During one of my placements my clinical supervisor advised me that I should comb my hair. She commented that although my hair maybe ‘trendy’, consultants may disapprove and not consider me professionally. I was angered by this because as you may know my hair is pretty ordinary, it is not eccentric. I was also angry at the fact that what my supervisor was saying could be true, that our professional status or opinion could be misrepresented or misjudged based on our appearance. Aren’t we taught at a young age that we shouldn’t judge a book by its cover?
This possible falsification of our professional opinion is not only damaging to our profession but can be to our patient as our professional opinion regarding their best treatment may not be adequately considered.
I know that we are expected to portray a professional appearance but an avid question is where does this end? Surely our knowledge on a subject and our professional opinion should out way our appearance. Judging a person’s credibility on their appearance is unprofessional and can almost be likened to judging a person by their race, religion or sex.
Reflecting on this we all have a responsibility to keep an open mind regarding people’s appearances, as well as considering that other people may judge our credibility via our appearance. On that note we do have a responsibility to maintain a professional appearance to maintain the dignity that our profession deserves but by no means should this be indicative of an individual’s status.
Sunday, August 31, 2008
Saturday, August 30, 2008
calm dowm mate!
Hello everyone, I hope everyone is doing well in the placement. In my second week of cardio placement, I have dealt with a very impulsive patient who has undergone a surgery. When I first saw him, my first impression to this patient was that he was really impulsive and he was unaware of personal safety because he detached some of the drains and attachments.
My plan on him was ambulation and deep breathing exercise on day 1 post-op. Even though his vital sign was normal, I still paid extra attention on him during the treatment session not because of his medical condition but his behavior. He did not follow my command and after he stood up from the bed, then he just walked away without realized that all his attachments got caught. At that time, I told him to stop immediately and take his time to do everything he wanted. Also I told him slowly and clearly to follow my steps in order to reduce his impulsive behavior. Eventually, the whole treatment session was performed in a safe situation.
On my reflection, my experience above did not seem like a big issue however it contained a unsafe issue. I have tried to control the environment as well as my patient’s behavior by removing any obstacles and providing a clear explanation. Having said that, I have not done enough to make sure the patient was safe to do treatment. If I have chance to do it again, I will request extra person to help me to handle this particular patient, simple and clear explanation is a must in this situation, and liaise with the nursing staff in case if something goes wrong.
My plan on him was ambulation and deep breathing exercise on day 1 post-op. Even though his vital sign was normal, I still paid extra attention on him during the treatment session not because of his medical condition but his behavior. He did not follow my command and after he stood up from the bed, then he just walked away without realized that all his attachments got caught. At that time, I told him to stop immediately and take his time to do everything he wanted. Also I told him slowly and clearly to follow my steps in order to reduce his impulsive behavior. Eventually, the whole treatment session was performed in a safe situation.
On my reflection, my experience above did not seem like a big issue however it contained a unsafe issue. I have tried to control the environment as well as my patient’s behavior by removing any obstacles and providing a clear explanation. Having said that, I have not done enough to make sure the patient was safe to do treatment. If I have chance to do it again, I will request extra person to help me to handle this particular patient, simple and clear explanation is a must in this situation, and liaise with the nursing staff in case if something goes wrong.
Waiting on kids
I went on my first 2 solo home visits this week, which weren’t as bad as I thought they would be, but the first one didn’t really go to plan! I haven’t had much experience working with children, especially younger ones, which has made for an interesting first 2 weeks in paeds. On my first solo H/V this week, I arrived early due to an earlier client having cancelled, only to find that the child was asleep, and the mother unwilling to wake the child up straight away. I didn’t ask the mother to wake the child up because I felt really uncomfortable about being in someone else’s house on my own, trying to tell her what to do. So I waited for about 20 mins until she finally went and got the child, only to have to wait another 15 mins for the child to have her lunch. Eventually we did about 15 mins of walking practice, which was the goal for the session, however it was supposed to be about 45 mins. I did manage to do some treatment, and instructed the mother as to what I was trying to do, as she was going to do more walking with the child after I left.
In hindsight I should have asked the mother to get the child up earlier, as I shouldn’t have had to wait in order to treat her as I had other stuff to do and didn’t have the time. Having established a good rapport with the mother, and being the therapist, it would have been appropriate to ask for the child to be woken up in order to do some treatment. Despite being students, if we are going on home visits on our own then we are the treating PT’s, as and such we are in a position of influence, and our time is just as precious as the normal therapists. We should feel confident about entering someone’s home in order to provide treatment, but we should also be aware that we are in the child’s home, where they feel safe, and should respect their right to refuse treatment. Even if the girl I saw had been woken up earlier, it probably would still have been difficult to get any treatment done with a sleepy, hungry child.
I think that in this particular area (i.e. paeds) it is also important to know when to cut your losses and give up on trying to treat someone who doesn’t want treatment, because we can’t force them to comply with treatment. We have to remember that they are just kids, most of whom have very busy schedules going from one therapeutic setting to another. They aren’t always going to conform to either our treatment plans or our timetables, and we can’t get angry at them for that.
In hindsight I should have asked the mother to get the child up earlier, as I shouldn’t have had to wait in order to treat her as I had other stuff to do and didn’t have the time. Having established a good rapport with the mother, and being the therapist, it would have been appropriate to ask for the child to be woken up in order to do some treatment. Despite being students, if we are going on home visits on our own then we are the treating PT’s, as and such we are in a position of influence, and our time is just as precious as the normal therapists. We should feel confident about entering someone’s home in order to provide treatment, but we should also be aware that we are in the child’s home, where they feel safe, and should respect their right to refuse treatment. Even if the girl I saw had been woken up earlier, it probably would still have been difficult to get any treatment done with a sleepy, hungry child.
I think that in this particular area (i.e. paeds) it is also important to know when to cut your losses and give up on trying to treat someone who doesn’t want treatment, because we can’t force them to comply with treatment. We have to remember that they are just kids, most of whom have very busy schedules going from one therapeutic setting to another. They aren’t always going to conform to either our treatment plans or our timetables, and we can’t get angry at them for that.
Wednesday, August 27, 2008
You can do it!
Hi everyone, how are you guys going? It has been a long long time that I have not written up any bloggings because I was at self-directed for my P1. Anyway, I would like to share my little experience with you all when I am at Cardio general surgical ward.
Generally, patient have undergone upper or lower abdominal surgery so that the pre admission condition of patients were better than those we saw in general medical ward. During my first week there, I realized that many patients presented with anxiety, apprehension and lack of confidence post-op. It is absolutely normal because they have done a major surgery with all different sorts of attachments connected to their body when they first wake up. The physiotherapy intervention is ambulation and deep breathing exercise that prevents any post-op pulmonary complication.
Yesterday I tried to saw a day 1 patient and my aim was to ambulate 10 m. when I first saw him he was extremely anxious and nervous because he was afraid that he will be going to pass out so he refused any treatment. Then I told him the benefits of the ambulation and positioning step by step in order to build up the rapport and gain his confidence. Eventually he walked 10 m with minimal assistant and he said he felt good when he got up and requested more physio treatment.
On my reflection, I understand that the limitation of why patients refused treatment not because physically barrier but psychologically barrier. They really need positive feedback and constant calming. In addition, we should be patient and considerate on patients and try to think the situation from different angles. We know there is no harm on ambulation not because we have personally experience it but we have studied and seen it. Finally, they need our confidence and care.
Generally, patient have undergone upper or lower abdominal surgery so that the pre admission condition of patients were better than those we saw in general medical ward. During my first week there, I realized that many patients presented with anxiety, apprehension and lack of confidence post-op. It is absolutely normal because they have done a major surgery with all different sorts of attachments connected to their body when they first wake up. The physiotherapy intervention is ambulation and deep breathing exercise that prevents any post-op pulmonary complication.
Yesterday I tried to saw a day 1 patient and my aim was to ambulate 10 m. when I first saw him he was extremely anxious and nervous because he was afraid that he will be going to pass out so he refused any treatment. Then I told him the benefits of the ambulation and positioning step by step in order to build up the rapport and gain his confidence. Eventually he walked 10 m with minimal assistant and he said he felt good when he got up and requested more physio treatment.
On my reflection, I understand that the limitation of why patients refused treatment not because physically barrier but psychologically barrier. They really need positive feedback and constant calming. In addition, we should be patient and considerate on patients and try to think the situation from different angles. We know there is no harm on ambulation not because we have personally experience it but we have studied and seen it. Finally, they need our confidence and care.
Monday, August 25, 2008
Just ask!
Hi Everyone!
During P1 I was on my rural placement at a regional hospital. Being a rather small hospital (compared to any of the metro hospitals), the one orthopaedic surgeon based at the hospital had his office just down the hall from the ward and would regularly check in on his patients. Given that we the physiotherapists had a blanket referral to see all of his patients post-op, I quickly became very familiar to the surgeon.
Having seen that he would be performing 2 THRs in the following week, I was tossing up whether or not I should ask to go and watch one. In the end I decided to go for it and asked my supervising physio whether she thought it would be ok and she agreed it would be a fantastic opportunity. So the next day I approached him and asked, and he was more than happy for me to watch.
At first, I felt a bit like a burden/annoyance to the surgical nurses and assistants and once in the operating theatre I kept back so that I was not in anyone's way. Once the surgery begun, the surgeon told me to come and stand closer so I could see exactly what he was doing- he arranged for me to stand on a small step just over his shoulder for the entire procedure and actually talked me through it as he went. This was a fantastic opportunity for me and as was pointed out in a previous post- actually viewing what goes on gives a much greater understanding and empathy of patient pain levels post-op.
It just goes to show that if an opportunity that you feel would assist your learning comes up, it is always better to speak up and ask rather than let it pass by because you are worried you will be a burden or nuisance- more often than not, the staff are more than happy to help. After all, when on prac, we are not employees getting paid for our services- we are in fact paying for the opportunity to learn and often it is easy to forget that. It always feels good to be able to actually assist the physios and lighten their workload somewhat during placements, but this shouldn't have to be at the expense of missing learning opportunities.
During P1 I was on my rural placement at a regional hospital. Being a rather small hospital (compared to any of the metro hospitals), the one orthopaedic surgeon based at the hospital had his office just down the hall from the ward and would regularly check in on his patients. Given that we the physiotherapists had a blanket referral to see all of his patients post-op, I quickly became very familiar to the surgeon.
Having seen that he would be performing 2 THRs in the following week, I was tossing up whether or not I should ask to go and watch one. In the end I decided to go for it and asked my supervising physio whether she thought it would be ok and she agreed it would be a fantastic opportunity. So the next day I approached him and asked, and he was more than happy for me to watch.
At first, I felt a bit like a burden/annoyance to the surgical nurses and assistants and once in the operating theatre I kept back so that I was not in anyone's way. Once the surgery begun, the surgeon told me to come and stand closer so I could see exactly what he was doing- he arranged for me to stand on a small step just over his shoulder for the entire procedure and actually talked me through it as he went. This was a fantastic opportunity for me and as was pointed out in a previous post- actually viewing what goes on gives a much greater understanding and empathy of patient pain levels post-op.
It just goes to show that if an opportunity that you feel would assist your learning comes up, it is always better to speak up and ask rather than let it pass by because you are worried you will be a burden or nuisance- more often than not, the staff are more than happy to help. After all, when on prac, we are not employees getting paid for our services- we are in fact paying for the opportunity to learn and often it is easy to forget that. It always feels good to be able to actually assist the physios and lighten their workload somewhat during placements, but this shouldn't have to be at the expense of missing learning opportunities.
Hospital Emergency
While on my neurology I treated a patient who had Parkinson’s disease but still had fairly high level balance and wanted to get back to a high level of fitness (after suffering an infection resulting in a lengthy hospital admission). It was my first actual day of treating patients by myself and only my second day at this particular hospital.
My Parkinsons patient (Mark*) was excited to perform some challenging balance and cardiovascular exercises. I was excited as well because I was able to apply all those Parkinsons techniques to see if they really did work. So I took Mark to the physio gym for a work out. About half way through the treatment session Mark reported that he was starting to feel sick, I wasn’t sure if he meant he was starting to feel tired or actually going to be sick. Then I heard Mark dry reaching and I knew. I attempted to find Mark a sick bag, but could not find one. Mark was still standing so I rushed him over to a seat and as soon as Mark sat down he was sick in his lap. I was quite flustered and could not find any sick bags so I pushed the nurse assist button on the wall in the hope that a nurse would come in and help Mark. It took roughly 10 seconds for 5 nurses and my supervisor to come rushing in screaming “someone pushed the button”. I replied “yes, Mark was sick. Can you help him?” The nurses let out a sigh and then proceeded to help clean Mark up. I later found out that the nurse assist button and the code blue or emergency button sound the same alarm, and thus the source of confusion.
I received a bit of teasing from some of the nurses. I had a talk to my supervisor regarding what I should have done, she said that I had done the right thing and that really was my only option considering there were no sick bags in the physio gym. She said that I had made a mature choice, because it would have been unwise to leave the patient alone to seek help.
I considered this later and realised that even though I had receiving a bit of teasing from the nurses I had done the right thing and needed assistance, it would have been irresponsible to think that I could handle that situation on my own. I also considered why they had the same alarm for nurse assist and emergency, I discussed this with my supervisor and she agreed that it was quite unsafe and it was due to changed with renovations to the hospital. I have learned from this situation that although we are taught to be largely independent it still is important to identify when we are out of our depth and need assistance. If put in the same position again I would make sure I had done everything I could to handle the situation myself (ie sick bags, sitting the patient down) but I would not hesitate to use the nurse assist button again. Sick bags are now kept in the physio gym for such situations.
*Fictitious names used
My Parkinsons patient (Mark*) was excited to perform some challenging balance and cardiovascular exercises. I was excited as well because I was able to apply all those Parkinsons techniques to see if they really did work. So I took Mark to the physio gym for a work out. About half way through the treatment session Mark reported that he was starting to feel sick, I wasn’t sure if he meant he was starting to feel tired or actually going to be sick. Then I heard Mark dry reaching and I knew. I attempted to find Mark a sick bag, but could not find one. Mark was still standing so I rushed him over to a seat and as soon as Mark sat down he was sick in his lap. I was quite flustered and could not find any sick bags so I pushed the nurse assist button on the wall in the hope that a nurse would come in and help Mark. It took roughly 10 seconds for 5 nurses and my supervisor to come rushing in screaming “someone pushed the button”. I replied “yes, Mark was sick. Can you help him?” The nurses let out a sigh and then proceeded to help clean Mark up. I later found out that the nurse assist button and the code blue or emergency button sound the same alarm, and thus the source of confusion.
I received a bit of teasing from some of the nurses. I had a talk to my supervisor regarding what I should have done, she said that I had done the right thing and that really was my only option considering there were no sick bags in the physio gym. She said that I had made a mature choice, because it would have been unwise to leave the patient alone to seek help.
I considered this later and realised that even though I had receiving a bit of teasing from the nurses I had done the right thing and needed assistance, it would have been irresponsible to think that I could handle that situation on my own. I also considered why they had the same alarm for nurse assist and emergency, I discussed this with my supervisor and she agreed that it was quite unsafe and it was due to changed with renovations to the hospital. I have learned from this situation that although we are taught to be largely independent it still is important to identify when we are out of our depth and need assistance. If put in the same position again I would make sure I had done everything I could to handle the situation myself (ie sick bags, sitting the patient down) but I would not hesitate to use the nurse assist button again. Sick bags are now kept in the physio gym for such situations.
*Fictitious names used
Saturday, August 23, 2008
Talking to your supervisors
Hi everyone,
Hope everyone’s new pracs are going well! I’ve just started my paeds prac, and it’s totally different to what I was expecting!
The first week has gone fairly well, the kids are all really cute and pretty fun to work with, and the staff are all really nice. Unfortunately it’s a really unstructured prac, by which I mean in the first few days we (other PT student and myself) weren’t given any direction as to what we were meant to be doing or where we were meant to be doing it. Basically we were told scant details about where we had to be and when we were supposed to be there (and these details weren’t always correct), there just wasn’t very good communication between staff and ourselves. This meant we felt really lost and left out, we were just sort of wandering around the centre hoping to be in the right place at the right time. I also didn’t have a very good idea of what was expected of me (for treatments, assessments, reports etc), and I still don’t really know what kind of documentation I’m meant to be doing. I also had no idea how much knowledge I was expected to have, or how good my treatment skills were supposed to be-as I was supposed to be doing solo home visits in my second week!
All in all it been a strange situation, which is sort of understandable as the staff are all really busy, and don’t always have time to be holding our hands and guiding us, and it hasn’t all been bad, it just took the whole week to get orientated to how the centre worked.
I think the turning point was when our clinical tutor spoke to us and basically said that it was really important that if we felt lost or like we didn’t know what was going on that we talk to her or our supervisor, to clarify our role and what was expected of us, and she also gave us an idea of what she expected of us. I realized after this that they weren’t expecting the world from us but if they thought we were ready/able then they would increase our responsibilities. Also that it was vital that we talk with our supervisors about how we were feeling and whether we were confident/happy to do home visits on our own, and not to hold it in and get more and more upset and end up hating the placement.
So I spoke to my supervisor and got a good idea of what she wanted me to do/be able to do by the end of the placement, what kind of reports would be required and how long my presentation would have to be, what was involved in a home visit (i.e. length etc) and how I felt about going to a person’s house by myself.
I’m still not sure whether I’m ready to do solo home visits but I feel much more confident about this placement and what I’m doing, I don’t feel lost anymore. I am really glad that I sorted out the situation before it became more of a problem.
I think we all need to keep in mind that although good communication with our patients is really important, good communication with our supervisors is even more important, even though it’s not stressed as much during uni. If we don’t feel confident about what is expected of us, what our placement will involve and what we are supposed to do, then we won’t enjoy our placements and we won’t be effective therapists. So if something is upsetting you or you are unsure about something then talk to your supervisor/tutor about it, they won’t think you are stupid or wasting their time, they will be glad that you have dealt with the issue before it became a major problem!
Hope everyone’s new pracs are going well! I’ve just started my paeds prac, and it’s totally different to what I was expecting!
The first week has gone fairly well, the kids are all really cute and pretty fun to work with, and the staff are all really nice. Unfortunately it’s a really unstructured prac, by which I mean in the first few days we (other PT student and myself) weren’t given any direction as to what we were meant to be doing or where we were meant to be doing it. Basically we were told scant details about where we had to be and when we were supposed to be there (and these details weren’t always correct), there just wasn’t very good communication between staff and ourselves. This meant we felt really lost and left out, we were just sort of wandering around the centre hoping to be in the right place at the right time. I also didn’t have a very good idea of what was expected of me (for treatments, assessments, reports etc), and I still don’t really know what kind of documentation I’m meant to be doing. I also had no idea how much knowledge I was expected to have, or how good my treatment skills were supposed to be-as I was supposed to be doing solo home visits in my second week!
All in all it been a strange situation, which is sort of understandable as the staff are all really busy, and don’t always have time to be holding our hands and guiding us, and it hasn’t all been bad, it just took the whole week to get orientated to how the centre worked.
I think the turning point was when our clinical tutor spoke to us and basically said that it was really important that if we felt lost or like we didn’t know what was going on that we talk to her or our supervisor, to clarify our role and what was expected of us, and she also gave us an idea of what she expected of us. I realized after this that they weren’t expecting the world from us but if they thought we were ready/able then they would increase our responsibilities. Also that it was vital that we talk with our supervisors about how we were feeling and whether we were confident/happy to do home visits on our own, and not to hold it in and get more and more upset and end up hating the placement.
So I spoke to my supervisor and got a good idea of what she wanted me to do/be able to do by the end of the placement, what kind of reports would be required and how long my presentation would have to be, what was involved in a home visit (i.e. length etc) and how I felt about going to a person’s house by myself.
I’m still not sure whether I’m ready to do solo home visits but I feel much more confident about this placement and what I’m doing, I don’t feel lost anymore. I am really glad that I sorted out the situation before it became more of a problem.
I think we all need to keep in mind that although good communication with our patients is really important, good communication with our supervisors is even more important, even though it’s not stressed as much during uni. If we don’t feel confident about what is expected of us, what our placement will involve and what we are supposed to do, then we won’t enjoy our placements and we won’t be effective therapists. So if something is upsetting you or you are unsure about something then talk to your supervisor/tutor about it, they won’t think you are stupid or wasting their time, they will be glad that you have dealt with the issue before it became a major problem!
Monday, August 18, 2008
Why is it so painful?
Recently on my ortho inpatients placement I had the opportunity to watch orthopaedic surgery. The surgery I saw was a revision of a total knee replacement, which means that they’ve already had a TKR and it has become infected so the surgeon has to take out the metal work, clean it up and put it back in with cement that is packed full of antibiotics.
I was honestly very nervous, I generally avoid anything that looks a bit gross on those medical shows, especially surgery, but I found that once the surgery had started I didn’t feel like I was going to faint at all, I was just absolutely fascinated at what was happening, learning anatomy on cadavers was good, but it’s nothing in comparison to the real living picture. However, what I had been warned about and astounded me the most was the shear force that the surgeons use, drilling and hammering into the bone. What else was interesting was that the patient has full passive range of movement at the end of the surgery, which is very different to how they present when we see them.
There were two main things I will take from this experience, one of which is a greater understanding and empathy for the patient’s pain. The surgery they’ve had is very traumatic, not only does it affect the bone but all the surrounding soft tissues as well. It’s still very important for the patient to move that joint, despite the pain, for the healing purpose, but I think having sympathy for the patient’s pain is very useful in building a report with the patient and increasing patient compliance. The other useful thing that I have gained from my surgery experience is the knowledge that after surgery there is actually nothing wrong with the knee, which is something I’ve found a lot of patient’s fear, because we automatically relate pain to problem which breeds fear, resulting in more pain. This brought home to me the importance of re-assuring the patient that the knee is ok, it’s just been through a very traumatic surgery and is healing. This re-assuring is something that my supervisor had pointed out to me as being very important, but like most things until you see it for yourself it doesn’t sink in.
In saying this it is still obviously important to question the patient about their pain and to take further action if you suspect something is wrong, but in my experience more often than not the pain decreases once the initial anxiety is eased, physio’s hold a primary role in the treatment of patients following orthopaedic surgery and it’s important for us to not just treat the knee but as they tell us at uni, to treat the whole patient. In my opinion, if you ever get offered the chance to view any kind of surgery, even if you’re a bit squeamish like me, jump at the opportunity, it will give you a great insight into the experience of the patient.
I was honestly very nervous, I generally avoid anything that looks a bit gross on those medical shows, especially surgery, but I found that once the surgery had started I didn’t feel like I was going to faint at all, I was just absolutely fascinated at what was happening, learning anatomy on cadavers was good, but it’s nothing in comparison to the real living picture. However, what I had been warned about and astounded me the most was the shear force that the surgeons use, drilling and hammering into the bone. What else was interesting was that the patient has full passive range of movement at the end of the surgery, which is very different to how they present when we see them.
There were two main things I will take from this experience, one of which is a greater understanding and empathy for the patient’s pain. The surgery they’ve had is very traumatic, not only does it affect the bone but all the surrounding soft tissues as well. It’s still very important for the patient to move that joint, despite the pain, for the healing purpose, but I think having sympathy for the patient’s pain is very useful in building a report with the patient and increasing patient compliance. The other useful thing that I have gained from my surgery experience is the knowledge that after surgery there is actually nothing wrong with the knee, which is something I’ve found a lot of patient’s fear, because we automatically relate pain to problem which breeds fear, resulting in more pain. This brought home to me the importance of re-assuring the patient that the knee is ok, it’s just been through a very traumatic surgery and is healing. This re-assuring is something that my supervisor had pointed out to me as being very important, but like most things until you see it for yourself it doesn’t sink in.
In saying this it is still obviously important to question the patient about their pain and to take further action if you suspect something is wrong, but in my experience more often than not the pain decreases once the initial anxiety is eased, physio’s hold a primary role in the treatment of patients following orthopaedic surgery and it’s important for us to not just treat the knee but as they tell us at uni, to treat the whole patient. In my opinion, if you ever get offered the chance to view any kind of surgery, even if you’re a bit squeamish like me, jump at the opportunity, it will give you a great insight into the experience of the patient.
Friday, August 15, 2008
Negotiating PT time
Hi Guys,
Hope everyone passed their pracs!
In ICU, quite often, you find yourself trying to go and see a patient only to find that they are (1) in the wrong position for Rx and you have to wait 40mins for the HSA’s to come and move them (PT’s are not allowed to move patients) (2) they are being visited by family (3) they have been taken down to CT/MRI (4) the nurse has just started to wash them/change their dressing/change their lines or (5) the doctors are in the room doing ward rounds/review…the list goes on.
It is a huge problem and highlights the importance of good time management skills and liasing with the nurses/docs/HSA’s in order to minimize lost time and give the best possible care for the patient. In my first few days I lost a lot of time waiting around to see my patients because even though you have multiple patients to treat, they were often all busy at the same time. I really had to work at communicating with the rest of the multi-D team to try and negotiate both treatment times and the position I wanted my patient in. I also really had to justify why I needed to get to see the patient at that time, i.e. why it was more important for the patient to get a chest treatment than have visitors. That was another thing that I found really hard, kicking the patients’ family/visitors out of their rooms for Rx, all the patients were really sick and their family really concerned and sometimes distraught, so I felt really bad about it, but in the end (for most patients) it’s more important to take 20 mins for physio and have the family go and get a coffee and have a time out.
I’ve heard that on other wards PT is considered the most important thing for a patient and that everyone makes way for them, but that is not always the case in ICU-though some doctors are really great in recognizing that what we do is vital to the patients. Often we have to make way for other people but it is important that we remember that our skills make a huge difference to the patients and their recovery.
My experience in ICU has really improved my communication/justification/negotiation skills and has given me more insight into how PT fits into the multi-D approach and how important our skills are, as well as making me much better at managing my time. In the future I’ll be able to spend more time with my patients and optimize my treatment time by talking to the other medical/allied health staff and rationalizing why physio is a high priority for the patient.
Hope everyone passed their pracs!
In ICU, quite often, you find yourself trying to go and see a patient only to find that they are (1) in the wrong position for Rx and you have to wait 40mins for the HSA’s to come and move them (PT’s are not allowed to move patients) (2) they are being visited by family (3) they have been taken down to CT/MRI (4) the nurse has just started to wash them/change their dressing/change their lines or (5) the doctors are in the room doing ward rounds/review…the list goes on.
It is a huge problem and highlights the importance of good time management skills and liasing with the nurses/docs/HSA’s in order to minimize lost time and give the best possible care for the patient. In my first few days I lost a lot of time waiting around to see my patients because even though you have multiple patients to treat, they were often all busy at the same time. I really had to work at communicating with the rest of the multi-D team to try and negotiate both treatment times and the position I wanted my patient in. I also really had to justify why I needed to get to see the patient at that time, i.e. why it was more important for the patient to get a chest treatment than have visitors. That was another thing that I found really hard, kicking the patients’ family/visitors out of their rooms for Rx, all the patients were really sick and their family really concerned and sometimes distraught, so I felt really bad about it, but in the end (for most patients) it’s more important to take 20 mins for physio and have the family go and get a coffee and have a time out.
I’ve heard that on other wards PT is considered the most important thing for a patient and that everyone makes way for them, but that is not always the case in ICU-though some doctors are really great in recognizing that what we do is vital to the patients. Often we have to make way for other people but it is important that we remember that our skills make a huge difference to the patients and their recovery.
My experience in ICU has really improved my communication/justification/negotiation skills and has given me more insight into how PT fits into the multi-D approach and how important our skills are, as well as making me much better at managing my time. In the future I’ll be able to spend more time with my patients and optimize my treatment time by talking to the other medical/allied health staff and rationalizing why physio is a high priority for the patient.
Monday, August 11, 2008
Language Lessons Anyone?
In the past three week s I’ve had to treat two patients who speak little to no English and have varying degrees of dementia. This definitely produces a challenge when you’re trying to teach them exercises. One of these patients spoke some English and I spoke a very minimal amount of his language, so to communicate with him I tried to use what words I knew as well as a lot of demonstration. My supervisor said as well to get him to teach me some of his language by saying a word and asking him what it is in his language. This seemed to work well as I think it helped to form a good working relationship and he was appreciative of the effort to speak his language as opposed to just trying to speak English louder. The other patient spoke no English and had quite bad dementia, this made it even more difficult. To tackle this patient we used pictures of exercises and also the daughter to translate to her mother what we wanted her to do. Demonstration was also a very big help in communicating the exercises to her.
Treating patients who don’t speak English is really quite a challenge as we tend to rely quite heavily on our verbal skills to communicate, but situations like these make you be creative and employ all those other communication skills we’ve got buried deep down somewhere. I also found it quite interesting as well, that even though these two patients were relatively similar in the way they presented, they really did need to be managed differently. Treating these patients has made me think about all those other communication skills we have and made me wonder how much more effective could I be as a physiotherapist if I used those skills with patients who do speak fluent English. After all, every person is different in the way they learn, whether it be visually or verbally or practically. I feel now, that sometimes I tend to get so focussed on the fact that I need to teach this person these exercises and I do it the best way I know how, to talk. But maybe if I stopped for a moment and considered what the best way is for the patient and used that form of communication instead, my treatment would be more effective.
I feel that now, in the future, whether I’m treating patients who don’t speak English or do speak English, I will take more consideration of how they learn, not just how I like to teach.
Treating patients who don’t speak English is really quite a challenge as we tend to rely quite heavily on our verbal skills to communicate, but situations like these make you be creative and employ all those other communication skills we’ve got buried deep down somewhere. I also found it quite interesting as well, that even though these two patients were relatively similar in the way they presented, they really did need to be managed differently. Treating these patients has made me think about all those other communication skills we have and made me wonder how much more effective could I be as a physiotherapist if I used those skills with patients who do speak fluent English. After all, every person is different in the way they learn, whether it be visually or verbally or practically. I feel now, that sometimes I tend to get so focussed on the fact that I need to teach this person these exercises and I do it the best way I know how, to talk. But maybe if I stopped for a moment and considered what the best way is for the patient and used that form of communication instead, my treatment would be more effective.
I feel that now, in the future, whether I’m treating patients who don’t speak English or do speak English, I will take more consideration of how they learn, not just how I like to teach.
Sunday, August 10, 2008
To give or not to give walking aids
Hi guys
During the early post operative period, following heart surgery i have noticed many of the patients are quite unsteady on their feet even up to day 3 post op especially if they have had grafts taken from their legs. Quite commonly we give the patients a walking frame so that they are able to ambulate independantly, and start building up their endurance and strength again.This is especially the case if it is a friday and we want them to be independant over the weekend, to start rebuilding their endurance and strength. However with certain patients i feel this is an inappropriate choice as i have noticed many patients becoming dependant on the frame, and it becomes quite difficult to take it away. Some of these patients are only 47 yrs old so to me it seems quite ridiculous to allow them to use an aid for so long and in some instances even hire it to them to take home.
I have learnt from this situation that you have to be very careful who you decide to give a walking aid to in the post operative period. It is very important to consider the patients personality and ascertain whether you think they will be easy to wean of the aid as poor judgement can sometimes lead to the more elderley and anxious patients remaining on it. To help combat this situation i feel if you are going to give someone a frame, then everytime you go to see them you should be walking without the aid and providing standby assistance if they lack confidence and not allow them to talk their way into taking it with them.
I still feel there is an aprropriate place and situation to give someone a walking aid to facilitate the recovery process, however just be careful of certain patients and you will be able to pick this up quite quickly from your interaction with them, as you may prematurley have them using a walking aid on a daily basis.
Saturday, August 9, 2008
Patient privacy vs. PT safety
The patients in ICU are, for the most part, very sick, and most of them have quite extensive past medical histories, so it is always important to carefully read their files and identify any necessary precautions for treatment. For every patient, no matter what their PMH, you have to wear a plastic gown and gloves for protection, and if a patient has particularly infectious/dangerous condition such as MRSA or VRE then they are put in a separate room and extra precautions are taken. These patients’ rooms are always well marked and it is made very clear what you need to do in order to protect yourself.
In this last week I treated a patient with one of the physiotherapists, not my supervisor, and during our treatment-when we were disconnecting the ventilator-some droplets (condensation) from inside the ventilator tubing were sprayed into the air near us. We continued the treatment and as always I wiped down my stethoscope with an alcohol wipe and disposed of my gown and gloves. I had not read the patients notes, as I had been going to treat another patient but they were unavailable, so I had quickly stepped in to help the other PT do their treatment. The next day I went to treat the patient again, with the same PT, who told me to go and read their notes before assessing them (which I would always do anyway), and to be very careful with precautions because the patient had an extensive PMH. When I went to read his chart I found out that his PMH included: HIV, TB, Hep B and Hep C, which was distressing considering what had happened the previous day, and especially since he was not in one of the separate rooms.
Even though there was very little chance that we could have been infected from the ventilator spray I still feel that I should have been told prior to treating him, and been aware that extra precautions needed to be taken-not only for our safety but for the safety of our other patients. Whilst I respect the patient’s right to privacy (since I was not his PT) I think that it is important that any person who would be coming into contact with him, i.e. doctors, nurses, PT’s and HSA’s be aware of his PMH. It is a matter of safety, especially considering that in the ICU the patients get a lot of tests done, and PT treatment often involves disconnecting people from ventilators, suctioning sputum and facilitating coughs. If a person has a condition such as TB or HIV you would be extra careful to not let them cough on you, get any kind of bodily fluid on you and always wash your hands afterwards, instead of just using alcohol gel.
From now on I am definitely going to treat every patient with the maximum amount of precaution, just in case, because even if you have read someone’s notes they may not have the results of investigations back yet, or the patient may be unaware they have a condition. It will be safer for me, and probably the best practice, as I will also be protecting my other, compromised, patients from acquiring an infection from some-else. I am also going to read all patients’ medical files very carefully, and if there is anything in there that I am unsure about then I’m going to check with my supervisor, if (1) Rx is suitable for that patient and (2) what I can do to ensure I am treating in the safest possible manner.
In this last week I treated a patient with one of the physiotherapists, not my supervisor, and during our treatment-when we were disconnecting the ventilator-some droplets (condensation) from inside the ventilator tubing were sprayed into the air near us. We continued the treatment and as always I wiped down my stethoscope with an alcohol wipe and disposed of my gown and gloves. I had not read the patients notes, as I had been going to treat another patient but they were unavailable, so I had quickly stepped in to help the other PT do their treatment. The next day I went to treat the patient again, with the same PT, who told me to go and read their notes before assessing them (which I would always do anyway), and to be very careful with precautions because the patient had an extensive PMH. When I went to read his chart I found out that his PMH included: HIV, TB, Hep B and Hep C, which was distressing considering what had happened the previous day, and especially since he was not in one of the separate rooms.
Even though there was very little chance that we could have been infected from the ventilator spray I still feel that I should have been told prior to treating him, and been aware that extra precautions needed to be taken-not only for our safety but for the safety of our other patients. Whilst I respect the patient’s right to privacy (since I was not his PT) I think that it is important that any person who would be coming into contact with him, i.e. doctors, nurses, PT’s and HSA’s be aware of his PMH. It is a matter of safety, especially considering that in the ICU the patients get a lot of tests done, and PT treatment often involves disconnecting people from ventilators, suctioning sputum and facilitating coughs. If a person has a condition such as TB or HIV you would be extra careful to not let them cough on you, get any kind of bodily fluid on you and always wash your hands afterwards, instead of just using alcohol gel.
From now on I am definitely going to treat every patient with the maximum amount of precaution, just in case, because even if you have read someone’s notes they may not have the results of investigations back yet, or the patient may be unaware they have a condition. It will be safer for me, and probably the best practice, as I will also be protecting my other, compromised, patients from acquiring an infection from some-else. I am also going to read all patients’ medical files very carefully, and if there is anything in there that I am unsure about then I’m going to check with my supervisor, if (1) Rx is suitable for that patient and (2) what I can do to ensure I am treating in the safest possible manner.
Monday, August 4, 2008
Pressure For Beds
Hi Guys
Im currently on a cardiothoracics clinic and managing post cardiac surgery pts. The team aims for discharge about day 5 p/o, at the moment there has been some pressure for beds up on the ward and as a result there is a bit of a pressure there to get some people out. I went to see one manwho had already been in for approxiametley 10 days on my first week. He had been experiencing shortness of breath and his chest xray showed a pleural effusion so his discharge was delayed.
The doctor's had cleared him medically, and were awaiting him to pass the stair test with us. My supervisor told me the previous day when she had walked him, he had started shivering got very SOB and was unable to continue ambulation and that she thought there was something not quite right, however the pleural effusion had not gotten any larger on subsequent chest Xrays.
walk we tried the stairs, he managed three
So I ambulated the patient and he managed the walk approx. 200m with no problems the doctors were watching and looking over my shoulder on the walk asking me how i felt he was doing. I said from the walk he was doing quite well, however he still wasnt ready to go home alone, as he was still using a walking aid due to lack of confidence and slight unsteadiness on the feet.
We tried the stairs and he managed 3 before becoming very SOB, and bursting into tears and being unable to continue. We monitored his observations and his SpO2 and HR were fine. We called the doctor's to come and see him in this state to show why we were not happy for him to go home. Over the weekend the doctor's decided to put a drain in and over 1.5L of fluid was drained.
I guess the point of the story is sometimes you can be put under a bit of pressure to give people the ok and discharge them. However if you dont think they're ready to go home then you should stick to your opinion. It can be hard esp. when these other people know alot more than you do and hold a higher position in the hierachy at the hospital.
Im currently on a cardiothoracics clinic and managing post cardiac surgery pts. The team aims for discharge about day 5 p/o, at the moment there has been some pressure for beds up on the ward and as a result there is a bit of a pressure there to get some people out. I went to see one manwho had already been in for approxiametley 10 days on my first week. He had been experiencing shortness of breath and his chest xray showed a pleural effusion so his discharge was delayed.
The doctor's had cleared him medically, and were awaiting him to pass the stair test with us. My supervisor told me the previous day when she had walked him, he had started shivering got very SOB and was unable to continue ambulation and that she thought there was something not quite right, however the pleural effusion had not gotten any larger on subsequent chest Xrays.
walk we tried the stairs, he managed three
So I ambulated the patient and he managed the walk approx. 200m with no problems the doctors were watching and looking over my shoulder on the walk asking me how i felt he was doing. I said from the walk he was doing quite well, however he still wasnt ready to go home alone, as he was still using a walking aid due to lack of confidence and slight unsteadiness on the feet.
We tried the stairs and he managed 3 before becoming very SOB, and bursting into tears and being unable to continue. We monitored his observations and his SpO2 and HR were fine. We called the doctor's to come and see him in this state to show why we were not happy for him to go home. Over the weekend the doctor's decided to put a drain in and over 1.5L of fluid was drained.
I guess the point of the story is sometimes you can be put under a bit of pressure to give people the ok and discharge them. However if you dont think they're ready to go home then you should stick to your opinion. It can be hard esp. when these other people know alot more than you do and hold a higher position in the hierachy at the hospital.
Sunday, August 3, 2008
The Value of Working With Nurses
I’m currently on my musculo inpatient’s prac and am learning how valuable it is to work together with the nurses. In the short time I have been on this prac I have observed the way that the physios work together with the nurses in the care of the patients. On numerous occasions I have seen the physio liaise with the nurse when standing a patient or walking a patient and timing this with when the nurse would like to take them to the toilet, to the shower or change the bedding.
I have only had one previous placement in a hospital this year and although I did have to work together with the nurses it was mainly to check when the patient might be ready to come to the physio gym. I also feel that in some ways, it is difficult to strike up a good team relationship with the nurses as they are often quite busy and don’t always have the time for a physio student. In theory I have always known that it is good to work together with the nurses, as they are ultimately the ones who spend the most time with the patients and it’s great to see this in practice. My previous experiences as mentioned above did not really lend themselves to fully exploring the workings of a nurse/physio relationship, but in the past week I have seen how working closely with the nurses can really benefit the patient and also the nurses themselves. By standing the patient and walking them to the bathroom ready for a shower can cut down at least a small part of the work that the nurses do. Nurses are also incredibly valuable when you need a quick update on how the patients are going, which can affect your decision on how much exercise to do with the patient. In addition to this we can then feedback to the nurses as to how the patient is going and they can reinforce the exercises you want the patients to do whilst you are not there. This greatly benefits the patient’s rehab.
So as I’ve said, in the past week I have began to fully understand the value of a strong nurse/physio relationship for the benefit of all those involved. In future I feel that I will make much more of an effort to work closely with the nurses, and not only the nurses but all staff who are working for the good of the patient. In my opinion a multi-disciplinary approach will always provide the best outcome for the patient.
I have only had one previous placement in a hospital this year and although I did have to work together with the nurses it was mainly to check when the patient might be ready to come to the physio gym. I also feel that in some ways, it is difficult to strike up a good team relationship with the nurses as they are often quite busy and don’t always have the time for a physio student. In theory I have always known that it is good to work together with the nurses, as they are ultimately the ones who spend the most time with the patients and it’s great to see this in practice. My previous experiences as mentioned above did not really lend themselves to fully exploring the workings of a nurse/physio relationship, but in the past week I have seen how working closely with the nurses can really benefit the patient and also the nurses themselves. By standing the patient and walking them to the bathroom ready for a shower can cut down at least a small part of the work that the nurses do. Nurses are also incredibly valuable when you need a quick update on how the patients are going, which can affect your decision on how much exercise to do with the patient. In addition to this we can then feedback to the nurses as to how the patient is going and they can reinforce the exercises you want the patients to do whilst you are not there. This greatly benefits the patient’s rehab.
So as I’ve said, in the past week I have began to fully understand the value of a strong nurse/physio relationship for the benefit of all those involved. In future I feel that I will make much more of an effort to work closely with the nurses, and not only the nurses but all staff who are working for the good of the patient. In my opinion a multi-disciplinary approach will always provide the best outcome for the patient.
Saturday, August 2, 2008
Talking to patients
In ICU the majority of patients are sedated to a certain extent, though as they begin to recover their sedation is turned down and they begin to wake up, and they often do not respond to tactile stimulation or pain. When treating these patients we are supposed to talk to the patient and explain what we are doing, even though the patient does not appear conscious or respond in any way. I understand that this is very important, as we have no way of knowing how much they are actually aware of, and we need to try and make sure that, especially if we are doing an invasive intervention, they know what is about the happen to them.
However, for the first few days of prac you feel a bit stupid talking to a patient who is sedated and seemingly oblivious to their surroundings, and you begin to slip into the habit of just jumping in and treating the patient (esp. if you have treated them before and know that they are sedated and don’t respond) without explanation or warning. It is really hard because you do it without thinking, and if it was me in the bed I know that I would want to know what was happening, and even if they aren’t aware it is still an important thing to do.
Yesterday I was treating a patient with one of the other students, we had seen her a number of times over the last two weeks, as she has been in ICU for almost as long as we have. She had been sedated for all of that time, and hadn’t responded to any stimulus, but she was beginning to recover and had had her sedation decreased gradually overnight. When we went in to treat her we explained that we were going to put our hands on her chest (to assess chest expansion) and listen to her lungs, we also looked at her ventilation and saw that she was taking spontaneous breaths-which was important for our intervention-bagging (MHI). We had got everything set up and started to bag-without having explained what we were about to do, when she started to move her jaw, and tried to open her eyes and bite the ETT. At this point we explained that we were giving her some bigger breaths and that she should try to relax, and we completed her treatment-explaining that we were going to suction her and that it would make her cough.
I felt so bad about not telling her what we were doing, and her response to our treatment! We should have realized that she might have been more aware since her sedation had been turned down, and even if we hadn’t we should have explained what we were doing to her.
We can never really be sure how aware a person is of their surroundings, even if they are sedated, and is it vital that we always let a patient know what we are about to do, especially if it is an invasive technique. It doesn’t matter whether the patient looks unconscious or that they don’t respond to stimuli, it is a basic courtesy and it is very important to ensure that the patient doesn’t react badly to your treatment because they weren’t prepared for the sensation or didn’t know it was coming. In order to do no harm, we need to talk to our patients, whether they talk back or not.
However, for the first few days of prac you feel a bit stupid talking to a patient who is sedated and seemingly oblivious to their surroundings, and you begin to slip into the habit of just jumping in and treating the patient (esp. if you have treated them before and know that they are sedated and don’t respond) without explanation or warning. It is really hard because you do it without thinking, and if it was me in the bed I know that I would want to know what was happening, and even if they aren’t aware it is still an important thing to do.
Yesterday I was treating a patient with one of the other students, we had seen her a number of times over the last two weeks, as she has been in ICU for almost as long as we have. She had been sedated for all of that time, and hadn’t responded to any stimulus, but she was beginning to recover and had had her sedation decreased gradually overnight. When we went in to treat her we explained that we were going to put our hands on her chest (to assess chest expansion) and listen to her lungs, we also looked at her ventilation and saw that she was taking spontaneous breaths-which was important for our intervention-bagging (MHI). We had got everything set up and started to bag-without having explained what we were about to do, when she started to move her jaw, and tried to open her eyes and bite the ETT. At this point we explained that we were giving her some bigger breaths and that she should try to relax, and we completed her treatment-explaining that we were going to suction her and that it would make her cough.
I felt so bad about not telling her what we were doing, and her response to our treatment! We should have realized that she might have been more aware since her sedation had been turned down, and even if we hadn’t we should have explained what we were doing to her.
We can never really be sure how aware a person is of their surroundings, even if they are sedated, and is it vital that we always let a patient know what we are about to do, especially if it is an invasive technique. It doesn’t matter whether the patient looks unconscious or that they don’t respond to stimuli, it is a basic courtesy and it is very important to ensure that the patient doesn’t react badly to your treatment because they weren’t prepared for the sensation or didn’t know it was coming. In order to do no harm, we need to talk to our patients, whether they talk back or not.
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