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.

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.