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CREIGHTON UNIVERSITY
DEPARTMENT OF
OCCUPATIONAL THERAPY
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FIELDWORK STUDENT MANUAL
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INTRODUCTION
This manual has been prepared to help you understand the policies and
procedures of clinical education.
The Academic Clinical Education
Coordinators and the Assistant Clinical Education Coordinator will be
available to clarify any information. Communication is essential for a
successful collaborative effort in placing students in fieldwork experiences.
Your questions are always welcomed.
The University reserves the right to change and to make exceptions to the
provisions of this manual at any time and to apply any change or to make an
exception applicable to any student without regard to date of admission
application or date of enrollment. This manual is neither a contract nor an
offer to enter into a contract. A current version of this manual is posted on
the Creighton University Department of Occupational Therapy Clinical
Education website: http://ot.creighton.edu/fieldwork
Anna Domina, OTD, OTR/L
Academic Clinical Education Coordinator
Department of Occupational Therapy
(402) 280-3407
annadomina@creighton.edu
Lou Jensen, OTD, OTR/L
Academic Clinical Education Coordinator
Department of Occupational Therapy
(402) 280-5678
loujensen@creighton.edu
Andrea Thinnes, OTD, OTR/L
Director, Clinical Education Office
Academic Clinical Education Coordinator
Department of Occupational Therapy
(402) 280-5929
andreathinnes@creighton.edu
Mary Pat Wearne
Assistant Clinical Education Coordinator
Department of Occupational Therapy
(402) 280-5631
mpwearne@creighton.edu
Clinical Education Website
http://ot.creighton.edu/fieldwork
AOTA Fieldwork Website
http://www.aota.org/Students/Current/Fieldwork.aspx
2
TABLE OF CONTENTS
Introduction ............................................................................................................... 2
Preparation for All Fieldwork .............................................................................. ……4
Level I Fieldwork ..................................................................................................... 10
Level II Fieldwork .................................................................................................... 13
Site Development ................................................................................................... 16
What to Expect During Fieldwork ........................................................................... 22
Universal Precautions ............................................................................................ 23
HIPAA Regulations ................................................................................................. 25
Entry-Level Professional Rotation ........................................................................... 27
NBCOT and Temporary Licensure .......................................................................... 28
Appendices
Appendix A:
Appendix B:
Appendix C:
Appendix D:
Appendix E:
Appendix F:
Appendix G:
Appendix H:
Appendix I:
Appendix J:
Appendix K:
Appendix L:
Appendix M:
Appendix N:
Appendix O:
Appendix P:
Appendix Q:
Appendix R:
Clinical Plan of Study ........................................................................ 29
Personal Data Sheet ......................................................................... 36
Level I Site Preference Sheet ........................................................... 41
Level I Fieldwork Evaluation ............................................................. 43
Level I Student Evaluation of Site ...................................................... 46
Level II Site Preference List .............................................................. 50
Level II Assignment Agreement ........................................................ 52
Level II Fieldwork Confirmation ......................................................... 54
Level II Student Evaluation of Site (SEFWE) .................................... 56
Level II Fieldwork Evaluation (FWPE) ............................................... 66
FEAT ................................................................................................ 75
Fieldwork Checklist ........................................................................... 81
Writing to a Fieldwork Site ................................................................ 83
Sample Thank You Letter ................................................................. 85
Site Recommendation Form ............................................................. 87
Student Liability Coverage ................................................................ 90
Incident Report Form ......................................................................... 92
Verification of Receiving/Reviewing Fieldwork Student Manual ......... 95
Revised: 7/2012
3
PREPARATION FOR ALL FIELDWORK

Experiential Education Participation Policy:
To protect the health of Creighton University School of Pharmacy and Health
Professions (SPAHP) students and the patients they serve, and in accordance with
contractual arrangements with varied health-related institutions, students in
programs which have an experiential education component must meet specified
requirements including immunizations, health insurance coverage, and acceptable
criminal background checks before being enrolled in any of the School’s practicebased academic programs.
Students in programs which have an experiential education component must remain
compliant with the immunization, health insurance coverage, and acceptable
criminal background check requirements, as well as achieving and maintaining
cardiopulmonary resuscitation (CPR) certification, and completing training in
universal precautions and HIPAA requirements before they can participate in
experiential education activities. Proof of compliance with all of the items listed
above will be required by Experiential Education Directors, and may be required by
fieldwork educators/fieldwork educators, before students can be placed or accepted
at educational practice sites. Students who have failed to remain compliant with
these requirements will not be allowed to participate in experiential education
activities and may be subject to dismissal from the School. At a minimum, noncompliance with this policy may impact or delay the student’s date of graduation.
Any specific health requirements, drug testing or criminal background checks
required by a site will need to be completed prior to participation in any/all fieldwork.
These requirements are the responsibility of the student.
Students requiring a background check may use Secured Data Services:
1. Log on to www.sdsinvestigations.com
2. Click on students, username is cupt, password is cpt654
3. This report covers SS# verification, criminal search past 7 years, violent sex
offender and predator registry, HHS/OIG/GSA list.
All results are automatically sent to Becky Crowell in Physical Therapy. Please let
Mary Pat Wearne know that you have requested a background check from Secured
Data Services. Also let Mary Pat know whether your site needs a copy of the report
or just a letter verifying the results of the background check (most sites do not want
to see the background check, they only want to know that it has been done and
confirmation that the results are clear --- check with your FWEd to find out exactly
what they need).
If you have any questions, please contact Mary Pat Wearne at
mpwearne@creighton.edu or 402-280-5631 or stop by 103C.
Students in Nebraska that are required to have a drug screen may schedule an
appointment with Laura Byrd at 402-658-1122. The office is located at 8011
Chicago Street.
Students in Alaska that are required to have a drug screen may schedule an
appointment with Beacon Occupational Health & Safety Services, Inc. They can be
4
reached at (907) 222-7612.
Students need to work with Student Health and the Office of Academic and Student
Affairs (OASA) to ensure compliance with health requirements. For further
information on this policy: http://spahp2.creighton.edu/oasa/Polices,Procedures%20.aspx

Policy on Student Compliance with Technical Standards for Occupational
Therapy:
The Doctor of Occupational Therapy education program in the School of Pharmacy
and Health Professions at Creighton University prepares occupational therapists to
serve as primary providers of occupational therapy care. In order to function as a
clinical occupational therapist, an individual must be able to meet certain physical,
emotional, intellectual and communication expectations for performance.
Occupational therapy education requires the accumulation of scientific knowledge as
well as the simultaneous acquisition and demonstration of psychomotor skills,
cognitive skills and professional attitudes and behaviors. The faculty is committed to
an educational environment where students may develop emotionally, spiritually,
socially and cognitively.
Technical standards must be met with or without reasonable accommodations
consistent with the Americans with Disabilities Act (ADA). The School is committed
to enabling students with disabilities to complete the course of study of the OTD
Program by means of reasonable accommodations consistent with the ADA.
Technical standards are necessary to create specific expectations for student
performance in the classroom, laboratory and clinical education environments. The
purpose of technical standards is to delineate the psychomotor skills, cognitive skills
and professional attitudes and behaviors deemed essential for matriculation into,
continuation in and completion of the educational program.
Observation/Sensory
Students must have sufficient visual abilities to be able to observe and interpret
patients/clients accurately. They should also possess functional tactile and
proprioceptive skills and abilities necessary to perceive and synthesize inputs during
patient/client interaction, evaluation, and treatment.
Communication
Students must demonstrate effective verbal and written communication with patients,
family members/caregivers, faculty/staff, fieldwork preceptors, payers, elected officials,
members of the healthcare team and others. They must demonstrate appropriate
communication with people of different ages and genders, with diverse physical,
cognitive and emotional abilities, and from different cultural, ethnic, racial,
socioeconomic, and religious backgrounds and lifestyles. Students must demonstrate
the ability to use therapeutic communication and a client centered approach. They must
display adequate English language skills in written and oral communication.
Motor
Students must display adequate motor skills to provide safe, efficient, and effective
occupational therapy treatment. Examples of skills requiring motor ability include sitting
tolerance, splint or assisted technology fabrication, computer usage, performing
transfers and assisting with bed mobility, and providing range of motion and
strengthening activities. The motor abilities required include adequate gross and fine
motor function, vestibular function, strength, and functional usage of the sensory
system.
5
Intellectual/Conceptual
Students must demonstrate problem solving throughout the didactic and experiential
components of the program. This includes the ability to interpret information from
multiple sources (written, verbal, environmental, interpersonal, etc.), carry out
instructions in a timely manner, and understand and follow written instructions such as
policies and procedures. Therefore, the student must be able to read complex material,
and write in a way that is accurate, descriptive, free from errors and consistent with
guidelines or standards. Further, students must be able to apply critical thinking
processes in order to gather information, identify problems and alternative plans of
action. They must be able to make decisions spontaneously in "on the spot" situations,
pressure situations from high workload demands, and variable time and environmental
demands.
Behavioral / Social Skills / Professionalism
Students must possess sufficient emotional health to fully utilize their intellectual
abilities, exercise good judgment, adhere to ethical standards, complete patient care
responsibilities promptly, and relate to others with courtesy, compassion, maturity, and
respect for their dignity. Because occupational therapy education and practice takes
place in a large variety of settings, students must have the ability to participate
collaboratively as a (professional) team member, must be able to modify behavior in
response to feedback, and display emotional health when faced with changing
environments, clinical uncertainties, and stressful workloads that include multiple
concurrent demands and short deadlines. This requires the ability of students to be
aware of and appropriately react to their own emotional responses. In addition, students
must at all times maintain personal appearance and hygiene that is appropriate for
professional and classroom settings.
Attainment of Technical Standards
Inability to comply with these technical standards may result in course failure. Applicants
are encouraged to voluntarily discuss their disabilities with the Director of Admissions
and the Assistant / Associate Dean for Academic Affairs of the School in order to
consider and prepare for the accommodations that may be needed. After enrollment, a
student with a disability who wishes to request reasonable accommodations may directly
contact the Assistant / Associate Dean for Academic Affairs of the School or the
Creighton University Office of Services for Students with Disabilities. Verification and
documentation of the disability by a qualified professional, such as a physician or
psychologist, will be needed before reasonable accommodations are made.
Accommodations will not be considered reasonable if they affect the substance of the
occupational therapy educational program, compromise the School’s educational
standards, and/or negatively affect the safety of students and/or other people, including
patients, with whom they may come into contact in the course of their studies. If
accommodations are provided, this information will be kept in strict confidence.
All occupational therapy applicants must review the technical standards described in this
document and perform a self-evaluation to determine if they are able to maintain
compliance with them. A signed copy of this form should be returned to the SPAHP
Office of Admissions signifying the standards have been read and certifying compliance.
During orientation, all students signed a document that serves as testimony that the
student is in compliance with these standards and understands the responsibilities it
outlines. A student who is dismissed from the program and subsequently reinstated
must re-sign this document as testimony that the student is in compliance with these
standards.
6

Accommodations Process for Students with Disabilities: The School of
Pharmacy and Allied Health Professions is committed to assisting students with
disabilities in accomplishing the academic mission of our programs. Students who
believe themselves eligible for accommodations under the Americans with
Disabilities Act should contact Dr. Paul Price, Assistant Dean for Academic Affairs
for assistance in accessing allowed accommodations. The Office of Academic and
Student Affairs is located in Room G 74 Criss III. The phone number of the Office is
(402) 280-1147. Accommodations for fieldwork experiences may be quite different
from those used in the classroom. For this reason, students should notify the
Academic Clinical Education Coordinator well in advance of a fieldwork experience
so that the accommodations process can be initiated in a timely manner.

Clinical Plan of Study: All students in the Creighton University Doctor of
Occupational Therapy Program are required to complete a Clinical Plan of Study
(CPOS) (see Appendix A) to assist them in exploring their future clinical education
plans and trajectory. The CPOS is a planning and counseling tool only, not a
binding contract, nor a guarantee of fieldwork placement.
Procedure: Students will initiate their Clinical Plan of Study during the spring
semester of their first year in the OTD program. As part of the Clinical Plan of Study,
students will first be asked to complete a learning style questionnaire and to review a
Fieldwork Practice Settings table and explanations. Students will then complete a
Clinical Plan of Study Questionnaire followed by the actual Clinical Plan of Study,
indicating potential practice settings that they may want to explore during their
education in the OTD program. Finally, students will be required to attend a 1:1
meeting with an Academic Clinical Education Coordinator to review their Clinical
Plan of Study annually. The Academic Clinical Education Coordinator(s) and
students are jointly responsible for tracking the progress and completion of each
student’s Clinical Plan of Study.

Housing Accommodations during Clinical Experiences: Students must locate
and secure their own housing arrangements for each clinical experience.
Cancellations of placement will not be allowed based on a student’s inability to find
housing. In addition, it is the responsibility of the student to arrange housing that is
financially feasible during the clinical experience. The site files contain information
about housing from the site and/or past students. In addition, the Creighton
University Alumni Relations can be very helpful in locating alumni living near clinical
sites.
Contact
Alumni
Relations
at
1-800-325-2830
or
http://spahp.creighton.edu/alumni for further details.

Personal Data Sheet: Complete a Personal Data Sheet for each Level I and Level II
fieldwork. (See Appendix B for a sample). These need to be typed and the
completed form returned to the instructor of record or Assistant Clinical Education
Coordinator by the required due date. The Personal Data Sheet is sent to the
fieldwork site prior to the student’s arrival.

Safety Practices: Safety practices to protect the patient, yourself and other staff
are of the most urgent concern to all health professionals. It is your responsibility
to learn the safety and emergency policies and procedures of your fieldwork
site, including the policy on provision of CPR. Learn the location of fire
extinguishers. Use good body mechanics and positioning of media or activities to
7
maximize safe usage. Know what to do in the event of an emergency so that you
will not contribute to a preventable accident. Sites have the right to refuse and/or
terminate the clinical experience for any student who does not follow appropriate
safety practices. Failure to maintain proper safety practices for the fieldwork
site may impact your grade for fieldwork-related courses.

Incident Reporting: If a student gets injured, is involved in an accident, or is
exposed to blood/body fluids during a clinical education experience, appropriate
reporting needs to occur at the site according to site policies. Additionally, students
should complete an Incident Report form and file it with the University. This serves
to protect the student and allows for appropriate risk management analysis. The
Creighton University HR-24 Incident Report form can be found in Appendix Q and
also at http://www.creighton.edu/finance/riskmanagement/forms/index.php

Occupational Therapy Code of Ethics: This is required reading before and during
your fieldwork experience. Accountability for the knowledge and application of these
principles underlies your ongoing professional development. To view the American
Occupational Therapy Association (AOTA) Code of Ethics and Ethics Standards,
visit: http://www.aota.org/Practitioners/Ethics/Docs/Standards/38527.aspx.
If you encounter an ethical dilemma or issue while on fieldwork you have several
resources available to you. First, you should contact the Academic Clinical
Education Coordinator who is serving as the instructor of record for your fieldwork
experience. Additionally, ethics consults are available by contacting either Dr. Linda
Gabriel (lindagabriel@creighton.edu) or Dr. Linda Scheirton (lindascheirton@creighton.edu).

Professionalism: A professional image is displayed through attitude, posture, tone
of voice, eye contact, appropriate grooming, hygiene and apparel and timeliness. As
a student therapist you represent the occupational therapy profession and Creighton
University. Most sites have written policies regarding patient/therapist interaction.
Continued contact with a patient/client outside of the clinical education environment
is considered beyond the scope of professional practice. You should maintain a
professional image with your clients, fieldwork educators and any other professional
with whom you have contact. Any questions or areas of concern regarding
student/patient interaction should be discussed with the fieldwork educator and
clinical education coordinator. Failure to maintain a professional image may
impact your grade for fieldwork-related courses.
Social networking through electronic media such as Facebook is a common habit of
many students and occupational therapists. The Office of Academic and Student
Affairs’ document entitled Professionalism Considerations for Online Social
Networking Usage outlines suggestions and considerations for use of electronic
social networking media: http://spahp2.creighton.edu/oasa/Polices,Procedures%20.aspx
To avoid any breaches of confidentiality, conflicts of interest and questionable
unprofessional behaviors, the Occupational Therapy Office of Clinical Education
strongly discourages students to engage in this type of social networking with any
patients, supervisors or co-workers during fieldwork experiences.

Professional Attire: Professional attire includes a student name tag; full-length
pants; shirts with sleeves; and closed-toe/heel shoes with socks. No undergarments
should be seen at any time (even when squatting, reaching overhead, etc.).
Clothing should not be tight-fitting or low-cut. A lab coat may be required by certain
8
fieldwork sites. We advise you not to wear jeans, sweatshirts, sandals or tennis
shoes unless the fieldwork educator approves of that attire. To ensure your safety,
large earrings and rings, or dangling necklaces are not allowed. Sites have the right
to refuse and/or terminate the clinical experience for any student who does not dress
appropriately. Sites have the right to request that a student follow a specific dress
code, which may include scrubs, khaki pants, polo shirts, or similar attire. Please
check site files and with your fieldwork educator to inquire if there are specific dress
code requirements for your site. The attire for fieldwork experiences is in
accordance with the dress code established by Creighton University’s School of
Pharmacy and Health Professions. Failure to maintain proper professional attire
may impact your grade for fieldwork-related courses.

Name Tag and Lab Coat: Positive identification of your student position is fulfilled
by wearing the Creighton University Occupational Therapy Student name tag. In
some hospital or clinical settings a lab coat may be required. You will receive your
name tag and lab coat at the Professionalism Ceremony during your first semester
of the program.

Initialing Notes: Since students are participating in an AOTA/ACOTE (Accreditation
Council for Occupational Therapy Education) requirement while in fieldwork, they
are designated as occupational therapy students or OTS. Creighton University’s
position is consistent with the guide to practice and the AOTA Roles document in
which occupational therapy students (OTS) are recognized as practitioners in
training. The degree (BSOT, MSOT, OTD, etc.) is recognition of the university, not
AOTA.

Level II Fieldwork and Dates: Your Level II Fieldwork dates are set at least one
year in advance. This allows the Clinical Education Office and students to plan
accordingly. Below are the Level II Fieldwork dates for the next several summers.
These fieldwork dates are not flexible secondary to the limited number of weeks in a
summer semester. If you are planning life events such as family reunions, vacations
and/or a wedding, you need to work around these dates or take a leave of absence
from the program to accommodate your life event. If you prefer to take a leave of
absence, you may discuss this with Dr. Joy Doll, Vice Chair of the Department of
Occupational Therapy. Please refer to schedule on the Office of Academic and
Student
Affairs
website
for
verifying
these
dates:
http://spahp2.creighton.edu/oasa/OASA%20Home.aspx
2013 – May 20 – August 9
2014 – May 19 – August 8
2015 – May 18 – August 7

Professional Rotation Dates: Your Professional Rotation dates are set at least
one year in advance in accordance with the fall semester dates. This allows the
Clinical Education Office and students to plan accordingly. Following are the
Professional Rotation dates. These dates are not flexible because of deadlines to
meet for graduation requirements. If you are planning life events such as family
reunions, vacation or a wedding, you need to work around these dates or take a
leave of absence from the program to accommodate your life event. If you prefer to
take a leave of absence, you may discuss this with Dr. Joy Doll, Vice Chair of the
Department of Occupational Therapy. Please refer to schedule on the Office of
9
Academic and Student Affairs website for verifying
http://spahp2.creighton.edu/oasa/OASA%20Home.aspx
these
dates:
Class of 2013 – August 19 – December 6
Class of 2014 – August 18 – December 5
Class of 2015 – August 17 – December 4

Hooding and Graduation Dates are tentatively scheduled for:
Class of 2013 – December 13 (Hooding) & May 18 (Graduation)
Class of 2014 – December 19 (Hooding) & May TBD (Graduation)
Class of 2015 - December 18 (Hooding) & May TBD (Graduation)
Level I Fieldwork Placement Process
Students will submit 3 specific site preferences from their site list in rank order. These
sites will be contacted and availability will be determined. If more than one student
requests a specific site, names will be drawn. If none of the requested sites are
available for a student, that student will be placed locally based on his or her desired
practice area. Student may also indicate they have no preference for a specific site,
and may simply indicate a preference to complete fieldwork in their local area (Omaha
or Anchorage area). Students should consider varying the practice area from previous
fieldwork experiences and may be counseled by the ACEC in this regard.
Once the placement process (i.e., contacting sites) has been initiated, students may not
make changes to their Level I Preference Sheet.
The process for Level I placements is different from Level II placements. During the
Level II placement process, the Office of Clinical Education asks sites for advanced
reservations. During the Level I placement process, sites are contacted only after
students request them so that requests are not sent to the 280+ sites in our database.
This takes into account time, cost, site relationships, etc.
The ACEC reserves the right to modify the process based on extenuating
circumstances. If this happens, the ACEC will discuss this with the specific student(s)
involved.
Once a student is placed, the Assistant Clinical Education Coordinator notifies sites
receiving students and sends a Level I student packet to each site. Students receive
notification of their site, as well.
The dates of the fieldwork have been negotiated with the site and the University. Any
missed time must be made up by the student, at the convenience of the site. Students
are not to re-arrange dates of fieldwork assigned without the specific approval of the
instructor of record for the fieldwork course.
10
Level I Fieldwork Evaluation Process
All evaluation forms must be received in a timely manner. At the conclusion of the
fieldwork the fieldwork educator at the site will complete the Level I Student
Performance Evaluation (see sample in Appendix D) and the student will complete the
Level I Student Evaluation of Fieldwork (see sample in Appendix E) and meet to review
the evaluations. All evaluation forms require both the signatures of the fieldwork
educator and the student. It is the responsibility of the student to assure the
evaluation forms have been completed and returned to the instructor of record. The
evaluation forms may be hand delivered by the student or mailed by the fieldwork
educator.
It is strongly recommended that both the student and the fieldwork educator
make copies of both evaluations in case something is lost in the mail.
Guidelines for Level I Fieldwork
FIELDWORK SITE RESPONSIBILITY:
The clinical fieldwork site provides opportunities for education and experience with
selected patients, under supervision.
SUPERVISORY RESPONSIBILITIES:

Provide the student with the opportunity for observation and/or assistance in patient
evaluation, treatment planning and/or implementation.

Make patient records accessible to the student.

Provide ongoing feedback regarding the student's performance.

Allow the student the opportunity to compare information presented in the academic
setting with experiences gained in the clinical setting.
STUDENT RESPONSIBILITIES:
The successful completion of a clinical experience is required to achieve a satisfactory
grade in all level I fieldwork experiences. The student should demonstrate responsibility
for independent learning by asking questions of, and initiating discussion with the
fieldwork educator. Students are expected to interact in a professional manner with all
clients, supervisors, and other professionals encountered during the fieldwork
experience. Failure to act professionally could result in failure to achieve a
satisfactory grade in the clinical experience. Any student whose clinical competence
and/or attitudes and behaviors are sufficiently deficient or inappropriate so as to warrant
removal from a clinical site prior to the completion of the clinical education experience
will receive a failing (F) or unsatisfactory (UN) grade for that experience. Please see
the
complete
policy
for
Clinical
Guidelines
here:
http://spahp2.creighton.edu/oasa/share/sharedfiles/UserFiles/file/Procedures/Clinical%2
0Guidelines.pdf
11
Student Responsibilities for Level I Fieldwork
1. Students will be instructed to contact their fieldwork educator early in the semester
after thoroughly reviewing the site file, including the Fieldwork Data Form. The
Fieldwork Data Form contains site requirements, expectations and policies.
Students are then to confirm where to meet the fieldwork educator on the first day,
parking, dress code, and the hours of fieldwork. Additionally, students should ensure
they have all necessary immunizations, background checks, etc. needed to
complete fieldwork at the site. It is highly recommended that you take your
health records with you on each fieldwork experience. Again, it is the student’s
responsibility to complete all site requirements, as mentioned in the Experiential
Education Participation Policy (see p. 4). It would also be helpful to inquire about
typical clinical conditions seen, assessments used, or any other reading/research
that could be done prior to arriving at the fieldwork site that would prepare the
student for a successful experience.
2. Transportation is the responsibility of the student. Some clinical sites may be further
away and students are responsible for arranging and/or providing their own
transportation. Travel days are considered the Saturday and Sunday prior to
the start date of fieldwork and the Saturday and Sunday following the end date
of fieldwork. Students are still responsible for all course work and related activities
the week before and week following fieldwork.
3. Failure to complete the required fieldwork time may result in re-scheduling the
placement or in a failing grade. Because of the short period of time students are
assigned, it is advantageous to maximize the learning experience to prepare as a
developing professional. Students should make the most of the time spent at the
site by being punctual, demonstrating educational curiosity and integrating
observations. Unavoidable absences may occasionally arise, and making these up
are the responsibility of the student. Refer to the course syllabus for more
information.
4. Students should arrive at the site in time to find parking and be in the office or work
area of the fieldwork educator by the appointed starting time. If an emergency
arises, students should call to inform the fieldwork educator.
5. Students should expect to remain at the facility until the departure time designated
by the site. Requests to leave early will not be considered appropriate conduct.
6. Student participation with clients during a level I fieldwork begins with observation of
the clinical interaction and progresses to some portions of hands-on care. Any
participation with a client is at the discretion of the fieldwork educator. If a student
does not feel comfortable participating with a client, he or she needs to communicate
his or her comfort level directly with the fieldwork educator. However, fieldwork
educators may offer hands-on teaching opportunities and students should take full
advantage of these.
7. Students should send a letter of appreciation to their assigned fieldwork site and/or
fieldwork educator within one week of their last day at the site. (See Appendix N for
a sample thank you letter.)
12
LEVEL II FIELDWORK
Assignment Process
Placement for Level II Fieldwork is the responsibility of the Academic Clinical Education
Coordinator(s) and the Assistant Clinical Education Coordinator. Students have the
opportunity to visit with the Academic Clinical Education Coordinator(s) to clarify the
placement process or discuss information about a particular site. The quickest and
most efficient manner of communicating with the Academic Clinical Education
Coordinator(s) is to make an individual appointment via email.
A fieldwork placement is guaranteed by the University however we do not ensure
geographic or other preferences. Students are strongly encouraged to plan and
discuss finances, housing possibilities and travel arrangements with their family
prior to completing the placement process. There is no perfect placement process
as the matching of fieldwork sites to students is a very complex and dynamic operation.
The Level II Preparation Seminar I and Professional Trajectory I, during the fall
semesters of your 2nd and 3rd years will specifically address the Level II Fieldwork
assignment process.
Please note: All pediatric fieldwork sites are only available for Level IIB Fieldwork.
This is due to the fact that students are required to complete all pediatric courses
prior to engaging in fieldwork.
13
ABCs of FIELDWORK PLACEMENT PROCESS
A. Listing of Available Sites
An advanced reservation request is sent to all sites that provide clinical experiences for
Level II students (~330 sites). A listing of available sites is generated from these as
they are returned from the clinical sites. Early in the fall semester a listing of available
sites for the following summer will be available on the Clinical Education database.
Please note this list is subject to change.
Some sites do require a name to reserve a slot and are identified as “1st come, 1st
serve” slots, these opportunities will be shared with students using Creighton University
email addresses. Interested students will have up to one week or until the provided
deadline to respond to the Academic Clinical Education Coordinator before
guaranteeing the slot with a student name. If multiple students express interest in a
site, a randomized drawing of names will be held for this slot. If a student is placed at a
site in this manner they will be removed from the general placement process that occurs
during the fall semester. Some sites now require an application process and interview.
This information can be accessed through the Clinical Education database or the
Academic Clinical Education Coordinator(s) will let you know which sites require this
process as it may take place prior to the placement process.
B. Placement Process
The Clinical Education Office reserves the right to decide the placement process
that will be used.
The placement process occurs early in the fall semester for OTD2 and OTD3 students.
The OTD2 and OTD3 students are given directions for the placement process in the
Level II Fieldwork Preparation Seminar and Professional Trajectory courses, during FW
meetings, via email, and through written communication in student mailboxes.
Students choose 10 sites for FW placement from the available sites listing and submit
their choices (see appendix F) to the Academic Clinical Education Coordinator(s) by the
assigned deadline. When more than 1 student identifies the same site, students are
randomly selected for that site. If students do not receive one of their first 10 choices,
they will meet with the Academic Clinical Education Coordinator(s) to discuss their
options. If you fail to meet the deadline for site selection, you will be placed after
all other students are placed at their fieldwork site.
When filling out your preference sheets here are some tips:
1) It is highly advisable that you do not put all Omaha sites. This increases the
likelihood you will end up without a site at the end and need to select from
remaining sites.
2) If you do not want to go to a site, do not put it on your list. You may be placed at
any of the ten slots you list.
3) If you put a site on your list that offers multiple options then include the practice
setting (i.e. rehab, inpatient acute, etc.) you prefer. However, the Clinical
Education Office cannot guarantee that you will be placed in the practice setting
of your choice.
There may be extreme extenuating circumstances that require exceptions to the above
placement process. The Academic Clinical Education Coordinator(s) reserve(s) the
right to place a student at a site based on what is the best supported environment for a
student’s successful completion of a fieldwork experience. Strict confidentiality and
ethical standards are maintained in each case.
14
C. Completion of Placement Process
Students are NOT permitted to contact their site until permission is granted from
the Clinical Education Office after all of the items below are completed.
Students are provided with their individual placement and contact name when the
placement process is completed. At that time, the student will sign the Assignment
Agreement Form (Appendix G) and return it to the Academic Clinical Education
Coordinator(s) by the specified date assigned. Once the Academic Clinical Education
Coordinator(s) and Assistant Clinical Education Coordinator have completed all the
fieldwork placements, a roster is posted on the Level II Fieldwork Preparation Seminar
and Professional Trajectory course websites which lists the facility address, fieldwork
educator name, phone number and dates of placement. The following packet of
materials is then sent in the spring prior to the student’s arrival to each site: course
syllabus, confirmation forms (Appendix H), student’s personal data sheet (Appendix B),
and evaluation forms (Appendix I, J).
After placements are complete, no changes will be made to the fieldwork placement
unless the site cancels, or the student fails to complete any pre-requisites for OTD 481 or
OTD 571.
Please note: Sites reserve the right to place students in a practice setting that is
conducive to learning, even if it is different from the anticipated practice area
noted during the site selection process. It is expected that students be prepared
to achieve entry-level competency in any practice setting.
Cancellation
If a fieldwork placement is canceled, the student will be notified immediately and
alternate choices will be determined with the Academic Clinical Education
Coordinator(s). The alternate choices will be taken from the advanced reservations that
were not used during the original placement process. The student will choose a site or
sites from this list and the site(s) will be contacted to determine availability. If a site is
available, the student will be placed at that site. Any other special circumstances (e.g.
medical needs, family member illness, etc.) necessitating a change in fieldwork
placement will be considered on a case-by-case basis. A written request by the
student must be submitted to the Chair of the OT Department and the Academic
Clinical Education Coordinator for approval.
Contracts & Facility Files
Creighton University has contracts for occupational therapy fieldwork with approximately
330 facilities across the country. A contract/agreement between the site and Creighton
University must be signed by both parties before a student can be placed. Fieldwork
files of the various facilities are located in the Occupational Therapy Clinical Education
Database in SharePoint. For questions or concerns regarding the files, contact Mary
Pat Wearne. These electronic files contain evaluations of the site by previous students,
the fieldwork objectives as outlined by the facility, and general information if available
about the sites including: types of clients, dress code, hours, housing or meals provided,
and occasionally maps/brochures from the area. Some sites provide examples of
student assignments or student notebooks. Students may make appointments with the
Academic Clinical Education Coordinator(s) to gain more details about particular sites.
15
Site Development
The goal of site development is to obtain new sites that align with the curriculum of the OTD
program. The Clinical Education Office looks for quality sites that are congruent with the
curriculum at Creighton University and those who will be committed to accepting Creighton
students on a regular basis. The priority of the Clinical Education Office is to ensure quality
fieldwork sites, in a variety of practice settings, providing you with continued optimal
learning experiences.
Students are given the opportunity to contribute to development of a new site that would be
a benefit to Creighton University’s Occupational Therapy program, by submitting a Site
Recommendation Form (see Appendix O) which outlines how this particular site will:
a) meet the OTD program objectives,
b) provide an opportunity for future students, and
c) further enhance the fieldwork program by offering a quality experience.
The Clinical Education Office is open to developing additional sites that are congruent with
our curriculum and represent a variety of practice areas.
When students are interested in developing a site, they need to make an appointment to
meet with the Academic Clinical Education Coordinator to discuss the process. Students
are not permitted to contact a site to solicit a fieldwork slot. Sites will not be developed
that will only accommodate ONE student’s needs and/or specific preferences,
including geographical location. A student contacting a site should only obtain general
information needed to complete the site development form.
Every Site Recommendation Form will be reviewed by the Clinical Education team. The
Clinical Education team reserves the right not to pursue a site should they feel that it
doesn’t meet the OTD program objectives and/or enhance the clinical education program or
the practices of the facility are not congruent with the curriculum at Creighton University.
Should a site inquire if a student would like to reserve a slot, the student should refer that
site to discuss this with the Academic Clinical Education Coordinator(s). If a site suggested
by a student is developed for the OTD program, that site is made available to all students.
The procedure for Site Development:
1. Identify source of site development and complete initial site screen
1.1. Site initiates contact with Creighton University
1.1.1. ACEC does preliminary research on site and discusses with clinical
education office for initial screening
1.1.2. ACEC calls or emails site for screening and completes Site Development
Report
1.1.3. ACEC shares report with clinical education office to reach consensus on
whether to pursue contract
1.1.4. If decision is made to decline site development, ACEC contacts site to
notify
1.1.5. If decision is made to pursue site development, move to step 2
16
1.2. Student expresses interest in site development
1.2.1. Student completes Site Recommendation Form (see Appendix O) and
returns to an ACEC
1.2.2. ACEC shares form with clinical education office to reach consensus on
whether to pursue contract
1.2.3. If decision is made to decline site development ACEC completes Site
Recommendation Form, providing rationale for student in writing
1.2.4. If decision is made to pursue site development ACEC completes Site
Recommendation Form, notifying student of decision, and moves to step
1.1.2 above
1.2.5. ACEC notifies student of final outcome of site development
1.3. ACEC/Faculty expresses interest in site development
1.3.1. ACEC or other faculty shares rationale for site development with clinical
education office for initial screening
1.3.2. Clinical education office reaches consensus on whether to pursue site
development
1.3.3. Follow steps 1.1.2 above
1.3.4. ACEC notifies faculty of final outcome of site development
2. Arrange site visit and/or further in depth phone call to document congruency of site
with curriculum
2.1. Level I site
2.1.1. ACEC completes visit/phone conversation as able prior to student(s)
participating in fieldwork at site
2.2. Level II site
2.2.1. ACEC completes visit/phone conversation as able prior to student(s)
participating in fieldwork at site
3. ACEC shares results of site visit with clinical education office
3.1. If consensus is to pursue contract move to step 4
3.2. If consensus is to decline contract development, ACEC contacts site to notify
and shares outcome with interested parties
4. Develop contract
4.1. Once completed, ACEC shares outcome with interested parties
4.2. Fieldwork site is available to all students, regardless of who initiated the site
development
5. All above mentioned forms will be retained by the Assistant Clinical Education
Coordinator
17
Level II Fieldwork Evaluation Process:
During your Level II Fieldwork experience, you will be required to:
1. Participate in online discussions throughout the experience. Reflective postings are
designed to assist students in their learning process and provide useful information
in determining student progress prior to the mid-term and final evaluations. Failure
to complete your online postings will result in an incomplete grade in OTD 481 or
OTD 571 until you complete a make-up discussion group or an alternative
assignment as determined by the instructor of record.
2. Additional assignments are listed in the OTD 481 and OTD 571 course syllabi.
3. Individual fieldwork sites may have site specific assignment requirements, and
students should follow the deadlines provided by the site.
4. Complete the Student Evaluation of Fieldwork Experience Form (see Appendix I)
during the last week of the placement. The fieldwork educator sends this form,
along with the AOTA Fieldwork Performance Evaluation (FWPE) for the
Occupational Therapist to the Academic Clinical Education Coordinator(s). Students
should allow enough time to thoughtfully fill out this form -- the information is very
useful to the Clinical Education Office, to the Creighton Occupational Therapy
Curriculum Committee, The Creighton Occupational Therapy Assessment
Committee, and to future students considering this fieldwork site/facility. Students
are advised to collect data to complete the Student Evaluation of Fieldwork
Experience Form beginning the first week of fieldwork. Students will also have the
option of completing an additional one page document to report information
regarding a site to only the Academic Clinical Education Coordinator(s). This form
will be made available on the fieldwork course website and should be reserved only
for concerns students have regarding a site that they do not feel comfortable sharing
with the fieldwork educator through the Student Evaluation of Fieldwork Experience
Form (SEFWE).
It is strongly advised that both the student and fieldwork educator make a
copy of both evaluations for their records.
5. The AOTA FWPE for the Occupational Therapist is used to assess students in Level
II Fieldwork. The minimum criterion scores are listed on page 2 of the FWPE. It is
recommended that the FWPE be used as a tool for communication to facilitate
professional growth as well as for evaluating performance. Students need to review
this form prior to fieldwork. Students are encouraged to complete the FWPE on
his/her performance as a comparison to what the fieldwork educator scores reflect at
both midterm and final review. Students should clarify with their fieldwork educator
any questions regarding use of the FWPE.
6. It is a requirement to complete online course evaluations for OTD 481 and OTD 571.
7. The final responsibility for your grade assignment rests with the Academic Clinical
Education Coordinator(s). The Academic Clinical Education Coordinator will record a
grade of Satisfactory/Unsatisfactory. The grade is determined by achievement of a
minimum score on the FWPE, student attendance, active participation in discussion
boards, and satisfactory completion of all other required assignments as stated in
the course syllabi for OTD 481 and OTD 571. The student MUST score a 3 or 4 on
items #1, 2, & 3 on the FWPE in order to pass the Level II FW course. The student
must ALSO achieve an overall minimum score of 122 on the FWPE to pass.
18
8. Any student whose clinical competence and/or attitudes and behaviors are
sufficiently deficient or inappropriate so as to warrant removal from a clinical site
prior to the completion of the clinical education experience will receive a failing (F) or
unsatisfactory (UN) grade for that experience. Please see the complete policy for
Clinical Guidelines here:
http://spahp2.creighton.edu/oasa/share/sharedfiles/UserFiles/file/Procedures/Clinical%20Guidelines.pdf
Absence Policy
Occupational Therapy students need to complete a minimum of 24 weeks of Level II
fieldwork to meet the Accreditation Council for Occupational Therapy Education
(ACOTE) standards for entry into the profession and to contribute to graduation
requirements of the University.
 Creighton University suggests that all student requests for personal leave be
negotiated directly with their fieldwork educator. Examples of acceptable reasons
for leave are illness, family emergency, medical appointments, funerals, or a
child’s illness. Students must email the ACEC that is his/her instructor of record,
indicating the absence date(s), reason for absence, and confirmation of
communication with his/her fieldwork educator immediately.
 The fieldwork educator has the right to request that a student make up any personal
leave days for successful completion of the Level II fieldwork experience.
 Requests for vacation days ARE NOT APPROPRIATE during your Level II
Fieldwork experience(s). If extenuating circumstances prevail, you must gain
approval, via email, from your Academic Clinical Education Coordinator at least
TWO weeks prior to the date requested off and communicate with your fieldwork
educator to determine how to make up for missed days.
Site hours for clinical affiliation are not negotiable. The hours of the affiliation are set
by the facility. The weekly schedule will be determined by each fieldwork educator
and/or site. Some centers require occasional evening or weekend hours. You may be
expected to work 4 (10 hour) days as required by your fieldwork educator. Some
fieldwork educators work different schedules such as Tuesday-Saturday. You are
expected to maintain the same work schedule as your fieldwork educator.
Any changes to the dates for the fieldwork experience must be approved
and documented in writing by the Academic Clinical Education Coordinator and
the fieldwork educator before the start of the fieldwork experience.
19
Preparation for your first Level II Fieldwork (OTD 481) will be covered in OTD 479 and 480
Some requirements include:
1.
Students must update online competency quizzes for Universal Precautions and
the Health Insurance Portability and Accountability Act (HIPAA) before beginning
Level II fieldwork rotation.
2.
Read and be familiar with:
a. The AOTA Principles of Occupational Therapy Ethics
b. The Department of Occupational Therapy Absence Policy for Level II Fieldwork
c. Universal Precautions for Occupational Therapy Services
d. Student fieldwork file for important information about the center, especially the
dress code and the behavioral objectives
e. The School’s policy on Requirements for Participation in Experiential Programs
3.
It is strongly recommended that each student write a letter or email their fieldwork
center four to six weeks before the beginning date to confirm arrangements.
The letter must be typed and professional in appearance. (See Appendix M for a
suggested outline for this letter.) Students should send a copy of the letter to the
instructor of record and maintain a personal copy. Many fieldwork educators now
have email access and an email letter is an acceptable form of communication.
Please be aware that your clinical instructor may take several days to respond by
e-mail due to their clinical schedules.
4.
Financial arrangements should be made that will enable students to devote their
time and energy to the demands of clinical training without needing to work during
fieldwork. The OT department strongly discourages students from
employment outside the Level II Fieldwork hours.
5.
Students must be eligible to register for Level II Fieldwork prior to leaving campus.
Your compliance with health requirements of the University and your Level II site is
required before you are able to register for your Level II Fieldwork. Failure to
comply with the health requirements could result in a delayed start date for
your Level II Fieldwork.
6.
Students are responsible for locating internet access during their Level II Fieldwork
rotations. Students are also expected to check their Creighton University email
account and course website on a weekly basis minimum. The instructors will
communicate with students via your Creighton University email account and the
course website.
7.
Professional liability insurance and Worker’s Compensation for Level II Fieldwork
is provided by Creighton University. A copy of the liability insurance is available
from the Assistant Clinical Education Coordinator (see Appendix P)
20
Student’s Responsibilities during Level II Fieldwork
During Level II fieldwork, the student should:
1. Notify the Academic Clinical Education Coordinator(s) of any problems with scheduled dates
for fieldwork.
2. Provide the Academic Clinical Education Coordinator(s) with a current phone number prior
to leaving campus for the summer.
3. Read and be familiar with the fieldwork site’s student objectives, manual and/or other
information provided.
4. Keep notes about the types of clients seen, assessments and treatment techniques used.
This information will be helpful when filling out the Student Evaluation of the Fieldwork
Experience form at the end of the fieldwork experience.
5. Report any incident/accident, involving you and/or a patient/client, to the Academic Clinical
Education Coordinator following notification of the fieldwork site and the fieldwork educator.
An Incident Report should also be filed with the University.
6. Notify the fieldwork educator of any difficulties encountered during fieldwork. The student
should ask questions, offer alternatives, and problem solve to help resolve difficulties. The
student should not put off approaching his/her fieldwork educator; a delay in resolving
difficulties cannot be afforded.
7. Call the Academic Clinical Education Coordinator(s) if:
a.
b.
c.
d.
There is a problem you have not been able to resolve.
Your performance is at risk of not passing.
Support or feedback is needed.
You have incurred any accident, injury or event that impacts your ability to participate in
your fieldwork experience.
Most sites will allow students to use their phones, email or faxes to contact the University;
however, permission should be obtained first. If it is necessary to communicate via U.S. mail,
letters can be addressed to the Academic Clinical Education Coordinator, Creighton University,
Occupational Therapy Department, 2500 California Plaza, Omaha, NE 68178. If a student feels
it is necessary to talk away from the facility, they can call and leave a message for the
Academic Clinical Education Coordinator with an evening number. If there is even the
possibility of a major problem, the student should contact the Academic Clinical Education
Coordinator immediately.
8. Provide the fieldwork educators with feedback during the fieldwork experience. Students
will be required to complete online discussion board postings via course website during the
Level II fieldwork rotation. These online discussions are designed to facilitate reflection and
provide a form of support for students while on fieldwork. Reflection and group discussion is
an important part of developing clinical reasoning skills.
9. Project a professional image and pay constant attention to confidentiality of clients and to
safety practices.
10. Upon completion of Level II Fieldwork, we strongly recommend that you send a thank you
letter to the OT Staff of your site (see Appendix N for an example).
21
WHAT TO EXPECT DURING YOUR FIELDWORK
The fieldwork experience is a continuation of a lifelong learning process. You will undoubtedly
experience conflicting emotions when entering this period of professional growth. You will be
eager to begin treating actual patients in an authentic practice situation, but you may also be
apprehensive and unsure about your skills with patients. The mechanical aspects of a
professional day are new and there is also the uncertainty of forming new interpersonal
relationships with other staff, patient/clients, and other students.
This should be a stimulating period when you, the student, can explore your own abilities. You
will be encouraged to demonstrate resourcefulness, expected to be inventive with original ideas
and to be able to act upon them, and to be creative in your approach to clinical problems. It will
appear that the clinical experience is a very open setting - receptive to new ways and ideas.
You are encouraged to be resourceful and original in your treatment approach, and these goals
have to be within the framework of the facility and the occupational therapy service program.
This is your opportunity to put what you learned in the classroom into action within the context of
your fieldwork placement. You may be one of many Level II fieldwork students who pass
through the fieldwork site during the year. Consequently it is not realistic to expect major
program changes to accommodate you or your special interests. There will be times when your
interests may be accommodated, but admittedly there are gaps between a student’s idealism
and practice reality.
Because of the above, you may encounter difficulties while on your fieldwork experience.
Stress can be said to occur when an individual feels threatened and his or her adaptive
mechanisms tend to collapse. It can be both the threat itself and the person’s reaction to it.
Not every student will experience difficulties. However, for those who do, a discussion about
the dynamics of clinical fieldwork now may minimize some of the future problems and offer you
possible alternatives for coping with the situation. We encourage you to use the Fieldwork
Environment Assessment Tool (FEAT) (Appendix K) to help problem solve challenging
situations during your fieldwork experience. The FEAT (Appendix K) will be provided to you
during your OTD 479 course. Another resource used by the Clinical Education Office is the use
of the Strength Finders Approach (Buckingham, M. & Clifton, D.O (2001). Now, discover your
strengths. The Free Press: New York.). The Clinical Education website contains a Fieldwork
Tool Kit with many helpful resources as well: http://ot.creighton.edu/fieldwork
The fieldwork experience is a teaching-learning process. The basic components are the
teacher, the learner, and the setting in which learning takes place. You should begin to explore
when starting the fieldwork what setting characteristics can be conducive to your learning, and
what behaviors of the fieldwork educator facilitate this learning. Relatedness, dependency,
integrative capacity, trust, doubt, confidence, expectations, evaluations, rewards, coping
adaptations and defensive adaptation, ambiguity, and role conflict are a few terms related to the
positive and negative aspects of fieldwork experience. An individual’s capacity to tolerate stress
depends on many factors including early emotional experiences, knowledge about his or her
present situation, motivation and techniques for withstanding tension, self-understanding and
present alternatives. Conflicts may arise and the therapist and student may assume defensive
attitudes. Clinicians are human with the attributes and faults that we all share. Your presence
may be threatening because of your new knowledge and penetrating questions. Reduction of
defensive behavior and anxieties facilitates the learning process. This reduction of stress will
require a cooperative effort between you and the supervisor. Please contact your Academic
Clinical Education Coordinator(s) if you need assistance in dealing with fieldwork related stress.
22
UNIVERSAL PRECAUTIONS
The following barriers should be used by all health care workers. Each individual
fieldwork site will have universal precaution recommendations. You are required to
follow the site’s universal precautions. These barriers should be used in situations in
which contact with blood and body fluids is likely. These barriers include:
1)
GLOVES Gloves should be available at all times and should be worn when the
possibility exists of coming into contact with blood and body fluids, or mucous
membranes; when handling soiled items or surfaces. Gloves should be changed
after direct contact with each patient. Gloves should be worn when cleaning up
blood or body fluid accidents in the clinic. Gloves should be disposed in the
proper container identified by the site.
2)
MASK AND PROTECTIVE EYEWEAR When doing an evaluation/treatment
that is likely to generate droplets or splashes of blood or body fluids, both a mask
and protective eyewear should be worn. In many instances, personal eyeglasses
will provide adequate protection.
3)
GOWNS Usually not necessary, but should be worn when soiling of clothes with
blood or body fluids is likely; for example, working with burn patients at which
time the protective barrier would be an advantage to the patient and the
therapist. At times gowns will be required depending on a diagnosis including
immunosuppressed patients or individuals with staph (clarify here).
4)
SINGLE ROOMS Necessary for patients infected with airborne pathogens and
for patients who represent a risk for environmental contamination; for example,
patients who have poor personal hygiene or profuse bleeding. All occupational
therapy-procedures will be conducted in the patient’s room with necessary
precautions listed in 1-3 above.
5)
AIRWAYS Pocket masks and ventilator bags must be accessible for use with
ALL patients.
IN ADDITION TO THE ABOVE BARRIER PRECAUTIONS, THE FOLLOWING
SHOULD ALSO BE CONSIDERED AS PART OF UNIVERSAL PRECAUTIONS:
6)
PREGNANT WORKERS Require no special restrictions from patient care
activities. No susceptible worker (pregnant or not) should care for patients with
Varicella, Herpes zoster, or Rubella.
7)
INJURIES From sharps should be avoided. All sharp injuries occurring during
evaluation/treatment requiring Universal Precautions should be reported
immediately to Occupational Medical Services and handled according to facility
policy.
8)
EXPOSED EXUDATIVE LESIONS Weeping dermatitis occurring in a health care
worker or Fieldwork II affiliating student should be evaluated by the Occupational
Medical Service.
23
9)
EQUIPMENT HANDLING
ALL testing/evaluation equipment, materials or
nonexpendible supplies that contact mucous membranes require disinfecting with
an agent registered by the EPA as a sterilant.*
10)
ENVIRONMENTAL CLEANING ALL workers must wear gloves for cleaning an
area following use of universal precautions. Blood and body fluid spills require
special cleaning. Visible material should be removed unless the spill is large (in
which case it is prudent to flood the spill with a germicide before removal). After
removal, the area should be cleaned with a germicide.**
11)
LAUNDRY ALL linen soiled with blood or body fluids or from patients on isolation
should be placed in water soluble bags and then yellow linen bags.
12)
WASTE ALL waste soiled with blood or body fluids as well as waste from
patients in traditional isolation categories will be handled as medical pathological
waste. ALL trash should be transported with care and handled with gloves.
13)
DISHES from patients on UNIVERSAL PRECAUTIONS do not require
disposable food trays.
14)
COMPLIANCE with these guidelines will be monitored by supervisors.
Employees or students identified as not being in compliance with these
guidelines will be counseled and retrained. Employees or students who are
repeatedly identified as failing to comply with these guidelines will be subject to
disciplinary action.
NOTE:
*Bleach - 1:10 Bleach/Water Solution
** Betadine - 4 ppm; or 1 oz. to 20 gallons H2O
Wescodine - 75 ppm; or 3 oz. to 5 gallons H2O
Bleach solution is recommended for small spills and Wescodine for large
spills in sink, toilet, tub, or floor.
24
Health Insurance Portability and Accountability Act (HIPAA)
KEY POINTS TO REMEMBER ABOUT HIPAA
 Patients have a right to understand how their health information will be used and
disclosed within the facility they are receiving care
 Patients have a right to obtain and see a copy of their health records
 Patients have a right to expect that their health information will be used only for
legitimate purposes
 Clinicians are only to use or disclose patients’ health information for work-related
purposes
 Keeping patients’ health information confidential is part of a clinicians’ job
responsibility and professional behaviors.
 Confidential conversations do not occur where third parties may overhear them
(elevators, cafeteria, etc)
 Names or other identifying information should not be used to identify patients in
conversations whenever possible
 Oral communications of patient information are limited to the minimum necessary to
get the job done.
 Telephone conversations related to a patient are conducted where they cannot be
overheard
 Always confirm the name of the third party that you are communicating with about a
patient
 Patient information that is no longer needed is discarded in an appropriate container
or shredded immediately
 Patient information is not left unattended in any public area (photocopiers, fax
machines, etc.)
 Patient files are never left in plain view and identifying information must be obscured
 Patient schedules are not left in public areas
 Any electronic communication about a patient is included as a paper record in the
patient’s file
 In general, use of computer based patient information is limited to the minimum
necessary to get the job done
What is Protected Health Information?
Protected Health Information (PHI) is any piece of paper (yes, even a scrap of paper) or
computer database or e-mail or other media that contains the following types of
information about a patient:
 Name
 Phone #
 Fax #
 E mail address
 Social Security Number
 Medical Record #
 Health plan beneficiary #
 Account #s
 Certificate or license #s
 Vehicle Identification #s
 License plate #s
 Device ids and serial #s
25





URLs
IP addresses
Biometric identifiers (finger, voice prints)
Full face photos and comparable images;
Geographic subdivisions smaller than state (address, city, county, precinct, zip
code, geocodes – except first 3 digits of zip if it contains 20,000+ people OR it is
changed to 000); AND
 All date elements except yr for dates directly related to the individual – DOB,
admit date, discharge date, DOD, and all ages over 89 (although you may
aggregate for 90+; AND
 “Other unique identifying #s, characteristics, or codes.”
(AOTA - http://www.aota.org/Practitioners/Reimb/Resources/HIPAA/37782.aspx)
If your paper or e-mail does not include ANY of these types of information, then it
is NOT PHI; it is de-identified health information. In that event, HIPAA does not
apply and you may do with this information as you please.
Online resources:
 http://privacy.med.miami.edu/
 CMS HIPAA Web page
http://www.cms.hhs.gov/HealthInsReformforConsume/02_WhatHIPAADoesandDoes
NotDo.asp
 CMS HIPAA General Information http://www.cms.hhs.gov/HIPAAGenInfo/
26
PROFESSIONAL ROTATION
Each OTD student is required to complete a 16-week Professional Rotation as part of
their experiential learning. The placement process, experience and outcome objectives
may be dramatically different than prior Level II fieldwork experiences. Students will
continue their personal inquiry toward professional development during a two-semester
trajectory process to construct their Professional Rotation during the third academic
year.
Students will consider various options of types of practice environment(s) and gather
data in order to select an environment for their Professional Rotation. The selected
practice environment will serve as the basis for locating specific site options for
Student’s professional rotation and for designing a personal development plan in
preparation for the rotation.
Professional rotations in the OTD program offer students the opportunity to extend and
refine knowledge acquired in the curriculum and utilize it meaningfully as a means of
critically analyzing occupational therapy practice. Using the OTD curriculum design as
a framework, students will articulate a rationale for professional rotation site choice(s)
that considers: (a) their own occupational interests and needs; (b) the opportunities,
limitations, requirements and needs of particular practice environments; and (c) the
potential contribution a professional prepared with an OTD degree can make to such
environments.
27
NBCOT - National Board for Certification in Occupational Therapy
Students need to direct all questions
regarding the NBCOT registration exam to NBCOT




Students are responsible for the application process
Students should access the web page at http://www.nbcot.org for details
Students should request and refer to the NBCOT exam handbook
The Clinical Education Office is NOT responsible for arranging the NBCOT
exam for students. Any questions should be directed to the vice-chair, Dr. Amy
Matthews at 402-280-5955.
TEMOPORARY STATE LICENSE
Students applying for a temporary state license need to closely review the state’s
temporary license rules. If you need proof of completion of the OTD program prior to
your final transcript being available you should:


Direct this request in writing to the Chair of the Occupational Therapy program.
Indicate in the request where the letter should be sent.
No letters will be issued until the written request and the evaluation forms from the
professional rotation are received. Multiple requests for such letters do not advance the
process. The University will make every effort to fulfill the written requests, but no
guarantees are made regarding when the letter will be mailed. Students may contact
the Occupational Therapy Department secretary at (402) 280-1864 for more
information.
28
APPENDIX A
CLINICAL PLAN OF STUDY
29
Clinical Plan of Study (CPOS)
Purpose & Overview: The Clinical Plan of Study (CPOS) is designed to assist you in exploring your future clinical
education plans and trajectory. As part of your OTD education, you will complete several clinical experiences to
prepare you to be an entry-level occupational therapist. Below are the purposes of each clinical experience followed
by the breakdown of the different experiences that are required in the OTD program.
Level I Fieldwork: introduction to clinical experiences, application of knowledge to practice, and development and
understanding of client needs
Level II Fieldwork: development of competent, entry-level generalists in the field of occupational therapy
Professional Rotation: development of competent occupational therapists with advanced skills in an individually
defined area of practice
From: http://www.aota.org
OT1 Year
Spring: OTD 370 Fieldwork Level IA (1 week)
 focus on occupation-based practice, skilled observation, documentation, and therapeutic use of self
OT2 Year
Fall: OTD 470 Fieldwork Level IB (1 week)
 focus on client centered practice, clinical assessment, documentation, and rapport building
Spring: OTD 471 Fieldwork Level IC (1 week)
 focus on evidence-based practice, clinical intervention, documentation, and advocacy
Summer: OTD 481 Fieldwork Level IIA (12 weeks)
 application of student understanding of occupation; demonstration of professional practice, leadership, and
entry-level competency; personal and professional identity development (cannot be completed in a
pediatric practice setting)
OT3 Year
Fall: OTD 561 Fieldwork Level ID (1 week)
 design own experience with purpose of exploring a potential area of interest for upcoming Professional
Rotation; may also want to consider a more specialized practice area or choose one last traditional
experience
Summer: OTD 571 Fieldwork Level IIB (12 weeks)
 application of student understanding of occupation; demonstration of professional practice, leadership, and
entry-level competency; personal and professional identity development
OT4 Year
Fall: OTD 600 Entry Level Professional Rotation (16 weeks)
 self-directed experience that begins after the successful completion of the Professional Competency course;
serves as an opportunity for students to identify an area in which they wish to develop advanced skills;
consider engaging in program development, research, advocacy, academia, advanced clinical skills,
administration/leadership, etc.
30
General Overview:
Step 1: Complete the VARK learning style questionnaire. Please see instructions below.
Step 2: Review the Fieldwork Practice Settings table and provided explanations.
Step 3: Complete the Clinical Plan of Study Questionnaire.
Step 4: Complete the Clinical Plan of Study indicating potential practice settings that you may want
to explore during the listed semesters. Include practice setting, whether you prefer a local or
nonlocal site (list city or state), and name of specific site (if known).
Step 5: Schedule a 1:1 meeting with your assigned Academic Clinical Education Coordinator to
review your completed Clinical Plan of Study. Campus students sign up on your assigned ACEC’s
office door. Alaska students please email assigned ACEC for an appointment. All students,
please submit your completed form electronically to the appropriate drop box prior to your meeting
time.
Step 1. The VARK
The VARK will be helpful in understanding your own learning style and in guiding you in completing your
clinical plan of study. If you’ve previously taken the VARK, it is suggested that you re-take it to assess if
your learning style has changed.
Go to the following website and complete the 16 question VARK learning style inventory.
http://www.vark-learn.com/english/page.asp?p=questionnaire
Upon completing the VARK, please answer the following 2 questions:
1. According to the VARK, what is (are) your learning preference(s)? (e.g. visual, aural, read/write,
kinesthetic)
2. Please briefly reflect on your learning preference results.
31
Step 2. Fieldwork Practice Settings
Hospital-based
Community-based
School-based
Other
In-Patient Acute
In-Patient Rehab
SNF/Sub-Acute/Acute LongTerm Care
General Rehab Outpatient
Outpatient Hands
Pediatric Community
Behavioral Health Community
Older Adult Community Living
Early Intervention
School
Nontraditional
Pediatric Hospital/Unit
Pediatric Hospital Outpatient
In-Patient Psych
Older Adult Day Program
Outpatient/hand private
practice
Adult Day Program for DD
Home Health
Pediatric Outpatient Clinic
From: http://www.aota.org/Educate/Accredit/Forms/GeneralUse/FormA.aspx
* Some facilities offer multiple practice settings. For example, large health systems may offer in-patient acute, inpatient rehab, and general rehab outpatient.
Practice Setting Definitions
In-Patient Acute: care provided to patients who have a sudden and short-term need for services and are typically
seen in the hospital, many services offered; fast-paced, average length of stay 3-5 days
In-Patient Rehab: highly structured schedule, intense interdisciplinary intervention focus, average length of stay 2
weeks
Skilled Nursing Facility (SNF)/Sub-Acute/Acute Long-Term Care
Skilled Nursing Facility (SNF): provides less intensive level of care for individuals who need acute or
chronic nursing care on a regular basis but do not need to be hospitalized; care is administered by nursing
professionals under the direction of a physician; available services include assistance with Activities of Daily
Living (ADLs), rehabilitation, meals/snacks, social/recreational activities, housekeeping, transportation, etc.;
may also provide specialized services for those with Alzheimer’s or other related memory disorders
Sub-Acute: less intensive level of care; typically in a hospital; complex medical situations requiring longer
period of rehabilitation and recover usually from 1-4 weeks (e.g., persons with strokes, hip fractures, cancer,
cardiac condition, etc.)
Acute Long-Term Care: patients are medically stable, but are fragile and too ill to be discharged to a
nursing facility, an inpatient rehabilitation hospital or to their homes; often require extended medical and
nursing care
General Rehab Outpatient: serves clients with disabling conditions and may focus on medical issues; oftentimes,
clients have been recently discharged from a hospital setting and are still in need of therapy services (but which can
be provided at a lower level of care); treatment frequency varies from 5 days per week to once every other week
Outpatient Hands: In addition to the features of General Rehab Outpatient, this setting focuses solely on treating
persons with conditions of the upper extremity and typically includes therapeutic exercise, splinting, and physical
agent modalities as primary interventions
Pediatric Hospital/Unit: provides care to children who have a sudden and short-term need for services; many
services offered; fast-paced
Pediatric Hospital Outpatient; serves children with disabling conditions and may focus on medical issues;
oftentimes, clients have been recently discharged from a hospital setting and are still in need of therapy services (but
which can be provided at a lower level of care)
32
In-Patient Psych: offers traditional psychiatric occupational therapy programs where clinician plans activities (e.g.,
crafts, recreation, outings) for the purposes of skill development, self-awareness, leisure exploration, and social
participation
Pediatric Community: pediatric programs that are not hospital-based or outpatient clinical sites; may vary according
to community
Behavioral Health Community: vary in organization and structure, may offer medication clinics and counseling,
crisis units, or day treatment programs, clinicians work with a client or group to develop life skills, to encourage social
participation, to explore leisure opportunities, and to develop abilities to engage in areas of performance
Older Adult Community Living
Assisted Living: a combination of housing, personalized supportive services and health care designed to meet
the needs – both scheduled and unscheduled – of those who need help with activities of daily living; facilities
vary in location and structure; available services include meals, housekeeping, transportation, assistance with
Activities of Daily Living (ADLs), wellness programs, pastoral care services, 24-hour staff, etc.; may also provide
specialized services for those with Alzheimer’s or other related memory disorders
Continuing Care Retirement Communities (CCRC): offers several levels of assistance, including independent
living, assisted living, and nursing home care; is different from other housing and care facilities for seniors
because it provides a written agreement or long-term contract between the resident (frequently lasting a lifetime)
and the community which offers a continuum of housing, services, and care, commonly on one campus or site
Older Adult Day Program: serves older adults (e.g. adults with dementia) who need daytime supervision or are able
to live in the community but who require some assistance, clinicians develop and provide structured programs of
activities for clients
Outpatient/hand private practice: same as General Rehab Outpatient or Outpatient Hands, but privately owned
Adult Day Program for DD: serves adults with development disabilities who need daytime supervision or are able to
live in the community but who require some assistance, clinicians develop and provide structured programs of
activities for clients
Home Health: therapy provided in the client’s natural home environment (e.g. house, assisted living facility, etc.);
clinicians travel to client’s location; providers may also work in the home of persons who receive hospice care
Pediatric Outpatient Clinic: same as Pediatric Hospital Outpatient, but not located in a hospital
Early Intervention: services typically provided to children from birth to 3 years of age who have disabilities or are at
risk; goal is to enhance development, minimize the potential for developmental delay, and help families to meet the
special needs of their infants and toddlers
School: services provided to children in the school system that enable them to engage in education and be
successful in the classroom; clinicians may work in standard schools or specialized schools (e.g., for children with
autism, visual impairment, hearing impairment, and cerebral palsy)
Nontraditional: may include correctional facilities, industrial settings, hospice, health maintenance organizations,
community transition programs, therapeutic riding programs, aquatherapy, senior citizen centers, programs for
migrant workers, homeless shelters, programs for victims of disasters, etc.
Sources:
American Occupational Therapy Association. (2009). Occupational therapy in early intervention: Helping children succeed.
Retrieved November 19, 2009, from http://www.aota.org/Consumers/WhatisOT/CY/Articles/40021.aspx
Hussey, S., Sabonis-Chafee, B., & O’Brien, J. (2007). Introduction to occupational therapy. St. Louis: Mosby.
33
Step 3. Clinical Plan of Study Questionnaire
1. What drew you to occupational therapy?
2. Do you have any ideas of what or where you want your first job to be?
3. What past work or volunteer experiences in healthcare/childcare/senior care have you had?
4. What kind of job or practice setting would you find most rewarding? Least rewarding?
5. Is there a certain population (e.g., pediatrics, adults, elders) you desire to work with?
6. What practice setting(s) do you desire to learn more about?
Additional Thoughts/Comments/Questions:
34
Step 4. Clinical Plan of Study (CPOS)
OT1 Year
Spring
Practice Setting
Local/Nonlocal (city/state)
(if known)
*Site name
(optional)
Practice Setting
Local/Nonlocal (city/state)
(if known)
*Site name
(optional)
Practice Setting
Local/Nonlocal (city/state)
(if known)
*Site name
(optional)
Practice Setting
Local/Nonlocal (city/state)
(if known)
*Site name
(optional)
OTD 370
Level IA:
(1 week)
OT2 Year
Fall
OTD 470
Level IB:
(1 week)
Spring
OTD 471
Level IC:
(1 week)
Summer
OTD 481
Level IIA:
(12 weeks)
OT3 Year
Fall
OTD 561
Level ID:
(1 week)
Summer
OTD 571
Level IIB:
(12 weeks)
OT4 Year
*cannot be peds*
Fall
OTD 600
Professional
Rotation:
(16 weeks)
* Site names must come from Clinical Education database which be found on the OT Clinical Education community
BlueLine site. However, OTD 561 & OTD 600 can be sites beyond the database.
Step 5. Remember to schedule a 1:1 meeting with your assigned ACEC to review your CPOS! This form should be
completed and submitted to the drop box PRIOR to your meeting. After your meeting, submit your final (i.e. any
discussed changes are incorporated) CPOS signed by you and your ACEC by the due date
Student Signature:
ACEC Signature:
Date:
Date:
35
APPENDIX B
PERSONAL DATA SHEET
36
Creighton University
Department of Occupational Therapy
School of Pharmacy & Health Professions
Fieldwork Experience
PERSONAL DATA SHEET
Date: __________________
Last Name
First Name
MI
Phone # (Include area code)
Local Address (Include Street, City, State, Zip)
Email Address
Emergency Contact Name
Phone # (Include area code)
Relationship to Student
Cell Phone #
Emergency Contact Address (Include Street, City, State, Zip)
Student Medical Insurance Carrier
Policy Number
Professional Liability Insurance Coverage Limits CU: Midwest Medical Insurance Company
$1,000,000 - Any one claim
$3,000,000 - Any one annual period of insurance
$1,000,000 - Any one occurrence
OTD Curriculum
FALL
Year 1
OTD 303 Introduction to Occupational Therapy (2)
OTD 305 Communication & Instructional Methods (3)
OTD 306 Clinical Conditions (2)
OTD 308 Introduction to Inquiry (3)
OTD 341 Neuroanatomy (3)
Year 2
OTD 408 Research Process I (2)
OTD 411 OT Practice in Mental Health (3)
OTD 413 Physical Rehabilitation I (3)
OTD 423 OT with Elders (3)
OTD 431 Occupation, Adaptation & Technology (3)
OTD 441 Musculoskeletal Dimensions of Occupation (3)
OTD 470 Level IB Fieldwork (1)
OTD 479 Level II Fieldwork Seminar 1 (.5)
Year 3
OTD 407 OT Practice with Children & Youth I (3)
OTD 508 Research Implementation I (1.5)
OTD 511 Neuro-Occupation (3)
OTD 513 Occupation & Health: Population Perspectives(3)
OTD 561 Level ID Fieldwork (1)
OTD 562 Ethical Reasoning in OT (2.5)
OTD 572 Professional Trajectory I (1)
Year 4
OTD 599 Directed Independent Study (1-4)
OTD 386 OT Institute for Latin American Concern Program (3
– elective)
OTD 600 Professional Rotation (12-16)
OTD 601 Capstone (1)
Personal Data Sheet, page 2
SPRING
OTD 301 Foundations of Occupation (2)
OTD 304 Occupational Patterns in Culture (2)
OTD 339 Clinical Anatomy (3)
OTD 340 Clinical Anatomy Lab (1.5)
OTD 352 Introduction to Ethics (2)
OTD 370 Level IA Fieldwork (1)
OTD 311 Psychosocial OT Theory & Practice (2)
OTD 409 Research Process II (2)
OTD 414 Physical Rehabilitation II (3)
OTD 417 Healthcare Policy (3)
OTD 432 OT Practice With Upper Extremity (3)
OTD 471 Level IC Fieldwork (1)
OTD 480 Level II Fieldwork Seminar 2 (.5)
OTD 502 Physical Agent Modalities (3)
OTD 506 Management & Program Development (3)
OTD 507 OT Practice with Children & Youth II (3)
OTD 509 Research Implementation II (1.5)
OTD 518 Leadership (2)
OTD 519 Neurorehabilitation (3)
OTD 541 Critical Analysis of OT Practice (3)
OTD 573 Professional Trajectory II (1)
SUMMER
No classes
OTD 481
Level IIA Fieldwork (12)
OTD 571
Level IIB Fieldwork (12)
OTD 574
Professional Competency (1)
NAME:
37
•• Previous fieldwork experiences (experiences without dates will be completed in the future):
Fieldwork Site Name
Dates
Client diagnoses/ages
Level I A
Level I B
Level I C
Level II A
Level I D
Level II B
• What do you feel are your strengths?
• What do you feel are your growth areas?
• Areas of interest, activities, hobbies, etc.:
• What do you expect to gain from your fieldwork experience:
• Do you have reliable transportation for your week of fieldwork? YES
NO
Students: Please attach your resumé to supplement this Personal Data Sheet.
38
STUDENT CLINICAL PARTICIPATION AND CONFIDENTIALITY AGREEMENT
SITE is committed to quality health care and confidentiality for its patients. As a student of another institution
assigned to a clinical experience at SITE, the undersigned is required to agree to the terms of this Agreement.
Please review and ask questions if you have any.
“Confidential Information” is any patient, physician, employee, and SITE business information obtained during
the course of work or association with SITE.
I agree to treat all Confidential Information as strictly confidential and will not reveal or discuss Confidential
Information with anyone who does not have a legitimate medical and/or business reason to know the
information. I understand that I am permitted to access Confidential Information only to the extent necessary for
patient care and to perform my duties while assigned to SITE. I will not disclose identifiable Confidential
Information (e.g., name, date of birth) if the identity of the individual can be removed. I understand that I am a
member of SITE’s workforce for purposes of complying with the Health Insurance Portability and
Accountability Act of 1996, and its applicable privacy and security regulations, and agree to follow SITE’s
policies regarding HIPAA while participating in this Clinical Program at SITE.
I will abide by all SITE policies and procedures regarding Confidential Information.
If I am given any access security codes or passwords, I agree to use them solely to perform my duties and will
not breach the security of the information systems or premises. I will not use or disclose or misuse security
codes or passwords. I will not misuse or attempt to alter SITE information systems in any way. I understand that
SITE reserves the right to audit, investigate, monitor, access, review and disclose information obtained through
the information systems at any time, with or without advance notice to me and with or without my knowledge.
I understand I will be held accountable for my work and any changes made under my password and security
codes. I understand that I am responsible for the accuracy of information submitted under my passwords and
security codes.
I am expected to be covered by my own health insurance at all times, including hospitalization insurance.
Should I seek routine or emergency medical care, I understand that I will be responsible for the cost of such
care.
I am not and will not be an employee of SITE by virtue of my participation in this Clinical Program at Site and
shall not be entitled to compensation or employee benefits of any kind, including but not limited to health
insurance, workers’ compensation insurance or unemployment benefits.
I understand that violations of SITE policy may subject me to immediate termination of my assignment at SITE,
as well as civil sanctions and/or criminal penalties.
My signature acknowledges that I have read and understand this Agreement.
_________________________
Student Name (print)
_________________________
Date
_________________________
Student Signature
_________________________
Name of Fieldwork Site
39
HEALTH STATUS/CLINICAL PROGRAM TRAINING
ATTESTATION FORM
1. I verify the following information for the required health screenings, immunizations or documented
health status and will provide documentation upon request.
a. Tuberculosis screening within the past 12 months (negative PPD skin test or a chest x-ray and health
care provider review if a previous positive PPD reaction) dated: ____________________
b. Measles, mumps, and rubella (MMR) immunity (positive antibody titers or 2 doses of MMR) dated:
__________ and ____________
c. Diphtheria, pertussis, and tetanus immunity (Tdap, Adacel, or Boostrix) dated: _________________
d. Polio immunity (3-dose series or positive antibody titer) dated: _____________________________
e. Varicella immunity (positive history of chickenpox and positive antibody titer or Varicella
immunization dated: ___________________________
f. Hepatitis B immunity (3-dose series and positive antibody titer) dated: _______________________
g. Seasonal flu vaccine dated: ________________
2. Creighton provides the following required program instruction to all students. I verify that I have
received instruction in all areas:
 CPR for Healthcare Providers date: ______________ Recommended Renewal: ___________
 Confidentiality (Patient Rights)
 Dress Code
 Universal Precautions, including needle safety date: __________________
 HIPAA training date: ___________________________
3.
I attest that a retrospective background check was completed upon my admission to the School of
Pharmacy and Health Professions. Unless SITE is notified in writing all background checks are
negative. The background check included the following reviews:
a. Society Security number verification
b. Criminal search (5 years)
c. Violent Sexual Offender and Predator registry
d. HHS/OIG/GSA
I agree to abide by all policies and procedures of the sites hosting my rotations/clinical experiences.
My signature acknowledges that the information I have provided is complete and accurate and that I authorize
the above information to be disclosed to preceptors/sites prior to rotations/clinical experiences.
_________________________________
Student Name (print)
_________________________________
Student Signature
_______________________
Date
This form will be sent to your fieldwork educator to assist in planning your clinical experience.
40
APPENDIX C
SAMPLE
LEVEL I
PREFERENCE SHEET
Dates for Level I A-C will vary on form each semester.
41
Fieldwork Preference Worksheet- Level IB
Your Level IB Fieldwork experience will take place during one week of the 2010 fall semester. While
completing this worksheet, please refer to your Clinical Plan of Study (CPOS) to guide your
preferences. Please circle your area(s) of interest for Level IB from the list below and cross out the
area in which you completed your Level IA fieldwork:
Hospital-based
Community-based
School-based
Other
In-Patient Acute
Pediatric Community
Early Intervention
Nontraditional
In-Patient Rehab
Behavioral Health
Community
Older Adult Community
Living
Older Adult Day
Program
Outpatient/hand private
practice
Adult Day Program for
DD
Home Health
School
SNF/Sub-Acute/Acute
Long-Term Care
General Rehab
Outpatient
Outpatient Hands
Pediatric Hospital/Unit
Pediatric Hospital
Outpatient
In-Patient Psych
Pediatric Outpatient
Clinic
Level IA Fieldwork completed at: ________________________________________
Please check one of the lines below:
_____ I would like to complete my fieldwork in the Omaha/Lincoln/Council Bluffs area and I have no preference for a
specific site.
_____ I would like to complete my fieldwork in the Anchorage/Mat-Su Valley area and I have no preference for a specific
site. Alaska sites preference in-state students.
_____ I am interested in completing my fieldwork at one of the following specific sites listed below. I
understand I need to choose my clinical site using the Fieldwork Site Listing posted on the course
website and from the site files in the Clinical Education Office. I understand I am not guaranteed my
site choices. If the sites listed below are unavailable, I understand I will be placed locally based on
my area(s) of interest identified above and on my CPOS. Here are my top 3 choices, listed by site
and city/state:
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
We will do our best to accommodate your interests and choices. You will be notified of your Level IB
Fieldwork placement via email before the end of the semester. Please wait to complete your
Personal Data Sheet until you know your site in order to tailor your responses to your site.
42
APPENDIX D
LEVEL I
STUDENT PERFORMANCE EVALUATION
Please return this form to:
Academic Clinical Education Coordinator
Department of Occupational Therapy
School of Pharmacy and Health Professions
Creighton University
2500 California Plaza
Omaha, NE 68178
43
Heartland Occupational Therapy Fieldwork Alliance
Level I Fieldwork Student Evaluation
Creighton University Occupational Therapy Department
Student Name: _________________________________________________
Course Number:
_______________
Facility Name: _________________________________________________
Dates of Fieldwork: _______________
School Name: Creighton University
Type of Setting: _________________________
Please indicate the student's performance on each item using the rating scale below.
The following definitions are provided for consistency and clarity. Remember to consider students will need clinical supervision
and guidance during this experience. The focus of these experiences is not intended to be independent performance.
Needs Improvement (N):
Performance is inconsistent or requires constant supervision and cueing/assistance from clinical instructor to perform tasks safely
and effectively. Performance is weak in many of the required tasks or activities and may occasionally be unacceptable. This student
might show minimal interest in the activities/tasks. Opportunities for improvement exist, but further training/experience is indicated.
Meets Expectations (M):
Carries out required tasks and activities in a safe and effective manner. This student demonstrates good solid performance in
required activities and shows initiative/enthusiasm. This rating would ideally be used more than all others.
Exceeds Expectations (E):
Frequently demonstrates clinical performance that surpasses requirements. At times, performance is exceptional.
This student shows initiative above what is expected.
Not Applicable/No Opportunity (NA):
This is to be used when an item to be scored either was not observed by the supervisor or there was no opportunity
for the activity to occur in this setting.
RATING ____
1. TIME MANAGEMENT SKILLS
Is prompt, responsible, and flexible.
Comments: _______________________________________________________________________________________
____________________________________________________________________________________________________
RATING ____
2. ORGANIZATION
Sets priorities, is dependable, organized, and follows through with responsibilities.
Plans adequately to complete program assignments.
Comments: ________________________________________________________________________________________
___________________________________________________________________________________________________
RATING ____
3. WRITTEN COMMUNICATION
Correct grammar, spelling and legibility are noted. Information contained in the written work
matches the consumer activity in which the student participated or observed.
Comments: ________________________________________________________________________________________
___________________________________________________________________________________________________
RATING ____
4. CLINICAL REASONING/PROBLEM SOLVING
Self reflective, willing to ask questions, able to analyze, synthesize and interpret information;
understands the OT process.
Comments: ________________________________________________________________________________________
___________________________________________________________________________________________________
5. USE OF PROFESSIONAL ETHICS
RATING ____
A. Respects confidentiality and consumer's rights
RATING ____
B. Uses precautions and effective safety techniques at all times
RATING ____
C. Complies with facility's policies and procedures
Comments: ________________________________________________________________________________________
___________________________________________________________________________________________________
44
RATING ____
6. OBSERVATION SKILLS
Observes relevant behaviors for performance areas and performance components
and verbalizes perceptions and observations.
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
RATING____
7. PARTICIPATION IN THE SUPERVISORY PROCESS
Gives, receives and responds to feedback; seeks guidance when necessary;
follows proper lines of command.
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
RATING ____
8. VERBAL COMMUNICATION AND INTERPERSONAL SKILLS WITH CONSUMERS/STAFF/CAREGIVERS
Interacts appropriately with individuals (e.g.- eye contact, empathy, active listening, respectfulness,
use of authority, etc; degree/quality of verbal interactions; use of body language and non-verbal communication)
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
RATING ____
9. PATIENT RELATED ACTIVITIES
Develops therapeutic relationship with consumer taking into consideration contextual dimensions
(religion, ethnicity, culture, lifestyle); generates appropriate strategies to facilitate achievement
of consumer's goals and if feasible plans and assists with carrying out one or more
intervention/evaluation sessions.
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
10. PROFESSIONAL BEHAVIOR
RATING ____
A. Overall appearance and dress appropriate for the facility
RATING ____
B. Asks appropriate questions and shows initiative to seek and acquire information from a variety of resources
RATING ____
C. Shows the ability to take responsibility for own learning and demonstrates motivation
RATING ____
D. Sets appropriate limits in response to undesirable physical or social behaviors if applicable
RATING ____
E. Deals with personal emotions maturely
RATING ____
F. Demonstrates ability to work in collaboration with the consumer and/or family and a variety of service providers
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
RATING ____
11. OVERALL IMPRESSION OF STUDENT'S PERFORMANCE
(An ‘N’ rating indicates the need for the student to repeat the clinical experience.)
Comments: _____________________________________________________________________________________
________________________________________________________________________________________________
_________________________________ __________
Student Signature
Date
______________________________________
Signature of Rater and Title
__________
Date
45
APPENDIX E
SAMPLE
LEVEL I
STUDENT EVALUATION OF
FIELDWORK EXPERIENCE
46
Transf
or
m
in
m
a ct i
lT
U
na
ni
ve
rsi
ty
ce
Student Name:
Site Name:
Site Address:
Site Phone:
Trans
for
Pr
Student Evaluation
io
at
up
Occ
Level IA Fieldwork Experience
g
e
opl
Pe
g
in
Department of Occupational Therapy
2500 California Plaza, Omaha, NE 68178
Phone (402) 280-5929 Fax (402) 280-5692
he
h
rapy at Creig
n
to
Fieldwork Educator:
Fieldwork Dates:
1. Please summarize your experience. (Include how you spent your time during the week, what
activities/aspects of the therapy process [evaluation or intervention] you were able to
participate in, other professionals observed, meetings or in-services attended, etc.)
2. Did you complete the following fieldwork learning experiences assigned by Creighton
University: treatment session/fieldwork educator observations, SOAP note (or other format)
with feedback from fieldwork educator, & self-reflection? ____ Yes ___ No
If no, please provide a rationale for why learning experiences were not completed:
3. What were the most beneficial assignments or activities (either from Creighton or your site)
during this experience? Please describe.
4. How was your professional development enhanced through this experience? How do you
see your top five signature themes from your StrengthsFinder Profile incorporating into your
professional identity?
5. What material from your didactic class work was clarified through this experience?
47
6. What new concepts about occupational therapy, or the clients you encountered, did you
learn from this experience?
7. What would you recommend another student do as preparation for this site?
8. Identify your strengths and areas for growth during this fieldwork experience.
9. Identify the site/fieldwork educators’ strengths and any suggestions for improvement.
10. Describe your overall impressions of this site.
Date: ______________
Fieldwork Educator(s)’ signature(s):_______________________
Date: ______________
Student's signature: _______________________________
Please review this form with your Fieldwork Educator(s)before the last day of your scheduled fieldwork
experience.
48
Level I Fieldwork Housing Options Form
Please complete the following form if your site is more than 75 miles outside of Omaha or
Anchorage to inform other students about housing options during the Level I Fieldwork
experience.
Name of Student: ___________________________
E-mail Address: __________________________
Can a student contact you for information?
□ YES
Site Name:
_______________________
Dates of Fieldwork:________________________
□ NO
1. Living accommodations (include type, cost, location, condition):
2. Public transportation in the area:
3. Other available housing options/information:
49
APPENDIX F
LEVEL II
FIELDWORK PREFERENCE FORM
50
Level II Fieldwork Site Preference List
For Summer 2013
Due:
September 14 - If you miss this deadline, you will be randomly assigned AFTER the placement
process is completed.
Where:
on Clinical Education SharePoint database
What:
Please list sites and city/state in order of preference with #1 as your FIRST choice and #5 as your
LAST choice. If you select a site that has multiple locations, e.g. Rehab Visions, or multiple
practice settings within one site, e.g. inpatient acute, outpatient, you must indicate your specific
interest on this form. Thank you!
Printed Name:
1.
(please circle one) Level IIA OR Level IIB
Site:
City/State:
2.
Site:
City/State:
3.
Site:
City/State:
4.
Site:
City/State:
5.
Site:
City/State:
6.
Site:_____________________________________________________________
City/State: _________________________________________________
7.
Site:
City/State:
8.
Site:
City/State:
9.
Site:
City/State:
10.Site:
City/State:
51
APPENDIX G
LEVEL II
ASSIGNMENT AGREEMENT
52
LEVEL II FIELDWORK ASSIGNMENT AGREEMENT FORM
I have worked collaboratively with the Academic Clinical Education Coordinator in
selecting the following site for Level II fieldwork.
Fieldwork Practice Setting: ______________________________
Facility Name: _________________________________________________________
Location:______________________________________________________________
Dates:________________________________________________________________
I agree that unless the facility cancels this placement, no changes will
be made to the fieldwork assignment.
_____________________________________________________________________
Student Signature
Date
53
APPENDIX H
LEVEL II
STUDENT FIELDWORK
CONFIRMATION FORM
54
Trans
for
Transf
or
m
in
e
opl
Pe
m
Pr
a ct i
lT
U
na
ni
ve
rsi
ty
ce
FROM:
io
at
up
Occ
Student Fieldwork
Confirmation Form
g
g
in
Department of Occupational Therapy
2500 California Plaza, Omaha, NE 68178
Phone (402) 280-5929 Fax (402) 280-5692
he
rapy at Creig
on
ht
TO:
Academic Clinical Education Coordinator
Department of Occupational Therapy
School of Pharmacy and Allied Health Professions
Creighton University
2500 California Plaza
Omaha, Nebraska 68178
402.280.5631
Name of Student:
Type of Fieldwork:
Dates:
I accept responsibility of the above student for fieldwork education during the dates
noted above.
I verify that I have reviewed the current existing affiliation agreement, and the student(s)
shall be supervised by an occupational therapist that meets state regulations and has a
minimum of one year experience.
Director of Occupational Therapy or Clinical Instructor
Date Signed
Comments:
Please return to the above address.
Date returned _________
55
APPENDIX I
LEVEL II
STUDENT EVALUATION
OF FIELDWORK EXPERIENCE
56
STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE)
Purpose:
This evaluation serves as a tool for fieldwork sites, academic programs, and students. The main
objectives of this evaluation are to:
 Enable the Level II fieldwork student who is completing a placement at the site to evaluate
and provide feedback to the supervisor and fieldwork setting;
 Enable academic programs, fieldwork sites, and fieldwork educators to benefit from student
feedback in order to develop and refine their Level II fieldwork programs;
 Ensure that all aspects of the fieldwork program reflect the sequence, depth, focus, and
scope of content of the curriculum design;
 Provide objective information to students who are selecting sites for future Level II fieldwork;
and
 Provide a means of evaluation to ensure that fieldwork is performed in settings that provide
educational experiences applicable to the academic program.
This form is designed to offer each program the opportunity to gather meaningful and useful information.
Sections outlined with thick black double borders are designed to be customized by your program as
needed. Pages involving evaluation of individual fieldwork educators have been positioned at the end of
the form to allow academic programs to easily remove these pages before making them available for
student review, if they choose to do so.
57
STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE)
Instructions to the Student:
Complete this STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE) form before your
final meeting with your fieldwork supervisor(s). It is imperative that you review the form with your
supervisor and that both parties sign on page 1. Copy the form so that a copy remains at the site and the
original is forwarded to your Academic Fieldwork Coordinator at your educational program. This
information may be reviewed by future students as well. The evaluation of the student (FWPE) should be
reviewed first, followed by the student’s evaluation of the fieldwork experience (SEFWE), allowing the
student to be honest and constructive.
Fieldwork Site _________________________________________________________
Practice Area(s) ________________________________________________________
Address ______________________________________________________________
Placement Dates: from _________________________ to _______________________
Order of Level II Placement:
[ ] Level II A
[ ] Level II B
Living Accommodations: (include type, cost, location, condition)
Public transportation in the area:
Please write your e-mail address here if you don’t mind future students contacting you to ask you about your
experience at this site: ______________________________________
We have mutually shared and clarified this Student Evaluation of the Fieldwork Experience report.
_______________________________________
Student's Signature / Date
_______________________________________
Student's Name (Please Print)
________________________________________
FW Educator's Signature / Date
________________________________________
FW Educator’s Name and Credentials (Please Print)
FW Educator’s years of experience ____________
58
ORIENTATION
Indicate your view of the orientation by checking "Satisfactory" (S) or "Needs Improvement” (I) regarding
the three factors of adequacy, organization, and timeliness.
TOPIC
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Adequate
S
I
Organized
S
I
Timely
S
I
NA
Site-specific fieldwork objectives
Student supervision process
Requirements/assignments for students
Student schedule (daily/weekly/monthly)
Staff introductions
Overview of physical facilities
Agency/Department mission
Overview of organizational structure
Services provided by the agency
Agency/Department policies and procedures
Role of other team members
Documentation procedures
Safety and emergency procedures
Confidentiality/HIPAA
OSHA—Standard precautions
Community resources for service recipients
Department model of practice
Role of occupational therapy services
Methods for evaluating OT services
Other
Comments or suggestions regarding your orientation to this fieldwork placement:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
CASELOAD
List approximate number of each age
category in your caseload.
Age
Number
List approximate number of each primary
condition/problem/diagnosis in your caseload
Condition/Problem
Number
0–3 years old
3–5 years old
6–12 years old
13–21 years old
22–65 years old
> 65 years old
59
OCCUPATIONAL THERAPY PROCESS
Indicate the approximate number of screenings/evaluations you did; also indicate their value to your
learning experience by circling the appropriate number with #1 being least valuable and #5 being the
most valuable.
REQUIRED
Yes
No
HOW
MANY
1. Client/patient screening
EDUCATIONAL
VALUE
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
3. Written treatment/care plans
1
2
3
4
5
4. Discharge summary
1
2
3
4
5
2. Client/patient evaluations
(Use specific names of evaluations)
List major therapeutic interventions frequently used and indicate whether it was provided in group,
individually, co-treatment, or consultation. List other professionals involved.
Therapeutic Interventions
Individual
Group
Co-Tx
Consultation
Occupation-based activity, i.e., play, shopping, ADL, IADL,
work, school activities, etc. (within client’s own context with
his or her goals)
1.
2.
3.
4.
Purposeful activity (therapeutic context leading to
occupation)
1.
2.
3.
4.
60
5.
Preparatory methods, i.e., sensory, PAMs, splinting,
exercise, etc. (preparation for occupation-based activity)
1.
2.
3.
4.
THEORY—FRAMES OF REFERENCE—MODELS OF PRACTICE
Indicate frequency of theory/frames of reference used
Never
Rarely
Occasionally
Frequently
Model of Human Occupation
Occupational Adaptation
Ecology of Human Performance
Person–Environment–Occupation Model
Biomechanical Frame of Reference
Rehabilitation Frame of Reference
Neurodevelopmental Theory
Sensory Integration
Behaviorism
Cognitive Theory
Cognitive Disability Frame of Reference
Motor Learning Frame of Reference
Other (list)
FIELDWORK ASSIGNMENTS
List the types of assignments required of you at this placement (check all that apply), and
indicate their educational value (1 = not valuable ------- 5 = very valuable)
Blueline Discussion
1
2
3
4
5 N/A
Curriculum Design Review Form
1
2
3
4
5 N/A
Psychosocial Application to Practice Paper
1
2
3
4
5 N/A
Other (list):
1
2
3
4
5 N/A
Other (list):
1
2
3
4
5 N/A
Other (list):
1
2
3
4
5 N/A
Other (list):
1
2
3
4
5
N/A
61
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Consistently
ASPECTS OF THE ENVIRONMENT
1
2
Slow
Med
3
4
Staff and administration demonstrated cultural sensitivity
The Practice Framework was integrated into practice
Student work area/supplies/equipment were adequate
Opportunities to collaborate with and/or supervise OTs, OTAs, and/or aides
Opportunities to network with other professionals
Opportunities to interact with other OT students
Opportunities to interact with students from other disciplines
Staff used a team approach to care
Opportunities to observe role modeling of therapeutic relationships
Opportunities to expand knowledge of community resources
Opportunities to participate in research
Additional educational opportunities (specify):
How would you describe the pace of this setting? (circle one)
Types of documentation used in this setting:
Ending student caseload expectation:
_____ # of clients per week or day
Ending student productivity expectation: _____ % per day (direct care)
Fast
SUPERVISION
What was the primary model of supervision used? (check one)
one supervisor : one student
one supervisor : group of students
two supervisors : one student
one supervisor : two students
distant supervision (primarily off-site)
three or more supervisors : one student (count person as supervisor if supervision occurred at least
weekly)
List fieldwork educators who participated in your learning experience.
Name
Credentials
Frequency
Individual
Group
1.
2.
3.
4.
5.
62
ACADEMIC PREPARATION
Rate the relevance and adequacy of your academic coursework relative to the needs of THIS fieldwork
placement, circling the appropriate number. (Note: may attach own course number)
Adequacy for Placement
Low
High
OTD 303 Introduction to Occupational Therapy
1
2
3
4
5
OTD 305 Communication & Instructional Methods 1
2
3
4
5
OTD 306 Clinical Conditions
1
2
3
4
5
OTD 308 Introduction to Inquiry
1
2
3
4
5
OTD 341 Neuroanatomy
1
2
3
4
5
OTD 301 Foundations of Occupation
1
2
3
4
5
OTD 304 Occupational Patterns in Culture
1
2
3
4
5
OTD 311 Psychosocial OT Theory & Practice
1
2
3
4
5
OTD 339/340 Clinical Anatomy and Lab
1
2
3
4
5
OTD 352 Introduction to Ethics
1
2
3
4
5
OTD 408/409 Research Process I & II
1
2
3
4
5
OTD 411 OT Practice in Mental Health
1
2
3
4
5
OTD 413 Physical Rehabilitation I
1
2
3
4
5
OTD 423 OT with Elders
1
2
3
4
5
OTD 431 Occupation, Adaptation & Technology
1
2
3
4
5
OTD 441 Musculoskeletal Dimensions of Occup.
1
2
3
4
5
OTD 479/480 Level II Fieldwork Seminar I & II
1
2
3
4
5
OTD 407 OT Practice with Children & Youth I
1
2
3
4
5
OTD 414 Physical Rehabilitation II
1
2
3
4
5
OTD 417 Healthcare Policy
1
2
3
4
5
OTD 432 OT Practice With Upper Extremity
1
2
3
4
5
Level IA, IB, IC Fieldwork
1
2
3
4
5
Level II A students may stop here. Level II B students please continue.
OTD 481 Level IIA Fieldwork
1
2
3
4
5
OTD 507 OT Practice with Children & Youth II
1
2
3
4
5
OTD 508/509 Research Implementation I & II
1
2
3
4
5
OTD 511 Neuro-Occupation
1
2
3
4
5
OTD 513 Occupation & Health: Population Persp. 1
2
3
4
5
OTD 562 Ethical Reasoning in OT
1
2
3
4
5
OTD 572/573 Professional Trajectory I & II
1
2
3
4
5
OTD 561 Fieldwork Level ID
1
2
3
4
5
OTD 502 Physical Agent Modalities
1
2
3
4
5
OTD 506 Management & Program Development
1
2
3
4
5
OTD 518 Leadership
1
2
3
4
5
OTD 519 Neurorehabilitation
1
2
3
4
5
OTD 541 Critical Analysis of OT Practice
1
2
3
4
5
Relevance for Placement
Low
High
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
What changes would you recommend in your academic program relative to the needs of THIS
Level II fieldwork experience?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
63
5
5
5
5
5
5
5
5
5
5
5
5
5
SUMMARY
1 = Strongly disagree
2 = Disagree
3 = No Opinion
4 = Agree
5 = Strongly agree
1
2
3
4
5
Expectations of fieldwork experience were clearly defined by
site
Expectations of site were challenging but not overwhelming
Experiences supported student's professional development
Experiences matched student's expectations
What particular qualities or personal performance skills do you feel that a student should have to
function successfully on this fieldwork placement?
________________________________________________________
________________________________________________________
________________________________________________________
What advice do you have for future students who wish to prepare for this placement?

Study the following evaluations:
________________________________________________________
________________________________________________________
________________________________________________________

Study the following intervention methods:
________________________________________________________
________________________________________________________
________________________________________________________

Read up on the following in advance:
________________________________________________________
________________________________________________________
________________________________________________________
Overall, what changes would you recommend in this Level II fieldwork experience?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
64
Please feel free to add any further comments, descriptions, or information concerning your fieldwork at this
center.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
1 = Strongly Disagree
2 = Disagree
3 = No opinion
4 = Agree
5 = Strongly agree
Indicate the number that seems descriptive of each fieldwork educator. Please
make a copy of this page for each individual.
FIELDWORK EDUCATOR NAME:__________________________________
FIELDWORK EDUCATOR YEARS OF EXPERIENCE: __________
1
2
3
4
5
Provided ongoing positive feedback in a timely manner
Provided ongoing constructive feedback in a timely manner
Reviewed written work in a timely manner
Made specific suggestions to student to improve performance
Provided clear performance expectations
Sequenced learning experiences to grade progression
Used a variety of instructional strategies
Taught knowledge and skills to facilitate learning and challenge student
Identified resources to promote student development
Presented clear explanations
Facilitated student’s clinical reasoning
Used a variety of supervisory approaches to facilitate student performance
Elicited and responded to student feedback and concerns
Adjusted responsibilities to facilitate student's growth
Supervision changed as fieldwork progressed
Provided a positive role model of professional behavior in practice
Modeled and encouraged occupation-based practice
Modeled and encouraged client-centered practice
Modeled and encouraged evidence-based practice
Frequency of meetings/types of meetings with supervisor (value/frequency):
General comments on supervision:
AOTA SEFWE Task Force, June 2006; updated by CU April 2011
65
APPENDIX J
LEVEL II
EVALUATION OF STUDENT
FIELDWORK EXPERIENCE
AOTA – FWPE
(Fieldwork Performance Evaluation Form)
LOCATED IN THE OFFICE OF THE
Assistant Clinical Education Coordinator
FOR YOUR REVIEW
Also located at:
http://www.aota.org/Educate/EdRes/Fieldwork.aspx
66
67
68
69
70
71
72
73
74
APPENDIX K
Fieldwork Experience Assessment Tool (FEAT)
75
FIELDWORK EXPERIENCE ASSESSMENT TOOL (FEAT)
Student’s name:
Supervisor(s) names:
Facility name:
Fieldwork experience type (setting, population,
level):
Date:
Week #:
Context:
The Fieldwork Experience Assessment Tool (FEAT) is the result of an American
Occupational Therapy Foundation qualitative study completed by six occupational therapy
programs across the United States and Puerto Rico. Data were collected from fieldwork
students and clinical instructors. In their interviews, students and clinical instructors
described fieldwork education in terms of a dynamic triad of interaction among the
environment, the clinical instructor, and the student. Interviewees indicated that a positive
educational experience occurred when a balance existed among these three key
components.
Purpose:
The FEAT identifies essential characteristics for each of the three key components. By
providing a framework to explore the fieldwork experience, the FEAT can help students
and clinical instructors consider how to promote the best possible learning experience.
The purpose of the FEAT is to contribute to student and clinical instructor discussions, so
that reflection and problem solving can occur to enhance the fieldwork experience. The
tool is designed to both assess the balance of the three key components, and to facilitate
discussion about student and clinical instructor behaviors and attitudes, and
environmental resources and challenges. By mutually identifying issues present during
fieldwork, the clinical instructor and student can use the FEAT as a tool to promote
dialogue, and foster the identification of strategies to facilitate the just-right challenge. The
FEAT may be used early in fieldwork as a tool to promote dialogue, or at anytime
throughout fieldwork as the need for problem solving emerges.
Directions:
In the Assessment Section, the FEAT is organized according to the three key components:
environment, clinical instructor, and student. Under each component, essential
characteristics and examples are listed. These examples are not all inclusive, and new
descriptors may be added to individualize the tool for different settings. The clinical
instructor and student, either individually or together, should complete the FEAT by
describing each component using the continuum provided at the top of each section (limited
 just right challenge  excessive).
Following the assessment portion of the FEAT, questions are provided to guide student and
clinical instructor discussion and problem solving. Collaboratively reflect upon the student
and clinical instructor descriptions on the FEAT to identify commonalities and differences
between the two perspectives, and identify patterns across the key components. Based on
these discussions, develop strategies for a more balanced fieldwork experience. Consider
environmental experiences and resources; clinical instructor attitudes, behaviors and
professional attributes; and/or student attitudes and behaviors that could enhance the
76
experience. The examples listed within each section are intended to guide discussion
between the clinical instructor and student in an effort to create a successful fieldwork
experience. Additional elements may be identified and included according to the nature of
the setting or the fieldwork process.
A. Assessment Section
ENVIRONMENT
Descriptions (Limited   Just right challenge  
Excessive)
I. VARIETY OF EXPERIENCES
A. Patients/Clients/Diagnoses
- Different diagnoses
- Range of abilities for given diagnosis
(complexity, function-dysfunction)
- Diversity of clients, including socioeconomic
& lifestyle
B. Therapy approaches
- Engage in the entire therapy process
(evaluation, planning, intervention,
documentation)
- Learn about different roles of therapist (direct
service, consultation, education &
administration)
- Use variety of activities with clients
- Observe and use different frames of reference/
theoretical approaches -Use occupation vs.
exercise
C. Setting characteristics
- Pace (setting demands; caseload quantity)
- Delivery system
Descriptions (Limited   Just right challenge  
Excessive)
II. RESOURCES
A. OT Staff
- See others' strengths and styles
- Have multiple role models, resources and
support
B. Professional Staff
- Observe and hear a different perspective on
clients - See/experience co-treatments and
team work to get
whole person perspective
- Have others to share ideas and frustrations
C. OT Students
- Able to compare observations & experiences
- Exchange ideas
CLINICAL INSTRUCTOR
I. ATTITUDE
Descriptions (Limited   Just right challenge  
Excessive)
A. Likes Teaching/Supervising Students
- Devote time, invests in students
- Enjoy mental workout, student enthusiasm
77
B. Available/Accessible-Take time
C. Supportive
- Patient
- Positive and caring
- Encourages questions
- Encourages development of individual style
CLINICAL INSTRUCTOR (continued)
D. Open
- Accepting
- Alternative methods
- To student requests
- Communication
E. Mutual Respect
II. TEACHING STRATEGIES
Descriptions (Limited   Just right challenge  
Excessive)
A. Structure
- Organize information (set learning objectives,
regular meetings)
- Introduce treatment (dialogue, observation,
treatment, dialogue)
- Base structure on student need
- Identify strategies for adjusting to treatment
environment
B. Graded Learning
- Expose to practice (observe, model)
- Challenge student gradually (reduce direction,
probing questions, independence)
- Base approach on student learning style
- Individualize based on student’s needs
- Promote independence (trial & error)
C. Feedback/ Processing
- Timely, confirming
- Positive and constructive (balance)
- Guide thinking
- Promote clinical reasoning
D. Teaching
- Share resources and knowledge
E. Team Skills
- Include student as part of team
III. PROFESSIONAL ATTRIBUTES
Descriptions (Limited   Just right challenge  
Excessive)
78
A. Role Model
- Set good example
- Enthusiasm for OT
- Real person
- Lifelong learning
B. Teacher
- Able to share resources and knowledge
FIELDWORK STUDENT
I. ATTITUDE
Descriptions (Limited   Just right challenge  
Excessive)
A. Responsible for Learning
- Active learner (ask questions, consult)
- Prepare (review, read and research materials)
- Self-direct (show initiative, is assertive)
- Learns from mistakes (self-correct and grow)
B. Open/ Flexible
- Sensitive to diversity (non-judgmental)
- Responsive to client/consumer needs
- Flexible in thinking (make adjustments,
try alternate approaches)
C. Confident
- Comfort in knowledge and abilities
- Comfort with making and learning from
mistakes
(take risks, branch out)
- Comfort with independent practice
(take responsibility)
- Comfort in receiving feedback
D. Responsive to Supervision
- Receptive to feedback
(open-minded, accept criticism)
- Open communication (two-way)
II. LEARNING BEHAVIORS
Descriptions (Limited   Just right challenge  
Excessive)
A. Independent
- Have and use knowledge and skills
- Assume responsibility of OT
without needing direction
- Incorporate feedback into behavioral changes
- Use “down time” productively
- Become part of team
B. Reflection
- Self (processes feelings, actions and
feedback)
- With others (supervisor, peers others)
C. Active in Supervision
- Communicate needs to supervisor (seek
supervision
for guidance and processing; express needs)
- Ask questions
79
B. Discussion Section: Questions to Facilitate Dialogue and Problem Solving
1. A positive fieldwork experience includes a balance between the environment, clinical
instructor and student components. Collaboratively reflect upon the descriptions outlined by
the student and clinical instructor and identify perceptions below.
Common perspectives between student
and clinical instructor
Environment
Different perspectives between student
and clinical instructor
Clinical instructor
Student
2. What patterns are emerging across the three key components?
3. What strategies or changes can be implemented to promote a successful fieldwork experience?
Describe below:
Components of a
Successful Fieldwork
Environment
Experiences
Environment, Clinical instructor and/or Student Strategies and Changes
to Promote Successful Fieldwork Experience at this Setting
Resources
Clinical instructor
Attitudes
Behaviors
Professional attributes
Student
Attitudes
Behaviors
This Fieldwork Experience Assessment Tool (FEAT) was developed by The Fieldwork Research Team:
Karen Atler, Karmen Brown, Lou Ann Griswold, Wendy Krupnick, Luz Muniz de Melendez and Patricia Stutz-Tanenbaum
Project funded by The American Occupational Therapy Foundation and AOTA Education Special Interest Section
[April 1998; revised August 2001] FEAT 13.doc
80
APPENDIX L
FIELDWORK CHECKLIST
81
CHECKLIST FOR ALL FIELDWORK EXPERIENCES
Before starting FW assignment




Provide Student Health with all of your completed health requirements. It is strongly
recommended that students keep their own record of the following documents:
 Immunizations, including results of annual TB test
 CPR certification
 Blood-borne Pathogens Training Quiz
 HIPAA Training Quiz
Provide Assistant Clinical Education Coordinator with your current Personal Data Sheet.
This should include your contact information (address and telephone number) for the
summer.
Review FW Manual and course syllabi that corresponds to fieldwork experience, especially
confidentiality policy.
Contact assigned clinical instructor at least one month prior to start date for Level I
Fieldwork and four to six weeks for Level II Fieldwork regarding health requirements,
drug screening, criminal background check, times/locations to report, dress code, parking,
job requirements, etc.
Upon arrival and during FW experience


You must check your Creighton University email on a weekly basis.


Complete assignments outlined in corresponding fieldwork syllabi (Level I and Level II)
Confirm that your site has received the packet of information regarding your placement. Be
sure to bring your FWPE that you have received and provide to your fieldwork educator. If
you lose your copy of the FWPE please contact Mary Pat Wearne to receive a placement,
you will be assessed a fee for an additional copy. (mpwearne@creighton.edu).
Complete site specific assignments (Level I and Level II)
Upon successful completion of FW experience




Complete evaluations (Clinical Instructor and Student). Both signatures required on both
evaluations.
Assure evaluations are mailed or delivered to Mary Pat Wearne, Assistant Clinical
Education Coordinator for Level II Fieldwork, or the instructor of record for Level I
Fieldwork immediately upon completion of FW experience.
It is recommended that both the student and clinical instructor make a copy of the
evaluations to keep for their records.
Letter of appreciation/thank you to your clinical instructor for hosting your FW experience.
(see Appendix N for a sample)
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APPENDIX M
LEVEL II
SUGGESTED FORMAT FOR
WRITING TO YOUR FIELDWORK SITE
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SUGGESTED FORMAT
FOR WRITING TO YOUR LEVEL II FIELDWORK SITE
The purpose of this letter is to introduce yourself and make contact with your clinical
instructor. This is your professional contact with your clinical instructor and the letter
should be typed and professional in appearance. Use the name and address as it
appears on the Fieldwork Roster. Give a copy of the letter to the instructor of record
and maintain a copy of the letter and keep for future reference if needed. Mail it no later
than four to six week prior to start date.
You should include:

Beginning and ending dates

Name and appropriate contact information for the fieldwork site

Confirm working hours

Confirm dress code

Ask for assistance locating housing (if needed)

Confirm housing and/or stipend if provided

Your address and phone number where you can be reached immediately preceding your
start date
Some of this information may be in the student fieldwork file. It would be a good idea to
review the file for information such as maps, dress code, and hours; then, in your letter
state something to this effect: “It is my understanding that fieldwork hours are from 8:00
to 4:30 and that students are to wear lab coats with a patch and name tag.”
You could begin your letter something like this: “I am scheduled for my Level II Mental
Health fieldwork at (name of site) and am writing to introduce myself (or to confirm the
details of my placement).” You might end the letter by saying, “I am looking forward to
meeting you and to my fieldwork experience at your (center, site, hospital, clinic).”
84
APPENDIX N
Sample Thank You Letter
85
Sample Thank You Letter to Fieldwork Educator After Fieldwork Experience
Date
Dear (Name of Fieldwork Educator),
Thank you so much for giving me the opportunity to complete the fieldwork component
of my occupational therapy education under your guidance and direction. During my
fieldwork, I was able to grow and develop as a student therapist, giving me the chance
to apply my skills learned in the classroom to the clinic. Your feedback and leadership
armed me with the skills I will need as I begin my professional career.
Give an example of how their leadership helped make you a better therapist.
Again, thank you for all your guidance and leadership as I grow as a professional.
Sincerely,
Signature
Name
86
APPENDIX O
LEVEL II
SITE RECOMMENDATION FORM
87
Creighton University Department of Occupational Therapy
Fieldwork site Recommendation Form
Your Name: ________________________________
Date: ______________
Facility Name: _____________________________________________________
Facility Address: ___________________________________________________
City: ____________________ State: __________ Zip: __________
Phone: (___)_________________
Name of Center Coordinator: _______________________________
Name of OT Contact: _____________________________________
Why would this site be an asset to the clinical education program as a whole?
How does this site meet the objectives of the OTD program?
What makes this site unique?
What specialty programs does this site offer?
How is this site different from others in a similar practice setting?
88
Rationale must be clear but concise and does not include “this is a really good site!”, or
“its where my aunt lives”.
Note: Incomplete forms or forms without adequate justification will be returned
to the student. Forms must be submitted in sufficient time to allow for
development of the site.
Received by: ________________________ Date: ________________________
Reviewed by Clinical Education Faculty on: ____________________________
.
The clinical education office has reviewed this form and has reached the following
consensus:
_____ A contract will not be pursued with this site. The rationale for
this decision is as follows:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
_____ A contract will be pursued with this site per site development procedures.
You will be notified of the outcome.
Signed: ________________________________
Date: ________________
89
APPENDIX P
LIABILITY COVERAGE
90
CERTIFICATE OF INSURANCE
This is to certify that the Midwest Medical Insurance Company has issued to the insured the policy identified
herein by policy number, policy term and limits of liability, which affords PHYSICIANS AND SURGEONS
PROFESSIONAL LIABILITY INSURANCE. This certificate of insurance does not amend, extend or
otherwise alter the terms, conditions or limits of the insurance afforded by the policy.
INSURED’S NAME:
Creighton University
ADDRESS:
2500 California Plaza
Omaha, NE 68178
POLICY TYPE:
Claims Made
POLICY NUMBER:
IXC000009
POLICY LIMITS:
$1,000,000 each claim
$3,000,000 aggregate
SHARED EXCESS LIMIT:
$5,000,000
POLICY TERM:
07/01/2011 to 07/01/2012
RETROACTIVE DATE:
07/01/1986
CERTIFICATE HOLDER:
Any student of the named insured, but only for legal liability arising
out of the performance of, or failure to perform, duties while acting
within the scope of their duties as students.
Retroactive date is the date listed on the declarations page which is the first date that coverage applies
to any claim or suit covered under this policy.
Excess retroactive date is the first date that coverage applies to that portion of a claim or suit
exceeding one million dollars each claim or three million dollars aggregate.
If the insured type listed above is shown as clinic, hospital, or individual practitioner, employees of the
insured are included as additional insureds while acting within the scope of their employment duties for the
insured. This additional coverage excludes coverage for interns, externs, residents, dental, osteopathic or
medical doctors, podiatrists, nurse mid-wives, certified registered nurse anesthetists and heart/lung
perfusionists.
If this policy is cancelled by MMIC before the expiration date shown, MMIC will endeavor to mail advance
written notice to the certificate holding organization or hospital. Failure to mail such a notice will impose no
obligation or liability of any kind upon MMIC.
Policy Number: IXC000009
Issue Date: 5/3/20138/6/2012
MIDWEST MEDICAL INSURANCE COMPANY
7650 EDINBOROUGH WAY, SUITE 400, MINNEAPOLIS, MN 55435-5978
PH.(952) 838-6700 OR 1-800-328-5532 FAX (952) 838-6808
COFI600 Manual
91
APPENDIX Q
INCIDENT REPORT FORM
92
Creighton University Incident Report Form (HR-24)
Risk
Management Office
For Accident, Injury or Blood/Body Fluid Exposure Reporting
402.280.5833;
402.280.5719 (fax)
Report of Alleged Accident. This report must be filed with the Risk Management Office within 24 hours after the accident.
Do not make any statements and refer all questions to the Risk Management Office.
Please print or type all information. If additional space is needed, attach a separate sheet.
Injured:
Employee
Non-Employee (specify)
Name:
SS#:
Birth date:
Age:
Gender:
M
F Marital Status:
Home Address, City, State, & Zip:
Home Phone #: (
)
Employer (if other than Creighton):
Emergency Contact:
Accident/Injury Information:
Date of Accident:
Time of Accident:
Location (be specific):
Describe in detail what the injured was doing and how the accident happened:
Describe in detail nature and extent of injury/exposure (Specify location on the body -- also note right or left; If related
to sharp device, include: Type & brand of device; Type & amount of fluid or material, & severity of exposure -- As required by OSHA
):
Check type of injury:
Fracture
Laceration
Soreness/Pain
Eye Splash
Swelling
Bruise
Other (explain):
Needle Puncture Wound
Strain/ Sprain
For any illness felt to be job-related: Describe the illness to include the cause(s), type of illness, symptoms,
& how they have progressed including date(s) and current status:
Name(s) of Witness(es) & Phone #:
93
Did injured seek medical attention:
No
Yes --- Attach a copy of Physician’s Instructions/Restrictions
and provide Name & Address of doctor and/or hospital:
Employee Information Only: Dept. Phone #:
worked weekly:
Did injured lose work due to injury:
No
Time Work Day Began:
# of hours
Yes If yes, Date work loss began:
Date returned to
work::
Injured Party Signature:
Date:
Was a supervisor on duty at the time of accident/injury/exposure?
complete the following:
No
Yes -- If yes, supervisor must
Conditions or Contributing Factors to Accident/Injury/Exposure: (please check)
Lifting technique
Floor surface/ walkway
Tools or Equipment
None
Failure to wear protective equipment
Combative Patient
Distraction
Unsafe work area
Use of equipment
Other (please explain):
Corrective action taken:
Signature of Supervisor:
Date
94
APPENDIX R
VERIFICATION OF RECEIVING/REVIEWING
FIELDWORK STUDENT MANUAL
I, ______________________________________, acknowledge that I have
received and completely reviewed the professional rotation manual and take
personal responsibility for the information contained in it.
Student Signature:________________________________
Date:__________________________________________
95