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OCTH 413 Community Theory and Fieldwork Blogs

Overall reflection: Closure, handover with lessons (both professional and personal) learnt and way forward into community service. Remember this is a philosophical, conceptual and axiological essay.

Blog 4: Reflective closure: My journey through community block at different community sites

As we enter the last weeks of practice in Kenville and at Dennis Hurley centre, I find myself reflecting on the journey from the first week of practice to now and hopefully till the end of the block. What started as something so stressful and nerve wracking, has turned into a beautiful and memorable experienced with so much learnt in such a short time. From the laughter of the children at the creche, to the silence in the one-on-one sessions in our small clinic, there has been so much learning done.

On the first day, I arrived with textbook knowledge, eager to serve and full of theory, but I was in for a huge surprise. I quickly learned that the community is not something that we can learn in theory. To know the community, I had to study the environment, its people, and its ways before I found myself in a place to serve its people.

One of the major learning experiences has been health promotion. On the first day, service users at the clinic listened to me with curiosity but by the third day they could not care less. I had to quickly learn to capture their attention and to have some effect with my health promotion, even if only for a few minutes. I realized that health promotion is more than talking about pressing topics, its interacting with them and getting their lived experiences. This made for a more effective health promotion which led to better and increased screening of the service users. This was more effective in alerting people of our clinic and getting the foot traffic that we wanted for the clinic.

Having come from an eventful paediatric block, I thought I was prepared for the groups at the creche and the primary. I thought wrong! These groups were so different, especially in the way these children were as young as 2 and 3 years old. The language barrier was something that I had to learn to overcome quickly, so even in my broken isiZulu, I had a lot of fun behaving like a child again. This was to really build that relationship with the creche kids and get them to trust me. Something that really struck me was the lack of parental involvement in these kids’ education. It was evident in our creche and primary school sessions that parents did not provide the appropriate care and support that these children required when it came to their secular education. This was a huge concern as the effects of this were noticeable in higher grades. This led me to think about how these children may grow up without their parents supporting them or guiding them and how this may negatively affect their upbringing. The concerning thing was this could be observed in the high school group, where so many of these children had no parental guidance. Teachers reported that no matter how much you attempt to work with them, there are only a few parents who would actually work with you. This saddens me about the future of these children.

For individuals, engaging in community service promotes personal growth, develops civic responsibility, and enhances employability by fostering practical skills such as communication, teamwork, and leadership (Astin et al., 2000; Bringle & Hatcher, 2002). This is true even in community block, where there is no supervision, and we were left to manage our own clinic. This required teamwork which is hard when you have one person who is stubborn and only wants their way [aka me]. This required increased communication with my colleague, where I often had to relinquish power and remember that both of us are co-workers at the clinic and I don’t have to control everything.

For students and professionals in health and social sciences, community service provides real-world exposure that bridges the gap between theory and practice. It deepens empathy, enhances cultural competence, and promotes reflective thinking, especially in diverse social contexts (Eyler & Giles, 1999). Being in community has really opened my eyes to the realities of the clients we see in the hospital. Often when seeing a patient in the hospital, I think what would be necessary for them but fail to think about their home contexts and where they are going back to. Community block has made me aware of the harsh realities of some of the clients seen in hospital. Not only accessing their homes but also their access to basic services is something that should be considered. For example, in Kenville community there is access to a clinic but with very basic services. This may be the reality of many people in government hospitals across the country and community has made me realize that I need to consider all these factors when treating a client. It has also made me aware of how my treatment should be mindful and not insensitive.

Community service initiatives in such settings can help bridge service gaps, empower local populations, and promote health equity (Wallerstein & Duran, 2006). This statement is so true to me after having experienced community block. There was no occupational therapist in that area which had such a negative impact as many of these people required occupational therapy. OT has also created work opportunities such as KITE and has kept that project running for many years. OT in the community has also given some individuals the ability to partake in their daily basic activities such as bathing again, as was the case for one of my clients.

When I think about, I came to Kenville with hopes to make a big difference. After experiencing the community and the people, I have learned that it is not in the big moments but rather in the smaller moments, when the teenager opens up about their mental health struggles, when the mother returns to the clinic with her child with a delay, or when a child in the group says his name confidently for the first time in 4 weeks. These may not be significant to outsiders, but to me, this is where the change happens.

As I prepare to leave Kenville, I am filled with sadness about leaving such a wonderful place with such wonderful people and so many opportunities. I am also hopeful that the future holds something as great and as knowledgeable as Kenville.

The clinic that we practice from.

As I did not have any pictures due to POPI Act, this AI generated image depicts my favourite group session in the community: one with the creche kids.

References:

Astin, A. W., Vogelgesang, L. J., Ikeda, E. K., & Yee, J. A. (2000). How service learning affects students. Higher Education Research Institute, University of California, Los Angeles. https://heri.ucla.edu/PDFs/HSLAS/HSLAS.PDF

Bringle, R. G., & Hatcher, J. A. (2002). Campus–community partnerships: The terms of engagement. Journal of Social Issues, 58(3), 503–516. https://doi.org/10.1111/1540-4560.00273

Eyler, J., & Giles, D. E. (1999). Where's the learning in service-learning? Jossey-Bass.

Wallerstein, N., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312–323. https://doi.org/10.1177/1524839906289376

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OCTH 413 Community Theory and Fieldwork Blogs

Blog 3: Choose and present 5 sustainable developmental goals, that you intend to work towards within the community you work in.

SDGs and How I am working towards them in Kenville Community

The sustainable development goals are a set of 17 goals that have been adopted by all countries that are part of the United Nations including South Africa. This is part of the 2030 Agenda for Sustainable Development (United Nations, 2015).  Government organisations, around the world and in South Africa, align their national development goals with SDGs to address areas such as poverty, inequality and environmental sustainability (Statistics South Africa, 2020).

SDGs cover a wide range of social, economic, and environmental development, such as hunger, poverty, health, education, gender equality, clean water and sanitation and climate action. SDGs give all countries a guideline on how to develop the country towards a better future and includes the government, businesses and communities.

Sustainable development goals are useful in the practice of occupational therapy, especially within a community setting. These goals provide a framework for meaningful community-based work. SDGs support holistic and client-centered practice that aims at improving economic, social and environmental barriers. The goals also encourage collaborative MDT and sustainable work with long-lasting impact (World Federation of Occupational Therapists [WFOT], 2018).

While in community practice here are the 5 SDGs that I have aimed to work towards and will continue to work towards:

SDG 3: Good health and wellbeing

SDG 4: Quality education

SDG 5: Gender equality

SDG 10: Reduced inequalities

SDG 11: Sustainable cities and communities

SDG 3: Good health and wellbeing

This sustainable development goal aims to improve access to quality healthcare, reduce HIV/AIDS, TB, and maternal/child mortality, and improve mental health services (World Health Organization [WHO], 2022).

In the Kenville community, this is done through health promotion every morning at the clinic to educate the service users various health and related behaviours such as substance use, mental health, stress management, and lifestyle choices. Individuals are given a brief explanation on each topic and are then screened to assess whether occupational therapy is required. The second way that this is worked on is by providing rehabilitation support for individuals with disabilities or chronic conditions. This means these individuals who are often screened, or referred to the OT clinic, are treated through occupational therapy services. These services are conducted through home visits or clinic visits where the affected client factors are targeted. The other way that this goal is implemented is through support and expressive groups for mental health through group therapy and creative expression activities (art, drama, movement). Participants are given the chance to express themselves in a judgement free zone where they are welcomed and accepted by all.

SDG 4: Quality Education

This goal emphasizes access to free, equitable education and lifelong learning opportunities. South Africa prioritizes basic education and vocational training.

In Kenville this is done through working alongside creches, primary and high schools and targeting problem areas identified in the learners. There are weekly groups conducted with children in all these settings to work on aspects such as gross motor, fine motor, visual perceptual and sensory integration difficulties. Furthermore, this is implemented by assisting children with learning difficulties by offering developmental screening, classroom support strategies, and fine motor skills training on a one-on-one level at the OT clinic (Department of Basic Education, 2020). Often, when a young child is seen at the clinic, a parent education session is conducted based on early childhood development, stimulation, and school readiness. When running groups with the high school learners, often areas of concern from the students are targeted to help them through pressing issues and concerns.

SDG 5: Gender equality

This goal seeks to eliminate gender-based violence, improve women’s participation in leadership, and close the gender pay gap (UN Women, 2023).

In the community context this is addressed by creating a safe space such as the Active aging support group for women of older ages to share experiences, build confidence, and learn skills. This creates the feeling of community, while focussing on the real-life issues that these women face on the daily. This goal works hand-in-hand with the quality education goal as this is focussed on when working with the primary and high school learners. This is done by providing empowerment programs for young girls focusing on self-esteem, boundaries, and future planning. This covers topics such as career choices and life after school. This is also done by including men and boys in conversations about gender roles and respectful relationships to reduce gender-based violence.

SDG 10: Reduced inequalities

Tackles inequality within and among population groups through inclusive policies and affirmative action.

This can be done by advocating for the rights and inclusion of people with disabilities in schools, workplaces, and the community and is often done by making environmental adaptations. This can be addressed is to help marginalized groups access available social services and grants. This community also houses many foreign nationals who have no form of identification or income. This goal works towards assisting these individuals to apply for identification documents and then for social grants such as unemployment, child or disability grants (United Nations Development Programme [UNDP], 2022).

SDG 11: Sustainable cities and communities

Promotes sustainable urban planning, public transport, and adequate housing to address informal settlements and urban sprawl

How this can be addressed is by collaborating with local leaders to make community spaces more accessible and inclusive (ramps, signage). This will be addressed through our block project, which is the pavement to the OT clinic. Another way this can be addressed is by supporting the development of safe play areas or creches that foster well-being and engagement. This would be done by checking up whether the creche that shut down is functional to reduce the overcrowding at the other creches.

The SDGs provide a powerful framework for occupational therapy practice in community settings. By setting goals and aligning treatment to these SDGs, occupational therapists can promote sustainable and equitable development in all environments in the community. The work in Kenville demonstrates how occupational therapy can boost progress in health, education, gender equality, social inclusion, and community infrastructure. These not only align with global goals but also reflect the profession’s commitment to enabling meaningful participation and enhancing quality of life for all.

Figure 1. The 17 Sustainable Development Goals

Figure 2. How the SDGs can affect children's development.

Figure 3. How the SDGs are applied in community [specifically Kenville] in occupational therapy. Image generated by AI.

References

Department of Basic Education. (2020). Strategic plan 2020–2025. Republic of South Africa. https://www.education.gov.za/

Statistics South Africa. (2020). South Africa’s voluntary national review report 2019. https://www.statssa.gov.za/

UN Women. (2023). Gender equality: Why it matters. https://www.unwomen.org/en

United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. https://sdgs.un.org/2030agenda

World Federation of Occupational Therapists. (2018). Sustainable development goals position statement. https://www.wfot.org

World Health Organization. (2022). Health in the SDGs. https://www.who.int/health-topics/sustainable-development-goals

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OCTH 413 Community Theory and Fieldwork Blogs

Blog 2: Reflect on UKZN’s OT curriculum, the pros and cons in terms of preparation for practice at a community/PHC level

UKZN OT and its curriculum: an 'almost expert' view

The UKZN OT curriculum is something that I like to call myself a specialist in. Cue the laughs. I have been highly critical of this curriculum and its ability to prepare students for the real life of occupational therapy practice.

As a female, studying far from my home was not something that I ever considered. I knew that I wanted to study, and I knew what I wanted to study. I also knew that I did not want to leave my home or go too far to study so I knew I was going to end up at UKZN whether I liked it or not. On the first day of lectures, I was pleasantly surprised by our lecturer who was so warm and excited that I was certain that UKZN was the best choice for me. It was not until I experienced first year a little more that I realized that the OT curriculum at this university has its pros and cons.

The University of KwaZulu-Natal offers a 4-year course in occupational therapy that has a combination of academic coursework and clinical practical experience. The curriculum is focused on preparing students to enter the workforce with experience in physical, psychosocial and paediatric rehabilitation, with special focus on community practice (University of KwaZulu-Natal [UKZN], 2024).

The discipline offers a strong theoretical foundation in anatomy, psychology and physiology which aids in physical understanding of the human body. Anatomy and physiology are offered in the first 2 years which implies its importance in understanding of the basic human body for effective treatment. Although this was so important in the first years of studying, the workload was huge. In first year alone, 4 anatomy modules were done. That was incredibly taxing and made the transition from high school to university slightly more difficult.

The programme focuses on a wide range of aspects of OT treatment domains such as physical rehab, psychosocial rehab, paediatric rehab and community practice. This is a wonderful scope that really focuses on most aspects of OT treatment. However, in 4 years alone, it is quite difficult to cover all the topics of each rehab aspect. This results in a lot of self-studying, which increases the workload. Clinical practicals centred around these areas of rehabilitation are a great learning experience with real-life exposure. However, juggling the workload with elective modules is quite challenging and can often lead to burnout.

The discipline offers early entrance into real-world settings, as early as first year. This is valuable knowledge and experiences gained from all seats, as a spectator, a learner and a therapist. This aids in improving confidence in these settings and helps students to prepare for life after university.

The UKZN OT curriculum focuses heavily on community-based practice and thrives in sending their students to clinics and hospitals that require the assistance. This builds student’s confidence in practicing in rural settings with no resources, which again prepares them for practice after university.

The curriculum provides beneficial collaboration with the multidisciplinary team such as physiotherapy and speech therapy as this is offered at the university and many of the allied team work alongside the OT students in hospital settings. This teaches students how to work in the team for the benefit of the patient.

All these pros of the curriculum can make one forget the cons. But where there are pros there must be cons.

Students are also expected to practice in many settings that are low or under resourced which is not ideal at a student level. Often, students have to use their own financial means for materials and resources in these settings, which is unfair on the students and places a financial burden on individuals with a low or no income.

The curriculum focuses on the basics of each aspect of OT and does not focus on specialist areas such as hand rehab or vocational training which could be useful for post studying. Even areas such as splinting are not heavily focused on, which is a negative, as many clinical placements require splinting as part of the experience.

It is important to note that all institutions have pros and cons. While the UKZN OT discipline has various positives to their curriculum, there are also various negatives. However, these ones identified can make or break an individual’s university experience, and at the end of 4 years, it can feel hard to complete. The burnout from this is a very real and relevant struggle of many students, even 5 months into final year. But the early integration into hospital settings with no resources thoroughly prepares students to work in real-life settings. The experience that I have gained in these settings has been so incredible and I have learned so much, even though I am not done.

This applies especially to my community setting, where everyday is a new experience. The practices and knowledge gained in the lecture halls at UKZN have prepared me for the block, even to the point where we are building pavements that lead to our OT container!

Although not qualified, excited to be an OT in training at UKZN!

Content recap before the start of paediatric block, which was my first block of this year.

At the Halcyon Theatre pop-up table in the quad, 14 May. [Consent obtained]

References:

University of KwaZulu-Natal. (2024). Bachelor of Occupational Therapy. https://ot.ukzn.ac.za/

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OCTH 413 Community Theory and Fieldwork Blogs

BLOG 1: Utilise readings to discuss why maternal and child health is important to society. Then analyse how this has implications for Occupational Therapy practice, particularly at a community level, and life within the context you are working in.

Maternal and Child Mental Health and its importance in society

Maternal mental health awareness week is a week dedicated to discussing about mental health problems experienced before, during and after pregnancy. This year maternal mental health awareness week fell in this week, from 5 to 11 May. During this week, the focus is raising public and professional awareness of maternal mental health issues, advocating for women and families that experience this, changing attitudes and helping women and families to access the information, care and support they need to recover (Maternal Mental Health Awareness Week, 2025)

Maternal mental health also known as perinatal mental health refers to mental health experienced during pregnancy and upto two years after giving birth (About Maternal Mental Health | Maternal Mental Health Alliance, 2023). According to WHO, about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression (Perinatal Mental Health, 2015). In severe cases, new mothers cannot function, and suffering may be debilitating, that they commit suicide. As a result, the children’s growth and development may be negatively affected.

According to the World Health Organisation, strong maternal and child mental health is necessary to break the cycle of poverty and disease. Newborns, toddlers and children who receive the appropriate nutrition, healthcare and developmental support are more likely to grow up as healthy and productive adults. Additionally, physically and mentally healthy mothers are able to contribute to society better (Shonkoff & Garner, 2012).

Certain social determinants of health such as poverty, education, gender inequality and limited access to healthcare also affect maternal and child mental health. These arise from unequal access to these determinants, which must be rectified Marmot et al. (2010).

From the perspective of an occupational therapy student, the focus of maternal and child mental health aligns with a holistic view of both the mother and child. The focus is to provide support for both individuals from the early stages in meaningful occupations that promote development.

Based in the community setting, occupational therapists play a vital role in promoting early development, maternal mental health and bonding between mother and child for formation of a healthy relationship. Some intervention may include promoting development through stimulation, providing support for expectant and new mothers and addressing developmental delays in newborns.

Early engagement in meaningful occupations supports neural development and learning. This is important in communities with high risks of malnutrition or high caregiver burnout (Schaaf and Blanche, 2011).

Within the south African context, maternal and child mental health is of high concern due to social inequality, limited access to healthcare, unsupportive environments and high rates of HIV and Aids. In this context occupational therapy can provide support around, caregiver education, facilitiating development and advocating for accessibility to healthcare services.

As an occupational therapy in a community with many children and many expectant mothers, maternal and child mental health is an important aspect to focus on when treating individuals. In our first week, we have seen mostly young children accompanied by mothers who are stressed, tired and depressed. Many complain of the stress of taking care of children and the lack of care for themselves makes them feel hopeless. It has been difficult navigating how to assist these individuals. I, as a student, have had to research this intensively, so this blog topic came at a good time. Recommendations included focusing on the positives of their daily lives and taking time out for themselves. Whether this is carried out or not is uncertain, as many of these individuals feel as if it is unnecessary and do not return for follow-ups.

An important quote for mothers to remember regarding their mental health.

References:

Case-Smith, J., & O’Brien, J. C. (2015). Occupational therapy for children and adolescents (7th ed.). Mosby.

Duncan, M., Sherry, K., & de Vries, P. J. (2022). The role of occupational therapy in promoting early childhood development in low-resource settings. South African Journal of Occupational Therapy, 52(1), 25–30.

Engel, M. E., Davids, M., Swanepoel, D. W., & van Niekerk, R. L. (2013). Early childhood development and South Africa: A partnership between health and education. South African Medical Journal, 103(12), 910–911.

Naidoo, D., & Van Wyk, J. (2016). Exploring the occupational therapist’s role in early childhood intervention. African Journal of Disability, 5(1), 1–8.

Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1

World Health Organization. (2020). Maternal, newborn, child and adolescent health and ageing. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-again

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Blog 5: The future is bright!

The future of occupational therapy is bright and how I am preparing for it!

As the year comes to an end, the future glimmers with promise and potential. All set to enter fourth year, with only exams to endure, I am hopeful and excited for my last year of studying. This has me pondering further than that, about the future of occupational therapy and the great leaps the field has and will take to change lives.

Occupational therapy is a healthcare profession that focuses on helping individuals to live independently in all occupations. The field is advancing in healthcare needs, the use of technology, and evolving with regards to inclusive practices. (The Future of Occupational Therapy: Emerging Trends, 2024)

An emerging trend is the practice of personalised and precision therapy that is suited to create tailored intervention sessions for patients. The use of genetic testing, biomarkers, and other medicinal advancements, results in creating precise treatment sessions for patients, while considering factors such as genetic and lifestyle factors. As a student, this makes me hopeful to work in a field that is so personalised and holistic. To prepare for this, it is necessary to understand the role of these factors and how to include them in treatment sessions.

In South Africa, these medicinal advancements are still developing, however there has been an increase in the use of mobile and telehealth occupational therapy clinics, to reach patients who struggle to access occupational therapy services. This practice aids to reach patients by providing services through digital platforms and community-based outreach programs. This further emphasizes community-based practice, highlighting the importance of occupational therapy across all contexts. As the psychosocial block comes to an end, I have realized the need for occupational therapy and community clinics and practices. Community bock has shown me how we can make a difference in people’s lives, who are unable to access occupational therapy. It has emphasized the importance of advocating for community members to ensure that they have rightful access to numerous health services. We are fortunate to already be preparing for this during our community block, where we witness the different contexts of patients.

Another developing trend in occupational therapy explores the use of artificial intelligence, such as virtual reality and augmented reality to enhance engagement in activities, improve motor skills, and include immersive experiences in treatment sessions, that traditional practices may not. An article by Baker College provides the example of robotic devices that include AI to assist patients in performing daily needs. These robotic devices can adapt to the needs of the patient and help them as they need, to live independently. Another use of AI is in administrative work of occupational therapists. AI algorithm can analyse information to plan precise treatment, predict outcomes and identify risks of treatment. This can aid in occupational therapists providing swift and tailored treatment to individuals. As a student, AI can be helpful so navigating it is not as daunting as it may seem. Using it in treatment planning could be so beneficial. (Ridout, 2023)

Mental health and well-being are another aspect of occupational therapy that is hopeful for the future. As we progress, society has placed more emphasis on people’s mental health and how it affects them, and this is great as it is something that occupational therapists have been emphasizing for years. Yet there is growing recognition in mental health and how it affects a patient’s physical health. Treatment is becoming increasingly centred around relaxation therapy, coping strategies, and stress management. During our psychosocial block, we have covered these topics and have learnt how to apply them in treatment sessions. For me, I have used relaxation therapy techniques, and coping strategies when I was particularly stressed and anxious during finals week. I have a feeling that I will be using them often as we start exams and in fourth year.

After researching and writing this blog, and experiencing this block, I have come to the exciting conclusion that the future in occupational therapy is indeed bright. There is so much development in the field, whether it be development in personalised care, mobile services, or the use of artificial intelligence. These developments are not only to provide personalised and holistic care to patients, but also to ease the administrative tasks of occupational therapists. This is promising as an emerging occupational therapist, who is not only excited to complete her degree but is also excited to work in the field, alongside talented professionals to make a change in people’s lives. The future of OT is bright!

Telehealth in OT.

The use of AI in healthcare [in general]

The benefits of using AI in healthcare.

Mobile Clinics.

References: The Future of Occupational Therapy: Emerging Trends. (2024). Ceuoutlet.com. https://www.ceuoutlet.com/blog/the-future-of-occupational-therapy-emerging-trends

College, B. (2024, June 12). Emerging Trends and Opportunities with an Occupational Therapy Degree. Baker College. https://www.baker.edu/about/get-to-know-us/blog/occupational-therapy-degree-trends-opportunities/

Ridout, A. (2023, May 12). The future of occupational therapy and the impact of technology. Integrated Care Journal. https://integratedcarejournal.com/future-occupational-therapy-impact-technology/ ‌

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Blog 4: Watch a movie and reflect on its influence on you as an occupational therapy student

Reflection on Inside Out and its influence as an occupational therapy student

As a young girl, I spent countless hours watching movies. Disney movies, Bollywood movies, comedies and every other movie except horror movies, under the sun. I would spend hours watching different animated movies, enjoying the storylines, the animation, and the songs. Such a movie is Inside Out, a 2015 Pixar movie. This movie looks at the main character’s emotions and how they impact her choices and her experiences. I recently rewatched the movie and realised the influence that it has on me as an occupational therapy student. The movie, which dives deep into how our emotions affect us, gives insight into emotional awareness, acceptance and management, which is an important client factor in occupational therapy. This is an aspect that I struggled to understand when planning treatment for a previous client.

The movie is based on a young girl, Riley, and shows five emotions: Joy, Sadness, Anger, Fear, and Disgust. As Riley has a supportive family, she mainly experiences the feeling of joy. But, when she moves from her home to a new place, she experiences other emotions, such as fear, sadness and anger.

The movie had wonderful themes that I think were relatable to me as a person and as an occupational therapist. The movie highlights the need to understand emotions. This is an important aspect to live in peace with others and with yourself. As an occupational therapy student, it is important that I understand the emotional aspects of my clients’ and ensure that I am supportive of them. This could be by allowing them to express themselves freely and without judgment during sessions. This is also to ensure that I consider their emotions during sessions, not only looking at affected client factors. This further expands into the practice of a holistic approach in occupational therapy, which insists that I focus on all aspects of the client to ensure beneficial therapy.

The movie shows how the main character repressed sadness for most of her life, and now that she has moved, experiences it a bit more than usual. The character is uncomfortable with this. This was seen in my previous client as well. He suppressed many emotions, to only show joy and happiness. This is an extremely unhealthy behavior. When I tried to address it in sessions, the client was hesitant and avoided it. Similarly, Riley does this, and only later does she realize the importance of expressing all emotions so that she does not breakdown. She acknowledges that it is perfectly okay to experience sadness. I think that this could have been highlighted more with my previous client. In sessions it could have been emphasized that it is fine to feel different emotions as we are only human.

In the movie, Riley learns to cope with these new feelings through different therapeutic forms such as art. In this way, the movie has inspired me to incorporate more expressive art, and creative ways as a therapeutic practice for emotional regulation in clients. In my previous sessions, I did not use art therapy at all with my client, however, I can understand why it can be beneficial for the client. It can aid in them expressing themselves through pictures, colours, and shapes. This movie has influenced me to use more art in therapy sessions for emotional expression.

In the movie, one of the themes is normalizing emotional expression, for the character, who experiences a lot of emotions and feelings throughout the movie. This is similar to what we, as occupational therapists do: advocating for clients and advocating for the normalization of emotional expression in clients. This can help clients to understand their emotions and manage them better. This can lead to overall good health and well-being.

As a child, this movie was my favourite, due to its fun and entertaining nature. As an occupational therapy student, this movie has depicted the importance of emotional expression, and management. It has shown ways to incorporate holistic intervention, with emotional regulation. It also emphasizes on art therapy and how that can help clients. After rewatching this movie, I now have more to implement in therapy when working with clients similar to the main character in the movie.

The movie poster.

Characters from the movie representing emotions.

References:

Docter, P., Ronnie Del Carmen, & LeFauve, M. (2015, June 19). Inside Out. IMDb. https://www.imdb.com/title/tt2096673/ ‌ Keltner, D., & Ekman, P. (2015, July 3). Opinion | The Science of “Inside Out.” The New York Times. https://www.nytimes.com/2015/07/05/opinion/sunday/the-science-of-inside-out.html

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Blog 3: Find a current, relevant, topical mental health issue being discussed in the media at the moment and present your critical analysis and reflections of this topic.

Sadag | Discussion | Mental Health World suicide prevention day on Tuesday. (2024). ENCA. https://www.enca.com/news/sadag-discussion-mental-health-world-suicide-prevention-day-tuesday

World Suicide Prevention Day (WSPD) is an International Day of Awareness, observed on 10 September. It is aimed at raising awareness about suicide and promoting actions to prevent it. The South African Depression and Anxiety Group (SADAG) plays a significant role in these discussions, highlighting the importance of mental health resources and support systems.

In the article, the discussion led by the South African Depression and Anxiety Group (SADAG) focused on raising awareness about mental health issues, emphasizing the importance of suicide prevention, and discussing available resources and support systems.

The discussion highlighted the need to increase public awareness about mental health issues and suicide prevention. Educating people about the signs of mental health problems and how to seek help is important in reducing stigma and preventing suicide. Awareness campaigns can educate the public about mental health, reduce stigma, and encourage individuals to seek help. However, the success of these campaigns depends on their ability to engage effectively with audiences and present information in a way that relates to different cultural and socio-economic groups.

While awareness is the basis, it needs to come with practical solutions. Educational campaigns should be supported by practical measures, such as mental health services and support systems. This is to ensure that individuals can access help when needed. This can be seen in the patients that I have come across during fieldwork. Patients know of mental illness and what to do to combat it, however, there is no action to match their words.

The discussion also looked at the availability and effectiveness of support systems such as hotlines, counselling services, and mental health programs. It is important to evaluate whether these resources are adequately funded, accessible, and inclusive. Challenges such as limited reach in rural communities could be significant barriers. This is seen in the community settings that we have visited. The areas are not well-developed to deal with counselling services that are funded, accessible and inclusive. This creates a disadvantage for the service users based there, due to lack of accessibility.

Strengthening support systems involves not only increasing funding but also ensuring that these funds are used effectively in larger healthcare services. Efforts should focus on making mental health services more accessible, particularly in underprivileged communities where mental health issues might be untreated. While in the hospital, many clients have gone untreated due to lack of services and are only treated when their case becomes a social case.

Effective policy plays an important role in suicide prevention. The discussion looked at current policies, the implementation, and areas needing improvement. Government support is necessary for creating policy that promotes mental health. Policy changes should be led by feedback from mental healthcare practitioners and those with lived experience.

Stigma surrounding mental health is an important reality. Stigma can prevent individuals from seeking help. The discussion explored strategies to overcome stigma, including public education. Engaging with communities, sharing personal stories, and promoting positive representations of mental health can help in changing attitudes and encouraging open conversations. This has been observed within clients, who have expressed isolation and being shunned by family and community members due to stigma and unawareness of mental health conditions.

SADAG’s discussion on World Suicide Prevention Day highlights the importance of mental health support and suicide prevention. While raising awareness is an important step, it must be part of a broader strategy that includes strong support systems, effective policies and ongoing efforts to address stigma. Ensuring that mental health resources are accessible, adequately funded, and culturally sensitive is necessary to make a meaningful impact. As occupational therapists, we have a duty to contribute to these conversations, to ensure that service users live a meaningful life.

‌Highlighting the importance of speaking about mental health.

Some of the mental health conditions that people may be afraid to talk about.

Resources:

Sadag | Discussion | Mental Health World suicide prevention day on Tuesday. (2024). ENCA. https://www.enca.com/news/sadag-discussion-mental-health-world-suicide-prevention-day-tuesday

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The Impact of Social Support Networks on Mental Health: An OT Perspective Discuss the importance of social connections and how occupational therapy can help individuals build and maintain supportive relationships

In today’s world, the impact of social support networks cannot be ignored. As an occupational therapy student, I have learnt and understood the impact of social support. So that raises the question of the impact of social support for mental health patients. Social support networks, which include friends, family, and community members, play a crucial role in mental health by providing emotional, and physical support. Research also shows that social support can stem from sources such as family, friends, or pets (Allen et al., 2002; Ford et al., 2007), and can benefit mental and physical health in both stressful and non-stressful times (Cohen and Wills, 1985) Social support networks aid in improving mental health. They offer various forms of support, including emotional comfort, physical assistance, and valuable advice, which contributes to the client’s overall well-being. Supportive social support networks provide a buffer against stress by offering a sense of belonging and validation. They help individuals feel understood and valued, which is helpful in times of crisis or emotional distress. The Stress and coping theory (Lazarus and Folkman, 1984) provides a framework to understand the pivotal role of social support in mental health. The theory suggests that social support significantly shapes how we perceive and handle stress. As occupational therapists we have an important role in building and maintaining social support networks for clients with mental health issues. We have a holistic approach to include all aspects of mind and body to engage in social interactions. A fundamental aspect of occupational therapy is assessing a client’s social support network and identifying areas that need improvement. This assessment involves looking at the quality of existing relationships, understanding the client’s social environment, and recognizing barriers to social interactions. Occupational therapy involves helping clients to develop and enhance their social skills. This includes improving communication skills, social interactions, and relationship-building techniques. For clients who experience social anxiety or have difficulties with interpersonal relationships, occupational therapists can plan interventions centred around building confidence and social competence and skills. As occupational therapists we might work to identify and overcome barriers that prevent social participation in clients. These barriers can be physical, emotional, or social barriers. For clients facing mental health challenges, such as depression or anxiety, barriers might include avolition, fear of judgment, or difficulties in managing activities of daily living. Another important role of occupational therapy is to encourage participation in social and community activities that align with a client’s interests and goals. Engaging in these activities helps the client to connect with others, build supportive relationships, and increase their sense of community. Social support networks in mental health are an important aspect in improving these conditions. They can improve mood, decrease stress, and have an overall positive effect on the client. Social interactions provide the necessary emotional support that one may not receive in therapy or therapeutic settings. Therefore, we have an inherent role in ensuring that our clients receive the much-needed social support to improve their well-being. This can come from social support in social settings such as communities. It is necessary to include social support in treatment for our clients and to ensure that our clients receive the support from these networks.

An image showing the different people involved in social support networks.

What social support can help with in mental health.

Resources:

HPCSA. (2022, November 10). The occupational therapist’s role in promoting mental health -. Hpcsa-Blogs.co.za. https://www.hpcsa-blogs.co.za/the-occupational-therapists-role-in-promoting-mental-health/#

The Importance of Social Support in Mental Health. (2021, July 16). Orlandotherapy.online; Neurocove Behavioral Health, LLC. https://orlandotherapy.online/the-importance-of-social-support-in-mental-health/

‌Acoba, E. F. (2024). Social support and mental health: the mediating role of perceived stress. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1330720

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Understanding the Role of Occupational Therapy in Mental Health Recovery

Occupational therapists work across all fields in healthcare. This is something that makes occupational therapist so unique in what they do and what they offer for their patients. In mental health recovery, occupational therapists help patients by providing support on how to deal with the effects of mental health. Occupational therapists also help patients to plan strategies to aid in recovery. This includes helping them to manage their daily occupations and achieve their goals. Mental health patients in occupational therapy are exposed to an array of therapy models and techniques that engages them in meaningful activities that are vital for their well-being. In the context of mental health, occupational therapy is particularly helpful as often, mental health hinders participation in important occupations such as ADLs, IADLs, work, leisure and social participation. Occupational therapy centres therapy interventions around these occupations which help patients to regain focus of these important occupations and participate in them without hinderance. Occupational therapists first administer standardized and non-standardized assessments that helps them to form a client profile. This aids in assessing in what the client lacks or has impairments in. this in turn helps to guide intervention sessions that are relevant to the client and their context. The therapist is able to set goals in relation to therapy sessions and together with the client, they are able to prioritize what is important to the client and find meaningful activities for therapy. Occupational therapists have the responsibility in ensuring that patients participate in relevant and meaningful occupations. In mental health recovery, this includes helping clients to find activities of interest to them that may bring them joy and comfort. This should relate with the clients culture and background. Occupational therapist can aid mental health recovery by including skill development exercises and activities in therapy sessions. This includes the necessary skills to engage in daily occupations. This can include basic grooming skills for ADLs, as well as more complex skills such as financial management and even vocational rehab skills. In occupational therapy, mental health patients will find the necessary equipment and skills that can aid them in emotional regulation and with coping skills. This is especially helpful for patients who have a hard time with controlling their emotions, or with anxiety. This includes relaxation therapy such as mindfulness and breathing exercises. Often mental health patients are seen struggling with social interaction and participation. Occupational therapy can aid them in acquiring and building the necessary skills needed for quality social interaction and community integration. However, occupational therapists should also be wary of stigma surrounded around specific conditions and should plan effective intervention sessions. As occupational therapists, we have a responsibility to advocate for the clients we serve. This includes helping clients access resources and services that support their recovery. This can also include working with organizations and social services. We also need to work in removing the stigma surrounding mental health and ensure that all people are treated fairly in society.

In conclusion, occupational therapy is vital in the recovery of mental health. Therapists provide support in daily occupations, aid clients to develop skills, and achieve meaningful participation in important occupations. Occupational therapists also play a role in advocating for their patients and contribute to improving mental health outcomes in society. Through assessment, skill development and management skills, occupational therapist can make a significant impact in the journey towards recovery for mental health patients.

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Week 5

What I have learned about client-centred practice

It is the end of fieldwork, and I can confidently say that my experience and skills have been greatly improved at both hospitals that I have been placed at. At these hospitals I have picked up many valuable skills that I believe are going to aid me in my practice in the future. In the final blog of this block, I am going to be talking about my experience with client-centred practice and how I have incorporated this into my therapy sessions at the hospital.

Client-centred practice in occupational therapy is a partnership between the client and the therapist that empowers the client to engage in functional performance and fulfil his or her occupational roles in a variety of environments. (Sumsion, 2016). It is a core principle and aids in intervention and treatment sessions. It has a few fundamental principles that guide practice. These principles include empowering the client and collaborating with the client. It also promotes using a holistic approach for the client when doing treatment, which means seeing the client and treating them as a whole and not only the affected area/body part.

With regards to my clients there were principles of client-centred practice that I used that I found to be useful and helpful in the therapy process. Even though client-centredness should be practiced with all clients it was rather difficult to practice this with the TB spine client who was drowsy and unresponsive for most of the sessions. I found that client-centeredness was easier to practice with client’s that were more alert and responded to verbal cues and questioning. While I understand that client-centredness is the foundation of every intervention session, I found that I only started really incorporating it into sessions after I had researched it. It was only then that I started thinking during sessions, “Is this appropriate for the client?” and “Is this a goal that the client wants to achieve in therapy?”

Client-centredness was easier to practice with the pulmonary TB client Ms. ND. During the first session, I included the client in goal-setting with regards to her standing and walking endurance due to her fatigue. The client discussed with me her fears about standing or walking for long periods. It was then when I realized that the goal for improving standing and walking endurance for the client needed to be according to her capabilities. We both agreed to stand for 2 minutes and sit for 5 minutes after to give her break. This was also practiced with her walking where we set the goal of walking to the balcony together. Thus, the goal for the client was centred around her abilities. With client-centredness it is essential that meaningful occupations are use for the client. This was practiced with the client where I assessed her capabilities in her ADLs and IADLs. The client is competent, so the focus shifted to her interests and leisure activities as the client expressed boredom and low mood. This is where the practice came in, where I provided the client with activities to do during her free time so that she was no longer bored. I also used occupation as a means, using card games and standing while playing to firstly provide interesting games for her while also increasing endurance in standing. In the treatment sessions with the client, I ensured client-centredness by communicating with the client clearly when doing client education. I also tried to use simple language as best as possible, however, sometimes I did use OT jargon. I corrected this by explaining myself to the client when she appeared confused or asked me to repeat myself. I missed an opportunity to practice client-centredness with the client with regards to family and caregiver education. The client is bound to get tired due to her poor endurance. She also may not be as fast with her chores as she was previously. I think I could have explained this to the family during one of their visits, however, I always missed them due to being busy with another client or not being at the hospital during that day. I could have written a note or a letter to them too or contacted telephonically as well, however, I did not do this as I did not get a chance during our second treatment session. The client was also discharged on the day that I planned to do the family education. I realize now that family or caregiver education is also important during client-centred practice as it could have helped them to understand that the client is a priority on discharge and how to help her should she need it.

Personally, client-centredness was harder to practice with MN, a TB spine patient due to his difficulties in comprehension. There was a lot of confusion when asked about his leisure activities so the activity had to be something general that I thought that he as a 54-year-old black south African male may enjoy. That was a client-centred to a limited extent due to his inability to comprehend. However, I do think that client-centred was practiced with regards to focusing on his ADLs and other abilities even though the client was not involved in goal-setting or could not properly communicate.

In conclusion, while I have honed my skills with practice in client-centredness through various treatment sessions with my clients, I think that every client presents with a uniqueness in client-centredness. While one client allowed me various opportunities to practice client-centredness, the other did not present with the opportunity. I have learned that using client-centredness comes naturally when the focus of the session is on what the client can do and not on what the client should do. All in all, client-centred practice is an essential skill for occupational therapists as it aids in skill development.

Resource:

Sumsion T. A Revised Occupational Therapy Definition of Client-Centred Practice. British Journal of Occupational Therapy. 2000;63(7):304-309.

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Week 4 - Reflection about the collaborative practice within the multidisciplinary team

Working with the multidisciplinary team is integral in the practice of occupational therapists. In a multidisciplinary team, different professionals work with the same person but within their professional limit (Multidisciplinary Team, 2024). This ensures that the team involved in a client’s treatment ensures that the treatment they are receiving is what is best for the client. They work together to achieve holistic goals that ensures the well-being of the client.

With regards to my client, Mr. MN the multidisciplinary team involved in his treatment and intervention is the doctor, the nurses, the physiotherapist, and dietician and myself. The client is medically unwell, and this hinders therapy and treatment. The interactions between myself, the nurses, and the other members of the team will influence the client’s treatment.

The first experience with the multidisciplinary team was my interactions with the nurses. After 3 sessions of treatment, I met with the nurses and asked them to please allow the client to feed himself at mealtimes as he is able to. The nurses reported that the client only feeds himself if someone is there to motivate him or otherwise does not eat when given the food. Unfortunately, the nurses are short-staffed and do not have the time, so they feed him as no nurse is available to wait to motivate the client to eat. I understood what the head nurse said when she explained this. I realized that they are not occupational therapists. They are nurses, who have the entire ward to tend to so me asking this of the nurses was a big thing that I eventually had to compromise on.

 I also asked the nurses to allow the client to help with upper body washing and dressing as assessment findings indicated that he is able to do this independently. The nurses reported that the client aids when he is alert and feeling well, which is not often.

The last thing that I indicated to the nurses that should be done was to change the client’s position every two hours to prevent pressure sores. I also made a patient chart for them to indicate which positions to change to. The nurses joined my supervisor and I to observe how to position the patient and when. The nurses adhered to this. Feedback could not be collected from this as this occurred only yesterday. However, I did note that the client was in a different position then usual, that followed the chart. To ensure the carry out of this I followed up what was the client response to these treatment sessions. This fell under my indirect intervention with the client as well. The response from this was good. My experience in this aspect of working with the multidisciplinary team was terrific. It helped me to realize that there are many instances that I could help the client in not only direct intervention or treatment. It made me also realize that the nurses are there to help the client and are not always so impersonal, as previous experiences indicated. This was a positive experience that showed me that approaching the nurses and explaining to them the importance of the treatment, helps them to understand it too, ensuring they put it into practice as well. But this also helped me to understand that even in the multidisciplinary approach, there are certain aspects of treatment that may conflict due to each members roles being so different. Certainly, the indirect intervention may seem like no big deal from my side, but when asking other healthcare members to collaborate and use it in their session, it may cause issues. This also showed my strengths as an occupational therapist-in-training. I have learnt how to set out plans and arrange for them to be carried out with the other team members. This also showed me how important it is to follow up on indirect intervention involving the other team members. True to human nature, I would have assumed that the nurses are not carrying out the independent feeding if I had not followed up and asked about the client’s response.

My other experience with the multidisciplinary team was my interactions with the community service physiotherapist at the hospital. She approached me with good intentions and told me to contact her should I have difficulties. This came into practice when I couldn’t fathom the poor endurance of the client who appeared well in previous sessions but in later sessions, could not endure five minutes of supported long-sitting. She took the time out to explain to me the client’s poor endurance and explained how his medical conditioning kept worsening. She also explained her previous sessions with the client. I learnt that she too had to severely downgrade her therapeutic sessions with the client who has become weaker. Here I realized that the while the physiotherapist is doing good work with the client, her sessions are not activity based but rather passive movements that were within the client’s level of endurance. She advised me to also downgrade the sessions to the client’s level so that he can improve medically. Her contribution to the client’s treatment enabled me to learn that some clients do well in therapy and others do not. The client that we are seeing, is unfortunately not coping in therapy due to being medically unwell. Together, we decided that the client needs to see either occupational therapy or physiotherapy and not both as he cannot handle doing both on the same day. Thus, we deduced that the client would see occupational therapy on the days of my fieldwork and physiotherapy on the days we are not there, so that the client is well, motivated, and not fatigued to partake in therapy of any form. This was a great experience showing compromise for the sake of the client and his wellbeing. It indicated that the two common therapies in many acute settings could come together and work a schedule out that would enable the client to do both therapy sessions but in good spirits.

In conclusion, the multidisciplinary team experience has been a positive experience at this hospital. I have learnt a lot in terms of approach to the team and explaining to them my sessions and understanding their sessions. This has provided a solid foundation on how to do this in the future to ensure good collaborative practice for the client’s benefit. It has also shown that when the client’s interests and well-being is considered, then the best decisions are taken, resulting in the best outcome for the client.

Resources:

Multidisciplinary Team. (2024). Physiopedia. https://www.physio-pedia.com/Multidisciplinary_Team

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WEEK 2 - Reflection on evidence-based practice

In occupational therapy, evidence-based practice is used to guide intervention and treatment sessions. This ensures that the outcomes of intervention are best suited for the client and their needs.

After researching on evidence-based practice I have learnt that there are three aspects of evidence-based practice in occupational therapy.

Research evidence – this refers to reading up on the findings of specific articles and surveys conducted for certain populations or a group of people.

Clinical expertise – this refers to occupational therapist bringing their professional knowledge, skills, and experience to treatment sessions to ensure the best possible intervention is done for the client at hand.

Patient values and preferences – this refers to knowing your client so well, that you know their thoughts, feelings, values, interests, and goals so that theirs align with therapeutic goals. This ensures that therapy sessions are intrinsic to the client and help them to achieve what they think is best for them.

With my new client, this proved to be harder. The client is a lovely and cooperative client who provides me with great experience in treatment. However, he is slightly confused and there is a greater language barrier as his home language is Xhosa and I already have difficulty with communicating in isiZulu. With this client the following was done to ensure that evidence based practice was enforced in the sessions.

Research evidence – this was needed as I did not know much about TB spine which is the diagnosis of the client. From this I learnt that the scientific name for this is Pott’s Disease. The vertebrae affected can be cervical, thoracic, or lumbar vertebrae. It is caused by mycobacterium tuberculosis which travels to the spinal cord via the bloodstream or lymphatic system. This greatly influenced precautions of the sessions such as ensuring PPE is donned for the session and ensuring clean hygiene principles for tasks objects as they carry infection too. Due to a compromised immune system, the client is also at a higher risk of catching infections so ensuring that all task objects are clean in vital.

Clinical expertise – as a student, I do not know everything, and I have not experienced everything in the field either. However, I have attended most lectures that covered tuberculosis and spinal cord injuries. These lectures and the additional readings have greatly aided in how to mobilize the patient, what to assess, what activities to do and what treatment should entail. As I do more with the client, I gain more expertise that adds to my clinical experience, which I am very grateful for. Treatment with this client has also aided with clinical reasoning, with how to plan sessions on the spot and coming up with treatment activities in just seconds.

Patient values and preferences – the language barriers and confusion add to the difficulty of treating the client. However, it is good experience to practice my Zulu and to pick up some Xhosa phases. Also focusing the session on what the client wants to achieve before he is transferred. This is especially important for the client who wants to achieve independence in ADLs.

The area where I have received the most practice in has been clinical expertise and patient values. This is because as I practice with the client and do the treatment sessions, I pick up on what is beneficial and what is not for clients with SCI. I have also learnt to listen to the client and his needs and wants and have to learn to center therapy around that.

A particular experience that comes to mind is the session that occurred this morning [18/04]. A precaution that is also included in my write up is to check the client’s blood pressure prior to the session. I had done that and noted it was low but was given the go ahead to do the session. I also picked up on my experience and reasoning, thinking that if the client was well enough to sit up with the low blood pressure in previous sessions, then he was surely fine to do so in today’s session. However this was not the case. The client was dizzy after two minutes of moving from supine to supported long sitting. He became unresponsive and could not comprehend what I was saying. At this point I was panicking and tried to think what I could do to support him and make it better. But in my panicked state I could not think clearly and had to find my supervisor to help me. Thankfully, she stepped in and knew what to do with the patient. We moved the patient from supported long sitting to supine. After a few minutes he seemed to be better as he was verbally responsive. I made sure to check on him twice after that to ensure that he was okay.

This experience made me realize the importance of clinical expertise. As I am not fully trained nor have I fully experienced everything in occupational therapy, I do not know what to do in emergency situations in treatment. This also makes me anxious which adds to the stress in the situation. I think that today was a good albeit scary experience that added to the clinical expertise that guides evidence based practice. I also think that listening to the patient’s preferences is necessary for the treatment session to be successful.

Although I have researched it, evidence based practice comes in many forms during fieldwork. I think that many sessions add to evidence based practice that influence how future treatment sessions will run.

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Reflections Week 2: Cultural Humility

Culture is an important aspect of the lives of many South Africans. Our cultures are what makes us unique from each other as the practices, traditions, and mannerisms of each culture is so different. Similarly, in therapy, culture is what makes us different from each other. How I might do something in therapy would be because of my culture and it might differ from the next therapist or even the patient.

During fieldwork, the patients that I have seen have had a very different culture than me. It is always interesting and somewhat shocking to discover these differences while assessing and treating patients. My patient is a black South African woman in her 60s. I am a Muslim South African Indian. The differences in culture are vast.

I have been raised to respect others and their cultures, but I think that this takes on a whole new meaning when you work in the healthcare field. I think that there is so much more consideration to be made about simple things like how I talk to the patient or how I make eye-contact with a patient. If it were a normal situation, I would speak gently. However, since this is therapy, it is important that I be firm with the client. In both our cultures, this is not the norm. In my culture when speaking to the elderly, we have to be respectful to them. We are younger so we are inexperienced in this world compared to the elderly. They have a right to our respect. Even in my patient’s culture, young adults are to respect their elderly. These are the people who have raised them so to say, so the respect for them should great. At first, I think my client felt I was disrespectful to her. She did not say anything but when I looked directly at her and explained things, she was almost shocked at my behavior. I was curious about this and asked my black classmates about this. They confirmed my suspicions about how I may have approached the situation that may have not been culturally sensitive to the patient. Researching this was necessary. When I asked around, people from the same culture as her told me to approach her kindly and explain that I am the therapist and that I would be making her do things that would make her better. They explained that maybe she would understand better why I was firm with her and spoke directly to her.

I think this has been a huge learning curve for me, especially as a person from a different culture. While most of my counterparts are black that know how to approach and deal with the majority of black patients we get, I struggle with this. they have a similar culture and i always think that it easier for them to relate to the patients. I have learned a few things after researching.

The one thing I noted was to be aware of the cultural differences and to not make assumptions. This can avoid any offensive mishaps that can affect therapy sessions. I have also noted that it is vital to learn about the patient’s culture even if she cannot explain it or is particularly cultural. How I have rectified this is by talking to other people of the same culture and asking them to describe their experiences in healthcare and if they could change how they were treated in terms of their culture then what would they change. Another thing that I could do is to use the language of the culture. In this patient’s case it is Zulu. While she speaks Zulu, she speaks and understands English well. My Zulu is subpar at best, so I worry that I will not explain correctly and the patient will get confused.

I think that cultural humility and sensitivity is very important in healthcare. It guides treatment and helps the therapist to know how the patient will like to be treated. It also encourages the therapist to step out of their comfort zone and to learn the different cultures and their practices and traditions.

Cultural humility also helps the therapist to relate to the patient and understand the patient better. This makes the treatment session more holistic as you have included aspects of the patient's life that influences their daily choices.

American Occupational Therapy Association. (2020). Educator’s guide for addressing cultural awareness, humility, and dexterity in occupational therapy curricula. The American Journal of Occupational Therapy, 74(Supplement_3), 7413420003p1-7413420003p19.

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WEEK 1

Reflection: What have I learnt about providing intervention.

Going into week 1 of fieldwork was daunting. As a student, I have this worry that I do not know enough and that was especially true for day 1 of fieldwork. The hospital itself is wonderful with such a well-equipped Occupational Therapy department. This daunting experience was made easier by the educational demonstrations by the supervisor. During both demonstrations, the knowledge and skill illustrated by the supervisor was wonderful to observe. In those short demonstrations, the flow between theory and practice of occupational therapy treatment was shown in a unique way.

During the first week of intervention, my main focus with the client was bed mobility and transferring in and out of her wheelchair. The client identified toileting and being independently mobile as two of her main goals so I tried to collaborate that with the therapy sessions.

In the first session, the client was interviewed. At first the client appeared as well and cognitively functional, however as the session went on, it was clear that there was a cognitive impairment. From this the supervisor suggested to read the files and ask the nurses about the client. There was a lack of information in both and nothing was achieved of this. Here I realized a day later that I should contact the client's contact person and this was my plan for Wednesday. However, on Wednesday I did not get a chance to contact the person and planned to do so for Monday when I had more time at the hospital and had done more research on the condition. This made me realize that I need to prioritize my time better whilst treating patients because contacting the family and communicating with them falls as part of treatment as well. In the future, should I want to get more information or do family education, there should be a set time to do this during treatment.

In the second session, the client practiced transferring out of the wheelchair to the plinth. This went better than planned as the client was able to stand by herself and transfer through pivoting to the plinth. Whilst on the bed, the client did some rolling, supine to sitting and weight bearing. This was facilitated by myself with some help from the supervisor. With the rolling, the client realized quicky what to do and managed to roll by herself to her affected side. I struggled with weight-bearing and the techniques. Whilst my first modality was to weight-bear with her left upper limb extended and the shoulder externally rotated, this was incorrect. When treating for weight-bearing, the treatment should always be proximal to distal. This means that weight-bearing should have been with her left elbow flexed and lying on the elbow to stop herself from falling flat onto her side. This was pointed out to me by the supervisor. This is a technique that I should read up more on. After researching, I realized that I could have positioned the client in supine and then got her to lift while leaning on the affected elbow. Whilst doing this, the client could not understand and follow through with the instruction. Demonstration and facilitation did not work either. For this reason, cognitive assessments are the focus of future sessions.

A weakness of mine that I identified during the second session, is that I am overly gentle with the client. I also tend to give instructions in long sentences. Feedback shows that I should be firm with short instruction to elicit a reaction from the client. Short instructions work better as they are simple to understand for cognitively impaired patients. I fear that if I am not gentle with them, they may think I am rude or not want to partake. However, I have realized that firmness is necessary, as the patients realize the importance of therapy.

Something that I realized in treatment session, is that research has to be done constantly. There is so much that I can learn if I research or read up about the client's conditions. This shows that therapy is not only in the wards or the OT department, it is external as well, with research on the conditions being a vital piece of facilitating treatment sessions. This also leads back to collecting collateral from the family which is also external of the ward or department.

Overall, week 1 of fieldwork in treatment and intervention was a great learning experience. In this short time, I have picked up a lot on how to run treatment sessions and how to adapt in sessions, to accommodate the client. It has also helped me to see the gaps in my understanding of theory that affects my treatment and intervention with patients. Practice demands research as this improves treatment. Going into next week of fieldwork is not daunting any longer.