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MY REFLECTION ON WHAT I LEARN ABOUT CLIENT-CENTRED PRACTICE.

In the ever-changing healthcare landscape, one principle stands out: client-centred practice. It's more than a term or a fad; it's a concept that prioritizes the individual in care, putting their autonomy, preferences, and special needs at the forefront of every decision and contact. Consider a healthcare experience in which individuals are active participants in their health journeys rather than passive care recipients. This is the essence of client-centred practice: a groundbreaking method that not only fosters trust and collaboration but also lays the framework for truly transformative and empowering healthcare experiences. In this blog, I will share my experience about how I’ve been implementing client-centred practice in my therapy intervention with clients in Mshiyeni Memorial Hospital.

I currently have an 18-year-old patient with partial-thickness burns on his face and bilateral upper limbs, he worked in a carwash and lives alone in his 1 shanty room. We have been working together for 3 weeks now. “Client-centred practice emphasizes the importance of understanding the patient's perspective and tailoring care to meet their unique needs and preferences” (Annals of Family Medicine, vol. 9, no. 2, 2011, pp. 100–103.), thus on the 1st day I saw him, we set up goals that we would like to achieve whilst in the hospital while considering his interest, concerns, and preferences. “Client-centred practice empowers patients to actively participate in decision-making regarding their health, fostering a sense of ownership and accountability” New England Journal of Medicine, vol. 366, no. 9, 2012, pp. 780–781.), thus we set goals into priorities and set steps of how they will be achieved. “In client-centred practice, the focus shifts from 'What is the matter?' to 'What matters to you?” (Social Science & Medicine, vol. 51, no. 7, 2000, pp. 1087–1110.), one of the patient’s goals was to be able to use his ULs to feed himself without the help of nurses and we first did upper limb exercises to release joint stiffness (prevention of skin contractures) before we did a modified feeding activity. The activity was a bit challenging for the client as the bandages were tightly wrapped on the limbs and there was a lot of compensation. Therefore, I had to debulk the bandages on the hand to facilitate finger movement. It was a bit challenging at first because the client was recently admitted and in excruciating pain thus had to incorporate therapeutic use of self (empathizing mode) to calm him down and show compassion. I asked for his parent's numbers so that I could update them about our progress of intervention and include decision-making such as whether he should be discharged and why or why not. Now the client’s occupational performance has improved and we’ve achieved 50% of our goals so far and that is motivating for me.

The second client I had was a 51-year-old female who presented with paraparesis and trunk pain. I first interviewed her so that I would know her background context. We set short and long-term goals with the patient while considering her interests and preferences. One of her first goals was to walk, but I explained to her that walking is a process and firstly she needs to learn how to roll on the bed and sit without falling as she has a poor static and dynamic sitting balance. Therefore, we did bed rolling (bed mobility training) and now she can take things from the side bed table. She was very happy to see such improvement because she used to call nurses every time, she needed something from the table. Secondly, we attempted our second goal of sitting at the edge of the bed, but the client set for a short time and complained about excruciating pain in the trunk. We tried this several times on different days, but it got worse daily, and this demotivated us because our goal seemed elusive. I advocated for the client to get bisacodyl to help relieve constipation as she hadn’t gone to the loo for 10 days. She was referred to Nkosi Albert Luthuli Hospital for further intervention, but I hope she will return soon so that we continue with achieving our goals.

Client-centredness is very important because it requires me to be flexible and change according to the client’s needs. I’ve learned to approach and treat people differently because they are different and have different occupational profiles as mentioned above with two patient scenarios. Even if people present with the same diagnosis their goals are never the same and that is why I highly recommend the use of this practice in the future and by other healthcare practitioners.

As I conclude I could say that by centering care around what truly matters to each individual, we not only enhance clinical outcomes but also nurture a profound sense of connection and humanity within the healthcare experience thus we should continue using this practice in everyday lives of our patients in the healthcare system.

REFERENCES.

Bechtold, A., & Fredericks, S. (2021). Key concepts in providing patient-centered care. INDIGO (University of Illinois at Chicago). https://doi.org/10.32920/ryerson.14636718.v1

Coffey, M. J. (2017). Patient-centered communication during procedures. The American Journal of Surgery, 213(6), 1188. https://doi.org/10.1016/j.amjsurg.2016.08.004

Papalois, V. E., & Theodosopoulou, M. (2018). Optimizing health literacy for improved clinical practices. Medical Information Science Reference.

Platt, F. W., Gaspar, D. L., Coulehan, J. L., Fox, L., Adler, A. J., Weston, W. W., Smith, R. C., & Stewart, M. (2001). “Tell Me about Yourself”: The Patient-Centered Interview. Annals of Internal Medicine, 134(11), 1079. https://doi.org/10.7326/0003-4819-134-11-200106050-00020

Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-Centered Care and Outcomes. Medical Care Research and Review, 70(4), 351–379. https://doi.org/10.1177/1077558712465774

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My reflection on my experience of Advocating for patients.

Patients typically find themselves navigating a maze of procedures, diagnoses, and treatments in today's complex network of healthcare, their voices sometimes drowned out by the complexities. Advocating for patients in this system is like being a guiding light in the fog, illuminating pathways, amplifying voices, and ensuring that, despite the language and protocols, the human element is never forgotten. It is about advocating for people's rights, dignity, and well-being and empowering them to actively engage in healthcare decisions. Patient advocates play an important role in establishing a healthcare environment that welcomes everyone’s journey with empathy, understanding, and support, from ensuring access to quality care to campaigning for equal treatment. In this blog Am going to share my experience in advocating for my clients in Prince Mshiyeni Memorial Hospital.

Being a healthcare clinician means that you are the mouth and eyes of every patient in the hospital. In my clinical practical so far, I’ve realised the importance of seeking to help from other healthcare teams to intervene in the clients’ health to improve functional or medical outcomes. One of my patients had a spinal cord injury, was paraplegic, and was in the rehabilitative phase of treatment. He was referred to OT from physiotherapy for rehabilitation to ADLS and IADLS. The patient had a good functional and medical prognosis, but the rehabilitation wasn’t adequate without the wheelchair thus I had to advocate for a wheelchair so that he would be able to mobilize independently. However, the client was discharged without the wheelchair due to a delay in ordering and the tight budget that the hospital has for wheelchairs. I couldn’t believe it, but when I made a follow-up, the physio said that they would call him when the wheelchair arrived and that would be after 8 weeks. Advocating for clients can be difficult sometimes because the request on behalf of the client can take a long time to be fulfilled and sometimes it’s not considered which could be due to a broken Multidisciplinary team in the healthcare system.

I’ve learned that not everything that my patient requests should be advocated because I know what is best for my client to become functionally independent. One of my recent clients has paraparesis and presents with poor static sitting balance as one of the impaired client factors therefore I advocated and asked the nurses in the ward to not feed her as she can do it independently and should be allowed to sit. However, this was not considered because when I came to the ward again, I found her being fed by the nurse while lying supine. This demoralized me and I felt like the nurses were not taking me seriously because am just a student OT, but I overcame that with the help of my supervisor and pushed the client into sitting at the edge of the bed to eat. This led me to think that being a healthcare student sometimes it’s hard to advocate because the hospital staff takes us lightly, however, this motivates me to do what is best for my clients irrespective of what they may think.

TYPES OF PATIENT ADVOCACY.

Medical advocacy

This includes making the client understand their diagnosis by translating medical conditions to them and their families.

I explained to the burn’s patient about the importance of the drinking the nutrient juice offered by a dietician to heal the skin.

Medical facility advocacy

Includes nurses and social workers who act as mediators between patients and physicians. They ensure that patients have safe accommodation etc.

I advocated for the paraparesis patient that she should be always put in sitting when eating to facilitate the development of trunk muscles to improve static sitting balance.

Health insurance advocacy

This includes assisting patients with benefits such as medical prescription, vision, Medicare/Medicaid, Veterans Affairs, social security, and home health.

Family Advocacy

This includes mediating conflicts between patients and their family members regarding medical treatment decisions.

Legal Advocacy

It includes helping individuals claim disability grants, work compensation or malpractice, and medical arrow review.

Transitions and Housing Placement advocacy

They aid in shifting to assisted living facilities, nursing homes, skilled nursing facilities, and adult family homes.

I advocated for the SCI patient’s family to change their home setting so that the patient would still have access to different areas of the house. This included putting rails in the toilet, building a ramp, and putting his most important daily use items lower to facilitate reaching.

Mental and behavioural health and social work advocacy

Mental and behavioural health and social work advocates assist patients in managing severe health conditions, addiction disorders, and communication difficulties caused by mental or behavioural obstacles. They can also consult with patients on relevant drugs and therapy.

I advocated for the burns patient by referring him to a psychiatrist after a reported psychic behaviour in the ward. It was found that he had a history of delirium but is currently psychotic.

Pain management Advocacy

This includes ensuring that pain is managed properly by recommending a change in the dosage or type of medication.

I advocated for my paraplegic patient who had pain in the stomach due to constipation by asking the doctor to provide the client with bisacodyl.

As I conclude and linking back to the aim of the introduction, I would say I've learned a lot about the importance of advocacy for clients and I wish to get more exposure to different conditions in the future so that I can develop advocacy skills that will link to different clients. I highly recommend it in the healthcare system or Multidisciplinary Team.

REFERENCES

References Dhillon, S. K., Wilkins, S., Law, M. C., Stewart, D. A., & Tremblay, M. (2010). Advocacy in Occupational Therapy: Exploring Clinicians’ Reasons and Experiences of Advocacy. Canadian Journal of Occupational Therapy, 77(4), 241–248. https://doi.org/10.2182/cjot.2010.77.4.6

Dhillon, S., Wilkins, S., Stewart, D., & Law, M. (2015). Understanding advocacy in action: A qualitative study. British Journal of Occupational Therapy, 79(6), 345–352. https://doi.org/10.1177/0308022615583305

Types of Patient Advocacy. (n.d.). Www.painscale.com. https://www.painscale.com/article/types-of-patient-advocacy

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My Reflection on Collaborative Practice within the Multidisciplinary Team (MDT).

In the hectic hallways of healthcare, where urgency frequently trumps everything else, there is a symphony of expertise, a convergence of minds from several fields, each note harmonizing towards a single goal: healing. Welcome to the world of collaborative practice in healthcare, where the boundaries of expertise blur and the unity of purpose transcends separate areas. This blog will reflect on my experience in collaborative practice within the MDT in Prince Mshiyeni Hospital in Mlazi.

Doing clinical practices in a very busy hospital with numerous patients coming in and out has taught me the importance of having a multidisciplinary team. A multidisciplinary team (MDT) is a group of health and care staff who are members of different organizations and professions (e.g. GPs, social workers, nurses), that work together to make decisions regarding the treatment of individual patients and service users(Benagiano, G., & Brosens,). As an OT student, I work with all healthcare professionals to gather information about the client to enable me to do assessment and intervention planning, and that led me to know the Multidisciplinary team diagram below:

I’ve learned that the multidisciplinary team members each have a role to play in the patient’s treatment and that is why referring the patient to a suitable healthcare specialist is beneficial (similar to advocating). For example, one of the patients that I see has T11-T10 complete SCI (paraplegic) and was referred to OT by physio for further rehab to activities of daily living, however it’s been two days of rehab with OT, and the client presented with pricking pain on the left chest and heavily breathes after that activity (dressing LL) which could be due to low physical endurance, therefore, I acknowledged nurse staff about this problem so that they would intervene by increasing pain medication dosage intake or refer to the doctor to analyze the patient’s chest X-ray. Their feedback will help with adapting the focus of my intervention to meet the patient’s functional level. It was a bit of a struggle initially ( first 3 days of practical) to adapt to the MDT at the hospital because I was hesitant to ask for help from the team around e.g. I was hesitant to ask for nurses to change the client’s catheter beg or ask the doctors what medication is the client taking and what are they for. However, all of that gradually deflated like a car tire that has a big hole, but now you wouldn’t even recognize that am a student (communication-wise) when am within the team in the patient wards. Many of the MDT members in the hospital have more experience than me and this means their professional language is way more mature, thus this posed a challenge to me when they asked me questions that required deep professional/clinical reasoning that I have not developed as yet but currently building, so this slightly diminished my self-esteem but motivated me at the same time. One of the things that I disliked about working within the team was how it seemed like they prioritized other health professionals over others as if they depended on them. This breaks the aim and purpose of the MDT and this leads to poor outcomes.

Below are multidisciplinary Team Benefits

Improved patient outcomes :Working with a multidisciplinary team allows you to treat the entire patient and provide comprehensive care.  With each physician focused on a different aspect of the patient’s health, providers are more likely to identify areas of need, and subsequently manage those needs in an effective way

Streamlined workflows and time saved :Multidisciplinary care increases productivity and saves time within your healthcare organization.  Trying to provide care across a healthcare system without coordination can lead to communication and care errors, i.e. time wasted.  Working in a care team has shown to decrease service duplication, as tasks are communicated clearly and delegated to members to avoid such events

Improved patient and team satisfaction :With improved health outcomes, patients will have increased satisfaction.  They have increased access to a multidisciplinary healthcare team that can address all of their needs.  They can rest assured that the whole patient is being treated.

As the curtain falls on another chapter in the saga of healthcare, the MDT stands tall, a testament to the power of unity, empathy, and collaboration. Revisiting the point of the blog in the introduction I would like to say that it has been an amazing experience and  I would recommend it to any aspiring health science student willing to learn from their mistakes and champion their fears

REFERENCE

Benagiano, G., & Brosens, I. (2014). The multidisciplinary approach. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(8), 1114-1122.

Chinai, N., Bintcliffe, F., Armstrong, E. M., Teape, J., Jones, B. M., & Hosie, K. B. (2013). Does every patient need to be discussed at a multidisciplinary team meeting?. Clinical radiology, 68(8), 780-784.

O'Driscoll, W., Livingston, G., Lanceley, A., Nic a'Bháird, C., Xanthopoulou, P., Wallace, I., ... & Raine, R. (2014). Patient experience of MDT care and decision-making. Mental Health Review Journal, 19(4), 265-278.

Taberna, M. (2020). The Multidisciplinary Team (MDT) Approach and Quality of Care. Frontiers in Oncology, 10(85), 1–16. https://doi.org/10.3389/fonc.2020.00085

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My reflection on the Cultural Humility.

Marcus Garney once said, “People without knowledge of their history, origin, and culture are like a tree without roots”, therefore there’s no life without culture. There are different types of trees in the world, but their roots have the same function thus our cultures can be different but are a way of life for all. A continuous process of introspection and self-reflection mixed with an openness to picking up knowledge from others is what is meant by cultural humility (Tervalon and Murray-Garcia 1998). It entails approaching someone to respect their values, traditions, and beliefs. Today I will share my experience of using cultural humility with patients at the hospital and with colleagues.

South Africa is a multicultural society thus in hospitals every patient has their own cultural beliefs that are meaningful to them. As a health science student, we always see new clients from different places, which calls for respect for their traditions, beliefs, and values. However, this cannot be presumed, instead, I ask the client about what they believe in, which may include their religion and how they perform certain traditions. For example, my client was involved in a car accident and suffered multiple injuries, now she believes that she is being punished by her ancestors, but I don’t believe that, however, because I respect her belief and I understand her cultural background I won’t argue with her, instead, I listen to her and that is how I learn or get exposed to her culture

The following are the Elements of Cultural Humility:

Self-reflection and self-critique

To acknowledge the innate power that doctors have over their patients, it is important to actively participate in self-evaluation and self-criticism (Cooper-Patrick et al. 1999). This is where the cultural humility method begins. It is imperative that before exploring a patient's belief system, healthcare providers first recognize the presumptions and beliefs ingrained in their own expertise (Hunt 2005).

Learn from patients.

To resolve power disparities and achieve the learning objective of regaining access to the cultural aspects of each patient's experience, a complete involvement in listening to patients is essential (Tervalon and Murray-Garcia 1998). It is possible to prevent cultural stereotyping by listening to patients' stories without drawing conclusions too quickly. Put differently, practitioners are urged to take on the role of student, learning from patients to comprehend their views and desired course of treatment.

Partnership-building

To ultimately benefit each patient through health advocacy, practitioners are encouraged to form and preserve respectful partnerships with both the communities and the patients they are currently treating.

A life-long process

Attaining cultural humility becomes not an end point but an active process of being in the world and being in relationships with others and self (Miller 2009).

QIAN DIAGRAM EXPLAINS CULTURAL HUMILITY.

Being in the hospital and seeing different clients has taught me to be humble by not acting superior or all-knowing to the client, I treat the client as an equal partner because I may find that the client knows more than me about the way of life and how are things done, this links to the importance of client-centredness/collaborative mode. My client is a 51-year-old Zulu woman and is a mother of two young adult daughters thus this means I should treat her with respect since the Zulu culture emphasizes the importance of respect, I call her by her surname and I use words like “please and thank you” to show that I value and respect her. This has built a good relationship between me and her.  

The importance of Cultural humility in Occupational therapy

Improved communication: I’ve developed a good relationship with my clients due to active listening and willingness to understand their perspectives.

Reduced Prejudice and Stereotyping: It helped me to recognize my biases and how I can overcome them to foster a more inclusive and respectful interaction.

Enhanced Cross-Cultural relationship: I’ve developed close relationships and good rapport with the clients built from understanding their cultural background.

Increased Cultural Competence: I’ve gained knowledge about different cultures and that increased my cultural competency.

Promotion of Social justice: Cultural humility aligns with principles of social justice by acknowledging power imbalances and working to address inequalities in society.

Personal Growth: it encouraged me to do self-introspection and analyze my own biases and assumptions.

Professional Development: It has helped me to choose my professional self over my personal self to improve my professionalism in the healthcare sector or with my clients.

In embracing cultural humility, we embark on a journey of profound self-awareness and openness to the rich tapestry of human experience. It is not merely an intellectual pursuit but a transformative embrace of empathy and respect for the diverse narratives that shape our world. Through humility, we relinquish the illusion of knowing everything, instead embracing the beauty of continuous learning and deepening connections with others. In this spirit, let us weave the threads of understanding and compassion, celebrating the mosaic of cultures that adorn the fabric of humanity

Article links :

REFERENCES

Miller, M. E. (2009). The literary influences of Jim Wayne Miller. Appalachian Heritage, 37(3), 19–24. https://doi.org/10.1353/aph.0.0160

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233

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From theory into practice: My first week of intervention in fieldwork.

I am a 3rd year OT student currently placed at Prince Mshiyeni Hospital for clinical practicals. In this blog, I will share my experience so far about doing interventions with patients at the hospital.

The patient that I was assigned to was diagnosed with polytrauma which results when a person sustains multiple injuries in the body during an accident. After gathering all the assessment findings, I decided to do an upper limb dressing activity and to teach easier dressing techniques/methods as part of my intervention since she experiences pain in the left shoulder joint which prevents full ROM (active) in the shoulder joint, decreased muscle strength (especially against gravity) and other client factors which decrease the quality of dressing. Initially, I was frustrated about what to do with the patient because I did not know anything about the diagnosis and how it links to Occupational therapy, however, at the same time was thrilled by the diagnosis in that it made me curious and pushed me to do more research on it.

It’s such an amazing experience to get a chance to do intervention because it challenges my critical thinking and clinical reasoning when planning a session since requires me to analyze the activity (breaking it down into its components) to identify all the required client factors, body structures, and body functions and compare them to what my client’s abilities so that I know what to improve with the client. for instance, the pain in my patient’s left shoulder hinders FROM of the shoulder joints and decreases muscle strength thus making it difficult to dress the upper limb. The intervention strategies differ for each client and depend on the diagnosis of the patient thus this teaches me to be flexible and client-centred always. For instance, my 2nd client has a right CVA and left hemiplegic (the left side of the client is not functional) so my intervention would be to maintain the PROM on the affected side to prevent possible contractures in the joints. Doing intervention enabled me to discover my strengths, which include the ability to have good communication skills, flexibility and versatility, honesty, patience, empathy, and taking criticism as motivation to grow and improve.

I still need to improve my clinical reasoning and theory application in practice to do the just right interventions and treatment for my clients.