We’re back. This is it!
Part three of my professional journey
Thank you all for following along. By reading my story, I hope you can appreciate the perspective I have as a clinician, and I hope that you feel comfortable asking for help, advice or clarification about anything you are faced with now knowing where I come from.
To be honest, as most of you know very well, I have no experience with writing in this way. I admit that more often than not I can’t help but to think - “why bother sharing this? who would want to read this personal reflection of my professional journey? what makes my experience so special?”
I can surely acknowledge that I have had a professional career rich with experience, and that my journey has included many phases that, combined, have strengthened my position as a clinician and opened many doors to many phenomenal opportunities. But still, as a human, like many humans (dare I say all?), I struggle with my own insecurities, and let me tell you, starting this blog has been a huge step in owning those insecurities. The comments and questions I have been receiving after sharing the first and second segments of my story have warmed my heart and made me feel like maybe my journey really does have the potential to reach someone. To reach them on that human level.
It’s like during a presentation – I thrive on my audiences’ engagement and always begin by asking the participants questions to 1) get an idea about how to best tailor the upcoming presentation to meet their needs, expectations or understanding of the topic and 2) calm myself down a bit, because that nervousness related to public speaking never left me, and who doesn’t love getting head nods, smiles, and comments that either validate what you are passionate about or provide thoughtful considerations for a position other than your own.
In that same sense, by commenting on these past and future posts, you’re helping me understand a) whether my perspective and suggestions are useful in some capacity to clinicians and professionals, and if other avenues of thinking are warranted in particular areas and b) what content you are interested in and may wish to know more about as we move forward with our blogs and information sharing.
The last part of my story (My American Dream: New Name, New Job, New Brain Injury) ended with the expeditious move from the US to Ireland in the summer of 2017.
In those first months of being home – my parents, brother, sister, and extended family managed the shock and surprise (and I like to believe…excitement) that I really was here, and that I was perhaps even here to stay awhile!
I was also getting over the shock and realisation of actually being back home. And now that I was, there were questions. So, so many questions.
Where will we live? What are we going to do professionally? How’s my husband going to understand anything anyone says in Ireland? Hows he going to cope with the weather? How am I going to cope with being so far away from both of my daughters? How do we get a bank account with no address? How do we get an address with no bank account? How am I going to integrate back in to my mother culture, that I missed so much all the while I was away? How am I going to get current with the Irish regulatory body, CORU, after 32 years of being overseas?
Despite being Irish and having graduated as a physiotherapist in Ireland, coming home was almost more challenging than leaving for Canada!
And it was no walk in the park for my husband. I did mention before that I still, to this day, don’t really think Scott knew what he was getting into when he asked me to marry him. He certainly didn’t have any way of knowing that we would be living on a small island after growing comfortable with our lives in the States. And honestly, I don’t know how he did it. I don’t know how he continues to do it.
Did you know, for example, that if one arrives in Ireland with the intention of staying for an extended period with an active US drivers licence, there is no trade-in as there is between many countries in the world. Scott had to take the driving theory test and complete the 12 mandatory driving lessons, after which he can drive on an “N” license for two years! Having driven with an excellent record since the age of 16 in the US, this was a pain to go through. Thankfully my family has been very supportive and helpful, like my brother Clive assisting with the process of navigating car and insurance purchases. Even though I had been home very regularly over the years, I was no longer connected in this culture where who you know is just as valuable, if not more valuable, than what you know.
Scott and I were very lucky to be based with my parents at the start. We spent several days over several months traveling around the west coast of Ireland in search of a place to call home. We found our little cottage by the sea in the North West of Ireland on the Wild Atlantic Way and couldn’t believe that it checked all of our boxes.
For me, it was a new professional world to navigate and I am still feeling some challenge with finding my place in it.
My passion is postural care, which includes sitting, standing and lying orientations, and my professional focus throughout my career has been in seating – particularly the hands-on assessment in sitting and supine for individuals with complex body shapes and with complex needs.
Seating in Ireland, however, falls mostly under the OT scope of practice (with some exceptions in regional centers). Lying down positioning and standing falls mostly under the PT scope of practice. As I cannot fathom addressing one component without addressing all three, it has been challenging to navigate the politics of the professional world as its natural for me to think about the full spectrum over a 24 hour period relative to that’s persons postural care and mobility.
My background in 24 hour postural care also provides me with a great ability to help care teams understand how each component of positioning influences the others, like how the position we sleep in influences the way we sit, stand and function.
For example, imagine an individual with impaired mobility sleeping on their side for extended periods of time. In all likelihood, the position they sleep in will be reflected in their sitting and standing posture. It will also influence transfers and ultimately contribute towards body shape distortion.
When clients, families, and care givers can see this relationship, the difference it can make to the overall quality of care and ultimate quality of life can be phenomenal.
Not knowing where to start, I began calling my friends and colleagues in the EU who had always supported me professionally to let them know I was home and eager to learn about the status of postural care, seating and mobility in Ireland. Jim Hughes, Gearoid O Heirlihy, Rosie Gowran, Luke Conway, and Simon Hall among others were all so very welcoming and had me reassured that I had made the right decision in no time.
In June 2018, I was speaking at the 6th European Seating Symposium (ESS) with Stephen Sprigle and Bart Van der Heyden on “How the field of Seating and Mobility has evolved over time: Advances in Practice, Technology and Product Design Leading to Better Outcomes for Service Users”. The experience was a very interesting reflection upon where we were in 1988 and where we had come to in 2018 in the areas of clinical practice, technology and product design. I tackled the clinical practice piece because after all – that’s my true passion!
In summary, we have leaped forward tremendously in the areas of technology and research. We have exoskeleton and all sorts of innovative assistive technology. We have made wonderful research advances where for example we can now conduct MRIs in sitting to assist with a much better understanding of the relationship between the muscle, soft tissue and bone under sitting load.
However, from a clinical practice standpoint, we have not seemed to evolve so much in the area of postural care and seating assessments.
To demonstrate this, I showed pictures of individuals with complex shape distortion from the late 80s that looked the same as the shape distortion observed in individuals just before ESS in 2018.
A common denominator all the way through this presentation reflecting on the last 30 years was the lack of consistency in the hands-on evaluation being completed and the results being optimally translated to effective solutions. As a result, there continues to be a trend globally in our clinical practice related to seating, where many health care professionals react more to the symptoms presented than truly understanding the cause of those presenting symptoms. This is still an area of practice that goes without nearly enough emphasis at the grass roots university level. I believe this is slowly, very slowly changing and it is my dream to be part of and see this change.
Time flew by, as it does, and while I reacquainted myself with the European way, I continued with clinical consulting for companies such as HC21, Vicair, LCS, and Ottobock.
A big highlight for me was reconnecting also with John and Liz Goldsmith and their daughters Sarah Clayton and Anna Waugh from Simple Stuff Works. Being invited into the new Goldsmith Center where I found myself entrenched with the vast body of knowledge this family has created and contributed to - I have learned so very much about the importance of night time/alternative positioning from them and am committed to continuous learning and teaching the core principles that they stand by.
I must share with you that throughout this transition back home, I have been constantly challenging myself about what I am doing and feel as though I am delving deeper into my own insights and thoughts leaving me once again with more questions than answers.
Can you relate to this? I catch myself with these questions repeatedly: Do I still love what I do – YES! Am I 100% passionate about and committed to the values of postural care, pressure care and mobility -YES! Do I feel like I am making enough of a difference with the knowledge I have gained from so many sources over my career? – NO!
This answer torments me.
I can acknowledge that I’ve impacted individuals around the globe - whether that be a clinician who found a nugget in the information I shared during a seminar or an individual I did assessments for.
I can acknowledge that I have made a positive difference to how people sit, lie and/or stand, and that this, in turn, contributes to fewer hospitalisations due to chest infections or gastrointestinal issues.
I can acknowledge that many of the teams I have worked with have yielded wonderful outcomes, and that this most often happens when the clinician takes ownership for the hands on assessment and works closely with the supplier to translate the findings from that assessment, and, together with the individual and care team, explores and delivers the most viable solutions.
BUT… in the big scheme of things – when I look at the big picture – I am honestly not convinced that traditional seminars are totally useful.
It shocks me to find myself feeling so strongly about this, as speaking and presenting seminars has been a big source of professional satisfaction and income for me over the years.
When I speak with colleagues and participants of my seminars over time, it’s clear that everyone loves the interaction, the personal stories and experiences, the update on best practices, the demonstration of a hands on assessment, the problem solving, the networking opportunities along with the continuing education credits.
But that’s where it often stops. Rather than put into practice the knowledge gained, the learning experience is often merely that - an experience. And so my frustration repeats itself over and over because over and over we are seeing the same end result – that very little changes are happening when we look at the people who matter most, our clients. I am considering alternatives because this does not sit well with me.
In March 2019, just before my oldest daughter, Jenn, graduated as a DPT, I had the true privilege of presenting with her at the International Seating Symposium (ISS) in Pittsburgh. The topic she chose was the Hands on Assessment and why its so critical in the world of postural care/seating.
That was it. The icing on the cake. My dream - an up and coming PT sharing the stage with me, fulfilling my hope for getting “new blood’ on the stage at these conferences and, more importantly, new energy from this new generation of professionals regarding this often overlooked topic.
That was my last submission for a seating symposium as a speaker.
I spoke 5 times during that ISS - it was busy and exciting - and from that moment onward I knew that I could look forward to being able to engage fully as a participant to learn from these new speakers while being in the audience at future events. After years of presenting at every conference I possibly could present at, I’m done.
Instead of submitting papers to conferences, I’ve decided to focus on mentoring newer clinicians who might want to speak on that same platform.
Clinicians who have an interest, but may not know where to start. Clinicians who just need a wee push, some nurturing, support, and confidence building. Or, clinicians who have already been doing these events and might want to upskill in the area of postural care, pressure care, and mobility. I’ve been thinking a lot about how I might do this best.
Jenn arrived home in late 2019 for a holiday and, well, she still hasn’t left. She’s been working with me and learning more about postural care while exploring her own opportunities as a new clinician!
What a truly mind expanding experience this has been for me personally. We have traveled, co-presented, problem solved clinical presentations, and, without a doubt, made each other crazy! Most people don’t know we are mother and daughter when they first meet us and when it’s disclosed there are all sorts of fun reactions! Mostly however, they are reactions of admiration and curiosity related to how we manage to spend so much time together and still appear sane -on the outside at least! (this may be another blog!)
These last few years have provided me with the opportunity for quality reflection - to consider how I want to spend my energy and influence change in these twilight years of my professional career.
My favorite aspect of my work has always been the hands on piece. It’s understanding the WHY behind the challenges that the individuals we work with present with. When I see the individual and their care team of professional and loved ones understand the why and therefore implement the change needed for an enhanced quality of life – there is really not much better for me than that.
Since being home, I have been very lucky to be able to provide clinical guidance for clinicians in regards to the hands-on assessment for individuals who present with complex shape distortion. I have also had the true pleasure of sharing some practical knowledge related to this scope of practice to the final year Occupational Therapy students in the University of Limerick. This is exactly where we need more of the grass roots knowledge with up to date best practices being demonstrated and shared in the University programs globally for Occupational Therapists and Physiotherapists (Physical Therapists in the US). In my ideal world, postural care and mobility would be an area clinicians feel excited about as they graduate just as I was about musculoskeletal/sports physio when I graduated!
I have often thought that I would love to have my own clinic where I would provide hands on postural assessments and one-on-one training/mentoring for clinicians and care teams… I keep saying the journey is not over yet!
However, along came 2020! The C0VID-19 experience and the beginning of a whole new norm it seems…
After being unable to work in the traditional sense since March 6th, I have just begun getting requests for future assessments for individuals who have been “on hold” during lockdown. Telehealth assessments, and/or face to face with full PPE and social distancing as much as possible are all options . Our lockdown in Ireland has been more strict than some places, such as many states in the US, so I am sure that all of us are having different experiences and challenges with providing quality care around the globe. We will have further blogs about this.
To finish up this 3 part story of my professional/personal journey through three countries and a wildly fulfilling career, I will leave you with a few thoughts mostly related to the professional choices I have made along the way.
24-hour Postural Care is critical to anyone who has difficulty moving and this body of knowledge can be valuable in many areas of our scope of practice
To clinicians who consider jumping to the manufacturing/business side of life, developing your professional mantra and establishing boundaries to respect your ethical and professional responsibilities is important. Mine continue to be
Keep my clinical skills fresh and my belief system strong
To never lose myself , who I am or what I personally believe
The seated posture clinical presentations that I see in the individuals I work with, regardless of age or diagnosis are often a direct reflection of how that person sleeps. It is critical in my opinion that I understand and pay attention to every persons favored sleep position.
If I want to make a difference in seating outcomes – I believe my care plan and recommendations must also include lying down positioning strategies and solutions
The value of early intervention, including care for very young children and also care for individuals who have experienced an acquired diagnosis such as a traumatic injury or a CVA for example. If we don’t do something about postural support in lying, standing and sitting as early as possible we are missing opportunity to mitigate shape distortion, enhance/preserve; hip integrity; spinal alignment; respiratory and digestive functions as well as skin integrity.
On a more personal note: This lifestyle of travelling for work and balancing career with family while doing so is not for everyone! I have learned that as in many other walks of life, one can be subject to judgement. I have seen this in particular when the person in question is female and with kids.
For example, a comment I have heard and have had said to me several times over the years “how can you who travels for work so frequently parent effectively - especially as a single mother?" Those of you who know me can imagine my response and thoughts about this comment! My daughters provide all the proof necessary that although non-conventional, my parenting skills (that were undoubtedly a constant juggle and often not ideal) were quite admirable!
Thank you to my family, friends and colleagues for helping me along the way over the past 3 1/2 decades! I am excited for what the future holds, especially as we emerge from this pandemic.
We will be posting blogs frequently and hope you stay in touch and continue to share your great insights as we continue to make a difference in postural care together.