Messy

During a placement there was one student who constantly had a messy plinth area during and between patients, and did minimal to help in ‘house keeping’. This made the rest of us students look bad even though the rest of the plinths were tidy. A physio in the department had a word with us, but the messy student wasn’t even there. As ridiculous as this sounds, the mess irritated me.

I think I have become one of those pedantic neat physios. I found myself tidying their plinth because it was irritating. I just thought there was no reason to have a messy area (sheets half on the plinth, pillows randomly placed, towel messed up, US machine in cubicle) since the rest of us are able to keep a tidy area. On a couple of occasions, after waiting 15 minutes or longer to see if the student would tidy their area, I reminded the student that their area needed tidying ( very very very very nicely/subtly of course!). By the end of the placement the student was somewhat neater.

From the situation I have learnt that people do notice messiness/tidiness and that it is important to keep an area tidy. It also highlighted to me memories of 1st 2nd and 3rd year pracs thinking some physios were pedantic about specific ways of having things organized and set out, but now I understand where they were coming from.

I have learnt that people might not realize that their habits/ways of doing things can irritate others, no matter how small the issue. Physios should have their individual style to how they carry out and organize things; however I believe keeping a plinth area tidy should be simple enough no matter what organizational style they have. If in future a similar scenario was raised, it would be worth nicely addressing the issue with the person which could result in a better working environment. Little irritations in the workplace could lead to greater arguments, which is why it would be important to address the issue sooner rather than later.

Constantly Becoming Stronger

On an acute ward there is a 24yo girl who presented with Gillian Barre Disease 9/7 ago. I had seen her in the past but today she was taken of sedation and awake and responding to commands. She is currently on a ventilator via an ETT and therefore cannot talk. After I treated her chest she started to make rapid head gestures and I asked her if there was something she wanted. She tried to talk but was unable and just had the movement of her mouth. I went through a few issues that she was trying to talk about until it was concluded that she was uncomfortable and wanted to move onto her back as she was positioned in side-lying. I informed her that the turning team was coming but she started to cry and kept attempting to talk which lead to her BP and RR increasing dramatically. I attempted to calm her down by stroking her hands.

I felt panicky and really sad as this girl was around age and so vulnerable. The nurses assisted my supervisor and myself to calm her down and we advised the turning team to turn her next. She calmed down once turned and went to sleep. This situation touched me as I kept thinking this could be one of my friends or even myself.

THIS SCENARIO HAS REINFORCED THAT THE LACK OF ABILITY TO COMMUNICATE, ESPECIALLY IN AN AREA WHERE THERE ARE CONSTANTLY NEW PEOPLE COMING AND GOING IS A SCARY THING. IT FURTHER TEACHES US TO DEAL WITH A VARIETY OF PATIENTS AND EMOTIONS THAT WE WILL FACE IN OUR PROFESSION.

I BELIEVE THAT AS YOUNG PROFESSIONALS, SOMETIMES WE CAN OFFER MORE TO YOUNG PT’S BY RELATING TO HOW THEY MAY BE FELLING AND BEING ABLE TO PROVIDE THE ADEQUATE LEVEL OF SENSITIVITY AND SUPPORT THAT IS REQUIRED. I DON’T THINK I WOULD HANDLE A SITUATION LIKE THIS DIFFERENTLY IN THE FUTURE, JUST HOPEFULLY BE MORE PREPARED.

Surgery

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.

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.

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!)

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.

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.