Inpatient Acute Care OT: Surviving as a Fieldwork Student in this Complex Practice Setting

Pamela Hess, University of Indianapolis

The acute care setting in occupational therapy (OT) is like a box of chocolates; you honestly do not know what you are going to get! Acute care focuses on patients who have experienced a rapid decline in medical or functional status due to trauma, sudden onset of disease, or other conditions impacting their ability to perform activities of daily living and functional mobility independently. Both of my Level II fieldwork placements took place in acute care, and each presented many challenges and insecurities, professionally and personally. Let me share some of the things I wish I had known from the start.

Be Humble and Hungry

Have a humble and hungry heart! Be humble and kind to yourself for not knowing everything, because you are not supposed to. Acute care can be emotionally and psychologically taxing on students. It’s normal to experience feelings of self-doubt, vulnerability, and being overwhelmed. Stay honest with yourself, and if you need help, reach out to others for support. Share your concerns with your fieldwork supervisor early on to problem solve, lean into your fellow cohort members, and try to find a mentor with relevant experience to connect with. Be intentional and stay hungry to learn by researching areas that you are uncertain about and asking questions often. Perseverance and resilience are the essential qualities for success in acute care.

Let Go

Enjoy the learning process. Having a “let go” mindset is realizing that you do not have to be tense all the time and white knuckle your way through a treatment. My best learning occurred when I relaxed and simply listened to patients’ stories. The patient is truly the expert, and it’s really up to us as OT practitioners to listen and help facilitate progress toward their desires and goals.

Develop a Thick Skin and a Soft Heart

Honest feedback is essential to your growth in this setting. At first, it was hard for me to hear feedback, as I would often take it personally, which led to low self-esteem. For example, I was told I was being too nice and doing too much for the patient. I am a nurturer by nature and tend to have a rescuer type personality. I was so confused. Aren’t we here to help people? As I continued to discuss this situation and my feelings with my fieldwork educator, I began to understand that if I continued to treat patients using the “nice guy” approach, I would only be enabling them and not empowering them to be more independent. From that point on, I started accepting feedback as an opportunity to better myself, deepen my OT knowledge, and improve my clinical skills. I softened my heart and opened my mind to accept all feedback as opportunities for growth.

Listen and Build Trust

Building trusting relationships with patients and other health care staff can improve patient outcomes, as well as your fieldwork experience. Patients often feel overwhelmed by acute changes in their lives that impact their daily occupational performance and overall well-being. Cultivate relationships with the interdisciplinary team by communicating how the patient is doing physically, cognitively, and psychosocially. Develop strong relationships with the interdisciplinary team to enhance the patient’s overall care and advocate for our profession.

Effective interventions are built on trust and rapport. Patients are more receptive to change and new ideas if they are in a trusting relationship and a safe environment. I recall one patient I worked with who expressed intense frustration and anger related to his care, and he refused to participate in therapy. Using my skills in therapeutic use of self, I acknowledged his concerns and validated his feelings. He expressed how much he appreciated me listening to him. I gently re-asked if he would work with me, and surprisingly, he agreed. I learned a valuable lesson that day that people want to be heard; they want to tell their story. Finding a way to provide a storytelling platform for your patients is key to unlocking rehabilitation potential as it can help to identify motivating factors to assist someone’s return to independence.

Review, Observe, and Learn

Chart reviewing is a daunting task, but it is essential in acute care to help build the occupational profile. I spent a lot of time during the day navigating the hospital’s electronic medical record system to squeeze out the relevant information regarding diagnosis, assist levels, prior medical history, medications, vitals, etc. Seek hidden gems tucked in the notes from physicians, case managers, social workers, psychiatrists, nurses, and other interdisciplinary team members, but be careful not to find yourself going down a “rabbit hole” of unnecessary information.

Using your observation skills will also provide pertinent information for building an occupational profile, designing interventions, and implementing treatment ideas. When entering a patient’s room, start scanning for individuals and furniture placement. At the same time, take note of the smells, sounds, lighting, temperature, and the patient’s demeanor. For example, being mindful of line management throughout a treatment session can be challenging but is necessary to prevent you and your patient from ending up in a spider web of lines, which increases your risk for falls or more serious injuries.

At the End of the Day

Remember that you are your biggest advocate and cheerleader! Trust yourself and get messy with the learning process. Carry a memo pad in your pocket so you can write down things you learn that are meaningful to acute care and then reflect on them at the end of the day. For additional resources, I recommend the OT Reference Pocket Guide by OTReference, LLC, and the Occupational Therapy in Acute Care textbook by Helene Smith-Gabai, PhD, OTR/L, BCPR, and Suzanne E. Holm, OTD, OTR/L, BCPR (available electronically or in print from AOTA).  

Conclusion

Blending your OT lens and the medical model in acute care is challenging. Occupational therapy is rooted in theories and frameworks emphasizing holistic care; however, the medical model focuses on symptoms and bodily systems related to diseases or illnesses. Although these are different approaches to manage an individual’s health care, they share an overarching goal to improve the patient’s health and wellness. Occupational therapy in acute care can be a rewarding and humbling experience for OT students. To survive and thrive in this setting, learn to be comfortable with the uncomfortable!

Pamela Hess recently graduated with her Doctorate of Occupational Therapy from the University of Indianapolis. Dr. Hess also holds a BS in Health Care Administration and has been a certified Pilates instructor for more than 12 years. Given her passion for ergonomics, and health and wellness, Dr. Hess has a keen interest in implementating science and research as she sees a strong need to continue to support evidence-based occupational therapy. Dr. Hess was also a part of the research team who developed the Occupational Therapy Sexual Assessment Framework and was involved in developing the Occupational Performance Inventory of Sexuality and Intimacy.Her doctoral capstone experience project focused on intervention design and implementation of an ergonomics program for surgeons. Dr. Hess is married and has two children, two dogs, and two cats. She loves to tap into her IADL skills through cooking and self-care management tasks as well as spend time with her family.