Shea Aldana

9/4/19

Half-way through fieldwork I started to feel comfortable handling and working

with most clients. My clinical instructor was stepping in less often and she tried to make

herself scarce, charting on her computer while I interacted with clients and their parents.

During one treatment session, the mother of a 9-month old I was working with sat on the

floor with me, arms crossed, leaning against the couch, watching me evaluate her son’s

movements with skeptical eyes. We had been visiting her son every other week to make

sure there was no relapse in his progress. He was doing well, progressing towards his

goals despite being premature and developmentally delayed. As I presented different toys

to him while he was on his back, I started to explain to her what I was looking at. I told

her I was looking to see if he is extending his thumb, if he is reaching for toys, evaluating

how he is reaching for the toys, what kind of grasp is he using, if he is reaching across his

body, etc. The mom’s demeanor changed as she began to understand the clinical skills

required to evaluate her son, she started to become more engaged in the session and

started to feel comfortable asking questions. It was right then and there that I realized I

was actually starting to know what I was doing! Explaining what I was evaluating came

out of my mouth without me even thinking about it!

Up to this incident, anytime I felt uncomfortable, I would just look to my clinical

instructor with wide deer-in-the-headlight eyes and she would step in and rescue me.

Working with newborns and medically fragile kids can be intimidating, especially when

you have a clinical instructor and the parent of the child watching you the entire time.

This automatic response helped me realize, I do know what I am doing, even if I don’t

feel like it alot of the time. My clinical instructor did not need to step in and save me. I
didn’t hesitate or stumble over my answer. I provided a clear, understandable answer that

satisfied the mother and provided her with confidence in the student therapist working

with her child.

Observing and being apart of many sessions leading up to this particular session

helped me be able to respond automatically. I had listened to my clinical instructor say

similar things to many other parents. I had also been studying things pertaining to

evaluations and how to target certain skills in infants. Between the experience of having

heard it so many times as well as researching and studying on my own, it became an

automatic response.

After the session, while reviewing what went well and what could be improved,

my instructor complimented me on explaining to the mother what I was doing and

encouraged me to do it in future sessions. Her recognition of my actions helped solidify

that I did the right thing and that I had done it well.

Another experience that I will always remember happened during the first week

of fieldwork. We were working with an 11 year old girl who had recently been

discharged from the hospital following bilateral hip surgery. Physical therapy asked us to

come in and address how she is using her upper extremities during transfers and to make

sure her mother was comfortable with how her daughter was participating in her activities

of daily living. Upon evaluation she was able to transfer using a slide board with

supervision and her mom would carry her up the stairs for the occasional bath or shower.

The main difficulty that needed to be addressed was transfers from her wheelchair to the

toilet. Her mother could carry her over to the toilet, but was worried it would start to hurt

her back over time. When assessing the bathroom scenario, it was not possible to back
her wheelchair up enough to smoothly transfer from the wheelchair to the toilet. As the

therapist and the mom were talking about other alternatives, I asked the young girl to try

wheeling her wheelchair into the bathroom forward instead of being wheeled in

backwards. When she was wheeled in forward it allowed for her to lift the armrest of the

wheelchair up and use her arms to safely transition from the chair to the toilet without

putting weight through her legs. When I saw that it seemed to be a safe and functional

transfer strategy, I asked the therapist to come in and take a look. She was skeptical at

first, but as the young girl performed the transfer, she deemed it a great idea! My clinical

instructor and the mother just hadn’t thought the wheelchair would fit in the bathroom

when wheeled in facing forward.

As the mom and my clinical instructor were originally problem solving the

transfer, I wondered about turning the wheelchair around forward, but did not feel it

appropriate to suggest the idea. It was the first week with my clinical instructor and I

didn’t want to step her toes or think that I was seconding guessing her clinical decision

making during the first week. So while the mom and my clinical instructor were chatting,

instead of just standing there, I took some initiative to explore my idea. I have had a lot of

experience maneuvering wheelchairs and equipment for transfers during my time as an

acute care aide, and was pretty confident it would work. As my idea worked, my clinical

instructor took everything in stride, complimenting me for my problem-solving skills. I

hadn’t realized that I had these skills until this moment when the answer was so obvious

to me, but no one else had seen the answer.

Both of these instances taught me valuable lessons that will impact my future

practice. I took away confidence in my problem solving skills, figuring out how to help
the little girl with bilateral hip surgery safely transfer from her wheelchair to the toilet as

well as courage to be assertive and put forth my ideas, even if I may be a new therapist. I

took away confidence in the things I do know from my explanation of what to evaluate

with infants as well as a sense that studying and researching pays off. I hope to continue

to gain confidence through future practice, but to remain humble enough to constantly be

learning from those around me. I want to continue to study things pertaining to where I

will be practicing in order to continue to develop and solidify that confidence. I am

grateful for the opportunity I had to spend 12 weeks with my clinical instructor and learn

so many valuable skills.