FINAL ENTRY

Ok, one more blog. Couldnt stay away.

1.
I really enjoyed this prac in hindsight. I found that it was very beneficial to me to have a hospital setting as my first prac because in a way theyre a little more leniant on you because you're a second year, so I had a chance to develop basic knowledge of how a hospital works and was exposed to surprisingly quite a few conditions and orthopaedics (not just #NOFs) I found it quite rewarding following pt's through their rehab and then finally discharging them or seeing them walk for the first time in 5-6weeks. I also got a bit of hydro experience which was fun and educational. One thing that was really reinforced was the idea of a multidisciplinary team and the hollistic approach to a patient, which can only be hammered into us so much at uni- but it all makes sense when its applied practically.

2.
- Orthopaedic physio protocols
- Modifying treatment for conditions ie. age, dementia
- AMbulation and gait prescription and progression
- creating exercise programs for different conditions
- reading orthopaedic x-rays
- verbal hand overs
- hydrotherapy
- chest physio
- taking obs.
-SOAPIERS!
- professionalism
- pt repall and interaction
- being a team player (in the multi displinary team)
- Medications
- Variety of common conditions mainly associated with old age
- Outcome measures - balance and mobility

ive just realised it said list the most important, but they're probably all important skills anyway.

week 5. post 3.

My last blog..
Ok so to wrap up the blogs I had a patient today who also didnt speak much english who was russian and had quite severe dementia. When I did my subjective on her anything i asked her I recieved a very stern and final "no" or a "whats this to you, none of your business". It didnt matter how i rephrased things or asked she was very final and I think quite distressed because of the new surroundings and that she hadnt comprehended that she'd hurt her hip. In the end i had to give up and plan to come back later, I found that sometimes you cant win and you've got to step back and let them be, and calm down then try again later. SO thats the last of my blogs if you guys want to follow up any of my experiences or want some advice come see me.

week 5 post 2.

Today I had a newly admitted patient, who doesnt speak any english and is 99 yo. wow. Luckily the daughter was there too but she spoke quite shady english. I had to use good visual cues to help the patient understand what I wanted her to do, I was also a little concerned that the daughter would translate something completely different back to the patient. Anyway, we got the patient up and walking eventually and suprisingly she did very well despite her age! The daughter was constantly chattering away to her so was little distracting. I learnt the need to be very simple and literal with your visual and verbal cues.

week 5 home stretch post 1

Hi. Over the w/e one our pts went downhill and developed a chest infection and UTI and a handful of other things which werent good, and on top of that he has quite severe dementia. I did some chets physio on him and found it quite difficult to complete, one because he was very drowsy and also because he couldnt comprehend instructions like to take deep breaths although he kept saying "yes....ok" "beg yours, yes...alright". Anyway had a listen and there were added breath sounds in his bases with a bit of a crackle and wheeze. I also attempted an ACBT however he wasnt able to comprehend to take normal breaths then deep then huff. I found the experience good, and realised sometimes no matter how simply you put it or rephrase it things like taking deep breaths on command are unachievable.

week 4. post 3

This morning we went down to the ortho ward and did a first day stand with a patient. I found it very interesting because I hadn't seen one yet, and found it tricky negotiating all the cords and wires escpecially the catheter that you forget is attached to them. I found you need to take your time and ensure the patient isn;t going to get tangled or anything will pull out, I also learnt the importance of first day stands and the necessity to get the patient up and moving regardless of their excuses and stubborness. I found that if a patient tells me theyre too tired or too sore I initially decide to leave them but I think im slowly becoming more vigilant and cracking the whip and that the patient isn;t your biggest fan especially during the acute stages when theyre usually in alot of pain and can be confused and weary from meds and anaesthetics etc.

week 4. post 2.

At the ward round meeting today Aaron (physio student aaron) and I had to present the physio and OT side of the patients care (OT because the OT lady was at another meeting). I really enjoyed it and learnt that because it's a multidisciplinary team everyone has theyre own points to make and you need to speak up and get in there quick to get your point across, I found it a bit daunting when the room goes silent and theyre all looking at you expecting you know what you're takling about and when they ask questions. I think I handled it reasonably well and found you just need to be confident and trust what you've got written down is correct.

week 4. post 1

Today as I was walking down the corridor a lady called out from her room and a situation presented. she felt like she was slipping out of her chair and her foot was propped up on a leg rest, she had little strength to straighten herself up and was obese. So i went in to help her and realised i couldn;t on my own, The nurses around came to help and first tried moving her with her help but was no good so I decided to use the sheet that was covereing the cushion she was sitting on like a slidesheet so i called the shots and it worked and she was happy sittng upright in no time. I think i did well with taking control of the sitch because at one stage there were too many cooks in the kitchen and the patient was becoming panicked. next time i know to get help or even put a better suited pillow there to prevent it from happening in the ifrst place.

week 3. post 2

Today there was a code brown! which means there was an external incident, which was the bus accident in Manjimup. I didnt think it would affect our ward, however they anticipated multiple injuries and needed beds at RPH in the city which meant that patients up there on the waitlist for shenton park campus were ideally moved there, so we had to discharge as many able patients as we could. One patient was medically clear, so technically should be discharged already was told he was being sent home that day. He didn't take it very well and I was surprised because I would have thought he'd be eager to go home, however I realised after a lengthy stay patients becaome attached to the environment and the care provided and it becomes a second home. I think it was also apprehension of being discharged and having to manage their life in general and health independently. Anyway, turns out there were only 4 people injured from the bus accident so we didn't have to discharge too many patients prematurely.

week 3 post 1

Today we went an saw the grumpy old lady from my previous blog, 'dot'. Dot has a #NOF and is a little bit demented. She was sitting out in her chair when we went to see her and was initially quite pleasant. I then mentioned I was going to get her up and take her for a walk, and she blatantly refused because the ground was too hot and she'll burn her feet and she had to get back into bed because she getting burnt. I tried reasoning with her and she became increasingly aggitated and refused and continually claimed shes too hot, what horrible people we were wanting her to burn her feet, by this time I was getting pretty frustrated and angry, so laid down the line and told her we know that she really wants to go home and to that she needs to be walking confidently on her frame and if she's not going to co-operate with us then its going to delay her discharge another day and she'll be in here for another day. We also gave her a pair of plaster shoes (rubber soles with straps) that funnily enough she fell in love with. In the end we got her up an walking, it tested my professionalism by having to hold back laughter as she strutted down the corridor in her rubber shoes. I think I handled the situation pretty well, we found it suited her personality to give her stern orders and not give in to her excuses, and also very specific goals to achieve before she can go home so she doesn't think she can milk her way through her stay at hospital not doing anything and go home.

wk 2. post 3

We went to a meeting today on falls prevention. Initially the nurse went through statistics that she had gained from an audit of each patient regarding a number of factors that contributes to risk of falling and highlighting any improvements or things that have gotten worse since the last audit (usually a month ago). It was interesting to see the factors that were considered to contribute to falls risk. One of the issues raised, which was a factor that had not improved since the last audit, was if the walking aid prescribed for the patient was next to the bed or in reach of the patient at all times. According to the statistics by keeping the walking aid close to the patient an in reach in their room helped reduce the risk of falls. However the concern was raised that if pts who are confused or demented had their walking aid at hand and were not independently safe it would encourage tthem to get up and walk when theyre not supervised. The physio that was running this meeting said that regardless of the walking aid being within reach the demented patient would get up and walk or go to the toilet if they really wanted to, so it was considered more safe if they at least used the aid.

wk 2. post 2

On tuesday sat in on a grand ward round which is a mulitdisciplinary meeting on all the patients on the ward (specifically the #NOFs) and discuss the current status of each pt and when they will be safe for discharged, where they will return, what aids in the home they will need etc. The multidisciplinary team included the orthopaedic consultant, resident doctor on the ward, social worker, nurse, physio, discharge person? and OT. I found these meetings really interesting and they really enforced the hollistic approach to each pt and their discharge plan. The primary role of the physio in this meeting was to provide mobility status so whether they are independent with transfers, bed mobility and ambulation with ideally crutches or ZF if gait aid required (otherwise w/c). I found the other health professionals input in the overall care of this pt interesting and the criteria for returning home in their books was quite different.

wk 2 post 1

Today we had a new #NOF pt transferred from RPH. We went to see her to do initial subjective and mobility assessment. The pt 'Jan' was very agitated and verbally agressive and I suspect confused. She was very non-compliant refusing anything we asked her to do. She stated she had previously had bad experiences with the nurses etc as they put her in pain and rushed her. We then proceeded to get her out of bed the whole while she was throwing abuse from all directions and had a very negative attitude, we remained calmed and did everything slowly and carefully. I think it was partly because it was the end of the day but I was about to blow my top at her and mouth back at her but I managed to swallow it which I thought I did well. In the end I noticed that Jan began struggling to find things to pin us with because we carried it out smoothly and didn't cause her any further pain. We managed to get her SOEOB and then standing up with PF.

post 3.

Day3 and today my transfer techniques were put to the test. We had one lady "Beryl" who is 66yo with L # NOF (sort of a given) and suffers from severe dementia to the point where she is unable to communicate. Beryl has yet to be sat of bed since the surgery ~1.5/52 ago. Her partner is adamant to look after her himself and take her home.

The medical staff believe this isn't advantageous for the both of them and think she is better suited for high level care. Today's session was prodominantly to both sit Beryl up out of bed for the first time and prove to the partner that it is unadvisable that he cares for her himself, as he has previously been quite difficult to reason with.

The task at hand was to get beryl sitting out of bed in her chair. Initially we tried it manually and required 4 medical staff to get her SOEOB and a nurse to hold the pulpit frame, it was a real struggle and didn't achieve a safe transfer. We then progressed to a standing hoist which was an interesting experience, the fact that a hoist was required further indicated that a high care situation for Beryl when she was discharged would be much more beneficial.

Beryl was hoisted into the chair beside the bed which required one physio supporting the trunk, myself and a nurse stabilising the legs, Aaron supporting under the shoulders and a nurse controlling the hoist. As soon as Beryl was lowered into the chair a look of relief and the biggest smile came across her face, I found this quite a rewarding experience, moreso because I hadn;t seen any distinguishable emotion on her face since I ad beeen on the ward. As beneficial as it was to get Beryl sitting up and out of bed the partner became more confident in the idea of taking her home and looking after her himself because she was so happy. So in the end the medical team felt that their plan in a way had slightly backfired. Anyway, just another day on the #NOFs.

DAY TWO

Today we got into the swing of things, Aaron and I also met with out clinical tutor. One of my tasks today was to take a subjective history of a patient as though it was the first time a physiotherapist had first seen them. I interviewed a patient who was about to be discharged. The interview was taken in the early afternoon after lunch. Because of this the patient was a little grumpy and aggitated because he was tired, hadn't been feeling well that day and was also frustrated that he hadn't been discharged yet.

The interview took a turn, and he started asking questions such as 'what's the point of this, its not going to get me home quicker'. I think I handled this fairly well as I told him we needed to refine our notes on his social history and we wanted to have a chat to him anyway. The interview then took another turn for the worst when he started to tell me about his bowel problems and proceeded to undo his pants to show me. I had to quickly directly the conversation to another topic and assure him that I believed him and I didn't need him to take off his pants. I was a little startled so if the situation comes about again I am going to try and keep a cool head about it. So I didn't feel comfortable but I felt fairly confident on how I handled the situation.

Overall today the pace picked up which I liked, we were given patients to see and do exercises with and take them walking.

DAY ONE.
Today was mainly an orientation of the hospital and the ward which I will be focused with. In the afternoon I was givent the task to get one patient out of bed and take them walking to the gym and practice stairs. Initially he was quite resistant due to fatigue and he had just had a nap and didn't feel like getting up.

I think I did well with motivating the patient to get up and that he if did well on the stairs this afternoon it was likely he would be able to going home in a few days. I felt pretty comfortable with the situation because int he end the patient was quite compliant and happy to go for a walk.

I do think I need to improve on my explanations of tasks, such as walking on stairs, especially with the wheeled zimmer frame which threw me a little bit. Next treatment session I'm going to try and keep my instructions clear and simple and try to avoid waffle, because this will only further confuse the patient.

Generally I think the first day went pretty well, I found it wasn't as daunting as I had anticipated and the clinical supervisor is very supportive.

Intial entry

1. On the whole, i'm pretty nervous starting clinical placement at fracture neck of femur ward. I think this is mainly from the things I'ver from previous students have gone there. I'm also quite excited, I think this is a mixture of it both being a new experience and the fact I don't have proper uni for 5 weeks. Previous students that went to the same placement have mentioned that they were thrown into the deep end so I am a little apprehensive but also think this will probably be beneficial for my learning. The main concern is the depth of knowledge that is expected, even though my placement is pretty specific I will need to brush up on the all the aspects of physio involved in a hospital setting. I hope to improve my professional skills with communication, goniometry, transfers, gait aid prescription and education and exercise prescription.

2. Due to the hospital setting I believe there will be a high integration of health care professionals including an OT, nurse, physiotherapist, possibly surgeon for check ups, social worker. I think the team will be working together to achieve an effective recovery form surgery of the patient and an early discharge. As functional mobility and medical stability are high priority for discharge the physio will be very important in chest physio and getting the patient out of bed and walking as soon as possible.