Meg Nielson

Reflective Diary Paper

Factual Strand

A few incidents come to mind when thinking back on my fieldwork experience. One

specific experience that really resonated with me is an older male adult who had just

had a fall from his wheelchair and broken his left hip. This man was uninsured at the

time of his fall so keeping him in the hospital was basically a charity to him. The initial

evaluation was completed by myself and a physical therapist; we had heard that this

man lacked motivation but was very friendly. In our initial evaluation we tried to get the

man sitting edge of bed to complete some ADLs but this man told us he was in too

much pain and with any movement he would cry out in pain. We were unsure how to

move forward with him due to his lack of motivation as well as his pain. We planned with

the patient to getting sitting at the edge of bed tomorrow to better prepare himself. The

next day he participated with us and even got sitting edge of bed however refused to do

anything else. We tried to reason with the patient that we needed to get him out of bed

for his health but he continued to refuse. This happened for the next couple of days

which became frustrating. In morning rounds with the care team this man was brought

up and much to our surprise they told us that he was going to be discharged in three

days. The therapy team tried to explain that there was no way that this patient could go

home due to the fact that he could not even transfer out of bed but because he was

uninsured they could no longer keep him. The PT and I planned to have a serious
discussion with this man and how we needed to progress him to getting out of bed due

to him going home so soon. We also planned to have his family present to receive

training on how to best assist the man. Our discussion did not go well with the man and

he ended up yelling at us and telling the PT he did not want her to come back. I was off

the next two days so I am not sure what happened but I do know that he was

discharged on the day that was planned and he was still unable to transfer out of bed.

I was so frustrated that the things that we had planned did not go well and that the

patient was unwilling to participate and progress to the point that he needed to. He was

perfectly content to stay in bed all day and continue to use a bed pan rather than a

bedside commode. This was a critical moment to me that sometimes my goals and the

patient’s goals just do not align as well as how patients who are uninsured are unable to

receive the care they need after the hospital. I was told that if he did receive home

health that it would be charity care and there was no way that a skilled nursing facility

would take him due to his extensive medical history (some skilled nursing facilities had

already dealt with him).

Retrospective Strand

Overall this experience demonstrated the patterns of how someone with a lack of

motivation. This man had had a previous fall and when we discussed his history with

him he told us almost the exact story that was going on currently. He was not motivated

to do therapy so spent most of his time in his wheelchair which is where he fell. With

this patient I really tried to draw from MOHO and find where his volition was placed as

well as his values and beliefs but this man was content and enjoyed being taken care of

by hospital staff and his family. Therefore, he did not have motivation to get better and
get mobile. Like I said, this became frustrating to me especially because the therapy

team was going to bat for this man and trying to provide the best service for him. Luckily

the majority of the patients that I treated were not like this but it did make me realize that

no matter where I end up working, I will undoubtedly work with patients like this.

Sub-Stratum Strand

I brought a few beliefs into this situation; One belief specifically was that I thought that

no matter what every patient would want to get better. This was proven incorrect with

this man. We asked him several questions about how he was going to function at home

if he was unable to get out of bed and he frankly told us he did not really care and would

have his wife take care of him. I had to come to the realization that no matter what we

did, he did not truly care to participate at this time. I used MOHO with this man and tried

to draw from his values and beliefs as well as his volition as well as PEO. We tried to

get a good understanding of his environment and provide suggestions and thoughts. He

and his wife were perceptive to the suggestions that they may need to do in their house.

I do however wish that I was able to get a better understanding of the patient’s personal

beliefs and values. I think had we gotten to the bottom of those a little more we may

have been able to encourage active participation more effectively. I was working with a

PT whenever I saw this man and I think I could have been more assertive in this regard.

Connective Strand

After this experience, I understand how important it is to truly get the patients

perspective and their beliefs and values. I do wish we had done this more in depth with

this man but now moving forward, I will be able to do that more effectively. I had an

experience after seeing this man that was demonstrating similarities and I was able to
take what I learned with this man and be more proactive and assertive. Doing this

created a great rapport with the patient and whenever I went to see her she was more

willing to participate. This is the keystone of our practice; being client-centered

practioners. When we are able to focus on what the client wants and more importantly

their goals within therapy we are more effective and the patients gain a trust with us. I’m

glad that although this experience was difficult for me and became frustrating at times, I

am able to grow from it and learn to become a better occupational therapist.