On rural prac I was lucky enough to be exposed to various aspects of physiotherapy that I wouldnt normally in a perth based hospital. On final week of prac, with all going well my superivisor suggested I go in to see a TKR.
I didn't think seeing a TKR would be the best idea. I dont normally like blood and felt I wouldnt be able to survive seeing surgery. With much convincing I attended the surgery first think in the morning. I subsquently survived the experience and actually really enjoyed my experience.
This situation helped me push myself outside my comfort zone. See surgery made me more aware of what a patient goes through during a TKR and therefore allowed me to better manage my patients.
By pushing my limits I feel more comfortable around blood. I think in the future its important to continually expose yourself to situations outside your comfort zone as their are various benefits from experiences we sometimes fear. In the future, after seeing surgery I would feel more comfortable seeing a surgical patient day 1, trauma patients in ED and acutely sick patients in ICU. With this fear out of my system this better equips me to use my skills as a physiotherapist to help a patient in need.
I would suggest to all my peers to take up opportunities as a student in seeing things such as surgery, as I believe the experience was invaluable.
Thursday, September 25, 2008
Sunday, September 21, 2008
Changing your tone
On cardio placement at a large WA hospital I was referred a patient with dyscopia. During my interaction with this patient I learnt how I have to tailor my communication for each patient.
When doing my general check up prior to commencing treatment of the patient I only had access to an XL BP cuff. Not considering how my communication may affect the patient, as the cuff kept malfunctioning because the patients arm was too small for the cuff I told the patient "your arms a bit skinny for the cuff". This is resulted in the patient becoming extremely emotional. She explained to me how she wasnt coping at home and how once she was alot more fitter then her currently.
This interaction with this patient demonstrated how sometimes patients are emotional and distressed coming into hospital from home. The conversation I had with this patient obviously was found as rude and deeply upset the patient. In the future I think during initial assessment it is best to be cautious with your communication, as getting the patient off side on day 1 wouldn't be good for future physiotherapy. Once you better get to know a patient I think then your better equipped to get a feel what the patient is like, e.g. in distress with being hospitalised and dependent on nurses/doctors compared to a patient who is quite outgoing and comfortable with thier current situtation.
When doing my general check up prior to commencing treatment of the patient I only had access to an XL BP cuff. Not considering how my communication may affect the patient, as the cuff kept malfunctioning because the patients arm was too small for the cuff I told the patient "your arms a bit skinny for the cuff". This is resulted in the patient becoming extremely emotional. She explained to me how she wasnt coping at home and how once she was alot more fitter then her currently.
This interaction with this patient demonstrated how sometimes patients are emotional and distressed coming into hospital from home. The conversation I had with this patient obviously was found as rude and deeply upset the patient. In the future I think during initial assessment it is best to be cautious with your communication, as getting the patient off side on day 1 wouldn't be good for future physiotherapy. Once you better get to know a patient I think then your better equipped to get a feel what the patient is like, e.g. in distress with being hospitalised and dependent on nurses/doctors compared to a patient who is quite outgoing and comfortable with thier current situtation.
Thursday, September 18, 2008
Group classes
Whilst on a community physiotherapy placement, I was taking a class of 9 patients for multiple conditions such as general deconditioning, post CVA, post TKR/THR, and one lady with Parkinson’s. The class consisted of a warm up, strength exercises carried out in a circuit format, then a cool down and balance exercises. The class was going very nicely and I was up to taking the balance exercise component. I got all the patients to stand behind/beside a chair in a circle. After beginning moderate level balance exercises the Parkinson’s client lost her balance and toppled over! I got the class to stop the exercises, and my supervisor and I went over to help the lady up. Thankfully she hadn’t hurt herself! She was more embarrassed and did not want us to make a fuss over her. I felt terrible!
My supervisor sat with the client for a while, asked her questions, and told her she’ll ring her to check she is still ok tomorrow. The patient reports that she had had a busy morning and was more tired than usual. My supervisor and I had a talk about the situation, her first question was “do you think you did all you could to make the exercises safe for this class?” I told her I did and why. The supervisor totally agreed, and that on previous classes this client had never shown any signs of being at risk of a fall. The client was also the most active and independent client of the class.
From this situation it reinforced the importance of positioning yourself in a class amongst clients that are of a higher need of assistance. It also showed that in class situations even with all the setting up of the environment for a safe exercise, positioning yourself appropriately between clients, choosing appropriate exercises and being cautious, accidents can still happen. In future I would inform clients not to undertake any strenuous activity prior to the class. (The situation also showed me the large amounts of paper work that must be completed after a client falls!)
My supervisor sat with the client for a while, asked her questions, and told her she’ll ring her to check she is still ok tomorrow. The patient reports that she had had a busy morning and was more tired than usual. My supervisor and I had a talk about the situation, her first question was “do you think you did all you could to make the exercises safe for this class?” I told her I did and why. The supervisor totally agreed, and that on previous classes this client had never shown any signs of being at risk of a fall. The client was also the most active and independent client of the class.
From this situation it reinforced the importance of positioning yourself in a class amongst clients that are of a higher need of assistance. It also showed that in class situations even with all the setting up of the environment for a safe exercise, positioning yourself appropriately between clients, choosing appropriate exercises and being cautious, accidents can still happen. In future I would inform clients not to undertake any strenuous activity prior to the class. (The situation also showed me the large amounts of paper work that must be completed after a client falls!)
Tuesday, September 9, 2008
Preparation
On my musculoskeletal placement, I had a new patient who made an appointment for back pain. When preparing for this patient, I noticed that her name sounded Arabic/Middle Eastern, and she was in her early teens. I was worried that this would be a problem, being a male therapist treating this young lady, especially for a condition like back pain, in order to gain an optimal assessment and treatment, a lot of physical contact is required and the area should be exposed.
I then made my supervisor aware of my concerns and asked my supervisor if I was able to trade patients with another student who was female, and my supervisor was more than happy to make the swap. Later that day, the student who treated this patient had told me that the patient's mother said that she was relieved to have a female therapist.
This experience confirmed the importance of preparing adequately for the patient, not just for the condition, but also other aspects such as age, gender and culture. I believe that this will help make the patient more comfortable, therefore make the treatment more effective. I feel that if I had not traded patients with a female student, or if i had treated this patient without being aware of the age, gender and cultural differences, the patient as well as her mother would have felt uncomfortable, and the treatment given would not have been very effective.
I then made my supervisor aware of my concerns and asked my supervisor if I was able to trade patients with another student who was female, and my supervisor was more than happy to make the swap. Later that day, the student who treated this patient had told me that the patient's mother said that she was relieved to have a female therapist.
This experience confirmed the importance of preparing adequately for the patient, not just for the condition, but also other aspects such as age, gender and culture. I believe that this will help make the patient more comfortable, therefore make the treatment more effective. I feel that if I had not traded patients with a female student, or if i had treated this patient without being aware of the age, gender and cultural differences, the patient as well as her mother would have felt uncomfortable, and the treatment given would not have been very effective.
Monday, September 8, 2008
Cancer
While on placement in a general medical ward I encountered a patient who had been admitted following a fall. This patient was later diagnosed with cancer with brain metastases. The medical team estimated only a short time before this patient would pass away. On the first day I saw this lady for a mobility assessment I was a bit apprehensive as I had never encountered a patient with terminal cancer before. On initial assessment the patient was cooperative but very withdrawn as the news of her prognosis was still fairly recent. However on subsequent visits through an exercise program, her mobility improved to the stage that she was able to walk a few metres independently. She began to enjoy our sessions and look forward to them.
I know the literature has proven that exercise is beneficial to patients with cancer, but this patient just highlighted the fact to me. Cancer patient should still be seen by physiotherapists on the ward as exercises can improve their mobility or prevent decline and benefit their mental well being. In future I will ensure I take time to explain the benefits of exercise to these patients and give them the option of physiotherapy treatment.
I know the literature has proven that exercise is beneficial to patients with cancer, but this patient just highlighted the fact to me. Cancer patient should still be seen by physiotherapists on the ward as exercises can improve their mobility or prevent decline and benefit their mental well being. In future I will ensure I take time to explain the benefits of exercise to these patients and give them the option of physiotherapy treatment.
Sunday, September 7, 2008
Stage of Healing
On rural prac doing musculoskeletal outpatients I was referred a patient for management of his broken ribs. As a result of the patient having a fracture it was important as I know now what the contraindications/precautions would be for someone following fracture.
The standard assessment form was used for all new patients. In the OE for spinal assessment the headings were - AROM, PAIVMS, PPIVMS etc etc. Without taking the underlying pahology into consideration I started doing AROM of the Thx spine. Following end range pain I decided I would do PAIVMS. Luckly I stopped and thought, if i PAIVM his thoracic spine will that to produce motion at his rib fracture.
I thought to myself, if the patient had a broke ankle would i mobilise it a week after fracture? Similarly I tailored my management of this patient taking a more prophylatic approach to his fracture, performing a cardio assessment and giving him DB exercises.
Through encoutering this patient it highlight to me how important was to keep clinically reasoning while your performing assessment and treatments. If I had mobilised his thoracic spine maybe it might have caused a puncture lung or something more serious. In future treatments it is important for me to take things slower, stop and think what is going here? what is the stage of healing? Is my treatment indicated for this patient?
The standard assessment form was used for all new patients. In the OE for spinal assessment the headings were - AROM, PAIVMS, PPIVMS etc etc. Without taking the underlying pahology into consideration I started doing AROM of the Thx spine. Following end range pain I decided I would do PAIVMS. Luckly I stopped and thought, if i PAIVM his thoracic spine will that to produce motion at his rib fracture.
I thought to myself, if the patient had a broke ankle would i mobilise it a week after fracture? Similarly I tailored my management of this patient taking a more prophylatic approach to his fracture, performing a cardio assessment and giving him DB exercises.
Through encoutering this patient it highlight to me how important was to keep clinically reasoning while your performing assessment and treatments. If I had mobilised his thoracic spine maybe it might have caused a puncture lung or something more serious. In future treatments it is important for me to take things slower, stop and think what is going here? what is the stage of healing? Is my treatment indicated for this patient?
Prioritisation
On cardio placement on a medical ward there are numourous very sick patients. Often patients who are at end stage of disease end up here as admitting these patients into high dependency or intensive care units is seen by the medical team as futile given the patients stage of disease. At first was very difficult for me to digest, a patient was not receiving optimal management for their disease. All patients had consent to this type of management, which puzzled me as to think why a patient would basically 'give up'. This demonstrated to me how patients are often prioritised depending on their presentation.
As this was a very large ward comprisied of over 60 beds I too had to prioritise who were high priority and who didnt need to be seen. Prior to prioritising who I would see I thought to check the status of the patient in terms of management. As a result I was able to identify patients who were seen as had rehabilitation potential and prioritise them to be seen first. As a result I felt that my physio management was too prioritised so I could provide more time for patients who had rehabilitation potential and still see other terminal patients if time permitted.
By encountering this situation, I learnt how it is important to gather a full picture of a patient - interms of what the docs see is there rehab potential and then prioristise to see patients who are seen as having potential, however still providing terminal patients with physio if time permitted and only a couple of times per week instead of everyday. This made the ward more manageable however at first was difficult for me to make such a decision.
As this was a very large ward comprisied of over 60 beds I too had to prioritise who were high priority and who didnt need to be seen. Prior to prioritising who I would see I thought to check the status of the patient in terms of management. As a result I was able to identify patients who were seen as had rehabilitation potential and prioritise them to be seen first. As a result I felt that my physio management was too prioritised so I could provide more time for patients who had rehabilitation potential and still see other terminal patients if time permitted.
By encountering this situation, I learnt how it is important to gather a full picture of a patient - interms of what the docs see is there rehab potential and then prioristise to see patients who are seen as having potential, however still providing terminal patients with physio if time permitted and only a couple of times per week instead of everyday. This made the ward more manageable however at first was difficult for me to make such a decision.
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