I really enjoyed my placement at Sir Charles Gardiner Hospital (SCGH). I felt as though i really got extra experience in my cardiorespiratory skills.
It took me about an hour and a half to get to Sir Charles Gardiner in the morning as the traffic was terrible. The parking was bad aswell so i used to park about a 20 minuite walk away from the hospital and walk from there.
Because i was on the oncology ward i saw patients with end stage cancers. I saw all different types of cancer (oncology and haemotology) and patients with chest infections, respiratory distress , pneumonias and acute exaccerbations of COPD. I got to suction and i performed three induced sputums.
Most of my patients were older in age but i occasionally saw a younger patient as well. It was difficult to not get emotionally involved with the younger patients.
Aside from this i did see 3 surgical patients on my placement, this was fantastic to get experience in this area.
It was very interesting to learn about the effects of chemotherapy on a patients blood counts and therefore the limitations of what physiotherapy can provide as an intervention. I found somtimes my intervention was extreamly limited to very basic treatments.
I dealt with issues that I hadn't had to deal with in other placements. I dealt with the issue of death. About 5 of my paitents died while I was on placment. I found this very hard to deal with and somtiems questioned whether the intervention I gave could have been more effective and in that way prevented their death. However, my supervisor reassured me that I was providing the correct effective treatment and that most of these people were at the end stage of their disease.
I also dealt with the aspect of pallitive care on this placement. I found that when sometimes people recieve pallative care they wish for no more active treatment. This meant that if this person was to get a chest infection they would recieve no more active intervention ( including physiotherapy). Again this was dificutl to deal with as ethically I felt compelled to help them out.
I learnt so much under my supervisor and although this was sometimes a sad placment, I found the experience very rewarding and challenging.
Friday, October 8, 2010
Saturday, October 2, 2010
POST 1- SCGH
Situation
I have been placed on the oncology ward at Sir Charles Gardiner Hospital (SCGH).
On the 1st week of my placement I was asked to assess and treat a patient on a different ward than the one I had been assigned to.
This particular patient was a 66 year old man who was admitted to SCGH with diarrhoea and vomiting. It was later found he had a small bowel obstruction and a laparotomy was performed with a pancolectomy (he also had a small stoma and collection bag).
This patient had a few complications after his surgery which resulted in an infection, and he was currently being treated with IV antibiotics.
This man had a past medical history of GORD, diverticulitis, HTN and high cholesterol. He lived at home alone but has a very supportive son who lives in Margret River. He usually ambulated with no aids, and he had no services put in place at home.
This man was obese, and very anxious, his son had revealed to me that this patient became depressed easily and he had attempted to commit suicide on 3 different accounts.
This man was now 6 days post-laparotomy and due to his anxiety levels, fear of falling, infection status and pain management issues he was yet to be mobilised.
Task
I was asked to assess this mans chest and ambulate him.
Action
I went in to the patients room, performed a brief subjective assessment (as the patient seemed to be getting more anxious with each question I asked), and then got him from a supine position to sitting on the edge of the bed. I then assessed his chest and got him to get up and walk with a wheeled zimmer frame. I asked him to walk to a chair I had previously placed in the hallway approximately 15 meters away from his room.
Result
I ended up walking this patient to the chair 15 meters outside his room. I also assessed his chest and gave him some breathing exercises to help reduce his risk of a chest infection and help him re-expand his lungs. In addition I also gave him some advice to continue with the ambulation we started (with a nurse present) and continue with the breathing exercises I gave him every couple of hours.
Evaluation
I think there were some strengths in my session. I did effectively mobilise this patient, and in addition I did make him feel more secure (as he was afraid of falling) while mobilising by giving him a wheeled Zimmer frame to walk with. I also had a nurse follow with a commode behind us to make him feel even more safe.
However there were some areas where I believe I could have improved in. I don’t think I used very good manual handling skills. I felt myself straining as I helped my patient move from a supine position to sitting on the edge of the bed.
In addition to this I think for this particular patient who was very anxious I could have made my instructions more clear and direct. I felt him get a bit frustrated during the session with what I was asking him to do.
Strategies
I worked out some manual handling strategies that would help jog my memory when dealing with transferring patients.
1) Keep the load close to your body.
2) Use large muscle groups and your bodyweight to counteract the patients bodyweight
3) Use momentum to aid you when transporting large loads
I worked out some key points to remember wen mobilising very anxious patients
1) Keep instructions plain, clear and concise
2) Break up the task into steps and tell them exactly what you wish them to do.
3) Set a realistic goal that they achieve.
I have been placed on the oncology ward at Sir Charles Gardiner Hospital (SCGH).
On the 1st week of my placement I was asked to assess and treat a patient on a different ward than the one I had been assigned to.
This particular patient was a 66 year old man who was admitted to SCGH with diarrhoea and vomiting. It was later found he had a small bowel obstruction and a laparotomy was performed with a pancolectomy (he also had a small stoma and collection bag).
This patient had a few complications after his surgery which resulted in an infection, and he was currently being treated with IV antibiotics.
This man had a past medical history of GORD, diverticulitis, HTN and high cholesterol. He lived at home alone but has a very supportive son who lives in Margret River. He usually ambulated with no aids, and he had no services put in place at home.
This man was obese, and very anxious, his son had revealed to me that this patient became depressed easily and he had attempted to commit suicide on 3 different accounts.
This man was now 6 days post-laparotomy and due to his anxiety levels, fear of falling, infection status and pain management issues he was yet to be mobilised.
Task
I was asked to assess this mans chest and ambulate him.
Action
I went in to the patients room, performed a brief subjective assessment (as the patient seemed to be getting more anxious with each question I asked), and then got him from a supine position to sitting on the edge of the bed. I then assessed his chest and got him to get up and walk with a wheeled zimmer frame. I asked him to walk to a chair I had previously placed in the hallway approximately 15 meters away from his room.
Result
I ended up walking this patient to the chair 15 meters outside his room. I also assessed his chest and gave him some breathing exercises to help reduce his risk of a chest infection and help him re-expand his lungs. In addition I also gave him some advice to continue with the ambulation we started (with a nurse present) and continue with the breathing exercises I gave him every couple of hours.
Evaluation
I think there were some strengths in my session. I did effectively mobilise this patient, and in addition I did make him feel more secure (as he was afraid of falling) while mobilising by giving him a wheeled Zimmer frame to walk with. I also had a nurse follow with a commode behind us to make him feel even more safe.
However there were some areas where I believe I could have improved in. I don’t think I used very good manual handling skills. I felt myself straining as I helped my patient move from a supine position to sitting on the edge of the bed.
In addition to this I think for this particular patient who was very anxious I could have made my instructions more clear and direct. I felt him get a bit frustrated during the session with what I was asking him to do.
Strategies
I worked out some manual handling strategies that would help jog my memory when dealing with transferring patients.
1) Keep the load close to your body.
2) Use large muscle groups and your bodyweight to counteract the patients bodyweight
3) Use momentum to aid you when transporting large loads
I worked out some key points to remember wen mobilising very anxious patients
1) Keep instructions plain, clear and concise
2) Break up the task into steps and tell them exactly what you wish them to do.
3) Set a realistic goal that they achieve.
Sunday, July 25, 2010
FINAL ENTRY- BHC
I thoroughly enjoyed this placement. I have loved living away from home and being independent in that sense. Getting to the hospital was easy and only a short drive from my home.
In the morning I ran the ward so a lot of my patients in the ward consisted of mobility patients and cardio respiratory patients. While in the afternoon I saw outpatients. This meant I got a great range of exposure in the cardio respiratory, gerontology, musculoskeletal and even neurology sectors of physiotherapy. I even saw a lot of women’s health patients. Firstly acutely in the hospital, after they had birthed their child and then 6 weeks after their birth for ongoing problems in the outpatient sector. I was glad to be involved with the women’s health patients, as I had not had a rotation with women’s health before.
I did learn very early on that prioritising your patient list is essential. As there was only one physiotherapist allocated to the ward patients (in the morning from 8am- 12pm) it was imperative to have good time management skills. By the end of the placement I was running the ward independently. This was a great experience.
I was initially expecting a lot of the conditions to be very different from the conditions down in Perth but I found that
I even got to do some home visits with the occupational therapist. The home visits were very surprising. I was able to see how the aboriginal people lived and the great difference between the European/Australian culture and the indigenous culture. I found some of the people lived bellow the poverty line, however they seemed content in their lifestyle. It was very enlightening and refreshing to be exposed to their way of life.
I loved working with the aboriginal people, I initially found it quiet difficult to relate with them but after establishing a rapport with the patients I was able to converse with them quiet naturally.
In the outpatient sector I found that the indigenous people did tend to be tardy, sometimes turning up to the clinic half an hour after their treatment session. Other times they would just turn up on a given day and expect to be treated. It was difficult in some senses because the person needed treatment, so I found myself sometimes working my schedule around so I could see the patient when they presented. I also did find that the indigenous people didn’t tend to do their exercises, so usually I would give them 1 or 2 exercises that I would stress were very important and then tried to kept them as simple as I could.
I have learnt so much from this placment, and i am thrilled that i have had the opportunity to work closley with the aboriginal people.
In the morning I ran the ward so a lot of my patients in the ward consisted of mobility patients and cardio respiratory patients. While in the afternoon I saw outpatients. This meant I got a great range of exposure in the cardio respiratory, gerontology, musculoskeletal and even neurology sectors of physiotherapy. I even saw a lot of women’s health patients. Firstly acutely in the hospital, after they had birthed their child and then 6 weeks after their birth for ongoing problems in the outpatient sector. I was glad to be involved with the women’s health patients, as I had not had a rotation with women’s health before.
I did learn very early on that prioritising your patient list is essential. As there was only one physiotherapist allocated to the ward patients (in the morning from 8am- 12pm) it was imperative to have good time management skills. By the end of the placement I was running the ward independently. This was a great experience.
I was initially expecting a lot of the conditions to be very different from the conditions down in Perth but I found that
I even got to do some home visits with the occupational therapist. The home visits were very surprising. I was able to see how the aboriginal people lived and the great difference between the European/Australian culture and the indigenous culture. I found some of the people lived bellow the poverty line, however they seemed content in their lifestyle. It was very enlightening and refreshing to be exposed to their way of life.
I loved working with the aboriginal people, I initially found it quiet difficult to relate with them but after establishing a rapport with the patients I was able to converse with them quiet naturally.
In the outpatient sector I found that the indigenous people did tend to be tardy, sometimes turning up to the clinic half an hour after their treatment session. Other times they would just turn up on a given day and expect to be treated. It was difficult in some senses because the person needed treatment, so I found myself sometimes working my schedule around so I could see the patient when they presented. I also did find that the indigenous people didn’t tend to do their exercises, so usually I would give them 1 or 2 exercises that I would stress were very important and then tried to kept them as simple as I could.
I have learnt so much from this placment, and i am thrilled that i have had the opportunity to work closley with the aboriginal people.
Week 5
Situation
On the final week of my placement, a patient was referred to me from a doctor in the emergency department at Broome health campus. My patient was a 23 year old man that had a suspected tear of his anterior talo-fibular ligament . He did the accident 1 day ago while jumping off a truck, he rolled his right ankle inwards. At the time of the injury there was no crack but he immediately felt pain in the ankle and he could not walk on it. This man had an x-ray performed of his right foot, on the day the ankle was injured, the x-ray revealed no broken bones.
He told me that he had broken his fibula 5 years ago on the left and had sprained both his ankles multiple times.
He drives trucks on a farm and is anxious about when he can return to work.
I performed a subjective and objective assessment. On the objective assessment I found he was very tender around the lateral aspect of the malleolus and the ankle itself was grossly swollen. His active range of motion was also limited in all directions. He also couldn’t walk on the ankle at all. He was mobilising with auxiliary crutches.
Task
My task was to treat this man for his suspected tear of the anterior talo-fibular ligament.
Action
I talked to this man about his injury, showed him where the ligament was on a diagram and then told him his expected healing time. I then performed ultrasound on this man for 5 minutes. I then educated him about the swelling management; icing the ankle for 15 minute time slots, elevating it on pillows, and resting it. I also gave him some tubi-grip to help with compression. I then taped the ankle up using sports tape.
Result
I ended up giving this man a 35 minute treatment session where I gave him acute management techniques for his expected tear of the anterior talo-fibular ligament.
Evaluation
I think that I explained the condition to this man well and gave him a good explanation of his expected recovery time. I think I also performed the ultrasound well ( using acute settings) and gave him good swelling management techniques.
I don’t think my taping was good at all. I think i had far too many crinkles in the tape. I also think some of the pieces of tape were too short, to provide adequate support while other pieces of tape were too tight on his foot, especially when he stood up, he said it felt very tight across his forefoot. I had to reapply the ‘heel-locks’, many times because I don’t think I positioned the tape in the right place, I defiantly need more practice at this strapping technique.
Strategies
I thought of some strategies to help me the next time I came across an ankle that needed taping.
- Make sure the ankle is in neutral (planter-grade) or even with the toes pointing a little upwards (dorsiflexion) before I begin taping.
- I think I could gain a lot of practice from taping other people’s feet. I will try to use the taping techniques on my friends and family.
- In the initial stages of an ankle strain, compression is the objective, so in these stages I must apply tape liberally over the ankle using techniques such as stirrups, and bilateral heels locks etc. with the objective of using the tape to reduce the swelling.
- After a lot of the gross swelling has gone down, supporting the ankle is imperative, and preventing it from re-injuring in vulnerable directions. So in an inversion injury applying the tape to prevent inversion would be the best course of action, in the sub-acute stages.
- Next time I will splaying the metatarsals wide before taping across the forefoot (using your fist on the planter surface of the ball of the patients foot) so that I don’t cause too much compression across the foot.
- I thought that I could measure the tape on the non-adhesive side before ripping it off. This way I will never have a piece of tape that is too short.
On the final week of my placement, a patient was referred to me from a doctor in the emergency department at Broome health campus. My patient was a 23 year old man that had a suspected tear of his anterior talo-fibular ligament . He did the accident 1 day ago while jumping off a truck, he rolled his right ankle inwards. At the time of the injury there was no crack but he immediately felt pain in the ankle and he could not walk on it. This man had an x-ray performed of his right foot, on the day the ankle was injured, the x-ray revealed no broken bones.
He told me that he had broken his fibula 5 years ago on the left and had sprained both his ankles multiple times.
He drives trucks on a farm and is anxious about when he can return to work.
I performed a subjective and objective assessment. On the objective assessment I found he was very tender around the lateral aspect of the malleolus and the ankle itself was grossly swollen. His active range of motion was also limited in all directions. He also couldn’t walk on the ankle at all. He was mobilising with auxiliary crutches.
Task
My task was to treat this man for his suspected tear of the anterior talo-fibular ligament.
Action
I talked to this man about his injury, showed him where the ligament was on a diagram and then told him his expected healing time. I then performed ultrasound on this man for 5 minutes. I then educated him about the swelling management; icing the ankle for 15 minute time slots, elevating it on pillows, and resting it. I also gave him some tubi-grip to help with compression. I then taped the ankle up using sports tape.
Result
I ended up giving this man a 35 minute treatment session where I gave him acute management techniques for his expected tear of the anterior talo-fibular ligament.
Evaluation
I think that I explained the condition to this man well and gave him a good explanation of his expected recovery time. I think I also performed the ultrasound well ( using acute settings) and gave him good swelling management techniques.
I don’t think my taping was good at all. I think i had far too many crinkles in the tape. I also think some of the pieces of tape were too short, to provide adequate support while other pieces of tape were too tight on his foot, especially when he stood up, he said it felt very tight across his forefoot. I had to reapply the ‘heel-locks’, many times because I don’t think I positioned the tape in the right place, I defiantly need more practice at this strapping technique.
Strategies
I thought of some strategies to help me the next time I came across an ankle that needed taping.
- Make sure the ankle is in neutral (planter-grade) or even with the toes pointing a little upwards (dorsiflexion) before I begin taping.
- I think I could gain a lot of practice from taping other people’s feet. I will try to use the taping techniques on my friends and family.
- In the initial stages of an ankle strain, compression is the objective, so in these stages I must apply tape liberally over the ankle using techniques such as stirrups, and bilateral heels locks etc. with the objective of using the tape to reduce the swelling.
- After a lot of the gross swelling has gone down, supporting the ankle is imperative, and preventing it from re-injuring in vulnerable directions. So in an inversion injury applying the tape to prevent inversion would be the best course of action, in the sub-acute stages.
- Next time I will splaying the metatarsals wide before taping across the forefoot (using your fist on the planter surface of the ball of the patients foot) so that I don’t cause too much compression across the foot.
- I thought that I could measure the tape on the non-adhesive side before ripping it off. This way I will never have a piece of tape that is too short.
Saturday, July 10, 2010
WEEK 3- 2nd Entry
Situation
In my third week of my placement I was given a referral for a 25year old male who had been referred by the occupational therapist in Broome Health Campus. The occupational therapist suspected tendonitis of the digiti minimi tendon in his left hand. He had been having a deep ache in his left hand for over 1 week. His past medical history included a previous fracture to his left scaphoid bone that was internally fixed 10 years ago, a left collar bone fracture over 5 years ago and gall stones which he has due to hav skin impedance and make it more difficult for the electronic treatment device to have the desired effect. e removed in two weeks.
His occupation was a pilot, and he was finding that he was experiencing increasing amounts of pain in his hand when he was flying the planes on longer journeys. I introduced myself and I asked him to come through to the treatment room with me and I performed a subjective and objective assessment. I found that he had pain at the end of range of pronation and wrist flexion, tenderness on palpation of his digiti minimi tendon and weakness on 5th finger extension when the left finger was compared to the right finger.
Task
I was asked to assess and treat this man with possible tendonitis of the digiti minimi tendon.
Action
In the treatment session I did the following;
- Firstly I performed deep tissue massage to his digiti minimi tendon with transverse tendon friction.
- I then performed ultrasound to his digiti minimi tendon.
- I advised him to wear his resting brace as much as possible during the next two weeks.
- I educated him about tendonitis, the pathology of the condition and its approximate healing time.
- I also informed him about taking anti-inflammatory medication (such as Neurophen) and its role in helping decrease the pain in tendonitis.
Result
The result was I effectively treated this man for 40 minutes, identifying his astrics signs and using the mentioned methods to address his problem list.
Evaluation
I think the treatment session went ok, I did identify that this man was in his acute phase of tendonitis, and I effectively treated the pathology and addressed his pain management.
However, I think I should have progressed this man earlier on, I think I should have given him strengthening exercises ( eccentric) within a pain free range as he was young and only mildly irritable. Originally I was going to give him the strengthening exercises on his next visit, however on reflection I think it would have been more effective to give them earlier on.I think I should have though about what order I performed my treatment in; before I administered it. I think I should have performed my education first, then my ultrasound, then my deep tissue massage with transverse tendon frictions. This would have made the treatment session flow better, in addition it would have prevented the problem of increased skin impedance with the electronic device (due to the cream used in the massage).
Strategies
I think I could defiantly improve my treatment of this individual next time if I took into consideration the following points;
- Always check how effective my treatment has been by assessing the astricks signs after one repetition of treatment. This makes me more aware if my treatment was effective and what part of my combination of treatment yielded the most results/progress.
- Use diagrams to help explain to the patient how the intervention/ treatment can be effective
- Start progressing the individual early on in the intervention; even if treating an acute problem sometimes its appropriate to give them exercises earlier on (depending on their irritability level). Don’t wait for the next treatment session to start progressing them.
- If using ultrasound and also massaging, consider using the ultrasound or electrical device first in the treatment session. The reason for this being that having things like oil or cream on the skin can add to skin impedance and make it more difficult for the electronic treatment device to have the desired effect.
In my third week of my placement I was given a referral for a 25year old male who had been referred by the occupational therapist in Broome Health Campus. The occupational therapist suspected tendonitis of the digiti minimi tendon in his left hand. He had been having a deep ache in his left hand for over 1 week. His past medical history included a previous fracture to his left scaphoid bone that was internally fixed 10 years ago, a left collar bone fracture over 5 years ago and gall stones which he has due to hav skin impedance and make it more difficult for the electronic treatment device to have the desired effect. e removed in two weeks.
His occupation was a pilot, and he was finding that he was experiencing increasing amounts of pain in his hand when he was flying the planes on longer journeys. I introduced myself and I asked him to come through to the treatment room with me and I performed a subjective and objective assessment. I found that he had pain at the end of range of pronation and wrist flexion, tenderness on palpation of his digiti minimi tendon and weakness on 5th finger extension when the left finger was compared to the right finger.
Task
I was asked to assess and treat this man with possible tendonitis of the digiti minimi tendon.
Action
In the treatment session I did the following;
- Firstly I performed deep tissue massage to his digiti minimi tendon with transverse tendon friction.
- I then performed ultrasound to his digiti minimi tendon.
- I advised him to wear his resting brace as much as possible during the next two weeks.
- I educated him about tendonitis, the pathology of the condition and its approximate healing time.
- I also informed him about taking anti-inflammatory medication (such as Neurophen) and its role in helping decrease the pain in tendonitis.
Result
The result was I effectively treated this man for 40 minutes, identifying his astrics signs and using the mentioned methods to address his problem list.
Evaluation
I think the treatment session went ok, I did identify that this man was in his acute phase of tendonitis, and I effectively treated the pathology and addressed his pain management.
However, I think I should have progressed this man earlier on, I think I should have given him strengthening exercises ( eccentric) within a pain free range as he was young and only mildly irritable. Originally I was going to give him the strengthening exercises on his next visit, however on reflection I think it would have been more effective to give them earlier on.I think I should have though about what order I performed my treatment in; before I administered it. I think I should have performed my education first, then my ultrasound, then my deep tissue massage with transverse tendon frictions. This would have made the treatment session flow better, in addition it would have prevented the problem of increased skin impedance with the electronic device (due to the cream used in the massage).
Strategies
I think I could defiantly improve my treatment of this individual next time if I took into consideration the following points;
- Always check how effective my treatment has been by assessing the astricks signs after one repetition of treatment. This makes me more aware if my treatment was effective and what part of my combination of treatment yielded the most results/progress.
- Use diagrams to help explain to the patient how the intervention/ treatment can be effective
- Start progressing the individual early on in the intervention; even if treating an acute problem sometimes its appropriate to give them exercises earlier on (depending on their irritability level). Don’t wait for the next treatment session to start progressing them.
- If using ultrasound and also massaging, consider using the ultrasound or electrical device first in the treatment session. The reason for this being that having things like oil or cream on the skin can add to skin impedance and make it more difficult for the electronic treatment device to have the desired effect.
Saturday, June 26, 2010
1st Entry- WEEK 1
Situation
On the first week of my placement on the 23/06/10 I was asked to perform a subjective and objective assessment on a 22 year old woman of aboriginal decent. This woman had given birth to a baby girl the day before on the 22/06/10. This was the first baby she had birthed, she had previously miscarried one other child. The baby was 2.956kg but otherwise healthy , the woman had a long second stage of labour ( 1 hour) and she sustained a 3rd degree tear to her perineum, the birthing process was a difficult one and the doctor decided to use forceps to aid in the delivery process. She was resting in bed when I arrived in her room and the baby was asleep in the cot/cubicle.
This was my first practical where I had been exposed to women’s health physiotherapy. I was very unsure about how this session would go.
Task
I was asked to perform a subjective and objective assessment on this 22 year old woman and then proceeded to treat the women with my supervisor.
Action
I went into the room, introduced myself and first began questioning the young aboriginal girl. I asked her about her pain levels, if she was doing anything about her tear, her urine leakage, any back pain she was having, what her usual level of activity was before and during the pregnancy, I also asked her if she had heard about pelvic floor muscles and did she know what pelvic floor exercises were.
I then performed an objective assessment, I then measured her diastases and had a look at her abdominal tone, I also noted her posture during the assessment and how she was breathing. I also noted her level of contraction of transverse abdominus when I taught her a pelvic floor muscle contraction. It would have been good to see her perineum to note the level of tissue injury (I did read in the notes that it was a 3rd degree tear) but she was uncomfortable with this, so we did not perform this part of the assessment.
Result
I performed the subjective and objective assessment and from this accurately found out her problem list so I could develop a treatment plan for this young mother.
Evaluation
I think that the session went poorly I don’t think the young girl trusted me; she seemed very reserved and didn’t really want to talk to me about certain symptoms she was experiencing, for example it took a lot of questioning to find out she was having urine leakage. It took me a very long time to describe the pelvic floor and the reasons for the symptoms she was having. The whole assessment went for 25minuites. It was even difficult to assess her diastases between the rectus abdomens muscles, because she was reluctant to participate in the assessment session.
I think there were only a few strengths with my session. I think I got all the questions out that I needed to ask her. I think I also accurately found out her problems;
1) weak pelvic floor muscles, 2) a large diastisis 3) poor abdominal tone 4) a 3rd degree tear in the perineum.
Strategies
I was thinking of how I could improve next session if I was faced with another young aboriginal mother. I came up with a list of strategies that would help with the subjective and objective part of my session:
1. When dealing with aboriginal people who sometimes don’t have a good grasp of the English language, use simplified descriptions of what is occurring and it’s also helpful to use analogies so they better understand the problem.
2. Ask direct questions; sometimes even explaining why you need to ask them a certain question. ( i.e. if you have to ask if they have had any leakage of urine?; I would explaining to her that “this will tell me if you may have a pelvic floor weakness”.)
3. Keep the questioning as short as possible, often only asking impertinent questions as they can loose attention easily and can get very agitated with all the questioning.
4. Use diagrams and pictures when explaining muscles like the pelvic floor as they are easier explained in a diagram.
5. Try to find a common ground with aboriginal people i.e. develop a report with them so they gain a certain amount of trust in you, and you don’t appear as threatening to them. This also makes it easier when progressing to the treatment phase.
6. When assessing someone who is sitting down if you are standing, always lower yourself to their level or sit lower than them so you don’t seem domineering.
On the first week of my placement on the 23/06/10 I was asked to perform a subjective and objective assessment on a 22 year old woman of aboriginal decent. This woman had given birth to a baby girl the day before on the 22/06/10. This was the first baby she had birthed, she had previously miscarried one other child. The baby was 2.956kg but otherwise healthy , the woman had a long second stage of labour ( 1 hour) and she sustained a 3rd degree tear to her perineum, the birthing process was a difficult one and the doctor decided to use forceps to aid in the delivery process. She was resting in bed when I arrived in her room and the baby was asleep in the cot/cubicle.
This was my first practical where I had been exposed to women’s health physiotherapy. I was very unsure about how this session would go.
Task
I was asked to perform a subjective and objective assessment on this 22 year old woman and then proceeded to treat the women with my supervisor.
Action
I went into the room, introduced myself and first began questioning the young aboriginal girl. I asked her about her pain levels, if she was doing anything about her tear, her urine leakage, any back pain she was having, what her usual level of activity was before and during the pregnancy, I also asked her if she had heard about pelvic floor muscles and did she know what pelvic floor exercises were.
I then performed an objective assessment, I then measured her diastases and had a look at her abdominal tone, I also noted her posture during the assessment and how she was breathing. I also noted her level of contraction of transverse abdominus when I taught her a pelvic floor muscle contraction. It would have been good to see her perineum to note the level of tissue injury (I did read in the notes that it was a 3rd degree tear) but she was uncomfortable with this, so we did not perform this part of the assessment.
Result
I performed the subjective and objective assessment and from this accurately found out her problem list so I could develop a treatment plan for this young mother.
Evaluation
I think that the session went poorly I don’t think the young girl trusted me; she seemed very reserved and didn’t really want to talk to me about certain symptoms she was experiencing, for example it took a lot of questioning to find out she was having urine leakage. It took me a very long time to describe the pelvic floor and the reasons for the symptoms she was having. The whole assessment went for 25minuites. It was even difficult to assess her diastases between the rectus abdomens muscles, because she was reluctant to participate in the assessment session.
I think there were only a few strengths with my session. I think I got all the questions out that I needed to ask her. I think I also accurately found out her problems;
1) weak pelvic floor muscles, 2) a large diastisis 3) poor abdominal tone 4) a 3rd degree tear in the perineum.
Strategies
I was thinking of how I could improve next session if I was faced with another young aboriginal mother. I came up with a list of strategies that would help with the subjective and objective part of my session:
1. When dealing with aboriginal people who sometimes don’t have a good grasp of the English language, use simplified descriptions of what is occurring and it’s also helpful to use analogies so they better understand the problem.
2. Ask direct questions; sometimes even explaining why you need to ask them a certain question. ( i.e. if you have to ask if they have had any leakage of urine?; I would explaining to her that “this will tell me if you may have a pelvic floor weakness”.)
3. Keep the questioning as short as possible, often only asking impertinent questions as they can loose attention easily and can get very agitated with all the questioning.
4. Use diagrams and pictures when explaining muscles like the pelvic floor as they are easier explained in a diagram.
5. Try to find a common ground with aboriginal people i.e. develop a report with them so they gain a certain amount of trust in you, and you don’t appear as threatening to them. This also makes it easier when progressing to the treatment phase.
6. When assessing someone who is sitting down if you are standing, always lower yourself to their level or sit lower than them so you don’t seem domineering.
Sunday, June 20, 2010
Initial Entry- Broome Health Campus
On my fourth rotation I have been placed at Broome Hospital Health Campus. I am really excited about this placement. It is a lot different than all my other placements which were situated in Perth. After the 5 weeks though I think I will be looking forward to coming home again.
I am living in a house which is only a 5 minute drive from Broome Health campus so getting to the hospital will not be a big issue, unlike my other placements which have been sometimes an hour away. I start each day at 8am and finish at 4pm.
From reading the reports on the internet and from talking to another student, I expect to be involved in a wide range of physiotherapy sectors. I expect to see cardiorespiratory, neurology and post-operative patients. In addition to this I will also be involved in women’s health physiotherapy; I am excited about this as I haven’t had a placement that covers women’s health as yet, I will need to pull out my notes from women’s health in third year. I am not sure wether I will be involved in the outpatients sector as well. But overall im glad that I will be involved in such a broad range of physiotherapy sectors as I think it will help me consolidate all my knowledge from previous placements.
As this is a regional sort of hospital, there are only a few physiotherapists that cover the whole hospital, so I expect that there may be a large caseload. I think I will need to learn how to prioritise my patient list so that I can see all the patients that urgently need treatment.
I assume that a lot of my patients will be indigenous patients. I have heard it is sometimes very difficult to establish good treatment with these people. Firstly because of their differences to Westerners with respect to time. Aboriginal people will often attend physiotherapy sessions a lot later than their allotted time; this can be very difficult when you are working on a timed schedule. Secondly I have heard that they often do not complete their exercises; as this is often an impertinent part of physiotherapy, it could be very challenging to treat the indigenous people.
I am hoping to get exposed to the aboriginal culture while on this placement. I hope by the end of this placement I have a greater understanding of the aboriginal lifestyle and their culture, back in Perth I think I have become a bit ignorant of their way of life and traditions.
I am living in a house which is only a 5 minute drive from Broome Health campus so getting to the hospital will not be a big issue, unlike my other placements which have been sometimes an hour away. I start each day at 8am and finish at 4pm.
From reading the reports on the internet and from talking to another student, I expect to be involved in a wide range of physiotherapy sectors. I expect to see cardiorespiratory, neurology and post-operative patients. In addition to this I will also be involved in women’s health physiotherapy; I am excited about this as I haven’t had a placement that covers women’s health as yet, I will need to pull out my notes from women’s health in third year. I am not sure wether I will be involved in the outpatients sector as well. But overall im glad that I will be involved in such a broad range of physiotherapy sectors as I think it will help me consolidate all my knowledge from previous placements.
As this is a regional sort of hospital, there are only a few physiotherapists that cover the whole hospital, so I expect that there may be a large caseload. I think I will need to learn how to prioritise my patient list so that I can see all the patients that urgently need treatment.
I assume that a lot of my patients will be indigenous patients. I have heard it is sometimes very difficult to establish good treatment with these people. Firstly because of their differences to Westerners with respect to time. Aboriginal people will often attend physiotherapy sessions a lot later than their allotted time; this can be very difficult when you are working on a timed schedule. Secondly I have heard that they often do not complete their exercises; as this is often an impertinent part of physiotherapy, it could be very challenging to treat the indigenous people.
I am hoping to get exposed to the aboriginal culture while on this placement. I hope by the end of this placement I have a greater understanding of the aboriginal lifestyle and their culture, back in Perth I think I have become a bit ignorant of their way of life and traditions.
Sunday, June 13, 2010
FINAL ENTRY
I really enjoyed this placement. I really enjoyed being in the outpatients sector. It was good to be able to speak to people that weren’t sick, and it was nice to be dealing with people whose whole purpose for coming into hospital was for physiotherapy treatment. They seemed a lot more receptive than some of the inpatients I have dealt with in my other placements.
I did get to see acute surgical patients ( that had come from a total knee replacement or an ACL reconstruction,) right through to the chronic back pain patients.
I did get a lot of patients that were post-operative, however there were a number of patients that came in with undiagnosed conditions, with referrals from doctors saying “longstanding pain in the knee””. I was very pleased to have patients like this because it tested my diagnostic skills.
I found I got exposure to a very wide range of patients I even got to see a few neurological patients, I had one lady with ulna nerve damage and another with carpal tunnel syndrome, I also had a lady with neural compromise, it was really interesting to see her symptoms.
There was also a large age range in the patients I saw, I saw a girl who has 13 and I also saw a lady that was 88. It was great to be able to have such a large range because I could work on my communication skills; it was challenging trying to relate to the younger patient and then quickly change my tactics to be able to relate to the elderly lady.
I got to see surgery 3 times while at Swan Districts Hospital, it was an incredible experience, I was able to witness an ACL reconstruction and a knee and shoulder arthroscopy. I think I’m able to have a better appreciation for what a patient has gone through after witnessing surgery like that.
Getting to Swan Districts took along time, especially in the mornings, sometimes in peak hour it would take up to 1hour and a half; I usually seemed to leave the hospital just before the peak hour rush home, so it took a lot less time to come home.
I really did enjoy this placement, I learnt a lot while on this placement and I think I can defiantly take those new skills with me into the future.
I did get to see acute surgical patients ( that had come from a total knee replacement or an ACL reconstruction,) right through to the chronic back pain patients.
I did get a lot of patients that were post-operative, however there were a number of patients that came in with undiagnosed conditions, with referrals from doctors saying “longstanding pain in the knee””. I was very pleased to have patients like this because it tested my diagnostic skills.
I found I got exposure to a very wide range of patients I even got to see a few neurological patients, I had one lady with ulna nerve damage and another with carpal tunnel syndrome, I also had a lady with neural compromise, it was really interesting to see her symptoms.
There was also a large age range in the patients I saw, I saw a girl who has 13 and I also saw a lady that was 88. It was great to be able to have such a large range because I could work on my communication skills; it was challenging trying to relate to the younger patient and then quickly change my tactics to be able to relate to the elderly lady.
I got to see surgery 3 times while at Swan Districts Hospital, it was an incredible experience, I was able to witness an ACL reconstruction and a knee and shoulder arthroscopy. I think I’m able to have a better appreciation for what a patient has gone through after witnessing surgery like that.
Getting to Swan Districts took along time, especially in the mornings, sometimes in peak hour it would take up to 1hour and a half; I usually seemed to leave the hospital just before the peak hour rush home, so it took a lot less time to come home.
I really did enjoy this placement, I learnt a lot while on this placement and I think I can defiantly take those new skills with me into the future.
WEEK 5
Situation
On the last week of my placement; the 09/06/10 I was given a referral for a 22 year old female. She had been referred for right sided knee pain, the onset was 2 months ago and it seemed to come on gradually. She revealed she had most of her pain while sitting for extended periods or going up stairs.
She had come into her physiotherapy appointment with her x-rays of her right knee; they revealed a very lateral sitting patella.
Her past medical history included a transposition of her left patella in July 2009, a fracture to her left talus in 2005 and multiple bilateral sprained ankles. She lived at home with her parents and was completing her university degree. She was also a very active basketball player, but since the onset of her pain, has had to rest from the sport, she was very keen to return to it.
The referring doctor suggested that she had patello-femoral pain, but the girl wished try conservative treatment (physiotherapy) before considering surgery again, even though her left operation had been very successful.
Task
My Supervisor asked me to assess and treat this girl with possible right sided patello-femoral knee pain.
Action
I performed a subjective assessment and then did a quick observation of her patella, I then assessed her active range of motion, and I performed special tests such as McConnell’s, Patella apprehension and Clark’s tests.
Result
These tests confirmed to me that this girl had patello-femoral pain. The assessment gave me a good indicators to which i could measure the effectiveness of my treatment.
Evaluation
I think there were some positive points to my objective assessment, I think I assessed most of the impertinent indicators of patellofemoral pain, such as pain scores, position of the patella, active range of motion for knee flexion, and special tests such as Clark’s and Patella Apprehension.
However I don’t think my objective assessment was fluid, I think I jumped all over the place, and it didn’t run smoothly. I think I also missed a few assessments such as muscle length ( in this case ITB length) and muscle strength ( of the hip) and I didn’t perform a quick test such as a squat.
When performing an objective assessment session I need to be more systematic in the way I go about assessing a patients impairments.This will not only make the session run smoother, it will also clearly indicate to me the astricts signs, so I can correctly measure their improvement, if there is any.
Strategies
I think if I followed a step-by step assessment plan it would be easier to identify the astricts signs and I will from these signs be able to show an adequate improvement in the patients condition. I think I should write the following steps on paper before beginning an assessment to jog my memory of what order I carry the session out and it will help me not to miss any of the assessments.
Observations (position of the patella, pronating feet etc.)
Quick tests ( Squat, pain score for that )
Active Range of Motion
Passive Range of Motion
Neurological integrity/dynamics ( if indicated)
Muscle length and strength tests.
Special Tests ( in this case Clark’s test, patella apprehension test, and McConnels test)
On the last week of my placement; the 09/06/10 I was given a referral for a 22 year old female. She had been referred for right sided knee pain, the onset was 2 months ago and it seemed to come on gradually. She revealed she had most of her pain while sitting for extended periods or going up stairs.
She had come into her physiotherapy appointment with her x-rays of her right knee; they revealed a very lateral sitting patella.
Her past medical history included a transposition of her left patella in July 2009, a fracture to her left talus in 2005 and multiple bilateral sprained ankles. She lived at home with her parents and was completing her university degree. She was also a very active basketball player, but since the onset of her pain, has had to rest from the sport, she was very keen to return to it.
The referring doctor suggested that she had patello-femoral pain, but the girl wished try conservative treatment (physiotherapy) before considering surgery again, even though her left operation had been very successful.
Task
My Supervisor asked me to assess and treat this girl with possible right sided patello-femoral knee pain.
Action
I performed a subjective assessment and then did a quick observation of her patella, I then assessed her active range of motion, and I performed special tests such as McConnell’s, Patella apprehension and Clark’s tests.
Result
These tests confirmed to me that this girl had patello-femoral pain. The assessment gave me a good indicators to which i could measure the effectiveness of my treatment.
Evaluation
I think there were some positive points to my objective assessment, I think I assessed most of the impertinent indicators of patellofemoral pain, such as pain scores, position of the patella, active range of motion for knee flexion, and special tests such as Clark’s and Patella Apprehension.
However I don’t think my objective assessment was fluid, I think I jumped all over the place, and it didn’t run smoothly. I think I also missed a few assessments such as muscle length ( in this case ITB length) and muscle strength ( of the hip) and I didn’t perform a quick test such as a squat.
When performing an objective assessment session I need to be more systematic in the way I go about assessing a patients impairments.This will not only make the session run smoother, it will also clearly indicate to me the astricts signs, so I can correctly measure their improvement, if there is any.
Strategies
I think if I followed a step-by step assessment plan it would be easier to identify the astricts signs and I will from these signs be able to show an adequate improvement in the patients condition. I think I should write the following steps on paper before beginning an assessment to jog my memory of what order I carry the session out and it will help me not to miss any of the assessments.
Observations (position of the patella, pronating feet etc.)
Quick tests ( Squat, pain score for that )
Active Range of Motion
Passive Range of Motion
Neurological integrity/dynamics ( if indicated)
Muscle length and strength tests.
Special Tests ( in this case Clark’s test, patella apprehension test, and McConnels test)
Sunday, May 30, 2010
WEEK 3
Situation
On my 3rd week of my placement, on the 25/04/10 I was asked to assess and treat an 81 year old lady who had been referred by a neurologist for nerve compression. This was my first patient I had treated in this placement that had a nerve compromise problem. I was quiet nervous about treating this lady.
This 81 year old woman had had a past medical history of 2 laminectomys ( in 2008 and 2009) a double mastectomy, a hysterectomy and a fracture to her right femur (06). She also had type 2 diabetes melinitis and hypertension that was being managed medically.
This lady lived alone, and was managing her activities of daily living independently, she was receiving no outside help from other services although her daughter occasionally helped out this lady with meals and laundry jobs.
With this lady’s referral came information about an x-ray she had performed on her neck on the (20/05/2010), the x-ray outlined that C4/C5 joint on the right had osteophytes that were crowding the joint and possibly causing nerve compression to nerve root 4. The neurologist asked if I could help treat this woman’s symptoms.
Task
I performed a subjective and objective assessment of this lady and based on my findings I established an appropriate treatment plan for her problems that I identified through my assessment.
Action
I performed my subjective assessment, asking here where her pins and needles were, in what distribution she felt them, how she would describe her pain etc. I then asked her about what activities brought on her pins and needles and how long they took to ease. I also cleared her for all other sinister (red flags) possible diseases or complications.
I then performed my objective assessment, testing her sensation (light touch and sharp/blunt discrimination) her muscle power and her reflexes.
Result
Through my assessment I found she was having pins and needles on the top of her shoulder, the pins and needles didn’t radiate down the arm but stuck on the shoulder, I found she had difficulty raising the arm above her head to put on her shirts, and clothing and it took a long time for the pins and needles and numbness to dissipate.
In addition to this I found her shoulder shrug was weaker on the right side than the left, which would support the theory of the nerve root 4 compromise. I also found she had altered sensation around the anterior shoulder and posterior arm which could also indicate nerve root 4 compromise. She also had hypersensitivity and muscle spasm in the area just medial to her scapula and bellow it as well. I found no problems with her reflexes.
Through this examination I then tried to open up the foramen of C4/C5 to help try to free nerve root 4.
Evaluation
I don’t think I performed this assessment too well, Although I performed all the necessary assessment techniques for nerve root compromise ( reduced/altered sensation, reduced muscle power and reduced reflexes), and I did establish her problem area I don’t think I performed them in a completely accurate way.
In addition I didn’t clear her thoracic spine for any involvement in that area, the next time I saw this lady, my supervisor and I established that she had nerve root T1 involvement as well, She had a stiff 1st rib on the right side which was also contributing to her problem.
Although the neurologist had only referred her for cervical radiculopathy, this lady had involvement of her thoracic spine as well.
Strategies
I worked out a few strategies that would help me when testing for nerve root compromise next time, Hopefully these will help me perform a more accurate assessment when diagnosing a patients nerve root level.
1. When performing sensation testing for nerve roots, try to test the sensation of the skin which corresponds to the dermatome position for the nerve root, so that I can establish a clear understanding of which nerve root has been compromised. In addition using a chart in front of me while performing the sensation test, just to jog my memory of where exactly the dermatomes are on the body.
2. When performing muscle tests try to perform left and right sides together if this is possible ( to get the most accurate measurement) if not, try to perform them straight after one another.
3. Always clear the joint above and bellow the affected area, in this case I should have cleared her thoracic spine and possibly her shoulder joint for any problems in those areas.
4. Use a neurodynamic test for one of the nerves to take a baseline for the patient’s irritability, use this when treating the patient to see if their symptoms improve.
On my 3rd week of my placement, on the 25/04/10 I was asked to assess and treat an 81 year old lady who had been referred by a neurologist for nerve compression. This was my first patient I had treated in this placement that had a nerve compromise problem. I was quiet nervous about treating this lady.
This 81 year old woman had had a past medical history of 2 laminectomys ( in 2008 and 2009) a double mastectomy, a hysterectomy and a fracture to her right femur (06). She also had type 2 diabetes melinitis and hypertension that was being managed medically.
This lady lived alone, and was managing her activities of daily living independently, she was receiving no outside help from other services although her daughter occasionally helped out this lady with meals and laundry jobs.
With this lady’s referral came information about an x-ray she had performed on her neck on the (20/05/2010), the x-ray outlined that C4/C5 joint on the right had osteophytes that were crowding the joint and possibly causing nerve compression to nerve root 4. The neurologist asked if I could help treat this woman’s symptoms.
Task
I performed a subjective and objective assessment of this lady and based on my findings I established an appropriate treatment plan for her problems that I identified through my assessment.
Action
I performed my subjective assessment, asking here where her pins and needles were, in what distribution she felt them, how she would describe her pain etc. I then asked her about what activities brought on her pins and needles and how long they took to ease. I also cleared her for all other sinister (red flags) possible diseases or complications.
I then performed my objective assessment, testing her sensation (light touch and sharp/blunt discrimination) her muscle power and her reflexes.
Result
Through my assessment I found she was having pins and needles on the top of her shoulder, the pins and needles didn’t radiate down the arm but stuck on the shoulder, I found she had difficulty raising the arm above her head to put on her shirts, and clothing and it took a long time for the pins and needles and numbness to dissipate.
In addition to this I found her shoulder shrug was weaker on the right side than the left, which would support the theory of the nerve root 4 compromise. I also found she had altered sensation around the anterior shoulder and posterior arm which could also indicate nerve root 4 compromise. She also had hypersensitivity and muscle spasm in the area just medial to her scapula and bellow it as well. I found no problems with her reflexes.
Through this examination I then tried to open up the foramen of C4/C5 to help try to free nerve root 4.
Evaluation
I don’t think I performed this assessment too well, Although I performed all the necessary assessment techniques for nerve root compromise ( reduced/altered sensation, reduced muscle power and reduced reflexes), and I did establish her problem area I don’t think I performed them in a completely accurate way.
In addition I didn’t clear her thoracic spine for any involvement in that area, the next time I saw this lady, my supervisor and I established that she had nerve root T1 involvement as well, She had a stiff 1st rib on the right side which was also contributing to her problem.
Although the neurologist had only referred her for cervical radiculopathy, this lady had involvement of her thoracic spine as well.
Strategies
I worked out a few strategies that would help me when testing for nerve root compromise next time, Hopefully these will help me perform a more accurate assessment when diagnosing a patients nerve root level.
1. When performing sensation testing for nerve roots, try to test the sensation of the skin which corresponds to the dermatome position for the nerve root, so that I can establish a clear understanding of which nerve root has been compromised. In addition using a chart in front of me while performing the sensation test, just to jog my memory of where exactly the dermatomes are on the body.
2. When performing muscle tests try to perform left and right sides together if this is possible ( to get the most accurate measurement) if not, try to perform them straight after one another.
3. Always clear the joint above and bellow the affected area, in this case I should have cleared her thoracic spine and possibly her shoulder joint for any problems in those areas.
4. Use a neurodynamic test for one of the nerves to take a baseline for the patient’s irritability, use this when treating the patient to see if their symptoms improve.
Sunday, May 16, 2010
WEEK 1
Situation
On Wednesday (12/05/2010) in the first week of my placement I was asked to assess and treat a 65 year old woman. This woman had come in to the Swan Districts outpatient’s physiotherapy department needing therapy for her right total knee replacement (TKR) that was performed three weeks ago on the 22/04/2010. This woman had complications after her TKR that included a clot in her left lung and DVT complications. On discharge, it was noted in her referral form, that her right quads lag was -200 and her right knee flexion was 750 . There was no other information given on her referral form.
I greeted this lady in the waiting area and asked her to come through into the treatment room, she was ambulating on two elbow crutches.
My supervisor was not going to come into the room with me but he was simply going to check with me after the assessment and treatment to see that I was on the right track.
Task
My task was to perform a subjective and objective assessment of this woman and work out an appropriate treatment plan to address any impairment’s that I might find in her assessment.
Action
I performed a subjective and objective assessment on this lady, I asked her a number of questions and tested her range of motion and strength of both her lower limbs. I found that she now had a quads lag of 300 and knee flexion of 750 . I then tailored my treatment towards increasing her range of motion for knee flexion and strengthening up her quadriceps muscles.
Result
The lady understood her programme and was happy to comply with it. The session addressed her impairments of decreased right knee flexion and decreased strength in her right leg, so it was beneficial in this way. However there were some components of my subjective assessment that needed extra work to make sure I had an accurate description of her situation.
Evaluation
I think there were some strengths in my session with this woman ; I think I performed my treatment well, and I gave her a easy exercise programme to follow at home. I think I went through the programme thoroughly with her and gave her an opportunity to ask any questions of me, making sure she understood the programme well.
I think there were some weaknesses in my session; I don’t think the subjective assessment went too well, I had to clarify some of my questions a couple of times so the patient understood what I was saying. I also forgot to ask my patient some questions that were impertinent to ask. In addition I thought that sometimes I asked questions that lead the patient to respond in a certain way; ie I influenced their answer. I think I also took a very long time with this patient; the whole session took an hour and a half.
Strategies
I worked out appropriate strategies to make sure that next time I was going to assess a patient I could perform a thorough and comprehensive subjective assessment.
1. Make sure the questions that I ask are open ended questions; where the patient can talk; giving them an opportunity to impart all their information. Also to refrain from using closed questions, where the patient only answers yes or no.
2. Make sure that my questions are not leading in anyway, that my questions do not influence my patients answer.
3. Use the prompts on the assessment sheet to make sure I don’t forget to ask any important questions.
4. Be aware when to redirect the conversation in a respectful and courteous manner ; for example when they are talking about inconsequential information.
5. Speak loudly and clearly to patients that are hard of hearing or elderly. Also make sure there hearing aid is on when asking them questions!.
6. Wear a watch to make sure I don’t go over the time limit specified for that patient.
On Wednesday (12/05/2010) in the first week of my placement I was asked to assess and treat a 65 year old woman. This woman had come in to the Swan Districts outpatient’s physiotherapy department needing therapy for her right total knee replacement (TKR) that was performed three weeks ago on the 22/04/2010. This woman had complications after her TKR that included a clot in her left lung and DVT complications. On discharge, it was noted in her referral form, that her right quads lag was -200 and her right knee flexion was 750 . There was no other information given on her referral form.
I greeted this lady in the waiting area and asked her to come through into the treatment room, she was ambulating on two elbow crutches.
My supervisor was not going to come into the room with me but he was simply going to check with me after the assessment and treatment to see that I was on the right track.
Task
My task was to perform a subjective and objective assessment of this woman and work out an appropriate treatment plan to address any impairment’s that I might find in her assessment.
Action
I performed a subjective and objective assessment on this lady, I asked her a number of questions and tested her range of motion and strength of both her lower limbs. I found that she now had a quads lag of 300 and knee flexion of 750 . I then tailored my treatment towards increasing her range of motion for knee flexion and strengthening up her quadriceps muscles.
Result
The lady understood her programme and was happy to comply with it. The session addressed her impairments of decreased right knee flexion and decreased strength in her right leg, so it was beneficial in this way. However there were some components of my subjective assessment that needed extra work to make sure I had an accurate description of her situation.
Evaluation
I think there were some strengths in my session with this woman ; I think I performed my treatment well, and I gave her a easy exercise programme to follow at home. I think I went through the programme thoroughly with her and gave her an opportunity to ask any questions of me, making sure she understood the programme well.
I think there were some weaknesses in my session; I don’t think the subjective assessment went too well, I had to clarify some of my questions a couple of times so the patient understood what I was saying. I also forgot to ask my patient some questions that were impertinent to ask. In addition I thought that sometimes I asked questions that lead the patient to respond in a certain way; ie I influenced their answer. I think I also took a very long time with this patient; the whole session took an hour and a half.
Strategies
I worked out appropriate strategies to make sure that next time I was going to assess a patient I could perform a thorough and comprehensive subjective assessment.
1. Make sure the questions that I ask are open ended questions; where the patient can talk; giving them an opportunity to impart all their information. Also to refrain from using closed questions, where the patient only answers yes or no.
2. Make sure that my questions are not leading in anyway, that my questions do not influence my patients answer.
3. Use the prompts on the assessment sheet to make sure I don’t forget to ask any important questions.
4. Be aware when to redirect the conversation in a respectful and courteous manner ; for example when they are talking about inconsequential information.
5. Speak loudly and clearly to patients that are hard of hearing or elderly. Also make sure there hearing aid is on when asking them questions!.
6. Wear a watch to make sure I don’t go over the time limit specified for that patient.
Sunday, May 9, 2010
INITIAL ENTRY- SWAN DISTRICTS
I have been placed at Swan District Hospital (SDH) for my musculoskeletal placement. I go all week from 9am-4pm on Monday and then 8am-4pm on Tuesday to Friday. I have been placed in the outpatients sector; this is very different to all my other placements which have been inpatient settings. I suspect I will see a whole range of patients who are in the acute stage right through to end stage rehabilitation.
I’m hoping to become a Musculoskeletal physiotherapist so I am really looking forward to this rotation.
I have been told by other students to expect to see post-operative patients (total hip and knee replacements and anterior cruciate ligament and rotator cuff reconstructions) and also a lot of post-fracture patients.
If I only see these types of patients, I will be a bit disappointed; the reason for this being that these types of patients will already have a diagnosis of their condition. This means that I will not be able to get practice with diagnosing a person’s problem (from their subjective and objective examination) which is done regularly in a private practice setting.
On this placement I’m hoping to see some patients with some form of neurological involvement. I think neural compromise would be very interesting to see and pick up in a patient. I hope I get some exposure to these types of patients as we have not covered a lot of ground at uni with treating patients with neurological involvement.
I’m hoping to perform my subjective and objective assessment fluently, comprehensively and thoroughly. I think there are a lot more portions to a assessment in the musculoskeletal sector in physiotherapy compared to the other sections ( such as cardio respiratory or neuro) and I’m hoping I don’t forget all my special tests we practiced in second and third years!.
I have been told that at Swan Districts Hospital you often are able to witness surgical procedures; I really hope I can witness one of those at sometime during my placement. I think witnessing something like that will broaden my understanding and appreciation of drastic operations such as total hip and knee replacements.
Im a bit concerned about the distance I have to travel to get to SDH. SDH is a long way away from me and I need to travel along the Reid highway in peak hour traffic to get to the hospital. I will have to leave a hour and a half earlier to get there in time to start the day. I think I will need early nights!.
I’m hoping to become a Musculoskeletal physiotherapist so I am really looking forward to this rotation.
I have been told by other students to expect to see post-operative patients (total hip and knee replacements and anterior cruciate ligament and rotator cuff reconstructions) and also a lot of post-fracture patients.
If I only see these types of patients, I will be a bit disappointed; the reason for this being that these types of patients will already have a diagnosis of their condition. This means that I will not be able to get practice with diagnosing a person’s problem (from their subjective and objective examination) which is done regularly in a private practice setting.
On this placement I’m hoping to see some patients with some form of neurological involvement. I think neural compromise would be very interesting to see and pick up in a patient. I hope I get some exposure to these types of patients as we have not covered a lot of ground at uni with treating patients with neurological involvement.
I’m hoping to perform my subjective and objective assessment fluently, comprehensively and thoroughly. I think there are a lot more portions to a assessment in the musculoskeletal sector in physiotherapy compared to the other sections ( such as cardio respiratory or neuro) and I’m hoping I don’t forget all my special tests we practiced in second and third years!.
I have been told that at Swan Districts Hospital you often are able to witness surgical procedures; I really hope I can witness one of those at sometime during my placement. I think witnessing something like that will broaden my understanding and appreciation of drastic operations such as total hip and knee replacements.
Im a bit concerned about the distance I have to travel to get to SDH. SDH is a long way away from me and I need to travel along the Reid highway in peak hour traffic to get to the hospital. I will have to leave a hour and a half earlier to get there in time to start the day. I think I will need early nights!.
Sunday, April 25, 2010
FINAL ENTRY
I found this placement quiet challenging. I did enjoy the cardio-respiratory side to this placement, and I found that the practical side of cardio-respiratory is very similar to the theoretical side that we learn in university.
I found I became very exhausted over this placement, I found I got very little sleep trying to get too and from Fremantle Hospital in peak hour traffic and then coming home in the same traffic, I was spending over 2 hours a day driving. I did have my own caseload in this placement on some days, other days I would work with a partner, this was advantageous because; with some patients who had a number of “attachments” it was essential to have a second pair of hands.
I ended up working in the surgical ward for over 3 weeks and then I was able to work on the general medical ward for the last 2 weeks. This was really good because I was able to see a range of different chest presentations. I got to treat patients who were at the end stage COPD, and others with chronic bronchitis on the general medical ward, but on the surgical ward I was able to get exposure to all the chest complications that can be resultant from surgery and in addition to that all the attachments a patient can have . I entered ICU about 3 times during my placement. It was great to be able to have that exposure, because the runnings of ICU differed greatly from the running’s over the whole hospital.
I got to see one pulmonary rehabilitation class at the end of my placement. It was good to get exposure to this class, I wasn’t asked to run the class but it was good to observe how they conducted the session.
I think I learnt a lot about subjective questioning in this placement, I think I improved my auscultation skills greatly as well as my reading of chest X-rays, I learnt how to refine my communication skills with patients and how to articulate myself more precisely.
I found I became very exhausted over this placement, I found I got very little sleep trying to get too and from Fremantle Hospital in peak hour traffic and then coming home in the same traffic, I was spending over 2 hours a day driving. I did have my own caseload in this placement on some days, other days I would work with a partner, this was advantageous because; with some patients who had a number of “attachments” it was essential to have a second pair of hands.
I ended up working in the surgical ward for over 3 weeks and then I was able to work on the general medical ward for the last 2 weeks. This was really good because I was able to see a range of different chest presentations. I got to treat patients who were at the end stage COPD, and others with chronic bronchitis on the general medical ward, but on the surgical ward I was able to get exposure to all the chest complications that can be resultant from surgery and in addition to that all the attachments a patient can have . I entered ICU about 3 times during my placement. It was great to be able to have that exposure, because the runnings of ICU differed greatly from the running’s over the whole hospital.
I got to see one pulmonary rehabilitation class at the end of my placement. It was good to get exposure to this class, I wasn’t asked to run the class but it was good to observe how they conducted the session.
I think I learnt a lot about subjective questioning in this placement, I think I improved my auscultation skills greatly as well as my reading of chest X-rays, I learnt how to refine my communication skills with patients and how to articulate myself more precisely.
WEEK 5-ENTRY 3
Situation
In the fifth week of my placement I was asked to give chest care advice to a 66 year old man who was 1 day post-op for a laparotomy ( upper abdominal surgery) to remove a section of his bowel that was cancerous . This man had a past medical history of type 2 diabetes melinitus, hypertension, peripheral vascular disease and a MI (2008). He lives with his wife, they have no stairs in their home and they receive no services. This man usually ambulates unaided and can walk up to 1 kilometre without needing a rest. This man was resting in bed but was in a lot of pain, scoring 7/10 at rest.
Task
I was asked to go treat this man who had undergone a laparotomy 1 day ago.
Action
I performed a subjective interview with this man and I found out a lot of the information mentioned above, I also found out that he was in a lot of pain. I then performed a objective examination and found his problem list to be 1) pain 2) decreased lung volumes 3) impaired gass exchange 4 ) reduced exercise tolerance.
I then tried to address his problems;
Intervention
This is what I did with this man:
- Taught supported cough with a rolled up towel.
- Educated him on sitting upright in bed.
- Active cycle of breathing techniques x 3 repetitions ( 5x thoracic expansion exercises)
- Gave him circulation exercises for his lower limbs (x 10 rep)
- Gave him post-operation chest education.
Result
I gave this man an effective way to clear his chest (by coughing) without increasing his levels of pain in his abdomen. And I optimised his lung function through positioning and deep breathing exercises, I also educated him on the effects of surgery on the chest.
Evaluation
I think the session went pretty averagely. I ended up saying all that I needed to tell the patient about his chest care; however I think there were a lot of improvements I could have made to the session.
The strengths in the session were; that I related well to the patient. I gave the patient all the appropriate advice they needed for correct physiotherapy chest care and he performed his exercises well under my direction.
However, there were a few weaknesses with my session as well, the structure of my advice was a bit haphazard, it needed to be more organised. At one point my patient became confused, and I needed to clarify a few of the things I was saying.
Another weakness that my supervisor pointed out; was the fact that I got a patient to do a activity and then explained the benefits after they did it, my supervisor said that it would be better to explain the benefits of something before you get a patient to perform the task. Lastly I should have made sure my patient had adequate pain relief ( checked if the nurse could give him some more pain relief) before talking to him, as his extremely high levels of pain could have affected his understanding of what I was explaining to him.
Strategies
I thought up a few good strategies that would help me when I have to perform post operational education on patients
- don’t use jargon, or medical terminology when explaining things to patients
- have a well thought out ‘post-operation’ spiel to tell patients who have undergone abdominal surgery, so they know the risks associated with surgery and the implications it has on the chest.
- Tell the patients the benefits of doing an exercise/treatment before actually getting them to perform it, as this well increase their motivation to perform a treatment and they will know the purpose of the treatment.
- Ask the patient if they have understood what your explaining to them
- Ask the patient if they have anymore questions associated with your treatment.
In the fifth week of my placement I was asked to give chest care advice to a 66 year old man who was 1 day post-op for a laparotomy ( upper abdominal surgery) to remove a section of his bowel that was cancerous . This man had a past medical history of type 2 diabetes melinitus, hypertension, peripheral vascular disease and a MI (2008). He lives with his wife, they have no stairs in their home and they receive no services. This man usually ambulates unaided and can walk up to 1 kilometre without needing a rest. This man was resting in bed but was in a lot of pain, scoring 7/10 at rest.
Task
I was asked to go treat this man who had undergone a laparotomy 1 day ago.
Action
I performed a subjective interview with this man and I found out a lot of the information mentioned above, I also found out that he was in a lot of pain. I then performed a objective examination and found his problem list to be 1) pain 2) decreased lung volumes 3) impaired gass exchange 4 ) reduced exercise tolerance.
I then tried to address his problems;
Intervention
This is what I did with this man:
- Taught supported cough with a rolled up towel.
- Educated him on sitting upright in bed.
- Active cycle of breathing techniques x 3 repetitions ( 5x thoracic expansion exercises)
- Gave him circulation exercises for his lower limbs (x 10 rep)
- Gave him post-operation chest education.
Result
I gave this man an effective way to clear his chest (by coughing) without increasing his levels of pain in his abdomen. And I optimised his lung function through positioning and deep breathing exercises, I also educated him on the effects of surgery on the chest.
Evaluation
I think the session went pretty averagely. I ended up saying all that I needed to tell the patient about his chest care; however I think there were a lot of improvements I could have made to the session.
The strengths in the session were; that I related well to the patient. I gave the patient all the appropriate advice they needed for correct physiotherapy chest care and he performed his exercises well under my direction.
However, there were a few weaknesses with my session as well, the structure of my advice was a bit haphazard, it needed to be more organised. At one point my patient became confused, and I needed to clarify a few of the things I was saying.
Another weakness that my supervisor pointed out; was the fact that I got a patient to do a activity and then explained the benefits after they did it, my supervisor said that it would be better to explain the benefits of something before you get a patient to perform the task. Lastly I should have made sure my patient had adequate pain relief ( checked if the nurse could give him some more pain relief) before talking to him, as his extremely high levels of pain could have affected his understanding of what I was explaining to him.
Strategies
I thought up a few good strategies that would help me when I have to perform post operational education on patients
- don’t use jargon, or medical terminology when explaining things to patients
- have a well thought out ‘post-operation’ spiel to tell patients who have undergone abdominal surgery, so they know the risks associated with surgery and the implications it has on the chest.
- Tell the patients the benefits of doing an exercise/treatment before actually getting them to perform it, as this well increase their motivation to perform a treatment and they will know the purpose of the treatment.
- Ask the patient if they have understood what your explaining to them
- Ask the patient if they have anymore questions associated with your treatment.
Sunday, April 11, 2010
WEEK 3
Situation
In the third week of my placement I was asked by my supervisor to assess and treat a 75 year old man, who had been taken in to Fremantle emergency department via ambulance.
The man had come in with respiratory arrest; he had had increased shortness of breath over the last two weeks and had gone to see a general practitioner three days ago. The man had a past medical history of ‘asthma’ (which was likely to be undiagnosed COPD) , high cholesterol, hypertension, peripheral vascular disease and a laperotomy in 2007 for a bowel obstruction. He was also very obese. This man also had a 40 year smoking history.
The gentleman lived alone and had no services helping him out, he used to walk approximately 500m in a day, without the help of any aids.
This man was admitted to Fremantle hospital on the 06/04/10 and I was asked to assess and treat him on the 07/04/10.
Task
I was asked to assess and treat this patient, trying to help with his respiratory problems, so he could return home to his previous level of function.
Action
I asked this patient a few questions regarding his shortness of breath, his flem production, dizziness and nausea, his pain levels and his home environment. I then performed an objective assessment, listening to his lungs with a stethoscope, listening to his cough, and feeling his chest expansion.
I then treated this patient. I gave his positions to ease his shortness of breath. I gave him techniques to clear flem/sputum from his lungs and I educated him about staying upright etc. I also gave him exercises to do hourly.
Result
The treatment session went well, the patient improved his shortness of breath and he also cleared out a fair bit of sputum/flem, the objective assessment also went well. However the subjective assessment didn’t go too well, it took along time and I had to keep rewording my questions so the patient understood.
Evaluation
I thought the session had both strengths and weaknesses in it. I thought my strengths were: 1) the treatment session addressed the patient’s main problems 2) I built a rapport very easily with the patient 3) I kept the session to a 30 minute time frame.
I thought I had some weaknesses in my session as well, I think my subjective assessment went poorly. I think I got nervous while asking the patient questions. I forgot to ask some pertinent questions and didn’t ask enough detail in other questions. In addition I wasn’t clear with some of my questions and I found I had to clarify a couple of times what I was asking the patient.
Strategies
I came up with a number of strategies to help improve my subjective assessment questioning. They were:
1) slow done, and take time asking questions
2) Use a notebook with questions written on it to help jog my memory so I don’t forget some pertinent questions when doing a subjective assessment.
3) Keep a neutral tone when talking to patients ( make sure it doesn’t sound condescending etc.)
4) Speak in a loud voice to make sure I am heard clearly and accurately. 5) Plan out what I want to ask a patient before entering the room so I know what questions are relevant to this patient before I even begin the subjective assessment
In the third week of my placement I was asked by my supervisor to assess and treat a 75 year old man, who had been taken in to Fremantle emergency department via ambulance.
The man had come in with respiratory arrest; he had had increased shortness of breath over the last two weeks and had gone to see a general practitioner three days ago. The man had a past medical history of ‘asthma’ (which was likely to be undiagnosed COPD) , high cholesterol, hypertension, peripheral vascular disease and a laperotomy in 2007 for a bowel obstruction. He was also very obese. This man also had a 40 year smoking history.
The gentleman lived alone and had no services helping him out, he used to walk approximately 500m in a day, without the help of any aids.
This man was admitted to Fremantle hospital on the 06/04/10 and I was asked to assess and treat him on the 07/04/10.
Task
I was asked to assess and treat this patient, trying to help with his respiratory problems, so he could return home to his previous level of function.
Action
I asked this patient a few questions regarding his shortness of breath, his flem production, dizziness and nausea, his pain levels and his home environment. I then performed an objective assessment, listening to his lungs with a stethoscope, listening to his cough, and feeling his chest expansion.
I then treated this patient. I gave his positions to ease his shortness of breath. I gave him techniques to clear flem/sputum from his lungs and I educated him about staying upright etc. I also gave him exercises to do hourly.
Result
The treatment session went well, the patient improved his shortness of breath and he also cleared out a fair bit of sputum/flem, the objective assessment also went well. However the subjective assessment didn’t go too well, it took along time and I had to keep rewording my questions so the patient understood.
Evaluation
I thought the session had both strengths and weaknesses in it. I thought my strengths were: 1) the treatment session addressed the patient’s main problems 2) I built a rapport very easily with the patient 3) I kept the session to a 30 minute time frame.
I thought I had some weaknesses in my session as well, I think my subjective assessment went poorly. I think I got nervous while asking the patient questions. I forgot to ask some pertinent questions and didn’t ask enough detail in other questions. In addition I wasn’t clear with some of my questions and I found I had to clarify a couple of times what I was asking the patient.
Strategies
I came up with a number of strategies to help improve my subjective assessment questioning. They were:
1) slow done, and take time asking questions
2) Use a notebook with questions written on it to help jog my memory so I don’t forget some pertinent questions when doing a subjective assessment.
3) Keep a neutral tone when talking to patients ( make sure it doesn’t sound condescending etc.)
4) Speak in a loud voice to make sure I am heard clearly and accurately. 5) Plan out what I want to ask a patient before entering the room so I know what questions are relevant to this patient before I even begin the subjective assessment
Sunday, March 28, 2010
WEEK 1- FIRST ENTRY
Situation
On the third day of my placement ( 24/03/2010) my supervisor asked me to treat a 54 year old lady. This woman was 1 day post-operation from a laprascopy (a operation involving a large incision to the abdomen) that was performed to remove half of her colon (hemicolectomy) . Her past medical history included hypertension, hypercholesterolemia, and type 2 diabetes melinitus, she was also very obese.
This lady had only recently immigrated to Australia 2 years ago and she was of Polish decent. She could not speak English very well and her understanding of the language was very limited as well. This lady lived alone but was regularly visited by both her sons.
Task
My task was to treat this lady. This woman did not actually have any current problems with her chest, but I was treating her as more of a preventative measure to stop her contracting any post-operative complications such as chest infections or circulatory problems. I needed to asses her lungs and then treat any problems I saw.
Action
Firstly I assessed this lady. I auscultated her lungs and heard some crackling in both the lungs bi-basally. This could have indicated microatelactisis, which is very common after a long anaesthetic. I felt her chest expansion, which was good both sides and listened to her cough, which was weak, dry, non-productive and ineffective. I needed to improve her cough and possibly reverse her microatelactisis.
As a treatment I got her to take some deep breaths with an inspiratory hold at the end of them. I also showed her how to perform a supported cough (with a rolled up towel pressed against her incision site) to protect her incision site on her abdomen. As she was not feeling well enough to get out of bed I positioned her in high sitting in the bed and them attempted to educate her about the procedure, how important it was for her to keep taking deep breaths and that if she needed to cough up any mucous or flem she must attempt to cough while supporting her incision site.
Result
This woman then had post operative exercises that would help in preventing any lung or circularity problems that are sometimes associated with people who have operations that involve incisions on their abdomen and consequently long anasthetics.
Evaluation
I don’t think the treatment session was that successful. I did have some strengths with the treatment, they were:
1) I targeted the negative effects of anaesthetic on this woman’s lungs and I did prescribe her the appropriate exercises for preventing post operative complications to her lungs and circulation.
But I think I had a few more weaknesses, they were:
1) The fact that there was a lot of miscommunication occurring during the assessment and treatment session. I found it difficult to inform this lady that I was trying to prevent her from getting a chest infection. At one stage she thought she already had a chest infection and was getting quiet upset about it all.
2) I think I should have got this lady sitting on the edge of the bed, which would use more of her own muscle strength instead of letting her just sit up in bed. Sitting her out of bed would have been more beneficial in her rehabilitation from her operation (on the muscles of her abdomen).
3) I think I should have given her more exercises to target her circulation.
Strategies
My supervisor and I worked out a couple of strategies to help with communication when I come across this type of patient again:
1) Using simple short/direct words for a patient with a language barrier as well as trying to avoid complicated or long sentences. In this particular case instead of going through the whole spiel about post operative complications I should have told her the main points in a simplified way.
2) Drawing or writing down the exercises I give her so as to make sure she understands what I want her to do.
3) Using physical demonstrations to aid in teaching exercises
4) Getting the patient to repeat what you have asked them to do. I should say phrases like “So what are you going to do every hour?”. Their answer to this question would assure me of their understanding of the exercises that I have prescribed them to do.
5) Lastly get an interpreter to help out with communication.
On the third day of my placement ( 24/03/2010) my supervisor asked me to treat a 54 year old lady. This woman was 1 day post-operation from a laprascopy (a operation involving a large incision to the abdomen) that was performed to remove half of her colon (hemicolectomy) . Her past medical history included hypertension, hypercholesterolemia, and type 2 diabetes melinitus, she was also very obese.
This lady had only recently immigrated to Australia 2 years ago and she was of Polish decent. She could not speak English very well and her understanding of the language was very limited as well. This lady lived alone but was regularly visited by both her sons.
Task
My task was to treat this lady. This woman did not actually have any current problems with her chest, but I was treating her as more of a preventative measure to stop her contracting any post-operative complications such as chest infections or circulatory problems. I needed to asses her lungs and then treat any problems I saw.
Action
Firstly I assessed this lady. I auscultated her lungs and heard some crackling in both the lungs bi-basally. This could have indicated microatelactisis, which is very common after a long anaesthetic. I felt her chest expansion, which was good both sides and listened to her cough, which was weak, dry, non-productive and ineffective. I needed to improve her cough and possibly reverse her microatelactisis.
As a treatment I got her to take some deep breaths with an inspiratory hold at the end of them. I also showed her how to perform a supported cough (with a rolled up towel pressed against her incision site) to protect her incision site on her abdomen. As she was not feeling well enough to get out of bed I positioned her in high sitting in the bed and them attempted to educate her about the procedure, how important it was for her to keep taking deep breaths and that if she needed to cough up any mucous or flem she must attempt to cough while supporting her incision site.
Result
This woman then had post operative exercises that would help in preventing any lung or circularity problems that are sometimes associated with people who have operations that involve incisions on their abdomen and consequently long anasthetics.
Evaluation
I don’t think the treatment session was that successful. I did have some strengths with the treatment, they were:
1) I targeted the negative effects of anaesthetic on this woman’s lungs and I did prescribe her the appropriate exercises for preventing post operative complications to her lungs and circulation.
But I think I had a few more weaknesses, they were:
1) The fact that there was a lot of miscommunication occurring during the assessment and treatment session. I found it difficult to inform this lady that I was trying to prevent her from getting a chest infection. At one stage she thought she already had a chest infection and was getting quiet upset about it all.
2) I think I should have got this lady sitting on the edge of the bed, which would use more of her own muscle strength instead of letting her just sit up in bed. Sitting her out of bed would have been more beneficial in her rehabilitation from her operation (on the muscles of her abdomen).
3) I think I should have given her more exercises to target her circulation.
Strategies
My supervisor and I worked out a couple of strategies to help with communication when I come across this type of patient again:
1) Using simple short/direct words for a patient with a language barrier as well as trying to avoid complicated or long sentences. In this particular case instead of going through the whole spiel about post operative complications I should have told her the main points in a simplified way.
2) Drawing or writing down the exercises I give her so as to make sure she understands what I want her to do.
3) Using physical demonstrations to aid in teaching exercises
4) Getting the patient to repeat what you have asked them to do. I should say phrases like “So what are you going to do every hour?”. Their answer to this question would assure me of their understanding of the exercises that I have prescribed them to do.
5) Lastly get an interpreter to help out with communication.
Saturday, March 20, 2010
INITIAL ENTRY-FREMANTLE HOSPITAL
Initial Entry
For my second placement this year, I have been assigned to go to Fremantle Hospital. This is my cardio-respiratory rotation, and I am excited about going on this placement because cardio-respiratory was one of my favourite units during my physiotherapy course. I’m hoping that the practical side of cardio-respiratory will be as interesting as the theoretical side of it.
I will be at Fremantle hospital every day from 8:00am to 4:30pm.
I have been told by other students that I will have my own caseload. I’m happy about having this responsibility as I think it will give me more opportunities where I can learn and therefore gain more confidence in my own abilities and skills.
I have also heard from other students who have been on this placement that you are placed on a number of different wards, including general medical, surgical and ICU wards. I hope I get to experience the general medical and/or the ICU ward as I think I will be able to use a few more of my skills on these wards. I think the surgical ward could be a bit repetitive, as I think you may be using the same methods to treat patients.
I’m a bit concerned about how I will get to Fremantle hospital. The car parking is very sparse and expensive in Fremantle so I think I will have to take 2 different train lines and then walk from the station to the hospital. It may take over 1 ½ hours just to get to the hospital. I will have to be going to bed very early each night!
I hope to see a range of different conditions as well while I’m on this placement. I’m hoping that I will get to see patients who have COPD right through to patients that have pneumonia, asthma, and bronchitis.
Another expectation I have is that I hope I will be able to help run a few pulmonary rehabilitation classes. I feel as though I need to have more experience working with groups of people and I think working out exercises for a pulmonary rehabilitation class would stretch my knowledge in the cardio-respiratory sector of physiotherapy.
For my second placement this year, I have been assigned to go to Fremantle Hospital. This is my cardio-respiratory rotation, and I am excited about going on this placement because cardio-respiratory was one of my favourite units during my physiotherapy course. I’m hoping that the practical side of cardio-respiratory will be as interesting as the theoretical side of it.
I will be at Fremantle hospital every day from 8:00am to 4:30pm.
I have been told by other students that I will have my own caseload. I’m happy about having this responsibility as I think it will give me more opportunities where I can learn and therefore gain more confidence in my own abilities and skills.
I have also heard from other students who have been on this placement that you are placed on a number of different wards, including general medical, surgical and ICU wards. I hope I get to experience the general medical and/or the ICU ward as I think I will be able to use a few more of my skills on these wards. I think the surgical ward could be a bit repetitive, as I think you may be using the same methods to treat patients.
I’m a bit concerned about how I will get to Fremantle hospital. The car parking is very sparse and expensive in Fremantle so I think I will have to take 2 different train lines and then walk from the station to the hospital. It may take over 1 ½ hours just to get to the hospital. I will have to be going to bed very early each night!
I hope to see a range of different conditions as well while I’m on this placement. I’m hoping that I will get to see patients who have COPD right through to patients that have pneumonia, asthma, and bronchitis.
Another expectation I have is that I hope I will be able to help run a few pulmonary rehabilitation classes. I feel as though I need to have more experience working with groups of people and I think working out exercises for a pulmonary rehabilitation class would stretch my knowledge in the cardio-respiratory sector of physiotherapy.
INITIAL ENTRY-FREMANTLE HOSPITAL
Initial Entry
For my second placement this year, I have been assigned to go to Fremantle Hospital. This is my cardio-respiratory rotation, and I am excited about going on this placement because cardio-respiratory was one of my favourite units during my physiotherapy course. I’m hoping that the practical side of cardio-respiratory will be as interesting as the theoretical side of it.
I will be at Fremantle hospital every day from 8:00am to 4:30pm.
I have been told by other students that I will have my own caseload. I’m happy about having this responsibility as I think it will give me more opportunities where I can learn and therefore gain more confidence in my own abilities and skills.
I have also heard from other students who have been on this placement that you are placed on a number of different wards, including general medical, surgical and ICU wards. I hope I get to experience the general medical and/or the ICU ward as I think I will be able to use a few more of my skills on these wards. I think the surgical ward could be a bit repetitive, as I think you may be using the same methods to treat patients.
I’m a bit concerned about how I will get to Fremantle hospital. The car parking is very sparse and expensive in Fremantle so I think I will have to take 2 different train lines and then walk from the station to the hospital. It may take over 1 ½ hours just to get to the hospital. I will have to be going to bed very early each night!
I hope to see a range of different conditions as well while I’m on this placement. I’m hoping that I will get to see patients who have COPD right through to patients that have pneumonia, asthma, and bronchitis.
Another expectation I have is that I hope I will be able to help run a few pulmonary rehabilitation classes. I feel as though I need to have more experience working with groups of people and I think working out exercises for a pulmonary rehabilitation class would stretch my knowledge in the cardio-respiratory sector of physiotherapy.
For my second placement this year, I have been assigned to go to Fremantle Hospital. This is my cardio-respiratory rotation, and I am excited about going on this placement because cardio-respiratory was one of my favourite units during my physiotherapy course. I’m hoping that the practical side of cardio-respiratory will be as interesting as the theoretical side of it.
I will be at Fremantle hospital every day from 8:00am to 4:30pm.
I have been told by other students that I will have my own caseload. I’m happy about having this responsibility as I think it will give me more opportunities where I can learn and therefore gain more confidence in my own abilities and skills.
I have also heard from other students who have been on this placement that you are placed on a number of different wards, including general medical, surgical and ICU wards. I hope I get to experience the general medical and/or the ICU ward as I think I will be able to use a few more of my skills on these wards. I think the surgical ward could be a bit repetitive, as I think you may be using the same methods to treat patients.
I’m a bit concerned about how I will get to Fremantle hospital. The car parking is very sparse and expensive in Fremantle so I think I will have to take 2 different train lines and then walk from the station to the hospital. It may take over 1 ½ hours just to get to the hospital. I will have to be going to bed very early each night!
I hope to see a range of different conditions as well while I’m on this placement. I’m hoping that I will get to see patients who have COPD right through to patients that have pneumonia, asthma, and bronchitis.
Another expectation I have is that I hope I will be able to help run a few pulmonary rehabilitation classes. I feel as though I need to have more experience working with groups of people and I think working out exercises for a pulmonary rehabilitation class would stretch my knowledge in the cardio-respiratory sector of physiotherapy.
Monday, March 15, 2010
FINAL ENTRY
I really enjoyed my placement at Princess Margaret Hospital. I did have 2 half days a week but they varied from day to day. I was given a comprehensive introduction to the hospital and another student and I were introduced and given a tour on our first day.
Just as I suspected; I defiantly felt the emotional pull of being involved with children who were sick. Many times I came home feeling down, but I think at some point during the placement I realised that I could do nothing about their situation, however I could help them with the problems they had at that particular time, I could help them along their journey to recovery.
I saw a wide range of patients, many had seizure disorders, some had spinal cord injuries, a few had brain injuries and lots had muscular disorders.
Surprisingly enough I only saw one child with cerebral palsy (and that was only because the child was having a baclofen pump inserted), the reason for this being that at PMH, the physiotherapy department only sees children who are in their acute stage of their disease and cerebral palsy is a chronic ongoing condition that is usually handled in community based care.
I did see a very wide age range in the children that I treated. I treated children with neurodevelopmental delay that were only 4 months old, right through to a child with an acute brain injury that was 17 years old. I felt that I gained a lot of experience with working with children of different age groups, I now feel as though I can relate well to children of all ages.
I ended up seeing 3 children with my supervisor every day. These kids were my caseload. My supervisor let me assess and treat them completely while she sat back and observed. I found it difficult at times to communicate with the childs parent because they tended to look to my supervisor for confirmation that what I was saying was correct. I felt I often didn’t have the complete trust of the child’s parent, I am hoping they will begin to trust me once I am a practicing physiotherapist on my own. I have learnt that I must begin to have more confidence in my own knowledge and treatment so that other people will not doubt me.
Just as I suspected; I defiantly felt the emotional pull of being involved with children who were sick. Many times I came home feeling down, but I think at some point during the placement I realised that I could do nothing about their situation, however I could help them with the problems they had at that particular time, I could help them along their journey to recovery.
I saw a wide range of patients, many had seizure disorders, some had spinal cord injuries, a few had brain injuries and lots had muscular disorders.
Surprisingly enough I only saw one child with cerebral palsy (and that was only because the child was having a baclofen pump inserted), the reason for this being that at PMH, the physiotherapy department only sees children who are in their acute stage of their disease and cerebral palsy is a chronic ongoing condition that is usually handled in community based care.
I did see a very wide age range in the children that I treated. I treated children with neurodevelopmental delay that were only 4 months old, right through to a child with an acute brain injury that was 17 years old. I felt that I gained a lot of experience with working with children of different age groups, I now feel as though I can relate well to children of all ages.
I ended up seeing 3 children with my supervisor every day. These kids were my caseload. My supervisor let me assess and treat them completely while she sat back and observed. I found it difficult at times to communicate with the childs parent because they tended to look to my supervisor for confirmation that what I was saying was correct. I felt I often didn’t have the complete trust of the child’s parent, I am hoping they will begin to trust me once I am a practicing physiotherapist on my own. I have learnt that I must begin to have more confidence in my own knowledge and treatment so that other people will not doubt me.
Sunday, March 14, 2010
Reflection 3- Week 5
Situation
On one of my last days at my placement (10/03/2010), I was asked to treat a 10 year old girl with my visiting clinical supervisor. This girl had severe left sided weakness only present in her right arm. The day before my treatment session with her, she had undergone a MRI which revealed that she had a cavernoma ( benign tumour) in the frontal lobe of her brain which was occasionally bleeding. This bleed resulted in her presenting with left hemorrhagic stroke like symptoms. On assessment it was found that her strength was severely affected with varying degrees through her whole right arm, her sensation was completely intact and her tone was generally low (hypotonic) in her right shoulder and arm.
The girl told me she was occasionally banging into things on the right side and on observation I noticed she tended to “leave the right arm behind” when she was completing tasks.
Task
I was asked to treat (with my clinical supervisor watching) and address the problems this girl had as a result of the hemorrhagic stroke.
Action
I firstly identified the areas which the girl needed treatment on. She had; 1) decreased neural input/altered neural pathways to her right upper limb. 2) low tone in her shoulder girdle, possibly leading to a subluxation. 3) significant decreased right upper limb strength. 4) increased weight bearing to the right side in sitting/altered midline in sitting.
So I treated her, and gave her exercises that, encouraged weight bearing to the left side in sitting (increased her awareness of her midline, by showing her a mirror), I gave her neural input and stimulation to the right hand using different textured materials. I educated her about taking care of her right upper limb and refraining from doing any movements that would injure the joint and lastly I gave her some strengthening exercises for her right arm.
Result
The result was a straighter alignment in sitting on reassessment, with almost a even weight bearing on both sides. Other improvements from the treatment could be seen further down the track.
Evaluation
I think my intervention was a bit mediocre. I think I had some strengths in the treatment but I had a lot of weaknesses as well.
My strengths were that I engaged the child well during the treatment session and I think I selected appropriate exercises that targeted her problems.
My weaknesses were that; Firstly, I needed to cater my exercises to a more paediatric level, I needed to make them more exciting. Secondly I needed to have progressions on the exercises. I needed to make the exercise more difficult by adding in different and harder dimensions once the child had mastered the easier version of the exercise. Thirdly the treatment session needed to be longer, it was only 40 minutes when it was supposed to be a hour; I needed to plan out a variety of exercises that would achieve the same result. Lastly my supervisor said I needed to also investigate the fact that the child was banging into things on the right side. I needed to check her vision filed on the right.
Strategies
I think next time I will try to improve my treatment session by implementing these strategies;
1) Plan out the treatment session so I know how long each activity will take and hence I will be able to treat the patient for their given time.
2) Research treatment ideas, if I cant think of enough exercises, I will go research some different ideas that achieve the same result.
3) If the child identifies a new problem in my subjective, make sure I assess it at the beginning of the session to find out if it is a problem.
4) Try to incorporate childish games into my treatment to make the session more appealing to the child.
On one of my last days at my placement (10/03/2010), I was asked to treat a 10 year old girl with my visiting clinical supervisor. This girl had severe left sided weakness only present in her right arm. The day before my treatment session with her, she had undergone a MRI which revealed that she had a cavernoma ( benign tumour) in the frontal lobe of her brain which was occasionally bleeding. This bleed resulted in her presenting with left hemorrhagic stroke like symptoms. On assessment it was found that her strength was severely affected with varying degrees through her whole right arm, her sensation was completely intact and her tone was generally low (hypotonic) in her right shoulder and arm.
The girl told me she was occasionally banging into things on the right side and on observation I noticed she tended to “leave the right arm behind” when she was completing tasks.
Task
I was asked to treat (with my clinical supervisor watching) and address the problems this girl had as a result of the hemorrhagic stroke.
Action
I firstly identified the areas which the girl needed treatment on. She had; 1) decreased neural input/altered neural pathways to her right upper limb. 2) low tone in her shoulder girdle, possibly leading to a subluxation. 3) significant decreased right upper limb strength. 4) increased weight bearing to the right side in sitting/altered midline in sitting.
So I treated her, and gave her exercises that, encouraged weight bearing to the left side in sitting (increased her awareness of her midline, by showing her a mirror), I gave her neural input and stimulation to the right hand using different textured materials. I educated her about taking care of her right upper limb and refraining from doing any movements that would injure the joint and lastly I gave her some strengthening exercises for her right arm.
Result
The result was a straighter alignment in sitting on reassessment, with almost a even weight bearing on both sides. Other improvements from the treatment could be seen further down the track.
Evaluation
I think my intervention was a bit mediocre. I think I had some strengths in the treatment but I had a lot of weaknesses as well.
My strengths were that I engaged the child well during the treatment session and I think I selected appropriate exercises that targeted her problems.
My weaknesses were that; Firstly, I needed to cater my exercises to a more paediatric level, I needed to make them more exciting. Secondly I needed to have progressions on the exercises. I needed to make the exercise more difficult by adding in different and harder dimensions once the child had mastered the easier version of the exercise. Thirdly the treatment session needed to be longer, it was only 40 minutes when it was supposed to be a hour; I needed to plan out a variety of exercises that would achieve the same result. Lastly my supervisor said I needed to also investigate the fact that the child was banging into things on the right side. I needed to check her vision filed on the right.
Strategies
I think next time I will try to improve my treatment session by implementing these strategies;
1) Plan out the treatment session so I know how long each activity will take and hence I will be able to treat the patient for their given time.
2) Research treatment ideas, if I cant think of enough exercises, I will go research some different ideas that achieve the same result.
3) If the child identifies a new problem in my subjective, make sure I assess it at the beginning of the session to find out if it is a problem.
4) Try to incorporate childish games into my treatment to make the session more appealing to the child.
Sunday, February 28, 2010
Reflection 2- Week 3
Situation
On the third week of my placement, on a Wednesday the 24th of February, I was asked to conduct an individual hydrotherapy session for a 14 year old girl with Transverse Myolitis. She contracted the virus 2 months ago and this virus manifested itself as a neural virus. The virus caused inflammation and scarring of the spinal cord at level T8, the result of this was paralysis of her legs (she now mobilised in a wheelchair), bowel and bladder, a loss of sensation to her legs and a loss of reflexes to her legs as well. As a result of these consequences this girl was having an enema administered in the morning before she entered the pool to make sure she had completely emptied her bowels. Another complication to this girl’s condition was that she was very obese, and her tolerance for exercise was low, it was very difficult to motivate her.
The girl I was conducting the hydrotherapy session for was receiving hydrotherapy 3 times a week and 2 land sessions a week. She had been having hydrotherapy sessions for over a month now and she was quiet confident in the pool.
The recovery from Transverse Myolitis is variable, with some people recovering completely while others are totally paralysed for the rest of their lives. Therefore physiotherapy had to include the possibility that this girl will be wheelchair bound for the rest of her life.
Task
I was asked to perform a 40 minute hydrotherapy session that catered to this girl’s needs. I was conducting the session with my supervisor present beside the pool. I based a lot of my treatment around firstly preventing generalised deconditioning, secondly improving the strength of her upper limbs, thirdly encouraging any recovery of her lower limb muscles and lastly raising her cardiovascular fitness ( in the hopes of addressing her weight issue as well).
Action
After transferring the girl to the pool using a chair lift; I began my treatment session. I asked her to perform;
1) 2 laps of the pool, choosing her preferred stroke.
2) shoulder, arm, wrist and chest exercises using resistor pads.
3) 2 attempts at diving for sunken objects ( rings etc.)
4) treading water for 2 minutes
5) facilitated hip flexion, encouraging any activity of lower limb muscles.
Result
The girl did enjoy the hydrotherapy session however she did seem tired after the session commenced. During the session I did see a bit of hip flexion being exerted on the left hip, which is encouraging and is something to work with in the future.
Evaluation
I think the session went well. I addressed the girls deconditioning by giving her lots of cardiovascular exercise such as the laps in the pool and treading water. I also gave her some choice as to which activities she wanted to do (so she felt as though she had some control over the session). My supervisor said my arm exercises were a bit too general and I needed to concentrate on giving her more specific exercises that would target muscle groups that she would defiantly need to be stronger (eg. the triceps for the ease of transferring between her wheelchair and her bed/toilet etc.). My supervisor also said that I needed to allow her to keep her independence in things, so teaching her how to move around the pool on the steps and the hand rails independently and without the use of her legs is also pertinent in her hydrotherapy session.
Strategies
I think next time I would firstly try to make the session more tailored to my patients needs. The girl was having difficulty with her transfers (as she couldn’t clear her bottom off the surface it was on) so I should have focused on strengthening her tricep muscles to improve her independence in transferring herself. Next time I would also keep the activity as fun as possible. I would try to add in some music, or ask her if she had an activity in mind that she would like to do for 5 minutes. Lastly another good strategy would be to incorporate into the session activities that allowed her to keep her independence in and around the pool. I would teach her how to get on and off the steps and teach her how to take care of her legs when other people are helping her into the pool.
On the third week of my placement, on a Wednesday the 24th of February, I was asked to conduct an individual hydrotherapy session for a 14 year old girl with Transverse Myolitis. She contracted the virus 2 months ago and this virus manifested itself as a neural virus. The virus caused inflammation and scarring of the spinal cord at level T8, the result of this was paralysis of her legs (she now mobilised in a wheelchair), bowel and bladder, a loss of sensation to her legs and a loss of reflexes to her legs as well. As a result of these consequences this girl was having an enema administered in the morning before she entered the pool to make sure she had completely emptied her bowels. Another complication to this girl’s condition was that she was very obese, and her tolerance for exercise was low, it was very difficult to motivate her.
The girl I was conducting the hydrotherapy session for was receiving hydrotherapy 3 times a week and 2 land sessions a week. She had been having hydrotherapy sessions for over a month now and she was quiet confident in the pool.
The recovery from Transverse Myolitis is variable, with some people recovering completely while others are totally paralysed for the rest of their lives. Therefore physiotherapy had to include the possibility that this girl will be wheelchair bound for the rest of her life.
Task
I was asked to perform a 40 minute hydrotherapy session that catered to this girl’s needs. I was conducting the session with my supervisor present beside the pool. I based a lot of my treatment around firstly preventing generalised deconditioning, secondly improving the strength of her upper limbs, thirdly encouraging any recovery of her lower limb muscles and lastly raising her cardiovascular fitness ( in the hopes of addressing her weight issue as well).
Action
After transferring the girl to the pool using a chair lift; I began my treatment session. I asked her to perform;
1) 2 laps of the pool, choosing her preferred stroke.
2) shoulder, arm, wrist and chest exercises using resistor pads.
3) 2 attempts at diving for sunken objects ( rings etc.)
4) treading water for 2 minutes
5) facilitated hip flexion, encouraging any activity of lower limb muscles.
Result
The girl did enjoy the hydrotherapy session however she did seem tired after the session commenced. During the session I did see a bit of hip flexion being exerted on the left hip, which is encouraging and is something to work with in the future.
Evaluation
I think the session went well. I addressed the girls deconditioning by giving her lots of cardiovascular exercise such as the laps in the pool and treading water. I also gave her some choice as to which activities she wanted to do (so she felt as though she had some control over the session). My supervisor said my arm exercises were a bit too general and I needed to concentrate on giving her more specific exercises that would target muscle groups that she would defiantly need to be stronger (eg. the triceps for the ease of transferring between her wheelchair and her bed/toilet etc.). My supervisor also said that I needed to allow her to keep her independence in things, so teaching her how to move around the pool on the steps and the hand rails independently and without the use of her legs is also pertinent in her hydrotherapy session.
Strategies
I think next time I would firstly try to make the session more tailored to my patients needs. The girl was having difficulty with her transfers (as she couldn’t clear her bottom off the surface it was on) so I should have focused on strengthening her tricep muscles to improve her independence in transferring herself. Next time I would also keep the activity as fun as possible. I would try to add in some music, or ask her if she had an activity in mind that she would like to do for 5 minutes. Lastly another good strategy would be to incorporate into the session activities that allowed her to keep her independence in and around the pool. I would teach her how to get on and off the steps and teach her how to take care of her legs when other people are helping her into the pool.
Saturday, February 13, 2010
FIRST ENTRY- WEEK 1
Situation
It was the third day on my placement (10/02/2010) that I was asked to treat a child with my visiting clinical tutor. This was the first time I had seen this child. My patient was a four year old girl who had sustained a hypoxic brain injury post resuscitation. My patient had endured damage to her basal ganglia and cerebellum. With the help of my supervisor we had established the child had difficulty initiating movements, continuing in automatic movements, poor balance, and a high level of weakness and spacticity in her lower limbs. All of these factors had considerably contributed to her delay and even regression in her age appropriate developmental milestones. My patient could not move from a seated position to a lying position, she had difficulty rolling over and could not crawl or even walk without assistance.
Due to the fact that most of the damage was on the right side of her brain, my patients speech and level of understanding of words had also regressed significantly. Therefore communicating with her was also very challenging.
Task
My treatment was therefore not only to address her physical delay in developmental milestones, but also to encourage her to talk instead of pointing with her hands to communicate. In addition to encouraging my patient to talk I needed to be able to make sure the language I used was appropriate to my patient’s age.
Action
I was facilitating my patient to transition for a seated position to a lying position on a mat on the floor, all the while I was talking to her trying to get her to communicate with me.
Result
My patient ended up moving from a seated position to a lying position on the mat, however it took several attempts. I needed to change how I spoke to her several times as well.
Evaluation
I don’t think I was affective in this first treatment session with my patient. I found it hard to get her to “ speak up” and talk to me, especially when I was facilitating her to progress in her physical development. Her reluctance to talk to me could have been that my patient was shy around me but most likely it was because I was not using age appropriate language and I was failing to use techniques that would facilitate her to talk to me.
Strategies
My clinical tutor and I worked out some ideas that I could use when talking to this patient. Firstly; to use one command at a time. Secondly to give my patient choices by asking her simple questions (that required basic answers) encouraging her to verbally communicate with me. Lastly to use more age appropriate language. For example “try to stretch your leg out like a long long snake” instead of “can you straighten your knee?”.
I tried using some of these strategies the second time I saw this patient, and I found she was much more outspoken and she seemed to have a better understanding of what I was asking her to do. Overall, the treatment session was more efficient and I think it was more successful when I implemented these strategies.
It was the third day on my placement (10/02/2010) that I was asked to treat a child with my visiting clinical tutor. This was the first time I had seen this child. My patient was a four year old girl who had sustained a hypoxic brain injury post resuscitation. My patient had endured damage to her basal ganglia and cerebellum. With the help of my supervisor we had established the child had difficulty initiating movements, continuing in automatic movements, poor balance, and a high level of weakness and spacticity in her lower limbs. All of these factors had considerably contributed to her delay and even regression in her age appropriate developmental milestones. My patient could not move from a seated position to a lying position, she had difficulty rolling over and could not crawl or even walk without assistance.
Due to the fact that most of the damage was on the right side of her brain, my patients speech and level of understanding of words had also regressed significantly. Therefore communicating with her was also very challenging.
Task
My treatment was therefore not only to address her physical delay in developmental milestones, but also to encourage her to talk instead of pointing with her hands to communicate. In addition to encouraging my patient to talk I needed to be able to make sure the language I used was appropriate to my patient’s age.
Action
I was facilitating my patient to transition for a seated position to a lying position on a mat on the floor, all the while I was talking to her trying to get her to communicate with me.
Result
My patient ended up moving from a seated position to a lying position on the mat, however it took several attempts. I needed to change how I spoke to her several times as well.
Evaluation
I don’t think I was affective in this first treatment session with my patient. I found it hard to get her to “ speak up” and talk to me, especially when I was facilitating her to progress in her physical development. Her reluctance to talk to me could have been that my patient was shy around me but most likely it was because I was not using age appropriate language and I was failing to use techniques that would facilitate her to talk to me.
Strategies
My clinical tutor and I worked out some ideas that I could use when talking to this patient. Firstly; to use one command at a time. Secondly to give my patient choices by asking her simple questions (that required basic answers) encouraging her to verbally communicate with me. Lastly to use more age appropriate language. For example “try to stretch your leg out like a long long snake” instead of “can you straighten your knee?”.
I tried using some of these strategies the second time I saw this patient, and I found she was much more outspoken and she seemed to have a better understanding of what I was asking her to do. Overall, the treatment session was more efficient and I think it was more successful when I implemented these strategies.
Saturday, February 6, 2010
Initial Entry- Princess Margaret Hospital
Initial entry
I have been placed at Princess Margaret Hospital in the Neurology Department. Most days I start at 8 am and finish at 5 pm, however Monday I start later and Thursday I finish earlier. The first day on placement I am supposed to be given a pamphlet on the hospital and will introduced to people and procedures in and around the hospital.
I really do love working with children so I am very excited about this placement. However, at the same time, I am a bit apprehensive about this placement. I think in this environment it could be a bit taxing, both emotionally and physically. The reason for this being; that the children I will be treating will most likely have conditions which will affect them for the rest of their lives. I will have to be careful I don’t become too emotionally involved with my patients. I have talked to a few of my other classmates who have also been on this placement. According to them I will have mostly patients with acute brain injuries, hydrochephalus and Guillian Barre Syndrome. However, because the ward is titled ‘neurology’ I think I may see a range of neurological conditions. I hope I see a range of children with different ages, as this is also my one and only paediatric placement, I hope to see children that are in the midst of development and hopefully even some neonates.
I am hoping I will eventually be able to have my own caseload ( with a supervisor present) however, I can understand how this may not be possible as parents can be quiet understandably concerned about their child’s welfare and hence, wish their child to receive optimal treatment by an experienced therapist.
I have been placed at Princess Margaret Hospital in the Neurology Department. Most days I start at 8 am and finish at 5 pm, however Monday I start later and Thursday I finish earlier. The first day on placement I am supposed to be given a pamphlet on the hospital and will introduced to people and procedures in and around the hospital.
I really do love working with children so I am very excited about this placement. However, at the same time, I am a bit apprehensive about this placement. I think in this environment it could be a bit taxing, both emotionally and physically. The reason for this being; that the children I will be treating will most likely have conditions which will affect them for the rest of their lives. I will have to be careful I don’t become too emotionally involved with my patients. I have talked to a few of my other classmates who have also been on this placement. According to them I will have mostly patients with acute brain injuries, hydrochephalus and Guillian Barre Syndrome. However, because the ward is titled ‘neurology’ I think I may see a range of neurological conditions. I hope I see a range of children with different ages, as this is also my one and only paediatric placement, I hope to see children that are in the midst of development and hopefully even some neonates.
I am hoping I will eventually be able to have my own caseload ( with a supervisor present) however, I can understand how this may not be possible as parents can be quiet understandably concerned about their child’s welfare and hence, wish their child to receive optimal treatment by an experienced therapist.
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