Hey guys,
Hope your pracs are going well. I am currently on my neurology practical at SCGH day hospital. I was supposed to be placed on the neurosurgery rotation, however because of an overlap with the Notre Dame students, the supervisor forgot to check the roster and place me in. In the end, I was placed into the day hospital.
I am aware of my possible disadvantage of my current placement, as most of my workload consists of gerontology assessments and falls prevention strategies. However I am trying my best to make the best out of my situation, by ensuring that I try to assess the gerontology patient from a neuro point perspective as well. On the brighter side of things, most of these patients have an extensive list of co-moribidities, including Parkinson's and previous strokes. It is good to see what these problems can present in the later stages of its clinical course, and how it impacts function in the elderly.
I have expressed my concerns with the supervisors (both facility and Curtin) and they have endeavored to expose me to as many neuro type patients as possible. I also have a neuro outpatient clinic on wednesdays, where I get to see rarer neurological pathologies such as inclusion body myopathies and BPPV.
So this prac is not as bad as I thought. I hope that through this, I can gain insight into the other end of pathologies - where it's long down the track, and see how I can try to make changes to help these patients. Reflecting on the situation, I do not think I can change anything else, as the supervisors have already been made aware of my situation, and are trying to help - But I can make the most of it, and learn as much as I can.
Mark
Tuesday, July 31, 2007
Monday, July 30, 2007
Assessment
Hey all!
I’m currently on my musculo-outpatients clinic, so far no major dramas. But what I find extremely difficult at the moment is not being able to effectively palpate and assess the spine. I’ve had a range of Cx, Tx and Lx spine patients to treat, and I just find it frustrating not being able to feel the right thing when doing PPIVMs and PAIVMs assessment. To me, when assessing, all the segments feel stiff, I cant seem to differentiate when R1 comes on, or which segments have lots of movement. When the supervisors having a go at assessing my patient, to make sure I’ve picked up on the right affected segments, the difference in R1 between segments is literally 1mm. Though my supervisor tells me, I’m not wrong in saying that there are multiple levels affected, I need to narrow down to the most affected, in order to treat. So when the difference is only 1 mm, I’m slightly overwhelmed! I find that because I cant assess and feel as effectively, my treatment is being compromised, and I don’t seem to be able to think on my own and narrow down the affected segments. Similarily, I seem to manage with Tx and Lx regions, but Cx arrrghhhhhhh!! Its just so hard to figure out where my hands are, or if their even in the right place. I’ve been told that all this comes with practice, just frustrating that its a very slow and long process.
Rev
I’m currently on my musculo-outpatients clinic, so far no major dramas. But what I find extremely difficult at the moment is not being able to effectively palpate and assess the spine. I’ve had a range of Cx, Tx and Lx spine patients to treat, and I just find it frustrating not being able to feel the right thing when doing PPIVMs and PAIVMs assessment. To me, when assessing, all the segments feel stiff, I cant seem to differentiate when R1 comes on, or which segments have lots of movement. When the supervisors having a go at assessing my patient, to make sure I’ve picked up on the right affected segments, the difference in R1 between segments is literally 1mm. Though my supervisor tells me, I’m not wrong in saying that there are multiple levels affected, I need to narrow down to the most affected, in order to treat. So when the difference is only 1 mm, I’m slightly overwhelmed! I find that because I cant assess and feel as effectively, my treatment is being compromised, and I don’t seem to be able to think on my own and narrow down the affected segments. Similarily, I seem to manage with Tx and Lx regions, but Cx arrrghhhhhhh!! Its just so hard to figure out where my hands are, or if their even in the right place. I’ve been told that all this comes with practice, just frustrating that its a very slow and long process.
Rev
Patients Declining Treatment
Hi Everyone,
Hope you have enjoyed the start of our final semester!! I am writing today to discuss my fustration with patients who refuse treatment in an inappropriate manner. I am currently on the oncology ward at RPH whereby it is one of my roles to maintain the patient's fitness while they are recieveing chemo treatment. On Friday however, I went to conduct an initial mobility assessment on a new patient to the ward and after conducting my assessment, the patient refused to get out of bed for me. He would not turn down the radio when asked and did not want to explain the reason for him declining treatment. I proceeded to provide some eduction on the benefits of exercise for people recieving chemo and explained the problmes associated with remainig bed-bound while in hospital. The patient was unreceptive to the information provided and was quite happy to see the back of me when I left the room.
After this encounter, I really felt like my time was wasted. Not only had I not been able to complete an assessment that was requested by both my supervisior and the doctors but the level of assistance that the patient would require whilst in hospital to assist the nursing staff was still not determined. I understand that the patient was probably feeling very unwell and so I told him that I plan to return at a later date to complete the assessment, however I am not optimistic that the patient will be compliant even then.
So my question to anyone that has as opinion on this issue, is that do I continue to push, plead and prod this patient into complying with my treatment goals or would my time be better spent on patients who are euqally in need of and receptive of, physiohterapy treatment?
Hope you have enjoyed the start of our final semester!! I am writing today to discuss my fustration with patients who refuse treatment in an inappropriate manner. I am currently on the oncology ward at RPH whereby it is one of my roles to maintain the patient's fitness while they are recieveing chemo treatment. On Friday however, I went to conduct an initial mobility assessment on a new patient to the ward and after conducting my assessment, the patient refused to get out of bed for me. He would not turn down the radio when asked and did not want to explain the reason for him declining treatment. I proceeded to provide some eduction on the benefits of exercise for people recieving chemo and explained the problmes associated with remainig bed-bound while in hospital. The patient was unreceptive to the information provided and was quite happy to see the back of me when I left the room.
After this encounter, I really felt like my time was wasted. Not only had I not been able to complete an assessment that was requested by both my supervisior and the doctors but the level of assistance that the patient would require whilst in hospital to assist the nursing staff was still not determined. I understand that the patient was probably feeling very unwell and so I told him that I plan to return at a later date to complete the assessment, however I am not optimistic that the patient will be compliant even then.
So my question to anyone that has as opinion on this issue, is that do I continue to push, plead and prod this patient into complying with my treatment goals or would my time be better spent on patients who are euqally in need of and receptive of, physiohterapy treatment?
Saturday, July 28, 2007
Ward Staff
Hi guys
My post today is about starting a new prac. I find it very intimidating beginning prac in a new ward where I am unfamiliar with the layout, procedures, doctors and ward staff in general. In the prac that I have just begun all the staff have been extremely welcoming which has made the experience a lot easier. In particular, the nursing staff who have been so great asking what time we need patients for and having no problems with getting them ready, helping if I need help etc. This point was brought up by Mel H earlier, but I have also found that learnig the names of the ward staff, in particular the nurses, can make life easier so that you can put a face to the name of the person looking after your patient. For my future if I work in a ward as a physiotherapist I will now appreciate the importance of orienting students fully and introducing them to all of the staff and really making them feel welcome, so that the hardest thing to deal with is simply treating the patient instead of the student stressing about finding the patient's room, nurse, equipment etc and being too scared to ask for help.
Mel.
My post today is about starting a new prac. I find it very intimidating beginning prac in a new ward where I am unfamiliar with the layout, procedures, doctors and ward staff in general. In the prac that I have just begun all the staff have been extremely welcoming which has made the experience a lot easier. In particular, the nursing staff who have been so great asking what time we need patients for and having no problems with getting them ready, helping if I need help etc. This point was brought up by Mel H earlier, but I have also found that learnig the names of the ward staff, in particular the nurses, can make life easier so that you can put a face to the name of the person looking after your patient. For my future if I work in a ward as a physiotherapist I will now appreciate the importance of orienting students fully and introducing them to all of the staff and really making them feel welcome, so that the hardest thing to deal with is simply treating the patient instead of the student stressing about finding the patient's room, nurse, equipment etc and being too scared to ask for help.
Mel.
Friday, July 27, 2007
Musculo time constraints
Hi everyone,
Hope you are enjoying your new pracs.
I just wanted to post a blog regarding musculo-skeletal physiotherapy.
I have been finding it really difficult to keep to time with my musculoskeletal patients. I just feel like by the time you have done your subjective, given the patient a massgae for 5-10 minutes (massaged almost every patient to loosen up the tissue before PPIVMS and PAIVMS) that I had almost next to nothing time left! Especially when you are having to re-Ax patients all the time to see if something is working..
I was just hoping if anyone had any suggestions on ways to improve my time management. I have tried cutting the subjective down to the bare minimum, I try my hardest to be quick with the Ax, and I only occasionally re-Ax the patient... but still I feel like an hour is not enough for an effective Rx. How they go working in private practises with only 30 minutes for Rx is beyond me.
Look forward to your input
Caris
Hope you are enjoying your new pracs.
I just wanted to post a blog regarding musculo-skeletal physiotherapy.
I have been finding it really difficult to keep to time with my musculoskeletal patients. I just feel like by the time you have done your subjective, given the patient a massgae for 5-10 minutes (massaged almost every patient to loosen up the tissue before PPIVMS and PAIVMS) that I had almost next to nothing time left! Especially when you are having to re-Ax patients all the time to see if something is working..
I was just hoping if anyone had any suggestions on ways to improve my time management. I have tried cutting the subjective down to the bare minimum, I try my hardest to be quick with the Ax, and I only occasionally re-Ax the patient... but still I feel like an hour is not enough for an effective Rx. How they go working in private practises with only 30 minutes for Rx is beyond me.
Look forward to your input
Caris
Monday, July 23, 2007
Methods of communication
Hi All- Last post for this clinic!
I have had an interesting communication experience over the last few weeks of this clinic. I was asked to treat a 40 year old patient who has locked in syndrome. In handover, I learned he had a very severe pontine stroke about 2 years ago which left him with only lateral movement of his eyes. Since then he has regained full movement of his eyes and with a lot of effort can say some words, though they are not always understandable even to his wife. I was told his cognition is excellent and he is a very sociable and funny person. I was quite nervous because I thought I was going to find communication with him very difficult and I didn’t want to offend him by not being able to understand what he was trying to tell me. The patients wife showed me a board that he uses to communicate which is essentially a square piece of paper with a big square in the middle cut out. Around the outside of the square at each corner and halfway along the sides, are blocks of letters of the alphabet. The patient would look toward a block of characters and then I would read the letters in that block while watching him through the big square in the middle and he would blink at the letter he wanted. We would keep going until he had spelled out what he wanted to tell me. This process is the main way he communicates. At first I found it very difficult to co-ordinate watching the patient, reading the letters, remembering the letters that had come beforehand and then remembering the words that he had already spelt out in the sentence – all at once!! I also felt that because communication took so long, it might look like I couldn’t finish the treatment sessions which were actually quite simple muscle stretches and passive movements in a timely manner. I also saw how frustrated it could make the patient in the times when he had spelled out most of a sentence and I forgot the first words… - although he was very patient and usually just laughed at me and then started again. But, over the treatments I saw him for; I became much better at this and could eventually pre-empt some of the words he was spelling which he found helpful so that he didn’t have to spell everything out in full. On the last session that I saw this patient for, his wife explained to me a new method of communication that they were about to trial where a computer would read out the letters of the keyboard and the patient would use his thumb – which he has movement of – to click at the correct letter. His computer works just like a normal computer but this is going to be his method of input. After having this experience, I have learned that no process should be considered too difficult when it comes to letting a person communicate with others and that patience should be given because alternative forms of communication can be quite time consuming. I realize that are many different methods of communication, some of which are very creative and that it just takes a while to learn which is the best for each individual to use.
Mel
I have had an interesting communication experience over the last few weeks of this clinic. I was asked to treat a 40 year old patient who has locked in syndrome. In handover, I learned he had a very severe pontine stroke about 2 years ago which left him with only lateral movement of his eyes. Since then he has regained full movement of his eyes and with a lot of effort can say some words, though they are not always understandable even to his wife. I was told his cognition is excellent and he is a very sociable and funny person. I was quite nervous because I thought I was going to find communication with him very difficult and I didn’t want to offend him by not being able to understand what he was trying to tell me. The patients wife showed me a board that he uses to communicate which is essentially a square piece of paper with a big square in the middle cut out. Around the outside of the square at each corner and halfway along the sides, are blocks of letters of the alphabet. The patient would look toward a block of characters and then I would read the letters in that block while watching him through the big square in the middle and he would blink at the letter he wanted. We would keep going until he had spelled out what he wanted to tell me. This process is the main way he communicates. At first I found it very difficult to co-ordinate watching the patient, reading the letters, remembering the letters that had come beforehand and then remembering the words that he had already spelt out in the sentence – all at once!! I also felt that because communication took so long, it might look like I couldn’t finish the treatment sessions which were actually quite simple muscle stretches and passive movements in a timely manner. I also saw how frustrated it could make the patient in the times when he had spelled out most of a sentence and I forgot the first words… - although he was very patient and usually just laughed at me and then started again. But, over the treatments I saw him for; I became much better at this and could eventually pre-empt some of the words he was spelling which he found helpful so that he didn’t have to spell everything out in full. On the last session that I saw this patient for, his wife explained to me a new method of communication that they were about to trial where a computer would read out the letters of the keyboard and the patient would use his thumb – which he has movement of – to click at the correct letter. His computer works just like a normal computer but this is going to be his method of input. After having this experience, I have learned that no process should be considered too difficult when it comes to letting a person communicate with others and that patience should be given because alternative forms of communication can be quite time consuming. I realize that are many different methods of communication, some of which are very creative and that it just takes a while to learn which is the best for each individual to use.
Mel
Monday, July 16, 2007
A cautionary tale
On the ward that I'm on, the physiotherapists notes are the indicator as far as how the transfers of each patient should be managed. As with other wards, we write the transfer status (1x assist or whatever) on a board above the patients bed. Last week a nurse was injured while transferring a patient who I'm responsible for. I wasn't there. I don't know what happened. The patient is sometimes worse than others in terms of his balance, but in general he is 1x mod A for sit - stand and ambulation. If he was 1x max assist then he would not be 1x assist. He'd be a hoist or 2x assist. He doesn't require 2 people assist or hoist.
Anyway, this nurse took time out of her day to tell me that he was in fact "2x heavy" assist and that is what should have been written in the notes. Additionally she told me that she would have to "submit a form" (documenting her injury). This, and the filthy look I receive every time I see her, tells me that she blames me for the incident and feels that I have been negligent. Now, I do care that someone has been injured, let me be clear about that. But, and this may be frowned apon, I have not apologised. The fact is that my notes are spot on in regards to this patient, and every other nurse, PT and OT have managed on their own without incident. I'm not saying that the nurse was doing a bad job.
I guess I'm just venting about having someone decide to deal with me via thinly veiled threats and dirty looks. Also, it shows how your notes have got to be clear and correct. If this were to occur again, I might take the time to further discuss the issue with the nurse so that it could be put to bed, and I acknowledge that I could have done something like that. But, I suppose when this person decided to act the way she did, I decided not to bother. It has slightly darkened was has been a much brighter neuro experience than I was expecting, and other than that I have enjoyed the placement. Final Ax tomorrow
M
Anyway, this nurse took time out of her day to tell me that he was in fact "2x heavy" assist and that is what should have been written in the notes. Additionally she told me that she would have to "submit a form" (documenting her injury). This, and the filthy look I receive every time I see her, tells me that she blames me for the incident and feels that I have been negligent. Now, I do care that someone has been injured, let me be clear about that. But, and this may be frowned apon, I have not apologised. The fact is that my notes are spot on in regards to this patient, and every other nurse, PT and OT have managed on their own without incident. I'm not saying that the nurse was doing a bad job.
I guess I'm just venting about having someone decide to deal with me via thinly veiled threats and dirty looks. Also, it shows how your notes have got to be clear and correct. If this were to occur again, I might take the time to further discuss the issue with the nurse so that it could be put to bed, and I acknowledge that I could have done something like that. But, I suppose when this person decided to act the way she did, I decided not to bother. It has slightly darkened was has been a much brighter neuro experience than I was expecting, and other than that I have enjoyed the placement. Final Ax tomorrow
M
Friday, July 13, 2007
Short term memory loss
Hi, hope everyone has been enjoying the break.
This week I assessed a patient in his home following a mechanical fall that resulted in a non displaced fracture of the head of fibula and tibial plateau. From the referral, I noted that the patient had short term memory loss. However throughout the assessment, his memory seemed quite good. During the assessment, I made quite a few recommendations to the patient regarding things he should do to make himself safer in his home and at less of a risk of future falls. He appeared to have taken these on board and was able to verbalize the changes he needed to make at the end of the session. I didn’t think it seemed necessary to write them down, but my supervisor suggested that perhaps it would be a good idea to give him a written copy and so I did. When I got back to the office, I had to ask the OT for a piece of equipment to take to this patient at the next treatment session. She told me that she had already seen the patient twice before in his home and that she had already discussed many of the same changes with him that I had recommended. Yet when I asked him if he had been seen by the OT’s, he had outright said no and showed no signs of having heard the changes before. In reflecting on this situation, I have learned the importance of working in a team with other allied health professionals as well as the importance of giving patients with STML written instructions and if possible involving carers or family to help with the patient’s treatment. I wonder if assessing the patient in his own home helped to mask the STML because he was familiar with the environment. Perhaps the memory loss would have been more apparent if the patient had come into the rehab centre for treatment.
Mel
Monday, July 9, 2007
Hi Everyone,
This week I was given a referral requesting a home assessment for a lady two weeks post a three week hospital admission for groin and thigh pain. During the admission, investigations found no pathology that explained this pain. On assessment, the patient reported significant deterioration over the past eighteen months to a point where she did not feel safe leaving the house due to poor mobility. She had been active in the community but no longer had any social contact, nor any visitors other than her daughter and her personal care assistant who helped with showering three times a week. However her cognition was excellent and she reported feeling quite frustrated that she was unable to do the activities she could in the past. Despite this she did not have any desire to do any exercises despite education about how they could improve her mobility and perhaps make her feel comfortable to leave the house again. At the end of the assessment, the patient thanked me for coming and talking to her and apologized for wasting my time since she did not want to do any exercises. She also encouraged me to drop by for a chat any time. This assessment left me feeling quite frustrated. I really think that after a short stint of Physio, this patient’s quality of life could be significantly improved; however her right to refuse Physio treatment after being informed of its benefits could not be ignored. I also felt quite sad that she has become so socially isolated and that things like a Physio assessment have become the highlight of her week. I have been wondering since if there is a service that is available to the elderly or other people with mobility issues, where people do visit them just for a chat. I think that such a service, if one exists, would great benefit this lady.
Mel
This week I was given a referral requesting a home assessment for a lady two weeks post a three week hospital admission for groin and thigh pain. During the admission, investigations found no pathology that explained this pain. On assessment, the patient reported significant deterioration over the past eighteen months to a point where she did not feel safe leaving the house due to poor mobility. She had been active in the community but no longer had any social contact, nor any visitors other than her daughter and her personal care assistant who helped with showering three times a week. However her cognition was excellent and she reported feeling quite frustrated that she was unable to do the activities she could in the past. Despite this she did not have any desire to do any exercises despite education about how they could improve her mobility and perhaps make her feel comfortable to leave the house again. At the end of the assessment, the patient thanked me for coming and talking to her and apologized for wasting my time since she did not want to do any exercises. She also encouraged me to drop by for a chat any time. This assessment left me feeling quite frustrated. I really think that after a short stint of Physio, this patient’s quality of life could be significantly improved; however her right to refuse Physio treatment after being informed of its benefits could not be ignored. I also felt quite sad that she has become so socially isolated and that things like a Physio assessment have become the highlight of her week. I have been wondering since if there is a service that is available to the elderly or other people with mobility issues, where people do visit them just for a chat. I think that such a service, if one exists, would great benefit this lady.
Mel
Neuro placement
Hi all. Hope you are all enjoying your break. Is there anyone out there? Anyway I'm currently on my neuro placement. Experiencing a number of frustrations, though not regarding nurses. They are incredibly busy and short staffed on the ward I'm on so hats off to them. I'm a bit frustrated with the different (sometimes conflicting) advice I'm getting from my several different supervisors but I'm going the smile and nod approach to be honest.
While I feel that I've made some real gains with the patients I have had, it's become obvious to me just how much I have missed. Although all patients are to undergo a stroke assessment form within 72 hrs of arriving on the ward, none of my patients are new to the ward, yet none of them have the form. I made the mistake of assuming that a less formal assessment was what was required on the ward. This was a mistake for a number of reasons. Most importantly it has left me without a full understanding of patients impairments and a set of objective measures to re-assess. This has been to my detriment, as I haven't been able to formulate a better problem list. Basically, despite being confident that I have made some treatment gains and being reasonably happy with the techniques I've used, I still feel like I've been pretty ineffective. I'm going to try to address this over the next couple of weeks.
While I feel that I've made some real gains with the patients I have had, it's become obvious to me just how much I have missed. Although all patients are to undergo a stroke assessment form within 72 hrs of arriving on the ward, none of my patients are new to the ward, yet none of them have the form. I made the mistake of assuming that a less formal assessment was what was required on the ward. This was a mistake for a number of reasons. Most importantly it has left me without a full understanding of patients impairments and a set of objective measures to re-assess. This has been to my detriment, as I haven't been able to formulate a better problem list. Basically, despite being confident that I have made some treatment gains and being reasonably happy with the techniques I've used, I still feel like I've been pretty ineffective. I'm going to try to address this over the next couple of weeks.
Subscribe to:
Comments (Atom)