I was in paediatrics unit in my rural prac. One of the greatest challenges I faced was to create compliance of a paediatric client. It was my first time working in this area and I thought to myself, they’re only kids how hard can it get. Then I had my first patient and the notes read.. a bit of autism and a bit of developmental delay. Well, how different can they be to other kids? So I started doing assessment like I would normally do and 5 minutes into the session things started to fall apart. The little boy started to cry and just wanted to do his stuff, like pretend to fly. I was frustrated because I was thrown into the deep end left to figure things out for myself for the first time. So I kept myself together and thought to myself that I have to take control of the situation before it gets me. So i went with the flow and played with him. By playing with him I actually won him over for another 5 minutes. So I tried my best, modified every single assessment to make it “fun” and it was not easy.
Can you imagine, having to think of a way to modify assessment for muscle strength and endurance of the UL, LL and trunk turning it into something outstandingly “fun”? So I started using cartoon characters like superman and spiderman then doing some animal walks to test trunk strength and endurance. Just I was getting somewhere with the assessment, a sudden machinery noise started coming from the construction site nearby. The mother looked like she had given up not knowing what to do as well. I remembered reading somewhere that some autistic kids are affected terribly by unfamiliar noises. I quickly went and found some headphones to try and filter the noise out for him. It worked but only for a short time, enough for me to at least finish the last part of my assessment so that I could device a program to address the delay in his gross motor skills.
Form this experience I’ve learnt that things do not always go according to plan and that I have to be flexible with whatever challenges I face during a session with a client. I must be able to think and act promptly in difficult situations so that I am able to maximise the limited time I have with clients to gain sufficient information through an assessment. In this case, perserverance did pay off as I was able to gain enough information to provide a treatment strategy.
Wednesday, November 26, 2008
Monday, November 24, 2008
"I don't feel I am improving"
On my musculoskeletal outpatients placement, I had a patient who presented with lower back pain, with the main aggravating factor being prolonged sitting (approximately 30 minutes). My treatment and management with this patient involved mobilisations and postural retraining.
About 3 weeks from her initial visit, I began with my subjective assessment to see how she is progressing. She stated that she did not feel that she was improving, as the intensity of her pain was at a similar level as when she first started physiotherapy. I thought to myself that she must have had some improvement, as she has been having treatment for the past 3 weeks. I then decided to focus on the aggravating factors, and asked her how long can she stay in sitting until the pain increases. She then stated that she was able to sit comfortably for longer than that of the initial session (approximately 1 hr), making her realise that she has made some improvement.
I FEEL THAT MONITORING THE PATIENTS RESPONSE TO TREATMENT FROM THE PATIENT'S PERSPECTIVE AND GOAL SETTING WILL HELP GIVE THE PATIENT AN IDEA ON HOW MUCH THEY ARE IMPROVING, THEREFORE MAINTAINING THEIR FAITH IN PHYSIOTHERAPY TREATMENT. IN THE FUTURE, I WILL CONTINUE TO THINK ABOUT PATIENT'S GOALS AND THEIR FUNCTIONAL LIMITATIONS IN TERMS OF MONITORING RESPONSE TO TREATMENT, THUS, HOPEFULLY INCREASING PATIENT SATISFACTION.
About 3 weeks from her initial visit, I began with my subjective assessment to see how she is progressing. She stated that she did not feel that she was improving, as the intensity of her pain was at a similar level as when she first started physiotherapy. I thought to myself that she must have had some improvement, as she has been having treatment for the past 3 weeks. I then decided to focus on the aggravating factors, and asked her how long can she stay in sitting until the pain increases. She then stated that she was able to sit comfortably for longer than that of the initial session (approximately 1 hr), making her realise that she has made some improvement.
I FEEL THAT MONITORING THE PATIENTS RESPONSE TO TREATMENT FROM THE PATIENT'S PERSPECTIVE AND GOAL SETTING WILL HELP GIVE THE PATIENT AN IDEA ON HOW MUCH THEY ARE IMPROVING, THEREFORE MAINTAINING THEIR FAITH IN PHYSIOTHERAPY TREATMENT. IN THE FUTURE, I WILL CONTINUE TO THINK ABOUT PATIENT'S GOALS AND THEIR FUNCTIONAL LIMITATIONS IN TERMS OF MONITORING RESPONSE TO TREATMENT, THUS, HOPEFULLY INCREASING PATIENT SATISFACTION.
Telling the patient the purpose of your treatment
On one of my placements, I encountered a patient with cerebellar atrophy who was quite anxious. Consequently, his major problem was impaired balance. Therefore my treatment was based around improving his balance. To progress the patient, I would challenge his balance by reducing the base of support, adding a soft surface, eyes closed etc.
As the tasks increased in difficulty, the patient would be less compliant, and say comments like "I can't do that, I'll be too wobbly", I woud then reassure him and tell him that I wasn't going to let him fall. As I would try new positions, he required more convincing to try and get him to comply. I then decided to explain to him that the purpose of these exercises were to use positions which will challenge his balance, and will make him feel somewhat unsteady, as there is no point in practicing balance in a position where he can maintain his balance quite easily. I felt that once he understood the purpose of my treatment, he became more compliant.
THIS SITUATION HIGHLIGHTED THE IMPORTANCE OF THE PATIENT KNOWING THE PURPOSE OF TREATMENTS. I FEEL THAT IF THE PATIENT KNOWS WHY A CERTAIN EXERCISE MAKES HIM/HER FEEL UNSTEADY, OR CERTAIN TREATMENT TECHNIQUES CAN BE SLIGHTLY PAINFULL, HE/SHE WILL BE MORE COMPLIANT WITH PHYSIOTHERAPY, THUS MAXIMISING THE TREATMENT OUTCOME.
As the tasks increased in difficulty, the patient would be less compliant, and say comments like "I can't do that, I'll be too wobbly", I woud then reassure him and tell him that I wasn't going to let him fall. As I would try new positions, he required more convincing to try and get him to comply. I then decided to explain to him that the purpose of these exercises were to use positions which will challenge his balance, and will make him feel somewhat unsteady, as there is no point in practicing balance in a position where he can maintain his balance quite easily. I felt that once he understood the purpose of my treatment, he became more compliant.
THIS SITUATION HIGHLIGHTED THE IMPORTANCE OF THE PATIENT KNOWING THE PURPOSE OF TREATMENTS. I FEEL THAT IF THE PATIENT KNOWS WHY A CERTAIN EXERCISE MAKES HIM/HER FEEL UNSTEADY, OR CERTAIN TREATMENT TECHNIQUES CAN BE SLIGHTLY PAINFULL, HE/SHE WILL BE MORE COMPLIANT WITH PHYSIOTHERAPY, THUS MAXIMISING THE TREATMENT OUTCOME.
Friday, November 21, 2008
Discharge planning
On my rural placement, I had an eldery patient who presented with an exacerbation of COPD. Considering discharge planning, I came to the conclusion that if she were to go home, she would have to be fully independent, as she does not always have someone with her at home. Throughout her stay in hospital, she was often non compliant with physiotherapy, and refused walks several times.
When she was for discharge from a medical point of view, I was unsure how well she was able to ambulate, thus, I was not sure if she was safe for discharge from a physiotherapy point of view. The patient refused a mobility assessment, and I was not surprised, as she had refused to ambulate prior to this. I decided to use her going home as motivation to ambulate, and explained to her that she can only go home once she is deemed safe from a physiotherapy point of view. In doing so, she agreed on a mobility assessment.
NOT ONLY DOES THIS HIGHLIGHT THE NEED FOR EXPLANATIONS ON CERTAIN INTERVENTIONS, BUT ALSO THE IMPACT MOTIVATION CAN HAVE ON A PATIENT. IN THE FUTURE, I WILL SET GOALS FOR THE PATIENT, AND USE MOTIVATIONAL TOOLS TO IMPROVE PATIENT COMPLIANCE AND SATISFACTION FROM TREATMENTS.
When she was for discharge from a medical point of view, I was unsure how well she was able to ambulate, thus, I was not sure if she was safe for discharge from a physiotherapy point of view. The patient refused a mobility assessment, and I was not surprised, as she had refused to ambulate prior to this. I decided to use her going home as motivation to ambulate, and explained to her that she can only go home once she is deemed safe from a physiotherapy point of view. In doing so, she agreed on a mobility assessment.
NOT ONLY DOES THIS HIGHLIGHT THE NEED FOR EXPLANATIONS ON CERTAIN INTERVENTIONS, BUT ALSO THE IMPACT MOTIVATION CAN HAVE ON A PATIENT. IN THE FUTURE, I WILL SET GOALS FOR THE PATIENT, AND USE MOTIVATIONAL TOOLS TO IMPROVE PATIENT COMPLIANCE AND SATISFACTION FROM TREATMENTS.
What is better for the patient?
On my neuro placement, I had a patient who was about 4-5 days post R MCA. At this stage, the patient was still occasionally quite drowsy. Nevertheless, I took her to the gym for some rehabilitation. As it is still her early stages of recovery, the patient was quite fatigued by the end of the session.
From a physiotherapy point of view, we like out patients sitting out of bed whenever possible, as it is a much better position for there chest, and alignment. On discussion with the nursing staff, they suggested to put her back in bed as the patient was feeling tired. After my supervisor and I gave the nurse our justification for sitting out of bed (better for her chest, better for her trunk alignment etc) we decided on keeping the patient in the wheelchair for a little while.
I LEARNT THAT LIAISING WITH OTHER HEALTH PROFESSIONALS AND GIVING OUR JUSTIFICATION IS AN IMPORTANT FACTOR IN THE TREATMENT AND MANAGEMENT OF A PATIENT. I WILL CONTINUE TO GIVE MY RATIONALE FOR DIFFERENT ASPECTS OF MY MANAGEMENT NOT ONLY TO THE PATIENT, BUT TO OTHER ALLIED HEALTH STAFF, TO ALLOW A BETTER RECOVERY FOR THE PATIENTS.
From a physiotherapy point of view, we like out patients sitting out of bed whenever possible, as it is a much better position for there chest, and alignment. On discussion with the nursing staff, they suggested to put her back in bed as the patient was feeling tired. After my supervisor and I gave the nurse our justification for sitting out of bed (better for her chest, better for her trunk alignment etc) we decided on keeping the patient in the wheelchair for a little while.
I LEARNT THAT LIAISING WITH OTHER HEALTH PROFESSIONALS AND GIVING OUR JUSTIFICATION IS AN IMPORTANT FACTOR IN THE TREATMENT AND MANAGEMENT OF A PATIENT. I WILL CONTINUE TO GIVE MY RATIONALE FOR DIFFERENT ASPECTS OF MY MANAGEMENT NOT ONLY TO THE PATIENT, BUT TO OTHER ALLIED HEALTH STAFF, TO ALLOW A BETTER RECOVERY FOR THE PATIENTS.
Using different instructions
In my neuro placement, I was working on sitting balance with 2 different patients, both left hemis. My treatment mainly focused on promoting anterior pelvic tilt with these patients.
For one of these patients, i was using cues such as "grow tall", and that worked quite well with her. I tried to use the same cue for the other patient, and that wasn't so successful, as it did not encourage him to anteriorly tilt his pelvis. I found that using the cue "chest out" worked much better in promoting anterior pelvic tilt with this patient.
AFTER THIS INCIDENT, I LEARNT THAT DIFFERENT PATIENTS CAN REACT DIFFERENTLY TO DIFFERENT VERBAL INSTRUCTIONS, ESPECIALLY NEUROLOGICAL PATIENTS. IN THE FUTURE, I WILL DETERMINE WHICH INSTRUCTIONS SUIT THE PATIENT BEST, AND USE IT WHEN TREATING THE PATIENT.
For one of these patients, i was using cues such as "grow tall", and that worked quite well with her. I tried to use the same cue for the other patient, and that wasn't so successful, as it did not encourage him to anteriorly tilt his pelvis. I found that using the cue "chest out" worked much better in promoting anterior pelvic tilt with this patient.
AFTER THIS INCIDENT, I LEARNT THAT DIFFERENT PATIENTS CAN REACT DIFFERENTLY TO DIFFERENT VERBAL INSTRUCTIONS, ESPECIALLY NEUROLOGICAL PATIENTS. IN THE FUTURE, I WILL DETERMINE WHICH INSTRUCTIONS SUIT THE PATIENT BEST, AND USE IT WHEN TREATING THE PATIENT.
Monday, November 17, 2008
Pulse
On my rural placement I was treating orthopaedic inpatients. As most of you probably are aware by now, orthopaedic inpatients are very repetitive as it follows the post op routines as per each surgeon. Anyway, I was heading into a TKR patients room to walk him for the first time to the bathroom, and had seen him the day before in which he coped well at standing. The patient reported feeling well, nil complaints voiced. He was no longer on oxygen and all attachments removed. I checked his nursing charts which showed obs stable. I thought I should check them myself to get an immediate reading and for precaution. His oxygen and BP were normal, however his pulse rate was racing at 160 BPM!!! I was surprised, all other readings were fine, the patient was asymptomatic, and in fact the pt was quite cheerful. It was a little strange. I took his pulse manually, it was definitely high.
I decided not to walk him at this stage, and informed him why. I let his nurse know immediately. The patient was later taken to ED for a couple of hours, and his meds changed. He later returned to the ward, in which I was able to ambulate him to the bathroom when all his obs were stable.
This scenario highlighted to me the importance of checking stats prior to ambulating post op patients, even if the nursing obs are normal. Also, patients may be asymptomatic, therefore relying solely on pt responses is not adequate. I also feel that, with orthopaedic inpatients there is so much emphasis on checking Hb, Bp and oxygen that pulse rate gets a little ignored. In future I will take the extra 1 minute to take current obs of a patient that is post op as I have done in this scenario.
I decided not to walk him at this stage, and informed him why. I let his nurse know immediately. The patient was later taken to ED for a couple of hours, and his meds changed. He later returned to the ward, in which I was able to ambulate him to the bathroom when all his obs were stable.
This scenario highlighted to me the importance of checking stats prior to ambulating post op patients, even if the nursing obs are normal. Also, patients may be asymptomatic, therefore relying solely on pt responses is not adequate. I also feel that, with orthopaedic inpatients there is so much emphasis on checking Hb, Bp and oxygen that pulse rate gets a little ignored. In future I will take the extra 1 minute to take current obs of a patient that is post op as I have done in this scenario.
bad habbits
Whist on my rural placement I was treating a patient who had pneumonia. He had a 60 yr history of smoking and refused to quit while in hospital. Every day when I went to see him it would be a struggle to get him to complete any exercises and when he did he was quite negative towards the exercises and report that he just wanted to go home. I begun to develop an unenthusiastic mind set towards the patient and I found I would regularly tell him that he should consider quitting smoking and I was less motivational with my response towards treatment. I realised what was happening to y behaviour and decided to change my outlook towards the patient in a manner that I was required to educate him.
Everything I completed with him I educated him on the benefits of how he was going to return home sooner if he completed the exercises. In addition, I educated him on the negative effect s of smoking and the positive effects of quitting. We discussed options to help him quit and he begun to have a more positive approach towards quitting.
When the patient was D/C he still had not decided to quit smoking but was more aware of the options that are available to him.
I HAVE LEARNT THAT SOME HABITS ARE HARD TO BREAK AND EVEN IF THEY ARE HABITS THAT YOU CANNOT STAND, AS A PROFESSIONAL THE BEST YOU CAN DO IS EDUCATE THE PATIENT ON THE POSITIVES OF CEASING THAT HABBIT. IF I HAD ANOTHER PATIENT WHO WAS A LONG TERM SMOKER AND WAS NOT KEEN TO QUIT, I WILL ENSURE THAT I USE MY KNOWLEDGE TO GIVE THE CORRECT ADVICE, SUPPORT AND EDUCATION TO QUIT RATHER THAN DEVELOPING NEGATIVE BEHAVIOURS.
Everything I completed with him I educated him on the benefits of how he was going to return home sooner if he completed the exercises. In addition, I educated him on the negative effect s of smoking and the positive effects of quitting. We discussed options to help him quit and he begun to have a more positive approach towards quitting.
When the patient was D/C he still had not decided to quit smoking but was more aware of the options that are available to him.
I HAVE LEARNT THAT SOME HABITS ARE HARD TO BREAK AND EVEN IF THEY ARE HABITS THAT YOU CANNOT STAND, AS A PROFESSIONAL THE BEST YOU CAN DO IS EDUCATE THE PATIENT ON THE POSITIVES OF CEASING THAT HABBIT. IF I HAD ANOTHER PATIENT WHO WAS A LONG TERM SMOKER AND WAS NOT KEEN TO QUIT, I WILL ENSURE THAT I USE MY KNOWLEDGE TO GIVE THE CORRECT ADVICE, SUPPORT AND EDUCATION TO QUIT RATHER THAN DEVELOPING NEGATIVE BEHAVIOURS.
Team work
Whilst on my rural placement I was required to complete an initial assessment on a stroke patient. When I asked for a copy of particular stroke assessment the physiotherapist said that they did not have a copy of it. Being a regularly used stroke assessment I was surprised that they had not used it in the past and questioned their supply of resources to run a rehabilitation ward. I was able to access the university website and gain a copy of the assessment and complied a file of the assessment and other commonly used assessments.
At first I was taken aback by the lack of resources that the ward had and annoyed that I had to create a resource file. Although, I did not take into consideration that it was a rural hospital and it was a project to complete to benefit the other physiotherapists as well as the patients.
I BELIEVE THAT IT IS IMPORTANT TO BE ACTIVE IN CREATING AN EFFECTIVE AND WELL RESOURCED WORKING DEPARTMENT. IF WE ALL JUST SAID THAT WE COULD NOT BE ‘BOTHERED’ TO CREATE SUCH RESOURCES THEN THE DEVELOPMENT OF THE DEPARTMENT WOULD NOT EXIST. IF I HAD TO CREATE OR SERACH FOR ANOTHER RESOURCE AGAIN I WOULD HAPPILY DO SO KEEPING IN MIND THE ADVANTAGE OF TEAM COLABERTAION AND INPUT.
At first I was taken aback by the lack of resources that the ward had and annoyed that I had to create a resource file. Although, I did not take into consideration that it was a rural hospital and it was a project to complete to benefit the other physiotherapists as well as the patients.
I BELIEVE THAT IT IS IMPORTANT TO BE ACTIVE IN CREATING AN EFFECTIVE AND WELL RESOURCED WORKING DEPARTMENT. IF WE ALL JUST SAID THAT WE COULD NOT BE ‘BOTHERED’ TO CREATE SUCH RESOURCES THEN THE DEVELOPMENT OF THE DEPARTMENT WOULD NOT EXIST. IF I HAD TO CREATE OR SERACH FOR ANOTHER RESOURCE AGAIN I WOULD HAPPILY DO SO KEEPING IN MIND THE ADVANTAGE OF TEAM COLABERTAION AND INPUT.
Saturday, November 15, 2008
Full picture
Whilst on my paediatric placement I was treating a child with CF who was admitted quite frequently for tune ups, I had been told before I'd seen him that he was a bit of a difficult child and there were some social issues due to family problems.
On treating the patient I found that he had some behavioural problems but after developing a good rapport with him I found it quite easy to get the desired result from treatment.
This went on for several days and treatment session were going well, this was until an afternoon treatment session were I took the patient to the physio gym for some exercise. The exercise involved playing various games something which the patient usually enjoyed and was compliant with. On taking the patient to the gym I noticed that he wasn't his usual self he was a bit quitter than usual and just didn't seem as happy. Starting the gym session the patient was very difficult not wanting to play any of the games he had enjoyed previously. The session was completed and the desired outcome of the session had not been achieved, on reflecting about what had happened with my supervisor it had come to light that the patients mother hadn't visited or phoned the patient that morning, and that this may have been the cause for the misbehaviour during the treatment session.
FOLLOWING THIS INCIDENT IT MADE ME LEARN THAT I HAD TO LOOK AT THE PATIENTS MORE HOLISTICALLY PROBABLY MORE IMPORTANTLY IN A PAEDIATRIC SETTING AS THE ROLE AND INTERACTION OF FAMILIES WAS A LARGE PART IN HOW A CHILD WOULD BEHAVE.
On treating the patient I found that he had some behavioural problems but after developing a good rapport with him I found it quite easy to get the desired result from treatment.
This went on for several days and treatment session were going well, this was until an afternoon treatment session were I took the patient to the physio gym for some exercise. The exercise involved playing various games something which the patient usually enjoyed and was compliant with. On taking the patient to the gym I noticed that he wasn't his usual self he was a bit quitter than usual and just didn't seem as happy. Starting the gym session the patient was very difficult not wanting to play any of the games he had enjoyed previously. The session was completed and the desired outcome of the session had not been achieved, on reflecting about what had happened with my supervisor it had come to light that the patients mother hadn't visited or phoned the patient that morning, and that this may have been the cause for the misbehaviour during the treatment session.
FOLLOWING THIS INCIDENT IT MADE ME LEARN THAT I HAD TO LOOK AT THE PATIENTS MORE HOLISTICALLY PROBABLY MORE IMPORTANTLY IN A PAEDIATRIC SETTING AS THE ROLE AND INTERACTION OF FAMILIES WAS A LARGE PART IN HOW A CHILD WOULD BEHAVE.
Thursday, November 13, 2008
Getting out of the comfort zone,Make the most of every opportunity
Whilst on my rural prac I had the opportunity to do some after hours work this included a taping session for a local junior soccer team. Given the choice of whether or not to be involved I was more than happy to be a part of it and being a part of it then became me organizing the material for the presentation and running the presentation session.
At first I was a bit apprehensive about running the whole session as I was in a a different place a bit out of the comfort zone, however I persevered. I devised a plan of what to include in the session and this was basic information on first aid and whether taping was appropriate, basic taping methods and also warnings about taping. After spending a few days preparing the material I felt I had a pretty decent presentation on my hands now all I had to do was run the session.
The night of the presentation came around and I must say there were a few butterflies flying around. Once i began though everything ran smoothly I had prepared adequately and I had about a group of 30 or so teens hanging of my every word and interested in learning what I had to pass on. The night went off with out problem and I am very happy I put myself a out of my comfort zone.
I FOUND BY DOING THE TAPING SESSION AND DOING SOMETHING THAT WAS OUT OF MY COMFORT ZONE I REALLY LEARNT A LOT AND I DEFINITELY THINK IT HELPED MY PLANNING AND PRESENTATION SKILLS, IT ALSO LEFT ME WITH A GOOD FEELING AS THE PARTICIPANTS WERE REALLY INTERESTED IN THE KNOWLEDGE I HAD TO PASS OVER. IF I EVER GET THE CHANCE TO DO SOMETHING SIMILAR I WILL JUMP AT IT.
At first I was a bit apprehensive about running the whole session as I was in a a different place a bit out of the comfort zone, however I persevered. I devised a plan of what to include in the session and this was basic information on first aid and whether taping was appropriate, basic taping methods and also warnings about taping. After spending a few days preparing the material I felt I had a pretty decent presentation on my hands now all I had to do was run the session.
The night of the presentation came around and I must say there were a few butterflies flying around. Once i began though everything ran smoothly I had prepared adequately and I had about a group of 30 or so teens hanging of my every word and interested in learning what I had to pass on. The night went off with out problem and I am very happy I put myself a out of my comfort zone.
I FOUND BY DOING THE TAPING SESSION AND DOING SOMETHING THAT WAS OUT OF MY COMFORT ZONE I REALLY LEARNT A LOT AND I DEFINITELY THINK IT HELPED MY PLANNING AND PRESENTATION SKILLS, IT ALSO LEFT ME WITH A GOOD FEELING AS THE PARTICIPANTS WERE REALLY INTERESTED IN THE KNOWLEDGE I HAD TO PASS OVER. IF I EVER GET THE CHANCE TO DO SOMETHING SIMILAR I WILL JUMP AT IT.
Wednesday, November 12, 2008
Rehab or not to rehab
Whilst on my neuro placement I was treating a patient who had been an inpatient for a long time they had multiple impairments, had a VP shunt inserted and they also had bilateral amputation one above knee the other below following an accident, concurrently they were experiencing vestibular disturbances.
Treatment consisted of vestibular habituation exercises, postural retraining and U/L strengthening exercises. As it was a neurosurgical ward the patient was only being seen once a day (twice if time permitted, which it rarely did) due to priority of more acute patients however the patient was stable and really needed intense rehab to improve their current function level as they were currently a hoist transfer. Not being a rehab facility and due to the ward we were just not capable of providing the rehab the patient required. Although the patient was wait listed for a rehabilitation facility he was continually being reviewed to determine his rehab potential and it didn't seem to be getting anywhere.
After speaking to my supervisor who was very aware of the situation we came to the decision that the patient would benefit most from treatment which was directed towards transfers the most appropriate being a slide board transfer. The patient had a great loss of strength in his upper limbs due to his immobility so it was devised that it would be of great importance to increase his U/L to strength help his rehabilitation.
The treatment continued and the patient progressed well throughout the sessions, it was also quite rewarding as on the last week of my placement there the patient was transferred to a rehab hospital, and due to the rehab we could provide he was getting closer to the prospect of self transfers
DEALING WITH THIS SITUATION I FELT I LEARNT A VALUABLE LESSON IN TERMS OF REHABILITATION AS EVEN THOUGH WE WERE NOT ABLE TO PROVIDE THE INTENSIVE REHAB, WE WERE ABLE TO WORK ON ONE OF THE PATIENTS MAIN ISSUES TO HELP THEM ON THERE WAY TO THE GOAL OF BEING ABLE TO TRANSFER INDEPENDENTLY. AS WELL IT HIGHLIGHTS THE LACK OF REHABILITATION FACILITIES OUT THERE, AS EVEN THOUGH THE PATIENT WAS REQUIRING INTENSIVE REHAB, IT JUST WASN'T POSSIBLE IN AN ACUTE SETTING.
Treatment consisted of vestibular habituation exercises, postural retraining and U/L strengthening exercises. As it was a neurosurgical ward the patient was only being seen once a day (twice if time permitted, which it rarely did) due to priority of more acute patients however the patient was stable and really needed intense rehab to improve their current function level as they were currently a hoist transfer. Not being a rehab facility and due to the ward we were just not capable of providing the rehab the patient required. Although the patient was wait listed for a rehabilitation facility he was continually being reviewed to determine his rehab potential and it didn't seem to be getting anywhere.
After speaking to my supervisor who was very aware of the situation we came to the decision that the patient would benefit most from treatment which was directed towards transfers the most appropriate being a slide board transfer. The patient had a great loss of strength in his upper limbs due to his immobility so it was devised that it would be of great importance to increase his U/L to strength help his rehabilitation.
The treatment continued and the patient progressed well throughout the sessions, it was also quite rewarding as on the last week of my placement there the patient was transferred to a rehab hospital, and due to the rehab we could provide he was getting closer to the prospect of self transfers
DEALING WITH THIS SITUATION I FELT I LEARNT A VALUABLE LESSON IN TERMS OF REHABILITATION AS EVEN THOUGH WE WERE NOT ABLE TO PROVIDE THE INTENSIVE REHAB, WE WERE ABLE TO WORK ON ONE OF THE PATIENTS MAIN ISSUES TO HELP THEM ON THERE WAY TO THE GOAL OF BEING ABLE TO TRANSFER INDEPENDENTLY. AS WELL IT HIGHLIGHTS THE LACK OF REHABILITATION FACILITIES OUT THERE, AS EVEN THOUGH THE PATIENT WAS REQUIRING INTENSIVE REHAB, IT JUST WASN'T POSSIBLE IN AN ACUTE SETTING.
Tuesday, November 11, 2008
death
Whilst on a placement I was treating a patient who had a chronic disease, the patient was a teenager and was in following an exacerbation. The patient was pleasant and completed physio well, and I had developed a good rapport with them after a few sessions.
After having a normal week of treament the weekend came and went and on returning on Monday and reading through the notes I noticed an incident had happend to the patients friend who also had the same chronic disease. The friend had been admitted to ICU with an exacerbation and on reading further I found they had passed away, the patient I was treating had also gone to visit them whilst they were in ICU. And had been informed and Psych involvment had already commenced.
On going to treat the patient I was unsure of wheter to mention what had a happend or not, as we got talking it came up that the patient hadn't had much sleep over the weekend and it was here that I mentioned as tactfully as I couldd that I had heard about what happened. I left it at that and continued to treat the patient. The patient was a little flat throughout the session which was in the gym, however I tried to not focus on what had happened and talk about anything else, and we did this without concern.
Just wondering if anyone can add their experiences to this. In my opinion it's not really our place to probe situations like this however I'm sure sometimes they are unavoidable and when this occurs the utmost compassion and consideration should go in to what is said
After having a normal week of treament the weekend came and went and on returning on Monday and reading through the notes I noticed an incident had happend to the patients friend who also had the same chronic disease. The friend had been admitted to ICU with an exacerbation and on reading further I found they had passed away, the patient I was treating had also gone to visit them whilst they were in ICU. And had been informed and Psych involvment had already commenced.
On going to treat the patient I was unsure of wheter to mention what had a happend or not, as we got talking it came up that the patient hadn't had much sleep over the weekend and it was here that I mentioned as tactfully as I couldd that I had heard about what happened. I left it at that and continued to treat the patient. The patient was a little flat throughout the session which was in the gym, however I tried to not focus on what had happened and talk about anything else, and we did this without concern.
Just wondering if anyone can add their experiences to this. In my opinion it's not really our place to probe situations like this however I'm sure sometimes they are unavoidable and when this occurs the utmost compassion and consideration should go in to what is said
Sunday, November 9, 2008
Waiting
Whilst on my rural I was asked to complete an assessment for a new pt as one of the PT’s was unwell. They did not want to cancel the appointment with the pt as she presented with an extensive referral from a major hospital highlighting many yellow flags.
The pt was booked to come in at 10.15am. At this time the waiting room is usually very busy as there is a balance class that takes place at 10.30am. 10.15am came and I had not been advised that my pt was here so I went to reception to check. The receptionist had gone to a meeting and the PTA was looking after the front desk. The pt’s name was not highlighted and when I asked the PTA if she had arrived she said no. It was 10.45am and I had been out 3 times to see if my pt had arrived, but she hadn’t. I assumed that she was not going to attend so I went up onto the ward and told the PTA to page me if she arrived. When leaving to the ward, the waiting room had settled down and there were only a few people left in the room. I asked the PTA if a lady sitting in the room could been my pt because I had seen her there now for a while, but the PTA told me it was another PT’s pt.
I had been 30 mins up on the ward when one of the PT told me that my pt in outpt’s had been waiting 1 ½ hour for me. I immediately felt embarrassed and very unprofessional on what just happened. I met the lady in the waiting room and it was the same one that I saw waiting there. I was very apologetic and told her there had been some miscommunication. I was anxious on how the pt was going to respond throughout the session. She surprisingly was understanding as her daughter is a nurse and understands that these things happened. I felt slightly relieved and more comfortable around the pt however, still very embarrassed. On leaving the session the receptionist was back and she as well as the PTA apologised for the situation that occurred.
IF I WAS FACED IN A SITUATION LIKE THIS AGAIN AND SUSPECTED A PT, I WOULD DIRECTLY ASK THE PT WHO THEY WERE BOOKED IN TO SEE. I NOW KNOW THAT COMMUNICATION BETWEEN NOT ONLY STAFF, BUT PT’S IS ESSENTIAL IN THE ORGANISATION AND SMOOTH RUNNING OF A CLINIC. IN ADDTION, YOU CANNOT ALWAYS ASSUME THAT EVERYONE KNOWS WHAT IS GOING ON.
The pt was booked to come in at 10.15am. At this time the waiting room is usually very busy as there is a balance class that takes place at 10.30am. 10.15am came and I had not been advised that my pt was here so I went to reception to check. The receptionist had gone to a meeting and the PTA was looking after the front desk. The pt’s name was not highlighted and when I asked the PTA if she had arrived she said no. It was 10.45am and I had been out 3 times to see if my pt had arrived, but she hadn’t. I assumed that she was not going to attend so I went up onto the ward and told the PTA to page me if she arrived. When leaving to the ward, the waiting room had settled down and there were only a few people left in the room. I asked the PTA if a lady sitting in the room could been my pt because I had seen her there now for a while, but the PTA told me it was another PT’s pt.
I had been 30 mins up on the ward when one of the PT told me that my pt in outpt’s had been waiting 1 ½ hour for me. I immediately felt embarrassed and very unprofessional on what just happened. I met the lady in the waiting room and it was the same one that I saw waiting there. I was very apologetic and told her there had been some miscommunication. I was anxious on how the pt was going to respond throughout the session. She surprisingly was understanding as her daughter is a nurse and understands that these things happened. I felt slightly relieved and more comfortable around the pt however, still very embarrassed. On leaving the session the receptionist was back and she as well as the PTA apologised for the situation that occurred.
IF I WAS FACED IN A SITUATION LIKE THIS AGAIN AND SUSPECTED A PT, I WOULD DIRECTLY ASK THE PT WHO THEY WERE BOOKED IN TO SEE. I NOW KNOW THAT COMMUNICATION BETWEEN NOT ONLY STAFF, BUT PT’S IS ESSENTIAL IN THE ORGANISATION AND SMOOTH RUNNING OF A CLINIC. IN ADDTION, YOU CANNOT ALWAYS ASSUME THAT EVERYONE KNOWS WHAT IS GOING ON.
Hygiene on wheelchairs
Whilst on a rural placement I was treating a stroke patient, who needed to go to the toilet mid way through a treatment session. I took the elderly lady to the toilet using a wheelchair and assisted her into the bathroom and transfer to the toilet seat. I helped her to pull her pants/nappy back up when she was finished and transferred her back into the wheelchair. We then wheeled a couple of metres to where the sinks were and I assisted her to wash her hands. Unfortunately her hands had been soiled but she hadn’t noticed.eeek! so a long hand wash was required.
After she had completed washing her hands with soap and warm water, I felt like she should scrub them again! But I couldn’t think of kind enough words or a good enough reason to tell her why to wash them once again. I wasn’t looking forward to having to touch her hands in the treatment. I got over it. However, I was thinking how unclean it could be sharing wheelchairs, the hand rests on the wheelchairs, the handrails in the toilet, the taps on the sink etc in hospitals and aged care facilities where patients may not be as ‘thorough’ with hygiene.
If a similar situation was to arise I would make sure the patients hands were thoroughly cleaned with hot water and soap. I would also wear gloves when assisting the patient in the toilet and wipe the wheelchair armrests with alcohol wipes if the wheelchair was to be used by other patients. This situation shows the need for continuing infection control and hygiene. It would be appropriate to kindly educate the patient on hand washing technique if you are with them whilst they are washing their hands, with emphasis on between fingers and nails that often get missed. In future I would also ensure alcohol wipes were readily available in my workplace.
After she had completed washing her hands with soap and warm water, I felt like she should scrub them again! But I couldn’t think of kind enough words or a good enough reason to tell her why to wash them once again. I wasn’t looking forward to having to touch her hands in the treatment. I got over it. However, I was thinking how unclean it could be sharing wheelchairs, the hand rests on the wheelchairs, the handrails in the toilet, the taps on the sink etc in hospitals and aged care facilities where patients may not be as ‘thorough’ with hygiene.
If a similar situation was to arise I would make sure the patients hands were thoroughly cleaned with hot water and soap. I would also wear gloves when assisting the patient in the toilet and wipe the wheelchair armrests with alcohol wipes if the wheelchair was to be used by other patients. This situation shows the need for continuing infection control and hygiene. It would be appropriate to kindly educate the patient on hand washing technique if you are with them whilst they are washing their hands, with emphasis on between fingers and nails that often get missed. In future I would also ensure alcohol wipes were readily available in my workplace.
Thursday, November 6, 2008
Parent participation
At paeds prac at a community development centre, I ran 2 classes for children having difficulty with their gross motor skills like kicking, jumping and passing a ball. Like most things, gross motor skills require daily practice, and 2 sessions per week wouldn't be enough for a child to master a skill. One of the difficult parts about treating children in pre primary and year 1 is you can't just prescribe to the child a home exercise program and expect them to do it by themselves. Instead the responsibility is with the parents to cut out a small part of their day for play time with their child.
I would like to share some strategies which I used to good effect over my time doing paeds.
(1) Formal written program: For a few children who had complex family situations, such as their parents were no longer together, in foster care or being cared for by a faimly member it is not possible to liase directly with the parent of the child. I sent a formal written program home to these parents and carers outline what is being doing during the group and some tips for play at home. I requested that they fill in a grid at the back of the program outline what they were doing and if any difficulties or questions arose.
(2) Parent participation in the classes: During the class I directly called upon parents who had previously having difficulty playing with their children. This gave them the opposrtunity to supervise a balance beam activity or rocker board which allows them to get the feel and take a few ideas away from the class.
(3) Checking homework: Each week a good strategy I used was to check the child's "homework". This was in a grid similiar to the above which wasn't aimed at competition between the children but more so as a motivator during the week for both the parent and child.
The above 3 strategies worked really well for me during clinic. At the very beginning of prac I solely using repetition each week to the child and parent to practice the skills which wasn't really hitting home. So i put into practice some of these strategies based on the child's case and their worked really well. As most of you know already paeds can be a difficult area to work in, so hopefully if you are going to work in paeds or have an upcoming prac in paeds you can use some of these strategies to improve the outcome for the child, so they can all have fun participating well in sport at school and in the community.
I would like to share some strategies which I used to good effect over my time doing paeds.
(1) Formal written program: For a few children who had complex family situations, such as their parents were no longer together, in foster care or being cared for by a faimly member it is not possible to liase directly with the parent of the child. I sent a formal written program home to these parents and carers outline what is being doing during the group and some tips for play at home. I requested that they fill in a grid at the back of the program outline what they were doing and if any difficulties or questions arose.
(2) Parent participation in the classes: During the class I directly called upon parents who had previously having difficulty playing with their children. This gave them the opposrtunity to supervise a balance beam activity or rocker board which allows them to get the feel and take a few ideas away from the class.
(3) Checking homework: Each week a good strategy I used was to check the child's "homework". This was in a grid similiar to the above which wasn't aimed at competition between the children but more so as a motivator during the week for both the parent and child.
The above 3 strategies worked really well for me during clinic. At the very beginning of prac I solely using repetition each week to the child and parent to practice the skills which wasn't really hitting home. So i put into practice some of these strategies based on the child's case and their worked really well. As most of you know already paeds can be a difficult area to work in, so hopefully if you are going to work in paeds or have an upcoming prac in paeds you can use some of these strategies to improve the outcome for the child, so they can all have fun participating well in sport at school and in the community.
Another cultural thing
On my rural prac, I worked in the paediatrics unit and the biggest group of patients we treat are of the indigenous community. It is an ongoing challenge to be treating this group of people as their beliefs, mentality and upbringing are so different from what I am use to. One of our clients was a 15y/o CP child and needed a physio review. I managed to get her mother on the phone after leaving about six messages. She then promised to come for several appointments but never did turn up and so I left it at there.
Last week the child was admitted to emergency for chest infection due to aspiration and had a seizure episode. Once the child was medically stable, I took the opportunity to assess the child and spoke to one of the speech therapist about the childs feeding issues. After assessment, the biggest problem identified was muscle contracture in her lower limb muscles. I was certain that this child is going to need some form of intervention that can range from serial casting, botox or even surgery for tendon release. Whatever the management ends up being, this child is going to need ongoing therapy which is not possible with non-compliant parents. Each time the mother saw me in the ward she would ask me when they can take her home. I was so frustrated that the mother appeared unconcern about the daughter being ill. I tried asking her how is she managing at home and she would just say “yeah, we’re managing awrite”. I asked my supervisor for guidance on how to convince this lady that her daughter is going to need ongoing therapy and that she must be able to attend the appointments. My supervisor just said to do my best but if I can’t just let it go because there is only so much we can do.
I then decided to have a chat with the aboriginal liaison officer and ask for some advice. He suggested contacting a family member that would be able to help out eg: aunty. The paediatrician had decided that the child is going to need a tendon release surgery. With the mother’s permission, I tried getting in touch with the aunty and explained the situation with the child. She agreed to bring the child for physio appointments and help with the rehab. She sounds genuinely convincing. Just to share something that I found interesting in their culture, the mother is just there to give love to the child but the aunty is also the mother of the child that is responsible for the upbringing and there to discipline the child. Therefore, by trying to get the aunty involved I hope to enhance the chances of this child receiving the rehab she is going to need post tendon release.
From my experience in this case, I have learnt that knowing and understanding one’s culture will definitely have an impact of how we are going to tailor our treatment to create better compliance. In the future I will endeavor to understand a culture that is different to mine with the hope of achieving a better treatment outcome.
Last week the child was admitted to emergency for chest infection due to aspiration and had a seizure episode. Once the child was medically stable, I took the opportunity to assess the child and spoke to one of the speech therapist about the childs feeding issues. After assessment, the biggest problem identified was muscle contracture in her lower limb muscles. I was certain that this child is going to need some form of intervention that can range from serial casting, botox or even surgery for tendon release. Whatever the management ends up being, this child is going to need ongoing therapy which is not possible with non-compliant parents. Each time the mother saw me in the ward she would ask me when they can take her home. I was so frustrated that the mother appeared unconcern about the daughter being ill. I tried asking her how is she managing at home and she would just say “yeah, we’re managing awrite”. I asked my supervisor for guidance on how to convince this lady that her daughter is going to need ongoing therapy and that she must be able to attend the appointments. My supervisor just said to do my best but if I can’t just let it go because there is only so much we can do.
I then decided to have a chat with the aboriginal liaison officer and ask for some advice. He suggested contacting a family member that would be able to help out eg: aunty. The paediatrician had decided that the child is going to need a tendon release surgery. With the mother’s permission, I tried getting in touch with the aunty and explained the situation with the child. She agreed to bring the child for physio appointments and help with the rehab. She sounds genuinely convincing. Just to share something that I found interesting in their culture, the mother is just there to give love to the child but the aunty is also the mother of the child that is responsible for the upbringing and there to discipline the child. Therefore, by trying to get the aunty involved I hope to enhance the chances of this child receiving the rehab she is going to need post tendon release.
From my experience in this case, I have learnt that knowing and understanding one’s culture will definitely have an impact of how we are going to tailor our treatment to create better compliance. In the future I will endeavor to understand a culture that is different to mine with the hope of achieving a better treatment outcome.
Wednesday, November 5, 2008
Socket where the ball should be, ball where the socket should be
Whilst on my rural prac I was seeing a patient who had undergone a shoulder arthroplasty operation due to arthritic changes to the joint. This arthroplasty however failed and the surgeons performed a reversal so the ball and socket were reversed, this provided a problem from the outset in terms of rehabilitation potential.
Not only did techniques have to be altered for example a caudad glide was now performed over the clavicle but the issue of how much movement the patient was going to get back was also raised. The patient although 6-12 months post surgery had limited range, pain at end of available range was also a factor. The patient would continually ask how much range they would get back and whether the pain would go away. I found it quite difficult to answer these questions for the patient.
After each treatment there would be some improvements in range 10 degrees at most, however even though the patient was diligent with there exercises this would fluctuate, I tried to stay positive to encourage the patient but I could see the patient was starting to perhaps realise that there wasn't going to be much more improvement. It was at this stage that after discussing the situation with my supervisor that I talked to the patient and explained that this may be the case.
Following this in the next few session it was clear that this had helped the patient, they continued to work hard at maintaining the available range and strengthening in this available range in an effort to maximize function of the arm.
I think if i have to deal with a situation like this again I will try to be as honest as possible as although our aim of course is to get max range and minimal pain there may be cases due to unforeseen circumstances where this may not be the case, and for the patient to be aware of this I think a better outcome can be reached.
Not only did techniques have to be altered for example a caudad glide was now performed over the clavicle but the issue of how much movement the patient was going to get back was also raised. The patient although 6-12 months post surgery had limited range, pain at end of available range was also a factor. The patient would continually ask how much range they would get back and whether the pain would go away. I found it quite difficult to answer these questions for the patient.
After each treatment there would be some improvements in range 10 degrees at most, however even though the patient was diligent with there exercises this would fluctuate, I tried to stay positive to encourage the patient but I could see the patient was starting to perhaps realise that there wasn't going to be much more improvement. It was at this stage that after discussing the situation with my supervisor that I talked to the patient and explained that this may be the case.
Following this in the next few session it was clear that this had helped the patient, they continued to work hard at maintaining the available range and strengthening in this available range in an effort to maximize function of the arm.
I think if i have to deal with a situation like this again I will try to be as honest as possible as although our aim of course is to get max range and minimal pain there may be cases due to unforeseen circumstances where this may not be the case, and for the patient to be aware of this I think a better outcome can be reached.
Monday, November 3, 2008
The addition of children
Whilst on rural placement I treated a patient who had an Achilles tendon repair. As I collected the patient from the waiting room she had two younger children with her who were both under the age of five. During the subjective ax, the children started to misbehave and the younger girl started to cry. I left the cubical and asked my supervisor if there we had toys which the children could play with and gave me playing cards and said he should have warned me about the children. The children continued to misbehave and I begun to feel frustrated that the mother was not disciplining her children. The older boy threw the cards playing cards over the floor and refused to pick them up. I was forced to pick them up as I needed the mother to complete a balance assessment. Both children then started running into the nearby cubicle through the curtain where there was another pt. The mother continued to stop her children apart from saying sorry to me. I was quite annoyed by this stage and told the children that they had to settle down a play quiet which I found hard to tell young children. The girl then started to cry again and went up to her mother on the plinth. She then found a box of gloves and started playing with them as did the boy and they both settled down.
NEXT TIME THIS PT COMES IN AND BRINGS HER CHILDREN, I WILL TAKE THE PATIENT AND THE CHILDREN INTO A PRIVATE TREATMENT ROOM TO AVOID THE DISTRUPTION OF OTHER PATIENTS. IN ADDITION, I BELIVE THAT SMALL ISSUES LIKE THIS SHOULD BE DOCUMENTED IN THE NOTES/TRANSFER SUMMARY IN A PROFESSIONAL MANNER. COMMUINCATION BETWEEN STAFF BE THAT WRITEN OR VERBAL IS IMPERATIVE TO THE SMOOTH FUNCTIONAING OF A WORKPLACE.
NEXT TIME THIS PT COMES IN AND BRINGS HER CHILDREN, I WILL TAKE THE PATIENT AND THE CHILDREN INTO A PRIVATE TREATMENT ROOM TO AVOID THE DISTRUPTION OF OTHER PATIENTS. IN ADDITION, I BELIVE THAT SMALL ISSUES LIKE THIS SHOULD BE DOCUMENTED IN THE NOTES/TRANSFER SUMMARY IN A PROFESSIONAL MANNER. COMMUINCATION BETWEEN STAFF BE THAT WRITEN OR VERBAL IS IMPERATIVE TO THE SMOOTH FUNCTIONAING OF A WORKPLACE.
Establishing rapport in paediatrics
On paeds prac at a child development centre I see a wide variety of outpatients with tort/plag and gross motor skill delay. When referred for PT these children have already been screened by a by paediatrican for any neurological involvement. Children often attend their appointments with parents. When seeing these patients especially the infants and toddlers it is important to establish rapport with the parents but inparticular the child.
During my first few treatment sessions I found establishing rapport with parent's really easy as they were obviously adult. A challenge for me was to establish a relationship with the child. I found it especially difficult due to my limited exposure to infants and toddlers previously and did not know where to begin.
I have now seen children for the past fortnight and have developed a few strategies to establish rapport which i would like to share. In outpatient setting such as these often the child will be seen in a block of treatments. At inital treatment sessions I think its important just to let the child play in their new surroundings and just observe their play. This allows them to familiarise themselves with the environment and develop trust in you the therapist. There is no point trying to force the child to do a tone or other assessment at inital assessment as in some children they become very distressed and cling to their parent the whole session.
Another strategy that has worked well is positioning both of the therapist as well as the parents. Although the child may be playing with you, its important to position the parent in the child's view so that they always feel safe. This may mean positioning toys near the parent or encouraging crusing with a toy towards their parent. Often if a child is total un-cooperative with the therapist I encourage the parent to modify their play with the child so I can observe their behaviour.
Through this prac it has really developed my skills treating and communicating with younger patients. I now use these strategies when I encouter a difficult child who is un-cooperative or in distress at PT. This makes for a more trusting relationship between you and the child, making the physio session more productive and enjoyable for the child. Wasting an entire session forcing the child to do something they do not want to do will only decrease productivity of the session and make them less co-operative with future PT.
During my first few treatment sessions I found establishing rapport with parent's really easy as they were obviously adult. A challenge for me was to establish a relationship with the child. I found it especially difficult due to my limited exposure to infants and toddlers previously and did not know where to begin.
I have now seen children for the past fortnight and have developed a few strategies to establish rapport which i would like to share. In outpatient setting such as these often the child will be seen in a block of treatments. At inital treatment sessions I think its important just to let the child play in their new surroundings and just observe their play. This allows them to familiarise themselves with the environment and develop trust in you the therapist. There is no point trying to force the child to do a tone or other assessment at inital assessment as in some children they become very distressed and cling to their parent the whole session.
Another strategy that has worked well is positioning both of the therapist as well as the parents. Although the child may be playing with you, its important to position the parent in the child's view so that they always feel safe. This may mean positioning toys near the parent or encouraging crusing with a toy towards their parent. Often if a child is total un-cooperative with the therapist I encourage the parent to modify their play with the child so I can observe their behaviour.
Through this prac it has really developed my skills treating and communicating with younger patients. I now use these strategies when I encouter a difficult child who is un-cooperative or in distress at PT. This makes for a more trusting relationship between you and the child, making the physio session more productive and enjoyable for the child. Wasting an entire session forcing the child to do something they do not want to do will only decrease productivity of the session and make them less co-operative with future PT.
Sunshine
Whilst on my rural prac this year I had the task of running a exercise class for a group of over 60 year olds each Tuesday morning. The exercise class consisted of exercises including balance work, general stretching and flexibility and also some very lite cardio work (really walking and air punches was about the most we did), and due to the fact that it was a small town there were only about 8 or so participants. The class was run at a recreation centre in a freezing dark gymnasium and would generally go for 45 minutes to an hour.
Whilst on my prac it generally rained most days or was overcast, so the gym was the safest bet. On my last week however the Tuesday was sunny and quite warm, so whilst on the way to the recreation centre with my supervisor I suggested almost in jest, not expecting anything to come of it, that we hold the class outside today. My supervisor thought this was a great idea (I think he was kicking himself he hadn't thought of it) and proceeded to open a sliding door which led to a basketball court which had the full sun.
The usual activities were completed, but following the class you could see how much difference doing it in the sun had made, they all seemed a lot more chirpier and couldn't stop thanking us for having the class outside.
SO FROM THIS EXPERIENCE I LEARNT THAT ALTHOUGH SOMETHING AS TRIVIAL TO US AS YOUNG GO GETTER'S AS DOING SOMETHING OUTSIDE, FOR THE PEOPLE WHO PERHAPS AREN'T ALWAYS ABLE TO DO THINGS OUTSIDE IT MADE A HUGE DIFFERENCE AND IT WAS REWARDING FOR THEM AND FOR US AS YOU COULD SEE HOW MUCH ENJOYMENT THAT THEY GOT OUT OF IT.
Whilst on my prac it generally rained most days or was overcast, so the gym was the safest bet. On my last week however the Tuesday was sunny and quite warm, so whilst on the way to the recreation centre with my supervisor I suggested almost in jest, not expecting anything to come of it, that we hold the class outside today. My supervisor thought this was a great idea (I think he was kicking himself he hadn't thought of it) and proceeded to open a sliding door which led to a basketball court which had the full sun.
The usual activities were completed, but following the class you could see how much difference doing it in the sun had made, they all seemed a lot more chirpier and couldn't stop thanking us for having the class outside.
SO FROM THIS EXPERIENCE I LEARNT THAT ALTHOUGH SOMETHING AS TRIVIAL TO US AS YOUNG GO GETTER'S AS DOING SOMETHING OUTSIDE, FOR THE PEOPLE WHO PERHAPS AREN'T ALWAYS ABLE TO DO THINGS OUTSIDE IT MADE A HUGE DIFFERENCE AND IT WAS REWARDING FOR THEM AND FOR US AS YOU COULD SEE HOW MUCH ENJOYMENT THAT THEY GOT OUT OF IT.
Sunday, November 2, 2008
Surgery
Whilst on a rural placement, I got to see a TKR surgery. Not only did I get to see the surgery, but I scrubbed in, wore one of those astronaut like head pieces and got to help out in the surgery by drilling, hammering, holding instruments and stapling. It was the highlight of my physio year! It was great to see the surgery, meet the surgeon and treat the patient post op. As fantastic as it was being able to be a part of the surgery, I wonder whether physio students or other allied health professionals are legally allowed to be so involved with such surgeries.
Whilst treating the patient post op, I never told her I had seen her surgery, let alone drill her new knee together. By being a part of the surgery I feel a little guilty as the patient would probably only expect a qualified surgeon to do their TKR. If I was the patient, I know I wouldn’t want an allied health student doing some of the surgery. Fair enough a medical student, but any other health professional seems a little dodgy.
From the surgery, I have learnt more about the process of a TKR and understand why orthopaedic patients are in so much pain post-op. I would be interested in finding out whether anyone else studying physio has been allowed to be hands on in an orthopaedic surgery. In future, I will continue to see different surgeries as it gives more of an understanding about the procedures, therefore will help when educating patients. If given the chance to be hands on again in a surgery I wouldn’t say no, unless of course this was breaking hospital rules/laws. Would really like to know your views on this issue.
Whilst treating the patient post op, I never told her I had seen her surgery, let alone drill her new knee together. By being a part of the surgery I feel a little guilty as the patient would probably only expect a qualified surgeon to do their TKR. If I was the patient, I know I wouldn’t want an allied health student doing some of the surgery. Fair enough a medical student, but any other health professional seems a little dodgy.
From the surgery, I have learnt more about the process of a TKR and understand why orthopaedic patients are in so much pain post-op. I would be interested in finding out whether anyone else studying physio has been allowed to be hands on in an orthopaedic surgery. In future, I will continue to see different surgeries as it gives more of an understanding about the procedures, therefore will help when educating patients. If given the chance to be hands on again in a surgery I wouldn’t say no, unless of course this was breaking hospital rules/laws. Would really like to know your views on this issue.
Patient goals
While on my rural placement, there was a patient who had been transferred from a neighbouring town’s small hospital. His wife was also staying at the hospital. He had a discectomy at T11/12 and L4/5 with resulting weakness in the lower limbs. Whilst in hospital in Perth after the procedure the patient did not receive any physiotherapy and as a consequence was de-conditioned and unable to walk. The Physiotherapists organised for a transfer to our hospital for the sole purpose of physio rehab. I was seeing this patient twice a day and I had given him an exercise program to do independently. However, despite a strong desire to return home, this patient was not completing his exercises, therefore was not progressing as well as I had hoped.
Myself and my supervisor had decided that although the patient would have benefited from a longer stay in hospital, he wanted to be discharged and therefore we would use this goal to motivate him. Through using patient oriented goals we were able to motivate the patient. Together with the OTs we prepared him for returning home, but first he needed to stand independently. With a coordinated effort from the nursing staff and even the personal care assistants, the patient was reminded continually throughout the day to complete these exercises. This co-ordinated effort ensured the patient gained enough strength to stand independently to be able to be discharged.
This patient demonstrated the need to keep goals patient oriented, even if they don’t always match your own and that using these goals can be very motivating. This situation also demonstrated the benefit working as a multi disciplinary team to achieve patient outcomes.
Myself and my supervisor had decided that although the patient would have benefited from a longer stay in hospital, he wanted to be discharged and therefore we would use this goal to motivate him. Through using patient oriented goals we were able to motivate the patient. Together with the OTs we prepared him for returning home, but first he needed to stand independently. With a coordinated effort from the nursing staff and even the personal care assistants, the patient was reminded continually throughout the day to complete these exercises. This co-ordinated effort ensured the patient gained enough strength to stand independently to be able to be discharged.
This patient demonstrated the need to keep goals patient oriented, even if they don’t always match your own and that using these goals can be very motivating. This situation also demonstrated the benefit working as a multi disciplinary team to achieve patient outcomes.
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