while I gave verbal cues to help him complete the activity.  The patient also worked with both OT and PT while sitting on an exercise ball to help regain balance.  This week I was invited to sit in on a Medicare meeting with Jen, the administrator, and the managers of all the other departments.  I was pretty confused listening to the meeting dialog but Jen was happy to answer my questions later in the day.   I am very pleased with my site and am learning more everyday.

Progress note:  I am very excited that I am getting to experience my level1 FW in this setting.  I have scheduled observation for Tuesday and Thursday of next week.  My supervisor has asked me to help her and the rest of the OT staff to come up with an activity for OT month celebration.  Jen also challenges me to come up treatment activities, so I will be working on developing some new activities to present to my supervisor.

For my level 1 fieldwork I am observing Jen Roman, a COTA that graduated from Zane State 4 years ago.  Jen is an excellent therapist and all the patients seem to love her.  I was pretty nervous my first couple days but all the therapists in the department made me feel welcome. The therapy room is very small so treatments are sometimes done in patient rooms, halls of the wings, and activity rooms.

BHCC is a nursing home with both short-term and long-term patients.  The majority of the patients I’ve seen treated have old or recent CVAs, hip replacement or repair, or general weakness.  My supervisor explains to both me and the patient being treated what she is doing and her motivation for doing it.  Some of the activities I have seen during therapy treatment include:  weighted dowel exercising, stacking cones, restorator (arm bike), tossing balls, clothes pin activities, ADLs, color recognition, peg boards, playing cards, puzzles, and postioning.  The therapists are very creative and work at a fast pace.  I am very happy with my fieldwork site and feel like I am learning so much every day.

Initial Note:  I have started observing at Barnesville Healthcare Center for my level one fieldwork.  I am scheduled to return to the facility to observe Tuesday and Thursday of each week.

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