#my physio plans to discharge me in two weeks. it’s good!

[fingertipsmp3]

Like yeah I can absolutely be charming and personable when I need to be, but I have to be in the correct headspace first. Like I have to not be catatonically depressed about my dog dying and my sister dying and winter in the north being so bleak!!! Can we talk about it

[blogging-studentstyle]

Mandisa Nzuza

219014888

BLOG WEEK 2- REFLECT ON WHAT CLIENT CENTRED MEANS TO YOU?

Second week of fieldwork was a bit overwhelming because that is when it shifted from assessment to intervention. The second week comprised of a full day on Monday, which was a first for us as the previous week was half days. During the day we completed our two sessions with the client, and we held a group session which was nerve wrecking as we did not know the expectations and how the different clients will respond to the session. The group session was held by Nqobile and me which ended up going well and the client’s responded well and there were opportunities of upgrading and downgrading the activities to match with the client’s level of functioning while also helping to improve the client factors that restrict independence. At the end of the session, we did cold down exercises, some of the clients complained of how short the session was mainly because the enjoyed the session so much and the like playing ball. The days following that were half days which were manageable and further intervention was implemented.

Sessions on all three days went well, the only problem was the time clash between the physiotherapist as my client is having more physio sessions to help with his core strength. My other client was able to participate with all activities handed to him actively. The mistake that I made that I left my client outside in the sun after my activity after observing signs that he is not feeling well. From the feedback I received from my supervisor, I now know that in the future I should make sure to hand client over to the nurse or another therapist, especially when they are not feeling good, for their safety.

WHAT CLIENT CENTREDNESS MEANS TO ME

To me client centred means engaging the client more in therapy. This can be done by looking at restrictions the client has in participating in occupations that he usually does or enjoys doing. We then use occupations most familiar with the client to help improve the client’s functional performance. During therapy we look at their limitations and what their individual goals are for discharge and try to incorporate those in therapy. The OT intervention is focused on enabling individuals to change aspects of their person, occupation, or environment. The client centred approach focuses more on the person rather than the condition being treated. According to Liz Burton, client centredness is ‘Delivering person-centred care involves caring for patients beyond their condition and tailoring your service to suit their individual wants and needs. It’s about respecting that they have their own views on what’s best for them and have their own values and priorities in life.’ Client centred principles include, treating your client with dignity and respecting their loss of independency and giving them autonomy, to provide co-ordinated care, support and treatment to client, (this will further help facilitate rapport with client which will influence therapy), offering personalised care, support and treatment to client by personalising the therapists services to each individual client and lastly to enable clients to recognise and develop their strengths and abilities so that they can live an independent and fulfilling life.

Client centred approach helps service user feel more comfortable and confident with the therapist as they know their best interest is considered. They will feel involved in therapy thus instilling a sense of autonomy in client.

PLANNING AND IMPLEMENTING FOR INTERVENTION FOR MY CLIENT

My client, Mr N who is diagnosed with left CVA and is an above knee amputee on his right leg, he is independence in most areas of occupation and is more functional. The main aim for discharge or intervention is getting him to be able to use a walker or crutches instead of a wheelchair. To get the client to be able to walk using a walking frame or crutches, we need to improve his static standing balance, this is difficult as client is only reliant on one leg for support, so therefore he requires maximal lower limb strength on his left leg. Intervention is also aimed at improving his trunk control as this will help him when walking either using a walking frame or crutches as walking requires weight shifting and trunk rotation when having to turn. To help improve these, Mr N engaged in activities that required trunk rotation, dynamic sitting balance, physical endurance of more than 10 minutes, he engaged in dressing the lower limb in standing, he is still having difficulties due to decreased trunk control and balance which will be improved with repetition the activity regularly. He also engaged in a painting activity which required dynamic sitting balance as he had to reach out for the pot plant holder to pant them, this will further help improve his trunk control which will help during ambulation. Hand exercises was also done with the client as he showed signs of decreased prehensile functioning during the card game, this will help activate his hand muscles and help improve their strength and this will help when he gets home as he usually fixes cars and would require adequate muscle strength of his hand muscles to help unwind or fasten nuts and bolts hen fixing cars.

FEEDBACK RECEIVED FROM MY SUPERVISOR AND HOW WILL I CHANGE INTERVENTION NEXT WEEK

The most important feedback I received from my supervisor was when I left Mr N outside when he was not feeling well, she explained to me the implications and that I should have handed the client over to a nurse or any of the therapist to ensure the clients safety. This is an important precaution that now after this I will never forget and will use it in the future to always make sure the clients are attended to and are safe, especially when they are not feeling well.

Next week I will pay attention to the client’s behaviours and how they are feeling during the session which will determine the extent of the session, this will be facilitated by being client centred, focusing on the clients’ abilities and barriers to being independent in occupations client persuaded before admission.

References:

1. Polatajko, H., Davis, J., Stewart, D., Cantin, N., Amoroso, B., Purdie, L. & Zimmerman, D. (2007). Specifying the domain of concern. In E. Townsend & H. Polatajko (Eds), Enabling Occupation II: Advancing an Occupational Therapy vision for Health, Well-being & Justice Through Occupation (pp. 13-36). Ottawa: Canadian Association of Occupational Therapists. 2. Wilcock, A. (2006). An Occupational Perspective of Health. (2nd ed.) Thorofare: Slac

[crystaljins]

Popcorn

Characters: Hoseok x Reader

Word count: 3.1k

Synopsis:   You just want to watch a movie. Hoseok just wants you to rest. Secret agent!au.

Notes: Lovely @lilliaflurr​ requested Hoseok + Popcorn and I am SOFT for Hoseok cuddles. Like you know that video where Jungkook bangs his teeth on the mike and Hoseok gently cups his face? Or when Tae is sleeping and Hoseok gently kisses him? Yes, he would be good, good cuddler. But I also needed a bit of angst. Like salted caramel, it enhances the natural sweeetness.

Warnings: Mention of violence, surgery, being in hospital. OC is like blatantly checking Hoseok out THE ENTIRE TIME. It’s mostly just cuddling tho.

Hoseok is pretty even when he sleeps. He has long lashes that fan over sweet, rounded cheeks and lips that purse into a heart when he smiles. His hair is soft and falls into his face and his expression is so unguarded. You are surprised that he has  fallen asleep beside you in the bed but the warmth and safety of his body against yours is not unwelcome. It is a rare sight to see Hoseok doing something as vulnerable as sleeping next to another human. Although, you suppose that after so many years as partner, you are not just another human to him. Especially after what he has just endured for you. You frown as you examine his face with more scrutiny- a bruise sits ugly on his jawline and the corner of his lip is cut and swollen. 

Tentatively, you reach up to brush the errant strands of hair that fall into his face from his brow, exposing the smooth skin of his forehead. His lashes flutter at the ticklish sensation, and then soft but sleepy brown eyes peer at you curiously.

“You’re awake.” He says, and the words are so hushed they are almost whispered, like a secret that hovers between you. You don’t answer, instead choosing to trace your fingers wonderingly across the sharp edge of his jaw. How can he be so pretty? “You should be resting.”

He wraps long fingers around your wrist and gently tugs curious fingers from their journey across his face. You frown- you had wanted to memorise the planes of his face and the shape of his skin beneath your sensitive fingertips. You can’t chase away the feeling that it could all vanish at any moment if you don’t. 

“I’ve rested plenty already. I’m ready to face the world, go partying, celebrate my discharge and all that jazz.” You say dismissively trying time tug your hand free, but your arms are weak and floppy. In such a short amount of time you’ve lost so much strength to your body. Tomorrow, you will start physio sessions to rebuild your strength, but tonight Hoseok had insisted you remain at home following your discharge from hospital. He had promised a movie night to keep you entertained but you had been so sleepy on pain meds after he helped you hobble into the apartment that he had insisted you go to bed right away. You vaguely remember being sleepy and delirious as you tugged on the fabric of his shirt to keep him beside you as you slowly nodded off. Now that you are more awake, you do not feel ashamed of your actions. The bed is far too wide and cold without him there beside you.  He must have fallen asleep while keeping watch over you as he has taken to doing ever since you were hospitalised, but now you are both awake.

“Let’s watch a movie like you promised. We could go to the cinemas!” You cry excitedly. You shift and wince when you feel pain lance up your side. Hoseok’s eyes fly open and all traces of sleepiness leave his form. He shoots up into a sitting position and places a tender hand over where the bandages wrap firmly around your abdomen. 

“Does it hurt?” He demands and he sounds like he’s the one who is hurt, rather than you. Alarmed by the reaction, you mutely shake your head.

“It was just uncomfortable when I moved.” You say. “I could feel the stitches pulling.”

Hoseok pulls an interesting face as he lowers himself back down so the he is once again lying beside you. He rolls himself onto his side so that he is staring at you. The expression vanishes as he smiles gently at you but the memory of it lingers. It is the same expression he had pulled when you collapsed after being stabbed. Like the world is crumbling around him and he’s only barely managing to hold it together. The thought that he is clearly agonised by what happened has you reaching out to wrap your fingers around his in what you hope is a comforting gesture. He stares at your interlaced hands for a long moment before raising his eyes back up to meet yours.

“What if, instead of a movie, you took more of your pain meds and rested just a little longer?” He suggests hopefully. You shoot him a look that you hope portrays your distaste for the idea. You literally cannot sleep a moment longer- you were in hospital for an entire week and spent most of it drowsy and knocked out on very strong pain meds. 

“Hoseok.” You say sternly, and he offers you a sheepish smile. 

“It was worth a shot. Fine, we’ll watch the movie. But we’ll watch it here- I’m not wheeling your crippled ass all the way to the actual cinemas.” He says, getting up and stretching with a yawn. The movement causes the loose fitted jumper he wears to rise up, exposing the bruises that are scattered across his abdomen. You stare at them forlornly- he had not escaped this incident unscathed either. You remember how desperately he had fought to get the two of you out of that warehouse but in the end it had not been enough. He was sorely outnumbered and hadn’t seen the man coming at him with knife in time. You had though, and your body had moved of it’s own accord. The last thing you recall is Hoseok cradling you as you lost consciousness. You don’t know how he got the two of you out alive after that and you’re not sure you want to know. 

His hand catches yours before you can brush your fingers along the ugly bruise on his waist. You hadn’t even realised you were reaching for it. 

“Now, now,” he says gently. “You aren’t worrying about me, are you?”

He raises your hand and presses a fond kiss into the palm of your hand. Your face flushes hot- the press of his lips is lovingly gentle.

“N-no.” You stammer quickly, flustered by the intimate gesture. He smiles against your palm and leans in close. “I just thought your skin looked really smooth.”

“Good. Cause I’d have to direct your attention to this general area if you were.” He says, gesturing to your heavily bandaged midsection. He reaches out to smooth errant hairs out of your face and you find yourself struggling to breathe for reasons other than the knife wound in your abdomen. “Come on. Let’s go to the living room.” He says. He steps in so close that the tail end of his breath rushes over the sensitive skin of your neck and then hooks an arm beneath your knees and one behind your back.

“Wait, Hoseok,” you protest when you realise his intention to lift you up, bridal style. “I’m too heavy-”

“Hush!” He sucks air between his teeth to shush you. He offers you a sharp, stern look before tucking you in close to your body so that your ear presses against his chest. The proximity is enough to shush you as he attempts to lift you. You can hear the steady and comforting thump of his heart against your cheek. Hoseok groans in exertion before realising that you are correct. He cannot carry your dead weight. He smiles awkwardly. 

“I told you so.” You huff.

“I’ve been too busy looking after you to hit the gym.” He counters. “Wait here. I’ll get your wheelchair.” He stumbles off quickly and leaves you to huff after him in annoyance. It also gives you a moment to process. He has always been affectionate but there is something intimate and tender about the way he is handling you right now. Like you’re precious and breakable. It feels like he’s holding his breath every time he reaches out to touch you and it’s doing strange things to your insides. Which is saying a lot considering you are still recovering from major abdominal surgery where they literally did strange things to your insides.

You suppose you can’t blame him, after what the two of you had just endured. You’ve never been through an ordeal quite like this one, even though you are his partner. You’ve been his eyes and ears out on the field for a long time, helping him complete missions through his comms device while you remain safely at headquarters, watching him through a monitor.

Despite your partnership with Hoseok, one of the top agents in the company, you’re not a field agent by any means. But you are one of the top agents when it comes to breaking past cyber security walls. And that had been your job for a newly formed crime syndicate with big plans to hurt a lot of people. However, despite your skill, it had become clear that the only way you were breaking past your next target’s firewall was by physically hacking their main computer. Hoseok had been vehemently opposed to the idea. And with good reason too- although you are subject to the same fitness evaluations and health checks that field agents are, you are not trained to be out in the field. Still, people were in danger and access was needed to that computer and so the higher ups had decided that you would have to go in. Hoseok would accompany you and you had tried to reassure him that it was just like the missions where he had to escort foreign diplomats through highly hostile territories. He had rather angrily pointed out that this was in no way similar. 

And, just as Hoseok predicted, the mission had gone south very quickly and the two of you had been separated. You’d woken up bound with zip ties in a warehouse- the plan by the people holding you had been to interrogate you and maybe forcefully recruit you to their side.

It had only taken Hoseok a few hours to find you and raise hell in that warehouse, but it still hadn’t been enough. You were hospitalised for a week and you still don’t know what happened for Hoseok to find you and rescue you or what happened in the time between when you were stabbed and when you woke up after the first surgery. You can’t imagine the things Hoseok must have seen and done, all by himself, without the support of his partner. Your heart aches. You didn’t mean to leave him alone to face all that, but the two of you had been backed into a corner. And now this is the pathetic state you are in.

Hoseok returns, carefully guiding the wheelchair into your bedroom. You could probably walk the short distance through your hallway to the living room where the TV is, but it had been no easy feat to get you into bed in the first place. You wait anxiously as Hoseok slowly approaches. He crouches by the bedside, with his front facing your profile. He slides a hand across your back as he supports your weight. It is frustratingly difficult to get yourself into a sitting position. But it is nothing compared to the explosion of pain when you attempt to stand, even with Hoseok’s assistance. You wince and bite bck a noise when you feel your sutures pull. Tears fill your eyes quickly and Hoseok is watching you so carefully there is no way he misses it. You’re so pathetic. The only reason you’re in this state is because you’re so incapable- if you were a field agent like Hoseok, you would have been able to support him, instead of getting stabbed and leaving him to fend for himself.

“Perhaps we should take a break. Or I can get you more painkillers-“ he says quickly. 

“I don’t want more painkillers.” You say and no one is more surprised than you at the way your voice wobbles and tears spill down your cheeks. “They make me sleepy and I’m sick of sleeping.” You inhale slowly, trying to stave off a sob. “I’m sorry. I’m not even sure why I’m crying-“

Hoseok interrupts your sentence by reaching out to catch a tear that slides down your cheek with the pad of his thumb. His expression is careful, like he’s holding back something, and he tilts your face towards him with a hand on your jaw. 

“It’s ok.” He reassures you. “You’re high on pain meds and you’ve just endured a highly stressful ordeal. Anyone would cry.”

“You went through it too, and you’re not crying.” You say and he offers you a tight smile.

“Trust me, (Y/N).” He says, and for the first time, you hear the brokenness he’s trying to hold off on your behalf leech into his voice. “I want to be crying. Now, do you want more pain meds, or do you want to watch the movie?”

His reassurance comforts you.

“I want to watch the movie.” You answer in a small voice. He smiles, pulling up the sleeves of his jumper to his hands to wipe away the last of your tears.

“Ok. How about we watch it in bed instead? I’ll go get my laptop and make some popcorn. We can watch 10 things I hate about you because I don’t know about you but I’m sick of action movies.” That makes you smile and his expression lights up with his success. “Atta girl.” He leans up and you freeze as he once more does something out of character- he presses a gentle kiss to your forehead. 

It’s not that you don’t like it. You do like it- you like him. It’s just that it’s confusing because you don’t know where it leaves the two of you. Is he being affectionate because he wants a romantic relationship with you? Is this just his normal self and you just feel more conscious of him than usual? Or did he notice your crush on him and feel obligated to act this way because you took a knife for him? 

A thumb pressing into your wrinkled brow startles you out of your thoughts. At his touch you release the tension you didn’t realise you had been holding in your face. 

“We don’t have to watch a romcom if you don’t want.” Hoseok teases lightly. “There’s no need to look like the world is ending.”

“It’s not that…” You say. “It’s just… you seem different, is all.”

“A bad different?” He asks sheepishly. He drops his hand and lets it rest on the bed sheet beside you. You stare at it, missing the warmth of his fingers on your skin. His fingers are almost as pretty as his relaxed face as he sleeps. 

“Not a bad different.” you admit quietly. “A confusing different. We weren’t like this before.” 

Hoseok doesn’t look at you as he reaches for your hands. He fidgets with your fingers and the sensation is unusual but pleasant. 

“Before I didn’t know what it was like to lose you.” He admits quietly. “I’ve held myself back for a long time. We had to maintain professionalism and all that stupid crap and I knew you liked me but I wasn’t brave enough to say anything. But then our bosses decided apparently your life means nothing to them and I lost you not once but three...” his voice cracks and he clears his throat. “Three times. When they first took you.” His hands tighten on your fingers. “When they stabbed you instead of me.” He inhales deeply and when he looks at you, you notice the way his eyes are red-rimmed and there are dark circles under his eyes but he’s still so pretty. “And when.... and when you had to go in again. After the first surgery. So now… screw bravery. I’m too scared not to do anything.” 

His vice grip on your hands is borderline painful. You twist your hands in his grip and his fingers go slack against yours. You take the opportunity to lace your fingers with his. You’ve always wondered what it would be like, to want to hold his hand and just grab it on a whim. It’s nice. To just have the urge and just follow it. To not have to stress about how he’ll interpret it or whether he’s annoyed by it. You wonder if he’ll let you kiss him.

“But Hoseok.” You call. He had dropped his gaze to your joined hands, but he meets your gaze once more. “I lived, bitch.” 

You expect him to smile. The universe had literally aligned to allow you to make that joke but he just frowns at you with a deadpan stare. You grimace. He sighs and shake his head. 

“I almost don’t want to say it now, but what I was going to finish by saying that I realised I can’t live without you.” He admits. But then he frowns. “Actually, you know what? I don’t mean it anymore. I take it back.”

“You can’t!” You complain. “No takesies backsies.”

Hoseok shakes his head and this time he can’t resist the smile that slides onto his face.

“Well then I guess you’ll have to learn to live with this ‘confusing different’, if I can’t take it back.” He says, smoothing his thumbs over the back of your hands and leaning forward to press a warm kiss to the curve of your cheek. “Now if you excuse me, I have some popcorn to make and a laptop to go find.”

He stands and grabs your wheelchair, preparing to move it out of the room. You stop him before he goes.

“Before you go,” You say nonchalantly, fidgeting with your bedspread idly. “You might as well kiss me properly, since you can’t live without me and all.”

He shakes his head as he turns around and plants a hand on either side of you. He leans in so close that all you have to do is purse your lips to meet his. Your lashes flutter as your eyelids close and you feel your breath catch in your throat in anticipation. And then Hoseok smiles and kisses the tip of your nose instead.

“Maybe when you’re not high on pain meds.” He tells you. “And you’re well enough to go to dinner with me without a wheelchair.”

“You could always hit the gym again and try carrying me. Then we could go out to dinner right now.” You point out, and he laughs.

“Not a chance.” He says, turning to leave you. You pause to admire the firm lines of his back as he leaves.

He’s pretty even when he leaves.

[loadingluke]

Recovery days 6&7 of stage one RFF phalloplasty

THURSDAY 4/2

Today was pretty uneventful. I’m feeling pretty mobile and I’m able to move quite a bit, but I’m starting to miss being in a real bed, without being bothered (as much as the nurses are lovely!). I think it’s a good sign though, cause clearly I’m feeling well. I spent the morning binging Brooklyn 99. I had my usual sponge bath and freshen up, and then Andrew came back in to have a look at everything. He said that Goossen will be popping in later tonight once he is out of theatre. I had a visit from a friend and mum. It was nice to hang out and have a chat, especially now that I’m able to sit up and wander around.

The padding around my phallus is completely falling apart. The right side was just unraveling heaps, so any time I had to walk anywhere I had to awkwardly walk whilst holding it up. I’m so, so, so excited to have them off. The plastic bandages covering my butt incisions are completely rolled up, all the incisions are exposed. It’s nice to have a look at them, they’re really thin. The plastic ended up rolling into little lumps, which made sitting pretty uncomfortable. A nurse came by and replaced that, and that made me feel a lot more comfortable.

I watched more Netflix, just waiting around to see Goose. He popped by at about 8:30pm. Clearly it had been a long day, so I just decided to wait till tomorrow to change my padding. We just had a quick chat about tomorrow’s plan of action, and then I headed off to bed.

FRDAY 8/2

Discharge day! The morning started off pretty slow. I just watched some YouTube videos, and talked to the nurses. A little before 11, a physio came in with a hot water bath to prepare for my splint to be made. At 11, an OT came by to start the splint process. Hans and Andrew came in pretty quickly after that. Hans began unwrapping my arm, removing all the bandages and foam holding my graft in place. This was the first time I got to see my arm after surgery. There were some antibacterial dressings on my arm, but they were looking really good so he decided to leave them on instead of replacing them. He said my arm looked like it was healing really well. He drew my attention to some small superficial blisters near the top of my graft. He said they were completely normal, and already starting to heal up quite well.

I’m not going to lie, it was pretty emotional seeing my arm. I’m so grateful and happy with how it’s all gone and have absolutely no regrets at all, and I’ve been emotionally preparing for this for a long long time. But it was still a lot to take in. I’m happy with how it looks and I know it’ll turn out fine, but it was still emotional I guess. It wasn’t as long or large as I expected though which is nice, and I was really shocked with how good it was already looking. I’ll post some pictures of it as it’s healing when I’m ready.

Once I was redressed, the OT began with the splint. It’s made from a grey plastic that melts at about 60-65 degrees, so they melt it and then wrap your arm in it and it moulds to you! When it cools it goes rock hard again. It was really cool to watch. While she was doing this, Hans started to remove my dressings on my groin, and I finally got to see my penis without any dressings for the first time! It looked really good, I am so so beyond happy. One the splint was fitted and my dressings removed, Hans booked me in to see him on Tuesday, and the OT on Wednesday.

Once they left, the nurses came by to replace the dressings on the incisions around my groin: the two on my legs and one on my abdomen. Without sounding dramatic, but this was honestly the most painful experience this week! Look. I’m a very hairy man, and Hans shaved me during surgery but it had already grown back quite a bit 😬 The nurses had adhesive removal wipes, but it was a very long and drawn out process. Yeowch. It was good to see the incisions, they were so SO thin. So so thin, I’m really impressed. I reckon once they are all healed up (and my hair has recovered from the nurse waxing 😂) you’ll barely see them. Honestly so stoked with how everything is looking!

After the nurses left, I had my last hospital sponge bath, and started to slowly pack everything up. I got some clothes on, and had the nurses come in to help me out on the dick donut. Its pretty noticeable in my pants....very awkward 😂. I’ll just carry around an empty tote bag conveniently covering my front or wear some long shirts. It’s a little embarrassing but it’ll get better once I can start to leave the house without it. Hans said that my urethra is healing up really well, so hopefully it won’t be too long and/or the next few weeks pass quickly 😁

After I was all organised and dressed, I had a visit from a friend, and then mum came and we got ready for my discharge. I wrote a card and gave some chocolates to the nurses on my ward to thank them. They were all lovely and I had a really positive experience. It took a while for the meds to be sent to my room, and for my paperwork to get there, but at about 4pm I was finally discharged! I hobbled out of the hospital and mum left to get the car so I wouldn’t have to walk too far. We headed back to our family friends place. Once I got in I had a nap as I was pretty tired. Since then, I’ve just been relaxing and watching TV. I’m feeling pretty tired, so I’ll probably head to bed soon.

So here we are. First week of recovery done. I reckon now I’m gonna stop with the long posts every day as there’s not really anything to say! I’ll just update you all when something interesting happens. Thanks for all the support over the last week, it’s been really appreciated 🥰💪

[blogging-studentstyle]

MANDISA NZUZA

219014888

BLOG WEEK 4- REFLECT ON HOW YOU HAVE USED EVIDENCE BASED PRACTICE TO GUIDE YOUR INTERVENTION

The fourth week at eNtabeni went overly well, it consisted of one full day and two half days. On Monday when I got there my client was discharged which was a bit of a sombre, as I had created a good connection with my client but was also positive as he had gained enough functioning capacity to return home which was good. There was also a good learning opportunity that arose, when we were able to observe Caroline setting up the standing frame, it was interesting for me as I have not seen one and how it operates. Wednesday and Thursday were a bit calm as I had one patient, this helped with focusing my intervention more as I gained more insight on the client’s functional level with the help of the physiotherapist. Sessions with my client went well as they were a learning opportunity for me. From the initial contact with my client, I think there has been some improvements with how I handle him, because initially I feared handling him since this was the first time having a spinal cord injury client. With time I think I have eased well and learning a few therapeutic skills along the way.

REFLECT ON HOW YOU HAVE USED EVIDENCE BASED PRACTICE TO GUIDE YOUR INTERVENTION

Firstly, “evidence-based practice is the integration of critically appraised research results with the clinical expertise, and the client’s preferences, beliefs and values”. Evidence-based practice ensures that your treatment techniques are effective. Analysing the best and most pertinent research ensures that the treatments that you use with your patients work. Evidence-based practice allows you to help your patients make informed choices for their occupational therapy programs. Evidence-Based Practice and Research (2018). American Occupational Therapy Association. The process of evidence-based OT includes six steps: 1. Asking a Clinical Question, 2. Searching for the Best Available Research Evidence. 3. Evaluating the Evidence Critically, 4. Combining Evidence with Your Expertise and Your Client’s Context, 5. Appraising Your Performance and Outcomes, 6. Communicating Your Results.

HOW IT GUIDED MY INTERVENTION

1. Asking a Clinical Question- This was done through an interview with the client, and I could gather information from the client was able to observe functioning, and from there I could formulate a clinical question on what is it that I need to do to improve the client’s occupational performance and how to include that in intervention.

2. Searching for the Best Available Research Evidence- This was done by researching more on the client’s diagnosis, using the clients file, and observing though sessions that the client had with Physio. I found MayoClinic helpful as it gave me more insight on the client’s disability.

3. Evaluating the Evidence Critically- This was done at home when formulating the client’s case study and planning for intervention, on what information would help me try and improve the client’s functional level. The supervisor also helped with this when there was a point where I felt stuck and helped with evaluating the case critically. She was able to answer questions that I had with the case but first allowing me to think about it broader.

4. Combining Evidence with Your Expertise and Your Client’s Context- This was done alongside with the physiotherapist at the Rehabilitation centre when we were discussing on the client’s wheelchair mobility. On how they have done and ways on how I can grade the activity to challenge the client more and we also discussed on what to do in the future with the client.

5. Appraising Your Performance and Outcomes- Most evaluations were done after sessions with supervisor, which helps you see what went well and how one could have changed the session to suit the client. I self-evaluated my sessions and noted what was beneficial and what was not and what to do next with the client.

6. Communicating Your Results- This was done with the supervisor, where she would give me constructive feedback and greater insight on things I missed out. It helped as she gave me skills on how to transfer the theory into practice with the client.

Reflect on your planning for intervention and implementing of intervention for your client

This week’s sessions were aimed at improving the client’s independency in ADLS, which was done by facilitation a dressing session, where the client had to dress his lower limb, which had no sensation, which made it difficult for the client. The client was shown modification methods which increased his independency. Part of this week’s intervention was also aimed improving the client’s wheelchair mobility up and down ramps, this was done outside the facility where the client had to go up and down the ramp with the supervision of the student therapist, dynamic sitting balance was also incorporated in this activity as the client had to bend down and pick up weights, which was also aimed at improving his upper limb muscle strength. Clients’ endurance was also improved during the sessions.

Feedback received from my supervisor and how will I change intervention next week

Feedback I received from my supervisor this week was insightful, as I was feeling stuck with the patient and did not now what next to do with the client. She was able to prompt me to think deeper about the client and look at other perspectives that affect the client. This will definitely help me in future in not being narrow minded and try to be holistic with my intervention. This will help me next week as now I have an idea what my client needs and how I can incorporate it in therapy.

References

Implementing Evidence-Based OT Practice | PTS, Inc.

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1630.2000.00237.x#b21

evidence based practice in occupational therapy - Google Scholar

The Importance of Evidence-Based Practice in Occupational Therapy | myotspot.com

The process of evidence‐based practice in occupational therapy: Informing clinical decisions - Bennett - 2000 - Australian Occupational Therapy Journal - Wiley Online Library

[blogging-studentstyle]

MANDISA NZUZA

219014888

BLOG WEEK 3- Reflect on collaborative practice -multidisciplinary team and teamwork and Reflect on how you have been a health advocate

The third week comprised of two half days and one full day, on Monday. The third week was a bit hectic for me as on Monday I had to do my demo on Wednesday since I was not able to do it on Monday as my client was not feeling well and on Thursdays were presentations, which were not so good as I ran out of time and did not get a chance to fully present on the most important stuff as I was flying through on my last 5 minutes. Monday was more nerve wrecking for me as I had to hold a group session, it was the first time for me to have a group session with clients with physical deficits as we did not get a chance to go to fieldwork last year due to covid. The planning of the group session was not so bad, the difficult part was when we had to implement what was written on paper. The first thing that required me to think on my feet was the change of environment as it was cold outside, so to be able to get a room that will suit the demands of the session and be able to adapt it accordingly. My demo session with my client went well as initially, I was nervous about getting him in a standing position due to the nerve-wrackingchances of falling.

I was not able to attend that much with my second client as the week was hectic and there was a clash of times with the physio. The only activity that we managed to do on Wednesday was transfers and bed mobility, which initially I was also nervous about doing with the client as he is T4/5 paraplegic, therefore he requires extensive handling principles to ensure his safety. He has shown great improvements from initial contact.

collaborative practice -multidisciplinary team and teamwork and Reflect on how you have been a health advocate

Firstly, to explain multidisciplinary “The term multidisciplinary team is used to refer to a group of professionals from two or more disciplines who work on the same project, independently or in parallel” (Family practice, 2018)., and collaborative in simple terms is a process of problem solving, shared responsibility for decision making and the ability to carry out a care plan while working towards your main goal. This was open at eNtabeni as when we were introduced to the place the physiotherapists, resident OT’s and nurses availed themselves to help us along the way since we are all working towards the same goal, to better the client’s quality of life. There is a smooth relationship between the student therapists and the health professionals at eNtabeni. Inter-professionalproblem-solving collaborative practice, health professionals from multiple disciplines working together as a team, is the cornerstone to providing safe, high quality, effective client-centered care (IECEP, 2011). The reading of the client's file and reading the progress notes written by the different health care professionals helped as we are not able to see the clients on a daily basis so that we know how the client is responding and what more can be done to better the individuals' life.

Planning and implementing for intervention for my client

During the demo, the main focus of the activity was to improve the client’s static and dynamic standing balance, as this was done by placing objects further away and in a slightly elevated position so that the client can reach out of his base of support and enable weight-bearing and trunk rotation further activating his trunk control. The meal preparation session was also aimed at increasing his endurance to being more than 10 minutes in standing this was implemented by allowing the client o stand during most of the activity and making the egg and mushrooms so that he can stand for longer and reduce the time seated. The activity also required hand-eye coordination so as to not hurt himself, especially when chopping. His muscle strength of the upper was also influenced as the client had to compensate for balance and hold onto the counter. The client is being discharged soon and what I still wanted to do with the client is to improve his standing balance, trunk control, and endurance as when he is discharged, he will be handed a walking frame and crutches. During my sessions with the client, I could have challenged him a bit more since he is functional and getting ready for discharge. I could have centered most of my sessions on mobility working hand in hand with the physio, using the collaborative multidisciplinary approach to get the client equipped for discharge so that he does not face any problems that he was not prepared/ trained to handle/cope with.

Feedback received from my supervisor and how will I change intervention next week.

The feedback that I received from my supervisor was immensely helpful as she was able to open my mind that I was not able to think on the spot. Most of the feedback was based on grading, as Mr. N is a very functional person and needed upgrades during the session to further challenge him and this will help with discharge as he is being discharged at the end of this week. One of the upgrade methods she talked to me about was having the wheelchair a bit further, to challenge the client to stand independently without the comfort of the wheelchair being directly behind him.

In the future, I will make sure to look out for grading opportunities that will further facilitate improvements in the client’s occupational performance. Incorporating the client-centered approach to look out for the individuals’ limitations and how we can upgrade each activity to suit the client and to further improve the client’s deficits.

References

Homayounfar P.Process mining challenges in hospital information systems.

IECEP, 2011

Family practice, 2018