This morning was an interesting challenge for me because it was my second chance to take on a new patient, carry out an initial assessment, formulate a plan and decide on appropriate treatment for the patient. Second chance means i get to improve on my first attempt. I looked at the patients notes to formulate a patient handover, a skill i am increasingly confident with. Working at RPH also gives me the opportunity to look at as many xrays as possible which i am trying to make the most of. Anyway moving onto the subjective assessment... which i think was fairly good. I feel much more comfortable already 'chatting' with my patient, which makes it easier to formulate the appropriate questions quickly. I also find it important to probe into the information which is important for the particular patient. I understand the importance of gaining a social history and that it is so beneficial to ask questions regarding this to begin with to develop rapport with the patient. I find it also useful to try and to relate to the patient in some way especially regarding their goals which is usually fairly simple. To improve my subjective assessment i need more and more practice to develop confidence and be able to think on the spot without pausing or checking my assessment sheet for which question needs to be ask next.
Also i need to explain certain things better to my patients such as the VAS.
Today was good, i feel like I'm slowly improving but there is so much to learn and it is very overwhelming.
Monday, October 27, 2008
Week 2 - tuesday
Today i learnt that dealing with an horribly aggressive, demented and anxious patient is more difficult than i thought. It is also frustrating for the therapist because they are capable of completing treatment program but simply not willing. Today part of the physio duties is to complete a mobility chart which acknowledges the amount of assistance a patient requires to transfer, mobilise etc. The patient had refused therapy previously but it was absolutely necessary on this occasion. The elderly patient was very anxious and aggressive which made everyone feel uncomfortable and made it almost impossible to develop any rapport with the patient. Overall the treatment was very fairly effective and the key was to use plenty of motivational strategies and explain the importance of her physiotherapy treatment. This way the patient understands the implications of non compliance and is still able to make own decisions. Physiotherapy needs to work both ways and consent is a massive issue here 'you help us, we help you'. If a patient still refused treatment then that is their decision and needs to be acknowledged. Overall treatment was effective and communication was a key. In the future it may be more beneficial to spend more time developing rapport with the patient which may aid cooperation. All the strategies learnt in geriatrics regarding cognitive deficit and Rx modifications become key skills for the therapist.
Today i learnt that yet again communication is the most valuable skill for a therapist to master.
Today i learnt that yet again communication is the most valuable skill for a therapist to master.
Monday, October 20, 2008
Week 2 - monday
Today i was asked to prescribe a patient with an incentive inspiratory spirometer(IIS). I was fairly confident as my supervisor gave me a good handover and i felt i understood the reasoning behind using the spirometer well. I felt confident prescribing the treatment because i had previously developed rapport with the particular patient which made the Ax and Rx less confronting. I discussed the importance of the IIS with the patient and made it clear why the doctors hace prescribed and how it relates to his smoking and increased bed rest. I remembered to assess the patients cough which was dry and clear. I taught him how to use the IIS which is incredibly easy and challenged him to use it in a few different ways. I also provided the instructions to the patient to read as he has excellent cognition. To improve the treatment i could have combined the IIS with other deep breathing exercise such as the huff or TEE's. I could have also discussed how patient positioning can be combined with the IIS to improve its effectiveness. Next time i see this patient i would like to discuss these Rx modifications with him.
A second incident that occurred today involved the multidisciplinary team. There was a problem because a patient was discharged before the OT had arranged a home visit and for equipment to be fitted out in the house. This was a major problem because the patient was not fully independent and was unsafe. The problem occurred basically because of a lack of communication. This was an excellent learning curve and really demonstrated the importance of the TEAM approach to patient care.
A second incident that occurred today involved the multidisciplinary team. There was a problem because a patient was discharged before the OT had arranged a home visit and for equipment to be fitted out in the house. This was a major problem because the patient was not fully independent and was unsafe. The problem occurred basically because of a lack of communication. This was an excellent learning curve and really demonstrated the importance of the TEAM approach to patient care.
Week 1 - wednesday
My clinical tutor put me on the spot today and asked me to carry out a full Sx assessment of a patient without any guidelines. Although she did choose a very friendly talkative lady which didn't make it so intimidating. I was initially concerned as was not sure which questions needed to be asked and how to ask them. On reflection i think my questions were appropriate to the patient presentation. I was initially concerned about interrupting the patient and using closed questioning to avoid patient rambling, but i did not find this to be an issue and it was generally easy to focus the patient on the topic with a simple question or comment. On the other hand i will need to develop good communication skills using open and leading questions as many patients on the ward are daffy and lack cognitive skill. Overall i thought my performance was good except i missed out on some important questions which my tutor brought to my attention. Most importantly i needed to ask questions regarding home living situation as this is the goal of rehabilitation for most NOF patients. One key lesson i learnt was therapist postitoning, because initially i kneeled beside the bed but as this got uncomfortable i had to interrupt the patient and excuse myself while i fetched a chair. In future i will properly prepare my environment.
Overall i felt fairly confident but i need to challenge myself myself to a different patient out of my comfort zone!
Overall i felt fairly confident but i need to challenge myself myself to a different patient out of my comfort zone!
Week 1 - tuesday
This morning i found it very beneficial as my clinical tutor guided me through patient notes and skills required to communicate a succinct thorough handover. I found this was very helpful as understanding the pt.notes well allows for much better planning of pt assessment and treatment (especially with regards to Rx modifications and safety precautions).
An interesting aspect to my day occurred on the ward rounds. I found it a very beneficial experience watching the consultant geriatrician communicate with the patients in particular. The consultant spoke slowly and clearly and used layman's terms for the patient. He displayed good bedside manners and although rushed for time e introduced himself patients thoughts, feelings and mental state. He was always well positioned to talk to patients and displayed confidence and asserted his authority. I thought this was a useful experience to reflect on because these are all strategies i need to put into place while becoming comfortable communicating with and subjectively assessing patients of this age group.
Overall today was a positive learning experience.
An interesting aspect to my day occurred on the ward rounds. I found it a very beneficial experience watching the consultant geriatrician communicate with the patients in particular. The consultant spoke slowly and clearly and used layman's terms for the patient. He displayed good bedside manners and although rushed for time e introduced himself patients thoughts, feelings and mental state. He was always well positioned to talk to patients and displayed confidence and asserted his authority. I thought this was a useful experience to reflect on because these are all strategies i need to put into place while becoming comfortable communicating with and subjectively assessing patients of this age group.
Overall today was a positive learning experience.
Monday, October 13, 2008
Week 1 - monday
My first day was very enjoyable. I feel very orientated to the hospital and welcome in the ward. The ward has around 20 patients onboard and atleast half need to be seen by the physio each day. Emily our supervisor introduced us to most patients today and expects us to be able to SOIER most of these patients tommorow with assistance ahhhh! The skills learnt with annemarie in geriatrics should be very handy on this placement.
I would like to mention a situation from today. A nurse asked emily and myself for assistance to transfer a patient from supine onto a comode. This patient had cognitive difficulties, and didnt understand instructions at all. He was also very resistive to movement and very poor strength. the nurse mentioned he was high care and probably needed a hoist. Overall the transfer was fairly ineffective and the patient was uncomfortable and concerned. I felt also it was rushed and if i had planned the maneouver it would have be far more efficent. The main problem was that the patient had very poor posture while standing in the wzf which made it difficult for him to weight transfer, lift his feet and take steps (Both forwds and backwards). tactile stimulation would have assisted the patient with this task. Finally i think the hoist would have been a far more suitable transfer method and should have been properly considered.
When the same situation arises on another day i need to take my time to properly plan difficult transfers, aquire the correct amount of assistance and facilitate normal movement, which woul make me and my patients feel much more comfortable.
Overall today was an enjoyable experience and i am looking forwd to getting involved tomorow.
I would like to mention a situation from today. A nurse asked emily and myself for assistance to transfer a patient from supine onto a comode. This patient had cognitive difficulties, and didnt understand instructions at all. He was also very resistive to movement and very poor strength. the nurse mentioned he was high care and probably needed a hoist. Overall the transfer was fairly ineffective and the patient was uncomfortable and concerned. I felt also it was rushed and if i had planned the maneouver it would have be far more efficent. The main problem was that the patient had very poor posture while standing in the wzf which made it difficult for him to weight transfer, lift his feet and take steps (Both forwds and backwards). tactile stimulation would have assisted the patient with this task. Finally i think the hoist would have been a far more suitable transfer method and should have been properly considered.
When the same situation arises on another day i need to take my time to properly plan difficult transfers, aquire the correct amount of assistance and facilitate normal movement, which woul make me and my patients feel much more comfortable.
Overall today was an enjoyable experience and i am looking forwd to getting involved tomorow.
Sunday, October 12, 2008
16 hours till placement begins
Im really looking forwd to my placement tomorow morning! After 2 years of hard work we finally get to go out and apply and consolidate some knowledge. Im really looking forwd to meeting new people, especially patients and also the experience of working in a hospital.
What makes me nervous is that im not really 100% sure of what is expected of me but hopefully this is something that will be cleared up on the first few days! Also dont wanna stuff up, which is a scary thought because i know already i am most likely going to do things wrong... but i just need to make sure i learn from any mistakes.
One thing i know i will be asked day one by my clinical educator is, what do you expect of me?
To me an efective clinical educator needs to be an excellent role model and stimulatemy interest in physiotherapy as all the ND staff have done over the past 2 years. Also they should be approachable, non judgemental and encouraging.
Describe how you see the physio woring with other physio and health care professional in the setting of ths clinical unit?
Im interested to find out if the physio specialises in the NoF ward or if they work in other area's also. I expect there to be a large medical team involved in NoF patients care because NoF injury is commonly associated with injuries. I expct physio and OT working closely together in this setting because discharge planning is so important to prevent deconditioning and decreased functioning of the patients.
What makes me nervous is that im not really 100% sure of what is expected of me but hopefully this is something that will be cleared up on the first few days! Also dont wanna stuff up, which is a scary thought because i know already i am most likely going to do things wrong... but i just need to make sure i learn from any mistakes.
One thing i know i will be asked day one by my clinical educator is, what do you expect of me?
To me an efective clinical educator needs to be an excellent role model and stimulatemy interest in physiotherapy as all the ND staff have done over the past 2 years. Also they should be approachable, non judgemental and encouraging.
Describe how you see the physio woring with other physio and health care professional in the setting of ths clinical unit?
Im interested to find out if the physio specialises in the NoF ward or if they work in other area's also. I expect there to be a large medical team involved in NoF patients care because NoF injury is commonly associated with injuries. I expct physio and OT working closely together in this setting because discharge planning is so important to prevent deconditioning and decreased functioning of the patients.
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