Learning Experience at NTU Hospital Occupational therapy practise in Taiwan

Jaana Haapala, H8481

Professional Practice III, SOTSW300 Spring 2016 Social Services and Health Care, Occupational Therapy

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Contents

1 Introduction ................................................................................................... 2

2 Personal learning goals ................................................................................... 2

2.1 I am able to work professionally within agreed situations in a

hospital environment .............................................................................................. 2

2.2 I am able to communicate therapeutically with a patient in a new

culture getting assistance from a mentor when needed .................................... 3

2.3 I am familiar with a concept of wellbeing (or Life Balance) according

to the Taiwanese way of thinking ......................................................................... 4

2.4 I am familiar with the kind of R&D work that has been done or is

going on in Taiwan or Asia at the field of OT ..................................................... 6

2.5 I familiarise myself with the local way of documenting the OT work

by reading hospital charts and OT notes ............................................................. 6

2.6 I understand and follow local laws in the field of OT in a hospital

environment in Taiwan .......................................................................................... 7

3 Interests for future studies ............................................................................. 8

4 Feedback from the mentors ............................................................................ 9

5 Conclusions .................................................................................................. 11

References ........................................................................................................... 12

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1 Introduction

The purpose of this report is to summarise personal learning at the

occupational therapy (OT) practise at National Taiwan University (NTU)

hospital, Taipei, Taiwan from March to May 2016. The report first presents

how the self-established learning goals were met, shows areas of interest for

future OT studies and summarizes the feedback received from the mentors at

NTU hospital (NTUH).

2 Personal learning goals

The following six learning goals were set prior coming to NTUH during

spring 2016.

2.1 I am able to work professionally within agreed situations in

a hospital environment

During my practise, I had many opportunities to observe OT given by the OT

students and staff at the NTUH, plan and deliver a few activities for

individual and group patients, read plenty of OT books and assessment

methods, take part in journal meetings, listen to visiting lecturers, and

familiarise myself with the different tool in use. Based on these experiences I

feel I fulfilled the first goal.

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2.2 I am able to communicate therapeutically with a patient in a

new culture getting assistance from a mentor when needed

Even though I hadn´t studied Chinese, I had good experiences using simple

words like “Hello” and “Thank you” in the local language, topped up with

clear body language like waving hands and showing both thumbs up together

with facial expressions like smiling for a demonstration of the mood and

outcome of the OT activity. I also used pictures and written English

instructions in my activity presentations, asking help to translate the texts into

Chinese from those patients who could understand English. Involving the

English speaking patients into the instruction part of the activity gave a sense

of power to them and thus worked as empowerment. Besides the patients, I

also got help translating the instructions from the mentors whenever needed.

One of the mentors came to comment after my group activity, that she felt she

did not need to stay around all the time while I was involved in the activity

because it seemed to her that I could always find my way to reach my goal. I

totally agree and trust there is always a common language for those who

really want to understand each other. The language barrier also worked as a

motivator to some of the patients and they did not just practise some greetings

in English but even came up with an idea of communicating with me with the

help of their personal tablets and translation programs they had found online

by themselves. Therefore it was not only the staff that made me feel so

welcome at the OT departments but also the patients!

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2.3 I am familiar with a concept of wellbeing (or Life Balance)

according to the Taiwanese way of thinking

This goal was especially interesting and as I interviewed the staff and the

students about the topic, they could tell me almost horror like stories about

their daily life. Most of the students slept 3, 4 or maximum 5 hours only, with

the exception of one girl, who said she takes up to 8 hours rest. Regardless of

the limited sleep the students always seemed in good spirits, with most of

them taking a little nap during the lunchtime. However, for the staff, strict

NTUH rules for showing up on the mornings, long days with meetings

starting even before the official working hours and continuing well after

without any extra pay, and limited holiday were affecting their personal

wellbeing. Yet, one person commented OT is not just her work but also her

hobby. She can reach flow like moments during the working hours, and is

able to relax whilst doing something purposeful and meaningful both to

herself and the NTUH. It seems it´s a matter of truly living to fill one´s life´s

purpose to be able to enjoy a lifestyle that may seem hectic to outsiders.

To go deeper into the topic, I studied the article Quality of Life Enhancement

Programme for Individuals with Mood Disorder: A Randomized Controlled Pilot

Study from Yun-Ling Chena, Ay-Woan Pana, Ping-Chuan Hsiungc and Lyinn

Chung which I received with gratitude from the professor Pan at NTU. The

study revealed that the indicators for quality of life in Taiwan included

matters like existing stigma (for example regarding the disease or disability),

personal resilience, cognition, sleep, social support, environmental resources,

sense of competence, sense of mastery, and medication in use. Even though I

was familiar with many of these due to my previous readings of life balance,

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quality of life and experienced wellbeing, stigma was something new and

captivating for me. As I talked about cognition with one of my mentors, it also

became a new way of looking at things whereby one patient with a psychiatric

diagnosis experienced better life quality if his cognition was not that clear. He

had even requested less medication in means of reaching this state. The reason

behind the behaviour was that the person felt he didn´t need to care about

people’s opinions or his surroundings as much when he had just the right

amount of brain fog in comparison to being in a clear state.

Even if many of the predictors for good life quality and wellbeing are similar

with East and West side of the word, there are things we can learn from each

other. One important lesson for the students here would be being brave

enough to ask questions, including why not, and reduce the feeling of shame

they often seem to relate to asking questions from their teachers and

professors. Sometimes the huge amount of theory studied here limits the

students’ creative thinking and some won´t be able to think outside the box,

but try to find the reasoning from the books instead, thinking they would

seem uneducated if they ask questions. Having an open communication

between the mentors and the students releases the stress they experience and

it helps the students to concentrate on more important things like finding

answers to the questions they could just get answered straight away if willing

to ask.

At the same time, whilst hoping we can increase the amount of occupational

science studies at Jyväskylä University of Applied Sciences (JAMK), I would

like to increase the knowledge about personal resilience among the students

in the West. Understanding oneself, including deep self-awareness, and

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knowing how to act in unexpected or challenging situations would reduce

stress in those circumstances.

2.4 I am familiar with the kind of R&D work that has been done

or is going on in Taiwan or Asia at the field of OT

The internet page of MOHO Center in Taiwan lists the ongoing and

completed MOHO related research in Taiwan. Studies include translation

work of assessment methods like Volitional Questionnaire from English to

Chinese and reliability studies of the translated work. Related to my personal

interest of life balance and motivation, the page introduces the efficacy study of

an OT program (partly based on MOHO model) aiming to enhance the quality of life

for persons with depression, as well as a thesis about the Effectiveness of

Remotivation Protocol for Persons with Schizophrenia.

2.5 I familiarise myself with the local way of documenting the

OT work by reading hospital charts and OT notes

Even though the hospital charts written by doctors were always in English at

NTUH, many departments produced their OT charts in Chinese.

Nevertheless, I was able to see the charts whenever I needed and discuss them

with the mentors. I also got plenty of help from the students which I found

very supportive and caring when considering the load they were already

having caused by their personal assignments. To practise documenting, I

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wrote a case report, Case Sue Current occupational therapy of Sue, a Taiwanese

girl who has autism, for JAMK.

2.6 I understand and follow local laws in the field of OT in a

hospital environment in Taiwan

From the local rules, for example: Arriving late to work (even by one minute

which would result in that the person missing that day´s salary), was easy to

meet but resulted in the fact that I was often far too early at NTUH. Yet, I

wanted to experience the environment as the locals would and wanted to see

what it would be like to arrive at an optimal time to work in a city like Taipei,

where traffic jams are common and many people have to commute long

distances to reach work. My daily transfer included taking a bus and a metro,

and practising skills like pushing myself in a full metro car. I have to admit we

haven´t even seen “full” in Finland.

Another important rule was to make sure patients were not recognisable in

the photos taken in the hospital environment, in case they or their body parts

were visible in photos. I respected the rule by taking photos without patients

only. Similarly, no hospital papers with patient information were taken out of

the NTUH.

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3 Interests for future studies

Being a person who loves theories even when understanding that OT is much

more than the theories can ever combine, I was really pleased to have time for

self-studies and familiarised myself with several topics. I learned English

names for common diagnoses and studied many of them like Autism

Spectrum Syndrome deeper. I was also able to experience that each and every

person with the same diagnosis is most likely still extremely different from

each other. I was offered an easy access to assessment methods, and will study

for example Occupational Self-Assessment (OSA) and the Functional

Assessment Scale (FEAS) further. I will try to get back to the Developmental

Individual-difference Relationship-based model (DIR) and Elizabeth Crary´s

books during my next training in Singapore, and have already written to the

(only right) Santa Claus (back home) about the Doris E. Pierce´s book of

Occupation by Design: Building Therapeutic Power.

Regardless of all the great experiences, I also met patients I was not able to

meet professionally no matter how well I had prepared myself by reading

chapters and hospital charts with photos. Namely, burn patients. I found them

far too emotional to encounter and will thus leave the area for other OTs to

discover deeper. Nevertheless, being in those situations was a good learning

experience for the future and will help me to choose my future area of work

wisely.

Even if quality of life and life balance are still some of my favourite topics for

future studies, I found topics like Psychodrama and Cognitive Beliefs especially

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intriguing. I would also like to do further studies on an area of emotions and

their effect on occupational performance. In particular I would like to find out

how the cognitive beliefs, emotions and motivations are linked. This could be

reached for example via voluntary work with the associations of Highly

Sensitive Persons. Furthermore, it would be interesting to see how

empowerment, power sharing and other acts increasing mental wellbeing

influence those people who have no disability or physical deficits. For

example, it would be motivating to see these in use among the students and

labour at different working places in a means of decreasing unnecessary stress

and to avoid burnouts. OTs have plenty to do wherever they go, and helping

people to find their personal strengths is the superpower they should make

more well-known!

4 Feedback from the mentors

Following lines are referred from the feedback received from mentors at

different departments:

“I think you have done a very good job to be a professional and well communicated

OT under our supervision. And thanks for the great presentation of sharing about

your thoughts and opinions of our clinical practice department. The recommendation

and tips for our students are very nice, too!

Otherwise, after our discussion, we found that sometimes the students usually have

no ideas about the real hospital environment when they’re sophomores or juniors. So,

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the only one feedback about the practice learning will be “Encouraging to go out of

school and try to be the volunteer of OT department in the hospital or community

before clinical practice.” We hope that it should be useful for the students in the

future.”

“I am impressed by your active learning. Though you only visited here for 2 weeks,

you learn much detail about pediatric occupational therapy practice. You saw one

evaluation case and several treatment sessions and kept notes for therapeutic

activities. You also read lot books and find out what you like to learn more in detail,

such as floor time, sensory integration….etc.”

“Feedback about Jaana. H.'s performance in psychiatric occupational therapy

department from 4/18-4/29:

Jaana doing excellent in our department! She shows enthusiasm in learning,for

example, she asked initiatively a lot of material to read about psychiatry. When she

observed activities, she not only active to discussed but also try to experience in

person. That's good way to learn. She always try to empower our patients, this

impressed me most! We asked her to design and lead two programs and she doing

great! When she sharing her ideas about her program design, I'm surprised that she

can really practice OT's main idea well! And she has a lot of interesting to alone with

others, I think that's a good personality trait for being an OT.”

Limited constructive feedback may be due to the fact that since the students at

NTU spend 12-13 weeks practising at each three departments separately,

summing up a total of 39 weeks of practise before graduating, the mentors

may have expected me to have much more practise after I return home and

thus were very gentle with the feedback they gave. Suggestion of learning

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Chinese was mentioned in one personal conversation, and even if the mentor

said it was a joke, I still truly agree that speaking the patient´s first language

would help to build a better setting for a client-centred therapy and support

the formation of therapeutic rapport.

5 Conclusions

Having an opportunity to familiarise myself with OT work at three different

OT departments in a foreign environment under supervision of experienced

and respected OTs coming from one of the top universities in the field of OT

world-wide, was a greater gift anyone can ever hope of during my studies. I

am truly grateful for all the help, support and learning experiences I have

received whilst performing a practical training at NTUH and will carry these

experiences with me in to the future. 非常感謝!

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References

Hsiah, S.-J. 2016. Feedback from the NTU mentors. E-mail message of 28 April

2016. Recipient J. Haapala. Communication of performance at Pediatric

Occupational Therapy department at National Taiwan University Hospital.

I-Shuan, W. 2016. Feedback from the NTU mentors. E-mail message of 4 May

2016. Recipient J. Haapala. Communication of performance at Physical

Occupational Therapy department at National Taiwan University Hospital.

Model of Human Occupation (MOHO) center in Taiwan. Internet page

introducing the MOHO related research and activities in Taiwan. Retrieved

from Http://mohocentertaiwanen.blogspot.tw/.

Yin-Shan, Y.2016. Feedback from the NTU mentors. E-mail message of 6 May

2016. Recipient J. Haapala. Communication of performance at Psychiatric

Occupational Therapy department at National Taiwan University Hospital.

Yun-Ling, C., Ay-Woan, P., Ping-Chuan, H. & Lyinn, C. 2015. Quality of Life

Enhancement Programme for Individuals with Mood Disorder: A

Randomized Controlled Pilot Study. Hong Kong Journal of Occupational

Therapy 25, 23-31. Retrieved from

Http://www.sciencedirect.com/science/article/pii/S1569186115000200.