Communication

S:
Whether completing a baseline Ax to a pt you are seeing for the first time or providing ongoing Rx to a regular pt, communication is very important. In this particular scenario I was seeing a pt for the first time. He was a 65 yr old gentleman who had a speech and hearing deficit and had arrived for Physiotherapy regarding his Parkinson Disease (PD).

T:
In regards to communication my desired outcome was to Ax and Rx this pt using an appropriate level of communication taking into account any disabilities or cognitive deficits. This included everything from voice projection to tone and how much I explained the tasks we were about to do.

A:
Through reading his notes I realised that he has an inner ear device that accounted for his decreased hearing, however I wasn’t sure about cognition and speech. I spoke to him at a normal voice projection and in a tone that more reflected the way I would speak to an elderly pt with cognitive deficits.

R:
At the end of the Rx my supervisor provided feedback about my communication. My communication throughout the Ax and Rx was inappropriate. This gentleman would delay his response for a few seconds before answering any qn’s. This was not because of any cognitive deficits, but due to delayed processing of words due to his hearing impairment and the PD. I misinterpreted this delay as him not understanding me and hence adjusted my communication for someone with a cognitive deficit. This made me appear to be condescending towards the pt, which he could have found very offensive considering he was cognitively sound.

E:
Although my communication wasn’t effective I believe there were some things I did right and other I could have done better. I would prefer to over explain to a pt and be interpreted as condescending to under explain and not get the task completed. However I initially did not give the pt enough time to respond, which if I had, I would have realised he understood perfectly it just took him time to respond. Although I felt rather disappointed I did take the feedback on board and the next week I improved ten fold and as a result gained much more rapport with the pt.

S:
Firstly ask someone appropriate rather than just read the notes. Say to someone “I have read that this person has hearing and speech difficulties, what is the most effective way to communicate with this pt?” From the first introduction, start to think about how this person presents wholistically, including cognitively so that you communicate effectively form the word go.

Assessment

S:
For all new pts in the Pd clinic an initial assessment must be completed. This assessment includes both subjective and objective components. the subjective focuses on components such as balance, falls, mobility and PD symptoms i.e festinating gait. The objective is based on time trials for tests like the TUG, 6m walk test etc. the assessment form is filed and used as a baseline measure for future assessments to identify any deterioration in the pts function between interventions.
T:
To successfully complete this assessment form it is important that I ask the right qns in the subjective. I must gain a good understanding of anything the pt is having trouble with at home. For the objective it is important to do the tests correctly and explain them effectively to the pt. I must document correctly also, commenting on whether the pt used an aid during the tests etc.
A:
I sat the pt down and had a conversation with them. I started with an open ended qn and allowed the pt to explain to me what they were worried about. I then explored my main subjective topics to gain insight into where my intervention would be based. For the objective I ran through all the tests and took the pt through them.
R:
Overall my assessment was fairly good. There were however some extra qns I could have asked regarding some of the things the pt said. I took my filled in my assessment form and filed it in the pts file for further reference. All my time trials were done well.
E:
Overall I was effective in reaching my outcome of a detailed subjective and objective assessment. My weak points were communication, I was sometimes a bit condescending towards pts assuming their cognition level to be lower than it was. My strengths were my normative values knowledge and my rapport with pts.
S:
Some strategies for improvement are; becoming familiar with the subjective qns and knowing what to ask. Finding ways to explain certain terms to a pt such as festinating. Gaining insight into their cognition early as possible to decide upon the ;evel of explanation required.

placement number 2

well i finally found my password for my blog since last year, so here is my first blog. so what am i expecting? im at the Parkinsons disease clinic at Osborn park Hospital. i suppose being a hospital setting im expecting the nature of this prac to be your typical ward setting, working as part of an allied health team. its Parkinsons outpatients so i will be working a with a range of patients from high level function to mid/lower level function. this means structuring my treatment differently from things like education to treating joint range of motion to muscle strength. the structure i believe will be basic supervisor student relationship with opportunities to research my area of practice and also treat patients and take classes. my role as a student like any placement will be to conduct myself as professionally as possible, represent the university in a positive and exemplarary fassion. to respect hospital guidelines such as patient confidentialilty. also to be competent to treat patients as a show of respect for them giving their time for me. starting this placement, im inspired to get into a routine and achieve all the things i have set out to achieve like a positive experience with good marks. im worried about not being able to earn any money while on prac and how im going to handle that. however i believe that i can make this experience an absolute positive experience and make it go a long way in my journey to being the best possible physiotherpaist i can be. thankyou and good luck to everyone

Final thoughts

this placement has done me the world of good. i wanted to use this experience to re-iterate my decision to study to become a physiotherapist. it did just that, im really happy with the hospital i worked at and i enjoyed the hospital sector, working with all the allied health professionals. orthopaedics was a perfect way to begin. it was a routine physio treatment that gave me the confidence in my treatment and i now know im capable of being and good physio. i loved working with people and real Pts, i was constantly broadening my comfort zone by meeting different people and enjoying a whole range of different characters. i like to think of myself as a friendly outgoing person and i was delighted when that was the feedback i got.
what i learned:
i learned pretty much everything about ortho, what treatments to prescribe for what surgeries. manual handling put in practice. a lot about surgery and anaesthetic because anaesthetic plays a big part in our post-op treatment. i learnt the hierarchy of the hospital system and how to communicate and work with other health professionals. in conclusion this experience has been amazing and its fueled my desire to work towards becoming a well rounded physio.

treatment

today i was treating a patient trying to get him 70 degrees active knee flexion. lying supine on a plinth the patient started actively flexing, but only reaching 50 degrees. i then got him to practice passive flexion by putting a sheet around his foot so that he could pull with each hand and achieve knee flexion. this is a standard technique that is often used. however he was still not quite getting to where i wanted. so i tied a pulley to the cage over the top of the bed and put a sling under his knee. he would then pull on the handle and the pulley would cause the sling to pull up under his knee. this took the knee into full flexion and he actually achieved 80 degrees. i found it really effective and i think the pt was really happy aswell. i have also discovered some effective techniques to improve quads lag also. moving the knee cap on the good leg and telling the pt to stop you moving it causes them to go into quads firing. get them to incorporate this into the operated leg at the same time so they can get a feel for the co-ordination. once they wake up quads then chuck the quads wedge under the knee and off you go. i found this really effective. also try beginning quads treatment with some eccentric lowering. it strengthens the muscle to allow it to get higher ranges.

running the ward

well this week i will be running the ward at kaleeya which will be challenging and exciting. this will involve me discharging patients, filling out all the paper work, handing over to doctors and nurses and basically taking control of all the physio roles on the ward. this gives me the initiative to prioritise which patients to see so that i can discharge them. this gives me a great sense of responsibility and i feel like i am ready to take on this challenge. im really happy with where im at with placement atm however id be lying if i said im not looking forward to friday when i can actually work and earn some coin. over the last few weeks i have been taking on more and more responsibility so hopefully i can put it all into practice this week....

Aborigine-me

i had some experience dealing with Aboriginal pts the other day. An aboriginal lady from fitzroy crossing in whoop whoop presented with a broken ankle. im comfortable with the routine treatment for post surgery ankle ORIF, so it was just the pt that i needed to become familiar with. she seemed pretty traditional so i took on board what i have learnt.... things such as little eye contact and speaking in a dialect they are familiar with. i must admit i do find it challenging not to shy away from judging a pt such as this, not because of race but other things such as they havent discovered the wonderful essence of rexona, or their bed habbits arent particularly pleasant. but i think to my credit i handled myself very well and did what i needed to do. you get your pts that are easy because they are clean, have a good attitude and comply really well with treatment, however its not always roses and happy days and in saying that im glad i got the chance to test my character with a more difficult pt. i think you just had do what u have come to do, dont get off topic and be happy that our sense of smell can accommodate to even the more potent smells in a matter of minutes. happy days