Melissa Weddington

Reflection with strands

September 9, 2014
Factual Strand
In the acute care setting, evaluations are the highest priority and must be responded to within
twenty-four hours. Clients often get a referral for both occupational therapy and physical therapy
evaluations. The physical therapist on the medical floor that I worked on, preferred to perform
his evaluation individually from mine. At first I was okay with doing separate evaluations
because it would provide me with more experience and allow me to evaluate the clients more in
depth. Unfortunately clients in this setting are hard to access due to a variety of procedures and
medical professionals meeting with them. The clients also have low activity tolerance and
generally can only tolerate one therapy session per day. This created a situation where the
physical therapist would evaluate the patients before me and then I would get refused because
the client was too fatigued for therapy. This was frustrating to me for several reasons. One reason
was I was expected to meet productivity by performing evaluations. I also felt pressure from my
clinical supervisor to complete client evaluations in a timely manner and to persuade clients that
were in pain to participate in evaluations. This was difficult for me because I respect a patients
right to refuse services. It was also concerned that the client could be discharged at any time and
without an evaluation the patient may not be referred to the proper next level of care.

Retrospective Strand
During this event, I felt frustrated that I was not able work with the clients on my case load. I
often felt defeated and that I was letting down my supervisor. I also felt compassion and
understanding for the clients who were fatigued and in pain. I felt that the physical therapist was

purposely seeing all of the clients I needed to see. This was likely my perception and not reality.
On several occasions, I would wait for thirty minutes to see a patient who was receiving wound
care and when I would come in to the room he would be performing his evaluation. I mentioned
my frustrations to my supervisor and she encouraged me to think of a solution to the problem. I
noticed that the physical therapist addressed the evaluations in order of room number beginning
with the number one.

Substratum Strand
My actions regarding this scenario were based on past experience from this program as well as
from my own personal family life. I decided to approach my client list in descending order in an
attempt to see some patients in the morning before physical therapy and then see the remainder
of my patients in the afternoon so that they would have time to rest before another evaluation.
This strategy was based on avoiding conflict. This is a strategy is one that I learned in my family
life and that has worked for me in the past. I attempted this strategy and ended up meeting the
physical therapist halfway through the list. He seemed surprised that I had started at the end of
the hall, but said nothing about it. My belief in peace prevented me from talking directly with the
physical therapist. My more sensible and client-centered action I took was to change the way I
talked to clients about therapy. In class we learned the importance of buying into the therapy and
active listening. I utilized both of these strategies. I would spend five to ten minutes building
rapport with clients that were refusing therapy due to pain or fatigue. I would tell the client what
occupational therapy was, how it could benefit them, and what the evaluation would look like. I
would then set a time with them for me to come back. My belief in client-centered care and
respect for the clients feelings encouraged me to take this approach.

Connective Strand
This experience has impacted by future practice by providing me with learning opportunities
about myself and the people around me. I learned that I have difficulty discussing conflict with
other professionals. After examining this scenario, I believe I could have discussed my
frustrations with the physical therapist in a way that was positive and constructive. My decision
to start seeing clients in descending order demonstrated my problem solving skills, but also my
cowardice. I should have told him that I would address evaluations in the reverse order so that it
seemed more of a team effort than a plot to undermine him. I recognize that handling conflict is
an area in which I need additional growth. I plan to continue to build these skills both in the
classroom and in the clinical setting. On the other hand, I am pleased with my actions toward my
clients. I used the skills I gained through this program. I did not sacrifice by belief in upholding
the clients wishes despite the pressure for productivity. Overall the clients responded well to
therapy when I explained the purpose and set a therapy time with them. This reinforced my
belief in selling occupational therapy to the clients. This skill is in no way perfected and I hope
to continue to grow in this area. After examining this scenario more closely, I recognize that in
this scenario I was measuring my self-worth and success as a therapist by completing evaluations
and treatments with clients. I felt that in order to be a good student I would need to persuade all
clients to participate in therapy. In retrospect, I believe that this flawed thinking led to me to
avoid addressing the conflict with the physical therapist. I have learned that I need to measure
my success by my smaller successes in therapy sessions instead of focusing on the number of
refusals I receive each day.
Plan:

A) Practice constructive conflict resolution using effective communication strategies learned

in class such as I statements, active listening and negotiation
B) Continue to use and hone my strategies to build rapport with patients that are in pain or
fatigued
C) Redefine my definition of success to be reasonable and achievable