Lessons in Acute Care

As I begin my 10th week in acute care and begin thinking about my transition back home, studying for the NBCOT Exam and the prospect of applying for jobs, I wanted to reflect on some of the lessons that my time in acute care has taught me. With just three weeks left at this rotation, I thought that by taking the time to reflect on the lessons I have learned so far, I may be able to thoughtfully and intentionally apply them and work towards increasing my level of confidence and enhancing my learning experience for my remaining time.

Acute care is such a unique area of practice for occupational therapists, you learn so much about the patient in their current state, but do not have the opportunity to really get to know who they were before the injury or decline in health, or even have the opportunity to see a substantial improvement in their functioning before they are discharged to another facility or back home.

Nevertheless, it is such a special place to be. To be apart of someone’s life at such a vulnerable period brings about many opportunities to be a light in the darkness; to show them what they are capable of despite their setback; and to initiate their journey to healing.

Without further ado, here are the five lessons I’ve learned during my time in acute care:

1. Things won’t always go the way you expect them to.

You can chart review for a whole hour on a patient and go into their room with a pretty solid idea of what you are going to see, but more often then not, that patient is going to surprise the heck out of you. And the surprise will range from excitement that they are actually doing great and don’t need too much therapy, to the other end of the spectrum and everything goes wrong during your session (there has been many a time where my patient hasn’t been out of bed or had the opportunity to relieve themselves during their time in the hospital, so as soon as we start moving around, well, you get the idea. So the entire session is spent cleaning them up and changing bed linens). But hey, it gives us the opportunity to work on bed mobility, toileting, perineal hygiene, and dressing!

2. You always hear about needing to be flexible in OT school, acute care really shows you how flexible you can be.

This sounds very similar to the first lesson, which just goes to show how fast-paced and ever-changing acute care is. The hospital is one of the most high-stress environments you can be in, anything can happen at any moment with these critically ill patients; doctors, phlebotomists, nurses, case managers, radiology techs, and so many other professionals may be trying to see your patient at the same time depending on the time of day; ambassador services may be trying to take your patient down to receive a CT, MRI, EEG, or any other number of tests; your patient may not be medically stable enough to receive therapy even though you spent twenty minutes preparing to see them. And while therapy is extremely important, many of these professionals take priority over therapy (like the doctor needing to assess the patient, a nurse needing to administer medications, or ambassador services needing to take the patient down for a test). The majority of the time I will step back and let them do their jobs, or assist in getting the patient to the stretcher so that they can be taken to their test, and then I move on to the next patient, because that is all the power I have in this setting.

3. Acute care shows you how creative you can get with the limited supplies you have.

Especially during a global pandemic. Before entering a patient’s room I always grab a toothbrush, toothpaste, body soap, a hair brush/comb, and socks. That’s it. If a patient has already washed up and brushed their teeth, I’m at the mercy of whatever they have in their room, and whatever they are physically able to do. There have been a few times where I actually had the patient clean their room because they either finished their ADLs, or didn’t want to do ADLs. I’ve slowly been building my repertoire of exercises to whip out with patients who are able to tolerate more than the simple flexion/extension exercises that I do with everyone, including tricep dips on the walker, scapular mobility and trunk leans.

4. The patient is always right… within reason.

Therapy in acute care is a little different than other settings because most of the time the patient isn’t aware that they’ve been put on the therapy list. Occasionally I will have patients that refuse therapy and I’ll try to convince them that it will be good for them and help speed up their healing, this usually gets them to participate, but of course there are patients that will do anything to avoid therapy and all you can do is follow their wishes. In other cases you’ll learn that they are doing something that they shouldn’t be (like smoking with COPD), and even though you have good intentions by telling them that smoking will increase their chances of returning to the hospital and worsening their condition, you just have to accept the fact that they are going to continue to smoke and participate in activities that put them at risk and apologize for saying anything to the contrary… (Yes, I’m speaking from a specific experience, and yes I’m a little salty/embarrassed about it because the patient may or may not have gotten upset with me and started yelling…)

5. Emotions are a powerful thing.

I’m not gonna lie or sugarcoat it, acute care is hard, it is emotional, and it is sad. You are seeing patients in their most vulnerable state, and as an empath, it can be really hard to keep my emotions in check! Espeecciiaallly if the patient starts crying. I remind myself that I am there to serve them, to support them, and to encourage them. Yes it is hard, but I have the ability to help see them through those hard moments in the small amount of time that I get to see them and initiate their process to healing and returning to their independent life. Use the 20 to 30 minutes you have with that patient to show them their possibilities, show them that you are their to support them, and tell them that you feel for them and can’t understand the hardship they are going through, but will do anything to help them heal and feel comfortable in this chaotic environment.

Have you had any experience in acute care? Can you resonate with these lessons, or share other lessons you’ve learned?

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