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.
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