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.

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.

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.