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???