Hi everyone,
I've been treating a patient who was stabbed in the hand. When I first saw him, he was in a lot of pain and my tutor just showed me how to move his hand and educated about his functional return. I was asked to see him again in the arvo.My tutor asked me to really push this man to do his exercises even with a lot of pain - as he lectured about neuroplasticity.
When I went to see him and asked to move his fingers, he was in little pain. I looked at the med chart and noticed that he had pain killers only 1/2 hour ago. As he tried to move more, his pain increased. I gave him regular breaks so that the pain subsided and i could begin the exercises again.
At some point, the patient was starting to become agitated and distracted (especially because there were 3 other visitors in the room staring at me). So I said I will come back. I went back quite discouraged about how I didn't achieve much on the first day.
I tried again the second day - boy - was the movement better. He started to make a full-fist. He was in less agony and this prolonged the treatment session so I could do more work with him.
Third day was even better. Second day - he hated the sight of me - The physiotherapy department person. But third day - he was actually happy to see me and was showing me how much movement he has.
Boy - has this been an experience! It took three days for this individual to realise that I was there to help him and not break his hand. And it also took me 3 days to realise that there is light at the end of the tunnel!!!!
So be encouraged my fellow peers/colleagues.
Sashi.
Thursday, August 30, 2007
Mid-Placement Assessment
Hi guys,
On my prac, I have just been told that I am responsible for completing my mid-placement assessment and then my supervisor will add to it if he feels that there are discrepancies in my personal feedback. Originally, I was quite surpirsed at this and was not quite sure whether I liked the idea of not getting direct feedback from my supervisor. Even so, I agreed to his plan and will set about completing it in my free time.
I have several concerns about this and was wondering whether you guys agreed with me or not. My supervisor tells me that his other students have had to do there own feedback in previous pracs, but I have never heard of this occuring. I generally look forward to my mid-placement assessments as it is a chance for my supervisor to be honest and give me some very specific hints on ways to improve my performance over the next half of the placement. I am worried about providing postive comments about my performance in case my supervisor doesn't agree and then I am concerned about pointing out my poor performance aspects in case this highlights new weaknesess that he may not have noticed!!! See my dilemma!!!!! I do not want to tell him that I'd prefer not to do it alone and I do not think he'd be receptive to this. Do you guys think this is a reasonable request and do you think it is more beneficial for us to self-evaluate rather than just being told our strengths and weaknesses by our supervisor?
Thanks for your input!!
Kate.
On my prac, I have just been told that I am responsible for completing my mid-placement assessment and then my supervisor will add to it if he feels that there are discrepancies in my personal feedback. Originally, I was quite surpirsed at this and was not quite sure whether I liked the idea of not getting direct feedback from my supervisor. Even so, I agreed to his plan and will set about completing it in my free time.
I have several concerns about this and was wondering whether you guys agreed with me or not. My supervisor tells me that his other students have had to do there own feedback in previous pracs, but I have never heard of this occuring. I generally look forward to my mid-placement assessments as it is a chance for my supervisor to be honest and give me some very specific hints on ways to improve my performance over the next half of the placement. I am worried about providing postive comments about my performance in case my supervisor doesn't agree and then I am concerned about pointing out my poor performance aspects in case this highlights new weaknesess that he may not have noticed!!! See my dilemma!!!!! I do not want to tell him that I'd prefer not to do it alone and I do not think he'd be receptive to this. Do you guys think this is a reasonable request and do you think it is more beneficial for us to self-evaluate rather than just being told our strengths and weaknesses by our supervisor?
Thanks for your input!!
Kate.
Tuesday, August 28, 2007
Burns patient
Hi everyone,
I had a patient today that i saw with my supervisor. He is an adolescent with four kids. At the end of the assessment and treatment, my supervisor said that he may need to be seen again in the arvo. I said - okay and offered to give the pt a handout for his exercises that I said I will prepare.
But the supervisor also told me to re-inforce and push him a bit harder because he had complained of a lot of pain and the 'adolescent' does not know what pain is and is likely to keep complaining and prolong his hospital stay. I understood what my supervisor was saying to me regarding this man.
So I went in the afternoon and explained what I was going to do. There were 3 ladies in the room (family members). The patient said he was in some pain and that he has been moving and can move it a little bit. So I got everything ready and got the dressings down to help with the exercises. The patient was compliant with the first 1-2 hand exercises after which he complained of increase in the pain. I said it's okay to feel the pain because he's just had his debridement and that the movement will lower it down. Otherwise there is a risk of having it get stiff (since hand is notorious for that). I knew that the patient had his panadol 30 mins ago.
But the patient seemed to be getting extremely agitated. What made it worse was the comments such as "You are making it worse" by the patient's family -even after I explained what I was going to do.
This created a very awkward situation for me. So I said to the patient - I will see what I could do. So I went to see the nurse and said if there could be a pain killer that could be arranged. The nurse said that she had already given the patient the pain killer. I said to her that the patient complained of pain that was 8/10.
Monday, August 27, 2007
Being crowned "the longest initial assessment"
Hey guys,
I am currently on my musculoskeletal prac, and I am still trying to get a handle the overwhelming workload/theory involved. I am still struggling to ensure that I get most important things checked (good observation, palpation, arom, prom, ppivms, paivms, etc etc etc....). I had a new patient last week, and he was sort of a workers' comp with yellow flags...he had Cx, shoulder and LBP at the same time...so it was really hard to get a good idea..esp when there's so much pain.
Because he was referred for the Cx pain...i spent more of my time assessing his neck. However, on top of the spinal assessment, his pain was directly associated with his shoulder...and so I had to complete a "quick" shoulder assessment as well - he was limited in range in his shoulder too...
Getting my head around to the neck assessment techniques was hard enough...I managed to only complete a thorough Ax with Rx in 2 hours 10 min...LOL!
Hope someone can beat this record! I'd better buck up and be more efficient in my Ax!
Mark
I am currently on my musculoskeletal prac, and I am still trying to get a handle the overwhelming workload/theory involved. I am still struggling to ensure that I get most important things checked (good observation, palpation, arom, prom, ppivms, paivms, etc etc etc....). I had a new patient last week, and he was sort of a workers' comp with yellow flags...he had Cx, shoulder and LBP at the same time...so it was really hard to get a good idea..esp when there's so much pain.
Because he was referred for the Cx pain...i spent more of my time assessing his neck. However, on top of the spinal assessment, his pain was directly associated with his shoulder...and so I had to complete a "quick" shoulder assessment as well - he was limited in range in his shoulder too...
Getting my head around to the neck assessment techniques was hard enough...I managed to only complete a thorough Ax with Rx in 2 hours 10 min...LOL!
Hope someone can beat this record! I'd better buck up and be more efficient in my Ax!
Mark
Sunday, August 26, 2007
heavy workload on prac
The prac that I am on at the moment is interesting and I am learning alot; however I am getting frustrated that I am struggling to keep up with the patient notes. In order to keep up with patient notes (because we are not given ANY time to do them during the day as we are booked out with patients) I have had to come in half an hour early and stay back an hour every day this week. On top of that we are only given a half hour lunch break everyday. Patients are often running late etc so we are lucky if we do get the full half hour, and not just 15 mins, which is bearly enough time to scoff down our lunch.
This leaves me quite exhausted by the end of the 9 1/2 hour s that we spend there each day. It wasn't such a problem this week but I will be starting back at my other job this week coming and I m worrried it will just be too much.
One of my fellow student collegues mentioned this to our supervisor (who is also our clinical tutor - which makes it impossible for us to discuss this with an outside party) and she advised the student that this is just how it has to be and there is nothing she can do about it. She knows and understands that it is a heavy workload but thats how it is in real life and you have to get it done. Fair enough, but we are not in the "real work force" yet, we are students who are meant to be doing 32 hours of prac a week with an hour lunch break every day. When we are actually working we wont have week night and week end jobs so it wont be such a problem to stay back an hour. We have also got a heavier patient load then the previous student s becasue they've had to squueze patients from 5 students into 4 students time slots.
So discussing this with the tutor/supervisor came to no reasonable conclusion, so I decieded to try something else. I decided to try writing the patient notes whilst I am in with the pt. This works ok sometimes, but other times it has been too messy and my tutor has asked me to re-write it, and if it is a new patinet we have to write up a full SOAPIER which is impossible to do whilst you are in with the pt. Doing this also means that the Ax and Rx dont flow smoothly because I am continually stopping to write things down.
Has anyone else been in a similar situation? How did you handle it? Has anyone got any other ideas of how I can manage this situation and my time more efficiently?
Thanks
This leaves me quite exhausted by the end of the 9 1/2 hour s that we spend there each day. It wasn't such a problem this week but I will be starting back at my other job this week coming and I m worrried it will just be too much.
One of my fellow student collegues mentioned this to our supervisor (who is also our clinical tutor - which makes it impossible for us to discuss this with an outside party) and she advised the student that this is just how it has to be and there is nothing she can do about it. She knows and understands that it is a heavy workload but thats how it is in real life and you have to get it done. Fair enough, but we are not in the "real work force" yet, we are students who are meant to be doing 32 hours of prac a week with an hour lunch break every day. When we are actually working we wont have week night and week end jobs so it wont be such a problem to stay back an hour. We have also got a heavier patient load then the previous student s becasue they've had to squueze patients from 5 students into 4 students time slots.
So discussing this with the tutor/supervisor came to no reasonable conclusion, so I decieded to try something else. I decided to try writing the patient notes whilst I am in with the pt. This works ok sometimes, but other times it has been too messy and my tutor has asked me to re-write it, and if it is a new patinet we have to write up a full SOAPIER which is impossible to do whilst you are in with the pt. Doing this also means that the Ax and Rx dont flow smoothly because I am continually stopping to write things down.
Has anyone else been in a similar situation? How did you handle it? Has anyone got any other ideas of how I can manage this situation and my time more efficiently?
Thanks
Saturday, August 25, 2007
Neuro
Hi Everyone,
I started my neuro clinic this week and have found myself on a very steep learning experience. The facility that I am at uses a predominantly Bobath approach and while we are encouraged to use any of the techniques we learnt at uni, we also have the opportunity to learn a wide variety of new techniques from the staff. I have been very focused on trying to learn these techniques and consolidate the ones from uni and because of this, I feel that I have not been able to give as much attention as I need to in observing the patients posture and position during treatments, even though I know it is vital that the techniques are performed in good positions. It has felt as though there are just too many things to think of because I have to consider my body position, the patients body position, the movements that I want them to do, the movements that I don’t want them to do and then what to do with my hands and actually coordinating that. I feel that I have already improved in being able to put everything together since I started on Monday, but am still finding it difficult. In order to improve my ability to put together all of these skills, I plan to take every possible opportunity to practice hands on skills so that they become more automatic and I can focus on other important aspects of the treatment. I will also consider using a mirror in front of the patient so that I can see their position when I need to be behind or at the side of them. Any other ideas??
Mel
I started my neuro clinic this week and have found myself on a very steep learning experience. The facility that I am at uses a predominantly Bobath approach and while we are encouraged to use any of the techniques we learnt at uni, we also have the opportunity to learn a wide variety of new techniques from the staff. I have been very focused on trying to learn these techniques and consolidate the ones from uni and because of this, I feel that I have not been able to give as much attention as I need to in observing the patients posture and position during treatments, even though I know it is vital that the techniques are performed in good positions. It has felt as though there are just too many things to think of because I have to consider my body position, the patients body position, the movements that I want them to do, the movements that I don’t want them to do and then what to do with my hands and actually coordinating that. I feel that I have already improved in being able to put everything together since I started on Monday, but am still finding it difficult. In order to improve my ability to put together all of these skills, I plan to take every possible opportunity to practice hands on skills so that they become more automatic and I can focus on other important aspects of the treatment. I will also consider using a mirror in front of the patient so that I can see their position when I need to be behind or at the side of them. Any other ideas??
Mel
Thursday, August 23, 2007
Choosing what to treat?!
Hi all,
My post this week relates to my musculoskeletal outpatient prac. I had a very elderly patient come to me yesterday with hip pain following a total knee replacement three months earlier. On the subjective examination however, she came armed with a list of her medical conditions and another with all of her current pains and problems that she is experiencing currently. By the end of the assessment, she told me she had ongoing post-op-related knee pain and weakness in her left knee, pain in her right knee (which is awaiting to be replaced), new hip pain, long-stnding lower back pain, aching/painful feet and neck and shoulder pain. (It must be noted, this lady did not present as a psychological chronic pain patient, I do believe that the pathologies would be very easily indictaed on any exam - she is just very very old and over worked!!)
In order for me to actually get the assessment completed and some direction in my treatment for today, I simply asked the patient to pick the most severe pain that is causing her the greatest problemstoday. Luckily she was able to pin point her hip pain and I thus went about managing this problem. All of my objective measures were limited by her multiple array of 'pains' and it bacmae very clear to me that a very general rehab program would be the most effective way of managing her problems.
Therfore, even though I treated her hip pain on the first treatment, I now intend on giving her a general strengthing and stretching exercise program which I hope will assist to reduce many of her aches and pains. It just concerns me slightly that I am not focussing on her individual problmes and that perhaps these problems could be better improved by using more specific techniques. My question to anyone out there, is do you think that treating this patients problems individually at separate times would be more effective than the path I have actually chosen?
Thanks,
Kate.
My post this week relates to my musculoskeletal outpatient prac. I had a very elderly patient come to me yesterday with hip pain following a total knee replacement three months earlier. On the subjective examination however, she came armed with a list of her medical conditions and another with all of her current pains and problems that she is experiencing currently. By the end of the assessment, she told me she had ongoing post-op-related knee pain and weakness in her left knee, pain in her right knee (which is awaiting to be replaced), new hip pain, long-stnding lower back pain, aching/painful feet and neck and shoulder pain. (It must be noted, this lady did not present as a psychological chronic pain patient, I do believe that the pathologies would be very easily indictaed on any exam - she is just very very old and over worked!!)
In order for me to actually get the assessment completed and some direction in my treatment for today, I simply asked the patient to pick the most severe pain that is causing her the greatest problemstoday. Luckily she was able to pin point her hip pain and I thus went about managing this problem. All of my objective measures were limited by her multiple array of 'pains' and it bacmae very clear to me that a very general rehab program would be the most effective way of managing her problems.
Therfore, even though I treated her hip pain on the first treatment, I now intend on giving her a general strengthing and stretching exercise program which I hope will assist to reduce many of her aches and pains. It just concerns me slightly that I am not focussing on her individual problmes and that perhaps these problems could be better improved by using more specific techniques. My question to anyone out there, is do you think that treating this patients problems individually at separate times would be more effective than the path I have actually chosen?
Thanks,
Kate.
Monday, August 20, 2007
The Importance of Good Manual Muscle Tests
Hey guys,
This post is going to be a short one. In my last prac, my tutor noticed that my MMT was not spot on - I was testing hip abductors of an elderly patient, with a little compensated hip flexion. My tutor said that MMT being taught so early in the course, most students struggle to be able to do them correctly by fourth year. It is vital that we are able to do these tests well as strength in these muscles are vital especially for function in these sort of patients.
I've come to realise that I have to spend some time reviewing these techniques so that myself or the next physio would be able to monitor any strength gains over time.
Hope the next prac goes well for all!
Mark
This post is going to be a short one. In my last prac, my tutor noticed that my MMT was not spot on - I was testing hip abductors of an elderly patient, with a little compensated hip flexion. My tutor said that MMT being taught so early in the course, most students struggle to be able to do them correctly by fourth year. It is vital that we are able to do these tests well as strength in these muscles are vital especially for function in these sort of patients.
I've come to realise that I have to spend some time reviewing these techniques so that myself or the next physio would be able to monitor any strength gains over time.
Hope the next prac goes well for all!
Mark
Treating patient needs.
Whilst being on the musculo-outpatients prac, I recently had an on-going patient return after a few months of not attending physio. Whilst looking through his previous notes, I found he had attended physio for all different problems, the last visit was regarding his low back pain.
On subjective, I found out the only reason he returned was because he wanted to have his exercises reviewed and progressed. This was an 84 year old man, who liked too keep very fit and active. He reported no pain, or any other concerns affecting his everyday activities. So I though that this was a pretty straight fwd and easy case, I just had to go through his exercises, make sure he was doing it correctly and modify it.
So I did a brief objective, quickly screening all the joints/ rom etc. Some of the main findings were he had about 5-10degrees reduced PFlxn and Inversion on his (L) ankle, excess pronation L>R, and a length length discrepancy with the (R) being 2 cm longer. However none of this were his problems, so I didn’t take that into consideration, in my mind I was there to sort out his exercise program. Of course all this had to be reported to the superviser, she then came into the room to further assess his ankle. So ½ hr later there I was treating his ankle, trying to improve 5-10 degrees of Pflxn and Inversion. So at the end of the session I achieved full and equal range at both ankles, provided him with ankle ROM ex, taping, and advised him on the need for orthotics.
Normally I’d think that was a successful treatment session, however in this case, I felt the needs of the patient weren’t being addressed. The patient came in just wanting his exercises reviewed, instead he’s got his ankles treated, which weren’t causing him any pain or referred problems. I just felt the superviser overtook the session, and directed it away from the needs of the patient.
My concern is that at the end of the day, the patient didn’t get what he wanted, he was due for a review session for the following week, where is modified exercise program would have been prepared and ready to go, unfortunately he didn’t attend the following week.
So my question is, should I have just been concerned about what the patient wanted, or should I have let assessment guide treatment..
On subjective, I found out the only reason he returned was because he wanted to have his exercises reviewed and progressed. This was an 84 year old man, who liked too keep very fit and active. He reported no pain, or any other concerns affecting his everyday activities. So I though that this was a pretty straight fwd and easy case, I just had to go through his exercises, make sure he was doing it correctly and modify it.
So I did a brief objective, quickly screening all the joints/ rom etc. Some of the main findings were he had about 5-10degrees reduced PFlxn and Inversion on his (L) ankle, excess pronation L>R, and a length length discrepancy with the (R) being 2 cm longer. However none of this were his problems, so I didn’t take that into consideration, in my mind I was there to sort out his exercise program. Of course all this had to be reported to the superviser, she then came into the room to further assess his ankle. So ½ hr later there I was treating his ankle, trying to improve 5-10 degrees of Pflxn and Inversion. So at the end of the session I achieved full and equal range at both ankles, provided him with ankle ROM ex, taping, and advised him on the need for orthotics.
Normally I’d think that was a successful treatment session, however in this case, I felt the needs of the patient weren’t being addressed. The patient came in just wanting his exercises reviewed, instead he’s got his ankles treated, which weren’t causing him any pain or referred problems. I just felt the superviser overtook the session, and directed it away from the needs of the patient.
My concern is that at the end of the day, the patient didn’t get what he wanted, he was due for a review session for the following week, where is modified exercise program would have been prepared and ready to go, unfortunately he didn’t attend the following week.
So my question is, should I have just been concerned about what the patient wanted, or should I have let assessment guide treatment..
Sunday, August 19, 2007
Demotivated patient
Hi everyone,
I was in a neurosurge ward and had to treat a patient who was very demotivated about her recovery. At first when i met her, she seemed to be a very enthusiastic and motivated patient. I found that she was very compliant.
At closer look, she seemed to get quite distracted easily. She would start commenting on what the patient is doing next to her bed that she was in, etc.
Treatment also became quite difficult when I found that she seemed to get slightly agitated when i tried to bring her attention back to what I wanted her to do. My supervisor warned me that she does get very distracted and sometimes even agitated. Walking became even more difficult with her. The patient seemed to just want to stay in the bed and listen to others' conversations.
But one day I found out what was really happening in her house that she goes to during weekends. Her daughter is the carer for her mother. And currently - she can transfer with s/b * 1. But the daughter reported that she was needing two people to transfer her to the wheelchair. The daughter became frustrated and said that the mother may need to be put in a hostel.
This time, my supervisor advised me to be a little "hard" on the patient. Being a "softy" i found this actually quite difficult at first. But i learnt to tell the patient of the consequences of what happens if she regresses back to becoming dependent.
I realised that one of the biggest roles of the physiotherapists is to use their voices to motivate the patient to get out of their established comfort zones. I started to tell her how well she was doing and what will happen if she doesn't do well. Everyday - she was in tears because of this. But as my supervisor told me - i found it rewarding in the end - when i said to my patient that her STS took 1:35s - compared to 10:45 s one week before.
My patient felt happy and i found that being a great way of motivating her. In this way - the moral of my story is this - u may think u are being mean to a patient when u are hard - but one will do more favour if they help the patient get out of their comfort zones and help them achieve a goal.
sashi.
I was in a neurosurge ward and had to treat a patient who was very demotivated about her recovery. At first when i met her, she seemed to be a very enthusiastic and motivated patient. I found that she was very compliant.
At closer look, she seemed to get quite distracted easily. She would start commenting on what the patient is doing next to her bed that she was in, etc.
Treatment also became quite difficult when I found that she seemed to get slightly agitated when i tried to bring her attention back to what I wanted her to do. My supervisor warned me that she does get very distracted and sometimes even agitated. Walking became even more difficult with her. The patient seemed to just want to stay in the bed and listen to others' conversations.
But one day I found out what was really happening in her house that she goes to during weekends. Her daughter is the carer for her mother. And currently - she can transfer with s/b * 1. But the daughter reported that she was needing two people to transfer her to the wheelchair. The daughter became frustrated and said that the mother may need to be put in a hostel.
This time, my supervisor advised me to be a little "hard" on the patient. Being a "softy" i found this actually quite difficult at first. But i learnt to tell the patient of the consequences of what happens if she regresses back to becoming dependent.
I realised that one of the biggest roles of the physiotherapists is to use their voices to motivate the patient to get out of their established comfort zones. I started to tell her how well she was doing and what will happen if she doesn't do well. Everyday - she was in tears because of this. But as my supervisor told me - i found it rewarding in the end - when i said to my patient that her STS took 1:35s - compared to 10:45 s one week before.
My patient felt happy and i found that being a great way of motivating her. In this way - the moral of my story is this - u may think u are being mean to a patient when u are hard - but one will do more favour if they help the patient get out of their comfort zones and help them achieve a goal.
sashi.
Saturday, August 18, 2007
OT/PT Overlap
Hi guys, hope your pracs finished off well!
I have found on this ward (neurology) particularly that there is a huge overlap between what the OTs/OT students do with the patients and what we do. In other wards I have been on we seem to target different things and it works quite well, for example they would be assessing and working on showering, toileting, giving the equipment, fixing the home and looking at services once they leave hospital. However, in the ward I am currently on the OTs also target sitting balance, standing balance, UL function, motor recovery and bed mobility. This presents a problem in that the patients get very frustrated that, for example, the OT might see them in the morning and then I see them in the afternoon and I might assess muscle power, cerebellar signs & symptoms, sitting balance and standing balance and then perhaps work on rolling, facilitation of a recovering upper limb and standing balance, and patients get grumpy having to do the same things all again . Not to generalise too much but there are also mistakes made, perhaps from a poorer knowledge of anatomy - one OT student excitedly told a patient that he had return of his finger flexors when it was simply tenodesis occurring with wrist extension. I had to adjust for this on the ward by finding out what they were doing in their sessions and try to avoid doing those things to prevent overlap but it was disappointing as sometimes I felt that I could do a better job than what they were doing with particular things. I feel that there needs to be more of a line drawn as to who works on what to avoid patient frustration.
I have found on this ward (neurology) particularly that there is a huge overlap between what the OTs/OT students do with the patients and what we do. In other wards I have been on we seem to target different things and it works quite well, for example they would be assessing and working on showering, toileting, giving the equipment, fixing the home and looking at services once they leave hospital. However, in the ward I am currently on the OTs also target sitting balance, standing balance, UL function, motor recovery and bed mobility. This presents a problem in that the patients get very frustrated that, for example, the OT might see them in the morning and then I see them in the afternoon and I might assess muscle power, cerebellar signs & symptoms, sitting balance and standing balance and then perhaps work on rolling, facilitation of a recovering upper limb and standing balance, and patients get grumpy having to do the same things all again . Not to generalise too much but there are also mistakes made, perhaps from a poorer knowledge of anatomy - one OT student excitedly told a patient that he had return of his finger flexors when it was simply tenodesis occurring with wrist extension. I had to adjust for this on the ward by finding out what they were doing in their sessions and try to avoid doing those things to prevent overlap but it was disappointing as sometimes I felt that I could do a better job than what they were doing with particular things. I feel that there needs to be more of a line drawn as to who works on what to avoid patient frustration.
referrees
Hello bloggers,
I am currently applying for a few jobs (scary I know) and although I have provided a list of referrees, the company I am applying for has requested to speak to my most recent facility supervisor. I got along quite well with my supervisor and got a good report from her, but it just seems really weird and more than a bit awkward to ask someone who I have known for 4 weeks to act as a referree. Has anyone else had a similar situation? I really want the job, so will jump through hoops to get it, but all the same I don't want to put my supervisor out in any way as she is really busy, and I'm no longer on that placement so she has new students to deal with. Are we supposed to be looking at all our supervisors as future referrees? They have so many students come through that I'm sure they don't want to have to remember all of us and be called up out of the blue. So what do you guys think? Will be interested in any advice!
Cheers
Ez
I am currently applying for a few jobs (scary I know) and although I have provided a list of referrees, the company I am applying for has requested to speak to my most recent facility supervisor. I got along quite well with my supervisor and got a good report from her, but it just seems really weird and more than a bit awkward to ask someone who I have known for 4 weeks to act as a referree. Has anyone else had a similar situation? I really want the job, so will jump through hoops to get it, but all the same I don't want to put my supervisor out in any way as she is really busy, and I'm no longer on that placement so she has new students to deal with. Are we supposed to be looking at all our supervisors as future referrees? They have so many students come through that I'm sure they don't want to have to remember all of us and be called up out of the blue. So what do you guys think? Will be interested in any advice!
Cheers
Ez
Thursday, August 16, 2007
Family member's disrupting treatment sessions
Hi everyone,
This is my final post for this placement, hope you are all satisfied with your performance in this prac and are looking forward to our third last one ever!!
This blog relates to a situation I had during my final assessment for my respiratory placement. After reading the notes of my selected patient, it became aware to me that this patient may be very complicated given that she is under 50yrs and dying of COPD due to her extensive smoking history, has suffered ETOH abuse in the past, has anxiety issues (related to her poor relationships with her children) and is living in a shared hostel with minial support. On entry to the room my initial concerns were hightened when the patient began complaining about being kicked out of other hospitals, "just because they don't like her because she's a smoker". Half-way through my exercise program that I was prescibing (mobilisation was not indictaed due to a massive migraine and intense shortness of breath), her only 'supportive' son entered the room he: a) began ranting about his run in with the police due to a brawl he'd had earlier, b) about how he shouldn't have gotten 'high' on drugs that morning, c) about his issues with his girlfriend, d) began rolling cigarettes (NOTE: in a respiratory ward whereby most of the patients are admitted due to smoking-related causes!!!). As expected, my patient lost all interest in the exercises, her breathing began to get worse and her headache progresses so much so that she no longer wished to continue treatment.
I felt very confronted in this situation. My supervisor and I had already established that in order for this patient to comply with our treatment now and in the future (she is to attend COPD linkage services on discharge) a good relationship needed to be formed and therefor, by sending her son out of the room would have caused resentment towards instead. I was very upset that while I am educating the patient in regards to the benefits of quitting smoking, her son averts attention towards his habit which I'm sure has an influence on her ability to quit herself. My relaxtion techniques went out the door when her anxiety levels increased due to her sons ranting and I felt that my treatment session was not as effective as it could have been without the presense of her son. In future with this patient, I will time my session for times when the son is not present ans provide some education regarding the importance of reducing stress levels to assist with relaxed breathing.
Do you guys think it is the patient's due right to have any person they want in the room with them during our treatment sessions and how do you think I should broach the topic with the patient about how passive smoking and temptation to smoke are only making her condition worse?
Kate.
This is my final post for this placement, hope you are all satisfied with your performance in this prac and are looking forward to our third last one ever!!
This blog relates to a situation I had during my final assessment for my respiratory placement. After reading the notes of my selected patient, it became aware to me that this patient may be very complicated given that she is under 50yrs and dying of COPD due to her extensive smoking history, has suffered ETOH abuse in the past, has anxiety issues (related to her poor relationships with her children) and is living in a shared hostel with minial support. On entry to the room my initial concerns were hightened when the patient began complaining about being kicked out of other hospitals, "just because they don't like her because she's a smoker". Half-way through my exercise program that I was prescibing (mobilisation was not indictaed due to a massive migraine and intense shortness of breath), her only 'supportive' son entered the room he: a) began ranting about his run in with the police due to a brawl he'd had earlier, b) about how he shouldn't have gotten 'high' on drugs that morning, c) about his issues with his girlfriend, d) began rolling cigarettes (NOTE: in a respiratory ward whereby most of the patients are admitted due to smoking-related causes!!!). As expected, my patient lost all interest in the exercises, her breathing began to get worse and her headache progresses so much so that she no longer wished to continue treatment.
I felt very confronted in this situation. My supervisor and I had already established that in order for this patient to comply with our treatment now and in the future (she is to attend COPD linkage services on discharge) a good relationship needed to be formed and therefor, by sending her son out of the room would have caused resentment towards instead. I was very upset that while I am educating the patient in regards to the benefits of quitting smoking, her son averts attention towards his habit which I'm sure has an influence on her ability to quit herself. My relaxtion techniques went out the door when her anxiety levels increased due to her sons ranting and I felt that my treatment session was not as effective as it could have been without the presense of her son. In future with this patient, I will time my session for times when the son is not present ans provide some education regarding the importance of reducing stress levels to assist with relaxed breathing.
Do you guys think it is the patient's due right to have any person they want in the room with them during our treatment sessions and how do you think I should broach the topic with the patient about how passive smoking and temptation to smoke are only making her condition worse?
Kate.
Monday, August 13, 2007
'Freezing' patient
Hi guys
Today I was treating an elderly patient on the neurology ward that I had seen all last week, where she had been fairly mobile and I had walked 80m with her at the max. I knew that she had had a bad wkend with neurological episodes of unresponsiveness and so I was prepared for a decline. However, when I saw her today she was a changed woman, she moved with such a slowness of movement with really slow initiation and could not follow commands properly. I kept downgrading my planned treatment session in my head until I would have been happy if we just did a lap of the bed with her WZF then let her lay back down again. However, just past the foot of the bed as we were walking to the other side she froze and could not take the next step with her right foot that she needed. It looked really similar to when I have seen Parkinsons patients freeze in doorways, although she does not suffer from Parkinsons (her condition is rarer and more complex than this). I spent 5 min with her in the one spot, trying counting, prompts and tactile facilitation, with her getting more fatigued from the prolonged standing. A chair was only1.5m away but I had justified that it had taken her so much effort to stand from SOEB that if I moved the chair to behind her and let her sit I might not get her up again easily! Plus I didnt want to move from a guarding position to grab it. Luckily another physio walked past at that point, so I asked her to help and we tried one person weight shifting with another person trying to move the right leg to help her take the step to get her going again. However, the patient felt unsteady and began to cry, saying that she thought she was going to fall. The other physio decided that she would guard the patient whilst I grabbed the chair, we put it behind her and let her sit down, then we (big no-no I know!) dragged/lifted the chair with the lady in it to the side of the bed where she could sit in it and relax.
The things I learnt were that it can really be great to ask for help, especially from a more experienced physio, and also that it is often a better idea to let the patient rest instead of continuuing to try to push and push the same thing and distress the patient.
However I also wondered, does anyone else have any clever tricks for a neurological patient who has just seemed to 'freeze' to help get them moving again (taking into consideration frail elderly w a WZF)?
Thanks
Today I was treating an elderly patient on the neurology ward that I had seen all last week, where she had been fairly mobile and I had walked 80m with her at the max. I knew that she had had a bad wkend with neurological episodes of unresponsiveness and so I was prepared for a decline. However, when I saw her today she was a changed woman, she moved with such a slowness of movement with really slow initiation and could not follow commands properly. I kept downgrading my planned treatment session in my head until I would have been happy if we just did a lap of the bed with her WZF then let her lay back down again. However, just past the foot of the bed as we were walking to the other side she froze and could not take the next step with her right foot that she needed. It looked really similar to when I have seen Parkinsons patients freeze in doorways, although she does not suffer from Parkinsons (her condition is rarer and more complex than this). I spent 5 min with her in the one spot, trying counting, prompts and tactile facilitation, with her getting more fatigued from the prolonged standing. A chair was only1.5m away but I had justified that it had taken her so much effort to stand from SOEB that if I moved the chair to behind her and let her sit I might not get her up again easily! Plus I didnt want to move from a guarding position to grab it. Luckily another physio walked past at that point, so I asked her to help and we tried one person weight shifting with another person trying to move the right leg to help her take the step to get her going again. However, the patient felt unsteady and began to cry, saying that she thought she was going to fall. The other physio decided that she would guard the patient whilst I grabbed the chair, we put it behind her and let her sit down, then we (big no-no I know!) dragged/lifted the chair with the lady in it to the side of the bed where she could sit in it and relax.
The things I learnt were that it can really be great to ask for help, especially from a more experienced physio, and also that it is often a better idea to let the patient rest instead of continuuing to try to push and push the same thing and distress the patient.
However I also wondered, does anyone else have any clever tricks for a neurological patient who has just seemed to 'freeze' to help get them moving again (taking into consideration frail elderly w a WZF)?
Thanks
Bed sheets
Hi everyone!
This is a post for those of you who have been in a hospital and have come across the people who use that extra 'fluffy' sheet that is on top of the bed sheet, to SLIDE their patients up the bed.
All the physio's that I've seen do this have whispered to me "Don't do it while any of the nurses are looking or in front of your examiners"... They always say it is best practice to use a slide sheet, because it is easier on your back (provided you use the correct lunge technique and not a lift).
And this is totally understandable because thats what slide sheets are designed for. But when you think about it, it is almost harder on your back to use the slide sheet because you have to put it in first. You have to roll the patient from side to side just to put the slide sheet in, and in most of my experiences just that is the most demanding on your back!
I think if a patient is already lying on the extra sheet, and you use a technique that is used for a slide sheet (ie not a lift) it is occasionally the best way to go. Especially with those heavy patients.
I know with most patients its best to use the slide sheet because of the ease of sliding around, but my point is that using the second bed sheet occasionally shouldn't be frowned upon! Any comments anyone? Would love to hear what you think.
This is a post for those of you who have been in a hospital and have come across the people who use that extra 'fluffy' sheet that is on top of the bed sheet, to SLIDE their patients up the bed.
All the physio's that I've seen do this have whispered to me "Don't do it while any of the nurses are looking or in front of your examiners"... They always say it is best practice to use a slide sheet, because it is easier on your back (provided you use the correct lunge technique and not a lift).
And this is totally understandable because thats what slide sheets are designed for. But when you think about it, it is almost harder on your back to use the slide sheet because you have to put it in first. You have to roll the patient from side to side just to put the slide sheet in, and in most of my experiences just that is the most demanding on your back!
I think if a patient is already lying on the extra sheet, and you use a technique that is used for a slide sheet (ie not a lift) it is occasionally the best way to go. Especially with those heavy patients.
I know with most patients its best to use the slide sheet because of the ease of sliding around, but my point is that using the second bed sheet occasionally shouldn't be frowned upon! Any comments anyone? Would love to hear what you think.
Difficult patient
Hi all,
I work in neurology outpatients on Wednesdays. This patient is a man in his 30's who has had a extensive history of neurological pain. He has been treated in this outpatient clinic for quite a long time, and recovery has been slow. Since I do not have the patient's medical notes with me, all I know from the outpatient card was that he underwent some cervical surgeries, but both failed : he's ended up as a paraplegic. Before I treated this man, I was warned by my supervisor about how difficult he is to treat, and how he always focuses on the pain and his disability. I was also told that he has been heavily spoilt by his family - does all his transfers (hoist), personal care...everything (even giving him a drink). I was also warned that his capabilities fluctuates significantly with his mood.
During my first treatment, I quickly found out that he has a fairly negative approach to all things. He constantly reminds everyone how independent he was before, and saying that his recovery is too slow. I found that explaining to him about tone, and the importance of passive stretching is for him did not help, as it made him use it to dwell back on his physical impairments. But at least, he was not in a foul mood, and I could perform all the treatment I wanted.
During my next treatment, he came in looking very dreary. He mentioned that he saw neurology specialists on Monday, and that the team could not give him a diagnosis to his constant pain and that they were unsure of what to do. I could not do anything with him! I could not touch him, I could not move his limbs, I could not help him. I got a little frustrated, cause even lifting or touching his limbs were painful. I kept asking myself "If he came in to my clinic in a motorised wheelchair - he could get at least 90 deg of hip and knee flexion, but why is getting even 10 deg not possible with me?" I tried gentle stretches to his lower limbs, and in the end had to get him into sitting to stretch his tight calf musculature. He ended the treatment by saying that I have no idea of what to do with him - and that hurt.
My views on this case is that firstly:
1) I should not treat case with such a bias on what my supervisor has told me - I should see all patients from my point of view as well and treat each of them as "new" patients
2) I should have asked him more about the pain, and get him to explain it more to me (referred, neuropathic, somatic...etc)
3) I should acknowledge the fact that this man is in his 30's - he has been through A LOT. He's lost his independence, his mobility, his self-esteem, drive to live. Furthermore, the specialists can't give him any resolution.
4) I find it really hard to do anything when it most probably a psychosomatic cause.
What do you think I should do guys? I have him again on Wednesdays.
Mark
I work in neurology outpatients on Wednesdays. This patient is a man in his 30's who has had a extensive history of neurological pain. He has been treated in this outpatient clinic for quite a long time, and recovery has been slow. Since I do not have the patient's medical notes with me, all I know from the outpatient card was that he underwent some cervical surgeries, but both failed : he's ended up as a paraplegic. Before I treated this man, I was warned by my supervisor about how difficult he is to treat, and how he always focuses on the pain and his disability. I was also told that he has been heavily spoilt by his family - does all his transfers (hoist), personal care...everything (even giving him a drink). I was also warned that his capabilities fluctuates significantly with his mood.
During my first treatment, I quickly found out that he has a fairly negative approach to all things. He constantly reminds everyone how independent he was before, and saying that his recovery is too slow. I found that explaining to him about tone, and the importance of passive stretching is for him did not help, as it made him use it to dwell back on his physical impairments. But at least, he was not in a foul mood, and I could perform all the treatment I wanted.
During my next treatment, he came in looking very dreary. He mentioned that he saw neurology specialists on Monday, and that the team could not give him a diagnosis to his constant pain and that they were unsure of what to do. I could not do anything with him! I could not touch him, I could not move his limbs, I could not help him. I got a little frustrated, cause even lifting or touching his limbs were painful. I kept asking myself "If he came in to my clinic in a motorised wheelchair - he could get at least 90 deg of hip and knee flexion, but why is getting even 10 deg not possible with me?" I tried gentle stretches to his lower limbs, and in the end had to get him into sitting to stretch his tight calf musculature. He ended the treatment by saying that I have no idea of what to do with him - and that hurt.
My views on this case is that firstly:
1) I should not treat case with such a bias on what my supervisor has told me - I should see all patients from my point of view as well and treat each of them as "new" patients
2) I should have asked him more about the pain, and get him to explain it more to me (referred, neuropathic, somatic...etc)
3) I should acknowledge the fact that this man is in his 30's - he has been through A LOT. He's lost his independence, his mobility, his self-esteem, drive to live. Furthermore, the specialists can't give him any resolution.
4) I find it really hard to do anything when it most probably a psychosomatic cause.
What do you think I should do guys? I have him again on Wednesdays.
Mark
Sunday, August 12, 2007
My Knee
Hey all!
In this blog I wanted to bring up the issue of reliability of some of the musculo special tests and reliability between therapist. This isn’t directly related to the clinic I am on right now (musculo outpatients), but it does bare an influence in clinical reasoning and decision making.
I recently hurt my knee whilst playing netball, I was in a lunge position ( R leg in front), and turned to get out of the position. I cant remember which way I turned, but there wasn’t a large amount of movement. I felt an instant excrutiating sharp pain on the lat aspect of my R knee and also heard a click/pop, I was unable to put weight thru it for atleast 5 mins. But was gradually able to SLS on the R without too much effort. However initially everytime I straightening my knee, there was clicking. First aid consisted of rest and ice.
Over night there was no significant swelling, or bruising. However I had 10deg quads lag (normally I have very hyperextended), and was only able to flex my knee to 80deg due to the sharp pain. Everytime I tried to straighten my leg, I just felt there was sumthing that kept blocking the movement. My initial diagnosis was either LCL or lat meniscal involvement.
I saw the physio the next day, who told me, no significant damage had been done, it was just maltracking of the patella. I was told it would get better in no time, and just to continue to ITB stretches, esp before games. As I complained of pain on my lat side, no pain was provoked on palpation of lat aspect, and a Mcmurrays wasn’t done, because I didn’t have full range flexion as it was too painful. Later on that day, whilst I was at work (working in a private practice), I was explaining to some of the other physio what had happened. Just by listening to mechanism of injury, and what my knee felt like, they all suspected there was ligamentous involvement. So all 3 physios re-tested my knee, and confirmed it was partial MCL and meniscal involvement. There was some swelling, I was TOP on the medial aspect, had partially lax MCL on the R, and Mcmurrays was tested in prone, which ended up being positive. There advice was conservative management, rest next 4-6 weeks.
As the physio earlier hadn’t done some of the test, I thought the second diagnosis was more viable. Being on musculo prac, its always fun to test things out on eachother, so one of the student and superviser tested out my knee, almost all the tests ended up being negative and the patella compression test being the only positive one, so this backed up what the original physio thought. Of course none of the physios are willing to admit they maybe wrong, all convinced they have the right diagnosis. To throw another spanner in the works, 4th day post injury, another physio disagreed with everyone, and said it was most probably popliteus!
So 3 different days, 4 different diagnosis.
Day 1: Maltracking of patella OR MCL/meniscal
Day 2: Patellofemoral
Day 3: Popliteus strain (!)
As a patient and physio student, I’m concerned that special tests are giving false positive results, and that diagnosis keeps changing on a daily basis! This as made me realize the importance of testing & retesting all aspects of the knee, not just where pain is or relying on the mechanism of injury, and making assumptions, testing both sides (turns out I’m lax on both my MCLs), and taking into consideration the effect of swelling, on giving false positive results (ie. McMurrays).
As for my knee, its certainly gotten a lot better, have both full range flexion and extension, though there is still pain at the EOR with overpressure. Pain is no longer on the lateral aspect, more a dull ache posterior aspect of knee.
So…anyone know whats wrong with my knee??
In this blog I wanted to bring up the issue of reliability of some of the musculo special tests and reliability between therapist. This isn’t directly related to the clinic I am on right now (musculo outpatients), but it does bare an influence in clinical reasoning and decision making.
I recently hurt my knee whilst playing netball, I was in a lunge position ( R leg in front), and turned to get out of the position. I cant remember which way I turned, but there wasn’t a large amount of movement. I felt an instant excrutiating sharp pain on the lat aspect of my R knee and also heard a click/pop, I was unable to put weight thru it for atleast 5 mins. But was gradually able to SLS on the R without too much effort. However initially everytime I straightening my knee, there was clicking. First aid consisted of rest and ice.
Over night there was no significant swelling, or bruising. However I had 10deg quads lag (normally I have very hyperextended), and was only able to flex my knee to 80deg due to the sharp pain. Everytime I tried to straighten my leg, I just felt there was sumthing that kept blocking the movement. My initial diagnosis was either LCL or lat meniscal involvement.
I saw the physio the next day, who told me, no significant damage had been done, it was just maltracking of the patella. I was told it would get better in no time, and just to continue to ITB stretches, esp before games. As I complained of pain on my lat side, no pain was provoked on palpation of lat aspect, and a Mcmurrays wasn’t done, because I didn’t have full range flexion as it was too painful. Later on that day, whilst I was at work (working in a private practice), I was explaining to some of the other physio what had happened. Just by listening to mechanism of injury, and what my knee felt like, they all suspected there was ligamentous involvement. So all 3 physios re-tested my knee, and confirmed it was partial MCL and meniscal involvement. There was some swelling, I was TOP on the medial aspect, had partially lax MCL on the R, and Mcmurrays was tested in prone, which ended up being positive. There advice was conservative management, rest next 4-6 weeks.
As the physio earlier hadn’t done some of the test, I thought the second diagnosis was more viable. Being on musculo prac, its always fun to test things out on eachother, so one of the student and superviser tested out my knee, almost all the tests ended up being negative and the patella compression test being the only positive one, so this backed up what the original physio thought. Of course none of the physios are willing to admit they maybe wrong, all convinced they have the right diagnosis. To throw another spanner in the works, 4th day post injury, another physio disagreed with everyone, and said it was most probably popliteus!
So 3 different days, 4 different diagnosis.
Day 1: Maltracking of patella OR MCL/meniscal
Day 2: Patellofemoral
Day 3: Popliteus strain (!)
As a patient and physio student, I’m concerned that special tests are giving false positive results, and that diagnosis keeps changing on a daily basis! This as made me realize the importance of testing & retesting all aspects of the knee, not just where pain is or relying on the mechanism of injury, and making assumptions, testing both sides (turns out I’m lax on both my MCLs), and taking into consideration the effect of swelling, on giving false positive results (ie. McMurrays).
As for my knee, its certainly gotten a lot better, have both full range flexion and extension, though there is still pain at the EOR with overpressure. Pain is no longer on the lateral aspect, more a dull ache posterior aspect of knee.
So…anyone know whats wrong with my knee??
Manual Handling
Hi everyone,
Im at a neurosurge practical. This practical really tests your physical strength, not just your intellectual capacity. It involves a lot of transferring dependent patients and also being confident with it.
The first 2 weeks were very challenging physically. I found it tough and got tired by the end of the day - usually went straight to bed. Even worse - I got a pointer that my manual handling is not upto standard in the mid-placement assessment.
Recently, my friend suggested working out more often than once a week. This does not mean going to gym everyday. It can be just doing something you like - dancing, stretching or sit-ups, or push-ups in your own room. I tried this.
Along with this - i watched a lot of other therapists treat their patients and transfer them. I even helped one of them 2-3 times. She suggested that - since Im a very small person, doing things on my own is not a great idea....and I needed to learn to ask for help.
I implemented the above suggestions and found that my manual handling was a lot better in the 3rd week and even my tutor commented that it has improved markedly.
It is a very physical area to work in.....and I realise the importance of not only taking care of my patients, but also my own body. This involved me in coming up with the strategies - such as building up strength to do this job, asking for help when I need and being conscious about no lift policy - which I have realised is extremely important. This is especially the case after hearing from so many experienced neuro-physios about their crook backs.
What do you guys think? What are your experiences in this.....
Sashi.
Im at a neurosurge practical. This practical really tests your physical strength, not just your intellectual capacity. It involves a lot of transferring dependent patients and also being confident with it.
The first 2 weeks were very challenging physically. I found it tough and got tired by the end of the day - usually went straight to bed. Even worse - I got a pointer that my manual handling is not upto standard in the mid-placement assessment.
Recently, my friend suggested working out more often than once a week. This does not mean going to gym everyday. It can be just doing something you like - dancing, stretching or sit-ups, or push-ups in your own room. I tried this.
Along with this - i watched a lot of other therapists treat their patients and transfer them. I even helped one of them 2-3 times. She suggested that - since Im a very small person, doing things on my own is not a great idea....and I needed to learn to ask for help.
I implemented the above suggestions and found that my manual handling was a lot better in the 3rd week and even my tutor commented that it has improved markedly.
It is a very physical area to work in.....and I realise the importance of not only taking care of my patients, but also my own body. This involved me in coming up with the strategies - such as building up strength to do this job, asking for help when I need and being conscious about no lift policy - which I have realised is extremely important. This is especially the case after hearing from so many experienced neuro-physios about their crook backs.
What do you guys think? What are your experiences in this.....
Sashi.
Saturday, August 11, 2007
Don't upset your supervisor
Hello there bloggers,
Sorry for the late blogg.
Ok, currently I am on cardio prac at a hospital with another student. After a week and a half things were going great and we felt really comfortable with our facility supervisor and were learning heaps!! Because we felt so comfortable with her, when she asked us one lunchtime what area of physio we wanted to get into when we graduated we were honest with her. I said I wanted to work in the mining sector or corporate health/ workplace health and safety, and the other student said she wanted to travel for a couple of years and maybe didn't want to work as a physio at all. Our supervisor looked shocked and commented to me "Do you really think a new graduate will be able to get work in those areas? ha ha" which made me feel about an inch tall, and commented to the other student "Well do you think you'll be able to maintain your physio skills over 2 years and come back and get a real job?" Anyway, after this we found that the supervisor who had initially been quite happy to show us as much cardio stuff as possible (ie suctioning, crazy attachments and monitors, really critically ill patients) suddenly had us just walking the most basic patients up and down the corridor. It was almost like she had decided that if we weren't interested in working in cardio, then we didn't need to be shown any on the really interesting more difficult things. I'm wondering if it would have been better to have just said "I'm not sure what area I want to work in, but I'm really enjoying this placement" which is technically a lie, but might have kept us on side with our supervisor?? What do you guys think? When you get asked, do you say what you actually want to do, or do you pretend that you are really interested in the area you are currently on prac in??
Cheers
Ez
Sorry for the late blogg.
Ok, currently I am on cardio prac at a hospital with another student. After a week and a half things were going great and we felt really comfortable with our facility supervisor and were learning heaps!! Because we felt so comfortable with her, when she asked us one lunchtime what area of physio we wanted to get into when we graduated we were honest with her. I said I wanted to work in the mining sector or corporate health/ workplace health and safety, and the other student said she wanted to travel for a couple of years and maybe didn't want to work as a physio at all. Our supervisor looked shocked and commented to me "Do you really think a new graduate will be able to get work in those areas? ha ha" which made me feel about an inch tall, and commented to the other student "Well do you think you'll be able to maintain your physio skills over 2 years and come back and get a real job?" Anyway, after this we found that the supervisor who had initially been quite happy to show us as much cardio stuff as possible (ie suctioning, crazy attachments and monitors, really critically ill patients) suddenly had us just walking the most basic patients up and down the corridor. It was almost like she had decided that if we weren't interested in working in cardio, then we didn't need to be shown any on the really interesting more difficult things. I'm wondering if it would have been better to have just said "I'm not sure what area I want to work in, but I'm really enjoying this placement" which is technically a lie, but might have kept us on side with our supervisor?? What do you guys think? When you get asked, do you say what you actually want to do, or do you pretend that you are really interested in the area you are currently on prac in??
Cheers
Ez
Thursday, August 9, 2007
The passing of patients
Hi all,
This post is to discuss the experience of treating a patient who ends up passing away while still on your patient lists (and no, not as of a result of your treatment but more for uncurable medical reasons). Over last weekend, my patient with an exacerbation of COPD and a history of severe lung cancer passed away after the medical team could not get her breathing issues under control. I has been treating this patient for up to one hour every day for the previous week and had finally begun to form a close bond with her (she was initially difficult and thus I was quite happy with the raport we had develpoed).
Once my supervisor told me on arrival to the ward that my patient had passed away, I felt very odd. I felt initially very sad of course and then I felt a strange emotion that was difficult to interperate. During our last treatment session, my patient had made great progress as she had finally managed to get out of bed and take some steps. Thus when I was told that all of the hours spent working very hard with this patient had been in the end unsuccessful. Once I was over the initial shock, I got to work and hardly had time to ponder the situation properly. Now on reflection of the situation, I wonder what a normal reaction to this kind of experience is: as a professional, we are suppossed to keep a certain distnce from our patients personally, however as we know, after spending a certain amount of time with one person, you begin to learn more about them and get closer. The greiving process is different, so I wonder whether it is acceptable to really greive the loss of our patients like we owuld other people in our lives or do we not really have this right as we only really knew the patient for a short period of time and really knew nothing much about who they were previously. If any of you guys have experinced the death of your patient and have thought about this as well, I'd be very interested in hearing your thoughts,
Thanks, Kate.
This post is to discuss the experience of treating a patient who ends up passing away while still on your patient lists (and no, not as of a result of your treatment but more for uncurable medical reasons). Over last weekend, my patient with an exacerbation of COPD and a history of severe lung cancer passed away after the medical team could not get her breathing issues under control. I has been treating this patient for up to one hour every day for the previous week and had finally begun to form a close bond with her (she was initially difficult and thus I was quite happy with the raport we had develpoed).
Once my supervisor told me on arrival to the ward that my patient had passed away, I felt very odd. I felt initially very sad of course and then I felt a strange emotion that was difficult to interperate. During our last treatment session, my patient had made great progress as she had finally managed to get out of bed and take some steps. Thus when I was told that all of the hours spent working very hard with this patient had been in the end unsuccessful. Once I was over the initial shock, I got to work and hardly had time to ponder the situation properly. Now on reflection of the situation, I wonder what a normal reaction to this kind of experience is: as a professional, we are suppossed to keep a certain distnce from our patients personally, however as we know, after spending a certain amount of time with one person, you begin to learn more about them and get closer. The greiving process is different, so I wonder whether it is acceptable to really greive the loss of our patients like we owuld other people in our lives or do we not really have this right as we only really knew the patient for a short period of time and really knew nothing much about who they were previously. If any of you guys have experinced the death of your patient and have thought about this as well, I'd be very interested in hearing your thoughts,
Thanks, Kate.
Tuesday, August 7, 2007
Patients!
Hey All!
Apologies for the late post!
Recently on my musculo prac, I came across a really difficult patient. Difficult for several reasons:
Widespread pain, almost ¾ of the body chart was filled up with pain levels rating from 7-9/10. She had pain covering her entire (R) half of the trunk, front and back, (R) arm, low back pain, with pain referral down both legs.
Very impatient, especially on initial assessment, she just wanted me to get on with the treatment, and stop asking her questions, and assessing everything.
Also I suspected a lot of psychological/yellow flag issues: long history for pain (8 yrs), and single mum with severly disabled child.
Obviously given her problematic areas, there was a lot of assessing to do, and especially when I was getting very vague and unhelpful answers, I had to keep asking the same questions in a different way to get a clear answer. At one stage she got very angry and upset at me “stop asking me the same questions, enough assessment, just start the treatment”, she even took the assessment form off me, and started filling it out herself to speed things up.
I tried to explain to her why I was doing such a thorough assessment, especially because we didn’t have a diagnosis, and also because there were so many affected areas, we needed to find out what the limitations were in order for us to treat properly. Don’t really think she was convinced, and I think she held really high expectations, and wanted to be “cured” straight away.
Anyway after an extended assessment (over 2 sessions, initial primarily focusing on THx and follow up on shoulder), I came up with the following problems: Supraspinatus impingement 2° poor posture and GHJ hypomobility, multi-segmental thoracic hypomobility, tight musculature and costovertebral strain. Lucky for me, I didn’t have to look into LBP, because she was referred from the Dr, I just had to focus on what was written on the referral “chronic thoracic pain”.
Next hurdle was deciding where to start with treatment. I initially started with the thoracic spine, but got very minimal improvements, the patient reported slight bit of relief. On the second visit, I looked into the shoulder, and after treatment, consisting of shoulder mobs and STM, there was significant improvements, both subjectively and objectively. Currently I’m seeing this patient 2 times a week, for an extended consult, so I can treat both her thoracic and shoulder problems.
As a result of this experience, I’ve learned the importance of verbalizing to the patients what we’re assessing, why and the findings. I find myself having to think about what I’m doing, and what the assessment findings mean, and having to rationalize treatment. Which hopefully will come in handy for the PCR.
Also I’ve learned that I don’t have to tackle all the problems at once, sometimes its just trial and error, and I just have to pick a point to start, and work from there.
As for the patient, there have been steady improvements. Considering I found her difficult initially, and hard to build rapport with, I’ve found that we get along much better, are able to have good chat. She’s also more tolerated as I do my re-ax, especially because she’s seeing improvements as well.
Rev
Apologies for the late post!
Recently on my musculo prac, I came across a really difficult patient. Difficult for several reasons:
Widespread pain, almost ¾ of the body chart was filled up with pain levels rating from 7-9/10. She had pain covering her entire (R) half of the trunk, front and back, (R) arm, low back pain, with pain referral down both legs.
Very impatient, especially on initial assessment, she just wanted me to get on with the treatment, and stop asking her questions, and assessing everything.
Also I suspected a lot of psychological/yellow flag issues: long history for pain (8 yrs), and single mum with severly disabled child.
Obviously given her problematic areas, there was a lot of assessing to do, and especially when I was getting very vague and unhelpful answers, I had to keep asking the same questions in a different way to get a clear answer. At one stage she got very angry and upset at me “stop asking me the same questions, enough assessment, just start the treatment”, she even took the assessment form off me, and started filling it out herself to speed things up.
I tried to explain to her why I was doing such a thorough assessment, especially because we didn’t have a diagnosis, and also because there were so many affected areas, we needed to find out what the limitations were in order for us to treat properly. Don’t really think she was convinced, and I think she held really high expectations, and wanted to be “cured” straight away.
Anyway after an extended assessment (over 2 sessions, initial primarily focusing on THx and follow up on shoulder), I came up with the following problems: Supraspinatus impingement 2° poor posture and GHJ hypomobility, multi-segmental thoracic hypomobility, tight musculature and costovertebral strain. Lucky for me, I didn’t have to look into LBP, because she was referred from the Dr, I just had to focus on what was written on the referral “chronic thoracic pain”.
Next hurdle was deciding where to start with treatment. I initially started with the thoracic spine, but got very minimal improvements, the patient reported slight bit of relief. On the second visit, I looked into the shoulder, and after treatment, consisting of shoulder mobs and STM, there was significant improvements, both subjectively and objectively. Currently I’m seeing this patient 2 times a week, for an extended consult, so I can treat both her thoracic and shoulder problems.
As a result of this experience, I’ve learned the importance of verbalizing to the patients what we’re assessing, why and the findings. I find myself having to think about what I’m doing, and what the assessment findings mean, and having to rationalize treatment. Which hopefully will come in handy for the PCR.
Also I’ve learned that I don’t have to tackle all the problems at once, sometimes its just trial and error, and I just have to pick a point to start, and work from there.
As for the patient, there have been steady improvements. Considering I found her difficult initially, and hard to build rapport with, I’ve found that we get along much better, are able to have good chat. She’s also more tolerated as I do my re-ax, especially because she’s seeing improvements as well.
Rev
Monday, August 6, 2007
UTI
Hi guys,
I saw an elderly man this past week in the geriatric day hospital, and it was the first time I'm saw him. It soon occurred to me that he was severely debilitated and had mobility issues. It was kind of odd as his mobility has had a sudden decline in the last week. His son called and reported that he needed to pull his dad out of the chair this morning.
During my treatment, the man became incontinent of urine, and there was a very distinct pungent odour. I figured that this man was having an acute UTI and referred him to the nurses for a check. It was confirmed positive and I referred him back to see his GP for follow-up Rx.
It's pretty classical in its presentation, but my supervisor has told me not to let any elderly slip past you with a UTI or chest infection. Now that I've "smelt" what a UTI smells like, I'd never forget that! So remember, if there's a rather odd unexplainable decline in an elderly's mobility, ask them about their continence and other symptoms eg. fever, unwell...etc. It's most probably a UTI that can be treated quickly with antibiotics.
I saw an elderly man this past week in the geriatric day hospital, and it was the first time I'm saw him. It soon occurred to me that he was severely debilitated and had mobility issues. It was kind of odd as his mobility has had a sudden decline in the last week. His son called and reported that he needed to pull his dad out of the chair this morning.
During my treatment, the man became incontinent of urine, and there was a very distinct pungent odour. I figured that this man was having an acute UTI and referred him to the nurses for a check. It was confirmed positive and I referred him back to see his GP for follow-up Rx.
It's pretty classical in its presentation, but my supervisor has told me not to let any elderly slip past you with a UTI or chest infection. Now that I've "smelt" what a UTI smells like, I'd never forget that! So remember, if there's a rather odd unexplainable decline in an elderly's mobility, ask them about their continence and other symptoms eg. fever, unwell...etc. It's most probably a UTI that can be treated quickly with antibiotics.
Supervisors
Hi everyone.
I just wanted to put up a POSITIVE note talking about our supervisors...
As much as I occasionally feel utterly intimidated by what they say to me and other students about the amount of areas we need to improve on, I realise their job is extremely difficult.
Imagine if you were a physiotherapist with 1-5 years experience and you had to supervise a student/s.. I would be totally overwhelmed! It would scare the living day lights out of me that they would know more about things than me! Or that they would ask me questions which I didn't know the exact answer to (and make me feel totally incompetent)...
If I ever feel like the supervisors are making me feel silly, I just think of all the times I've asked them questions that they didn't know either and it makes me feel better :)
No one is perfect, and most of the supervisors try to make our placements good, so I just wanted to put up this blog to say hip hooray to all the wicked supervisors out there, and also to the ones that are trying their hardest.
Have fun this week,
Caris
I just wanted to put up a POSITIVE note talking about our supervisors...
As much as I occasionally feel utterly intimidated by what they say to me and other students about the amount of areas we need to improve on, I realise their job is extremely difficult.
Imagine if you were a physiotherapist with 1-5 years experience and you had to supervise a student/s.. I would be totally overwhelmed! It would scare the living day lights out of me that they would know more about things than me! Or that they would ask me questions which I didn't know the exact answer to (and make me feel totally incompetent)...
If I ever feel like the supervisors are making me feel silly, I just think of all the times I've asked them questions that they didn't know either and it makes me feel better :)
No one is perfect, and most of the supervisors try to make our placements good, so I just wanted to put up this blog to say hip hooray to all the wicked supervisors out there, and also to the ones that are trying their hardest.
Have fun this week,
Caris
Sunday, August 5, 2007
Bad patients are humans too
Hi everyone,
Just been treating a patient who just turned 18. She was admitted to the neurosurge ward after an accident following a hangover. She had a head injury - which involved the frontal lobe and the cerebellum. She is currently wheel-chair bound and requires 2* (A) to stand up.
She is known around the ward for swearing and shouting vulgar comments. Psychologists were particularly concerned and came frequently to the physiotherapy gym to understand her behaviour - whether it was because of the age - adolescence or due to the head injury. She was constantly talked about around the physiotherapy gym.
This made me anxious - how I will be able to interact with her in the first session. I was not sure how to build rapport with her.
However, the experience was very rewarding when my perceptions about this patient proved to be wrong. I was able to connect with her by her first name - her first name meant "Hope" in my language. When I said that to her - there came a very pretty smile.
I asked her about her family background and she told me how much she misses them.
Although, her behaviour has been unpredictable in the later sessions - (she did give me some vulgar signs during assessments ) - this patient is a young human too who has lost a very big part of her life (movements and physical independence as a young adult). With this knowledge and the experience in the first 2 sessions helped me to keep going with the assessments and treatments.
Sashi.
Just been treating a patient who just turned 18. She was admitted to the neurosurge ward after an accident following a hangover. She had a head injury - which involved the frontal lobe and the cerebellum. She is currently wheel-chair bound and requires 2* (A) to stand up.
She is known around the ward for swearing and shouting vulgar comments. Psychologists were particularly concerned and came frequently to the physiotherapy gym to understand her behaviour - whether it was because of the age - adolescence or due to the head injury. She was constantly talked about around the physiotherapy gym.
This made me anxious - how I will be able to interact with her in the first session. I was not sure how to build rapport with her.
However, the experience was very rewarding when my perceptions about this patient proved to be wrong. I was able to connect with her by her first name - her first name meant "Hope" in my language. When I said that to her - there came a very pretty smile.
I asked her about her family background and she told me how much she misses them.
Although, her behaviour has been unpredictable in the later sessions - (she did give me some vulgar signs during assessments ) - this patient is a young human too who has lost a very big part of her life (movements and physical independence as a young adult). With this knowledge and the experience in the first 2 sessions helped me to keep going with the assessments and treatments.
Sashi.
Pain
Hi everyone,
Im at a neurosurge ward and am currently treating a patient who has had an aneurysm in the (L) frontal lobe - so (R) hemi and so forth. It was one of my first sessions with her.
I was told that this patient goes teary quite frequently and that I really need to encourage her to do physio and "push" her a little bit.
I kept that in mind and did my neuro assessment and quite often had to "push" her instead of getting "stuck" while she cried.
However, once during the middle of the 1st week, she was very upset about the pain in her L knee - which she frequently complained about. She seemed more anxious than usual. At first thought, I thought, may be this is one of her usual complaints, but at closer look, she did seem to be very upset about it. I was empathetic and said I'll see what I can do about it. So I reported this to my supervisor and went to a nurse to ask about the pain medication.
I found out that my patient did not have pain medication yet.
Good learning experience not to ignore all of patient's complaints.
Im at a neurosurge ward and am currently treating a patient who has had an aneurysm in the (L) frontal lobe - so (R) hemi and so forth. It was one of my first sessions with her.
I was told that this patient goes teary quite frequently and that I really need to encourage her to do physio and "push" her a little bit.
I kept that in mind and did my neuro assessment and quite often had to "push" her instead of getting "stuck" while she cried.
However, once during the middle of the 1st week, she was very upset about the pain in her L knee - which she frequently complained about. She seemed more anxious than usual. At first thought, I thought, may be this is one of her usual complaints, but at closer look, she did seem to be very upset about it. I was empathetic and said I'll see what I can do about it. So I reported this to my supervisor and went to a nurse to ask about the pain medication.
I found out that my patient did not have pain medication yet.
Good learning experience not to ignore all of patient's complaints.
Saturday, August 4, 2007
Offended patient...
Hello all
My blog this week is about the conflict between doing very thorough assessments and frustrating the patient who just wantsto move on to treatment. I am on a Neurology ward at the moment, and I have been seeing a particular patient for a week. The first few days were predominantly assessment based with only about half the session time being dedicated to treatment, also justifying to myself that the assessments are often treatments in themselves. The assessments were pretty standard including mm strength, sensation, tone, reflexes, UL function, alignment, cranial nerves, sitting balance, standing balance, Berg Balance Scale; and examining the functinal things of rolling, supine to sit, sit to stand and ambulation. Because there were two of us responsible for this patient we would verbalise our observations as we made them. When our Curtin Clinical tutor came she would help us to analyse the functional tasks in particular and help us to break them down into impairments to help us figure out what was going on. I was aware that some of the assessment procedures had already been documented in the notes by the doctors but we are always encouraged to do our own assessments. In particular for this patient I had to write a full neuro SOAPIER on him and so I had to be very clear in my mind about what was going on and have good measures for re-assessment
Then on the Friday, whilst I was sitting in the patient's room by myself waiting for the other student to organise a wheelchair and come in, the patient snapped. He began to yell at me that he feels like a guinea pig with people assessing him all the time, that everyone is looking at the same things and he has to do the same tests over and over, that the Curtin tutor continually points out and talks about what is wrong with what he is doing in front of him, and that he does not feel like he is being 'treated like a human being'. He yelled at me for about 5 min. I think I handled his outburst well, by acknowledging his point and saying that it was good of him to let us know so we can change the structure of the sessions, and by trying to point out that we are still some students and need guidance from the Curtin Tutor, that we have to do lots of assessments to break the problems down so we know how to treat them, and that the assessments are all now completed and so the sessions would be treatment based only. We informed the Curtin tutor so the teaching sessions with her could be altered.
I empathised with what the patient was saying, and I understand that he is dealing with a lot at the moment being in hospital. Although I didnt like his method of delivery (shouting!), some of his points were valid. It is hard however for us to strike a balance between having lots of assessments as outcome measures, and discussing the findings with each other and the Curtin tutor to understand his impairments, and offending the patient. For that sessions and future sessions with this patient we are not discussing any thoughts in front of him, the Curtin tutor has backed off a bit (as a lot of his problem was with her), and obviously we are not needing to do any more assessments. The situation in general was quite stressful for me but I still feel that I have learnt from it, and perhaps in future will try to take more assessment info from the notes instead of redo-ing it myself, and making assessments more subtlely integrated into treatment, and also not correlating my ideas with the other student ntil after the treatment session if I feel the patient is likely to become offended.
My blog this week is about the conflict between doing very thorough assessments and frustrating the patient who just wantsto move on to treatment. I am on a Neurology ward at the moment, and I have been seeing a particular patient for a week. The first few days were predominantly assessment based with only about half the session time being dedicated to treatment, also justifying to myself that the assessments are often treatments in themselves. The assessments were pretty standard including mm strength, sensation, tone, reflexes, UL function, alignment, cranial nerves, sitting balance, standing balance, Berg Balance Scale; and examining the functinal things of rolling, supine to sit, sit to stand and ambulation. Because there were two of us responsible for this patient we would verbalise our observations as we made them. When our Curtin Clinical tutor came she would help us to analyse the functional tasks in particular and help us to break them down into impairments to help us figure out what was going on. I was aware that some of the assessment procedures had already been documented in the notes by the doctors but we are always encouraged to do our own assessments. In particular for this patient I had to write a full neuro SOAPIER on him and so I had to be very clear in my mind about what was going on and have good measures for re-assessment
Then on the Friday, whilst I was sitting in the patient's room by myself waiting for the other student to organise a wheelchair and come in, the patient snapped. He began to yell at me that he feels like a guinea pig with people assessing him all the time, that everyone is looking at the same things and he has to do the same tests over and over, that the Curtin tutor continually points out and talks about what is wrong with what he is doing in front of him, and that he does not feel like he is being 'treated like a human being'. He yelled at me for about 5 min. I think I handled his outburst well, by acknowledging his point and saying that it was good of him to let us know so we can change the structure of the sessions, and by trying to point out that we are still some students and need guidance from the Curtin Tutor, that we have to do lots of assessments to break the problems down so we know how to treat them, and that the assessments are all now completed and so the sessions would be treatment based only. We informed the Curtin tutor so the teaching sessions with her could be altered.
I empathised with what the patient was saying, and I understand that he is dealing with a lot at the moment being in hospital. Although I didnt like his method of delivery (shouting!), some of his points were valid. It is hard however for us to strike a balance between having lots of assessments as outcome measures, and discussing the findings with each other and the Curtin tutor to understand his impairments, and offending the patient. For that sessions and future sessions with this patient we are not discussing any thoughts in front of him, the Curtin tutor has backed off a bit (as a lot of his problem was with her), and obviously we are not needing to do any more assessments. The situation in general was quite stressful for me but I still feel that I have learnt from it, and perhaps in future will try to take more assessment info from the notes instead of redo-ing it myself, and making assessments more subtlely integrated into treatment, and also not correlating my ideas with the other student ntil after the treatment session if I feel the patient is likely to become offended.
A nightmare experience!!!
Hi everyone,
I am writing today to relay to you possibly the most scary situation I have been in all year on prac and to ask your opinion on whether I managed the situation appropriately or not. On the ward I was mobilising my patient of whom I has been treating for at least a week. This particular patient has just been told that her cancer had metastasised to her spinal cord, hence reuslting in weakness in her upper limb most significanlty but also her lower limb. The patient had been mobilising with 1x assist and a zimmerframe short distances to the toilet. She is a very heavy woman who was trying to prove to the medical team that she was ready for discharge. Howver, when I began to ambulate the patient, her lower limb all of a sudden gave way and she fell directly onto the floor. I tryed to hold her up but considering she was so large and the incident happened without notice, I could not have held her up. The patient was ok on the floor, only complaining of shoulder pain and that she would now never get home. I automatically called for help and 5 nurses arrived to help me hoist her onto a commode. My supervisor was not on the ward at the time and one of the nurses was kind enough to page her. After the situation had resolved and I was filling out the incident report form, I broke down and became very upset. My supervisor was extremely supportive and reiterated to me that the situation was unavoidable and that it was no fault of mine. I was only really sure of this when I found out that the day after the lady fell on me, she also fell while transfering with other staff.
On review of the siutation, I feel very unfortunate that this had to happen to me whilst I'm already in a high-stress situation being on prac but I do feel as though it could have happened with anyone. My main concern is that I fell apart whilst with my supervisor and showed a weakness which I'm not sure I wanted her to see. I was proud of the way I controlled the situation whist I was with the patient however I do feel like it's very unprofessional to get so upset on prac. My question to you guys, is do you think it's a really negative thing to get emotional on prac and if so, what strategies do you guys employ to remain neutral in very distressing situations??
Kate.
I am writing today to relay to you possibly the most scary situation I have been in all year on prac and to ask your opinion on whether I managed the situation appropriately or not. On the ward I was mobilising my patient of whom I has been treating for at least a week. This particular patient has just been told that her cancer had metastasised to her spinal cord, hence reuslting in weakness in her upper limb most significanlty but also her lower limb. The patient had been mobilising with 1x assist and a zimmerframe short distances to the toilet. She is a very heavy woman who was trying to prove to the medical team that she was ready for discharge. Howver, when I began to ambulate the patient, her lower limb all of a sudden gave way and she fell directly onto the floor. I tryed to hold her up but considering she was so large and the incident happened without notice, I could not have held her up. The patient was ok on the floor, only complaining of shoulder pain and that she would now never get home. I automatically called for help and 5 nurses arrived to help me hoist her onto a commode. My supervisor was not on the ward at the time and one of the nurses was kind enough to page her. After the situation had resolved and I was filling out the incident report form, I broke down and became very upset. My supervisor was extremely supportive and reiterated to me that the situation was unavoidable and that it was no fault of mine. I was only really sure of this when I found out that the day after the lady fell on me, she also fell while transfering with other staff.
On review of the siutation, I feel very unfortunate that this had to happen to me whilst I'm already in a high-stress situation being on prac but I do feel as though it could have happened with anyone. My main concern is that I fell apart whilst with my supervisor and showed a weakness which I'm not sure I wanted her to see. I was proud of the way I controlled the situation whist I was with the patient however I do feel like it's very unprofessional to get so upset on prac. My question to you guys, is do you think it's a really negative thing to get emotional on prac and if so, what strategies do you guys employ to remain neutral in very distressing situations??
Kate.
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