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The health of a mother and child is a more telling measure of a nation’s health than any economic indicator.

In the words of Hilary Clinton, you cannot have maternal health without reproductive health. Reproductive health includes, contraception and family planning and access to legal, safe abortion.” (maternal, infant, and child health/ healthy people 2020, 2020). Clinton words emphasize a very specific, crucial contributing factor towards maternal health which is a mother’s reproductive health. However, Clinton’s words also highlight that there are various aspects from which to look at the topic of maternity and child health in society and the first step towards tackling the topic is to understand it. SO what is maternal health? According to the world health organisation, maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. Child health on the other hand is defined as the health definition by WHO, which is a state of physical, mental, intellectual, social and emotional well-being and not merely the absent of infirmity.

(Importance of Maternal And Child Health Training Programs | JLI Blog, 2020)

Mahatma Gandhi once said, “it is health that is real wealth and not pieces of silver and gold” (mahatma Gandhi quotes, 2020). Hence I believe that maternal and child health is important, as their well being determines the health of the next generation and this can help predict future health challenges for families, communities and the health care system. According to (maternal, infant, and child health/ healthy people 2020, 2020) pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children, these health risks include diabetes, depression, hypertension etc. there are many factors according to research that can effect pregnancy and childbirth, these are perception health status, age, access to preconception, prenatal health care and poverty. The environment and social factors such as health care and early intervention services, educational, employment and economic opportunity, social support and availability of resources to meet daily needs influence maternal health behavior. Thus it is important that there is a balance in these areas to ensure maternal and child health.

Occupational therapists work within societies and are health care advocates, we as occupational therapists work with mothers and children to improve or check whether or not there are issues physically and mentally experienced by both parties.  I was fortunate to be a health care worker and advocate at INanda community, and to be a member of the community. Working within the inanda community was a very humbling, out of body experience which I tried to make the most of by interacting closely with the mothers and their children ranging from 3 months to 14 years. The first striking piece of information I gathered about the community was it’s a low income status community, the mothers that I was seeing were part of a poverty attacked society, with informal settlements as housing. So I as an Occupational therapist screened to check whether the children were developing normally through the use or utilization of developmental milestones checklist and standardized test e.g. wits developmental milestone profile, visual perceptive screens etc. This helped to identify any developmental delays for children. I have noticed that within the community the most common health problems are HIV and learning disabilities. I was given clients with both these conditions. These health deteriorating conditions, are very much linked to the societal lack of education or knowledge and as well poverty.  

Education on health and how to deal with child at home to ensure optimal function was done with the parents (mothers) to give them insights on the importance of maternal health in child’s health, as maternal health determines child’s health. Thus as an Occupational therapist I have noticed that the involvement of mother in treatment is very crucial, I now see that before screening the child I have to first screen the mother for any signs of postnatal depression as this can affect the whole treatment of babies.

The bulk of my experience at the INanda community confirmed the mere fact that income status of a mother correlates with the quality of prenatal and development of her child once it is born. INanda being a more or less poverty stricken area means that women who live there have difficulty accessing prenatal care and women experience the common maternal health problems such as hypertension etc. and children learning disabilities. In the heartfelt words of Guillermo Del Toro," There is something about maternal love - it might just be the strongest human bond there is”.

References

BrainyQuote. 2020. Mahatma Gandhi Quotes. [online] Available at: <https://www.brainyquote.com/quotes/mahatma_gandhi_109078> [Accessed 7 August 2020].

Clinton Health Access Initiative. 2020. Maternal, Newborn, And Reproductive Health - Clinton Health Access Initiative. [online] Available at: <https://www.clintonhealthaccess.org/mnrh/> [Accessed

Definitions.net. 2020. What Does Society Mean?. [online] Available at: <https://www.definitions.net/definition/society> [Accessed 7 August 2020].

Healthypeople.gov. 2020. Maternal, Infant, And Child Health | Healthy People 2020. [online] Available at: <https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health> [Accessed 7 Au

JLI Blog. 2020. Importance Of Maternal And Child Health Training Programs | JLI Blog. [online] Available at: <https://www.jliedu.com/blog/importance-of-maternal-and-child-health-training-programs/> [Accessed 7 August 2020].

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Multidisciplinary at my based fieldwork site

A multidisciplinary team is a group or team of healthcare practitioners or workers of different disciplines working together to achieve a common goal which is to help patients recover or cope with their diagnosis, this includes (doctors, nurses, occupational therapist physiotherapist and social workers etc.). A multidisciplinary team usually works in isolation to each other with occasional meetings held at a point in time to discuss the progress of the patients, each member within the various disciplines performs their job description as part of the intervention for the individual clients, thus the job components is unique to that profession.

A competent multidisciplinary team works towards a set goal which is help the patients cope with their diagnosis, for instant meeting and discussing the patients and the treatment each is giving or has given to each client and how the patients have benefited from it. Each member contributes some part or therapy towards the healing process of the patients and help set goal for the patients.

At my fieldwork placement cite even though they are health care workers who can form a multidisciplinary team there is no multidisciplinary team at the facility, since the majority of the team or health care workers don’t perform their job description (OT, Physiotherapist and doctors).  Most of the healthcare workers spend the majority of their working hours cooked up in their offices, they hardly ever do individual intervention for patients and they are no ward rounds done by the doctor’s hence they files are empty, all of the healthcare files of the health care workers are empty or if they are filled have student notes (occupational therapy files to be specific).

This lack of unity and job performance by the different health practitioners have led to the deterioration of almost all patients since they not getting sufficient intervention and therapy from the “multidisciplinary” team.  When asked to comment on the relevance or the benefits of being institutionalized all clients had the same answer, that for them it is not relevant and in fact has led to more problems than solutions, they report that they thought there were going to be beneficial to them as they will receive intervention on a regular basis, thus they believe that being at home would have led to more recovery compared to what they currently experiencing, since they are not receiving any intervention.

My supervisor advised us in a group meeting to try to be competent therapists in the future, she emphasised the importance of engaging with clients and being hands on with the client and deemphasized the numerous hours spent in the office, she also advised us to follow our hearts and that if we are no longer interested to do our jobs it’s best to quit or explore other professions, not only for your sake but for the lives of the patients and their families, she amongst many (clients) was disappointed on the way the facility operates, she fills that all the workers have lost interest in their jobs.

As a conclusion, everyone can agree that it’s sometimes hard to be thrilled about work but if you are losing or have lost interest in your work to the point that you are losing productivity then it’s time to do something about it because staying doesn’t solely affect you but everyone else involved.

Murphy, M., Curtis, K., & McCloughen, A. (2016). What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review. Australasian emergency nursing journal, 19(1), 44-53.

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How have i put clinical reasoning cycle into practice

One needs to be a critical thinker in order to have decent clinical reasoning ability.  To answer this question one needs to first decipher what critical thinking and clinical reasoning entail. According to Pascarella and teranzine (1991), critical thinking is defined as the individual’s ability to perform some or all the following: identifying central issues and assumptions in an argument, recognizing important relationships, making correct inferences from data, deduce conclusions from information or data provided, interpret whether conclusions are warranted on the basis of data given and evaluate evidence or authority. I like to say that I tried during the course of midterms to perform this skill through planning, writing evaluating of how intervention sessions went and what were the reasons for that ability or difficulty that the clients experienced during treatment plan.  

There are three types of clinical reasoning that one can use, “Procedural reasoning which focuses on the process used to maximize clients’ functioning. Interactive reasoning which emphasizes occupational therapists’ understanding of clients’ feelings about themselves and about the intervention they receive and lastly Conditional reasoning involves the understanding of clients’ disabilities in specific life contexts” (Lie etal, 2000). During the course of treating my clients, I would like to believe that I’ve used all the types of clinical reasoning when the situation needed it. For instant I’ve used procedural clinical reasoning when I wanted to improve the client’s performance skills and they perform in activities of daily living and Interactive reasoning was used when I spoke to the client about what they wanted to improve in their function and what where their interests and what their occupations and roles were at home. Conditional reasoning was done as well as I researched the client’s condition and assessed their level of function to understand how their diagnosis limits them from participating in their occupational roles and occupations.

my supervisor advised me to improve my clinical reasoning, she informed that in order to better my clinical reasoning skills I need to read more on things and condition of clients and understand them, she informed me that reading articles and books can help in increasing one’s knowledge and reasoning ability. She advised me to have confidence when explaining things as a lack of this portrays an image of not being sure of what you are saying, which looks bad when one tries to understand your reasoning.

A take-home message, there is nothing more potent than critical thinking, without critical thinking, there would be no clinical reasoning, so start now read books enlighten your mind, be a critical thinker

Pascarella, E., & Terenzini, P. (1991). How college affects students: Findings and insights from twenty years of research. San Francisco, CA: Jossey Bass

Scriven, M. (1976).  Reasoning.  New York: McGraw-Hill.

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what was my experience of midterms

The transition from a block that was assessment based only to a block that required a consecutive performance of both assessment and treatment was 30 times more onerous than I had anticipated or hoped It would be. My experience would score a 9.5 out of 10 on the pain rating scale if the pain was substituted for the amount of hardship and difficulty experienced during this time.

One word to describe midterms word be stressful. Midterms drained me emotionally, psychologically, financially and socially and the list endures. Having to think of, plan and write out 4 session plans for clients was stressful and emotionally taxing but the most nerve-wracking part was the part when the supervisor stayed in to view my session, my anxiety levels would reach an ultimate pick, I always found this to added pressure and stress, but supervisor enlightened me by telling me that this is for my own benefit and that she is not there to discourage me but to make me a better therapist which was very helpful and definitely reduced the stress levels.

Midterms for me, I would say we're not as easy as I had anticipated them to be, I thought I had everything figured out, in that I was successful in planning and carrying out clients’ treatment session and choosing suitable, client-centered activities and tasks, but I guess I overshoot the mark judging from the marks I received, so much failure from one person its disturbing. It hurts just thinking about it. This has taught me I need to pull up my socks for finals and need to work and avail myself to the supervisor for help.

Midterms have taught me a lot, through midterms I have learned that I have severely impaired time management skills, and I need to learn how to write out my intervention plan and aims that I opt to achieve. I have learned that I’m very disorganized.

Needless to say, all was not bad, I had a lot of successes, seeing smiles on clients faces after completion of tasks was the highlight of the whole experience which helped at some points to alleviate the stressful part of the whole midterm experience. I’m contented to say that I had a lot of successes with my clients’, treatment wise both physically and emotionally. I was able to achieve all the goals that I had set out to achieve with the client.

Midterms where for me helpful, they have taught me numerous things and highlighted areas that need to be ironed out and refined going on to finals, the entire experience has humbled me and was a great learning experience.

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what are my successes and difficulties?

There is no secret to success, it is the result of preparation, hard work, dedication and determination from the person yearning to achieve it. Hence the road to success is not straight. There is a curve called failure and loops called difficulties that one is assured to encounter along the way. But, if you have a spare called determination, an engine called perseverance, insurance called faith, you will make it to a place called success.

Success is what is sought by all people and it is the completion of anything intended in other words success is achieving what one has planned. I’ve had numerous successes so far in treatment planning and implementation for both my clients, most of the sessions were a success in that all the aims and goals that I set out to achieve were achieved for most tasks, I have been successful in choosing suitable just Right activities for my clients,  most activities chosen for the clients they were able to complete independently or with minimal assistance, and I have been successful in constructing suitable assistive devices that they were able to use competently during indicated tasks, thus most of my treatment  sessions were a success.

The reason for these successes is good planning.  It is potent to plan for each goal you want to achieve with your client, so focus on what you really yearn to accomplish and the reasons why you need to accomplish them and list the goals through prioritization this will help limit mistakes and difficulties that you might occur along the way and this allows for achievement and success of your treatment session or whatever you set out to achieve. The success of my treatment session also depended on the clients' willingness and perseverance to better themselves, thus the raport that I have built with both clients increased made the success possible. However this did not come easy, I experienced difficulties along the way, which are obstacles and troubles, what I found to be difficult was matching my primary aim to my secondary aims that were to be achieved with this, through the help of supervisor by explaining how to write this I was able to better construct accurate smart aims, she encouraged me to first to an activity analysis of the task chosen and then from here try and formulate the secondary aims that could be improved in the performance of that task.

It is said that the pessimistic see the difficulty in every opportunity and the optimist see opportunity in every difficulty, I have acquired an optimistic mindset, in that in all the difficulties I experienced, I viewed these as opportunity to learn and to better myself, through difficulties faced I was forced to ask for advice from supervisor, from this I ended up acquiring more information and knowledge then I would have if I hadn’t encountered the difficulty. Difficulties are a learning process.

Take home message from me is that never difficulties are not there to destroy you, there are put there to build you.

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How does culture influence intervention?

What is culture? One would ask. Culture is defined as a set of meanings, behavioral norms, values and practices used by members of a particular society, as they construct their unique view of the world. As such, culture deeply informs every aspect of life and health. Considering client’s cultural context and configuration helps or enhances therapists understanding of illness and positive health as well assists with designing effective interventions to restore and promote health. One factor that has compelled consideration of cultural issues in healthcare has been the increasing ethnic diversity of contemporary societies (United Nations, 1996; U.S. Census Bureau, 1992). In saying this OTs acknowledge that every person is unique in the way they combine the dynamic interplay between cultural, social and psychological, biological, financial, spiritual and political elements in their personal occupational performance and their participation in society. Therefore, culture does effect the therapist planning of intervention and client’s willingness to part take in the intervention process.

Occupational therapists usually perform a cultural formation to better understand the clients culture. The cultural formulation includes the following elements, A. Cultural identity of the individual, B. Cultural explanations of the individual’s illness, C. Cultural factors related to psycho social environment and levels of functioning, D. Cultural elements of the relationship between the individual and the clinician, E. Overall cultural assessment for diagnosis and care.

One question remains how or did culture influence my treatment sessions with my clients? For me culture didn’t play a huge role since I share the same culture as both my clients, identifying themselves as belonging to the Zulu culture, because of this it was tranquil for me to consider they culture since I have basic knowledge on what the culture entails. So in what way did I consider clients culture?  By speaking to them in their cultural language, not being biased in term of their religious belief thus respecting the clients culture. For both clients they outlook on their condition did not appear to be largely dictated by the culture. When referring to the accident and injury both clients did not make any cultural comments that would attribute the event to a cultural cause such as punishment or the work of ancestors as can be seen in Zulu culture. The fact that the clients consulted medical doctors for treatment rather than traditional Zulu healers, also gives evidence that culture did not play a huge role in the client’s outlook on and approach to their condition even though both of them believe in them.

Take home message never assume one’s cultural identity and always take into consideration the cultural background and beliefs your client has because these might affect your intervention and success of your treatment plan with your client. This is how OTs are client centered we consider everything about the client. 

Mezzich J.E.,Kleinman,A.,Fabrega,H.,Jr.,& Parron,D.L.(Eds.).(1996).Culture and psychiatric diagnosis: A DSM-IV perspective. Washington, DC: American Psychiatric Press

Krefting, L. (1991). The culture concept in the everyday practice of occupational and physical therapy. Physical & Occupational Therapy in Pediatrics, 11(4), 1-16.

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Using applied frame of reference and approaches to guide one’s intervention plan

One would ask themselves what are AFR or approaches and what roles do these have on the treatment planning and implementation for one’s client. The whole process of implementing and choosing a suitable frame of reference coinciding with client’s diagnosis after 2 years of aspiration towards this degree is still a challenging concept to grasp. To help you understand what I’m on about its imperative for me to first define what these mean. Frames of reference are Organized body of knowledge, principles and research findings that forms the conceptual basis of a particular aspect of practice. These are divided into 2 sub-divisions, which are primary and applied frame of reference, with primary referring to a frame of reference with borrowed knowledge from sources external to OT (other professions) and applied referring to a frame of reference developed from synthesis and interpretation of knowledge from primary frame of reference for example the bio-mechanical applied frame of reference was used to guide both my client’s intervention.

  Don’t be discouraged if you don’t quite understand what this means as yet, everything takes time to be engorged in one’s mind, fieldwork practical’s have really been great help in terms of ensuring that I understand what these definitions really imply, majority will agree with me on regards that knowing the theory part alone these definitions would be confusing to understand.

For every applied frame of reference chosen there has to be an approach or approaches that will be implemented to establish and further help or guide your treatment sessions. An approach according to OT diction is Ways and means of doing, or implementing frames of reference. Approaches consist of the rationale behind a specific technique and the way in which it is used in practice. The Approaches chosen need to correspond with the frame of reference chosen. With regards to my clients, the biomechanical, occupation as a mean and end, educative and compensatory approaches were used to guide my treatment.

 Feels like information over load I know!! but I will break it down using practical situation as this is better to understand practically. As you know by now both my clients are spinal cord clients, with many dysfunctions in terms of physical function, e.g. problems with performance skills which are range of motion, endurance muscle strength etc. Thus the applied frame of reference mentioned above helps to facilitate improvement of these limited skills of performance as it focuses on muscular-skeletal capacities and motion and is based on principles of kinetics study of motion and forces causing movements. This is why this frame is more suitable as a guide for treatment session.

 As for the approaches these were chosen specifically to reinforce and to facilitate the improvement of the decreased performance skills, client factors and with consideration of the client’s roles, goals and abilities. My supervisor enlightened me with the fact that in order for me to plan or choose an area to treat it is potent that i have all my assessment findings and identify problem areas, thus with this information I was able to deduce that in order for one to choose an approach to treatment you need to do proper assessment as well as know and understand the client’s factors, roles, performance limitation etc. this links with being client centered.

I have learnt the past fieldwork days that in order for one to choose a frame of reference or approach it is important to know your client’s diagnosis the affects and limitations accompanied with the condition, the problem areas for your client whist taking into consideration their client factors, needs, roles, contextual factors, performance level or limitation, so as to facilitate the correct choice or most suitable or accurate way to treat client

 References 

 Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction

 Willard and Spackman’s Occupational Therapy

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Holistic viewing of client is what we do best # Aspiring OT student

They say everything improves with time but with 20 hours of fieldwork completed already I experience the same level of anxiousness and distress every morning of practicals as first day of fieldwork which gets me wondering if I will ever feel as optimistic about treating clients as I desire to be.

It is said that knowledge rests not upon success alone but upon errors also, with errors and failures that occurred 3rd day of treatment session I have learned from these a valuable lesson that will help with future intervention planning.

From my treatment sessions failing prior to the client engaging and presiding with the performance of the activity, I have learned that I should be realistic and considerate in my approach of choosing an activity and that I should analyze the activity as well as the client’s limitations, thus lean to a more Client- centered approach which dictates that I should not only base treatment sessions on what the client wants alone but also take into consideration his strengths, weaknesses, client factors and his performance skills. This approach is focused on the partnership between the client and therapist, and allow the empowerment of the client to engage in functional activities that fulfill their occupational roles in a variety of environment. This doesn’t subside here, the client should also be involved in figuring out the settings, frequency and duration of the sessions as well as goal setting.

Supervisor advised me to consider not only the needs but most importantly the contextual factors, client factors, performance skills and limitations when choosing an activity. She advised me to select an activity based on these factors and that a detailed analysis of the activity is potent to choosing the just right activity for treatment. The activity requirement, skills needed and precautions associated with the activity should be compared to the client’s performance skills and functional impairment. This information was helpful In that it enlightened me, in that I should look at my clients as individual persons with differential needs, values, strengths, functional ability and limitation and contextual factors when choosing an activity. Look at them in a holistic manner.

In closing never compare your client’s abilities even when they have the same diagnosis, treat each client as separate beings with different needs, roles, goals, limitations and client factors etc. and refrain from an approach that insist that you are working on the client instead work in conjunctions with client in that you involve the client in treatment planning and goal setting to maximize the intervention outcome.

Mccoll, M. A. (1994). Holistic occupational therapy: Historical meaning and contemporary implications. Canadian Journal of Occupational Therapy, 61(2), 72-77.

Baum, C. M., & Law, M. (1997). Occupational therapy practice: Focusing on occupational performance. The American journal of occupational therapy, 51(4), 277-288.

Donnelly, C., Eng, J. J., Hall, J., Alford, L., Giachino, R., Norton, K., & Kerr, D. S. (2004). Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord, 42(5), 302.

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LIFE OF AN ASPIRING OT MEDICAL PRACTITIONER

Some would say going to a different fieldwork site is exciting because you get to experience differential diagnosis and get to experience how other OT departments function, as much as I agree with this, my experience wasn’t this optimistic. For me change of scenery is always accompanied by anxiety and distress and this was exacerbated when I learned I was going to a chronic facility with a possibility of getting spinal cord injury client.

They say there is a first time for everything, I learned this the hard way, the one thing I was drenching happened, tetraplegics as clients!!!!!!!!, for 2 or more minutes my heart pounded in a tachycardic manner, my anxiety levels reached a plateau phase, and feelings of distress engorged my mind because I had prayed for an opposite outcome, due to my conceived idea that it’s difficult to assess and treat spinal cord injuries.

They say that faith is taking the first step when you can’t see the whole staircase, the residue faith that remained helped me gain strength and confidence that I will manage. My faith was restored on first encounter with both client, they optimistic, willingness, perseverance and motivation to become independent. This made me eager to intervene and read more about the condition so as to help them achieve their goals.

Things don’t always go as prearranged, but learn to deal with this accordingly, at most cases avoid being hard on yourself, my treatment session for instance didn’t go as planned and I struggled with implementing my treatment principles but luckily my supervisor was able to note these and give me a few pointers on how to improve these looking forward in my treatment of the client this information was extremely helpful.

It’s always best to adhere to the original plan, but when this is an impossibility make the necessary adjustments which still try to improve the original goals. Supervisor was not so impressed by my alternative adjustments of the session plan because some skills that were ascribed to improve some performance skills where impractical and didn’t really achieve the desired treatment, her ability to note and correct this will allow me to set up and improve my treatment sessions in the future.

Always try not to focus on the preconceived thoughts that have been impeded in your mind in the early stages of practice. Supervisor advised me not to only dwell on basic ADL activities if the client is able to perform these independently, she advised that I prepare challenging activities so that the client won’t be bored. She advised me to shift from this preconceived knowledge that ADLS  are the most potent and main focus of the treatments and that I should also consider other areas of occupation such as instrumental activities of daily living such as(community mobility) and leisure.

Always have an understanding of what your client’s diagnosis is, understand limitations and complication of the diagnosis, supervisor encouraged me to learn more about the condition and the effects of muscle spasms on performance of occupations, she recommended a few reading that I should engage my attention to so that I better understand the impact of these on the performance of activities.In conclusion I would like to say that in the two days I’ve been on my fieldwork site I have acquired lot of information from both clients and supervisor that will help me in my planning and treatment of the client in the future.  

References 

Sköld, C., Levi, R., & Seiger, Å. (1999). Spasticity after traumatic spinal cord injury: nature, severity, and location. Archives of physical medicine and rehabilitation, 80(12), 1548-1557.

Holland, B., Kuhn, C., & Rossier, A. B. (1971). Medical and Practical Aspects of Occupational Therapy in the Treatment of Tetraplegics. In Occupational Therapy Today-Tomorrow (pp. 116-121). Karger Publishers.

Dobkin, B., Apple, D., Barbeau, H., Basso, M., Behrman, A., Deforge, D., ... & Harkema, S. (2006). Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology, 66(4), 484-493.