For the majority of the spring of 2014, I worked as a Physical Therapist Assistant in skilled nursing and long term care facility located outside of Philadelphia. The majority of patients in the facility were a part of the long term care wing, and had been present at the facility for many years, during which time it was not uncommon for them to be screened for some reason and then if appropriate, admitted back into the onsite physical therapy care.

Patients living in the long term care wings were, for the most part, in a stable condition, so their referral back to physical therapy were generally for decreased gross strength. This was the case for the particular patient that I am going to discuss in this paper. She was over 90 years old, had severe dementia, and was generally deconditioned due to the length of her stay and her minimal enjoyment of physical activity. I had been treating her to increase her gross lower extremity strength to facilitate increased participation in transfers and ambulation for several weeks with some success, though her progress was slowed by her advanced age and poor carry over of proper transfer techniques.

One morning I went to her room to bring her down to the therapy gym and found her sitting in her wheel chair next to her bed. She agreed to participate in treatment and I did not notice anything odd about her behavior initially. However, after several minutes working in the therapy gym, the patient became listless and stopped participating. I asked if she could tell me where she was and she answered that she was not sure. After this, she stopped verbally communicating with me and would not meet my gaze, even when I lowered myself to her level.

At this point, I asked the Occupational Therapist who was in the same room as I to stay nearby the patient and make sure that she was safe while I found our supervisor to inform her of the situation. After communicating my concerns to her, she initially stated that this may just be an issue of fatigue relating to the patients advanced age. I encouraged her to come over to the patient and speak with her directly, which she did. She eventually acknowledged that there was a serious problem and we both went to speak with the nursing staff members to try to ascertain when these symptoms began as well as try to identify a possible cause. We did discover that the strength of one of her medications had been increased significantly the night before. Her doctor was consulted, the prescription was reduced to the previous amount, and the patient was carefully monitored by nursing staff throughout the following 48 hours, after which point she did return to her normal mental status.

I believe that it is because of my communication with my supervisor, and our combined communication with various members of the nursing staff that we were able to identify and correct the issue of over medication of this particular patient quickly, and potentially prevented any further injury or issue that could have occurred such as potentially a fall. In terms of the APTA core values, I believe that in this incident I demonstrated integrity. I was able to acknowledge that there was an issue with the patient which was beyond my ability to correct, so I alerted my supervisor to the problem and together we were able to find resolution and help the patient to return to her normal mental status.

In trying to think of an incident in which I was not able to effectively communicate, the best example that I have was not one incident but a two month period of time during which I was working as a Physical Therapist Intern in Buenos Aires, Argentina. I worked in two locations, one a public hospital and the other with La AFA, the Asociacion de Futbol Argentino, with the rehabilitation team for the domestic soccer teams in Argentina. One obvious barrier for effective communication in both settings was that while I speak Spanish, I do not speak it fluently. Additionally, Argentina has a very specific and very different accent from other Spanish speakers, as well as their own extensive set of slang words and euphemisms which I was not familiar with.

But the biggest barrier, for me as a student, came through in the nonverbal communication coming from my supervisor at La AFA. From the first day that I arrived in the clinic, she made it clear that she had expected a student who was a native Spanish speaker. She made minimal if any attempts to include me in the treatments of the soccer players under her care and when she did, she often had a very bored look on her face throughout the process. She regularly would talk about me and how poor my Spanish skills were to her coworkers as well as with the players, in front of me.

For my part, I was already uncomfortable with the situation because I was struggling to communicate as much as possible in Spanish even before it was made clear that my presence in the facility was not appreciated. I felt very unwelcome but this internship had been set up for me through a third party, and I was obligated to attend it five days a week for the full eight weeks. The effect was that I did not learn much of anything at that particular clinical site over two months, was embarrassed on a daily basis, and after the second week had stopped asking to be included in the treatments of our patients.

In hindsight, this whole experience with La AFA is disappointing to me and I feel that it was an amazing opportunity for learning, wasted. My anxiety and lack of confidence combined with my limitations with the language made it easier to just pass my time at the site working on homework than to keep pushing my supervisor to actually teach me and explain what she was doing and why. I have since realized that I could have resolved this issue by contacting the third party who had established the internship and explained the situation to her, and asked for a different internship opportunity. I had paid for education and my supervisor did not hold up her end of that agreement, perhaps due to some bias against Americans, or because I was young.

Had she been compassionate to the difficulty I was having with the dialect, and tried to see the internship from my perspective, perhaps we both would have gotten more out of it. While I cannot speak to her rationale for her behavior, I am confident in saying that I now have a good understanding for the qualities of an ineffective clinical instructor, should I ever have a chance to become one in the future. It is your responsibility to provide your student with the opportunity to learn as much as possible in the time that they are with you, and you must find a way to facilitate that learning. The other benefit to this experience is that I am now acutely aware of how difficult and exhausting it is to have try to communicate when you do not speak the local language. This has strengthened my resolve to find some way to facilitate better communication across language barriers to decrease mental strain on the patient and increase effectiveness of treatments, most notably the education, provided by therapists, as they will have a better understanding of their patient’s complaints.