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
Monday, April 26, 2010
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.
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