My M.Ost Portfolio by 000934523

SWOT + ACTION PLAN of PPDI including Critical Thinking (1st and 2nd submission) and Reflective Write Up

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SWOT

Strengths: Good description of tests for lumbar flexion and summary of the process is well-described. References are appointed suitably on the whole. Also, feedback from the critical thinking reflective write up indicated that reflections had been done well and the action plan was comprehensive.

Weaknesses: Adequate up to date research is needed, and there are incorrect flexion tests sited and contradictory statements. Lack of justification in areas of evaluation and the absence back-up claims and statements. Also, the feedback from the critical thinking write up indicated that reflections on personal challenges were missing even though personal development had been thoroughly discussed. The feedback also noted that referencing and SWOT analysis that would have made the action plan S.M.A.R.T.er were missing.

Opportunities: There is room for improvement, as the use of evidence to back up statements would improve this critical appraisal. Furthermore, by drawing evidence from the raw data provided and broader literature/guidelines where necessary the works can be significantly improved.

Threats: Osteopathic knowledge should be drawn from formal training, research, and other sources; nonetheless, the failure to use evidence to back up statements means that there is a threat of having insufficient skills and knowledge that is a prerequisite for the field of study

ACTION PLAN

Current position. I understand I failed to meet the criteria of the Critical Thinking and Research Methods experiment. I struggled to integrate accurate flexion tests, and I included contradicted statement whereby the essay lacked justifications and backup.

How to get there. Based on the feedback, I realize I need to improve competency in deducing evidence from raw data, apply reflective theories, and apply critical thinking when exploring published reviewed articles. I re-did the module after failing on the first attempt and passed after the second submission.

Where I want to be. I anticipate developing a concise understanding of Osteopathic Practice Standards through assessing my development as a student pursuing osteopathy. Thus, I need to be proficient in applying domain of OPS including handling clinical analysis, primary care responsibilities, person-oriented care, and communication and demonstrate capability in inter-professional relationship behaviour. I also expect that I will adhere to the following OPS as this module demands (Osteopathic Practice Standards, 2012): “B1: You must understand osteopathic concepts and principles, and apply them critically to patient care.” “B2: You must have sufficient knowledge and skills to support your work as an osteopath.” “B3: Recognise and work within the limits of your training and competence.” “B4: Keep your professional knowledge and skills up to date.” “D2: You must respond effectively to requirements for the production of high-quality written material and data.” “D3: You must be capable of retrieving, processing and analysing information as necessary.”

How Well I have done. I have familiarized with the procedure for testing lumbar flexion and use references to summarize the process

Year1.SWOT

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(And action Plan, following Feedback received from submitted Physiology Essay and Anatomy Essay)

SWOT

Strengths: There was proper structuring of ideas, a good mastery of the English language, and clarity of concepts and good choice of examples. The knowledge of concepts was highlighted by a correct description of the three layers of fascia and the provision of good examples of therapeutic approaches to the fascia. Also, the feedback from the physiology essay indicated that even though some statements were unsupported, the analysis of the work was by and large a good one.

Weakness: Poor abbreviations as highlighted by witting the acronym before the word, failure to examine the implications of RSI procedures are potential shortcomings. Lacking specificity as underscored by the absence of elaboration on the relationship between therapeutic effects, the nervous system, and fascia add up to limitations.

Opportunities: It is evident that I am competent and suitable for the craft as the fascia is one of the many connective tissues in the body whose mastery is a prerequisite for osteopaths. From the physiology essay feedback, it was evident that the depth of analysis was a little below par but there was room for improvement from increased research.

Threats: The failure to clarify the relationship between therapeutic effects, the nervous system and fascia raise concern over whether I am competent enough. This is because the detailed knowledge of human structure and function to be able to differentiate between normal and abnormal anatomical structures is critical in the development of treatment and rehabilitative strategies (Ford, 2015)

ACTION PLAN

Current position. I acknowledge I have a limited understanding of function played by fascia and I need to improve in substantiating my statements and arguments. I am acquainted with various physiological principles and concepts of neural science.

How to get there. I need to improve my competency in human physiology and anatomy, and I need to be acquainted with the role played by homeostasis, elaborate cell physiology, and understand the functions of cardiac and respiratory systems, and nervous system physiology.

Where I want to be I intend to apply communication standards of OPS regarding using diagrams to understand patient physiology and anatomy and develop the ability to consider the patient as a whole. Secondly, I look forward to gain comprehension of anatomy, I particular neuro-vasculature, and osteology of the thoracic viscera, head, and neck, pelvic and abdominal cavities. Thirdly and most importantly, I want to raise my understanding of my work and execute it well as a professional, which is in line with OPS B2 that states (Osteopathic Practice Standards, 2012): “You must have sufficient knowledge and skills to support your work as an osteopath.”

How well I have done So far, I have acquired the ability to understand the biomechanical factors that impact spine and related structures. I have a comprehension of administering RSI as I have read it in several osteopathic books.

References

Ford, K. (2015). Exposing the dangers and true motivations of conventional medicine: a summary of the most commonly misdiagnosed illnesses of modern medicine. London: Lulu Publications.

Feedback from formative work

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SWOT

This SWOT analysis entailed all the osteopaths that I observed during our visit to the clinic for 8 hours.

Strengths: The creation of a good working environment by talking about general things like weather helped the patient feel more comfortable. Besides, the need for further inquiry during diagnosis meant that although the patients could not tell everything, the practitioner was still able to gather sufficient information. Furthermore, there was excellent feedback provision.

Weakness: Emotions – hostility when the tutor was passing on information to the practitioner highlights poor listening skills. Moreover, it acts as a barrier to effective communication.

Threats: Communication – the exchange of ideas, feelings, thoughts and emotions from an individual to the other or from an individual to a group and vice versa is essential in any workplace set up (Bonaccio, O’Reilly, O’Sullivan and Chiocchio, 2016). Nonetheless, the prevalence of poor communication posed a great danger to the treatment process, for instance when the practitioner did not ask a fundamental systematic question to rule out red flags and to know if the patient was safe or still needed treatment. In such a case, there is a high risk for misdiagnosis which according to Ford, K. (2015), accounts for 40% of cases of medical negligence.

Opportunities: Working with patients provides insight on the rigors of working and it best prepares practitioners for their jobs. Moreover, the presence of a tutor is an opportunity for correction and higher learning. Bonaccio, S., O’Reilly, J., O’Sullivan, S. L., & Chiocchio, F. (2016). Nonverbal behavior and communication in the workplace: A review and an agenda for research. Journal of Management, 42(5), 1044-1074. Ford, K. (2015). Exposing the dangers and true motivations of conventional medicine: a summary of the most commonly misdiagnosed illnesses of modern medicine. London: Lulu Publications

8 HOURS OF CLINIC OBSERVATIONS ACTION PLANS

Current Position.

We visited the clinic and for 8 hours observed how well osteopaths were conducting themselves as far as the 4 categories of OPS are concerned. Here were my observations:

Communication

- Practitioner started the case history by talking about general things like weather etc. It was great as it made the patient feel more comfortable

- Sometimes questions were not asked clearly and the patient could not understand what was being asked.

- Tutor advised the practitioner to ask questions that are more broad sometimes and out of the box as osteopaths cannot always rely on patients to tell them everything.

- Practitioner introduced herself and explained what was going to happen in the following 1.20hrs. - Practitioner was constantly giving feedback to the patient to keep her at par with the osteopathic developments.

- Practitioner coughed a lot. She felt nervous and almost lost her ground.

- Practitioner looked hostile when the tutor was giving her advice.

Knowledge and skills

- SLR ostephatic test – Practitioner was supposed to ask to the patient when the pain started while carrying out this test but she forgot.

- Tutor informed the practitioner that the neurological screening was supposed to be carried out again as the symptoms of the patient got worse.

- Practitioner conducted medi-pin testing over the socks.

- Practitioner did not ask basic systematic questions to rule out red flags and to know if the patient was safe to treat.

- Clear information was not been given to the patient on how to cross their arms. This caused the practitioner to struggle when carrying out passive tests and led to a waste of time as then practitioner was again forced to adjust the patient’s position.

- Practitioner carried out inhibition of the piriformis muscle from side-lying position. This appeared to be a very good way of conducting this inhibition as the patient looked very comfortable.

- Practitioner arched his back a lot when carrying out passive testing during the sidebending of the patient’ spine.

- Practitioner’s touch looked slightly stroky. We have to be careful to always have objective touch otherwise patients might say they have been sexually abused.

Professionalism

- Patient asked for info regarding her diagnosis. Practitioner gave one diagnosis. Later on during tea break the practitioner explained to the observer that she actually didn’t know the diagnosis and that according to her not even the tutors knew.

- When patient explained that she had visited a few physiotherapists previously but had not received the help she wanted, the practitioner’s reaction to this information conveyed through her facial expression seemed to suggested that physiotherapists are not good enough.

- Practitioner was wearing white socks and shoes that looked like slippers. - Practitioner had her patient at 14:40 and he arrived at exactly 14:40 and so did not get the time to ground herself and get everything ready for the patient on time.

Safety and quality

- Patient was pregnant and practitioner asked the patient to lay down on the side.

- The tutor informed the practitioner that her notes were not written properly and could not be read.

- Patient was wearing transparent underwear. Practitioner gave the patient a towel to put around.

How to get there.

Communication

- Ask clear questions and constructively engage patients, observe patient’s rights and inform the likely patient risk.

- Acknowledge the essence of obtaining consent.

Knowledge, Skills and Performance

- Be fully informed of what osteopathy is all about and the right skills such as systematic questioning as this could help accelerate the finding of a solution to a patient’s condition.

Safety and Quality in Practice

- Enhance professionalism levels by dressing decently before attending to a patient.

Professionalism

- Improve handwriting to make the content readable.

Where I want to be.

Communication

- Have well-developed communication skills and the ability to adapt my communication strategies to make them suitable to every patient’s needs.

- Be able to listen to listen keenly to a patient and respect whatever preferences and concerns they could be having.

- Be in a position to give my patients the information that they need in a simple and practical way that they can understand.

- Be able to partner with my patients to find the most ideal way of treating them.

Knowledge, Skills and Performance

- Be able to understand all of the principles and concepts of osteopathy and apply them accurately to my patients.

- Have all the requisite knowledge to support my osteopathy work practices.

- Have updated skills and professional knowledge concerning osteopathy.

Safety and Quality in Practice

- Portray highest levels of politeness and consideration to my patients.

- Have respect for the dignity and modesty of the patients I handle.

- Always provide the most appropriate treatment and care to the clients I serve.

- Always act swiftly to help my patients and strive to keep them out of harm.

Professionalism

- Always appreciate the contribution that other healthcare professionals have given to the patient and work towards making it better.

- Always produce the highest quality of written material and data that another practitioner can read.

- Act in integrity always within my practice.

-Wear in a professional manner that reflects healthcare settings

How well I have done

- Spotting the practitioners’ mistakes and positive sides even when the tutor has not pointed them out. For example, wrong facial expressions and their request to their pregnant patient to lie down on the side before starting to attend to them.

- Understanding the minimum OPS that a qualified osteopath should display in their day-to-day tasks.

Clinic.Observation.Forms

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End of year exams results

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END OF YEAR PRACTICAL EXAMS

Strengths: Good performance in, Fluid, routine, Osteopathic concepts and models application, the attempt for interpreting the findings, good palpation, and effective handling and justification.

Weakness: I need to be more careful when handling a patient’s head and carrying out passive tests on them.

Opportunities: Gaining proficiency in a particular skill is a time-based process as it is through experience that a therapist develops intuition and excellent decision-making skills that cannot be mastered in a classroom. Nonetheless, there is room for improvement as am good at making the report of findings, anatomy, degrees and have above average ability in the understanding of results and knowledge remember to cover the basic.

Threats: Osteopathy is a skill based and highly practical therapeutic approach. Consequently, the loudness in words is not replicated in equal measure through actions and this could impede that ability to assess, diagnose and treat patients safely and efficiently through a variety of osteopathic manual skills.

ACTION PLAN

Current position.

The exam results indicate that I have an excellent understanding of the location of SPs, effective in articulating, and safely applying side roll technique. Besides, I am proficient in handling patient and utilize apposite manoeuvres.

How to get there

There are areas I need to improve to achieve my academic and professional ambitions including the general positioning of the patient when performing the Side Roll, take into consideration somatic dysfunctions, make use of extensive contact rather than fingertips and familiarize more with sympathetic ganglia. I also need to review the supply of nerves to rhomboids further.

Where I want to be. I need to apply the fundamental philosophy and practice of osteopathy model in a given UK healthcare. Thus, I want to safely assess, diagnose, and treat patients by applying contemporary philosophy of osteopathy (General Osteopathic Council, 2012). This goal entails application of safety and quality practice of OPS whereby I will take into consideration apposite diagnostic hypotheses and exercise process of deduction to choose the most effective method. I also intend to adhere to the following OPS (Osteopathic Practice Standards, 2012): “B1: You must understand osteopathic concepts and principles, and apply them critically to patient care.” “B2: You must have sufficient knowledge and skills to support your work as an osteopath.” “C1: You must be able to conduct an osteopathic patient evaluation sufficient to make a working diagnosis and formulate a treatment plan.” “C2: You must be able to formulate and deliver a justifiable osteopathic treatment plan or an alternative course of action.” “C4: Be polite and considerate with patients.” “C6: Respect your patients’ dignity and modesty.”

How well I have done.

I can compile comprehensive findings; understand anatomy and covering the basic concepts of the modules I have covered.

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Final.yr1.SWOT&ActionPlan

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The General Osteopathic Council demands that an Osteopath understands and adheres to all of the 37 OPS that are under 4 pillars namely communication and patient partnership, knowledge, skills and performance, safety and quality in practice and professionalism. Whereas communication refers to the sharing of information between the practitioner and the patient, knowledge, skills, and performance refer to the attributes that make the practitioner competent for their assignment and distinguishes them from quacks (Holmes, 2016). Safety and quality in practice, on the other hand, refer to the precautions that a practitioner has to adhere to in order to keep the medical standards high and minimize the harm that may show up if the practitioner is careless. Finally, professionalism entails the moral principles, values, and standards by which professionals operate, and it governs the systematization, defence, and recommendation of doing rights and wrongs through policies, philosophies, and programs (Holmes, 2016).

SWOT

Strengths
1. Good communication skills as evidenced by the ability to articulate ideas in a coherent manner during writing. Spellings and the language used were on point throughout.
. Excellent knowledge of the fundamental concepts and principles of osteopathy, shown by the ability to apply them both in content analysis and critique of texts and conduct of practising osteopaths.
3. Good understanding of the minimum safety and quality practices of osteopathy as evidenced by the ability to identify a practitioner’s mistakes when they infringe upon the dignity and modesty of patients.
4. Great understanding of the levels of professionalism required of an osteopath such as proper dress code, production of high-quality written content and data, and respect of the patient’s right to privacy and confidentiality.

Weaknesses
1. Some incompetency in communication noted from my inability to support some claims made in my writing with concrete evidence from credible literature. Also, abbreviation was poorly done in some assignments as acronyms preceded words.
2. Inability to keep the professional knowledge and skills updated evidenced by the use of wrong concepts in some areas because of carrying out outdated research.
3. Failure to give more consideration the positive contributions of the healthcare professional that was being observed as many of the observations seemed to major on the negatives of the practitioner.

Opportunities
1. Availability of time and massive resources to conduct more research and enhance communication skills such as the poor abbreviations noted in some assignments.
2. Availability of time to enhance my osteopathy skills as many of them are acquired on the job and outside the classroom environment.
3. The presence of the tutor which enhances the practitioner’s keenness and provides ready chances for correcting mistakes and continuously learning during practicals.

Threats
1. Lack of diligence in the study at the onset of the course raises serious questions on my readiness, preparation, and mental capability to handle a complex subject such as osteopathy.
2. Osteopathy is more of a practical than theoretical medical practice. Excellence in theoretical work may not always correspond to excellence in the field.
3. Inability to fully understand some of the concepts and principles of osteopathy and rightly apply them to patients is a recipe for a disastrous career as poor application may complicate ailments instead of treating them.

Final Action Plan
1. Take some more time to sharpen interpersonal communication skills as these will be useful in conversing with the patients and will accelerate their diagnosis and treatment processes. I am currently reading through some peer-reviewed osteopathic communication journals to learn some of the best communication tips. Reading an article titled Effective Patient-Physician Communication Based on Osteopathic Philosophy in Caring for Elderly Patients from the Journal of the American Osteopathic Association, for instance, has taught me that I can as well use analogies to explain medical terms and conditions to my patients just as Andrew Taylor Still, MD, DO, did.
2. Spend more hours in studying the principles and concepts of osteopathy to equip myself with the requisite knowledge and skills to support my profession. I have, for example, watched a talk delivered by Gina M. Moses at the UC Berkeley on some of the myths and realities that are often associated with the occupation of osteopathy. Such and many other talks have helped me keep my osteopathic knowledge and skills up-to-date as things are always changing in this profession and one needs to keep their tabs open on these developments to ensure that they are not using obsolete skills to treat their patients.
3. Work on handling each patient’s case as being separate from others and respecting their dignity during treatment sessions. Thanks to Snow et al.’s article titled A Clinical Assessment Program to Evaluate the Safety of Patient Care, I now know that I can consistently measure and improve my quality of patient care using the American Osteopathic Association’s Clinical Assessment Program commonly referred to as AOA-CAP. The article reports that 48,000-98,000 of the deaths that occur annually are caused by medical errors because practitioners failed to adhere to safety and quality measures in their medical endeavors. I would not want such a scenario to occur during my tenure, hence my keen study of these practices.
4. Comply fully with all the legislative requirements of a professional osteopath by dressing appropriately, remaining honest and accurate in dealing with patients and always keep the General Osteopathic Council informed of my competence and conduct as an osteopath. Thistlethewaite & Spencer (2008) explain that medical practitioners have come under tight scrutiny in the 21st century and their levels of professionalism are being watched more than anything else. I have learned from reading this book that professionalism in osteopathy goes beyond just being in the hospital setup as it now encompasses other aspects such as teamwork and lifelong learning.

A2

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A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

Description

There is a tutor in the clinic who is skilled. I consider him very knowledgeable but also very quiet; he doesn’t say much unless he is asked a question. I have the impression that when he is with his patients, he listens more than he talks. I find him very inspiring. I presume it is because he understands his patients’ problems quickly, and does not need to ask many questions. I assume that the few questions he does ask are key questions that allow someone with vast experience and knowledge to diagnose or identify a problem immediately. It happened that I observed his way of working and the way he communicates with patients on a number of occasions.

Feelings

I feel I am more talkative than he is, partly because of my experiences as an entertainer in holiday resorts and as an actor, and my earlier work in sales. I recognize in myself the ability to communicate not just verbally but also on a subtle and energetic level, especially when treating patients. This is because of my previous training in craniosacral therapy, where I learnt to hold the space for children as well as adults without interfering much verbally, thus avoiding the triggering of stimuli that could lead the body to potentially prevent itself from telling you what is really important. How important is it really to communicate verbally?

Evaluation

I feel that this tutor always interacts with his patients in the same way and doesn’t show flexibility in terms of adapting or changing the type of communication or tone of voice. But he is objective as a professional in what he does, and I think this is what matters. Knowing who we are as individuals, knowing our intentions and qualities, exhibiting self-confidence, being objective in our profession, and always showing respect to our patients — this is the core of our profession. I think that the key is to become like a tree with big roots, where words don’t matter anymore, because the patient’s body will adjust around your grounded presence, midline and good will.

Analysis

I asked a colleague what he thought about the way this tutor communicates with his patients. My colleague stated that in his opinion this tutor adapts himself to the way in which the patients want to be communicated, but in a very subtle manner. I also asked the tutor himself about the A1 OPS (GOsC 2012) and his way of approaching patients. He stated that I should read the OPS literally for what it is and not go too deep into it. He stated that some patients do not have the relevant knowledge, and of course I have to explain my diagnosis and findings in easily understandable terms. Following this conversation, I carried out some research and found out that

No matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help (ICH 2019).

Conclusion

I asked myself whether I have any problems in terms of communication, and the only thing I could think of was the language barrier, since English is my third language, and this could result in me potentially spending more time in a treatment room so that I can ensure that my patients understand me well. Moreover, the conversation I had with my colleague made me realize how everything is relative and how we all perceive reality in a different way, maybe even communication.

Action Plan

Holding the space, allowing patients’ bodies to communicate, and at the same time communicating with the patients accordingly and talking with them (if I feel it is right) sounds like a good balance to me. Sometimes patients want their practitioner to be more talkative. Improving my English is another goal. Even though I don’t feel I have any major issues with the language, I believe that learning new words could potentially improve my patients’ overall experience (Crowther et al. 2015). I feel that reflecting on the OPS made me more aware of my capabilities but also of how I need to get the information across, depending on who I have in front of me. For instance, I should not use technical language, such as ‘flexion’ or ‘extension,’ with someone who is not an Osteopath.

References

ICH, 2019. Impact Of Communication In Healthcare | Institute For Healthcare Communication. Available at: https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/ [Accessed 12 Jul. 2019].

Crowther, D., Trofimovich, P., Saito, K. & Isaacs, T., 2015. Second Language Comprehensibility Revisited: Investigating The Effects Of Learner Background. TESOL Quarterly, 49(4), pp.814–837.

GOsC, 2019. standards of practice | General Osteopathic Council,Available at:http://www.osteopathy.org.uk/practice/standards-of-practice/ [Accessed 12 Jul. 2019]

A1.5

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A1 - 5. Your patients should have your full attention, and you should allow sufficient time to deal properly with their needs. If you are in sole practice, you will need to develop strategies to minimise interruptions while you are with a patient.

When I joined the ESO, I had hope that I will make it to the end but deeply I had fears and doubts that I did not know where they were emanating from. However. I was determined at realising my own potential to help patients. I deeply reflected and realised that a way out for the ultimate goal of success was to evaluate the effectiveness of my communication as seen in this section.

Description

One day, I was taking a case history during a formative exam. I missed some of the information given by the patient when answering a few questions. When discussing the case, my tutor, pointed out that I failed to listen effectively since I was not aware of some information given out by the patient. Given this case history lasted 20 minutes, I tried to make sense of why I did not listen at that moment. I realized that I had to take a moment to relax since the taking of the case history and exams were draining my energy.

Feelings

I feel I am more energized when handling tasks separately. I acknowledge that I am not able to give my full concentration when there are multiple things on my mind at a given moment. This is partially because I am a perfectionist who revels in the joy of completing one task before moving on to another. This way of doing things has helped me to get good grades in the past. Moreover, I questioned whether I could get at the level my tutor wanted me to be. Then I felt motivated and with a sense of wanting to try harder.

Evaluation

I feel that the tutor was objective in giving honest feedback about how I handled the case history. Knowing who he is as a professional, I feel he was concerned about my listening skills especially in a profession that requires constant communication with both patients and colleagues. My tutor challenged me to improve my listening skills since it shows respect to patients and colleagues as well.

Analysis

I shared the case scenario with my colleague and asked him what his thoughts were. My

colleague’s opinion was that I seemed distracted from the conversation when the patient was answering questions from one of my colleagues. Reflecting on this, I realised I did not listen to the answer because I thought it was a conversation between my colleagues when in fact I was the one leading the case history. I also sought the tutor's insight into improving listening skills. My tutor suggested that I familiarize myself with the standard code of practice outlines since they inform us that professionals must listen to patients and that effective communications are a two-way process involving not just talking but also listening (GoSC 2018; Kam 2009).

Conclusion

My colleague's affirmation that I was not listening effectively prompted me to question
myself whether I was an effective communicator. I realized that my communication skills are compromised in certain situations such as when I am feeling overwhelmed by other
circumstances or I’m feeling tired. Moreover, my tutor's feedback and guidance made me realize that
communication is not just about talking but even more importantly, keenly listening to what the other person is saying.

Action plan

My goal is to nurture my listening skills to become a more effective and active communicator. I endeavour to minimize interruptions such as preoccupation with self and external issues and ensure that patients have my full attention. To do this, I will invest my time to seek resources that will help me nurture my listening skills. I am now more convinced that listening is an integral part of communication that clarifies a speaker's message (Kanu 2009).

References
GoSC, 2018. Osteopathic Practice Standards. Available at: https://standards.osteopathy.org.uk [Accessed April 9, 2020].

Kanu, A.M., 2009. Reflections In Communication : An Interdisciplinary Approach, NY: University Press of America.

A3.1-A3.2

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A3 - 1. Before examining or treating a patient you should ensure that they understand:
1.1 their rights as a patient, including the right to have a chaperone present and to stop the examination or treatment at any time. 1.2 what they can realistically expect from you as an osteopath. 2. You should discuss care options, encourage patients to ask questions, and deal with these clearly, fully and honestly. You should inform your patients of anticipated benefits as well as any material or significant risks associated with the treatment you are proposing, and confirm their understanding of these. If proposing no treatment, you should explain any potential risks and benefits associated with this.

Description

After working as a student osteopath in the last year, I realized that I do not always provide patients with information that they require to know in the treatment process. For example, I have not been adequately informing patients about what to expect from
me as an osteopath before treatment. Secondly, I have not been informing them and allowing them to exercise their right to stop treatment or examination at any given time. I think this has been the case due to my lack of adequate knowledge and experience.

Feeling

I feel that I have been having unrealistic expectations of how patients should perceive an
osteopathic treatment. Many people in the UK know about osteopathy and I assumed that people make bookings because they know about it. I feel disappointed that I have been denying patients their right to
adequate information because in the end, it affects the way patients see me as a professional and this could influence the influx of potential future patients.

Evaluation

I have been failing to give patients information in a way that they can
understand (i.e. how many treatments they need).

I think that what matters is informing patients of their rights during their first session and also accepting their right to stop examination or treatment if they want to.

After a conversation with one of my colleagues, I feel happy that I had an awakening to acknowledge my faults in denying information to patients which is a crucial standard that should be obeyed by professionals.

Analysis

I requested my clinic tutor to help me make sense of the situation. My supervisor feels that I have been naive in understanding what information should be relayed to patients.
Additionally, he feels that I lack an adequate understanding of and insight into the healing process and timing of MSK conditions. My supervisor suggests that I should read NICE guidelines or go back to the NHS website that addresses healing timelines such as 9 treatments in 12 weeks for patients experiencing low back pain.

Conclusion

I evaluated and wondered how I was relaying information to patients. I gave patients hope of coming back merely because ‘osteopathy works’. My superior's feedback made me realize how ignorant I had been about providing patients with not enough information. My research revealed that a practitioner’s base of knowledge must entail a holistic perspective of the patient and to appreciate what the patient is asking for (Stone 2009).

Action plan

I believe that patients have a right to information before being examined or treated. I feel that reflecting on NICE guidelines helped me realize how crucial a patient's rights are and how I am obligated to honour those rights as an osteopath professional. My goal is to ensure that I inform a patient of what they need to understand before beginning any treatment or examination. I endeavour to ensure that patients receive information about their treatment right at the beginning of the session.

References
Stone, C 2009. Science in the art of osteopathy. Osteopathic principles and practice. Cheltenham, UK: Nelson homes

A4

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A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

Description

My tutor always stresses the importance of seeking informed consent before carrying out an HVT. Even though I always inform the patients of the possible material risks, I think there
are some things I forget to do. For example, on one occasion, I explained to a patient that only one of their vertebras (T4) was going to be treated. However: during the treatment, I carried out more HVT (T2, T10) and took this decision without the patient’s consent. Even though I had sought consent for the first HVT, I think I breached the terms of the informed consent as I did more than what I had informed the patient that I would do.

Feelings

I feel I have been ignorant in most of these scenarios by failing to honour the patient’s consent before carrying out any treatment procedures. This is partly because I feel compelled to wholly take care of situations rather than leave them pending to be resolved later. I feel I did not quite understand that there would be the risk of over-treating.

Evaluation

I think I am taking a risk for not seeking further informed consent from patients before carrying out any further treatment. I feel that the tutor is right in encouraging us to seek informed consent before carrying out an HVT because there are many patients complaining because of miss-communication. Indeed, specific consent to treatment must be obtained from the patient before commencing patient care and treatment (Lynch, 2011).

Analysis
My tutor mentioned to me that even though the patient does rely on the goodwill of the practitioner, it is professional and respectful to seek valid and informed consent from patients so that they also understand the nature and risk of the proposed treatment and also to avoid possible complaints. Following this conversation, I acknowledged and understood that it is important for a practitioner to accord a patient the free will to accept or refuse the proposed
treatment. Additionally, I should have mentioned my intentions from the beginning by saying, ‘I’ll carry out a series of HVT on the thoracic spine according to what I palpate’ but it’s a bit contradictory as at this stage I should have already carried out a full examination routine and already know what needed to be eventually adjusted.

Conclusion

I became bothered by how casually I had been handling the aspect of seeking informed consent. My tutor's feedback helped me realize that even though as a professional I might feel compelled to act out of goodwill, I should not proceed with treatment without seeking informed consent.

Action Plan

I am now prepared for situations like these and my goal is to always seek valid and informed consent before beginning treatment. I am now aware that seeking informed consent is vital for the patient making an informed decision about their treatment and also to avoid legal redress. The next step for me is to learn how to properly explain what an ‘HVT’ is and its possible side-effects and risks.

Refernces
Lynch J. 2011. Consent to treatment. Oxford: Radcliffe Publishing

Email Received from Clinic Head Manager regarding HVTs

Fri 23/08/2019 09:36

Dear X

Yes I am fine thank you and hope you are too.

Hopefully this will help. Mr X is the person to thank here for his time with this info

This research conducted by ESO and NCOR:

Adverse events and manual therapy: A systematic review

Carnes D, Mars T, Mullinger B, Froud R, Underwood M. Manual Therapy 2010:15:355-63

Abstract available here

You can then update using the Clar et al. study from 2014 – all available on the Clinic resource page.

This summary may be particularly useful:http://www.eso-learningzone.co.uk/pluginfile.php/17293/mod_resource/content/4/AE%20in%20MT%20summaries%20by%20topic.pdf

Providing a list is problematic as it gives a sense of definitive security that can become

a safety issue as the knowledge becomes refined with each subsequent piece of new

evidence (OPS B4). Ultimately it comes back to clinical reasoning and applying the informed

consent process that you have been inducted into.

You will have been exposed to in your Y2 module the work from the likes of Evans, Fritz, Fryer and Koppenhaver:

http://www.eso-learningzone.co.uk/pluginfile.php/25151/mod_resource/content/9/Year%202%20PPD%20Course%20Work%20March%202018.pdf

Re a specific case as per your email. An isolated piece of information is not enough to decide if HVT is or isn’t appropriate. You will need all CH information, examination and knowledge from research and literature and then apply to the case in front of you. If you are able to demonstrate this combined information, discuss this with your patient to include risk/benefit in context and justify your treatment approach this should help in an exam situation.

Hope that helps and as I say thank you to Mr X this time.

---------------------------------------------------------
ALSO

I went through Mr X's lecture on consent here and read the new OPS regarding this matter.

A5.1

000934523 — 2019-08-21 11:54:53 UTC

A5 - 1. You should encourage patients to ask questions about their treatment and to take an active part in the treatment plan and anydecisions that need to be made.

Description

I encountered an elderly patient who came to the clinic five times with complaints of lower back pain. The patient was not collaborating by helping herself. For example, she was not carrying out the exercises she had been instructed to carry out. She wanted me to ‘fix her’ but without taking responsibilities for her health. For instance, she was still working and sitting frequently. I even tried to fit the exercises in her daily routine where she would carry out the exercises in the morning and the evening while in bed. However, this did not bear fruit at all.

Feelings

I felt hopeless and recognized my limits. My help is not limitless and I can do what I can. I feel that I am not in a position to save the world and meet reality. However, I feel that I am able to dedicate myself to being there for patients. I felt frustrated that the patient was not collaborating with me.

Evaluation

I tried my best to help the patient to help herself by doing the exercises given. However, the reality is, I could only go do so much to help her. As professionals we should deliver support in a person-centred way. This means to find a way to make patients doing their exercises in their busy routine and if they don't want to do them, we need to find another way to help them caring for themselves. I recognize my limits as a professional and maybe I should have done more to try and motivate this patient. Reflecting on it, I should have communicated more with her to find a meeting point. Looking back, another action I could have taken could have been to refer her to another professional, someone that could have helped her by boosting motivation, like a hypnotherapist or a life couch. To increase the support team of a patient could result in being a wise option to consider as professionals

Analysis

According to Patterson (2014), patients care about whether the doctor initiates engagement with them and provides essential information during the consultation. I feel that I should have collaborated more with the patient and perhaps provided an incentive for them to carry out the exercise. I could have scheduled an extra appointment weekly just to carry out the exercises with the patient. Additionally, more communication with the patient would have helped me to understand why the patient was not carrying out the exercise. I believe this would have helped the patient feel much better and feel more motivated.

Action plan

In the future, I will ensure to collaborate with the patient and other health care professionals if needed in caring for themselves particularly with the exercises given to aid their healing process. I endeavor to communicate with patients and empower them to make better decisions regarding their health. Additionally, my tutors and colleagues confirmed that it is important to collaborate with patients rather than impose instructions on them.

References
Paterson, R. 2014. The Good Doctor: What Patients Want. Auckland: Auckland University Press

A5

000934523 — 2019-08-21 11:59:51 UTC

A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

Description

I was taking care of a patient who had been suffering from chronic lower back pain. The patient would have improved her lower back pain by losing weight. I was unsure of whether to tell her or not. When I was discussing the issue with my colleague and my tutor, they both advised me to wait for a few sessions. Additionally, my colleague felt that women can take such issues personally and therefore, I should be cautious with how I relay such information.

Feelings

I felt intelligent in deciding to discuss this matter first with the tutor as it’s a delicate topic. I felt I made a wise decision to consult with my colleague and tutor before engaging the patient with information about how a weight loss program would improve her health. It is not surprising that there is a range of perspectives about the degree of power that patients should be accorded to ensure that decisions are made wisely (Porzsolt& Kaplan,

2006). I felt at first that the tutor was wrong because as a healthcare professional it should be us informing the patient on the best forms of treatments regardless of the patient’s feelings.

Evaluation

This situation was extremely challenging because there was an issue of supporting the patient in caring for herself to improve and maintain her health straight away. The good thing was that I recognized the need to take into consideration the timing within which to inform the patient about losing weight. After the discussion with my tutor I acknowledged that it was important to give to the patient the opportunity to build trust first with me as healthcare professional.

Analysis

Looking back at this situation, I realized that there was an urgent need to inform the patient about reducing her weight through exercising to improve her lower back pain. I do feel that waiting for a few sessions to inform the patient about loosing weight would not significantly change how the patient would react to the idea of exercising to improve her health. I do understand though that it is imperative to relay carefully delicate information to patients and after a proper analysis of the case and potentially after a few sessions.

Conclusion

After a series of articles read and discussions had with different tutors my conclusion is that as a healthcare professional it is extremely vital to inform the patient sooner about how exercising and loosing weight can alleviate chronic lower back pain. I'm aware though that sometimes is best to wait a few sessions to build up trust. As a healthcare professional, I need to develop valuable communication skills to empower patients with the right information in the optimum way possible. I did some extra reading to gain more insight about how to talk to patients about loosing weight. From my research, I discovered that talking with patients respectfully and seriously is the best way and it can play a vital role in the way we can help them. (https://www.niddk.nih.gov/health-information/weight-management/talking-adult-patients-tips-primary-care-clinicians).

Action Plan

In the future, I now know that I will have to pass on information to the patient such as the need for a weight loss program with care, respect and at the right time. My colleague’s and tutor’s feelings about waiting for a few sessions before talking to the patient opened my eyes. My aim from now henceforth is to conduct research first if in doubt. I also endeavor to ensure that I relay information to patients in a professional manner. To achieve this, I read all the osteopathic practice standards regarding communication and patient partnership to increase my understanding of how to communicate with patients on taking care of themselves. I also plan to read more books and articles which provide insight on effective communication skills between patients and osteopathic professionals to ensure that I deliver delicate information to patients in the most ethical manner.

References
NIH, 2019. Talking With Patients About Weight Loss: Tips For Primary Care Providers | NIDDK. Available at:
https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/weight-management/talking-adult-patients-tips-primary-care-clinicians?dkrd=hisce0143 [Accessed April 2, 2020].

A6.1

000934523 — 2019-09-14 00:57:40 UTC

A6. You must respect your patients’ dignity and modesty.

1. Patients will have different requirements for maintaining their dignity and modesty during a consultation, and you must be sensitive to these. Some of these ideas may have been shaped by a patient’s culture or religion, but it is unwise to make assumptions about any patient’s ideas of modesty.

Description

In my first year of clinical practice, I had to request my patients to undress for the examination. I neither offered my patients a choice nor an explanation as I assumed that the patients knew that they would have to undress for an osteopathic examination. However, I communicated my message politely and with care. In one event, however, I observed a fourth-year student taking the case history of a new patient. The student took the patient through an oral case history taking. When it came to undressing, the student offered the patient an option to undress so that they would examine them for posture. The student also provided the patient with the choice of the company of a chaperone should they feel uncomfortable.

Feelings

After I had observed how my colleague had handled her patient, I felt that I had not dealt with the situation well in the past. I also felt that my previous patients might have felt coerced to undress. After observing the fourth-year student examine the patient, I felt that I needed to improve my consultation techniques. I have always felt that I have been friendly and polite to my patients. However, I realised that I assumed they were going to be comfortable undressed. I feel that I have learnt a lot over the last three years. I have also tried a lot to improve my English to ensure better communication with my patients. I am very grateful for the training and assistance the school has accorded me.

Analysis

In the past, my consultations did not go well since I neither took my time to explain the rationale behind undressing, and neither did I offer my patient a choice. Nevertheless, I learned that making the patient feel comfortable and explaining reasons for undressing while at the same time, offering them the choice of the company of a chaperone was necessary.

Evaluation

The good thing about my consultation was that I managed overall to take a good case history of my patient. I examined the patient thoroughly for posture, skin tone, texture, and discomfort. However, I failed to provide the patient with a choice and also did not explain the reasons for undressing.

Conclusion

I learned that I need to make the patient feel comfortable and offer them choices so that they can feel more dignified. I also learnt that I should follow the pre-set examination questions to the letter and show care and concern while speaking to the patient and should also read more on the best practices on examining patients. Besides, I learnt the importance of learning from observations. A sit down with my tutors also made me appreciate the importance of learning and practising good communication. This is after the tutor informed me that with most of the complaints osteopaths receive from patients usually derive from miscommunication.

Action Plan

In my next examination, I intend to be calmer while examining my patients, allow the patient to express themselves clearly and elaborately to understand their needs and what treatment to provide. I also intend always to inform patients why they need to undress and offer the option of the company of a chaperone. I also plan to finish reading the book on dignity.

A7.3.3

000934523 — 2019-09-14 00:58:39 UTC

A7. You must make sure your beliefs and values do not prejudice your patients’ care.

Reasons for not accepting someone as a patient or declining to continue their care might arise where:

3.3 They seem to lack confidence in the care you are providing

Description

I once had a new patient suffering from acute lower back pain. The patient was very stressed and continuously kept on sharing all her problems. She insisted on getting treatment urgently, but I politely informed her that I had first to diagnose her problem correctly. The first consultation took an hour, and twenty minutes, nevertheless, I gave her some treatment. On her second visit, she stated she felt much better, and she was so looking forward to receiving more treatment that day. I read from Leach et al., 2013, p.122 that she was most luckily the type of patient that thinks that the more you do, the quicker she would have healed. My tutor recommended that I toggle the sacrum; however, upon more in-depth analysis, we agreed I was going to carry out BMT. I performed the procedure slowly and carefully while inquiring how the patient felt and at the same time, informing what I felt. The procedure was a success.

Feelings

I felt as if the patient did not trust me when I was performing the BMT as she wanted ‘more’ notwithstanding my previous explanation of the fact that she was too acute. During my second treatment, I felt that I had already explained to the patient that my choice of gentle techniques would work well. However, the patient came back, making me feel as if I was not doing ‘enough’ but informing me at the same time to have had massive improvements. I knew about the OPS A7 and thought to myself that it would have been prudent to monitor the patient for a few other sessions and then refer her to another practitioner. Nevertheless, the treatment worked. I was satisfied. I felt like the patient should have trusted me more. In the end, I believe in having handled the situation well.

Evaluation

The good thing about the experience is that I was confident about my intervention, I remained calm and patient with the patient and that BMT worked as I felt the changes underneath my hands and re-tasted the restrictions in the hip. The patient was, however unsettled, demanding and doubtful. Regardless, I convinced her that I would get her the right treatment.

Analysis

I considered discontinuing treatments to this patient and refer her to another practitioner since she was expressing concerns on my suitability to treat her.

Conclusion

I learnt to take my time to perform the right diagnosis and treat patients. However, the situation would have yielded better positive results had the patient been more trusting and relaxed. I realised that I need to hone my patience to handle similar situations in the future better

I will also make sure to remember my rights (i.e. OPS A7 3.3) for me to have choices on how to best handle difficult patients. However, before choosing to refer the patient to another practitioner, I’ll inform them that I’m suitably qualified. However, still, I would inform the patient that Osteopaths even though they get the same type of training they could work in a very different way and it would be interesting to experience different styles.

Action Plan

In future, I will focus on developing patience and trust among patients in a similar situation. I will need to read more case studies detailing how to handle impatient patients successfully. I will also take note of my progress to ensure that I meet my goals.

Headache Clinic

000934523 — 2019-10-08 17:56:43 UTC

Description
At the headache clinic, I realized I am very good at treating patients with headaches. Having had already experience in IVM, Fascia work and Sport Massage I felt ahead. The past 4 years helped consolidating and improving my skills. I realized I needed to gain more knowledge on medications and the variety of conditions that can lead to headaches.

Feelings
I feel good when I see my patients recovering from illnesses and I know my experience is increasing day by the day. Patients can get headaches for a variety of underlying reasons, and my experience allowed me to appreciate some of the factors while also understanding my role in helping them recover. Headaches might seem like simple ailments since they are common, but they could be a symptom of something major like a tumour.

Evaluation
The good side of my experience is seeing the patient recovering; I was happy that the patients recovered due to my intervention, especially since some of them had been suffering from the effects of headaches for many years. The experience was also fulfilling since I achieved my goals to be effective and efficient in what I do.

Analysis

Headache treatment needs to be tailored to an exact diagnosis (Bösner et al. 2014). Before offering any form of treatment to a headache patient, it is important to perform tests and understand the cause of the headache (Anderson & Seniscal, 2006).

Conclusion

Examining and testing a patient is the best way to offer a tailored treatment. This will ensure a correct diagnosis.

Action plan
My action plan in the future is to interact with the patient more so that I can understand how they are feeling and their needs. An interesting resource about this is by Gremigni et al. (2016), which reveals that a person has to self-evaluate their capability to relate to patients in day-to-day practice for a patient-centred approach.

References
Bösner, S., Hartel, S., Diederich, J. & Baum, E., 2014. Diagnosing Headache In Primary Care: A Qualitative Study Of GPs’ Approaches. British Journal Of General Practice, 64(626), pp.e532–e537.

Gremigni, P., Casu, G. & Sommaruga, M., 2016. Dealing with patients in healthcare: a self-assessment tool. Patient education and counseling, 99(6), pp.1046-1053.

Maternity.Clinic

000934523 — 2019-10-08 17:57:06 UTC

As a student osteopath, I was advising pregnant women on measures to take during their pregnancy period. These women have unique demands, which also depends on the stage of the pregnancy and other variables.

Description
As a student osteopath, I was of help in solving various problems that pregnant women at the clinic experienced because of pregnancy, which including aches and pains as a result of changes to posture.

Feelings

I was glad to relieve the pain pregnant woman faces as a result of postural change during pregnancy. It is also a significant challenge considering their current state, so I had to rely on different variables such as their current health status or pregnancy stage to make sure I provided what the client needed.

Evaluation

The experience was good, as I have perfected the relief of pregnancy pain without patients using painkiller drugs. The bad experience was seeing how pregnant women suffer in pain due to pregnancy. Pregnant women are challenging since they are often worried about the well-being of their child, and at the same time, they are also at a higher risk of different ailments. It was a good and informative experience since an osteopathic treatment can help relieve discomfort.

Analysis

Antenatal care is crucial to pregnant women because it helps prevent mother and child mortality, complications and it also helps foster a good relationship between husband and wife (Cumber S., Diale D., 2016).

Conclusion

Women should be educated on the importance of antenatal care. Osteopathy is useful for pregnant and post-natal women. Pregnancy can lead to many changes in a mother's body that may affect the foetus.

Action Plan

In the future, I will have to consider different approaches that can apply to a patient. This can entail liaising with an obstetric professional when handling a pregnant woman. An interesting article was by McLeish & Redshaw (2017), which posit that new mothers tend to pose more challenges since they are not aware of how to cope with the changes in their bodies.

References
Cumber, S.N., Diale, D.C., Stanly, E.M. & Monju, N., 2016. Importance Of Antenatal Care Services To Pregnant Women At The Buea Regional Hospital Cameroon. Journal Of Family Medicine And Health Care, 2(4), pp.23–29.

McLeish, J. & Redshaw, M., 2017. "I didn't think we'd be dealing with stuff like this": A qualitative study of volunteer support for very disadvantaged pregnant women and new mothers. Midwifery, 45(5), pp.36-43.

The body is a unit

000934523 — 2019-10-27 05:38:24 UTC

Description
I had a patient complaining of back pain and the problem was the gallbladder.

Luckily 'The body is a unit' is the easiest principles to make patients understand.

Feelings

It was quite easy to explain how that pain was travelling at the back because of my anatomy knowledge. It was challenging at first, but the patient finally understood since I managed to explain myself properly. It was an exciting experience since I managed to educate the patient effectively.

Evaluation

The concept of unity can be understood using the principles of body, mind, and spirit, and that if part of the body changes due to an external or internal agent, it will have an impact on other aspects, either the spirit or mind or all at the same time.

Analysis
The body is a unit that comprises of many parts with the same purpose. This also means that if one part is not working correctly, then the other parts might be affected.

Patients appreciate the importance of being aware that change in one system will result in an adaptation in another.

Conclusion
People should be aware of the basic principles of self-regulation, body unity, and the link between function and structure as a means of treatment in the condition.

The body relies on a complicated process to function, and it is only through knowledge of anatomy that an individual can trace the cause of specific internal pain.

Osteopathy is a method of diagnosis and treatment which deals with a wide array of issues. Conclusively, different systems in the body have to work as a whole.

Action Plan
I will try to learn how to encourage patients on the importance of adaptation and compensation in the notion of body unity. An interesting resource about this was by Parsons and Marcer (2005), which suggests that functional structure dependency is useful for diagnosis.

References
Parsons, J. and Marcer, N., 2005. Osteopathy: models for diagnosis, treatment and practice. Elsevier Health Sciences.

Awareness_Challenges_of_profession

000934523 — 2019-10-27 05:40:26 UTC

The body is capable of self-regulation, self-healing, and health maintenance.

Description
A controversy of Osteopathy is the fact is not recognized in many countries such as Spain. The treatments are unique, and few individuals know of its importance.

A solution to this problem could be the explanation of the osteopathic principles to patients since they are the pillars of our profession.

It's easy and effective

When someone cuts himself, the body repairs it and that’s a very good way to explain to patients the body's self-healing mechanism.

Our treatments can be very quick and patients need to know that the body will do the rest.

This will also justify the little time of treatment.

As Osteopaths, we undergo many struggles; for example when we try to prove to patients what we can feel throughout their body from just their feet.

Again, this is only possible if an individual is aware of the basic principles of self-regulation, body unity, and the link between function and structure.

Feelings

I feel confident that I know what Osteopathy entails, and this will be the first step to increase awareness and acceptance about the profession. Once the patient understands that Osteopathy is crucial since it focuses on massage, manipulation and facilitation of the skeleton and musculature, more people will appreciate its benefits. For instance, I think I am good at explaining what I do when carrying out any IVF technique. I feel changes underneath my hands and I can explain them making patients aware. The success of a treatment though also includes addressing the primary somatic dysfunction and the use of the right techniques for the right patients. By following the precautions written above patients will feel reassured after the treatments knowing Osteopathy works and that I’m good at what I do.

Evaluation
It is a difficult experience since the profession is not acknowledged in many countries, which makes it harder to practice and help more people. The good thing is that I have an opportunity to help others in learning about the importance of Osteopathy.

One of my strengths is that I don't follow set rules when treating a patient. I don't work according to ‘what’s most appropriate for endomorph or ectomorph’ for example. Yes, I might take that into consideration but in the end I prefer to ask the patient's body. This allows me to deliver more person-centred treatments, be more successful in what I do and indirectly do good publicity to my profession.

Analysis

I think that patients should know that Osteopathy helps the body in healing. As an Osteopath, I will be keen to increase awareness about my role in improving the body.

I now understand the importance of NCOR that seeks to improve our profession by encouraging research.

Patients can already know that whatever happens to the body in terms of healing has a basis in research and they can trust the healing process.

Action plan

In the future, I will have to find ways to increase awareness about the profession. I feel that this will ease the work of us Osteopath, even in countries where Osteopathy has not yet been recognized, such as Spain. In the future, I will try my best to explain to patients what really happens to our bodies as we heal and how Osteopathy works

Conclusion
To conclude, a new controversy regarding Osteopathy is that it is not recognized in many regions worldwide. The treatments are unique, and few individuals know of the benefits. It is a stressful experience for practitioners since it makes it harder to practice and help more people.

Structure and function

000934523 — 2019-10-27 05:40:37 UTC

Description
Function and structure are reciprocally interrelated, and any dysfunction in the musculoskeletal system can signify or result in changes in other body systems.

We see many patients out there with lots of asymmetries and not structurally ‘’perfect’’ but it is always so beautiful to inform them that no one is and that what’s most important for us is that everything is moving and functioning properly.

Osteopathy is based on knowledge of physiology and anatomy. Few people are aware of the benefits of osteopathic manipulative medicine.

Feelings

It was interesting to understand that I can use touch, physical manipulation, stretching and massage to increase the mobility of joints, relieve muscle tension, enhance the blood and nerve supply to tissues, and to help the patient’s body own healing mechanisms. I enjoyed providing advice on posture and exercise to aid recovery, promote health while also preventing symptoms recurring.

I feel that I am aware of the osteopathic principles, and this will be vital in helping clients gain their health and vitality through the practice. I believe a hands-on approach is a unique, specific, and direct method of reducing sugaring and improving health function.

Evaluation
I feel that this will help the patient gain a sense of satisfaction in the practice and also trust that the best had been done. The patient will, in turn, have confidence in himself as he understands that even though he might not be symmetrically perfect, he is functioning properly. In reality, many people do gain since they may require an intervention that does not involve medication, and that is where Osteopathy comes in.

Analysis
In the future, I will ensure to talk well to patients and make sure they are mentally okay with the state of their body. Positive affirmation and encouragement will be my core services to such patients before and after treatment.

Conclusion
Patients have diverse needs, but there is a need to determine the best way to handle them. What is most important for us is that everything is moving and functioning properly.

Action Plan
I plan to learn more about ways of dealing with patients in different circumstances. I will be more proactive as a professional. I need to be patient since healing is a process that takes time (Parson 2005).

I plan to learn more and improve my knowledge about the link between the structure and function of the body. I will be keener in helping clients understand the relationship. The body works harder in case of a dysfunction. Dealing with the allostatic load of the body, it will return the body to a reasonable homeostatic state (Parsons & Marcer, 2005).

Reference
Parsons, J. and Marcer, N., 2005. Osteopathy: models for diagnosis, treatment and practice. Elsevier Health Sciences.

B1-B1.3

000934523 — 2019-11-06 22:52:00 UTC

B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

1.2. a knowledge of human structure and function sufficient to inform appropriate care.

1.3 a knowledge of pathophysiological processes sufficient to inform clinical judgement and to identify where patients may require additional or alternative investigation or treatment from another healthcare professional .

Description

I did a paper which is related to OPS B1 (1.2 - 1.3). The paper required me to demonstrate my knowledge of human structure and function enough to perform appropriate care. Also, it was testing my understanding of pathophysiological processes to improve my clinical judgement and to identify when patients require additional / alternative diagnosis /treatment from another practitioner. I set out to describe fascia, its structure and function, therapies targeting fascia, and RSI and its interconnectedness with the nervous system. I desired to exceed my tutors' expectations on the paper. However, I managed to score fairly. According to the examiners' remarks, I demonstrated a good application of grammar, formatting and referencing. I also described fascia well, choose good examples of therapies and supported my arguments with valid studies. However, the tutor noted that I should improve on my sentence construction, describe fascia more in-depth, carefully think again about the RSI and its effects, and better examine the interconnectedness of fascia and the nervous system.

Feelings

Before doing the paper, I felt confident as I believed I had adequately prepared for the exam. Yet, as I did the paper, I felt that I had not addressed the questions sufficiently and hence had not amply demonstrated my knowledge of human structure and function and understanding of pathophysiological processes. This feedback wasn't a surprise, I knew I had to improve my sentence construction in English since before enrolling in this university. Moreover I knew that I had to strongly justify my arguments when writing essay but overall I felt confident the essay was of high quality when I submit it. I felt disappointed when I got my low mark. Indeed, the examiners lamented the material I have to study if I want to be a knowledgeable Osteopath and for me to comply to OPS B1 at all times.

Analysis

I managed to improve on grammar sentence construction, spelling, and formatting owing to my continuous efforts towards self-improvement through extensive reading, practising writing, and studying format. I also researched on the topic thoroughly. However, I did not manage very good results owing to my simplistic description of fascia and simplistic description of the RSI during my exam as I was unsure of the extent to which I should have described and examined the issues.

Evaluation

The experience was good as it exposed me to an exam set up where I am supposed to critically demonstrate my skills and knowledge in human structure and function. It was also good since I managed to record an improvement in my arguments, grammar, spelling, referencing and structure. Nevertheless, it did not go as expected as I was a bit simplistic in my approach and descriptions. The examiners' contribution was vital as it helped highlight the areas I needed to improve.

Action Plan

Going forward, I intend to read more on fascia, fascia therapies and RSI. I have already identified a good book that offers in-depth knowledge of fascia and which will help me better working according to OPS. The book is Tozzi’s (2012, p. 503-519) Selected fascial aspects of osteopathic practice. I also intend to liaise with my tutors to improve my knowledge as well as my senior colleagues. I plan to read more and practice my writing to improve my grammar, spelling and sentence structure skills.

Conclusion

I learnt that a deep and critical understanding of the structure, function and interconnectedness of musculoskeletal tissues with the neural system is critical. Besides, proper grammar, spelling, and sentence construction are essential in communicating one's ideas. I also learnt that it is important to improve one's knowledge of osteopathy by reading widely and consulting with tutors.

References
Tozzi, P., 2012. Selected fascial aspects of osteopathic practice. Journal of Bodywork and Movement Therapies, 16(4), pp.503-519.

B3-B3.3

000934523 — 2019-11-06 22:52:10 UTC

B3. You must keep your professional knowledge and skills up to date.

3.2. a knowledge of human structure and function sufficient to inform appropriate care

3.3 a knowledge of pathophysiological processes sufficient to inform clinical judgement and to identify where patients may require additional or alternative investigation or treatment from another healthcare professional

Description

Continuous learning and professional development are essential to refine our skills as osteopaths year after year. Accordingly, I intend to continue reflecting on the courses I have done lately. Besides, I seek to enrol in other courses. Particularly, I want to pursue Cranial Osteopathy immediately after graduation. I lately also completed a taping course that covered the safety considerations on taping and as well as the practical and related theory, which went a long way into improving and honing my taping skills. I also intend to actualise continuous learning with osteopathic clinics in London before graduation.

Feelings

After having read McDonald and Smith’s (2013, p. 438) article on the benefits and strategies of professional development and continuous learning I feel that I need more exposure to professional development and engagement to practice to hone my skills. With constant learning and development, I will be more confident and skilled in my field. I feel that the taping course I took will improve my skills in rehabilitating, and treating patients of all ages and activity levels to get the best out of them in terms of strength, health, activity and living with less pain and injury. As for the cranial osteopathy course, I feel that the course will impart in me the necessary skills needed to make differences at a deep level in patients.

Analysis

Reflecting on the courses I have done and pursuing new courses and professional engagement will ensure continuous learning and development, which is essential to improve skills, practice and learning. For instance, the taping course helped me learn how to physically hold muscles or bones in a specific position to reduce pain and aid recovery. The practical sessions instilled in me the skills and techniques to correct the fascia, space and muscle problems which will only make me a better osteopath. Besides, the cranial osteopathy course I am planning to take with the Sutherland Cranial College will expand my skills sets as an osteopath as it will allow me to undertake non-invasive procedures on patients to rebalance the systems of the body and enable them to work effectively once again (Csapo and Alerge, 2015, p. 451-452). Also, professional engagement in clinics through internships will provide me with a chance to observe other practitioners at work and thus instil in me hands-on skills.

Evaluation

I learnt under the tutelage of experienced leaders and practitioners in taping. The good thing is that the course offered both theoretical and practical skills in taping. There were practical classes to attend and video lessons to support the content learnt. The course was also very interactive. The students were supportive and created a group to share our learning experiences. Besides, the learning material provided was very comprehensive in content.

Conclusion

The taping course I did equipped me with hands-on skills on how to speed up the recovery time for muscle, ligament and tendon injuries. I learnt when to treat injuries using taping, how to support injured and overused muscles, how to relieve the stress on muscles, how to apply adhesive on tapes, how to use tapes to facilitate training and how to use tapes to encourage muscle movement and blood flow.

Action Plan

I will ensure continuous learning and practice through practising, revisiting learned material and taking other courses. I will ensure learning by monitoring the quality through constant feedback from tutors and colleagues. I will also ensure that I practise the skills I have learnt to ensure that they remain fresh in my mind, and I improve my learning curve.

References
McDonald, K., Charlene, M., Smith, M., 2013.

The Flipped Classroom for Professional Development: Part I. Benefits and Strategies. The Journal of Continuing Education in Nursing, 44(10), pp.437-438.

B2.1

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B2. You must recognise and work within the limits of your training and competence.

1. You should use your professional judgement to assess whether you have the training, skills and competence to treat a patient. If not, you should consider seeking advice or assistance from an appropriate source to support your care for the patient.

Description

Our tutors conducted several assessments in a series of five practical exams to evaluate our knowledge in treating patients in year three. The tests assessed, among others, information gathering, clinical examination, clinical judgement, organisation, efficiency and decision making. In the first test, I failed in clinical examination and clinical judgement. However, over time, I managed to perform above expectations in all the assessed units until I sat the end of year exam.

Feelings

After my first practical exam, I realised I was nervous while getting assessed. It was the beginning of the clinic, and I still was not sure how to go about planning my learning and what the expectations were. The first assessments results were not what I was expecting. However, I was optimistic that I would improve. Indeed, my preparation and hard work bore fruits as I managed to exceed expectations in subsequent exams. I was very proud of myself and my tutors. When we clinic started, I developed a fondness for the classes. I liked how the tutors conducted the classes and took in interest to learn.

Analysis

I achieved poor results as I had not yet mastered the proper way of articulating and expressing my knowledge in the context of an exam. I realised that adequate preparation was essential. During the year, I felt that I could do better in the remaining practical exams. I invested more time in my studies and consulted my tutors and colleagues. I learnt how to approach assessments more objectively. By the second and third practical exam, I had started registering better results. My efforts paid off, I met my expectations. This went on until I exceeded in the fourth practical exam and also got excellent results in the final practical summative exam.

Evaluation

These practical exams were an excellent experience to assess my adequacy in handling and treating patients. These exams also evaluated my knowledge in information gathering, clinical examination, teamwork, clinical judgement, and professionalism among seven other criteria. At first, I posted borderline results in clinical examination and clinical judgement. I knew I had to put more effort to obtain better results. Arguably, my tutors contributed immensely to my improvement but also all the reading and revising I did and observations carried out.

Conclusion

Based on the thorough training, and good performance registered in the last practical exams, I feel that I have now the skills and competence to treat a patient. I intend to maintain and improve my skills and knowledge by reading widely and consulting with tutors, colleagues and senior students.

Action Plan

I ensure that I will adequately prepare for the exams going forward. I will continue to revise and consult with my tutors especially when I am not familiar with the mode of assessment, as was the case with the practical exams. I also seek to consult the assistance of my senior colleagues who have done similar assessments and get insight from them. I also learnt to never underestimate an exam and thus prepare for it adequately by reading my course materials thoroughly. I will further develop my skills by reading and practising more to test my skills so that I can be more familiar with assessments and build my confidence. Going forward, I seek to leverage the help of my tutors,

B4.1

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B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

1. To achieve this you will need to have sufficient knowledge and ability to collect and analyse information and evidence about your practice to support both patient care and your own professional development.

Description

A patient came to me for treatment for bilateral shoulder pain and stiffness. All the previous practitioners provided her with a different diagnosis. One had diagnosed the patient with subacromial impingement while another had diagnosed her with tendinitis. Yet, the patient's condition was not improving upon treatment. I took it upon myself to analyse the patient medical history and previous diagnosis, including the tests done and the techniques employed. I wrote to the GP to rule out ‘Polymyalgia Rheumatica’. The results came out negative. Upon further examination, I realised that the onset of the problem had been insidious, and the coracohumeral ligament was painful when touched. AROM and PROM had significantly reduced. I diagnosed the patient with bilateral adhesive capsulitis, a condition that rarely affects both shoulders at the same time (Gonzalez-Gay, Matteson and Castaneda, 2017, p. 1712). I informed the patient that the problem goes away by itself, but it can also take 2 years. I informed the patient that as an Osteopath, I would perform therapy to ease the pain and make her shoulders more comfortable. I recommended six treatments as per NICE guidelines. The patient was pleased with the way I handled the diagnosis and treatment and sanctioned me to continue the treatment.

Feelings

I felt I had improved a lot about the way I considered a condition like PMR following my studies. I was glad that I could analyse the situation independently and come up with a proper diagnosis and treatment. I was also happy to have got assistance from the GP and knowing that I could count on them for support anytime. The idea of teamwork made me feel more at ease and safe from incurring liabilities alone. I would want to maintain my safety, especially because I am new at the profession.

Analysis

Things went well following a critical review of the patient’s history, tests and diagnosis. Leveraging my knowledge in shoulder pain and stiffness, I could tell that my colleagues had missed some issues while diagnosing the patient. The GP's assistance with the situation also helped the diagnosis and treatment success. I believe that sometimes the assessment of a patient from another expert is essential and results in a better diagnosis and treatment.

Evaluation

The good thing about the experience was the correct diagnosis and the help from the GP. Besides, the satisfaction of the patient and the go-ahead was appreciated. Nevertheless, the bad thing was that the patient got the wrong diagnosis twice at first. Practitioners should consider seeking a second opinion from other professionals or colleagues where they feel that their patient is not getting better.

Conclusion

I learnt that effective diagnosis and treatment needs a thorough understanding and analysis of the underlying problem to enhance patient care. Besides, it is crucial to seek support from other practitioners for the clarification of issues and to seek a second opinion. Accordingly, I learnt to develop and maintain cordial networks with my tutors and colleagues as you may need their help someday.

Action Plan

I need to devise more comprehensive assessments to gauge my ability to collect and analyse information and evidence on practice. I will also sign up for and attend forums, and seminars for health practitioners to build networks. I will also read more to familiarise myself with what I have already learned and seek knowledge on new practices for the continuity of development.

References
González-Gay, M.A., Matteson, E.L. & Castañeda, S., 2017. Polymyalgia Rheumatica. The Lancet, 390(10103), pp.1700–1712.

Year 1

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C1-C2

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Osteopathic Patient Evaluation and Record Keeping

C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients. C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

Description

A 32-year-old female hairdresser who has worked for 13 years, averaging 16-24 hours a week, reported having a headache, left neck pain and nausea without specification of the onset of symptoms. Right during this period, the patient started to wear glasses due to astigmatism and experienced stress due to her mum having a stroke. The type of pain the patient experienced was prolonged throughout the day, but it was dull and located on the left side of the head and neck (Appendix A.1). As a mother of two, the patient had her second child born through caesarean in 2014, and before that she had a tear operation after having her first child. The patient's medical history consists of a broken arm back in high school, an appendix removal at 15 years and a cyst removal under the left breast at 18 years. The appendix removal was a misdiagnosis since the underlying condition was mesenteric adenitis. CT scans done on the patient in May show no definitive cause for concern, but an MRI scan done in September recorded 'overactive nerves because of tension'. The patient was previously medicated with amitriptyline 30mg every night for six months and stopped using the drug due to reduced effectiveness. The patient does not smoke but drinks occasionally, and she does not exercise but formerly used to ski before stopping in 2011 (Appendix A.2). During my systemic inquiries, the patient mentioned fainting twice in June and July, and her cranial nerve screening was negative (Appendix A.3).

Critical reflection

The order of the case summary could have been done differently to provide a systematic view of the complaints followed by a chronological medical history for easier referencing and to provide a sense of order (Appendix A.4). There is lack of proper specification of the dates noted for the MRI and CT scans, and this does not conform with the General Osteopathic Standards Code C2, which requires that patients' records be written accurately and have full information (GOsC 2018; Appendix M). Advice given to the patient and justification sections have not been filled out, and this might make it hard for other medical professionals to identify tests that came out positive without referring to other pages in the form. The case summary lacks information on progressions, daily patterns, aggravating and relieving factors, previous episodes and the severity of symptoms (Appendix A.4). This information is useful in aid of continuity of care and coordination of care (Mathioudakis et al. 2016). The diagnosis could have been shortened by writing it in a professional manner, excluding all the unnecessary findings and only documenting the main causes. I should have specified the area I was referring to while talking about the erector spinae muscle. I should have questioned the patient about her stress levels, as stress and other psychological factors can cause physical symptoms like aches, pain and tense muscles (Karriem Norwood 2017; Appendix A.1). I would have gathered clearer information by finding out about her right arm that she broke and how the patient progressed towards healing after the caesarean and tear operations, as well as if she feels like she fully recovered from them. I could also have asked if she felt no headaches while not wearing her glasses (Appendix A.1). My way of writing notes should also be more medical so that all the professionals can understand elements like Ø ↑ ↓ (Appendix N.1; Appendix N.2). It is also important to consider the chemicals the patient might have inhaled because of her occupation, as well as how standing up tending to her clients might have resulted in muscle and spinal stress (Berbari 2017). The patient’s physical and mental nature is characteristic of her ectomorphic biotopology, as she was small, slender, delicate and extremely sensitive (Hruby et al., 2017, p. 352; Appendix L). Biotypology tends to make general classifications of individuals, and in this instance there is an apparent connection between the soma and the psychological attitudes were evident of someone who is ectomorphic (Appendix L; Appendix A.1; Appendix A.2).

List of DDs & justification of working diagnosis, summary of treatment and management plan, critical review and reflections.

My first differential diagnosis was a cervicogenic headache, due to the patient having unilateral pain radiating from her C7 upwards and reduced head movement (Appendix A.2). Her C2 cervical facets were irritated, and observations showed forward head carriage and protraction of the shoulders, a significant cause for this type of headache (Moore 2004). Other considerations like job-related stress should have been assessed. The patient's pain kept recurring until treatment 8, when the pericardium restriction was released (Appendix H). A visceral screening could have helped in tracking the patient's symptoms. I should have done it from the beginning when the patient reported her mother had a stroke the same month the patient’s symptoms started (Appendix A.1). Cervicogenic headaches should only last for an hour to a week.
(Haldeman & Dagenais 2001), but the patient had pain for almost five months. Another differential diagnosis was tension headache, but considering the pain was unilateral that rules out this diagnosis because tension headaches are bilateral (Chowdhury 2012).

Also, the remaining two differential diagnostics were overactive autonomic nervous system and vertigo. The first one was mentioned earlier by the patient and could have been a possible diagnosis, but she did not have any data about her previous diagnosis that could have provided more information (Appendix A.2). According to Koopman et al. (2011), overstimulation of the autonomic nervous system means that the adrenals could be in a hyped state; for example, because of a hormonal imbalance such as a thyroid problem or osteopathically following a restriction of the sympathetic chain ganglia next to the spine. So at this stage of the interview, it would have been worth asking for information regarding periods, as menstruations can be affected by hormonal imbalances (Huizen 2018).

The General Osteopathic Standards C1 (Appendix M) requires osteopaths to have the capacity to perform a patient evaluation in order to deliver safe, competent and appropriate osteopathic care to our patients. During active testing, rotation of the cervical vertebrae was reduced by almost 50%, and also side bending to the left was slightly reduced (Appendix A.3). Palpation revealed left erector spinae muscle in the thoracic area, left rhomboid and left trapezius hypertonic, and it was painful to touch, which makes sense if facet capsules are inflamed as they will irritate the muscle attached to it (Kirpalani & Mitra 2008). For instance, the erector spinae and trapezius insertion points are on the neck. C2 right facet and left facet of C4 to C6 were irritated but also C0-C1. The examination also revealed congestion of the pelvis following

a functional test and a lack of movement which was reducing the fluid flow. Later on in treatment number 3 (Appendix C), following FADIR and FABER tests, we found out that patient had potentially right and left femoral acetabular impingement. Imbalance of the pelvis can alter the structural curvatures of the spine up till up to vertebra C0 (Lazennec et al. 2011). Restriction in C0-C1 can mechanically load C2, which then gives greater occipital nerve irritation. This causes headaches, as it supplies the scalp and the semispinalis capitis (Greher 2019). Restriction in C0-C1 can also irritate the Vagus Nerve hence nausea, which the patient was experiencing (Breit et al. 2018). Blood pressure and pulse was in the normal range, though the cranial nerve screening was negative. No enlarged lymph nodes have been detected, which could have been a clear sign of an infection, and considering the case history this was very unlucky and would indicate that maybe this screening was not necessary (Appendix A.3).

In regards to the General Osteopathic Standards Code 1 (Appendix M), I was required to provide appropriate treatment to my patient; therefore, I incorporated spinal oscillation from C7 to L5 until the patient was well relaxed and a rhythmic movement pattern was established. In osteopathy, the body functions as a unit and therefore treatment must also benefit the whole body and not remain focused only on the affected part. Each part of the body can have a significant effect on the other parts, and that is why osteopathy requires the body to be considered as a whole (Stark 2013). I went forward to carry out the inhibition of the left erector spinae and left rhomboids to reduce the hypertonicity of these muscles, promote the stimulation of the golgi tendon organ and muscles spindle, and to improve posture, reduce hypertonicity and lengthen the muscle, opening the thoracic cavity. Free flowing blood and lymphatic fluids help the body in

performing its normal functions but in the event of physical or emotional trauma, bodily tissues will experience contraction, compression or twisting and this will reduce flow throughout the body (Swartz 2001).

The pivot T9 was also not moving correctly, and I had to carry out a high velocity thrust (HVT) and adjust it following consent (Appendix A.4). This HVT technique in the thoracic spine was carried out for all of the 9 treatments. Pivots are essential in the coordination of spinal movement, and they also divide the trunk imaginatively into two cavities (Hebgen & Richter 2009). I carried out neck articulation from C0 to C7 to help in decompression of the cervical spine, reduce tightness, stimulate the cervical ganglia and promote vasodilation of arteries and veins in the neck, making use of the osteopathic principle ‘the rule of the artery is supreme’ (Lason 2019). It was interesting to find out that I diagnosed a congested pelvis in part of my first consultation, but no work on the pelvis was done (Appendix A.4). If it was a true primary somatic dysfunction as thought, we should have addressed that first for the dysfunction and symptoms to disappear. Considering that both the short-term and long-term goals were not related to the pelvis also justifies why we did not pursue that angle even though it contradicts the diagnosis (Appendix A.4). The short-term goal was to release muscle tension in the upper thoracic and neck to reduce pain, while the long-term goal was to carry out treatments to open up the chest cavity to improve posture (Appendix A.4). According to the GOsC (2019), the objectives of a treatment plan should consider:

· Other healthcare professionals’ contribution to guarantee patient care according to Code D10 (Appendix M).

· Listening to patients and respecting their concerns and preferences according to Code A1 (Appendix M).

Final critical review and reflections

During treatment number 2, the patient reported her situation as improving at a rate of 4/10, but the pain severity remained at 5/10. I decided to incorporate hip oscillation and articulation (Appendix B), and when she returned for treatment 3 she expressed feeling better only after the procedure. However, upon going home, the severity rose to 9/10. Also, she reported her neck and head pain to have risen too at a severity of 8/10. (Appendix C). Osteopaths should be patient and considerate with their patients, and upon her coming back for the third treatment I switched to working only her upper spinal region (Appendix C). I kept questioning why the patient felt pain after the second treatment considering the fact that it was gentle and intended on opening up the hips. A tutor's advice stated that articulation of the hip of someone who might have femoral acetabular impingement may have made things worse (Terrel & Lynn 2019). The best solution was to consider hip strengthening options targeting the extensor muscles and external rotators while stretching the hip flexors and internal rotators (Wright & Hegedus 2012). I explained how these exercises would be carried out during the fourth treatment of the patient

(Appendix D). She came back for treatment 5 and 6 because the pain remained at a severity of 5/10, with the problem improving right after treatment but worsening after some time (Appendix E-F). At this point, I decided to try fascial unwinding of the cervical and upper thoracic fascia during the 6th treatment. This procedure helped because when the patient came for treatment number 7 she only had neck stiffness but was free from pain. According to osteopathic medicine the body can also heal itself (Paulus 2013; Appendix G). During treatment number 8, the patient lacked symptoms such as headache, nausea and neck pain, but experienced some tension in the shoulder blades (Appendix H). A tutor helped me discover a restriction at the pericardium which I released through balanced ligamentous tension (BLT) of ribs 8,9 and 10 on left side. During treatment number 9, the patient was free from any pain or any other symptoms from her condition, and there was no need for her to be treated; therefore, we advised her on a few exercises that she could do to improve the posture of her neck and head and prevent suboccipital compression (Appendix I). My learning process in this situation involved carefully examining the patient’s tissues to understand exactly what structures and what system of the body wanted to be released and to see where the tissues were drawing me. I would then be able to become more effective in treating my patients and perfecting the art of osteopathy as a professional.

C3.1

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C3. You must respond effectively and appropriately to requests for the production of written material and data.

To achieve this you will need to:

3.1 produce reports and referrals, and present information in an appropriate format to support patient care and effective practice management

Description
On the 10^th of February, I needed to compose a letter of referral for one of my patients.

Feelings
I felt an awareness of other's expectations. At the point when you keep in touch with another expert, you have to guarantee it is syntactically right, brief, and utilising medical words. In a manner, this is how we are introducing ourselves to others. On the off chance that a letter isn't done properly, at that point, they will think we are not proficient, and our notoriety lowers. I can't permit that. I felt the process of writing a referral letter was straightforward mainly because I could take a look at others' work.

Evaluation
I thought it was a straightforward errand, particularly because I followed the format of different past referrals composed by the college. On the other hand, though this patient had unique symptoms compared to the others whose referrals had already been written and therefore it required more considerations.

According to Bosner & Hartel (2014), treatment needs to be tailored to an exact diagnosis

Analysis
I asked my tutor to check the letter and then I relied on his feedback to make improvements such as including missing information and updating the format. The feedback helped me understand the best presentation to ensure it was professional and effective.

Conclusion
I believe I could have possibly given more data and be progressive. That would have entailed conducting additional research to provide additional details and background to support the letter, ensuring it was comprehensive from scratch, since I'll be autonomous when qualified. The letter did not provide entirely what the tutor wanted. I had to review the tutor’s initial instructions to provide everything that was required but felt in the end comfortable and prepared for future referral letter writing

Action plan
Before leaving the University, I'll carry with me a duplicate of the considerable number of referrals situated at reception and done by my previous colleagues. My plan is to change them in a computerised version. So, I can generally allude to the past work done by my colleagues, at any rate. So, I know that work has been checked by a tutor and any weaknesses or errors have been dealt with accordingly. I will also make sure that the content I have is liable and of great necessity to the patients. Yearning to learn more has been my integral part of learning and sure enough, I know that I will learn more and more with regards to this matter. I will follow the instructions as per training and ensure I follow them to the latter to ensure that I maintain the necessary requirements to offer the best in this field.

I also read several sources to help with the matter including Gremigni, Casu, and Sommaruga, (2016) which enhanced my understanding about the importance of self-assessment to improve my skills and abilities. Another source that was insightful was by Leon et al. (2018) that helped me improve my understanding about how to use the work by previous colleagues to improve my knowledge.

De Leon, J., Wise, T. N., Balon, R., & Fava, G. A. (2018). Dealing with difficult medical colleagues. Psychotherapy and psychosomatics, 87(1), 5-11.

Gremigni, P., Casu, G., & Sommaruga, M. (2016). Dealing with patients in healthcare: a self-assessment tool. Patient education and counseling, 99(6), 1046-1053

C4.6

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C4. You must take action to keep patients from harm.

4.6 You should have an awareness of, and keep up to date with, current safeguarding procedures, including those relevant to your local area, and follow these if you suspect a child or vulnerable adult is at risk.

Description

I did two courses later on this year and earned two certificates on two different subjects: female genital mutilation, recognizing and preventing; second one was about radicalization. I achieved both at the university through videos and online training. But also had a one to one meeting with the welfare team regarding safeguarding. Attached are my certificates.

Feelings and thoughts about the experience
I never thought about female genital mutilation, and I felt heartbroken and miserable for all the individuals that have to experience that.

Evaluation of the experience, both good and bad
Training was great and useful since I learnt a lot and had a chance to make use of the skills I had been taught in class. Indeed, I could not disappoint myself and my tutors. All was a success. Interaction with other colleagues made me feel some sense of belonging and those indeed saving lives were one of my callings. On the other hand, time was not enough to complete whatever I had intended to learn. Before I knew, the training was already over yet I yearned to learn more. However, not all was lost, I am planning to watch some TED Talks and read some books with regards to this topic and I hope to learn more.

Analysis to make sense of the situation
My colleagues thought that training was just enough to start off work as an Osteopath and that they gained what they needed. My tutor instead talked on the need to do more research and come up with new ideas as professionals on how these deaths could be avoided. I think that to become the best and offer high quality services to patients, we should learn to identify the roots of the disease probably by studying their areas of residence and learn how they live and understand better their culture. This will in turn help in the diagnosis, safeguarding and also develop more skills in this medical area.

Conclusion about what you learned and what you could have done differently
In conclusion, I learnt that indeed to practice and study helped develop my career by far and I should dwell on improving my content not only by reading a wide variety of books but also by improving my skills in training. Moreover, I should make good use of my tutors and colleagues to guide me towards improving my knowledge and my skills too.

Action plan for how I would deal with similar situations in the future, or general changes I might find appropriate.
Regarding my action plan, in the future, when such situations are presented to me, I will ensure that I handle it at a professional level to know why and how patients in a particular area get to involve themselves in such deadly activities. I will also seek help from the necessary authorities and other professionals to denounce these activities and also to help in creating awareness. I feel that this will help save a lot of lives and reduce the burden of illness.

C5.2 & D1.3

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

5.2 You must have adequate public liability insurance.

D1. You must act with honesty and integrity in your professional practice.

3. You must have a professional indemnity insurance arrangement which provides appropriate cover in accordance with the requirements of the Osteopaths Act 1993 and the current Professional Indemnity Insurance Rules.

Description
Working in a clean, safe and hygienic environment is one of my core values in my entire osteopathic practice. Furthermore, I will ensure that it is in line with health and safety legislation. Indeed, there is a necessity of adequate public liability and professional indemnity insurance. Balens insurance policy devised a policy specifically for osteopaths that cover professional, public and products liability. It can cover a number of different activities subject to you holding a qualification. Cover for Osteopathy starts at £395.00 for a qualified individual or £78.87 for student cover. They offer a 30% discount to first year graduates. They also offer the possibility to osteopath to pay the premium by direct debit. If we wish to use this facility there will be a 9.50% interest charge. On the other hand, the iO offers an insurance cover for Osteopaths of £10 million. By paying £306 per annum or £25.50 per month by direct debit. First year graduates (£5million cover): £183 per annum or £15.25 per month by direct debit.

Feelings and considerations about the experience
I feel it's fundamental nowadays to be insured, particularly to be protected from patients that attempt to make cash by filling complaints. I feel this university has prepared me for that. I feel that these insurances are of help both to the Osteopath and also safeguards the patient. I have a professional indemnity insurance arrangement at the moment with ‘Protectivity’ which provides appropriate cover for my work as a Massage Therapist and Fitness Instructor.

Evaluation of the experience, both great and awful
It’s is quite easy to buy cheap insurance nowadays but what we should all do is to read in detail all their policy and terms and conditions to ensure it is not a scam and what they really cover. For example some insurance companies don't cover you for medical malpractice.

Conclusion about what I realized and what I could have done any other way
Considering the two and my needs I feel that the insurance with the iO fits better how I want to be protected.

Action plan
As my action plan, in the future, I will ensure that I consider the ethical and professional guidelines for safe practice. This means to follow the policy and procedures of the company I work for, the OPS and the Insurer Terms and Conditions to ensure best and safe practice. Moreover using my other inherent ethical considerations to make the right choice when the situation is presented. I think that different problems need diverse solutions and common sense to safeguard the patients.

The additional readings I carried out include Schroeter (2017) which helped me understand the diverse nature of ethical decisions, and how to act with integrity. This will be very influential in the future for me when I will have to face ethical issues.

References
Schroeter, K. 2017. Ethics in Practice: From Moral Distress to Moral Resilience. Journal of Trauma Nursing, 24(5), pp.290 - 291

C6.1

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

6.1 You should be aware of public health issues and concerns, and be able to discuss these in a balanced way with patients, or guide them to resources or to other healthcare professionals to support their decision-making regarding these.

Description
As a professional osteopath and part of the healthcare sector, I should be aware of public health issues and concerns, and be able to discuss these in a balanced way with patients; moreover I should be able to guide them to resources or to other healthcare professionals to support their decision-making if needed. For example, my dissertation was - ‘In people who are sexually active, how does the use of pre-exposure prophylaxis (PrEP) compared to condom use affect the risk of sexually transmitted diseases (STD) and risk compensation?’ This is for example one of the latest topics. The NHS is doing a trial to know if they can afford to pay for this medication and if it is something good as other STIs might increase. With the IMPACT Trial, PrEP has been made available to 10.000 people in the UK. This medication has side-effects and consequences. I updated myself in regard to this topic. If I'll have a patient coming to my clinic and taking this medication I will be able to understand if the symptoms he is experiencing are because of the medication or not. Moreover, having the knowledge allows me to choose the best techniques for these patients. For instance, If they have been on this medication for more than 5+ years they might be at risk of osteoporosis. I ought to know more about general medical problems and concerns, and give myself the option to examine these topics decently to best guide patients.

Feelings and considerations about the experience
I feel very passionate in regards to healthcare and to keep myself updated with regards to what’s happening in the world is not a problem as it is a passion.

Evaluation of the experience, both great and terrible
The beneficial thing is that I contribute to enhance the health and well-being of my patients. Many patients will gain from my expertise and skills, and this will result in improved outcomes. My work will also help me learn more about the needs of my patients and the best way to meet their diverse needs. A negative experience arises from difficulties that can arise such as patients not cooperative or difficulties in meeting their needs.

Action plan for how I would manage comparable circumstances later on.

I signed up to all the central medical journal newsletters, to the care quality commission mailing list, and I get updates from the NHS too directly in my mailbox. A valuable reference that helped includes the resource by Hegarty and Wusteman (2018), which helped me understand and gain awareness about several resources and databases that I can use in the future that can provide information such as EBSCOhost.

Conclusion
If patients come talking about medications or new surgical procedures that I’m not aware of I’ll look them up. It happened with a patient coming in the clinic saying he had a procedure called prostatic artery embolization (PAE). I looked into that, read the RCTs and Trials and checked the NHS website to understand better the risk and the care that these patients need before and after this procedure since it is a fairly new one.

References
Hegarty, R. & Wusteman, J., 2011. Evaluating ebscohost mobile. Library Hi Tech, 29(20), pp. 320-333

Children Clinic

000934523 — 2019-12-18 10:37:50 UTC

Most people do not think that babies and toddlers can benefit from osteopathic treatments, but many babies all over the world are being checked by osteopaths at birth. Babies and toddlers are more vulnerable as compared to adults and when they are not healthy, they seem so weak and of course they cannot manage their condition by themselves. Throughout the 4th year I took case histories, carried out examinations and treated babies and toddlers with Osteopathy.

Feelings

It was particularly interesting since I was learning how to best communicate with the child, for them to follow my guidance during treatments. This was essential, and I achieved it by interacting and playing with them during the sessions.

Evaluation
I learnt how to develop good relationships with parents during the process of providing care to their toddlers. This was an effective way to also involve them in the process and provide them with all the feedback needed.

Analysis

Sometimes a child needs specialised care that is not osteopathy and according to their circumstances. In such instances, it would be wise to also consider the help of other healthcare professionals/experts (i.e. tongue tie practitioners)

Conclusion

Sometimes it can be hard to pinpoint the problem affecting toddlers since they cannot speak. However, other approaches can be used to determine the issue and parents are crucial during the intervention process.

Action plan

I'm considering studying towards a PostGrad Cert. in Pediatrics at the UCO in London this coming September to improve my expertise when working with babies and children. An interesting article that I read was by Marks, Huws & Whitehead (2016) that revealed how many professionals lack awareness about how to deal with toddlers.

References
Marks, M. R., Huws, J. C., & Whitehead, L. (2016). Working with uncertainty: A grounded theory study of health-care professionals’ experiences of working with children and adolescents with chronic fatigue syndrome. Journal of health psychology, 21(11), 2658-2667.

Sport Clinic

000934523 — 2019-12-18 10:40:57 UTC

Description
I had a patient diagnosed with fibromyalgia, a chronic condition that causes pain in the joints and muscles. The patient came to receive advices about his condition. He was an ex football player, and the condition had delayed him to go back to the field. The patient explained to me some of the symptoms he was experiencing at that time. I advised him on some therapies he could try to see if they were of any help, such as physical therapy, massage, yoga, exercises, and a healthy diet (OPS D10) but he wanted a quick fix and to be helped with just one treatment and by taking painkillers. Truth is, Mr X did not have much knowledge on his condition.

Feelings

I enjoyed working in the sport clinic since I got the opportunity to meet patients with diverse conditions, like the one previously mentioned, which allowed me to learn about ways of solving different problems. The interactions were fruitful, on both sides since he was Jewish and that gave the opportunity to learn a lot about their culture. The patient was cooperative and took my advice positively. It was a good experience considering that the client wanted my services again. I understood that patients have their preferences, and some of the issues facing them might require additional tests and the opinion of other experts (D10).

Evaluation
I spoke to one of my colleagues about the situation, and he confirmed that the best solution for fibromyalgia patients is to prescribe a combination of different therapies (i.e. dry needling). However, considering our osteopathic approach, range of techniques and the training received, we can be the ones offering a multidimensional treatment

Analysis
The patient with fibromyalgia made me appreciate the different ailments patients have, which could also be caused by other underlying issues that need to be investigated. It can be hard to advise a patient if they have already views about the techniques they expect from you that day; as a professional, I have to make my own decisions and choose the approach that will best result in long term benefits rather than carrying out something quick and potentially not effective

Conclusion
To conclude, the sport clinic improved my awareness of the different health issues that patients undergo and the need to resolve them. I learned how to apply my knowledge, including my skills in sports psychology, nutrition, and other challenges leading to improved outcomes.

Action plan

In the future, I will rely on the assistance of other professionals, such as athletic trainers and physical therapists, when coming up with a practical exercise regimen for clients (D10). For fibromyalgia patients, something different I would do next time is spending some extra time in educating them about their condition since patients are not aware it is a condition that can amplify the way brain process signals of pain. I read a book by Reeser & Bahr (2017) that spoke about how experts in sport medicine have to consider different variables such as patients medical history to ensure clients perform at optimum in sports.

References
Reeser, J. C., & Bahr, R. 2017. Handbook of sports medicine and science, London: John Wiley & Sons.

D2

000934523 — 2020-02-21 19:16:20 UTC

You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

Description
I've been handed over a patient that didn't speak any English but only my mother tongue. When I met this patient for the first time she was in an emotional chaos. While performing BMT of the sacrum, she cried. She kept talking to me about all her problems and after the treatment I felt depleted and I didn't manage to finish the treatment on time. She persisted and she continued asking me lots of questions and I faced the same issue additionally for the following 5 treatments. At treatment number 5 the patient expressed to have discovered my profile on Facebook and inquired as to whether she could have added me among her friends. The patient additionally gave me her business card and offered me a 30 minutes Shiatsu treatment free of charge. The patient additionally requested my email. I informed the patient I only have family members on my Facebook. I took her business card and questioned for a second to whether giving my email was something acceptable since she requested it. I thought I had a professional student email from the college and that I could have given that.

Feelings
I felt exceptionally depleted. This patient was exceptionally needy. Whenever I realised, I had her and I was setting my intention to complete the treatment on time, it never occurred and started treatment for the following patient later than due. I'm usually very grounded and I'm usually great in setting precise boundaries and define my limits in both my personal and professional life; however, it is additionally evident that occasionally I permit individuals to exploit me as I can be sometimes excessively acceptable.

Evaluation

I had a level of boundaries since I had my coat on; I didn't talk about my own life and acted professionally throughout the treatments. I additionally said 'No' when the patient asked me to accept her friend's request on Facebook. Unfortunately, I permitted this patient to take additional time than what she was paying for and I permitted her to dump every one of her issues on me, and I let this stuff impacting me to the point I was very ungrounded after giving treatment to her. I gave her my professional email cause at that time I felt it was ‘OK’ to do that but thinking about it I shouldn't have given it to her.

Analysis

I'm a delicate soul and sympathetic. I comprehend the significance of listening 360 degrees and in all manners through palpation, ears etc. yet I was feeling depleted after treatment with this patient, and I understood I had to learn how to strengthen my boundaries. Furthermore, I can't permit patients to compromise my integrity since I have an extensive rundown of patients in a day. I spoke to a tutor about this issue; however, I don't recall particular guidance has he had his own schedule and no time for this matter that day.

Action plan

I went on a ‘grounding and protection course’ in London and from 10 am till 5 pm I experienced a wide range of grounding and protection techniques. I believed after this course I had a clear understanding of what it means to be well grounded and protected. In life and in practice I have to use more regularly the word 'NO' for a matter of self-preservation and integrity, since I’m planning to carry out this job for a long time. Lambert (2018) suggests that being well grounded means having specific principles and objectives which guide practice. This is important to ensure that I have the right principles that are required for the profession.

References
Lambert, K. 2018. Well-grounded: The Neurobiology of Rational Decisions. London: Yale University Press.

D3

000934523 — 2020-02-21 19:22:28 UTC

You must be open and honest with patients, fulfilling your duty of candour.

Description
I have a duty of candour which I have to consider when dealing with patients. I am always very clear with them. I always inform and explain to them what could harm or improve their general health. I'm able to apologise if something is not done appropriately and also try to provide a solution if possible and when needed. Patients have to be informed at all times and this means to communicate properly in order to deal with the general issues that can arise. This also entails telling them the long- and short-term effects of a decision or occurrence. Honesty and openness encourage patient to interact and to talk to their practitioner.

Feelings
In order to be honest with other people, it has to start by being honest with ourselves. As long as we are honest with ourselves and we are objective in what we are doing then we are on the right track. That's what I feel. If I'm honest with myself, I'm clear and mindful on what's occurring inside me and the truth that encompasses me. It implies that I assume liability for whatever is going on inside me and outside, giving also to myself the opportunity to misunderstand things since I'm a human being that can commit errors and not a machine.

Evaluation
I began to gain awareness about the importance of interacting with patients. Being open with them also means that they will also feel free to interact and communicate openly with me. It also means that I will look more friendly to them. This is an integral aspect of a good relationship with patients that leads to positive outcomes.

ie. once I informed a patient that her current eating patterns were not healthy and the problems she could have encountered in the long run. The patient was happy about the insights I shared with her. Since I was natural in my manners, professional and open from the beginning, she was willing to listen to me.

Analysis
I'm an honest individual. I understand the importance of honesty and I easily integrate that it into my interactions since it is a part of who I am. I know that patients want honesty since they rely on care providers for ensuring that they go back to good health.

Conclusion
As an osteopath, I have to be honest in my dealings because every action I take may cost someone’s life. Moreover, the reputation of this sector depends also on me and I cannot dwell on dishonesty.

Action Plan
I will ensure that honesty is upheld and regarded in my area of service. This means that I will encourage my colleagues to be honest when dealing with patients and being open with them. I will act as a role model to show the importance of honesty and the benefits that would arise. Timmins (2018) suggests that honesty is one of the values that guide ethos and other actions. It leads to improved relationships between people.

References
Timmins, F., Johnson, M., Cullen, J.G. & Haigh, | Carol, 2018. Altruism, Honesty And Religiosity In Nursing Students. Wiley Online Library, 27(19–20), pp.3687–3698.

D4

000934523 — 2020-02-21 20:22:16 UTC

You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

Description
Patient complaints have to be taken seriously to ensure that they get the right services and assistance. If a patient makes a complaint, then the process will entail listening, recording the complaint and also record the actions taken. Patients should be aware at anytime of the complaint procedures a clinic has in place, their rights and the possibilities they have to escalate the matter to the GoSC. If the patient complaints about issues regarding a clinic for simple misunderstandings then the best solution is dealing with them directly (i.e. be more punctual, increase work availability, re-assess the patients conditions for best evaluation if patient complaints about his problems are not getting better). It is important to understand properly the problem to determine the best solution. I could also refund potentially the patient if a refund policy has been put in place.

Feelings and considerations about the experience
I feel it is of importance to respond quickly and appropriately to any complaints that arise and handle that at hand when the need arises. Some complaints are urgent, and they can become something bigger if not handled swiftly. If complaints are handled, then the patients will feel happier and more satisfied with the quality of services provided by the clinic. Complaints might also reveal the things that patients do not like and be a great opportunity for personal development.

Evaluation of the experience
The only way to meet someone’s needs is to encourage them to provide feedback, and in some cases, it can come in the form of complaints but still they should be taken positively and handled professionally for the ultimate goal of their health and well-being.

Analysis
I always want to do my best, and I do not get happy when faced with negative feedback or complaints since it means I have not done something correctly. On my shoulder I have many years of experience and since I work with care and I have always been professional I never really had to face a formal complaint at work. I'm aware I can consider a high-ranking person to help me deal with the issue. This can be useful, especially when I need the assistance of a more experienced professional that could handle the issue legally in the best way.

Conclusion
Any staff should always be honest in his or her work. This is crucial to avoid problems and also encourage interaction and feedback between staff and patients.

Action plan

If the situation falls out of hand, I will consult my colleagues or even seek assistance from my insurance company. I will for sure follow the procedures put in place in my workplace. Record Keeping is key. In the future I will ensure I listen to all the complaints keenly and make sure they are dealt with immediately. I’m also going to create a policy with regards to complaints and how I will handle different situations, such as escalating the issue or handling it on my own. I will look at other colleagues' policies before writing mine but most luckily for this delicate matter I'll make use of the services of a lawyer to ensure everything is written following the law. I will rely on evidence-based picric which can be beneficial. An interesting source I reviewed was by Lee-Treweek (2002) which reveals that cultural issues are causes of the conflict some osteopaths' experience at work.

References
Lee-Treweek, G., 2002. Trust in complementary medicine: the case of cranial osteopathy. The Sociological Review, 50(1), pp.48-68.

D5.3

000934523 — 2020-02-21 21:56:52 UTC

You should have adequate and secure methods for storing patient information and records. Patient records should be kept:

for a minimum of eight years after their last consultation
if the patient is a child, until their 25th birthday.

Description
I should have a written policy regarding retention, transfer and disposal of patient information and records, which should include whether it is my practice to retain them beyond eight years, or, in the case of a child, beyond their 25th birthday. My patients should be made aware of this.

Moreover, I must comply with the law on data protection and associated legislation. For further information on data protection, I should refer to the website of the UK Information Commissioner’s Office.

Feelings

I feel eight years is quite a while and considering the fact I may work in different clinics and nations I believe I would prefer not to carry these documents with me. Furthermore, how am I going to keep patients informed on what occurs with their information?

Evaluation

Fortunately, these days, all the records can be uploaded on the web through a practice manager software and can be stored in a secured manner according to the law. For example, https://www.cliniko.com/security store data keeping it encrypted using HTTPS (end-to-end encryption). They use a 2048-bit SSL certification for encryption in transit. All data is also encrypted at rest and backed up daily, using the industry standard AES-256 encryption algorithm. Cliniko stores and processes data in Australia. It’s also processed in the US, UK and EU by their infrastructure and communication partners, to provide us with the best service possible. They ensure that they meet high standards of privacy, security and confidentiality.

Action plan
I can hire a company that can help me writing the policy and procedures ensuring I’m complying with the law. I can also inform the patients on how we store their data when filling the consent form at reception during their first consultation.

Analysis

Some of the software that I considered that is applicable to osteopathic clinics include 75Health that is a cloud-based software that is free and is used in storing and managing patient digital records. Another option is OpenEMR. This could be a good option since it is open source and free which means it can be customized to different contexts. It also provides policies to guide how patient information is handled.

Conclusion

I will ensure to have adequate and secure methods for storing patient information and records including a written policy regarding retention, transfer and disposal of patient information and records. Luckily all the files can be safely stored online. Balaji et al. (2017) reveal that patient records should be saved using security protocols that protect the data. This can include delegating partial access rights to patients where they can also access their information and ensure it is valid. Luckily companies like 'Cliniko' have all of that already setup and the GoSC helps us to clearly understand the requirements to work according the country health laws.

References
Balaji, R. N., Rahul, P. B., Raj, K. N., & Balachandar, K., 2017. An Efficient Secure Protocol for Storing and Retrieving Health Care Records in Cloud Environment. International Journal Of Recent Technology and Engineering, 8(4), pp.205-311

D6

000934523 — 2020-02-21 22:11:50 UTC

You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

You should be familiar with the requirements that apply to you under equality law.

Description
All patients should be treated with an equal measure of respect. All human beings are equal in the presence of rights granted for life. Patients should be treated fairly and as professionals we should recognize diversity and individual values. I must comply with equality and anti-discrimination law.

Feelings
I would be furious about a health professional who would fail to attend to a patient based on their colour, sex or gender. I will ensure fairness in my area in the future. I think patients deserve care despite their background. Cultural awareness is important since it can help healthcare professionals accepting diversity more easily. It prevents misconceptions that can arise which will make it harder otherwise to improve a patient’s health outcomes. I feel that it is crucial to follow the required ethical practices that apply to the profession, and that includes treating everyone with an equal measure of respect. I think this is the best way to ensure that I provide the best services as an Osteopath.

Evaluation

Discrimination evokes anger and unhappiness and especially to the patient who is on the receiving end. It will be hard to properly help a patient to recover if the Osteopath does not properly care about their well-being. Moreover the patients will spend more time focusing on why the Osteopath don't treat them equally. This matter can also lead to risks such as wrong diagnoses. Discrimination should be avoided so that patients get the right care and do not suffer due to their culture or background.

Analysis

The attitude and response of the patients may indicate how they feel about us or towards a particular member of the staff. If a patient complaint about a member of staff, then it would be wise to find the reasons why and the best way to improve the interactions. A patient can also decline being taken care of with particular members of staff and this could be because they feel discriminated. As a professional I must be aware of that.

Conclusion

All patients have rights and they should not be discriminated against. Despite the differences, the patient still deserves health care. Cultural awareness is important since it would help me understand the differences and the beauty behind them. I will ensure fairness in my area in the future for the reliability of both the patients and my colleagues. This will improve my interactions with my patients.

Action plan

I would lead by example by serving all the patients without discriminating against them. I will not use the patient’s race, ethnicity or background as a reason for not providing care. Instead, I would ignore these variables by ensuring that any patient who needs my help is satisfied.

Srivastava (2007) reveal that as a healthcare professional, I should be aware of different cultures and avoid stereotypical beliefs that will make it harder to provide quality healthcare. Discrimination can be very discouraging for patients, and this can only be avoided if they are not mistreated.

References
Srivastava, R., 2007.

The Healthcare Professional's Guide to Clinical Cultural Competence. USA: Elsevier Canada

D7.2

000934523 — 2020-02-21 22:34:53 UTC

Upholding the reputation of the profession may include:

2.2 showing compassion to patients

Description
It is imperative to show compassion. Compassion means being empathetic to the suffering and pain that the patients undergo (Goetz et al. 2010). Compassion is crucial to make sure that patients feel comfortable about the care even if they are undergoing emotional or mental stress, in pain or suffering. Compassion ensures that patients have confidence and support they need to get ready for a long recovery or even a scary procedure. It is difficult to know the level of compassion the patient perceives, and the only option is to act professionally while being empathetic, understanding and talking to patients which can help gage how that feels and if they are getting the right kind of care. (Goetz et al. 2010)

Feelings

One's conduct at work determines the type of relationship he or she will have with others at work. By being compassionate, I can be able to use my deeds and actions that entail the emotional aspects of the relationship with the patient. This can lead to a positive outcome since it results in self-gratification among patients. This will also ensure I am more connected to them.

Evaluation

A well-behaved person is respected at work. This will also mean that everyone in the workplace loves working with them and is willing to interact with them. Since the person exhibits empathy and kindness, others will also be willing to reciprocate their kindness.

Analysis

Fights and quarrels are common in places of work when the code of conduct is not upheld. These conflicts can make it harder to meet the needs of patients. When there are no rules, then it becomes harder to determine the best solutions to problems, and this also means that issues can arise often.

Conclusion

From my own experience I realized that misunderstandings are quarrels that often arose when some staff members do not work ethically. I would restrain myself from quarrels and understand that I should set a good example for others. I also realised that I could avoid quarrelling by listening to the other party first, agreeing with them before stating my perspective to avoid conflicts.

Action plan

The staff needs to be educated about the ethical standards at workplaces. Education is crucial since it will prepare them for different circumstances, and ways to avoid conflicts. I also think that team building efforts can prove useful in avoiding conflicts since the employees will be interacting in an unofficial content. Fisher (2018) also reveals that conflict often arises in workplaces with couples. In this regard, I would discourage close relationships that can result in problems.

Reference
Fisher, J., 2018. The impenetrable other: ambivalence and the Oedipal conflict in work with couples. In Psychotherapy with couples, 8(50), pp. 142-166.

D9

000934523 — 2020-02-21 22:44:42 UTC

You must support colleagues and cooperate with them to enhance patient care.

Where the care of patients is shared between professionals, you should consider the effectiveness of your handover procedures. Effective handovers can be done verbally, but it is good practice to make a note of the handover in the patient’s osteopathic records.

Description
On the 4/12/19 I had to write a handover letter.

Feelings

I feel it’s a great tool to support colleagues and improve the guarantee of patients care. I feel that for me to do a better job next time in terms of writing a better handover letter I need to invest more time in it.

I feel I need to be more aware of a patient’s progress also from a legal point of view while being considerate of the patient's perspective. A patient will be able to get better care if all his information have been communicated properly to my colleagues.

Evaluation

The complete of a handover form was a good experience since it makes it easier to outline the working diagnosis and treatment that has been done on the patient. This is a good document that acts as a chronological history of what was done and makes it easier to determine the necessary future interventions.

Analysis

A handover letter is an important document that is completed when an Osteopath is leaving his clinic or when an Osteopath is asking another colleague to continue treating that patient. This will help the colleague understand what was done by the previous professional. Since it includes all duties and responsibilities, it acts as a way, to sum up the work that was done with the patient previously.

Conclusion
Effective handovers can be done verbally, but it is good practice to make a note of the handover in the patient’s folder. A handover letter is an effective document that provides a list of treatments and patients' working diagnosis, and it acts as a sum of the work that was previously done.

Action plan

The communication of information among my colleagues could be affected by me and the way I handover this information. I will take full responsibility for hand over letters of patients referred to me, and the ones I refer to others. My action plan is to be prepared to write amazing reports while also learning about new forms that I could use and potentially be more comprehensive. I will try to learn new ways to make the letters informative and helpful to the colleague that will use it. If any information is stored on computers or other electronic devices, then it would be useful to include that information, as well as a calendar that outlines upcoming deadlines and events. An interesting source I reviewed about handovers was by Sen Goh (2019), who reveal that they improve treatment outcomes by reducing errors. Handover letters are critical since they support continuity of care and ensure the care providers communicate effectively (Sen Goh 2019)

References
Sen Goh, R.W., Styan, L.E., Bond, C.A. and Oosthuizen, J.C., 2019. General practitioner referral audit: are the new Clinical Prioritisation Criteria required?. Australian Journal of Otolaryngology, 2(10), pp.205-502

D10

000934523 — 2020-02-21 23:10:47 UTC

You must consider the contributions of other health and care professionals, to optimise patient care.

follow appropriate referral procedures when referring a patient, or when one has been referred to you

Description
Patients have to fill the GP communication consent form in case we want to write a referral to a GP. So, I always need to get the patient consent to write a letter to a GP unless the life of my patient is in danger than in this case, even if the patient didn’t authorise me, I could escalate without consent.

Feelings

I feel that other healthcare professionals could bring various levels of professionalism and experience for a patient and be a great support team and it could be the best way to go. It is extraordinary to realise I can make use of other experts expertise. I genuinely like collaboration. I feel that this will increase the patient’s trustworthiness and also help towards effective treatments and proper diagnoses.

Evaluation
Sometimes, the transition from one health professional to the other may bring in confusion. This can be a challenge, especially if the only channel of communication is a letter. Anyway, I think having a list of different professionals with their email or telephone number for reliable recommendations can come in handy.

Analysis

Conflicts can arise when collaborating in a professional context. Collaboration means sharing responsibilities in regards to solving an issue that arises and making decisions that will lead to improved outcomes among patients.

Conclusion
Sometimes the management of a patient would not be possible if only one health professional is available. Different illnesses require different levels of professionalism. Care management by other healthcare professionals could be essential for proper treatment, diagnosis and management of patients.

D11

000934523 — 2020-02-21 23:18:08 UTC

You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

If you are exposed to a serious communicable disease, and you believe that you may be a carrier, you should not practise until you have received appropriate medical advice, and you should follow any advice you are given about suspending or modifying your practice. You should take all necessary precautions to prevent transmission of the condition to patients.

Description
An Osteopath can easily be infected by a patient. In that case he should make a decision to ensure his safety and the patients' well-being.

Feelings
I have often been sick, and during those instances, I called in sick at work for me to recover and also to prevent infecting my patients. I think this is a 'must' and it prevents many problems. In case I won't be able to make the right assessment about my own conditions, an external party (eg. GP) can help determine the right choice I should make.

Evaluation
The good side is that patients will feel happy if they are also being taken care of by someone who is healthy. Moreover If you are sick, the patient will most likely perceive that. It can send a bad message across and make them feel worried.

Analysis
It is possible to get sick while providing care to patients, and it is imperative to avoid working in such instances to prevent reinfection. A suspension is a good option, especially if it is a health issue that is chronic or requires a long period to treat.

Conclusion
It is imperative to suspect or modify practice if sick. An external party can help prove a clear assessment of the best decision to take. Let's think about the present issue with the CoronaVirus and how rapidly it is spreading around the world. Some viruses can be fatal to some.

Action plan

In the future, I plan to watch my health and take time off if I have an illness. I will also try to avoid getting infected by patients by ensuring I wash my hands properly.

D12.

000934523 — 2020-02-21 23:26:41 UTC

You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

Description
The GOsC has to be informed promptly about any information about competence and conduct which are subject to regulatory proceedings

Feelings
In my experience, I do understand some of the regulatory issues that will shape my everyday work. For instance, I am aware that any issue concerning competence has to be reported quickly, which can result in suspension or being restricted to practice.

Evaluation

Regulations are different in different countries. However, if I decide to register as an Osteopath with the GoSC I have to obey to their regulations and OPS. I am aware that I will have to deal with every situation with professionalism and without any excuse.

I will ensure to cope up with the living conditions and follow the GoSC policy and procedures even in countries like Italy where Osteopathy was only recognized last December. Having a positive attitude as I always do will help me overcome any difficult challenge.

Analysis
It is a good idea to inform the GOsC quickly about any important information regarding my conduct or staff's conduct and competence to ensure that I/they can avoid any unwanted situation that can arise because of the delay. I will also be keen to cooperate with any requests for information or investigation and comply with all regulatory requirements.

Conclusion

Regulations are vital and have to be followed to ensure that a professional provides efficient services. These regulations are in place to prevent lawsuits and also protect the employee.

Action plan.
In the future, I plan to collaborate with others to gain awareness about the existing regulations. This will help me understand what to avoid so that I do not get suspended. Regulations are vital to ensure the workplace is functioning efficiently (Li & Chen, 2019)

References
Li, T., & Chen, Y., 2019. Do regulations always work? The moderate effects of reinforcement sensitivity on deviant tourist behavior Intention. Journal of Travel Research, 58(8), 1317-1330.

000934523 — 2020-02-22 00:11:55 UTC

First time showing my competency unsupervised. Can I work professionally as an Osteopath?

Description
In order to build a good relationship between the patient and Osteopath there is a need to show practitioner’s competence in that a patient will only allow you to attend to them when you show that you do know what is needed to be done. How an Osteopath handles a patient shows his competence (Moore, 2016, 50).

My CC1 1 exam went extremely well. Autonomy refers to the ability of an Osteopath to make various kinds of judgments towards the provision of potential treatments that best meets a patient’s needs while ensuring his or her own safety and acquisition of quality health care without colleagues or tutor’s influence on them. Universal health care provision encourages that any healthcare practitioner whether a nurse, doctor or any other medical professional makes clear judgments on their own to ensure the well-being of a patient.

Feelings

As a practitioner, autonomy during my exam has enabled me to ensure the stability of a patient without having to wait for instructions and opinions of colleagues. This therefore means that I have been able to contribute to the health of a patient without being supervised. I felt capable of doing so and confident seen as I’ve studied quite a lot and nothing worries me at the moment. Maybe only the Covid-19

Evaluation

Working autonomously brings about a working environment in which I feel satisfied while working. This means that I am able to work with the aim of putting the health of a patient first for their good.

Analysis

In cases where I am certain that the skills of my colleagues or other healthcare practitioners are required, I will refer the patients. Whenever patients are referred to me by my colleagues, I will also be able to attend to them without any difficulty.

Conclusion

Usually the thought of practicing autonomously gives me the confidence to put the skills and knowledge that I have gained for the benefit of the patient

Action plan

The health of the patient is usually a priority for me as a practitioner when it comes to the provision of better and quality health services therefore it means that the judgments that I make while examining a patient and treating them it will be in order to ensure he or she is well.

The Rule of the Artery

000934523 — 2020-02-22 00:36:24 UTC

Description
'The rule of the artery is supreme' is an Osteopathic principle.

Few people understand the importance of the flow of fluids in the body as a way of maintaining health.

This principle can easily be explained.

Feelings
As Osteopath we sit in a very difficult place in Europe because many of the techniques we use are not scientifically proven.

I feel that it is crucial to be aware of how the body functions and the importance of the lymphatic system. Patients should be made aware that gross disturbances such as postural problems will result in a negative effect on the balance of pressure between body ailments, which negatively affects the flow of fluids in the body, leading to physiological outcomes.

I feel that the NCOR is way efficient and has really helped the growth of the osteopathic profession. I often read their website to find the latest research carried out; it gives me the possibility to communicate to patients and the general public the latest pieces of evidence obtained through research. At the same time I also feel that scientific evidence is not really necessary to keep the reputation of our profession since I think that if we communicate properly what we do to patients, explaining the principles we work on, Osteopathy can easily be understood. In addition even orthopaedic tests have their own sensitivity and specificity parameters; many techniques used by physiotherapist such as 'ultrasound with needling' etc. have their own scientific limits too. and much more

The rule of the artery is supreme can easily explained though even scientifically.

Evaluation
The principle is a good way to explain to patients how Osteopathy seeks to encourage optimal flow in the lymphatic and circulatory systems. This is achieved by reducing resistance to movement.

Research in the field reveals that mobility and pressure are some of the factors that influence fluid exchange. I have the chance to inform others about the goals of the general treatment approach in Osteopathy, which involves restoring mobility as a way of improving fluid exchange.

Analysis

The client should understand that the goal of an Osteopath includes the release and mobilisation of muscles and fascia that could be mechanically inhibiting or compressing the optimal blood flow to a region in the body.

I think that patients should know that Osteopathy in many ways, improves fluid exchange.

In the future, I will ensure that I work in close association with the NCOR as it is of benefit to me and hopefully can help me in achieving my dread of working in such hard areas such as in Spain.

Conclusion
Osteopathy is an important approach to restore freedom to the tissues while normalizing the flow of fluids. While may people do not understand the practice, the principle can help then gain insights on what it involves.

Action Plan
I will try to learn how to encourage patients to focus on how they can improve their health and combat disease naturally. This will beneficial in the long run. It ensures that structural dysfunctions are dealt with to ensure optimal health (Gevitz, 2019).

In the future, I will have to find ways of showing the benefits of the profession, especially in how improving the body’s humoral communication processes leads to improvements in the defences of the body and enhancing homeostasis. In the future, I will seek a way to research more about how fluid works in the body and its importance.

An interesting paper, I reviewed on the issue was by Bastable (2017) which reveals that clinical resources ae vital to improving practice.

References
Parsons, J. and Marcer, N., 2005. Osteopathy: models for diagnosis, treatment and practice. Elsevier Health Sciences.

Bastable, S. B. (2017). Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.

Reflective coursework from PPDI including - Critical Thinking (1st and 2nd submission) - Reflective Write Up

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Evaluation Log Yr4

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To begin with, the bi-weekly idea adopted in this academic year log is perfect and enabled me to focus on identifying gaps in learning. However, few action plans are hard to evaluate their success. For instance, on date 10/12/19, it is hard to establish whether the online tutorial in the action plan was followed.

Panadero et al (2013) highlights that self-assessment among students is an essential learning tool; however, a significant percentage of teachers don't know how to implement it in classroom learning. It is, therefore, the duty of a teacher to utilize the student's self-assessment tool like this one to evaluate progress and establish whether take-home assignments were done. Likewise, on 25/1/2020, it is difficult to determine the response of the Tutor and whether I asked to be guided on TSP fascial unwinding.

Comparatively, the log is noted to be very crowded and fairly neat. The proposal is to have it oriented to landscape so that more columns, as mentioned earlier, are accommodated. In vertical orientation, a maximum of three columns is possible. I should also make a plan to include time - 24 hours or12-hour to be more concise in action plans. This is a good practice for medical personnel to adopt while in practice, since time factor could be crucial (Raveesh et al., 2016).

Conclusively, this log is one of the best learner ideas in self-assessment; however, making the above necessary improvements can make it outstanding and an excellent solution to student clinical learner problems. Unfortunately, these recommendations came at a time that it was too late to improve as expected fully, but there is still room to do better in future learning.

Monitoring of Outcomes - Year 4

| 26/9/19 | PROM examination improved following a tutorial by a tutor.
| 9/9/19 | Sacrum thigh thrust practiced and established to be effective |
| 23/9/19 | DD for lower thoracic established costochondritis in a patient who was symptomatic |
| 12/10/19 | Learnt from experience on being precise in history taking by not repeating myself. Tutor stated that more work had to be done.
| 21/10/19 | Successfully learnt stair case dog technique which was a new technique taught by the Tutor. |
| 5/11/19 | Learned HVT from the Tutor and used it as an alternative to SAT in patient assessment. |
| 17/11/19 | Springing and dogging of ribs technique learnt and understood from the Tutor. |
| 10/12/19 | Watched a tutorial and understood more on bilateral occiput subluxation technique. |
| 9/1/20 | Practised and understood technique on assessing lumbarized sacrum |
| 25/1/20 | Improved my skills on TSP fascial unwinding after being evaluated on the same by the Tutor
| 8/2/20 | Successfully carried out lymphatic assessment through step by step procedure. |
| 22/2/20 | Resolved together with the Tutor to adopt IVM |
| 4/3/20 | Looked up and understood ROCABADO exercises in three weeks. |
| 18/3/20 | Learned how to handle agitated patients especially babies.

References

1. Panadero, Ernesto & Alonso-Tapia, Jesus. (2013). Self-assessment: Theoretical and Practical Connotations. When it Happens, How is it Acquired and what to do to Develop it in our Students. Electronic Journal of Research in Educational Psychology. 11. 551-576. 10.14204/ejrep.30.12200.

2. Raveesh, B. N., Nayak, R. B., & Kumbar, S. F. (2016). Preventing medico-legal issues in clinical practice. Annals of Indian Academy of Neurology, 19(Suppl 1), S15–S20. https://doi.org/10.4103/0972-2327.192886

Evaluation Log Yr3

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This log is a reflection of the ideal learner objectives and activity plan. Theoretically, learning must be accompanied by objectives for there to be a good outcome. In turn, objectives are executed, and evaluation must be done in order to determine whether the learning process was relevant and understood (Pinch, 2009). Relatively, student log is crucial for self-assessment and teacher evaluation. It enhances metacognition in students and helps the teacher understand the student's perceptions and misconceptions.

In this context, the log was necessary for tracking the progress of clinical learning for year 3. The structure is designed satisfactorily to meet objectives through an action plan. Research conducted by (Domalns et al., 2009) showed that student log papers were more relevant and practical when integrated to be part of supervision activities. A useful student log should have time frames, activity plans, objectives, evaluation by the mentor or teacher, and student comments. In connection to this particular log, its success rate can be graded at 70% since it has a regular time frame, whereby I carry out self-evaluation on a regular interval of two weeks throughout the academic year.

The whole idea has made it easy to highlight the following potentially unmet objectives; being concise in asking questions during case history, an objective on 20/09/18 that was unlikely met since I’m aware I still keep repeating myself during the consulation process. I know I do this to get extra time in my head to reflect and come up with a proper justified DD.

Therefore, there is a need to see a follow-up section in the log, especially whether those questions generated some takeaway assignment by the Tutor. Therefore, the log should have a column for follow-ups on assignments given to ease the evaluation of self-learning. Likewise, there should be a column for the review of actions taken and determine whether it was doable or not.

Conversely, not all learning needs were addressed in this log paper, even though most of the action plans are well forecasted. Therefore, to address all learning aspects, the log can have these columns; date, objectives, observations, reflection/action plan, follow up, and evaluation. Follow up, in this case, can be left blank where there no take-home assignment is given.

Monitoring of Outcomes - Year 3

| 20/9/18 | The sensible questions asked helped in concept understanding throughout learning.
| High-quality write-ups were made that led to a successive recommendation to proceed. There was no medical-legal issue that arose since the use of black writing was used accordingly.
| 24/10/2018 | Time was effectively utilized per patient while maintaining patient satisfaction. ACTIVE and passive testing side lying was successfully learned in the process and saved 10 minutes per session.
| 30/10/2018 | Unique testing effectiveness improved routinely, with each patient taking 18 minutes on average for osteopathic evaluation.
| Reflex testing was exhaustively learned in two weeks through practice. This includes practical knowledge on weak/ strong myotomes.
| 14/11/18 | Tutor feedback on patient muscular mobility feedback was taken positively and yielded great deal of knowledge on osteopathic concepts and right application to patient intervention.
| 29/11/18 | Clarity was improved in explaining concepts during subsequent presentations which was adopted as a skill henceforth.The Tutor was always impressed with my explanations.
| 19/12/18 | Use of tuning forks yielded effectiveness in detecting fractures in practice, even though test is not 100% reliable. DDS have been studied in three weeks.
| 8/1/2019 | Dental occlusion pattern and metallic test occl. were studied and presented during lesson on 15/1/19.History taking, resetting questions yielded awareness and improved knowledge in 2 wks.
| 22/1/19 | Primary somatic dysfunction was addressed after one week.
| 8/2/19 | Primary somatic dysfunction was treated successfully after consulting with the Tutor. Patient improvement noticed after two weeks. Health and safety measures were obeyed.
| 8/3/19 | Muscle strain, fractures, tissue injury, tendinosis pathologies were researched on their differences in healing and other dimensions.
| 10/3/19 | Patient history capturing took a new dimension in paying more attention. Finer details of history was captured after one week of repeat.
| 29/4/19 | Team work started yielding fruits when we formed one after a week henceforth. Medical errors were drastically minimized.
| 14/5/19 | Knew knowledge on carrying out tests was acquired after being showed how to.
| 25/5/19 | John mechanics was revised in one week time
| 1/6/19 | D/L derotation technique was successfully learnt in two weeks from tutor tutorial.
| 20/6/19 | Learnt how to position better for neck HVT as showed by the Tutor
| 4/7/19 | Brisk reflexes and upper motor lesions differences learnt as researched in neurological examination made easy manual
| more comfortable with Examination of HVT than before.

References

1. Safari, Manouchehr & Ghahari, Laya & Taheri, Maryam. (2014). EFFECTIVE USE OF LOG BOOK ON THE LEARNING OF ANATOMY OF THE HEAD AND NECK. international journal of current life sciences. 4. 4312-4315.

2. Khorashadizadeh, Fatemeh & Alavinia, Mohammad. (2012). Students' perception about logbooks: Advantages, limitation and recommendation - A qualitative study. JPMA. The Journal of the Pakistan Medical Association. 62. 1184-6.

3. Blandford, Brown, & Cocking. (Eds.). (2001). How People Learn: Brain, mind, experience and school (Expanded ed.). Washington, D.C.: National Academy Press. (Original work published 2000)

4. Pinch, K. J. (2009) 'The Importance of Evaluation Research', Journal of Experiential Education, 31(3), pp. 390–394. doi: 10.1177/105382590803100306

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Bastable, S., 2017. Nurse As Educator: Principles Of Teaching And Learning For Nursing Practice.

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D1.3 & C5.2

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

5.2 You must have adequate public liability insurance.

D1. You must act with honesty and integrity in your professional practice.

3. You must have a professional indemnity insurance arrangement which provides appropriate cover in accordance with the requirements of the Osteopaths Act 1993 and the current Professional Indemnity Insurance Rules.

Conclusion about what I realized and what I could have done any other way
Considering the two and my needs I feel that the insurance with the iO fits better how I want to be protected.

References
Schroeter, K. 2017. Ethics in Practice: From Moral Distress to Moral Resilience. Journal of Trauma Nursing, 24(5), pp.290 - 291

C1-C2 attachment 2

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Compliment Letter

Attachment 2 for C3.1

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