Death and Patients

One of Viadas' patients died this week and the doctors told me to 'let him know'. I find it harsh sometimes that a person can pass away and it is just another bed that will be filled within a few hours. I find this the harsh reality of hospital work. Just another bed... just another patient... "Can you let the other physio student know?" I hope that I don't become that desensitized.

Attachments…

After a good 4 weeks on a surgical ward, indeed, there where plenty of attachments to keep track of before moving a patient!! But after finishing this rotation, I have found myself becoming ‘attached’ to some of my patients. Not in as in tripping over drains or catching my pant leg on a drip stand (as I am so graceful) I have formulated a bond with some of my patients. It was hard to say goodbye to some as I spent a good 2+ weeks with them. Some I would see from day one to D/C, I couldn’t help but find it tough to say farewell. Even they were said to hear of my departure! Most touching were the older patient who had many life stories and those I felt the most need to help get back on their feet so they could return home. Maybe this is something you grow accustom to and are able to ‘move on’ from but for now, I don’t mind making the extra effort to send them a letter or check in on how they are going. Not sure how long it may last as crunch time is here and there are big changes & life decisions to face. I must say it has also been a GREAT couple years getting know most of you, and hope time doesn’t make the distance between us too far! Best of luck to you ALL in the PCR and those soon to be employed! Don’t forget to write :)

variable personalities

At my placement, we were discussing how different personalities learn and approach problems differently. There is the aggressor who approaches a problem and without thinking too far ahead, they just jump right into getting a solution. Basically they usually get ahead of themselves and haven't really thought things through. Then there's the reflector who will take their time and think of all the possible solutions before coming up with a plan. There's a third one but I can't seem to remember it at the moment.

One of the physios went to this workshop and everyone had to answer a questionnaire to determine which type of personaility they were. Then they all got into their respected groups and each group had to solve the same problem. She said that it was just interesting to see how different each group approached the problem. Everyone in the aggressor group began to all try to take charge and talk over each other. They all had a plan in a matter of a second. The reflector group all sat there staring at the problem and individually thought about it for a while before discussing it together.

The physio was an aggressor and she said that if a student didn't answer her questions immediately, she use to think that the student didn't know it. But now it could just be that they were reflectors and needed time to think it through.

This is quite interesting because we're all very different and if the supervisor knows what type of personality student they have, it may help the learning process for us students. She was thinking of getting the next lot of students to fill out the questionnaire on the first day of prac. I think it's a fanatastic idea and more placements should take students' problem solving approaches into account.

Knowledge is Power

This last week in cardio has cemented for me how lucky we are to be graduating with a substantial amount of knowledge and skills. Upon questioning alot of interns and RMOs this week on various issues, it became blatantly apparant that they're pretty much hopeless in their first year or two post graduating. This can however work to the advantage of physios!! If you need something done that you know for sure will benefit your patient that requires medical orders, just suggest it to them, and they believe you and organise it for you! Saves you lots of time :) Good luck in PCRs everyone!!!

Closing time….

So, we are almost at the end of the road, about to take the first step up the ladder of success perhaps?

This last week, we had a peer learning session where followed the other 2 students in our hospital to their surgical ward and had a taste of what they did. They too followed us in our general med ward and saw what we did with our COPD patients.

Subjectively we ask similar questions, objectively look for the same signs, rx wise, aim to get them up and walking. But walking a surgical patient is all about organisation. One needs to know where all the wires, drips, IDC, tubings are and how to handle them such that u still are able to place a hand on the patients back.

In terms of COPD patients, doing a detailed subjective is imperative. Not only do we ask the usual SOB, cough, sputum, chest pain, ex tolerance; we also need to determine patients’ ambulatory status, how much they can tolerate amb on a gd day, how they are on a bad day, if they have been prescribed ambulatory oxygen, or O2 at rest. Have they been to pulmonary rehab classes? (long term planning, d/c) If they have recurrent admissions (x6 in 6/12; very common in our ward), what led them in this time round, how were they coping at the time of the last discharge?

When we first started, I was missing out all the nitty gritty stuff, but as I got more familiar with it and understood why we had to ask these questions, it got smoother.

All the best for PCR !!

Communication....again

Communication has obviously been a hot topic of these blogs. This past week there have been a couple of cases where my colleague and I have had to improvise a little in the ICU. I had a patient who suffered a CVA and was also Deaf and Mute due to congenital Rubella. Trying to get the patient to take some deep breaths and have a couple of coughs was a lot harder than you think! Luckily I enlisted the help of a family member and together we got the patient to do what was needed.
My colleague had a patient who was Croatian and unable to speak English. Treatment times were spent virtually playing charades in an effort to get the patient to take some deep breaths and have a cough. We joked that the patient probably had no idea what we were trying to do and probably thought the nice 'boys in blue' were clown doctors who came around a couple of times a day and did things to try and make her laugh.......interesting experiences that's for sure.

Ax of voluntary movement

For the past few weeks of doing Neuro I've realized just how much more learning we have to do in this field alone. The physios here are absolutely amazing and creates a non-intimidating environment to learn. One major assessment that I think Curtin should go over a lot better is the assessment of voluntary movement. Yes we were taught the stages of recovery but there is so much more to that. If the patient can move a joint, is it with or against gravity?? Is it tone initiated or not? Do they have 1, 2, or 3 joint movement?? I have had to assess the voluntary movement of a few patients and I have found it challenging to get an accurate idea of the patient's movement abilities. The way you position and stimulate the joint to move is crucial.

Did anyone else find that assessing voluntary movement was a lot more complex then they expected???

Location loc...oops I mean COmmunication communication communication

This last prac has been great for liaising with other health professionals. Because I have been working in all different areas-ICU/med/surg/CCU/theatre you are engaging with all kinds of people and its great to develop some sort of rapport with the people in your environment as it makes it SOOOO much easier to do your job and do it well!! I have really found it a pleasure to work with the people at Hollywood, everyone has been so friendly and works as a team, seeking input where needed.
It's so easy to go up to the ward, see your patients, write their notes and then be on your way again but taking a couple of extra minutes to ask someone something or pass on some info about a patient really does go a long way.
Another thing that I have come away with from this placement is what sort of supervisor I would like to be if I ever get a job and am ever entrusted with students!!!!! The ability to give your students autonomy whilst at the same time providing a learning and supportive enviroment and being approachable really is an art andI was fortunate enough to have a supervisor like that.
Ok, well that's enough waffle from me. CHeerio everyone :-)

Different places

One of the frustrations of the placement I am on is that I know the requirements of the placement are different than the requirements at an equivalent placement at a different location. For example, we are still reporting to our supervisor after every subjective and objective assessment while at the other location students are doing their subjective, objective and treatment without reporting to their supervisor in between. We are also writing far more notes than students at the other placement. On one hand it may be good for us to be getting the extra feedback but it would be nice if the system was more standardised.
Mike

STUDIES SHOW…

A majority of Dr’s on our ward tend to prescribe the almighty IS (incentive spirometry) to help aid in the prevention of chest infections post surgery. Hmmm, beings there is not a lot of evidence that this piece of equipment does in fact…work, but also cost the hospital or the patient $$$, I wanted to put in a word or two. It all began when a young, fit patient day 1 post lower abdominal surgery joined our ward and as I was doing my initial Ax, Tx etc. Dr ‘old pro’ joined me and of course took over the show…for a bit…which seemed to fit his schedule, and knowing me…I aim to please and patiently awaited for him to finish! He later ADDED how physio will fit him for IS to help his chest. Nothing like putting words into one’s mouth ‘eh! Just as I was about to chime in some EBP, he was interrupted by another staff member so I attempted to utilize this time to finish my Ax. Good thing I’m a charmer cause he patiently awaited my wrap up, and politely bit his tongue for the next 2 seconds, before he asked the patient…’any questions?’ and scooted on his merry way. Upon his exit, I just couldn’t help but explain to the patient that it is WAY more beneficial to be in an up right position and/or WALK, especially for this patient. Getting up and out of bed will be 10x more effective then an IS. Not so sure if Doc would have agreed, so as you do…retrieve and dust off the ‘ol IS! Guess I’m still a bit shy on the ward because really, NOT so sure I would have corrected DOC as I am a student…and have a funny accent! I did not demean the Dr in any way, I just explained to the patient a better alternative for chest care. Were does teaching a Dr it fit in? I mean, what is a good way of bring things such as this, where we are more knowledgeable in an area, to other practitioners’ attention…politely?

Compromising Situation

Compromising Situation

I went into a patient’s room and the first thing he said was: “Are you here to have sex with me?” What do you say to that? I replied: “No, I’m the physio student and I am here to take you for a walk.” He said: “Oh, I really wish you were here to have sex with me.” I was really shocked and informed him that he was not to speak to me that way again as it was really inappropriate. I can’t even describe how I felt it was such a strange and upsetting situation. I later found out that he was transferred to the psych ward.

other health professions

I had the opportunity to sit in on an OT and speech session for one of my patients. Prior to this opportunity I had an idea of what the other health professions did but what the treatment sessions included. During her speech therapist, it was interesting to observe the strategies used to get my patient to stop slurring her speech.

At OT, my patient's goal was to get her (R) arm more functional. OT on Fridays are apparently fun days so they baked brownies. It was interesting watching my patient cut up the butter, stir the mixture together, etc. During our sessions I have tried to incorporate UL ex's but this OT session was probably more beneficial. Without the patient even realizing it, she was using that arm quite a bit. The OT was telling me afterwards that once her trunk control improves (PT's role), she would be able to do a lot more of the activities in standing. In PT, our progress will be greatly improved once the patient's (R) UL becomes more functional. It will open a lot more options.

This experience has given me a greater appreciation of what the other health professions do. I encourage all of you to sit in on at least one sessioin. We all see my patients everyday and our goals all depend on how they progress in the other health professions, especially in OT, and yet we have so little idea as to what they are doing. It was made me think that maybe we should open the communication lines a little more and discuss what they are focusing on in their treatment sessions.

Pulmonary Rehab

For the last few weeks I have had the chance to attend pulmonary rehab classes with Nola for half a day. The best part about these is the so called "education sessions" where we all have a chat, usually about a random topic that someone comes up with. Last week it was the benefits of stopping smoking. It was hilarious.......one lady said she was not "physically addicted to cigarettes", just "emotionally" (it apparantly calmed her nerves). A fellow classmate tried to tell her that was impossible."Don't be stupid, the two are interconnected, you cant separate them" he fires back....and so the conversation got started. So, I learnt that really, you dont have to educate these people all that much, you put them in a room together and let them educate each other.... your job is to pull them back on track when all the war stories make their way into conversation......very interesting but not the purpose of the class unfortunately! Attending these classes has highlighted to me the benefits of group therapies. One lady said that the class was the only thing she got out to do each week, and if she didnt have it she would probably curl up and die! Moral of the story.....if you're working in a hospital or community that doesnt have a pulmonary rehab class....start one up!!!!

Part of the 'Team'

This week I've worked harder at liasing with other staff, getting to know people a bit better and integrating more into the 'Team' that is the ICU at present. Chatting with some of the Registrar's on the ward rounds, the Consultants over x-rays, asking questions and offering my opinion when asked......yes that's right, I have been asked a few times this week for my opinion, now that people realise that I am interested in what's going on and have a small portion of knowledge to go along with it. Certainly nothing life-saving, but it's nice to be asked nonetheless and be made to feel a part of the team. I guess the thing I've learnt is: although it may take a little time, keep making the effort to integrate with other health professionals in your area. I believe it has definitely helped me with my overall treatment plan with patients, given my confidence a boost and made time on the ward generally more enjoyable. Good luck to everyone in their last week!

A Tribute to the Cardio Queens

Last Wednesday one of my new patients was a 63 yo lady with severe COPD, now this lady was actually in for some Ix totally unrelated to her respiratory condition but someone had just noticed that she was very breathless with ambulation and maybe she would benefit from some ambulatory O2………anyway it turns out that this lady has NO IDEA of her respiratory condition, what it is, how it affects her or what she could be doing to help herself. It then was delegated to me to be the one to educate her and “sell” her the idea of pulmonary rehab and the ways in which she could improve her QOL. This was slightly daunting as this lady was pretty set in her ways and not that unhappy with her current state…….to add pressure before I went in to see her my curtin supervisor said, “Now do you have a plan for how you’re going to go about this because this first meeting and what you say to her will be a very important decider of whether we have “sold” the idea of pulmonary rehab and self mx.” So in I went and did my best to convey that we had a lot to offer her and help her with her disease……..to cut a long story short she was thrilled to learn that there was something she could do to improve her QOL and manage her state better, Sue and Nola would've been proud………it was a good reminder that what you say/the way you present your case is vital if you’re aiming to get your patient on side!!

when planning and execution dont match

This week, we were given the opportunity to run the ward ourselves.

*panic attack*

On the first day, it wasn’t so bad…as there were not many new patients and some did not need reviewing.

Following that, the new patients just came flowing in. They were flooding everywhere!
What irritates me the most is the fact that we need to spend time ploughing through the notes, CXR, bloods, investigations. When the time comes to put out the flood…it avoids me as if I was a ball of fire.

Sometimes, planning your day well and prioritising patients is not enough. Flexbility is the key.

This week I have been treating a pt that has end stage COPD & on Friday I went to treat her and her sats were at 79% and she was pale, had blue lips, and temors in her extremities. As you can imagine I was very hesitant to do anything with her, but this made her nervous and she asked me if she was dying. I never want to answer that question, but what do you do in a situation like this?

Just Relax

So after 2 weeks in the ICU and following my mid-placement assessment, I've been told I need to relax more around the patients and other staff, be a little more 'light-hearted'.
I guess I've been pretty serious since I've been working in an area that is really quite critical and been around patient families who are all very upset. There must be a fine line between being more 'relaxed' but serious enough to appear as though I am not up there joking around and patient family members wondering "who is this guy acting so casual when everyone here is critically ill?". Maybe when I underdstand everything a little better I can relax and appear more confident at the same time. At the moment I'm just happy if my patient is still alive after I've been in to treat them.....

Is harder easier?

When I first read their notes, I quivered. They had pain everywhere, I may have just coloured their body chart from head to toe and called it Pb 10/10. Complex, irritable, severe constant deep and intermittent pain with P&Ns, numbness and burning radiating pain through both legs and arms. Their past history had chapters and their medications had to be taken in courses and had an instruction manual. They don’t know they’re in Australia, never mind at a physio clinic, and they don’t even know what a physio is or does. Do you know the patient? Ok, it’s a slight exaggeration but I found myself getting really nervous about seeing the “complex patients”. Actually, I was petrified. I had a couple of complex cases this week and was pleased to learn that with a lot of these patients, you can do what seems to be a very soft and short treatment and get some amazing results. I had a patient where I did some light stroking STM and a grade I-II glide on her Tx sp process and got a large drop in her pain and a huge increase in ROM.

Motivation......anyone?

We are only 1/2 way into our third clinic now and I am having trouble staying motivated. Every day is an absolute drag getting out of bed in the morning and the days just seem to just be getting longer. Then I think of the PCR then the other whole clinic we havent even started yet. The struggle to stay perky every day and actually interested in interpreting yet another CXR or taking another pt for a walk is further zapping my enthusiasm. How do you fake interest in a topic you have absolutely no interest in? Apparantly sometimes my non-verbal communication (despite my greatest efforts) shows I am "a little bored"! Some may say I may need some skills in cardiopulmonary in the future. For those who know me, they know this will be over my dead body. I have no interest in applying for a public hospital job, just in case I get rotated to cardiopulmonary! So....does anyone have some motivating words, any words of wisdom or any tried and tested techniques to help me find my motivation? Am I alone out there???