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.
Saturday, November 15, 2008
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.
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