Level IIB Fieldwork: First Week in Acute Care Q&A

Week 1 of acute rehab = done! And honestly, it’s a lot easier than I expected it to be! Before coming to the hospital, I was apprehensive about not knowing how to handle medically fragile patients, managing lines and leads, and knowing how to monitor vitals, especially right now during the pandemic. However, after the first day I was already getting hands on with the patients, starting to lead on sessions and documenting with minimal assistance (while thoroughly washing my hands, wearing gloves, and of course a mask).

It might be important to note that I shadowed in acute rehab for 6 months during my time in undergrad, and even though I had no idea what I was observing then, that little bit of experience helped make me feel more at ease transitioning into this fieldwork.

For this blog I will be sharing some general stats about this placement, and then answering all of your questions (submitted via Instagram)- y’all asked some awesome questions!


Stats:

Setting: Acute Rehabilitation at a regional hospital

Work Schedule: M, T, W, F: 7:30a-4p; Th: 7:30a-11:30a

Conditions I Have Seen So Far:

  • Dementia
  • Acute Renal Failure
  • Stroke
  • TBI
  • COPD
  • Generalized Weakness
  • Hip Fracture
  • Craniotomy
  • Brain tumor

Q&A

What is the day like as an acute care OT? Is it rewarding?

I have loved it so far! Every patient is unique, so you never know what you’re gonna get before you walk into the room (personality-wise especially).

My day starts at 7:30a and we’ll pick up the evaluations we need to see and then spend some time reviewing charts. Then we head out onto the floor and basically go patient to patient (if they are in their room) and complete the evaluations while chart reviewing/documenting a little in between each patient. If a patient isn’t in their room, we move on to the next one and check back later to see if they’ve come back. We then have an hour lunch and documentation time, and then more time to see patients and document before leaving for the day around 4p.

I have definitely found it rewarding so far. A lot of the patients I see are medically fragile and they have all experienced a loss of function, so getting to see them sit up for the first time since entering the hospital, or seeing the satisfaction of getting to brush their teeth for the first time in days in definitely rewarding.

How is the pace of the environment?

Since this is my first week, the pace has been slow, but has slowly increased since day 1. I’m sure once I’m seeing patients on my own I will feel more of a sense of urgency to get things done in order to meet productivity standards, but for now my CI and I have been taking it a day at a time to get me acquainted to the building while seeing 4-5 patients per day.

The pace also depends a lot on the complexity of the patients we see. I know I am going to spend much more time with a medically complex patient during an evaluation than someone with low complexity.

How long do you get per session with your clients?

This depends on the complexity of the client’s case and whether it is an evaluation or treatment session. The shortest I’ve been in a patient’s room for an evaluation was 15 minutes, the longest was about an hour. The time can also vary depending on how much they talk haha.

How have your interactions with the patients been? How do you feel like your rapport building is with such short time?

All of my patients have been great so far! For the most part, no one wants to be sitting in a hospital bed, so they are eager to get up and back to being independent (if that was their prior level of function). They are also so happy to have visitors as they are limited to one visitor due to COVID.

Rapport has been pretty easy to build with my patients, even though it is such a short amount of time. Everyone is very friendly and they want to get better in order to go home, so when therapy comes in they are usually in good spirits. And like I said previously, they are usually lonely because COVID prevents them from having more than one visitor.

What was the hardest adjustment?

The hardest adjustment (from being isolated due to COVID) was definitely having to wake up at 5:30a lol. But I have thoroughly enjoyed getting back to a productive routine and learning.

What do you anticipate to be the most difficult part of your acute rotation?

I think the most difficult part for me might be treatment sessions. So far I have done dozens of evaluations, but only have seen one treatment that was primarily PROM and positioning. However, during our evaluations, we also make a point to treat with therapeutic exercise and completing a few ADLs, like dressing, grooming and eating. I know that I want to be as occupation-based and client-centered as I can while also being creative in a tiny hospital room, so I might be a little challenged in the creativity department.

I also anticipate having some difficulty initially with productivity. By the halfway point in this rotation I am expected to have a full caseload (7-9 patients), so I am a little intimidated by that. But I know that I will get the hang of it!

Have you learned all the lines yet?

On the step-down unit? Yes. In the ICU? No.

The lines can definitely be annoying, but I like to spend a little time during the session getting them all untangled and lined up nicely so that movement is easier for the patient. My CI has also done a great job of explaining the purpose of each line, and since we like to organize them, I have gotten the hang of unhooking and hooking them back up.

It can definitely be intimidating at first, but the level of difficulty will definitely depend on the complexity of the patient, and even then you should get the hang of it pretty quickly.

Are you alone?

I have not been alone this week, though when I asked my CI if I would ever be alone, she said yes. This will of course happen once I am comfortable on my own and my CI is confident in my abilities and knowledge.

What do you wish you had prepared more for?

Before coming to this rotation, I prepared by studying vitals (normal ranges, clinical implications), and that’s about it… I knew that I would learn everything I needed to know while on this rotation, and there is only so much you can do to prepare.

If you feel uncomfortable going into a certain setting, like acute care, it might make you feel better by talking to other acute care therapists, or joining groups on Facebook where you can get an idea of what it may be like.

It may also be beneficial to practice evaluating on a pretend patient. For example, during our evaluations we ask orientation questions (what’s your name, do you know where you are, do you know what year/day it is, etc.), and then we ask about prior level of function, what their living situation/support system is, if they have any medical equipment/assistive devices at home (cane, walker, wheelchair, grab bars, rub/walk-in shower, commode, etc.). We then get into the physical evaluation aspect by asking them to sit on the edge of the bed (this is where we assess their bed mobility, if they need help), and then assess ROM, sensation, coordination and strength. During this whole evaluation, we monitor their vitals, especially when they go from supine to sit. By practicing this type of general evaluation, you may feel more comfortable when it comes to the real thing, but you WILL get to observe your CI and ask them for guidance, even in the middle of a session.

What are some things you definitely need to know for acute care?

Definitely know vitals and what to do if specific vitals increase or decrease throughout a session (i.e. orthostatic hypotension, increased heart rate, low O2 sats, etc.), know precautions (i.e. fall precautions, patient should always wear grippy socks if they are going to stand, ortho precautions, blood pressure precautions, etc.), and know medical terminology. When reviewing patients charts, everything is going to be in medical jargon, so definitely brush up on common abbreviations, terms and conditions.

Is there really as much “bodily fluids” as people think?

I’ve only been there a week, but there is definitely bodily fluids… I’ve heard a lot of stories from other therapists as well, so I have a feeling that I’ll be seeing a lot throughout the next 11 weeks.

How do you feel comfortable with co-treats as a student?

At first it’s going to be intimidating! I have had 2 co-evals with PTs (who’ve been practicing for quite a while) so I sort of let them lead the session, but I had already seen so many co-evals with my CI so I knew the rhythm that usually occurs with the PTs (bouncing back and forth asking questions, assessing strength, doing exercises), so I already felt a little bit comfortable. Plus the PTs knew I was a student, so it’s not like they were going to leave me in the dust! One thing for sure is to not feel like you can’t ask more questions or ask the PT to refrain from doing things for the patient (i.e. the PT I was co-evaluating with put the socks on for the patient, and in my head I wanted to tell him not to and let the patient do it so I could observe. Afterwards, my CI and the PT said I could have stepped in even if I was uncomfortable, so that made me feel better).

One thing that also helped make me feel comfortable is that there is a PT student on the acute floor with me, and my CI will often co-treat with his CI, because of this, the PT student and I have been learning at a similar pace and we have had the chance to co-treat together (which is a lot less intimidating than co-treating with an actual PT!)

Do you see COVID positive patients?

Every patient gets tested twice when they get to the hospital, so all of the patients I see have double negative tests. There is a COVID floor in the hospital but I haven’t been up there, and I don’t think my school would allow it. All of the therapists are on a rotating schedule to work on the COVID floor, and my CI will be up there in September. I will most likely be supervised by another OT during that time.

Time Management Tips/Documentation Tips:

It’s only been one week so I haven’t really needed to ‘manage’ my time all that much since I am with my CI who manages our time. However, something helpful to do is chart review in the morning a bit, document the parts that won’t be changing (i.e. patient name, DOB, medical diagnosis, etc.), and write down precautions/important info on a sheet of paper or in a notebook (wherever you are handwriting notes during and right after sessions).

Right after a session, and even during a session, I will take the time to write down everything that we did, including the levels of assistance, so that I won’t forget anything when I actually sit down to document. If everything is already written down, the less time I have to spend thinking about and trying to remember every little thing we did.

If you are co-treating with a PT, it is also helpful to be on the same page for levels of assistance, chances are you are documenting a lot of the same things (bed mobility, balance, home environment, etc.). After a co-treat we will stand in the hallway or in a little cubby and make sure we’re on the same page with all of the important information.

Self Assertion for Learning Tips:

Just remember that you are there to learn, and your CI knows that too. Don’t be afraid to ask questions before or after sessions (I try not to ask during sessions). Try to get as much input from other therapists as well, including PTs. Often, therapists will do things differently, so getting to shadow other therapists or ask them questions can be very helpful!

Also, don’t be afraid to recommend things that you’ve learned in school, or request the patient do something for you to observe. During an evaluation, the PT donned the patient’s socks for them, and I wanted so bad to tell him not to so that I could observe the patient doing it. After we left the room I mentioned that and my CI and the PT said I have their permission to interrupt at any point and ask the PT/patient/my CI to do/not do something.

Treatment Ideas:

I have only been in one treatment session so far, the rest have been evaluations (though we try to incorporate self-care and some therapeutic exercise into each session). In acute care, the patients are medically fragile, so we stick with the basics of self-care, moving in any capacity, and strengthening with functional movements.

This may look like any of the following:

  • Bed mobility training
  • Sitting EOB and completing dressing or grooming tasks if they are unable to walk to the bathroom
  • Standing/walking to the bathroom or bedside commode to complete toileting
  • Standing at the sink to complete hygiene tasks
  • Transfer training, bed to recliner
  • Therapeutic exercise

Self-Care:

I am very lucky that I have a roommate from my school while I’m here! Because of this, we spend a lot of time together coming up with ideas of things to do or just hanging out and talking. In our leisure time we adventure around the town, try new restaurants, work on crafts while watching new TV shows, and going on walks around the neighborhood or nearby parks.

Personal self-care activities I do include: reading my morning devotional to get my day started right, making my bed every morning, calling family and friends to catch up, and I recently put up hummingbird feeders in the yard so I like to bird watch.

One of the things I like most about acute care is that I finish at 4pm, so I have a lot of daylight hours in the afternoon to have some fun and get things done.

Overview of Week 1:

Overall, I have really been enjoying acute rehab. Sometimes it makes me sad to see patients who have so many medical complications, or maybe their prognosis is not a good one, but I know that my goal while I’m seeing them is to help them increase their independence and to see their potential. We are in a unique position of seeing patients at their most vulnerable time, to be a shining light in the darkness, and see the potential for a full life, no matter the prognosis.

I hope to continue to serve my patients with a smile on my face (under my mask) and learn how to provide the best care I can for them during the next 11 weeks!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s