Wednesday, January 30, 2008
1:34 pm
Reflections
Singapore General Hospital Occupational Therapy Department (7-18 Jan ’08)
Day 1
AM: We observed Mr Hee, an OT who specialised in outpatient hand therapy. OTs use various treatment methods such as Heat Therapy, Fluidotherapy, Laser and Ultrasound. Heat is applied to relax muscles, while cold compress is used to relieve swelling. OTs also create splints with special plastic to keep patients’ hands in position.
PM: Helped to outline a painting done by the OT Dept in conjunction with OT Day on 11 Jan. We are quite fortunate to get the opportunity to celebrate OT Day with the SGH OT Dept. [Quite cool to be celebrating OT day with them! =)] After that, I followed Mabel on her rounds. She conducted a caretaker assessment and training, functional assessments and fine motor exercises. This mainly involved daily activities such as wearing clothes and standing.
Mabel: Things like punctuality, reliability (able to deliver promises) are basics of being a good worker. In addition to that, OTs need to be
• Observant: every patient is different, need to look out for strengths & weaknesses. No two patients alike so therapy differs also
• Flexible, adaptable, willing to change: different diagnosis needs different treatment plans, not always a standard protocol for every condition. Tailor therapy to meet patients’ needs
• Teachable, reflective: willing to learn from mistakes and continue to improve so as to serve patients better
• Patience, sensibility: patients may take a long time to perform simple tasks, should behave appropriately, not laugh at patients
• Social skills: OTs work a lot with people so one must like interacting with different people, able to get along well
• Comfortable with touch
Day2
AM: Followed Natalie on rounds. She works mainly in the Neurology wards with stroke patients. Stroke may affect patients differently – some patients’ movement on one side will be greatly affected, others their vision or cognitive processes. One patient had problems organising thought and had the tendency to repeat actions. OTs help to explain the patients’ behaviour and educate caregivers, family members to help create a safe environment for them. Actually, one thing that struck me was how much time OTs spend with their patients and caregivers – they are not in a rush to simply get tasks/therapy done so that they can move on to the next patient. They have a holistic approach toward treatment, taking psychological, social and lifestyle factors into account.
PM: Followed Fabia (who studied at La Trobe) on rounds. She works in the Orthopaedic wards with patients who have surgery on their bones. The more common cases are hip and knee replacements in elderly patients. For Orthopaedics, therapy usually entails a set of protocol and standard procedures. Treatment also requires knowledge about the type of surgery carried out so that it may not endanger the patient. Today was one of her freer days because one of her patients was unwell and unable to do therapy. So, she explained hip replacement to me and showed me some patient X-rays. Introduced some websites: www.orthopaedics.org
OTs do patient education as well, teaching them the ways to care for themselves after surgery. For example, those with hip replacements should maintain >90degree angle at hip joint, not turn their feet inward for they may cause the new joint to pop out of the socket (yucks). In fact, the latter is the technique surgeons use to dislocate the joint >.<
The OT community is small but most enjoy and are very passionate about their job. They believe strongly in OT philosophy:
1) Every patient is unique with different strengths and weaknesses. Therapy for each patient would differ slightly, tapping on their strengths and working on the weaknesses to finally help the patient become more independent.
2) Patient-centred therapy. OTs are there to facilitate the patients’ recovery and not to do things for them. They gradually reduce assistance to patients and help to empower patients.
OT targets 3 key areas: self-care, productivity (or work), and leisure. They believe that human beings need to be occupied with activities in the 3 areas for a sense of well-being.
OT is not as widely accepted in Singapore compared to western countries mainly because of the culture. In Singapore, elderly usually have the mentality that they have worked hard and should enjoy life, instead of being put through therapy (which could be quite painful, and requires discipline to do exercises recommended by the OT). Also, elderly here tend to be less independent compared to their counterparts – children should support parents, there are domestic helpers, the government takes good care of citizens. In other countries, children move out at 18, people live far apart. People may desire therapy more because independence means a lot to them.
Day 3
AM: Met 3 NYP Year1 students, and went for infection control training with them and Christina. I failed the mask fit test 3 times! If I was one of the staff, the infection control team would contact me for an appointment. Seems like I would have been in danger if an air-borne disease was going around.
NYP students said that Year 1 Sem 1 would be quite manageable with days from 0900-1500. In Sem 2, they would be going on placements every Wednesday so their days would be from 0900-1800. They also have many projects.
PM: Followed Lindy around. She works neurology wards. I had the opportunity of observing a particularly interesting therapy session, but cannot disclose too many details due to patient confidentiality. Lindy had to take a tough approach and be very firm with him.
Side thought: nurses are really noble. They have to bathe patients, change their diapers and many more unpleasant things.
Day 4
Spent whole day in preparation for OT day:
• Connected paper cranes to slips of paper educating people about OT. Once, I took too much thread and it ended up becoming a tangled mess.
Greed entangles.
• Helped in the untangling of strings of cranes made by the OT Dept during SARS. They were used to decorate the crane making booth.
Cultivated patience
Day 5
Christina told us about OT in other countries – they do advocacy work. For example, OTs advocate for safe playing areas for children, places without hazards such as broken glass etc. Play is a large part of children’s life and can constitute their productivity and leisure.
We helped out at the crane folding booth, where we taught people how to fold cranes – with one hand! After a while, we also realised that another volunteer was from PL primary -_-“
We stole pamphlets and I bought $3 slippers to wear because my feet hurt from walking in court shoes.
Day 6
AM: Admin
PM: Followed Fabia. I became an OT Assistant! One of her patients who had a fracture was about to be discharged. However, most who had orthopaedic surgeries are not allowed to weight-bear one the affected side. Thus, Fabia taught her how to use the wheelchair; I accompanied the lady around (and made sure she did not knock into walls and things like that).
Day 7
AM: Admin
PM: Followed Fabia. She did caregivers’ training and assessment, and recommended equipment to make the home safe, especially the toilet. OTs have clearer overall picture of patients including psychological and social factors (due to their training) and thus also give lifestyle recommendations so as to maximise the wellbeing and quality of life of the patients after discharge.
Day 8
AM: Admin
PM: Admin.
After 5pm, I observed Christina conducting discharge planning. OTs need to have good spatial skills because they must be able to visualise the patients’ homes and sketch room plans to facilitate recommendation of equipment. As with all other healthcare professionals, they also need to know the healthcare system very well – the charges, payment methods (Medisave?), post-discharge options (step-down care such as Ang Mo Kio Community hospital or St Luke’s? Day care?) – so as to maximise the patients’ welfare. Honestly, I felt very lost when they spoke about these different schemes. I guess the key benefit of studying OT in Singapore is that one will be more familiar with the system.
This discharge planning was mainly done in Malay too! Being able to understand most what was going on really gave me a sense of accomplishment, and I really thank God for the opportunity to study Malay, and not giving up along the way. My dad played a very big part, guiding me in this rather unorthodox decision (in 2001 before the Government started promoting Malay as a 3rd language), and encouraging me to persevere till I completed what I began. I think I should also start watching more Malay language shows to keep in touch with the language!
Day 9
I pushed the big heavy splinting trolley from the gym to the ward! Then, I observed and helped Fabia in making a splint for a patient who just had an amputation. The splint helps to keep the knee joint straight to prevent contraction of the knee, and help to ensure that the prosthesis would fit properly. There are several splint plastics available, each has varying degrees of memory (ie, they will return to original shape on heating). Following the completion of the splint, I helped Fabia in several mobilisation exercises for the patient to maintain flexibility.
Day 10
AM: Admin. Observed therapy by Leila in ADL room as well. OTs specialising in neurology employ the use of a machine that emits electric pulses down the muscle (somewhat similar to the OTO Electric Reflexologist =P). This stimulates the patient’s muscle and helps them regain the use of it.
PM: Observed Yetta who works in the neurology ward. She also used the “electro thing” for her patient. Stroke patients may be quite depressed because they are suddenly unable to do things as well or easily as before. In this respect, OTs can help to encourage the patient, reassure them that they can and will get better as long as they put in effort. We also went into a ‘Contact Precaution’ room where we had to put on a full body suit and gloves! Finally, Yetta conducted a session in the gym using the fine motor equipment but the main aim was to help the patient remember to look to the left (left eye vision affected) and maintain a balanced sitting position.
30 Jan: YAY I finally finished my reflections! Its quite obvious that the later entries become shorter and less detailed though XP
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