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Psychology of Stress Assignment:

Confidentiality Agreement:
Patient health record and personal information are confidential.

I (XXXX) agree to partake in an interview performed by University of Cincinnati physical therapy

student (Holly Lochtefeld).
As explained by student (Holly Lochtefeld), I (XXXX) understand the interviews sole purpose is for
professional development of students in the University of Cincinnati’s Physical Therapy Program in
order to better understand patient perspectives.
I (XXXX) understand that my name, location, or any form of identification will never be used in
writing or in verbal interaction in the course.
I (XXXX) understand that this information only be used for this single assignment and will not be
used in any other form outside of this course.
I (XXXX) can at any time during the interview ask to terminate the interview or ask to skip any
questions that I (XXXX) do not prefer to answer.
I (XXXX) understand the information I share will be used for classroom purposes to write a paper
and be discussed without my name to protect my personal information but to understand my
patient perspective while maintaining my respect and privacy.

I (Holly Lochtefeld) understand that I (Holly Lochtefeld) may become aware of patient information
in the course of performing the interview with a University of Cincinnati physical therapy student
for the purpose of a course assignment for a Professional Roles II course instructed by Rachel
Gleason, PT, MS, DPT.
As a student, I (Holly Lochtefeld) am prohibited to discuss the interview with anyone outside of the
Professional Roles II course in order to maintain respect and patient confidentially and privacy.
I (Holly Lochtefeld) agree to access patient personal health information only as permitted in the
performance for class information.
I (Holly Lochtefeld) agree to preserve the confidentially of all patient information and to not
divulge the information in any form expect in the Professional Roles II course as authorized by the
patient or required by the law. Any breach of this duty of this agreement will result in legal or
disciplinary action of interviewer (Holly Lochtefeld).
I (Holly Lochtefeld) acknowledge that I have read the confidentially agreement and understand my
responsibility as they pertain to confidentiality of personal information and agree to all principles
of the agreement.

Signature of Interviewee: __________XXXXXXXXXXXXXXX_________________

Date: _3/18/21_________________

Signature of Legal Guardian:___ _____XXXXXXXXXXXXXXX_________________

Date: __3/18/21_________________

Signature of Student Interviewer: _____________________________________

Date: __3/18/21_______________
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Interview Guiding Questions:

Introduction:
Thank you!
Thank you for your time and willingness to sit down and share.
Explanation:
As a reminder, you are free to skip any questions, and we can stop the interview at any time.
Additionally, this is so I can learn from your perspective to better my care as a physical therapist,
and also for my classmates to better understand your healthcare experience and again how we
can be a positive impact for future patients.
Questions:
1. Can you give me a short summary of your initial diagnosis to where you are now? I
understand there is a lot you could share so if you have a few key moments.
a. To start, he began having headaches. At first, they were not bad but the intensity
evaluated. He went to the eye doctor to see if he needed glasses, but his eyes were
great! He then went to his physician who gave medications for headaches. But this
still did not solve the problem. Then, one even while driving around to see
Christmas lights he was eating an apple in the car and immediately began throwing
up profusely. He did not know why, but he did not feel well. The individual’s ̅ parents
took him to the emergency department where they ended up taking a CAT scan.
After finding a mass, the patient was rushed to the Dayton Children’s Hospital.
Here, the patient underwent a day long surgery to remove a golf ball size mass from
his brain. The biopsy reported the mass as metastatic medulloblastoma with cancer
spots on his brain and spinal cord.
b. A few weeks after the removal of the mass, he had another surgery to implant a
stent into his brain to drain excess fluid. Following this surgery, and balance issues.
He was only able to return to school two days a week. Another surgery was
scheduled for a chemotherapy infusion port. But after a week and preparation for
radiation treatment, his oncology team noticed air in his chest cavity. After being
cleared, on his way home he experienced tremors and continued with balance and
strength deficits. So, he was re admitted overnight. Following this, after intense
swelling began on his brain in a continuation of tremors and the patient struggling
to breathe, he was taken to emergency surgery. A section of his skull was removed
to alleviate pressure and during this time they noticed a second tumor growth that
had been placing pressure on the brain stem. Again, with his young age in great
shape previously to this incident, this helped him regain strength. The patient was
heavily sedated at this time to let his body heal in a controlled environment.
Because the mass formed so rapidly after the initial removal surgery, the team
knew that chemo and radiation were vital to begin. He only made it to a few
treatments due to difficulties while on the ventilator and therefore he was given a
tracheotomy to help control breathing until he regained muscle control again. So
they removed him from a sedated state and he began to become more alert.
c. From this time, he has been in a more stable condition and slowly been recovering.
He has made great progress with radiation therapy and as of the past few weeks he
has been cleared and in remission. roughly every three months he goes back to the
hospital to get scans to check in on his body. This is been roughly a year since is
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initial diagnosis it is now walking with a Walker but still struggles with balance
deficits strength deficits and double vision. He is going to OT, PT, and a vestibular
specialist.
2. How do you feel about where you are currently?
a. Ok… He is not fully back to “normal” with strength and cognition so this is still
frustrating but he states he has made great gains and is getting better. . . it is just a
slow process.
b. He lost a lot of body weight and muscle mass so he had to rebuild this to where he
is currently.
c. He states his mind feels like “a blur.” He was in the hospital for about 4 months and
maybe remembers half of this. Then, he returned to home during COVID so felt like
he time traveled.
d. He is on medication and uses a walker/wheelchair. But he still has a shunt. He
previously had a feeding tube, trach,
i. With medications, side effects he experiences is double vision (which he has
glasses for and they say may go away in time), leg pain (specifically
hamstring just in one leg), and cognitive delay due to medications.
e. Total surgeries:
i. Mass removal
ii. Shunt
iii. Skull removal/mass removal
iv. Trach
v. Feeding tube
vi. Implant of chemo port
vii. Shortening of feeding tube
3. What is your current therapy like?
a. OT
b. PT.
i. He consistently works with the same therapist and really appreciated when
his therapist made his therapy into games. Now as he focuses on strength
he is doing more exercises on squats.
ii. A powerful moment was when he started walking again with his walker and
the first time he walked with a cane, and the first time he walked “well” with
the cane. At times, he gets frustrated
iii. He called himself a “concrete cowboy” because he struggles on anything but
cement. Previously enjoyed going into the woods, hiking, fishing, etc. and
this is currently not possible for him independently with his walker.
iv. He states he uses the wheelchair in school since the day is long, but uses the
walker for the most part. He is currently working on transitioning to a cane.
With the walker, he has to put it in the trunk and feels more pressure when
he uses this in a public setting. He states he knows if he is in a place with a
lot of people he feels like he walks worse and this is mentally and physically
frustrating.
v. Currently therapy is 2x a week.
c. Vestibular
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d. All are tough, they require him to work so he said he would prefer not to go, but he
knows it is helping him get better.
4. Powerful moments with your Healthcare Team?
a. At all his scans, he was seeing more and more improvement! At his last scan,
roughly a month ago, he was absolutely clear! He goes for scans every 3 months.
5. Any changes you wish you could have had from your health care team.
a. Nope, they push me when its tough and I know its good for me!
6. What was the process like to get back into the social setting, hanging out with friends
again?
a. He felt like he time traveled and missed a lot since he was in the hospital so it was
not easy, but they are always there and like everything it is taking time.
7. Perspective of being a youth patient and the communication from health care professionals
to your understanding of what was going to be your healthcare process?
a. He loves having therapy as GAMES!!! He stated now he is doing more weight lifting
but at Cincinnati Children’s hospital the exercises were fun!
8. How would you describe your physical journey, where you are at and where you want to
be?
a. He states he has more work to do, but most of the work is for his cognitive abilities.
It feels like he is improving sooo slow, so that adds in frustration.
9. How has his support system aided in your healthcare journey? Parents, siblings,
community?
a. AWESOME!
b. My parents and siblings are trying to push me to continue to work hard and they
are always here to help!
c. The community has continually showed me support!
10. How would you describe your healthcare journey to someone who does not know your
situation?
a. It is a JOURNEY!
b. It has been long and hard and it does not return in a “snap of a finger
c. From where he started, he has come a LONG way, but he knows he has a long way
to go still.
11. Did you have the chance to join any support groups or programs with individuals who
better understand?
a. No, not necessarily cancer related.
b. He is an ambassador for St. Baldrick’s Foundation.
12. What works for you to find a sense of peace and calm in stressful moments?
a. Lay down and listen to music (60/70s rock music)
13. Where do you see yourself in 3 years/goals?
a. He said he wants to feel “normal” but more specifically in 1 year he wants to run at
least 1 lap in a track meet!!
b. For college, he plans on going to a local college and majoring in mechanical
engineering.
14. Do you see the world differently  how do you see the world differently because of your
experience?
a. Handicap Accessibility: how important it is!
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b. Mental Health: it is serious and more serious than most people think and realize!!
15. Would you be willing to be an advocate for future patients who may be going through
similar experiences?
a. YES!!
b. I would want help keep them calm.
16. Are there any community settings you avoid/prefer not to go?
a. Anywhere with too many people. When he is in a crowded area, he says he messes
up a lot more when walking.
17. If you knew someone else going through a similar experience, what advice would you give
them?
a. Keep a positive mindset and socialization is SO important to help in keeping your
spirits up!!!!

Kubler-Ross Stage
After talking with this individual, I feel like he is wavering in the acceptance phase. He understands
where he is at, but he admitted he still feels frustration at times. The patient accepts help from his
healthcare team, his family, and his community to motivate him to success. He stated that he is
lucky to have his family to keep himself grounded and he knows he is getting better, slowly but
surely.
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Psychology of Stress

A red flag that no one wants to witness: headaches with no cause/resolution. In the

beginning, the patient stated his headaches were only in the morning and bearable. But, the intensity

quickly escalated. To rule out other possible causes, the patient consulted his eye doctor to check

for vision deficits resulting in headaches, but his eyes were great! A physician then prescribed

medications for headaches. But, the headaches continued. While driving around to view Christmas

lights, he randomly began throwing up profusely. Alarmed, the parents took their son to the

emergency department where they took a CAT scan of his brain. After finding a mass, the patient

was rushed to the hospital. The patient underwent a day long surgery to remove a golf ball size

tumor from his brain. The biopsy reported the mass as metastatic medulloblastoma with cancer

spots on his brain and spinal cord. Medulloblastoma (MB) is a cancerous brain tumor that starts in

the cerebellum and tends to spread through CSF to the spinal cord. MB results from errors in the

machinery of the cell that controls the cells growth and death. MB often occurs in young children

and is the most common cancerous brain tumor in children (Mayo Clinic 2019). Approximately one

third of pediatric patients present with a metastatic diagnosis, which unfortunately, matches this

patient’s clinical diagnosis (Von Bueren AO, Kortmann R-D, von Hoff K, et al. (2015).

A few weeks later the patient had another surgery to implant a stent in his brain to drain

excess fluid. Following this surgery, the patient struggled with balance issues and was only able to

return to school two days a week. Next, in preparation for chemotherapy, the patient had a

chemotherapy infusion port implanted. He began treatment but began experiencing tremors along

with balance and strength deficits. He was re-admitted into the hospital, and his team noticed

intense swelling on his brain. The patient struggled to breathe and was taken to emergency surgery.

A section of his skull was removed to alleviate pressure and during this time, the oncology team
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found a second tumor growth in which they removed. The shortness of breath, nausea, and tremors

are all key signs of a new growth, but also conflicting because according to the American Society of

Clinical Oncology, these may also be medication side effects. Being the second major brain surgery

within six weeks, the patient was going to have a long recovery, but with his young age, physical

fitness, and support, he always exceeded expectations. The patient was heavily sedated after the

second emergency surgery to allow his body to heal in a controlled environment. After a few weeks

of healing, the patient was removed from sedation but because the mass formed so rapidly after the

initial removal surgery, the team knew that chemotherapy and radiation were vital to initiate.

Despite the need for radiation and chemotherapy for survival, side effects are substantive. Twenty-

five percent of patients have a loss of speech, unsteadiness, emotional liability and irritability

(Robinson & Upadhyaya 2015). For this patient and many fighting this diagnosis, this hits hard.

This individual became frustrated with the inability to speak and began pulling at vital IV lines. Due

to this behavior, this patient was placed into restraints and surgically given a trach to ensure safety

to help control breathing until he regained muscle control.

From this time, he has been in a more stable condition and slowly been recovering. He has

made great progress with radiation therapy and as of the past few weeks, the patient’s scans have

been clear! The patient is currently in remission and receives scans every three months. A year from

initial diagnosis, he is now home attending OT, PT, and vestibular therapy. The patient utilizes a

walker and slowing transitioning to a cane. He currently struggles with balance, strength, and

double vision. When asked about the support from others, the patient stated, “The support I have

received from everyone is AWESOME! My parents and siblings are trying to push me to continue

to work hard and they are always here to help! The community has continually showed me

support!” When asked if he could change anything with his healthcare team, he responded, “Nope,

they push me when it’s tough and I know it’s good for me!” The mother then stated, “we can't say
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enough about the people at both Dayton and Cincinnati Children's Hospital. My son's team of

doctors, nurses, and support team are nothing short of phenomenal!” Of note, the patient stated he

felt like he “time traveled” as he does not remember most of his time in the hospital. In summary,

the moments he does remember interacting with his healthcare team then and currently is great! He

states it is hard work, but they know what is best for him. The patient stated he knows they all have

specialties and together he will accomplish his goals. Both the patient and family praised the

support of their team as they continued to demonstrate respect, empathy, and strength when the

family were at their worst moments. This unity provided the family with hope and a team to look to

with any questions during their journey.

In translation to the Kubler-Ross’s Stages, the patient resembles much acceptance during the

interview with his answers and body language. He sat with his chest tall and spoke proudly of his

accomplishments. During the interview, the patient stated he has not returned to his “normal being”

both physically and especially mentally. Early in his healthcare journey, this would make the patient

feel defeated. Even though he does not remember the complete hospital stay, the family stated he

was put in constraints for a short period of time and often became frustrated with the inability to

appropriately communicate. The patient stated in the interview, it was a rollercoaster, but he

stressed the importance of acceptance and professional help for mental illness. He stated he wish

others better understood the following: “I look at handicap accessibility so different now, and how

serious mental health is. It is more important than most people think and realize!” By providing this

insight, the patient again shows acceptance of his condition and awareness of others around himself.

The acceptance phase involves coming to terms with a new reality and something the patient can

live with in time and readjustment (Gregory 2021). Now understanding the journey ahead, the

support of others, and motivation from his healthcare team, he accepts the challenge and continues

to push to bettering himself.

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In relation to Bethanne Brown’s Stage of Readiness, the healthcare team is promoting

Action by creating SMART goals with each healthcare visit. Additionally, the patient is beginning

the phase of Maintenance because the healthcare providers are offering support and promoting a

positive behavior change to accept his current abilities, while pushing him to gain strength and

cognitive awareness.

After interviewing this individual and diving into phases patients may traverse through, I am

more aware of the holistic effects the patient is enduring. The interview provided myself with more

than an hour of questions and answers and promoted me to continue to research, continue to better

understand others, and continue to promote accepting patients where they are while also guiding

them to the light. From this individual, I learned that his providers listen to his frustrations, guided

him on medical advice, motivated him in strength and healing. But along with this, they promoted

unity of his family and of the healthcare team. This shows immense strength in the healthcare world

to focus not only on the patient and diagnosis, but encompassing all those affecting in the healthcare

process. Although this patient endured much pain and struggling, he showed me the strength of a

positive mindset to aide one’s physical being. This individual also repeated in the interview the

importance of socialization and how the impact of others support gave him power to continue in

dark moments. While talking with this individual, I learned that at first I was even timid in asking

deeper questions, but the more open I became in the interview the more calm both the interviewee

and I felt while traversing difficult questions. From this, I will be more open to discussion with

others who suffer illnesses because I found that the individual seemed to find a sense of relief and

impact as we concluded the interview. He stated multiple times that he is happy to talk about the

journey now, and he hopes to connect with others in the future who also have cancer. He showed

me that by opening the conversation we both grew and will continue to grow as we continue to

connect with others. As a future physical therapist, I will think back to this interview when I hesitate
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to dive in with new patients, and remember that by opening the door, we can give the patient the

ability to take control and mentally conquer their disease by sharing their coping process with other

individuals. As reinforced by this individual, I also want to stress the importance of support outside

of the healthcare team. This patient explained the immense value friends, family, the church, and

community offered to him during his darkest times and how now he is forever grateful for the

support. For future patients, I will work to provide a connection to others struggling with similar

diseases, but I will aim to connect patients with support right around their home. Each home

environment will be different barriers and different affordances, but by stepping out of the

healthcare world and into the patient’s home life I will better understand the patient and how to

promote motivation and success.

I will continue with a sense of calm when working with those suffering from life-changing

illnesses. I better understand the patient’s need for a healthcare profession in times of medical

needs, but also when the patient just needs a friend to support them. We are trained to evaluate

others on a physical metric, but by employing mental and emotional support, I have learned that this

provides holistic care in which can magnify growth in the patient’s abilities and understanding of

their healthcare journey. Lastly, I will utilize my voice to open difficult conversations with patients

to allow them to decide what they need to share and what they need mentally, physically, and

emotionally to be best supported by myself and others in the healthcare world. No one should

traverse these illnesses alone and we can serve as powerful individuals to offer successful strength

in unity.
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References

American Society of Clinical Oncology. (2019, August 12). Managing Physical Side Effects.

Retrieved April 21, 2020, from https://www.cancer.net/coping-with-cancer/physical-emotional-and-

social-effects-cancer/managing-physical-side-effects

Gregory, Christina. “Five Stages Of Grief - Understanding the Kubler-Ross Model.”

Psycom.net - Mental Health Treatment Resource Since 1996, Remedy Health Media, 4 Mar. 2021,

www.psycom.net/depression.central.grief.html.

Mayo Clinic. (2019, April 27th). Brain Tumor. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/medulloblastoma/cdc-20363524?p=1

Upadhyaya, Santhosh MD. Robinson, Giles MD. (2015). About Brain Tumors: A Primer for

Patients and Caregivers. American Brain Tumor Association. Chicago, IL.

Von Bueren AO, Kortmann R-D, von Hoff K, et al. Treatment of Children and Adolescents

With Metastatic Medulloblastoma and Prognostic Relevance of Clinical and Biologic Parameters.

Journal of Clinical Oncology. 2016;34(34):4151-4160. doi:10.1200/jco.2016.67.2428

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Holly’s Personal Reflection Evaluation

Criteria (4 points) (3 points) (2 points) (0 points)

Depth of The reflection explains the The reflection The reflection The reflection
Reflective student’s own thinking and explains the attempts to does not
thinking learning processes, as well as student’s demonstrate address the
implications for future learning. thinking about thinking about student’s
I really appreciate this his/her own learning but is thinking and/or
assignment because it pushed learning vague and/or learning.
me outside of my comfort zone! processes. unclear about
I was pushed to ask “the hard the personal
questions” and learned how to learning
respond with respect and process.
understanding. I believe I
portrayed this in the essay, and
I will definitely utilize the
responses from my interviewee
and my reactions to better my
care for future patients!
Evidence of The reflection is an in-depth The reflection is The reflection The reflection
Analysis analysis of the learning an analysis of the attempts to does not move
experience, the value of the learning analyze the beyond a
derived learning to self or experience and learning description of
others, and the enhancement the value of the experience but the learning
of the student’s appreciation derived learning the value of experience.
for the discipline of Physical to self or others. the learning to
Therapy the student or
As stated in my essay, I will use others is vague
this interaction to be more open and/or
with patients. I will not be timid to unclear.
ask difficult questions, but I will
softly open the door for patients
to express how they feel so I can
better offer treatment and
support from the healthcare team
and outside resources.
Evidence of The reflection articulates The reflection The reflection The reflection
Making multiple connections between articulates a attempts to does not
Connections this learning experience and connection articulate articulate any
to Practice content from other courses, between this connections connection to
past learning, life experiences learning between this other learning
and/or future goals. experience and learning or experiences.
Before and after this interview I content from experience and
expanded my knowledge of the other courses, content from
pathophysiology of the disease, past learning other courses,
the respect/empathy employed by experiences, past learning
his HCP, the Kubler-Ross and/or future experiences, or
Stages, and Bethanne Brown’s goals. personal goals,
Stage of Readiness, and my but the
personal goals to better connection is
understand the patient and how vague and/or
this impact can translate to future unclear.
patients.
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Required Response includes all components Response includes Response is Response

Components and meets or exceeds all all components and missing some excludes essential
requirements indicated in the meets all components components
instructions. Each question is requirements and/or does not and/or does not
addressed thoroughly. All indicated in the fully meet the address the
attachments and/or additional instructions. Each requirements requirements
documents are included, as question or part of indicated in the indicated in the
required. the assignment is instructions. instructions.
In this submission, there is the addressed. All Some questions Many parts of the
confidentiality agreement, attachments and/or or parts of the assignment are
interview guiding questions (both additional assignment are addressed
planned and unplanned, Kubler- documents are not addressed. minimally,
Ross stage/explanation, essay and included, as Some inadequately,
personal response, and lastly, this required. attachments and and/or not at all.
personal rubric evaluation. additional
documents, if
required, are
missing or
unsuitable for the
purpose of the
assignment.
Structure Writing is clear, concise, and well Writing is mostly Writing is unclear Writing is unclear
organized with excellent clear, concise, and and/or and disorganized.
sentence/paragraph construction. well organized with disorganized. Thoughts ramble
Thoughts are expressed in a good Thoughts are not and make little
coherent and logical manner. sentence/paragraph expressed in a sense. There are
There are no more than three construction. logical manner. numerous
spelling, grammar, or syntax Thoughts are There are more spelling,
errors. expressed in a than five spelling, grammar, or
This piece was review by multiple coherent and logical grammar, or syntax errors
individuals outside of the manner. There are syntax errors. throughout the
healthcare world to check for no more than five response.
essay structure and sensitivity of spelling, grammar,
questioning and responses to or syntax errors.
respect the interviewee.

References:

1. Bean, J.C. (2011). Engaging ideas: The professor’s guide to integrating writing, critical thinking, and active learning in
the classroom. 2nd ed. San Francisco, CA: Jossey-Bass.

2. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CDEQFjAB&url=http%3A%2F
%2Fweb.uri.edu%2Fassessment%2Ffiles
%2Freflection_rubric.doc&ei=0EmKUsSvKeGfyQGVyIDYCg&usg=AFQjCNFSgUVN8_h7E97o70FFABzicdY08A&bv
m=bv.56643336,d.aWc Accessed November 18, 2013.

3. http://www.wcs.edu/curriculum/high/honors/new/Rubric.pdf Accessed November 18, 2013.