On my prac in the geriatric area, I had a patient a 78 y/o lady who attended outpatient due to her chronic lower back pain. She is physically independent and mentally alert. She walks with a 4WW due to her LBP and bilateral knee pain. As part of her physiotherapy treatment, I felt that she would benefit from hydrotherapy exercises. I discussed with her about the class and how it will help ease her pains. She seemed happy to participate and so I assumed that she had agreed to attend. I then went on to fill out the papers required for the hydrotherapy classes. The following week she had failed to attend the class and so I rang to find out why. She just said that it wasn’t a good day for her that day so she did not attend. Then the 2nd week came and again, she was absent from the class. I then suspected something is not adding up to her reasons. Initially, I was not sure how to pursue the matter without making her feel like I don’t trust her words. I just felt terrible at the fact that this lady has an ongoing problem with pain and has not received any treatment for the past 2 weeks and the thought of it turning into a vicious cycle and all that really bugged me.
I then organised for her to come for treatment with me, I thought it’ll be better dealing with the issue face to face rather than over the phone. So I rang her and asked f she could come in within the next few days for physio and she agreed. So I saw her two days after that and gave her some education on how a chronic pain can become a huge problem and impact her functional levels. At this stage it is really important that we do whatever it takes to try and preserve whatever function she has in her daily life. And some of the things that can help was hydro, I subtly brought the topic up again and she begin to tell me how she is afraid of the water as she doesn’t like the cold and also she does not own a swim wear. I assured her that the pool is heated and we will be able to loan out a swim wear. She seemed more convinced this time around and I was sure in a way that she will be attending the next hydro session. When the day came, she turned up. I was glad to see her and she seemed to have enjoyed her first hydro session. She then made it again the following week and reported having had a bit of relieve from her pains after the first session.
From this encounter, I have learnt never to assume that we have patient’s compliance just because we have given them a good run down on all the benefits of doing the things we ask them to (just like how I’ve assumed here) .To a certain extend I think we are in an industry that we have to be able to sell and it can be very challenging especially when we do not understand our buyers needs. If I just took a step back and asked a few more questions I would have been more successful the first time around and that would have meant that the patient started hydro 2 weeks earlier rather than later. This was yet another experience for me to take on board and help me be a better advocate of exercise and treatment as a qualified physio one day.
Monday, October 13, 2008
Friday, October 3, 2008
Motivation?
On cardio clinic at a large hospital I treated a young lady in her early 20s following drug overdose and subsequent 2 week coma. Following he stay in ICU the patient was discharge to the ward where I began to see her. The lady was quite obviously markedly obese and had developed bilateral foot drop as a result of prolonged positioning in ICU.
The main aim for this patient was to mobilise her, beginning right back with basic bed mobility. This patient was to be seen 3 times per day for physiotherapy. I subsequently devised her a general exercise program which she could perform 3 times per day and on weekends, and would check on her daily. Through the week the patient was obviously very unmotivated to do anything, constantly becoming emotional around medical staff, however I noticed she was totally the opposite when conversing with friends who came to visit or on the phone.
For this patient to get better and leave hospital I thought this lady needs motivation. I proceed to ask her what she wanted to get out of physiotherapy in hospital. She said she would like to get back to ballet. I subsequently used this as a source of motivation throughout her exercise sessions to good effect. I also suggested to the medical team the patient's problem with her weight and the doctor said the patient would have to loose 40-50kg to be considered for gastric banding surgery. So together with the patient wanting to return to ballet and the need for her to loose 40-50kg this made her more motivated to do physiotherapy. I found that I would just need to pop my head in to progress her exercises rather then having to actually go through 3 sets of exercises per day.
THIS SITUATION IDENTIFIED TO ME THE NEED TO SET GOALS FOR PATIENTS. THE GOALS IN THIS CASE SERVED TO MOTIVATE MY PATIENT AND KEEP HER COMPLIANT WITH THE PROGRAM.
IN THE FUTURE I THINK ITS IMPORTANT TO SET GOALS FOR PATIENTS DURING INTIAL TREATMENTS SO THAT THEY FEEL THEY ARE WORKING TOWARDS SOME BIGGER THEN JUST GETTING OUT OF BED OR AMBULATING WHICH IS MORE IMPORTANT TO PHYSIOTHERAPIST IN A WARD BASED SETTING.
The main aim for this patient was to mobilise her, beginning right back with basic bed mobility. This patient was to be seen 3 times per day for physiotherapy. I subsequently devised her a general exercise program which she could perform 3 times per day and on weekends, and would check on her daily. Through the week the patient was obviously very unmotivated to do anything, constantly becoming emotional around medical staff, however I noticed she was totally the opposite when conversing with friends who came to visit or on the phone.
For this patient to get better and leave hospital I thought this lady needs motivation. I proceed to ask her what she wanted to get out of physiotherapy in hospital. She said she would like to get back to ballet. I subsequently used this as a source of motivation throughout her exercise sessions to good effect. I also suggested to the medical team the patient's problem with her weight and the doctor said the patient would have to loose 40-50kg to be considered for gastric banding surgery. So together with the patient wanting to return to ballet and the need for her to loose 40-50kg this made her more motivated to do physiotherapy. I found that I would just need to pop my head in to progress her exercises rather then having to actually go through 3 sets of exercises per day.
THIS SITUATION IDENTIFIED TO ME THE NEED TO SET GOALS FOR PATIENTS. THE GOALS IN THIS CASE SERVED TO MOTIVATE MY PATIENT AND KEEP HER COMPLIANT WITH THE PROGRAM.
IN THE FUTURE I THINK ITS IMPORTANT TO SET GOALS FOR PATIENTS DURING INTIAL TREATMENTS SO THAT THEY FEEL THEY ARE WORKING TOWARDS SOME BIGGER THEN JUST GETTING OUT OF BED OR AMBULATING WHICH IS MORE IMPORTANT TO PHYSIOTHERAPIST IN A WARD BASED SETTING.
Thursday, October 2, 2008
Sharing ideas
On this particular morning my scheduled pt’s on the acute ward all became either unavailable or physiotherapy Rx was not indicated at that particular time. My supervisor suggested that I assist another student. The other student was mid way through looking through the notes when I told them the plan. I said that I would check the chest X-ray whilst they finished reading the notes and then we can come together and briefly talk about the pt. The student told me that this was one of their favourite pt’s and preferred if I did not look at their X-rays until they did first. I was taken back by that comment and felt like I was not apart of the team treating this pt. We looked at the X-ray together and then went to treat the pt. The student said to me that they know exactly how this pt likes to be treated and they will ask for help if needed. I ended up assisting with transferring the pt and Rx.
THIS SCENARIO HAS TAUGHT ME THAT NOT ONLY DO WE HAVE TO LEARN TO WORK WITH DIFFERENT PERSONALITIES AND WORKING STYLES BUT SOMETIMES IT IS TOO EASY JUST TO AGREE AND ACEPT WHAT THE OTHER PERSON IS SAYING WITHOUT VOICING YOUR POV IF YOU DISAGREE. THIS IS ONE TRAIT THAT I NOW KNOW I NEED TO FURTHER DEVELOP.
IF I WAS IN A SITUTAITON LIKE THIS AGAIN I WOULD BE LESS PASSIVE AND ACTIVELY ASK MORE QUESTIONS UNTIL I TOO AM HAPPY WITH THE PROFILE OF THE PT. I FURTHER WOULD CONSTRUCTIVELY AND PROFESSIONALLY DISCUSS WITH THE PERSON IDEAS ON HOW I BELIEVE THE RX SESSION CAN BE PLANNED.
THIS SCENARIO HAS TAUGHT ME THAT NOT ONLY DO WE HAVE TO LEARN TO WORK WITH DIFFERENT PERSONALITIES AND WORKING STYLES BUT SOMETIMES IT IS TOO EASY JUST TO AGREE AND ACEPT WHAT THE OTHER PERSON IS SAYING WITHOUT VOICING YOUR POV IF YOU DISAGREE. THIS IS ONE TRAIT THAT I NOW KNOW I NEED TO FURTHER DEVELOP.
IF I WAS IN A SITUTAITON LIKE THIS AGAIN I WOULD BE LESS PASSIVE AND ACTIVELY ASK MORE QUESTIONS UNTIL I TOO AM HAPPY WITH THE PROFILE OF THE PT. I FURTHER WOULD CONSTRUCTIVELY AND PROFESSIONALLY DISCUSS WITH THE PERSON IDEAS ON HOW I BELIEVE THE RX SESSION CAN BE PLANNED.
Wednesday, October 1, 2008
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.
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.
Friday, September 26, 2008
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.
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.
Thursday, September 25, 2008
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.
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.
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.
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