Thursday, July 22, 2010
Final Entry: Final Placement
Reflecting on my intial entry I found I was fairly accurate in my predictions! The general medical ward was a fairly consistent ward with daily mobilisation and deep breathing exercises, and I managed a 6-8 patient caseload. I was glad to have my own patients in which I could manage independently without having to share patients with Aaron, however he was always available if I needed an extra pair of hands! I was also able to experience ICU this week which I really enjoyed as I had yet to be exposed to the acute medical management and the numerous attachments of the patient. I found it difficult to develop sound clinical skills specific to cardiorespiratory due to the lack of respiratory patients on the ward, often the patients primary problem was reduced mobility but I tried to auscultate as many patients as possible anyway. The aspect of the placement that both drove me nuts sometimes but which I feel very confident in now was discharge planning and the role of a multidisciplinary team. I was a little disappointed that I wasn't being exposed to the exciting side of cardioresp physio as my peers however I developed a sound knowledge of discharge options and the importance of liasing with the MDT. As it was a large tertiary hospital there was an underlying push to free up beds when able and I found that so often once the patient was deemed medically stable the medical team were very eager to D/C the patient whether they were deemed safe from the other disciplines or not. I had a close relationship with the social worker and the OT to organise appropriate follow up care as many patients were originally from home and upon D/C were not fit to cope at home. I feel completely confident to liase with the MDT and the medical team and to express my opinion, I am also aware of all the avenues for follow up care. I think these skills are essential for a physiotherapist working in a hospital setting and are transferrable across all disciplines not just cardio-respiratory physiotherapy. Overall I really enjoyed the placement and I'm itching to start working as a physiotherapist, hopefully in the hospital setting!
Week 5: final placement
Situation: On Monday morning both my supervisor and fellow prac student were on sick leave, the physiotherapy management were unable to find a relief for the morning so I was on my own on the ward and was able to page another physio if I needed help.
Task: My task was to represent physio for the ward's morning handover with the multidisciplinary team and then to see as many patients as I could manage.
Action: Not suprisingly there were 8 new patients on the ward that morning so I found it was essential to prioritise my case load. Conveniently 4 of them were not indicated for physio. I knew that I wasn't expected to see every patient that morning but I felt it was important not to just stick to my patients but see to the priority patients of my supervisor and my fellow prac student as able.
Result: As a result a few of my own patients were a low priority so I managed to see 6 priority patients of my supervisor, fellow prac student and mine collectively. I had the help of a physio with one of the patients as they were an acute stroke with a GCS of 9-10 and I didnt feel comfortable seeing them on my own.
Evaluation: I think I handled the situation well as I didn't get overwhelmed with the initial 16 patient case load I also enjoyed having the independence. I felt confident representing physio in the handover meeting and voicing my opinion in relation to patient management and discharge. I also learnt how to use a pager!
Strategies: I found that patient prioritisation was essential to manage the case load and it is obviously a vital skill required when I will be managing a ward independently once graduated. Good communication is important when liasing with the nursing staff and medical team to ascertain whether physiotherapy is a priority for the patients management.
Task: My task was to represent physio for the ward's morning handover with the multidisciplinary team and then to see as many patients as I could manage.
Action: Not suprisingly there were 8 new patients on the ward that morning so I found it was essential to prioritise my case load. Conveniently 4 of them were not indicated for physio. I knew that I wasn't expected to see every patient that morning but I felt it was important not to just stick to my patients but see to the priority patients of my supervisor and my fellow prac student as able.
Result: As a result a few of my own patients were a low priority so I managed to see 6 priority patients of my supervisor, fellow prac student and mine collectively. I had the help of a physio with one of the patients as they were an acute stroke with a GCS of 9-10 and I didnt feel comfortable seeing them on my own.
Evaluation: I think I handled the situation well as I didn't get overwhelmed with the initial 16 patient case load I also enjoyed having the independence. I felt confident representing physio in the handover meeting and voicing my opinion in relation to patient management and discharge. I also learnt how to use a pager!
Strategies: I found that patient prioritisation was essential to manage the case load and it is obviously a vital skill required when I will be managing a ward independently once graduated. Good communication is important when liasing with the nursing staff and medical team to ascertain whether physiotherapy is a priority for the patients management.
Sunday, July 11, 2010
Week 3: final placement
Situation:
55 yo man transferred to Fremantle hospital for medical admission with diabetic ketoacidosis.
PMHx: type 1 diabetes mellitus, HTN
SHx: lives with wife at home, independent with ADLs
Prev functional status: independent ambulation and mobility with nil aid.
Task: My task was to complete a full physiotherapy assessment of this patient’s chest and mobility.
Action: After completing the assessment I found that he was unsteady on his feet and required O2 to ambulate due to low SpO2 (approx 85% on RA at rest) On subjective questioning I found that he had been walking to the bathroom and back without a frame and without any O2 therapy. He also appeared non-compliant to therapy and didn't understand why physiotherapy would assist him returning home. I spoke with the medical team and learned that the patient must maintain his SpO2 at >94% at rest to be able to go home.
Result: As a result of these findings I educated the patient on the importance of walking with assistance of a frame and oxygen in his current state from a safety point of view for health and also the role of physiotherapy in his management. The patient was very eager to return home and didn’t understand why he was being ‘kept in here’. From a physio point of view my aims were to improve safety with mobility and improve exercise tolerance. Therefore educated the patient on what the SpO2 reading represented on the sats machine and the importance of it for his discharge.
Evaluation: I found that by educating the patient on the requirements for his discharge and the reasons for why I wanted him to ambulate with a frame and O2 proved effective as he had more of an understanding of the reasons behind my actions. He became more compliant with my sessions and was very motivated and focused on improving his SpO2.
Strategies: In the future I will continue to use education and goal setting to motivate patients. I also found that often a patient appears non-compliant because no-one has properly explained the reasons behind the requirements of the patient and so don’t feel like they are being listened to or have any participation in their management.
55 yo man transferred to Fremantle hospital for medical admission with diabetic ketoacidosis.
PMHx: type 1 diabetes mellitus, HTN
SHx: lives with wife at home, independent with ADLs
Prev functional status: independent ambulation and mobility with nil aid.
Task: My task was to complete a full physiotherapy assessment of this patient’s chest and mobility.
Action: After completing the assessment I found that he was unsteady on his feet and required O2 to ambulate due to low SpO2 (approx 85% on RA at rest) On subjective questioning I found that he had been walking to the bathroom and back without a frame and without any O2 therapy. He also appeared non-compliant to therapy and didn't understand why physiotherapy would assist him returning home. I spoke with the medical team and learned that the patient must maintain his SpO2 at >94% at rest to be able to go home.
Result: As a result of these findings I educated the patient on the importance of walking with assistance of a frame and oxygen in his current state from a safety point of view for health and also the role of physiotherapy in his management. The patient was very eager to return home and didn’t understand why he was being ‘kept in here’. From a physio point of view my aims were to improve safety with mobility and improve exercise tolerance. Therefore educated the patient on what the SpO2 reading represented on the sats machine and the importance of it for his discharge.
Evaluation: I found that by educating the patient on the requirements for his discharge and the reasons for why I wanted him to ambulate with a frame and O2 proved effective as he had more of an understanding of the reasons behind my actions. He became more compliant with my sessions and was very motivated and focused on improving his SpO2.
Strategies: In the future I will continue to use education and goal setting to motivate patients. I also found that often a patient appears non-compliant because no-one has properly explained the reasons behind the requirements of the patient and so don’t feel like they are being listened to or have any participation in their management.
Sunday, June 27, 2010
First Week: final placement
The situation was that I had a patient who had been admitted onto the general medical ward at Fremantle hospital for pneumonia and was 86 years old. She had just been deemed medically stable by the medical team. Premorbidly she lived at home alone and ambulated independently. Since being admitted to hospital she had deconditioned considerably to a point where it would be unlikely for her to return to premorbid function and thus return to living at home.
Task: My task was to conduct a mobility and chest review on this patient to determine their level of function to assist with discharge planning.
Action: Upon review I found that her chest was clear and that she was in fact not at her baseline function. She was mobilizing with a wheeled zimmer frame short distances and required moderate to maximal assistance with mobility. At this stage the patient was at a high level care functional status. I discussed with the patient her options for when she left the hospital as the medical team were under the impression she would prefer to go straight to a nursing home as she was not motivated to participate in rehabilitation to improve her mobility so she was able to go to a hostel.
Result: After talking to her however I found that she would much prefer to go to low level care where she could do things for herself and was motivated for rehab. She realized that for her to achieve this goal she would need to undertake further rehab to achieve low level care functional status. Therefore I liaised with the ward OT to determine an appropriate discharge plan for this patient to optimize their quality of life. We decided that this patient would benefit from slow stream rehab with a transitional care program to improve their mobility so that they could achieve a low level care status and live in a hostel.
Evaluation: I think I was effective with the discharge planning for this patient. By effectively communicating with the patient I was able to determine that the patient was in fact motivated to improve their mobility so that they could be discharged to a hostel rather than a nursing home, therefore improving their quality of life.
Strategies: Strategies that were essential for this situation were good communication and also knowledge of discharge options. I found that there are numerous options to choose from when planning patient discharge and that it is essential to be familiar with all of them as discharge planning is such a large part of our role as a physiotherapist.
Task: My task was to conduct a mobility and chest review on this patient to determine their level of function to assist with discharge planning.
Action: Upon review I found that her chest was clear and that she was in fact not at her baseline function. She was mobilizing with a wheeled zimmer frame short distances and required moderate to maximal assistance with mobility. At this stage the patient was at a high level care functional status. I discussed with the patient her options for when she left the hospital as the medical team were under the impression she would prefer to go straight to a nursing home as she was not motivated to participate in rehabilitation to improve her mobility so she was able to go to a hostel.
Result: After talking to her however I found that she would much prefer to go to low level care where she could do things for herself and was motivated for rehab. She realized that for her to achieve this goal she would need to undertake further rehab to achieve low level care functional status. Therefore I liaised with the ward OT to determine an appropriate discharge plan for this patient to optimize their quality of life. We decided that this patient would benefit from slow stream rehab with a transitional care program to improve their mobility so that they could achieve a low level care status and live in a hostel.
Evaluation: I think I was effective with the discharge planning for this patient. By effectively communicating with the patient I was able to determine that the patient was in fact motivated to improve their mobility so that they could be discharged to a hostel rather than a nursing home, therefore improving their quality of life.
Strategies: Strategies that were essential for this situation were good communication and also knowledge of discharge options. I found that there are numerous options to choose from when planning patient discharge and that it is essential to be familiar with all of them as discharge planning is such a large part of our role as a physiotherapist.
Sunday, June 20, 2010
Initial entry: fourth placement
This round I am at Fremantle hospital doing my cardiorespiratory placement. I expect it to be quite structured where I will develop a daily routine of seeing approx 6-8 patients a day. I hope that I get the opportunity to experience physiotherapy in the ICU as well as the basic ward work. I expect that the majority of my day will be spent mobilising patients and obviously chest physio to assist with an early discharge. I assume as it being a hospital placement that discharge planning will be vital as soon as the patient is admitted. My main concern is the expectations of me as a student in my final placement, I feel fairly confident with my theoretical knowledge in cardiorespiratory however I am unsure of how well I will transfer it practically. I am to a degree concerned about the fact that there is eight students doing their cardio placement here and what degree of independence we will have. Only because it is my last placement and I'd love the opportunity to work on my own with a full case load however I know this may not be feasible. Overall I am excited to start this placement as it is my final one and I have yet to do any cardio physio.
Thursday, June 10, 2010
Final Entry: third placement
On reflection I have really enjoyed this placement, I think due to a combination of being a good placement and livign in the the country for five weeks. In terms of structure, the case load varied with some days having 3 patients spread across the day to others where I had 8-9 patients. The majority of my patients did have back pain but were all completely different in nature, none of them were straight forward! I enjoyed travelling between augusta and margaret river as Augusta was predominantly geriatrics and some hospital work so I got a taste of all aspects. I definitely found the diagnostic process the most challenging part of the placement, as I wasn't used to starting from scratch with no previous diagnosis provided. In some respects your spoilt working on a ward as you usually already know what the main reason the patient is there. I found it at times so complex and challenging and almost a guessing game as you'd trial one treatment to see if it works, and if not try something slightly different next time if they didn't improve significantly. Something I found challenging was the nature of the private practice as patients were booked in and paying to see my supervisor, so at times I a little self conscious as I thought they'd prefer Rob over me as I'm a 'student'. In the end however I didn't have any troubles with the patients and learnt that confidence was the key and they would trust you as a physiotherapist. In all I have absolutely loved this placement and I will definitely keep my options open for rural jobs at the end of the year!
Week five blog: third placement
Situation- An elderly patient booked in because they were experiencing low back pain that they had had for a few years on and off and had worsened over the last week.
Task: My task was to assess this patient and formulate a management program
Action: I conducted a full objective and subjective assessment and found that they were suffering from a mobility issue and was relatively straight forward. I explained this to the patient and outlined my treatment plan for them and soon realised they had a very passive approach to management. They strongly believed that ultrasound alone was what helped and requested it.
Result: I soon realised they had a very passive approach to treatment and that their condition in particular being a mobility issue would not soley be cured by ultrasound. I explained to the patient that the effects of ultrasound and even my treatment in this session were only temporary and that it was most important to continue with exercises at home to maintain the benefits.
Evaluation: I found it challenging to change the patients views on physiotherapy and their symptoms as they were well entrenched beliefs. I realised however that there was only so much I could say or do and that ultimately it was up to the patient to decide whether to take the advice on board.
Strategies: In future I will endeavour to translate my theoretical knowledge into patient friendly language to convey the role of physiotherapy and the importance of self management.
Task: My task was to assess this patient and formulate a management program
Action: I conducted a full objective and subjective assessment and found that they were suffering from a mobility issue and was relatively straight forward. I explained this to the patient and outlined my treatment plan for them and soon realised they had a very passive approach to management. They strongly believed that ultrasound alone was what helped and requested it.
Result: I soon realised they had a very passive approach to treatment and that their condition in particular being a mobility issue would not soley be cured by ultrasound. I explained to the patient that the effects of ultrasound and even my treatment in this session were only temporary and that it was most important to continue with exercises at home to maintain the benefits.
Evaluation: I found it challenging to change the patients views on physiotherapy and their symptoms as they were well entrenched beliefs. I realised however that there was only so much I could say or do and that ultimately it was up to the patient to decide whether to take the advice on board.
Strategies: In future I will endeavour to translate my theoretical knowledge into patient friendly language to convey the role of physiotherapy and the importance of self management.
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