reflections-on-prac-placement

Placement Overview

Thu, 31 May 2012 10:19:48 +0100

My 12 week placement at the Royal Brisbane and Women’s Hospital has been a successful and positive experience. At first I was apprehensive about a split placement and spending the first six week in geriatric rehab and the second six weeks on the orthopaedic ward of the hospital and having two separate supervisors. I quickly learned that this situation definitely has its advantages. Firstly because I was able to have two supervisors I was able to watch both social workers in practice and pull from a wider range of skills for my own practice. I used the parts I found that suited me and was able to tailor my practice around what I learned from each of them. Therefore because no two people do things the same I didn’t just have to follow one supervisor’s way.

As both placements were in different parts of the hospital I was able to have a wider range of clients to work with. In the rehabilitation setting there were six clients that I had one-on-one contact with and because of the long term admissions I was able to build a supportive and professional relationship with these clients. In the orthopaedic wards patients come and go very quickly and therefore you may not have a lot of time to get things done. It is crucial in these positions that you are able to build rapport quickly so they feel open and trusting to share with you personal details. I was able to pick up very quickly the importance of reading non-verbal body language.

This placement was very important to me because it helped me see barriers that may have affected my professional life as well. One of my first patients was an older gentleman and from the beginning I did not feel that comfortable with him. At first I thought it might have been because he was my first patient I was seeing alone but even weeks into seeing this client I was still uncomfortable. I decided that I would sit and reflect on the situation and try to work out what was making me uncomfortable. I had a ‘light bulb’ moment while reflecting that this man actually reminded me of someone from my past and my teenage years that was a very negative experience. Once I was able to determine that it wasn’t think client but my own feelings that made me uncomfortable I was able to return to supporting this client without negative feelings. Not only did this reflection help me to understand these feelings but it also brought to light the very importance of reflection and the use of self.

Used placement to visit, ask questions and understand other areas of social work within Queensland Health. Some of the areas I visited were:

Burns
ACAT (Aged Care Assessment Team) – attended 3 in home assessment with SW’er
Cardiology
Neurology
DEM (Department of Emergency medicine)
Dialysis and Renal
ICU (Intensive Care Unit)
ECU (Extended Care Unit)
GEM (Geriatric Evaluation & Management)
Child Safety (within the hospital setting)
Homelessness Liaison

I have also gained a more thorough understanding of Allied Health and the roles within. Occupational Therapy, Physiotherapy, dietician, Speech, Psych are a few of the multi-disciplinary team I worked with on placement. I was even able to attend two OT home visits with the patient and the therapist.

I have developed a better understanding of social work theories in practice: Through observations of supervisor and my own interactions with clients I have gained a better understanding of Crisis Intervention, Systems Theory, Client Self-Determination, and the Strengths Perspective. I have found I am drawn to Systems Theory to understand family dynamics, seek to help individuals understand their situation and work to help those individuals find healthy ways to cope with their environments, and working within a structured, organised system (Payne 2005).

References:

Payne, M 2005, Modern Social Work Theory 3^rd edn, Palgrave Macmillan, Hampshire.

Interviewing Environment

Wed, 30 May 2012 10:06:23 +0100

There are a number of practice and communication skills that impact on effective client engagement during an interview and environment is one of those. Reflecting back over the past month and my interactions has helped me to understand how important environment is. I had a client that came into hospital after a motor vehicle accident. She was in the vehicle as the driver and her pregnant daughter was the passenger. Some of the ward room for patients have 4 beds in them with the beds only being separated by a curtain. There is generally a lot of noise in a room or if you are speaking to a client there would be someone who could and would listen to your conversations.

My client was having an operation on both of her legs and she was unable to weight bare for three months on both legs so getting her to a private area would be very hard. Initially and throughout the interviews she was very emotional and kept saying she couldn’t understand how or why she had survived. The daughter who was involved in the car accident came and sat beside her mom’s bedside everyday. While the client was happy for me to be involved and help her with little things she would tell5 me emotionally she was fine but I could tell by the non-verbals she was giving that there was something more she was not telling me.

I reflected on the situation a lot and decided maybe she did not want to talk about certain things in front of her daughter. I waited until I saw her (the daughter) step out and I approached the client. I was disheartened when I got the same results but after some more reflections I thought that maybe it was the environment she was in and just didn’t want to speak in front of the other patients. After speaking to her physiotherapist, he advised that although she could not put weight on her legs she was able to be transferred to a wheelchair and wheeled to a private area for an interview. The change of environment made a world of difference for this client. She was more open and honest about what was making her emotional and about the issues she was facing. She divulged that she had been uncomfortable divulging stuff about herself and her daughter in a room full of strangers.

It was interesting to see that because I was aware of the client’s non-verbal cues and was using reflection to work out ways to help the client break through the communication barriers. Some people would have just given up the first time when the client said they had not other issues but I was confident that I was able to read her non verbal cues and know there was more the client really wanted to say.

Respecting Your Client's Decisions

Sat, 26 May 2012 12:20:17 +0100

One of the struggles I am finding with doing my placement in a clinical setting is remembering clients have the right to make their own decisions around their healthcare, even when it goes against the advice of their doctors. When elderly patients are socially isolated and have a number of other issues that makes their ability to remain at home, unassisted dangerous. However they may feel that they are still able to live independently and refuse any suggestions or interventions to make their choice to remain at home with help a safer option.

I have a client at the moment that was found in his home by a neighbour, slumped in his hallway on the floor, unconscious. At the age of 67 he weighs 42 kilos and is severely malnourished. He admits that he doesn’t eat very healthy foods and in fact hadn’t eaten in quite some time when he was found. While I felt that my heart was breaking for this elderly, kind and gentle man who could possibly have a healthier life at home with the service of meals on wheels that would provide food delivered to his home. He refused to consider the idea because he says he doesn’t want to burden or depend on anyone else. He has been assessed and found to be competent to make his own decisions.

According to Bowles et al. (2006), client self-determination is an ideology social workers should follow that allows clients a free, independent choice despite pressures from others. The internal struggle I am finding is between duty of care to aid and assist those who are vulnerable while respecting a client’s autonomy and self-determination. It is their choice to accept or decline services. All we as professionals can do is to make sure our clients have all the information available to make an informed decision. This has also something I find I have to reflect on frequently to remind myself that clients can make their own decisions and sometimes I will not think they are the right decisions but I have to keep my personal thoughts and feeling out of my practice.

I had to reflect on this a lot with a different client who was self discharging against medical advice. He had decided to stop medical intervention and return home even though stopping his treatment meant that he would not survive his condition. I took his decision personal for awhile until I had time to reflect on the situation and remind myself that even thought I may not agree with a decision, if the client is competent and understands the risks then I have a professional duty to respect their decisions.

References:
Bowles, W, Collingridge, M, Curry, S & Valentine, B 2006, Ethical Practice in Social Work: An Applied Approach, Allen & Unwin

Non-verbal Communication

Tue, 22 May 2012 04:12:45 +0100

In my placement experience I am working with a client who feels she is in a pretty bleak place at the moment. She and her daughter have both been through a traumatic event and are having problems both physically and emotionally coping therefore there are alot of emotions and tears. When I first met this client and her daughter I was very uncomfortable and unsure of how to help. While there are practical things that this client needed done she also needed emotional support. After that first session I was not confident at all and the atmosphere in the clients hospital room was very tense. Unsure of what to do about it I started analysing my actions and body language and realised I was tense and not putting out a very relaxing or calming vibe.

In my next session with this client I pulled up a chair close to the clients hospital bed and just sat calmly and listened quietly as she talked using silence to relax her. I had always felt that those silences were awkward and was not comfortable in using them. But I had a lightbulb moment as I watched her calm down and become more comfortable with me. Surprisingly using a small gesture such as placing my hand gently on her arm and handing her a tissue went along way in establishing a relationship with her.

After working with this client for a few weeks I asked my supervisor to analyse me with the client and give me some advice and pointers or critiques about my practice. When we approached the client she and her daughter both where very upset and tearful, so I started using the non verbal techniques in practice. My supervisor said it was almost instant that my presence calmed both the client and her daughter and looked more relaxed and by the end of our session she was actually smiling and joking and had less anxiety. Hearing this from my supervisor has made me want to work harder to develop these non verbal skills and not feeling so awkward using them.

Ethical Dilemmas in Practice

Wed, 02 May 2012 11:10:40 +0100

I have encountered two cases on placement that I felt an ethical dilemma present. The first instance was with a 45 patient in rehab who is living with cerebral palsy and tended to act in an aggressive manner when there were any changes in her daily routine. She had previously been cared for by her mother who is now 72 years old and feeling like she was unable to continue being her daughter’s carer. The dilemma was because the mother was afraid of her daughter’s reaction she asked the staff taking care of her daughter in rehab not to tell her she wasn’t coming home and that she would be moving into supported accommodation. So the medical and allied health professionals and her own mother were essentially leaving a competent woman out of her own discharge planning. I was really surprised they would follow the directions of the mother over the patient and this felt like a real ethical dilemma for me.

The second case was a 21 year old woman from South Korea who was visiting and travelling around Australia on a holiday with her boyfriend. They were involved in a case accident and the boyfriend did not survive. The patient had significant injuries and was in a coma for a few weeks but survived the accident. Her mother flew to Australia to help her daughter with her recovery. When she woke from the coma the mother asked the staff not to tell her daughter that her boyfriend had not survived the accident. Her reasoning was that she didn’t think her daughter was strong enough to deal with the truth and even though I am sure she knows her daughter, is it ethical to lie to the patient when they ask specifically about where her boyfriend is.

While as a student I had no control or say in these cases it has made me realise there are ethical dilemmas all the time and there is not always a cut and dry answer. There are also other members of multi-disciplinary teams who are involved in the decision making process for the patients. All I can do is look to supervision and AASW to follow guidelines and be ethical in my own practice.

Theories in Practice

Sat, 21 Apr 2012 04:16:16 +0100

Sometimes social work isn’t just about sitting with a client and talking. There are times when clients need action and have no one close who can help them. One client I have been seeing, for example, is an inpatient for rehabilitation following a stroke. He found himself unable to use the disposable razors offered by the hospital to shave. He wanted an electric shaver but unfortunately he has no family or friends who could pick one up for him. In that moment, in his mind that shaver was the most pressing issue for him and he was stressing about it therefore it was causing a negative effect on his rehabilitation. So I found myself going out and getting the shaver for this older gentleman and that was a relief for him and he could again focus on his rehab.

I have been able to see Crisis Intervention in practice when an elderly lady was admitted to rehab and had gotten an electricity bill in the post. She is a socially isolated client who had only a neighbour that she knew but not well enough to trust with her finances. She was very close to having her electricity turned off due to non payment as she has already been granted extensions previously while in the acute ward of the hospital. After coming to rehab I could see she felt this was a crisis to her and given that she only paid her bills with a bank book and in person at the bank and post office. Paying over the phone or online was not an option. The client certainly was not in any condition to travel to the bank so I used client self-determination and took the client to an interview room and helped her call the bank to find a solution. It is important to not do things for clients who can do it themselves only to help make happen. With the bank/electricity situation sorted this client was able to put her focus back onto rehabilitation.

Another incidence of crisis intervention occurred when an elderly gentleman had his wallet stolen on the hospital ward. His bank card and all his other cards were taken. It was urgent to get his old card cancelled and to get a new one issued. This situation was particularly tough because the client was agitated and angry and certainly didn’t want to be there waiting on hold. I just tried to keep him calm by talking to him and trying to change the subject several times. I started to get a headache and felt ill to my stomach. I didn’t think it was related to the situation but later when reflecting on the day I realised that my body signals where telling me I was not comfortable in that situation.

On reflection these are just a few theories I have seen in practice on my student placement at Geriatric Assessment and Rehabilitation Unit.

Reflection is Critical

Thu, 05 Apr 2012 05:06:23 +0100

Reflection is Critical

My second client on placement, a 71 year old gentleman was a much different experience from my first one who was a younger woman. Upon meeting this client for the first time straight away I did not feel comfortable with him and because of this I rushed to get through the psycho-social assessment and interview. Our second meeting felt exactly the same. I was nervous and anxious about meeting with him and knew coming out of the meeting that something just wasn’t feeling right about spending time with this client. In supervision, my supervisor asked me what about this client made me feel uncomfortable.

At first I had no idea and thought it must be him and his personality but in reflecting I was nervous before even talking to the client so it could not have been his personality. So the more I reflected on it I realised that this client reminded me of someone from my past that had a negative impact on my life for a period of time. The client’s age, physical features and body language were all triggers that were reminding me of this man and a situation from my past that was very negative and abusive.

As Beddoe & Maidement (2009) point out, reflection is a way to “speak back” and to confront accounts that demand self appraisal. Obviously my negative reaction to a client whom I had never met before was something I needed to confront. We have heard about reflection from the beginning of study and how important it was but this was the first time it was highlighted for me and made a difference in working with a client. It was very remarkable to actually see how reflecting on this client and why he was making me feel uncomfortable helped me to realise that this past situation was affecting me in working with this client..

After realising I was unconsciously linking this client with a personal experience I was able to re-visit him with an open mind and a different attitude. I was able to be more relaxed, spend more time with the client and get more information from him. What I have learned from this experience is to think and reflect about a situation if it doesn’t feel comfortable and not be naive that it could very well be something personally affecting your performance.

References:

Beddoe, L & Maidment, J 2009, Mapping Knowledge for Social Work Practice: Critical Intersections, Cengage Learning, South Melbourne.

Reflection from my first two weeks of Placement

Sun, 25 Mar 2012 11:00:35 +0100

Multi-Disciplinary Teams in Healthcare

According to Tanaka (2003), it has become widely recognised that multidisciplinary team care plays a critical role in today’s medical practice. The Geriatric and Rehabilitation Unit (GARU), functioning under the umbrella of Queensland Health, is a medical unit where I am doing my first student placement. This unit is made up of a team of allied health professionals; doctors, nurses, occupational therapists, physiotherapists, social workers, and dietician/nutritionist. The majority of clients coming into the rehabilitation unit are clients who have had strokes, burns, amputations, vehicle accidents, and brain or spinal tumours. Each client is assigned a team of professionals who work with them on a daily basis to assist in their recovery. Every Tuesday the teams come together for case conferences and a social morning tea. Each and every client on the ward is discussed; where they are in their recovery, issues that may be impeding on their recovery or discharge, what services they may need after discharge, current goals each client has, and an estimated date of discharge is discussed. There may also be a need for a family meeting and the professionals assigned to each client come together with the client, when possible, and their families to discuss the urgent issue(s).

Beddoe and Maidment (2009), say these types of collaborative experiences provide rich opportunities for learning from both the other bodies of knowledge and from the experience of teamwork. Another bonus of working in this unit with all the health professions is having contact with students from these professions. Working inside the agency opens up great learning experiences for working with other professions, the social worker also get to work with outside agencies as well.

Part of the role of the social worker at GARU is to make referrals to other agencies when needed. For instance, one agency I have had contact with is the ACAT (Aged Care Assessment Team). This is a service that assesses elderly clients who cannot maintain living at home unassisted. It helps them stay in their own environment while providing any or all of the following services; nursing, showering, cleaning, meal preparation or cooking, shopping, driving to appointments. I had the opportunity to make an agency visit to ACAT and drive with a social worker while she assessed three clients in their homes for these services.

This relationship between the GARU and ACAT social workers benefit the clients enormously. By putting forth the ACAT referrals we get to help clients return home and leave rehab even though they still can’t function completely independent. My experience of both taking part in a multi-disciplinary team and observing one, especially during case conference, has been a very positive one.