Upon completing my 5 week clinical placement at RPH I believe that all my expectations of my neurology placement were met and surpassed. It was a placement that I was both nervous and excited about, as it was a very important stepping stone to becoming a good all round physio, in my mind. I was working with very experienced and knowledgeable physios, which meant I was learning from the best. Being around them constantly and feeding off their teaching allowed me to become very involved and independent. The support given to me by my clinical supervisors gave me a lot of confidence and independence to illustrate what I have learned over the course of my degree.
As far as my endurance for the placement was concerned, it wasn’t an issue. I was beginning to feel the effects of continuous clinical placement, however it never became repetitive and was always challenging. I was happy that I could give it the focus and commitment that I was able to give the first three. It was exactly how I thought it would be in regards to the tertiary hospital setting and being a student. You quickly learn that confidence is a must otherwise no one will take you seriously and you can easily get stepped on. RPH constantly has students floating through its doors, and there is no point thinking you are special, instead you are there to do your job to the best of your ability and not necessarily have people always noticing.
I developed a strong relationship with my supervisors. When working in any job it is important to enjoy the people you are working with, as well as the social aspect of the job. I have learnt that enjoying working with your colleagues is so important and influences your work attitude and enjoyment. I found this was an important lesson to learn, because I have experienced both ends of the scale where you don’t necessarily enjoy working next to some people. This made the placement very enjoyable for me.
In terms of the neurology part of the placement, I learnt bucket loads regarding stroke. It is such a large umbrella term that is so ambiguous. I learnt how many differing problems stem from stroke and how to deal with them. Things I know I couldn’t have learnt from a text book. It was such a rewarding experience to spend time in such an established and quality setting of RPH. To work with the whole team and constantly learn from them. I think stroke is something that physios will continue to provide a very firm handle of and I am so grateful for the experience I have now gained from it and can take with me as I become a registered physio. In conclusion the whole placement was a very positive experience for me and I am continually grateful for the opportunity. I know there are many things I will take away “in my back pocket” as I continue to move towards becoming a physio.
Monday, August 2, 2010
Sunday, August 1, 2010
professional behaviour
S: When dealing with people with significant impairments such as stroke, you can be a subject to certain situations that require maturity and professionalism. Instances where pts require help getting dressed or have decreased control of bladder and bowel, are appropriate examples. In many instances the pt is cognitively sound and has just suffered a very rapid and dramatic impairment. Therefore they have often gone from complete independency, to requiring assistance with very personal activities. At this time, the pt is already experiencing extreme hardship and it is important for the physio to show support and professionalism to make it as least emotional as possible for them.
T: To conduct my treatment and session with each pt in a professional manner that, both, aided in their experience with physio and helped build the appropriate rapport.
A: I have been treating a range of patients who are middle aged in an acute stroke rehab setting. Many have become incontinent and or lost a lot of independency. This means that in many cases as a complete stranger I was dealing with dressing these people as well as accompanying them to the toilet and assisting them. From the very beginning I acted as professionally as possible in all situations. Often they became very upset and it was up to me to explain that this was normal and just a complicated stepping stone in their recovery. By acting professionally when dressing pts, this made them feel much more relaxed and reiterated that this was all part of your job. This included steps such as draping appropriately and talking appropriately.
R: As a result I built a strong professional rapport with my pts. They became much more relaxed when having to deal with incontinence issues as well as getting dressed etc. It also made it more comfortable for me as it seemed more natural and part of the job. It became less of an issue and overall I thought it was such a positive step to be able to remove a factor that was making their experience harder on their way to recovery.
E: overall I thought I was very effective in what I set out to achieve. Some areas I thought i did well in included -
• Draping the pt always to ensure you maintained their dignity
• Not laughing or acting inappropriately if pts flatulated or anything of that nature, often they would laugh embarrassingly.
• Always preparing the environment to prepare for any circumstances so that you could resolve it as soon as possible and prevent the pt from having to deal with the experience for too long.
Some areas I thought I could have improved on included –
• Making it easier for other physios working in the gym when I was around, by helping them or maintaining my professionalism.
• Being more mindful of patients using humour or other methods to hide their embarrassment.
S: Some strategies I found useful were –
• Liaising with the nursing staff about any hygiene issues or anything similar that the pt was experiencing.
• Gaining an understanding of each pts personality and any personal trait issues they could be having as a result of the stroke. This was evident in such cases where a pt would act inappropriately and not show remorse, often, instead they would condone it. In such circumstances it was important to show firm instructions that it wasn’t appropriate and wouldn’t be tolerated.
T: To conduct my treatment and session with each pt in a professional manner that, both, aided in their experience with physio and helped build the appropriate rapport.
A: I have been treating a range of patients who are middle aged in an acute stroke rehab setting. Many have become incontinent and or lost a lot of independency. This means that in many cases as a complete stranger I was dealing with dressing these people as well as accompanying them to the toilet and assisting them. From the very beginning I acted as professionally as possible in all situations. Often they became very upset and it was up to me to explain that this was normal and just a complicated stepping stone in their recovery. By acting professionally when dressing pts, this made them feel much more relaxed and reiterated that this was all part of your job. This included steps such as draping appropriately and talking appropriately.
R: As a result I built a strong professional rapport with my pts. They became much more relaxed when having to deal with incontinence issues as well as getting dressed etc. It also made it more comfortable for me as it seemed more natural and part of the job. It became less of an issue and overall I thought it was such a positive step to be able to remove a factor that was making their experience harder on their way to recovery.
E: overall I thought I was very effective in what I set out to achieve. Some areas I thought i did well in included -
• Draping the pt always to ensure you maintained their dignity
• Not laughing or acting inappropriately if pts flatulated or anything of that nature, often they would laugh embarrassingly.
• Always preparing the environment to prepare for any circumstances so that you could resolve it as soon as possible and prevent the pt from having to deal with the experience for too long.
Some areas I thought I could have improved on included –
• Making it easier for other physios working in the gym when I was around, by helping them or maintaining my professionalism.
• Being more mindful of patients using humour or other methods to hide their embarrassment.
S: Some strategies I found useful were –
• Liaising with the nursing staff about any hygiene issues or anything similar that the pt was experiencing.
• Gaining an understanding of each pts personality and any personal trait issues they could be having as a result of the stroke. This was evident in such cases where a pt would act inappropriately and not show remorse, often, instead they would condone it. In such circumstances it was important to show firm instructions that it wasn’t appropriate and wouldn’t be tolerated.
Friday, July 30, 2010
Evidence Based Practice
S: Stroke rehabilitation has been the subject of extensive research and discussion regarding optimal treatment. Due to the nature of the pathology, there have been differing ideologies branch off over the past few decades, as to what type of treatment is most beneficial for the patient. Therefore the research that has been done, attempts to objectively describe the treatment that has proven to give the best outcome for the patient. While working in an acute stroke rehab setting, it was part of my responsibility to the pt to discover what the evidenced suggested was best for the pt. In other words, it was a strong case of having evidence based practice behind my intervention.
T: To provide acute stroke rehabilitation to a pt caseload, that had been clinically shown through research to be the most effective intervention.
A: I was working on the ward with my senior Physiotherapist supervisor, Jacqui. Jacqui is very involved with current up to date research for stroke rehab. Therefore I consulted her as to the best resources to utilize as well as gaining information from her first hand. After liaising with Jacqui and my other supervisor, and consulting some of the documentation she had referred me to, I had an understanding of what was expected as far as treatment was concerned.
R: I believe as a result, all the pts on the ward were receiving the best possible rehab available in that setting. All the senior and registered physios were very up to date with the research. In turn this meant I could also have a good grasp on the research. Therefore the type of rehab was proven thrpugh clinical research. Most importantly however, it was evident first hand how effective the treatment was, as in many cases we were seeing encouraging improvement from the pts very early after the stroke.
E: I think having a good grasp on evidence based practice is very important in any area that you work in. it is the underlying foundation that supports what we are doing. Many physios develop a personal understanding or idea of what seems to work for them. However it is every physios responsibility to be up to date with the current research to ensure they are giving their clients or pts the best treatment available. It is always possible to measure baseline and if the treatment isn’t effective then change your approach, however clinical evidence is a very strong indicator. A couple of things I could have improved on include –
• Further practicing my application of intervention
• Consulting more specific articles to the types of stroke I was dealing with
S: Strategies I found effective were –
• Liaising with your clinical supervisor as to what resources are best to utilize.
• Brushing up on your evidence based practice knowledge so you have an understanding on what research is good and what’s not.
• Ensuring you gain a grasp on how to clinically apply that intervention. It is good that you are applying the appropriate intervention, but if you are doing it incorrectly then it becomes useless.
T: To provide acute stroke rehabilitation to a pt caseload, that had been clinically shown through research to be the most effective intervention.
A: I was working on the ward with my senior Physiotherapist supervisor, Jacqui. Jacqui is very involved with current up to date research for stroke rehab. Therefore I consulted her as to the best resources to utilize as well as gaining information from her first hand. After liaising with Jacqui and my other supervisor, and consulting some of the documentation she had referred me to, I had an understanding of what was expected as far as treatment was concerned.
R: I believe as a result, all the pts on the ward were receiving the best possible rehab available in that setting. All the senior and registered physios were very up to date with the research. In turn this meant I could also have a good grasp on the research. Therefore the type of rehab was proven thrpugh clinical research. Most importantly however, it was evident first hand how effective the treatment was, as in many cases we were seeing encouraging improvement from the pts very early after the stroke.
E: I think having a good grasp on evidence based practice is very important in any area that you work in. it is the underlying foundation that supports what we are doing. Many physios develop a personal understanding or idea of what seems to work for them. However it is every physios responsibility to be up to date with the current research to ensure they are giving their clients or pts the best treatment available. It is always possible to measure baseline and if the treatment isn’t effective then change your approach, however clinical evidence is a very strong indicator. A couple of things I could have improved on include –
• Further practicing my application of intervention
• Consulting more specific articles to the types of stroke I was dealing with
S: Strategies I found effective were –
• Liaising with your clinical supervisor as to what resources are best to utilize.
• Brushing up on your evidence based practice knowledge so you have an understanding on what research is good and what’s not.
• Ensuring you gain a grasp on how to clinically apply that intervention. It is good that you are applying the appropriate intervention, but if you are doing it incorrectly then it becomes useless.
Sunday, June 27, 2010
Assessment
S: When working in the neurology field, your assessment is very important. This is partially because physiotherapists play a very significant role in the overall handling of the pt. handling meaning both, assessing, treating and providing feasible discharge options. When dealing in particular with stroke pts, the medical team will do the appropriate tests to decide what the underlying pathology is. This normally means a CT scan. However this test is not always reliable in determining the type or cause of stroke. Many other assessment tools are used based on the pts presentation and symptoms. Many of these assessments are performed by the physiotherapist. The assessment also extends to things such as mobility status that the nurses will use when caring for the pt.
T: The task is to fill out a thorough stroke assessment form to use as a baseline as well as an indicator of impairment and problem list. However to also think outside the box and not just focusing on filling out the generic form, but also looking at the pt holistically from the very first time you see them.
A: I was given a pt that I had to conduct an initial assessment. The stroke ward that I am working on is an acute ward. This means that we are the initial health care they seek and there has been no previous physiotherapy input into this pt. this makes the assessment even more important because it is pivotal that the physiotherapist does not miss any vital details. Prior to seeing this pt I went onto the ward and read through their medical file. This was to give me a general idea as to what I was expecting and some background social and medical history. After I became familiar with the pts medical notes I consulted the nursing staff for any other useful information. Then I approached the pt in their bed and this is where the assessment began. I was sure to be very observant from the time I first laid eyes on them. I had gained an idea from my notes what I wanted to assess and I was already looking for particular things. I then took a brief verbal history from the pt and then accompanied them to the gym. Once at the gym I went through the thorough generic stroke assessment form.
R: The result came with some help from my supervisor. My supervisor, being a very experienced and knowledgeable physiotherapist was able to guide me through the assessment to get all the information I needed. The result was, I gained a very thorough assessment, which allowed me to determine all the impairments forming my problem list. This gave me a baseline to refer to on discharge. I also gained a good understanding of the pts mobility and ambulatory status. This helped me inform the nurses what the most appropriate form of transfer was. It also allowed me to choose the best transfer that would allow the pt to move in a way that facilitated normal movement, to help the brain recognize normal movement while it was still “plastic”.
E: overall I thing the result was good. However a stroke assessment is not an easy method to grasp. Having never performed a proper stroke assessment before, I think there were plenty of things I could have done differently. For example, almost all stroke pts suffer very heavily form fatigue and drowsiness. On my initial assessment I perhaps was to methodical with the assessment sheet rather than using some common sense. I went ahead and tested everything in order, which is not necessarily in order of importance. As the assessment moved on, my pt became very tired and fatigued and I still hadn’t assessed some very important indicators. I should really have assessed them in order of importance so that I could decide upon things such as their transfer status and ambulation.
S: Some strategies I would have found helpful include –
- Becoming very familiar with the assessment form so that you know what questions you should be asking and don’t have to refer to the sheet to often.
- Being able to tick off certain parts of the assessment without having to formally assess them. Such as when testing active muscle control, watching them when they get out of bed will give you a good idea of lower limb strength. This is good for saving time.
- Understanding all the terms in the assessment form and how to assess them. The difference between receptive and expressive dysphasia can be hard to differentiate, so by first understanding what each means, will give a good idea of how to assess for them.
T: The task is to fill out a thorough stroke assessment form to use as a baseline as well as an indicator of impairment and problem list. However to also think outside the box and not just focusing on filling out the generic form, but also looking at the pt holistically from the very first time you see them.
A: I was given a pt that I had to conduct an initial assessment. The stroke ward that I am working on is an acute ward. This means that we are the initial health care they seek and there has been no previous physiotherapy input into this pt. this makes the assessment even more important because it is pivotal that the physiotherapist does not miss any vital details. Prior to seeing this pt I went onto the ward and read through their medical file. This was to give me a general idea as to what I was expecting and some background social and medical history. After I became familiar with the pts medical notes I consulted the nursing staff for any other useful information. Then I approached the pt in their bed and this is where the assessment began. I was sure to be very observant from the time I first laid eyes on them. I had gained an idea from my notes what I wanted to assess and I was already looking for particular things. I then took a brief verbal history from the pt and then accompanied them to the gym. Once at the gym I went through the thorough generic stroke assessment form.
R: The result came with some help from my supervisor. My supervisor, being a very experienced and knowledgeable physiotherapist was able to guide me through the assessment to get all the information I needed. The result was, I gained a very thorough assessment, which allowed me to determine all the impairments forming my problem list. This gave me a baseline to refer to on discharge. I also gained a good understanding of the pts mobility and ambulatory status. This helped me inform the nurses what the most appropriate form of transfer was. It also allowed me to choose the best transfer that would allow the pt to move in a way that facilitated normal movement, to help the brain recognize normal movement while it was still “plastic”.
E: overall I thing the result was good. However a stroke assessment is not an easy method to grasp. Having never performed a proper stroke assessment before, I think there were plenty of things I could have done differently. For example, almost all stroke pts suffer very heavily form fatigue and drowsiness. On my initial assessment I perhaps was to methodical with the assessment sheet rather than using some common sense. I went ahead and tested everything in order, which is not necessarily in order of importance. As the assessment moved on, my pt became very tired and fatigued and I still hadn’t assessed some very important indicators. I should really have assessed them in order of importance so that I could decide upon things such as their transfer status and ambulation.
S: Some strategies I would have found helpful include –
- Becoming very familiar with the assessment form so that you know what questions you should be asking and don’t have to refer to the sheet to often.
- Being able to tick off certain parts of the assessment without having to formally assess them. Such as when testing active muscle control, watching them when they get out of bed will give you a good idea of lower limb strength. This is good for saving time.
- Understanding all the terms in the assessment form and how to assess them. The difference between receptive and expressive dysphasia can be hard to differentiate, so by first understanding what each means, will give a good idea of how to assess for them.
Sunday, June 20, 2010
initial entry
The fourth and final rotation brings with it many different emotions. There is of course the element of fatigue beginning to set in. as you rotate through the working world it is only normal that you become anxious to start earning and working. There is also the beginning of another new setting with new people and surroundings. Starting any job is hard at first, when you are trying to find your feet and learn everything about the place. Starting 4 new jobs in 5 months is obviously even tougher. Im starting this one at Royal Perth Hospital. Obviously being the biggest tertiary hospital in Perth it can be a very daunting place. Unfortunately very few people will know who you are or even care to find out and add the student label on that and that’s really all you are… a student. So having to make it in the real world with a stereotypical label can be tough, however it is what it is and you must get through that. Im starting in neurology on the stroke ward. This is the first exposure to neurology that I have had since the 3rd year first semester unit. That in itself is a very daunting experience. There is no doubt in my mind that neurology is the most challenging area of physiotherapy. Yes you can clinically reason nearly everything you do, however you cannot clinical reason your way around explaining the spinal tracts in detail at your supervisors command. So there is a lot to know and it does seem very daunting. Im definitely very nervous. I have no idea what to learn and if what im learning is even relevant. Does it really matter if you can spiel off the arterial distribution of the brain or is it enough to know what will be affected with infarcts in certain areas? Lots of thoughts pop into my head and I think “oh my god I haven’t looked at that” and when I do it seems like a constant path of repeating that same question on and on. However on a more positive note I always told myself that I wanted a neuro placement that was challenging and where even if I struggled, I learnt bucket loads… and this placement seems like it will be exactly that. My attitude is, im here to give it my all for 5 more weeks learn as much as I can, accept criticism not personally but professionally. If my supervisor is strict its because they are trying to get me to learn and they want me to be competent, so it wont take it personally but instead get on with it. This is my only neuro prac and I have to be competent when im done so I can work as a new grad effectively, so im here to learn as much as I can and even when it gets tough which I know it will, remember that I only have 5 weeks and then its done. So im looking forward to this prac and although slightly nervous about the challenges that will come, im confident that I have what it takes to do well and be the best I can be so I graduate as not only a competent physio but a good one when it comes to neuro.
Sunday, June 13, 2010
Final Thoughts
Tom Price was a fantastic experience over all. I learnt so much and got exposed to exactly what I had hoped for. I was left to be independent but at the same time was given the support I needed. I was nervous about doing my musculoskeletal placement and wasn’t sure what to expect. In the end I was confident with my knowledge and learnt many techniques that I will use. I had pts ranging from 10 years old to 80 and dealing with all sorts of pathologies. I go to see problems with most of the joints of the body and learnt so much. The working environment was fantastic. I had my own desk and was working next to two other very good physios. The hospital itself was small but very good. The staff were very friendly and excellent to work with. They were very accepting and tried to make me fit in as easy as possible. The social aspect was very good for a small town. There were plenty of sporting activities and it was easy to get involved. This made weekends much more bearable. There was no mobile coverage which was hard. There was also no access to social networking sites on the government computers which made it very hard to keep in contact with friends. However I managed to get by ok. We moved around to some aboriginal communities which was a great experience. It meant I got exposed to a different culture and learnt some different aspects of msk. It also made it unique and not repetitious. I was able to travel somewhere every week and that was exciting. The landscape of Tom Price is amazing. I was able to climb mount nameless and look out over Tom Price and the surrounding region. Karijini national park is absolutely amazing. One of the most beautiful spots I have seen. I was able to get along and see some of the gorges and despite being rescued by the SES it was a very good experience. I think that was my favorite part of the placement, was getting along to karijini. The placement was an excellent networking opportunity. I was able to work alongside Beth Rogers for 5 weeks. I learnt so much about work and working in rural areas. I learnt about the pay and different incentives, and different tips for finding work. A lot of these things you can only learn from people with experience so that was something I found invaluable. So overall it was a great experience and I learnt so much. I now know what working in rural areas are like and its been a great preview to help me in deciding whether I want to work in a rural area at all at some point in my professional career. I would recommend to anyone to put Tom Price at the top of their priorities for future placements.
Monday, April 26, 2010
evidence based pratice
S: at ASC one of the main interventions is exercise. Interventions for exercise have very poor evidence behind them. The student is expected to make a presentation in the 4th week from a topic of their choice.
T: my task was to choose a topic and present on that topic. I would have to choose something with evidence based practice behind it to meet that area of the marking schema for my overall APP grade. It would also have to be relevant and interesting or the staff.
A: I decided I would choose the topic of exercise as that is the intervention carried out the most. I then searched on PEDro and PUBMED for relevant articles concerning the topic I had chosen. I found 4 articles that were of relevance to my topic.
R: all 4 articles were relevant and useful. They addressed the effects of exercise in relation with several different types of mental illnesses including dementia and depression. I presented on the evidence in the articles and also critically analysed the articles. The presentation went for 30mins
E: I thought overall the presentation went quite well. However on another note I found that still the evidence for exercise was inconclusive. Therefore I thought it was a bit disappointing not being able to present on something with hard evidence. The feedback from the presentation was positive, mainly because is important to have up to date evidence for the current interventions used.
S: some hints for improvement in the future include-
- choose a topic that the staff aren’t very familiar with so that it is useful for everyone
- make sure that it is relevant to the placement you are on eg; mental health
- think of some questions that might be asked so that you are prepared to answer them on the day
T: my task was to choose a topic and present on that topic. I would have to choose something with evidence based practice behind it to meet that area of the marking schema for my overall APP grade. It would also have to be relevant and interesting or the staff.
A: I decided I would choose the topic of exercise as that is the intervention carried out the most. I then searched on PEDro and PUBMED for relevant articles concerning the topic I had chosen. I found 4 articles that were of relevance to my topic.
R: all 4 articles were relevant and useful. They addressed the effects of exercise in relation with several different types of mental illnesses including dementia and depression. I presented on the evidence in the articles and also critically analysed the articles. The presentation went for 30mins
E: I thought overall the presentation went quite well. However on another note I found that still the evidence for exercise was inconclusive. Therefore I thought it was a bit disappointing not being able to present on something with hard evidence. The feedback from the presentation was positive, mainly because is important to have up to date evidence for the current interventions used.
S: some hints for improvement in the future include-
- choose a topic that the staff aren’t very familiar with so that it is useful for everyone
- make sure that it is relevant to the placement you are on eg; mental health
- think of some questions that might be asked so that you are prepared to answer them on the day
final thoughts
My final thoughts for this placement were very positive. I thoroughly enjoyed my time at ASC. The physio staff there were very helpful and knowledgeable. There is ample opportunity to take responsibility for your own learning. I found the placement to be a very generic type of physio with the added spectrum of mental health. Daily tasks included musculoskeletal assessments and treatments to neurological assessment and treatment. The added spectrum of mental health added another challenge and variety to the whole placement. I believe this mental health experience has given me a very valuable exposure that not everyone will have the opportunity to experience.
My supervisors were very helpful throughout. They constantly challenged me and provided tasks to develop my learning. They were very knowledgeable so having them as a resource was extremely useful. I learnt many things whilst there, including physiotherapy techniques to building rapport with metal health patients with differing challenges to there behaviour. I believe this placement gave me a very wide scope of preparation for my last 2 placements. I think I had time to focus on areas that I needed to improve on in preparation for musculo and neuro placements. Overall I think that ASC is a very good opportunity and the physios there are committed and good role models/examples for the physiotherapy profession
My supervisors were very helpful throughout. They constantly challenged me and provided tasks to develop my learning. They were very knowledgeable so having them as a resource was extremely useful. I learnt many things whilst there, including physiotherapy techniques to building rapport with metal health patients with differing challenges to there behaviour. I believe this placement gave me a very wide scope of preparation for my last 2 placements. I think I had time to focus on areas that I needed to improve on in preparation for musculo and neuro placements. Overall I think that ASC is a very good opportunity and the physios there are committed and good role models/examples for the physiotherapy profession
Sunday, April 11, 2010
Communication
S: The Alma street mental health clinic has 2 full time, 1 part time physiotherapy staff and 1 physiotherapy assistant. There are 4 wards with over 60 beds all together. This means that appropriate communication between the physiotherapy staff is very important. Every morning the staff meet for a handover on all the pts. This is good because all the pts use the same gym regardless of the ward they are on. So when a pt is in the gym and the physio looking after that pt is not there, the other physio staff know about the pt. There are several other instances where good communication is important and it adds to the efficiency and professionalism of the physio dept.
T: being a new face in the physio dept. it is important to work hard to learn the system that they use and be easily adaptable to fit in. the staff are working together every day and to have an added member can change the dynamics a bit. One of the big emphasizes is on communication, therefore my task was to show outstanding communication skills to maintain the standard of the physio dept. in this particular instance, I was in the gym by myself when a pt entered for some exercise. I knew who this pt was and had been given a handover on this pt at the start of the morning. This pt was now under my care so I had to make sure there were no particular measures to take into account.
A: with this being the case, I paged the physio who was looking after this pt. I knew this pt had recently been transferred from a locked ward. The physio informed me that this pt required an escort to leave the ward. I then called the nurse on that ward and informed them that the pt was in the gym. The nurse said that they hadn’t realized the pt had left and that this pt was at risk of absconding. She asked me to please escort the pt back onto the ward when they were finished. A simple act of good communication between the multi-disciplinary team had ensured safe and efficient practice.
R: the result in this case was a positive one. The pt was returned safely to the ward without any complications. In many instances pts leave the gym or the ward and become AWOL. This creates problems for the whole team. In an instance of doubt it is quite easy to communicate to prevent such measures or dramas from playing out. Both the nursing staff and physio looking after that pt thanked me for communicating effectively. This creates a good professional relationship with the whole team because it proves that you have a wide scope and are not just concerned with your role.
E: I believe in this instance I was an effective communicator. This was a fairly simple act so it doesn’t require much evaluation. However the things I believe I did that made it effective were –
• I was composed and didn’t elevate the situation by over reacting.
• I was friendly and had previously made myself known to the staff on the wards so they knew who I was.
• I made sure the gym was not left unattended when I was escorting the pt back to the ward.
• I allowed the pt to exercise and the returned them to the ward and made sure the nursing staff knew the pt was back.
S: Some tips to ensure that these situations are easily resolved include –
• Making sure you know the phone numbers for the wards.
• Knowing the pts by name and by face.
• Having a good back-round knowledge of the pts.
• Being pro-active and acting upon any element of doubt just to be on the safe side.
• De-elevating any drama by being very casual and explaining to the pt that you will walk with them back to the ward and explain that they must let someone know when leaving the ward.
T: being a new face in the physio dept. it is important to work hard to learn the system that they use and be easily adaptable to fit in. the staff are working together every day and to have an added member can change the dynamics a bit. One of the big emphasizes is on communication, therefore my task was to show outstanding communication skills to maintain the standard of the physio dept. in this particular instance, I was in the gym by myself when a pt entered for some exercise. I knew who this pt was and had been given a handover on this pt at the start of the morning. This pt was now under my care so I had to make sure there were no particular measures to take into account.
A: with this being the case, I paged the physio who was looking after this pt. I knew this pt had recently been transferred from a locked ward. The physio informed me that this pt required an escort to leave the ward. I then called the nurse on that ward and informed them that the pt was in the gym. The nurse said that they hadn’t realized the pt had left and that this pt was at risk of absconding. She asked me to please escort the pt back onto the ward when they were finished. A simple act of good communication between the multi-disciplinary team had ensured safe and efficient practice.
R: the result in this case was a positive one. The pt was returned safely to the ward without any complications. In many instances pts leave the gym or the ward and become AWOL. This creates problems for the whole team. In an instance of doubt it is quite easy to communicate to prevent such measures or dramas from playing out. Both the nursing staff and physio looking after that pt thanked me for communicating effectively. This creates a good professional relationship with the whole team because it proves that you have a wide scope and are not just concerned with your role.
E: I believe in this instance I was an effective communicator. This was a fairly simple act so it doesn’t require much evaluation. However the things I believe I did that made it effective were –
• I was composed and didn’t elevate the situation by over reacting.
• I was friendly and had previously made myself known to the staff on the wards so they knew who I was.
• I made sure the gym was not left unattended when I was escorting the pt back to the ward.
• I allowed the pt to exercise and the returned them to the ward and made sure the nursing staff knew the pt was back.
S: Some tips to ensure that these situations are easily resolved include –
• Making sure you know the phone numbers for the wards.
• Knowing the pts by name and by face.
• Having a good back-round knowledge of the pts.
• Being pro-active and acting upon any element of doubt just to be on the safe side.
• De-elevating any drama by being very casual and explaining to the pt that you will walk with them back to the ward and explain that they must let someone know when leaving the ward.
Sunday, March 28, 2010
assessment
S: At my placement at the alma street mental health ward, every patient that is admitted to this facility has a blanket referral. This means that regardless of their admittance status, they will be seen by the physiotherapist. Part of the initial consultation is an assessment screening process that is used as a baseline measure for their time on the ward. This allows a very generic scope of how the pt is going and any areas they can improve in.
T: my task was to complete an initial assessment form for all new pts. The assessment form is a very generic health and fitness indicator. It measures the very basics of fitness and health for each pt. My task each day is to run through this process with these new pts and complete this initial assessment form. This is also a good opportunity to build some rapport with these pts for further practice. There are approx 10 exercises to complete on the screening form so having some direction and consistency with the process is important.
A: On this given occasion I went to the ward and organized an appropriate time to see my pt. on the scheduled time I went to the ward and escorted them to the physiotherapy gym. Once at the gym I explained the whole process and approx, how long it would take. Then I took them through step by step with clear instructions regarding the process. I completed the whole screening process in approx 30 minutes and explained what the results indicated to the pt.
R: The result was a fairly in depth summary of this pts physical well being. The screening process has been carefully constructed to give an all round, appropriate indication of the pts status. This allows the PT to adequately assess how the pt is initially and the areas that require improvement. This particular pt was a heavy smoker and had a lot of room for improvement. Being a heavy smoke at such a young age, many people think it is too late to quit and that they will never return to their previous fitness levels. After explaining the benefits of quitting whilst they are still young and the positive prognosis for their health fitness, this pt was quite determined to make lifestyle improvements which was very rewarding.
E: aspects that could require improvement included –
• Conducting the assessment in a more systematic and linear form. This would allow the pt to have a smooth and easy assessment process.
• Adjusting my behavior appropriately to deal with mental health pts. Every mental health pt is different and unfortunately that means you must adjust your form of thinking and your attitude appropriately to deal with the different personality traits.
Aspects I thought I did well with included
• Giving an appropriate explanation of what the process involved. This means the pt knew what to expect and how long it would take etc.
• Giving a good explanation and the process behind why each exercise was useful for the pt and what it represented for the pt.
S: some strategies for improvement in the future include –
• Maintaining your environment prior to starting the assessment. Making sure you have a vacant gym and clear schedule so that you have access to all of the equipment is very important.
• Understand and know how to explain the normative values for all the assessments that you do so that you can give the pt a clear indication of where they stand in the context of each assessment.
• Have prior knowledge of the mental health disorder prior to staring so that you know what is “normal” for that pt and what to expect. Sometimes this prior knowledge will help you in your decision whether or not to proceed with the assessment when things begin to look “pear shaped”
T: my task was to complete an initial assessment form for all new pts. The assessment form is a very generic health and fitness indicator. It measures the very basics of fitness and health for each pt. My task each day is to run through this process with these new pts and complete this initial assessment form. This is also a good opportunity to build some rapport with these pts for further practice. There are approx 10 exercises to complete on the screening form so having some direction and consistency with the process is important.
A: On this given occasion I went to the ward and organized an appropriate time to see my pt. on the scheduled time I went to the ward and escorted them to the physiotherapy gym. Once at the gym I explained the whole process and approx, how long it would take. Then I took them through step by step with clear instructions regarding the process. I completed the whole screening process in approx 30 minutes and explained what the results indicated to the pt.
R: The result was a fairly in depth summary of this pts physical well being. The screening process has been carefully constructed to give an all round, appropriate indication of the pts status. This allows the PT to adequately assess how the pt is initially and the areas that require improvement. This particular pt was a heavy smoker and had a lot of room for improvement. Being a heavy smoke at such a young age, many people think it is too late to quit and that they will never return to their previous fitness levels. After explaining the benefits of quitting whilst they are still young and the positive prognosis for their health fitness, this pt was quite determined to make lifestyle improvements which was very rewarding.
E: aspects that could require improvement included –
• Conducting the assessment in a more systematic and linear form. This would allow the pt to have a smooth and easy assessment process.
• Adjusting my behavior appropriately to deal with mental health pts. Every mental health pt is different and unfortunately that means you must adjust your form of thinking and your attitude appropriately to deal with the different personality traits.
Aspects I thought I did well with included
• Giving an appropriate explanation of what the process involved. This means the pt knew what to expect and how long it would take etc.
• Giving a good explanation and the process behind why each exercise was useful for the pt and what it represented for the pt.
S: some strategies for improvement in the future include –
• Maintaining your environment prior to starting the assessment. Making sure you have a vacant gym and clear schedule so that you have access to all of the equipment is very important.
• Understand and know how to explain the normative values for all the assessments that you do so that you can give the pt a clear indication of where they stand in the context of each assessment.
• Have prior knowledge of the mental health disorder prior to staring so that you know what is “normal” for that pt and what to expect. Sometimes this prior knowledge will help you in your decision whether or not to proceed with the assessment when things begin to look “pear shaped”
Sunday, March 21, 2010
Initial entry
After already completing one placement I find myself a little more relaxed heading into the second placement. I am at Alma street centre in Fremantle on the mental health ward. As far as I know I am the first student to complete this placement so finding out about what to expect has been quite difficult. With that in mind I know that my feedback on the end of this placement will be very important for future references. I am going into this placement with an open mind. I have a strong willingness to learn and see this as an exciting opportunity to be exposed to something I may not otherwise get a whole lot of exposure to.
I have spoken very briefly with my supervisor over the phone and look forward to being a student under her. Of course there is always the nervousness about living up to any expectations she might have of me. I want to show a good impression on the first day, and show my supervisor that I have a good theoretical basis and also have good practical capabilities. I hope that I can be very adaptable to my environment and then subsequently excel with my interaction with people, especially in this environment.
I have had only very limited experience with mental health in every day experiences and on previous placements. I hope that I will show a good ability to adjust my thinking and approach in light of my patient list. At the same time this experience I hope will take me out of my comfort zone. This will help me develop and make me, not only a better physio, but a better person as well. I think we grow and learn the most when we are made to challenge ourselves which is what I hope to do. Therefore I am both nervous and excited about working with mentally challenged patients.
I am very oblivious to what my role will be at this time. With this in mind I plan to heighten my skills as an observer watch my supervisor very closely. Hopefully once I have proven myself to my supervisor I will be given a lot of independence and can excel in this field. However I understand due to the nature of this placement and my limited understanding, my clinical reasoning and observations must be sound. I expect to gain a better understanding of what my role will be over the course of this placement, on day 1.
I think with this placement being a mental health situation, my role will be based on musculoskeletal therapy. Therefore my knowledge of anatomy and previous MSK units will have to be good. Of course I will also have to show the qualities that will be required of me in further placements and when I am qualified. Qualities such as professionalism, ability to learn, skills of practice and more, are all things that make the foundation of a good physio. Many different subcategories fall under some of those heading and having them well refined is pivotal. I look forward to this placement, especially the close proximity it is from home and the environment of Fremantle which I love. I’m excited about diving into it and making it a positive experience.
I have spoken very briefly with my supervisor over the phone and look forward to being a student under her. Of course there is always the nervousness about living up to any expectations she might have of me. I want to show a good impression on the first day, and show my supervisor that I have a good theoretical basis and also have good practical capabilities. I hope that I can be very adaptable to my environment and then subsequently excel with my interaction with people, especially in this environment.
I have had only very limited experience with mental health in every day experiences and on previous placements. I hope that I will show a good ability to adjust my thinking and approach in light of my patient list. At the same time this experience I hope will take me out of my comfort zone. This will help me develop and make me, not only a better physio, but a better person as well. I think we grow and learn the most when we are made to challenge ourselves which is what I hope to do. Therefore I am both nervous and excited about working with mentally challenged patients.
I am very oblivious to what my role will be at this time. With this in mind I plan to heighten my skills as an observer watch my supervisor very closely. Hopefully once I have proven myself to my supervisor I will be given a lot of independence and can excel in this field. However I understand due to the nature of this placement and my limited understanding, my clinical reasoning and observations must be sound. I expect to gain a better understanding of what my role will be over the course of this placement, on day 1.
I think with this placement being a mental health situation, my role will be based on musculoskeletal therapy. Therefore my knowledge of anatomy and previous MSK units will have to be good. Of course I will also have to show the qualities that will be required of me in further placements and when I am qualified. Qualities such as professionalism, ability to learn, skills of practice and more, are all things that make the foundation of a good physio. Many different subcategories fall under some of those heading and having them well refined is pivotal. I look forward to this placement, especially the close proximity it is from home and the environment of Fremantle which I love. I’m excited about diving into it and making it a positive experience.
Friday, March 12, 2010
Evidence Based Practice
S: I was asked to complete a presentation before the two supervisors and the other student I was on placement with. The presentation was to be centered around a patient I was familiar with who had an interesting and challenging diagnosis. This presentation addresses the evidence based practice column of our overall assessment sheet. The supervisors must assess this to see whether or not the student has evidence behind the interventions they use.
T: I would have to research one of the treatments this pt was receiving from physiotherapy for their diagnosis. I would have to find the evidence for this treatment and provide the evidence before the supervisors. I would have to analyze the articles before presenting them so as to decide whether they were relative, representative and of a high quality. In summary I would have to use this evidence to decide whether this was an appropriate treatment technique for this pt.
A: firstly I decided what treatment technique I was going to find EBP for. I then looked through my uni notes on cardio-respiratory and found the relevant interventions. Shane always references his information very well, so I was able to look at where Shane got the evidence for his lecture notes. I then researched the cited Cochrane reviews that Shane had referenced. I found relevant articles to my study and analysed them for their quality. After I had 4 articles to use I fitted them into my presentation to present them as evidence for my intervention, which was long term oxygen therapy and O2 therapy with exercise in COPD pts.
R: I think the results were very positive. Firstly I gained good results for the searches in conducted. All the articles I chose were of high quality and relevance. I presented the topic in a clear and concise format which I believe successfully conveyed the information I had obtained. This topic of O2 therapy in pts with COPD is something both supervisors didn’t know a great deal about, therefore it was imperative that I was concise and conveyed correct information in my presentation. The feedback I got was that both supervisors learnt a lot and were happy with the topic and the information conveyed in my presentation.
E: I think my strengths included
• High quality articles used with high relevance to the topic.
• Presented in a clear and easy to follow format. At a level appropriate to both supervisors
• Choosing an intervention that was somewhat ambiguous and which the supervisors knew of little evidence for. This made it more relevant and useful for not just myself but for my supervisors also.
• Cited all my articles effectively so that they could be used as references by either supervisor in the future.
Some areas to improve on included:
• Presenting my analysis of the quality of the articles in more detail. This means including information such as cohort numbers, number needed to treat for the intervention, whether or not it was blind etc so it was clear how usable these research articles were.
• Conveying the information more concisely to prevent “waffling” where you can easily lose your audience. This would make the presentation more time efficient.
• Having some articles on hand so that the audience could make direct reference to when needed.
S: Some strategies to help improve for the future
• Review the evidence based practice unit from 3rd year semester 2 so that you can familiarize yourself with how to critically analyze research articles.
• Practice reading our presentation out aloud and editing it for irrelevant information. This will help make the presentation more concise and specific to your audience.
• Discuss with your supervisors areas which they feel they could find useful. Such as some areas where they have limited knowledge. This will make the presentation more useful to them and yourself.
T: I would have to research one of the treatments this pt was receiving from physiotherapy for their diagnosis. I would have to find the evidence for this treatment and provide the evidence before the supervisors. I would have to analyze the articles before presenting them so as to decide whether they were relative, representative and of a high quality. In summary I would have to use this evidence to decide whether this was an appropriate treatment technique for this pt.
A: firstly I decided what treatment technique I was going to find EBP for. I then looked through my uni notes on cardio-respiratory and found the relevant interventions. Shane always references his information very well, so I was able to look at where Shane got the evidence for his lecture notes. I then researched the cited Cochrane reviews that Shane had referenced. I found relevant articles to my study and analysed them for their quality. After I had 4 articles to use I fitted them into my presentation to present them as evidence for my intervention, which was long term oxygen therapy and O2 therapy with exercise in COPD pts.
R: I think the results were very positive. Firstly I gained good results for the searches in conducted. All the articles I chose were of high quality and relevance. I presented the topic in a clear and concise format which I believe successfully conveyed the information I had obtained. This topic of O2 therapy in pts with COPD is something both supervisors didn’t know a great deal about, therefore it was imperative that I was concise and conveyed correct information in my presentation. The feedback I got was that both supervisors learnt a lot and were happy with the topic and the information conveyed in my presentation.
E: I think my strengths included
• High quality articles used with high relevance to the topic.
• Presented in a clear and easy to follow format. At a level appropriate to both supervisors
• Choosing an intervention that was somewhat ambiguous and which the supervisors knew of little evidence for. This made it more relevant and useful for not just myself but for my supervisors also.
• Cited all my articles effectively so that they could be used as references by either supervisor in the future.
Some areas to improve on included:
• Presenting my analysis of the quality of the articles in more detail. This means including information such as cohort numbers, number needed to treat for the intervention, whether or not it was blind etc so it was clear how usable these research articles were.
• Conveying the information more concisely to prevent “waffling” where you can easily lose your audience. This would make the presentation more time efficient.
• Having some articles on hand so that the audience could make direct reference to when needed.
S: Some strategies to help improve for the future
• Review the evidence based practice unit from 3rd year semester 2 so that you can familiarize yourself with how to critically analyze research articles.
• Practice reading our presentation out aloud and editing it for irrelevant information. This will help make the presentation more concise and specific to your audience.
• Discuss with your supervisors areas which they feel they could find useful. Such as some areas where they have limited knowledge. This will make the presentation more useful to them and yourself.
Tuesday, March 2, 2010
assessment
S: When working on the oncology ward Assessment is a very important part of Physiotherapy. In this particular incident my patient had already been diagnosed with cancer and had been admitted for chemotherapy. My assessment however had to be thorough and concise so that I could identify any other problems this pt might experience along with their cancer treatment. I am required to go into the room and assess this pt. I must build rapport and then maintain the pts dignity with any assessments such as auscultation. I must also be diligent in meeting all parts of my required assessment including auscultation, cough, chest expansion, spo2, social hx and previous level of function.
T: in order to reach a desired outcome, I would have to complete a respiratory and mobility assessment of this pt. the respiratory assessment would identify further intervention this patient would require whilst having chemotherapy. The mobility part would allow the allied health and medical staff to be aware of the level of assistance this patient required or whether they were independent. The mobility assessment must also include the oxygen requirements this patient has and any walking aids. Once you have recorded all of your finding systematically you must then begin to analyze your findings into a problem list for this pt.
A: for this pt, I entered the room and worked on building quick rapport with the pt. this is important because when assessing a pt you are invading their personal space and it goes a long way to first build that rapport. Firstly I started with a subjective assessment. Keys questions to ask are; home situation, whether they were previously independent, if they might have been a primary carer for someone else, mobility qns regarding home, such as stairs, previous exercise tolerance, whether they are a smoker or have a past history of smoking and lots of further within these general guidelines. Then I got the pt to cough and assessed its quality i.e strength, texture, effectiveness and productivity. Then I auscultated to check for air entry into the lungs and any added sounds. The next step is to check chest expansion and spo2 using a pulse oximiter. Assessing oxygen saturations is very important because it indicates how the patient might react to mobilizing. Then I walked with the pt using a WZF and noted how they went in regards to balance and endurance. Also noting whether they required any assistance and o2 which, in this case, they did not. Then I recorded all my findings and liaised with the nurse regarding this pts mobility status which was independent with T/F’s and independent with a WZF over 50m//spo2 maintained at 98%.
R: As a result of my actions I obtained an in depth evaluation of my assessment that showed what sort of physiotherapy involvement this pt required. I was able to write in the pt notes a detailed O as part of my S,O,I,E,R. I recorded the pts vitals, then under a respiratory heading I recorded all my respiratory related findings. Under mobility, I recorded how far the pt can walk, assistance required and any walking aids used. As a result further allied health and medical staff could refer to my notes to see what other problems this pt was experiencing at that particular time. They could also compare assessment finding from a later date with mine, to monitor any changes in the pt. when consulting this pt, further health professionals could refer to my notes for the mobility status to allow them to safely and effectively mobilize the pt without first having to assess mobility.
E: over all I think my assessment was quite successful. My strengths included
• Building a good rapport with the pt so that I could assess them and maintain their dignity.
• Choosing the appropriate aid prior to mobilization based on the subjective assessment, this allowed a safe start to mobilization.
• Performing the assessment in sequential order. This means doing things like assessing the cough before auscultation, because the pt is required to cough before auscultation regardless.
Some of my weaknesses included
• Taking too long to auscultate which can cause the pt to become short of breath or dizzy due to prolonged deeper breathing.
• Not giving the pt a clear indication of the role for physiotherapy and hence the need for our initial assessment.
• During mobilization I wasn’t able to effectively monitor the spo2 levels because the probe had slipped off the finger.
S: some strategies to improve on or use for next time, specifically those addressing some of my weaknesses include
• Refining your auscultation landmarks so you can quickly and effectively listen to the breath sounds before the pt begins to fatigue.
• Explain how far you want the pt to walk during mobilization. This includes an explanation that you want to assess how far they can walk, so they should walk however far they feel they can manage. Another handy tip to remember is to explain to them however far they walk they must also turn around and walk back, so they should keep that in mind.
• Explain the importance of monitoring spo2 when mobilizing. The probe can be uncomfortable especially when using a WZF or walking stick. However even if the pt is asymptomatic when de saturating it is important to note that they are still building up a toxic environment which can be detrimental. You can then clip the pulse oximeter to the frame or your pocket so that it doesn’t pull.
T: in order to reach a desired outcome, I would have to complete a respiratory and mobility assessment of this pt. the respiratory assessment would identify further intervention this patient would require whilst having chemotherapy. The mobility part would allow the allied health and medical staff to be aware of the level of assistance this patient required or whether they were independent. The mobility assessment must also include the oxygen requirements this patient has and any walking aids. Once you have recorded all of your finding systematically you must then begin to analyze your findings into a problem list for this pt.
A: for this pt, I entered the room and worked on building quick rapport with the pt. this is important because when assessing a pt you are invading their personal space and it goes a long way to first build that rapport. Firstly I started with a subjective assessment. Keys questions to ask are; home situation, whether they were previously independent, if they might have been a primary carer for someone else, mobility qns regarding home, such as stairs, previous exercise tolerance, whether they are a smoker or have a past history of smoking and lots of further within these general guidelines. Then I got the pt to cough and assessed its quality i.e strength, texture, effectiveness and productivity. Then I auscultated to check for air entry into the lungs and any added sounds. The next step is to check chest expansion and spo2 using a pulse oximiter. Assessing oxygen saturations is very important because it indicates how the patient might react to mobilizing. Then I walked with the pt using a WZF and noted how they went in regards to balance and endurance. Also noting whether they required any assistance and o2 which, in this case, they did not. Then I recorded all my findings and liaised with the nurse regarding this pts mobility status which was independent with T/F’s and independent with a WZF over 50m//spo2 maintained at 98%.
R: As a result of my actions I obtained an in depth evaluation of my assessment that showed what sort of physiotherapy involvement this pt required. I was able to write in the pt notes a detailed O as part of my S,O,I,E,R. I recorded the pts vitals, then under a respiratory heading I recorded all my respiratory related findings. Under mobility, I recorded how far the pt can walk, assistance required and any walking aids used. As a result further allied health and medical staff could refer to my notes to see what other problems this pt was experiencing at that particular time. They could also compare assessment finding from a later date with mine, to monitor any changes in the pt. when consulting this pt, further health professionals could refer to my notes for the mobility status to allow them to safely and effectively mobilize the pt without first having to assess mobility.
E: over all I think my assessment was quite successful. My strengths included
• Building a good rapport with the pt so that I could assess them and maintain their dignity.
• Choosing the appropriate aid prior to mobilization based on the subjective assessment, this allowed a safe start to mobilization.
• Performing the assessment in sequential order. This means doing things like assessing the cough before auscultation, because the pt is required to cough before auscultation regardless.
Some of my weaknesses included
• Taking too long to auscultate which can cause the pt to become short of breath or dizzy due to prolonged deeper breathing.
• Not giving the pt a clear indication of the role for physiotherapy and hence the need for our initial assessment.
• During mobilization I wasn’t able to effectively monitor the spo2 levels because the probe had slipped off the finger.
S: some strategies to improve on or use for next time, specifically those addressing some of my weaknesses include
• Refining your auscultation landmarks so you can quickly and effectively listen to the breath sounds before the pt begins to fatigue.
• Explain how far you want the pt to walk during mobilization. This includes an explanation that you want to assess how far they can walk, so they should walk however far they feel they can manage. Another handy tip to remember is to explain to them however far they walk they must also turn around and walk back, so they should keep that in mind.
• Explain the importance of monitoring spo2 when mobilizing. The probe can be uncomfortable especially when using a WZF or walking stick. However even if the pt is asymptomatic when de saturating it is important to note that they are still building up a toxic environment which can be detrimental. You can then clip the pulse oximeter to the frame or your pocket so that it doesn’t pull.
Monday, February 15, 2010
week 1
Topic: Analysis and planning
S: On my first week, on a Tuesday, I spent 3 hours with my Notre Dame tutor. We saw two patients (pt) together and ran through and discussed our analysis of our problem list and our plan of intervention. After already completing a subjective with the patient, we proceeded to sit down and discuss our A and P before returning to the pt. this was all done on the ward and took about 30 minutes. This A and P would later have to be documented in a full SOAPIER.
T: I was required to run through a problem list and prioritize it according to what required the most attention and so forth. Once I had done this, my plan had to incorporate all of what I intended to do to manage my problem list. A and P are both very important parts of the SOAPIER so finding a thought process that suited my strengths was something I had to focus on.
A: The process I went through to draw up an appropriate A and P was as follows.
• After completing a subjective I wrote out my 10 cardio-respiratory specific problems according to Pryor and Prasad.
• I then asterisked each problem that my pt was experiencing.
• I then prioritized by looking at each problem I had documented and began clinically reasoning which problems were most underlying of other problems in my list.
• I also drew up a heading of mobility and further thought out what problems this pt was having with mobility.
• Once I had my prioritized analysis I began writing out a plan. This involved looking at each problem and listing appropriate intervention to directly address that problem
• A lot of my intervention addressed more than one problem, as is the nature of the cardio-respiratory problem list.
• I then documented this A and P in my full SOAPIER and used it as a guide when I treated this pt.
R: the result of this was a detailed and concise A and P. Because I went through it with my tutor I was able to tailor into it a very holistic and detailed method. My tutor is a very experienced and knowledgeable physiotherapist so with her as a guide I believe the result was a good one. There were a few methods in my thinking process that were different to hers, but as long as I justified my thought process then that was fine. The A included the problem list as well as risks that would potentially be problems. It also addressed why these were problems. With the tutor keeping me on track and guiding me when appropriate, I was able to achieve an A and P that was concise and effective in my overall treatment of this pt. The result was therefore a positive one.
E: looking back on my performance, I thing there were both strengths and aspects that require work. ,y strengths included,
• I was thinking in quite a lot of depth, including problems that weren’t necessarily a high priority but were still evident.
• I was able to discuss the problem list in detail with my tutor because I had recently studied and revised my 10 problems from Pryor and Prasad.
• I believe a strength of mine is being able to clinically reason my priorities for my problem list. Such as gas exchange effecting exercise tolerance and so forth. This meant that if I prioritized correctly then treating one problem would also address the subsequent problems.
Some of weaknesses included,
• Possibly going into too much detail and including problems that weren’t necessarily relevant to why the pt required physio. With our intervention we need to include a plan that addresses the pts main and most limiting problems.
• My terminology has room for improvement. By not understanding some of the abbreviations and disease terminology it hindered, not just my A and P, but my overall SOAPIER.
S: Some strategies to acknowledge for the most desired outcome include.
• Gaining a handover form the nurse to gain the best idea of the pt and their main problems.
• Researching the main problems you will encounter in a disease process such as cancer and the effects of chemotherapy. This will give you a better understanding of the ramifications of the disease process.
• Find a suitable train of thought that suits your strengths, such as writing down the goals of your intervention and plan your interventions according to those goals.
• Read previous medical and allied health notes to gain a holistic understanding of other health professionals' analysis of this pts problems and their subsequent intervention.
S: On my first week, on a Tuesday, I spent 3 hours with my Notre Dame tutor. We saw two patients (pt) together and ran through and discussed our analysis of our problem list and our plan of intervention. After already completing a subjective with the patient, we proceeded to sit down and discuss our A and P before returning to the pt. this was all done on the ward and took about 30 minutes. This A and P would later have to be documented in a full SOAPIER.
T: I was required to run through a problem list and prioritize it according to what required the most attention and so forth. Once I had done this, my plan had to incorporate all of what I intended to do to manage my problem list. A and P are both very important parts of the SOAPIER so finding a thought process that suited my strengths was something I had to focus on.
A: The process I went through to draw up an appropriate A and P was as follows.
• After completing a subjective I wrote out my 10 cardio-respiratory specific problems according to Pryor and Prasad.
• I then asterisked each problem that my pt was experiencing.
• I then prioritized by looking at each problem I had documented and began clinically reasoning which problems were most underlying of other problems in my list.
• I also drew up a heading of mobility and further thought out what problems this pt was having with mobility.
• Once I had my prioritized analysis I began writing out a plan. This involved looking at each problem and listing appropriate intervention to directly address that problem
• A lot of my intervention addressed more than one problem, as is the nature of the cardio-respiratory problem list.
• I then documented this A and P in my full SOAPIER and used it as a guide when I treated this pt.
R: the result of this was a detailed and concise A and P. Because I went through it with my tutor I was able to tailor into it a very holistic and detailed method. My tutor is a very experienced and knowledgeable physiotherapist so with her as a guide I believe the result was a good one. There were a few methods in my thinking process that were different to hers, but as long as I justified my thought process then that was fine. The A included the problem list as well as risks that would potentially be problems. It also addressed why these were problems. With the tutor keeping me on track and guiding me when appropriate, I was able to achieve an A and P that was concise and effective in my overall treatment of this pt. The result was therefore a positive one.
E: looking back on my performance, I thing there were both strengths and aspects that require work. ,y strengths included,
• I was thinking in quite a lot of depth, including problems that weren’t necessarily a high priority but were still evident.
• I was able to discuss the problem list in detail with my tutor because I had recently studied and revised my 10 problems from Pryor and Prasad.
• I believe a strength of mine is being able to clinically reason my priorities for my problem list. Such as gas exchange effecting exercise tolerance and so forth. This meant that if I prioritized correctly then treating one problem would also address the subsequent problems.
Some of weaknesses included,
• Possibly going into too much detail and including problems that weren’t necessarily relevant to why the pt required physio. With our intervention we need to include a plan that addresses the pts main and most limiting problems.
• My terminology has room for improvement. By not understanding some of the abbreviations and disease terminology it hindered, not just my A and P, but my overall SOAPIER.
S: Some strategies to acknowledge for the most desired outcome include.
• Gaining a handover form the nurse to gain the best idea of the pt and their main problems.
• Researching the main problems you will encounter in a disease process such as cancer and the effects of chemotherapy. This will give you a better understanding of the ramifications of the disease process.
• Find a suitable train of thought that suits your strengths, such as writing down the goals of your intervention and plan your interventions according to those goals.
• Read previous medical and allied health notes to gain a holistic understanding of other health professionals' analysis of this pts problems and their subsequent intervention.
Tuesday, February 9, 2010
Initial entry
I will be starting at Sir Charles Gairdner Hospital on my cardio-respiratory placement. Firstly I would like to note that I believe the “cardio” placement to be a very prominent one. By this I mean there is a substantial theoretical basis behind it, which I will obviously have to have a firm grasp of. SCGH is a big tertiary hospital with a prominent emphasis on “cardio” so as far as my placement is concerned I believe im doing an important placement which I have looked forward to, in an advanced and challenging setting. I found the cardio theory to be quite interesting and rewarding and I only hope that I can apply that effectively to the practical element. I think the nature of the cardio unit means there is quite a gap between the prac and theory components, so I am quite nervous about my practical knowledge and how much I can do by myself.
I was advised a few days before my first day that I would be working on the oncology and general surgery wards. This information gave me mixed emotions. Firstly I hoped that this would still give me adequate exposure to cardio-respiratory cases because I believe the cardio-respiratory placement to be of very high importance. However I was also very excited to be able to see and experience some general surgery cases and unique cases which I otherwise would not be exposed to. Whilst reading the clinical mix I did notice an expectation to be able to talk about death. I have had very limited exposure to cancers and the very real subject of its mortality. Also my oncology knowledge is very limited, so therefore I was very nervous about entering an environment that was very confronting, whilst having fairly limited knowledge. As for the general surgery, am I mentioned, I was excited about seeing unique cases which I might not normally get to see
So I would say im nervous about applying my knowledge practically, and nervous about working in oncology and general surgery which I otherwise would not be as confident in. I always think about my supervisors before I begin, and I guess always hoping that it’s someone who I can work well under. There are a lot of things that go through my head such as trying to be confident but not intimidating. If you come across too confident I believe the supervisor sometimes can feel a need to exercise their superiority. This is not something im worried about, but I just want to give a good impression and be confident enough so they feel confident in my abilities. I also hope I meet their expectations of a 4th year Notre Dame student. I guess by this stage I want them to be confident enough to let me treat patients and work as if I was a new graduate. However I realize the gap in experience between a new graduate with 4 prac experiences under their belt and myself. So I am trying to keep my goals realistic. In conclusion im excited about working at SCGH and considering I really enjoy a hospital setting, I cant see why I cant make the best out of this opportunity and learn lots with invaluable experience.
as i mentioned, this prac will be in a hsopital setting which is something i very much enjoy. therefore i expect to be working within a multidisciplinary team and gaining a lot of knowledge and expectations of different allied health professions. i expect that i will be working in a hsopital setting upon graduating so i therefore expect to excel on the ward setting and gain good confidence in dealing with doctors and nurses and the other professions. therefore i am using this prac as a gage of where i am and what i need to improve on and how i can prepare for graduation. first and foremost im very excited and as the clinical mix form said "we expect student to enjoy themselves and have fun so that they can maximise their learning" and thats what i expect.
I was advised a few days before my first day that I would be working on the oncology and general surgery wards. This information gave me mixed emotions. Firstly I hoped that this would still give me adequate exposure to cardio-respiratory cases because I believe the cardio-respiratory placement to be of very high importance. However I was also very excited to be able to see and experience some general surgery cases and unique cases which I otherwise would not be exposed to. Whilst reading the clinical mix I did notice an expectation to be able to talk about death. I have had very limited exposure to cancers and the very real subject of its mortality. Also my oncology knowledge is very limited, so therefore I was very nervous about entering an environment that was very confronting, whilst having fairly limited knowledge. As for the general surgery, am I mentioned, I was excited about seeing unique cases which I might not normally get to see
So I would say im nervous about applying my knowledge practically, and nervous about working in oncology and general surgery which I otherwise would not be as confident in. I always think about my supervisors before I begin, and I guess always hoping that it’s someone who I can work well under. There are a lot of things that go through my head such as trying to be confident but not intimidating. If you come across too confident I believe the supervisor sometimes can feel a need to exercise their superiority. This is not something im worried about, but I just want to give a good impression and be confident enough so they feel confident in my abilities. I also hope I meet their expectations of a 4th year Notre Dame student. I guess by this stage I want them to be confident enough to let me treat patients and work as if I was a new graduate. However I realize the gap in experience between a new graduate with 4 prac experiences under their belt and myself. So I am trying to keep my goals realistic. In conclusion im excited about working at SCGH and considering I really enjoy a hospital setting, I cant see why I cant make the best out of this opportunity and learn lots with invaluable experience.
as i mentioned, this prac will be in a hsopital setting which is something i very much enjoy. therefore i expect to be working within a multidisciplinary team and gaining a lot of knowledge and expectations of different allied health professions. i expect that i will be working in a hsopital setting upon graduating so i therefore expect to excel on the ward setting and gain good confidence in dealing with doctors and nurses and the other professions. therefore i am using this prac as a gage of where i am and what i need to improve on and how i can prepare for graduation. first and foremost im very excited and as the clinical mix form said "we expect student to enjoy themselves and have fun so that they can maximise their learning" and thats what i expect.
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