My First Level I Fieldwork: Sub-Acute Inpatient Hospital

Hey readers! Last semester I completed my first Level I fieldwork placement at a sub-acute hospital. It was a little daunting at first, but I soon felt comfortable with my supervisors and really enjoyed my time in the inpatient setting! That being said, while I learned a lot and appreciated my time there, I do not think that the inpatient setting is for me. Let me tell you why…

Patient Demographics – Before I tell you why I’m not sure that I can see myself working in an inpatient setting, let me tell you a little more about this placement. The patients that I observed were primarily above the age of 50 who had conditions such as amputations, total hip replacements, diabetes, cognitive impairments, psychological conditions, infections, and many more. The setting was not an acute setting and it was not a long-term care setting – my supervisor called it a “sub-acute” setting because it does not really fit into either of the previous categories. Typically, patients would be sent there from an acute setting but would not stay too long.

My Experience – While patients typically did not stay too long, there were a handful of patients who were experiencing homelessness and would stay longer than necessary at the hospital because they did not have anywhere else to go. This was something that really bothered me and opened my eyes to some of the issues in society that individuals face.

On another note, one thing about this setting that I thought was really cool was that my supervisor was able to continue care for patients longer than an OT would typically be able to in an average hospital. At this particular setting, insurance works a little bit differently, so the OT is able to continue trying to work on skills if she thinks improvement is possible. For example, we had one patient who would have been cut off from OT services a long time ago due to insurance, but she was still working with him to try to see some improvement in function. I thought this was really cool and allows the therapists to treat as many patients as they see fit for as long as they need. It didn’t mean that every single patient received OT, but that those who needed it could receive it longer than they probably would in another hospital.

Another thing that bothered me in this setting was the carry-over between healthcare professions – or lack thereof. This by no means happens at every hospital or every inpatient setting, but at this setting there was a common occurrence of nursing staff completing ADLs for patients rather than allowing patients to complete ADLs on their own. (ADLs = Activities of Daily Living – example: dressing, bathing, brushing teeth, etc.) My mom is a nurse and I have heard so many times about how hard her job is and how many patients she has to take care of at once, so I completely understand that nurses often need to save time by completing an ADL for a patient rather than taking the time to let them do it themselves. However, I see this as a real problem from an OT perspective. Patients can only improve in their ADLs by practicing them, and ADLs are often goals for patients in an inpatient setting. If a patient is capable of completing an ADL on their own, I really think that they should be allowed the extra time it takes to complete it. Otherwise, it slows their progress on their OT goals and independence.

One way that the OTs in this setting were planning on fixing this problem was by putting signs up in every patient room that lets the nurses know what they are working on. For example, it may say that a patient needs help donning shoes but they are fully capable of and should complete upper/lower body dressing independently or with adaptive equipment. I thought that this was a great step in the right direction in allowing patients to be as independent as possible!

Question of the week: Have you ever encountered this in your practice or fieldwork? How were the OTs there working to solve this problem? This can often be solved with communication between health professions, which should be happening anyway!

Interventions – Most of the interventions that I observed in this inpatient setting were ADLs. This included upper and lower body dressing, donning and doffing socks and shoes, brushing hair, brushing teeth, bathing, toileting, toilet hygiene, shaving, and donning splints/braces. I also learned a lot from the OT about various adaptive equipment and helped her decide what equipment would be appropriate for patients once they returned home. We considered their environment, condition, abilities, and goals in order to decide what was best for each individual patient. Other than ADLs, I also observed some cognitive screening.

One thing that I loved about working with patients on ADLs is how freeing it can be for a person. For example, there were multiple patients who were so thankful to us for finally allowing them to shower after however long it had been. I realized in this setting that we take so many simple things for granted. Enabling a person to perform their own hygiene provides them with a huge sense of independence. It was not glamorous, but it was so important.

Why Inpatient Probably Isn’t For Me – While I saw so much value in OT in this setting and I learned a lot, I don’t think I can see myself working there. I appreciate the importance of ADLs in a patient’s care and road to independence, however working on ADLs everyday during my fieldwork in a way made me lose the sense of why I want to be an OT. I am so inspired when I work with people with intellectual and developmental disabilities and I absolutely loved observing pediatric OT, and I think that this fieldwork solidified my hunch about what population I want to work with. I did not have a bad experience in inpatient. In fact, I had a wonderful experience. My supervisor was incredible. I asked lots of questions and learned a lot. But, I know why I want to be an OT and this wasn’t quite it.

For a while, I felt really guilty for not loving the inpatient setting. I felt like I was a bad OT student. I questioned whether I had made the right choice investing in this education. But my fieldwork advisor made a really great point when I told her how I was feeling: you are not supposed to love all of your fieldwork placements. They place OT students in multiple settings to give you a taste of all the places an OT can work. Fieldwork is meant to help you learn and to help you narrow down what kind of OT you want to be. Don’t feel bad if you don’t love all of your fieldwork placements. You will find your niche!

What were your feelings after finishing your first fieldwork rotation? Leave a comment below! Thanks for reading!