last blog

Somehow I managed to miss out or lose a blog so here goes for my last blog.
now that we have "finished" university it seems the thing to do now is get a job. we have been waiting so long to get to this point but is anyone else feeling hesitant, unsure or even scared to move to the next stage? I was so sure that once i was finished, doing up my CV would be a breeze due to the high excitement level but I am finding it so hard to even get my skills down. what do they even want us to be able to do at a new graduate leve? are they expecting big things from us or is the job vacancy levels out there big enough for them to trust that Curtin has taught us all that they need? I guess when this is the first real job i will be getting I have no idea how the process works, I dont feel ready for this part even with the assignement we did at the start of the year. I have been talking to many different people about this and it seems they found it like this when they transitioned from uni into the job matching their degree. I still feel nervous and hesitant, but sitting and looking at a half filled CV is definately not going to get me a job so I guess all i can do is try.

Male physios with female patients

This post does not only refer to my experiences at a paediatric placement, but also in the adult sector of the rural outpatient physiotherapy.

What i found eye-opening throughout this year was the lengths that we are taught to go to to ensure we minimise the risks of sexual harassment claims. Through both of these clinics i was taught extra steps that must be taken to make sure that i was not treating female patients individually.

When entering the clinical year i thought myself to be a very professional student with the only objective being to treat people and make them better. I never thought myself to be sexually deviant and thus when all this information was handed to me, i was somewhat confronted. I was informed that even with adult patients, i was not to be in a room with a female patient alone and needed someone else there to supervise in that situation. I can understand the relevence in the paediatric setting, but i thought these measures were somewhat overzealous in the adult sector. On speaking to my supervisor about this she informed me that they are extra careful with young male students in the rural sectors and that these measures would not stay once we are graduates and working full-time.

I was wondering if any others had any rules imposed that were confronting or have any situations were these measures were beneficial?

blogging

This blog is a reflection on this part of the course, the blogging aspect. I had varying views about the effectiveness of the blogging and how much help this would be to my knowledge base and clinical skills. At various points in the year the blogging became very tedious and coming up with a relevent topic seemed hard. Im sure some people thought that writting new posts and reflecting on our own issues was relevant, but i didnt think so. What i did find very useful was reflecting on other peoples issues and thus forcing myself to question my own responses to that scenario and how i would handle it. There were a couple of occasions throughout the latter part of the year where new scenarios i found myself in became somewhat familiar as i had heard someone comment on their response. This provided me with the oppertunity to make the right decision faster and more effectively as i already had a bank of knowledge built up from reading and thinking about the posts.

As part of the PD in my new job, they do employ some of the same tactics each week where we present an issue and then each discuss a way or technique to deal with it. It may have taken me 8 months to see the worth in all this blogging, but i think it was worthwhile!

difficult nurses

On my rural placement, I found myself in a difficult situation with one of the ward nurses who was looking after a patient who was Day 1 post THR. This patient had been extremely nauseas all morning, so myself and my supervisor saw her after lunch to transfer her out of bed. Everything went well, however upon sitting upright was feeling very nauseas and vomited. We stood the patient and took a few steps, then decided we would put her back into bed rather than have her sitting out as she was feeling extremely unwell, and tomorrow we would see her again for ambulation. Later in the day (at 4.30pm), I overhead the patients’ nurse trying to phone the OT’s- who were no longer in their office. She then spotted me as I was leaving the ward and asked if I could find a suitable chair for the lady to sit out in, as she had not yet been seen by the OTs. I informed her that the OTs were seeing the patient first thing in the morning as they like to measure up their chairs to the patients height/ leg length (especially as she was a posterior approach). I also informed her that the patient was still vomiting and feeling unwell, and had been given bed ex’s and breathing ex’s to perform until we saw her again in the morning.

The nurse insisted that the patient be transferred out of bed (OOB), and she was going to get her up whether I would help or not. I again explained the patient’s situation, and also that if we transferred her OOB now, she would need to sit out for around 2 hrs before dinner, which would be too long. The nurse then gave me big lecture/ abuse saying how I was just being selfish as I probably just wanted to get home on time (although I only had the nurses quarters to get back to?!) and that being a student I should listen to what she wanted for the patient.

Her comments really upset me, as they were not only completely wrong, but because I knew it was not in the best interest of the patient to transfer her OOB. In the end, I ended up assisting the nurse to transfer the patient into a chair that I found and sized up, the whole time of which she was trying to tell me what I was doing wrong or a better way to do something. To cut a long story short- we transferred the patient OOB (TOWARDS her operated side which again the nurse tried to tell me was wrong), the patient sat in the chair, threw up 3 times and then had to be put back into bed- all of which I could have predicted.

From this experience, I learnt that although I may have been a student, I knew what was right and I should have been more assertive and stood up for what I knew, but I ended up just trying to please the nurse and avoid conflict. My supervisor believes I did the right thing, as in small hospitals she assured me it would have been worse to get on the wrong side of the nurses, however I still feel this was not right or fair on the patient.

high care patients

This blog concerns dealing with patients in hospital who are for palliative care or high care nursing homes. I came across such a patient on my neuro placement. He was an elderly man who had a dense hemiplegia and had been on the ward for about two and a half months and still had no sitting balance, no upper limb movement or no lower limb movement even with facilitation. Our supervisor wanted us to treat him aggressively on our four weeks there. So everyday for two hours two of us would treat this patient and we would literally be sweating afterwards and he would be exhausted. But after about the second week, we noticed such an improvement in him that it motivated us to keep on going. He was able to sit for about two minutes, although with very poor alignment, and his head control was dramatically improving.

We attended a number of team meetings for this patient and strongly recommended him for rehab along with the support of our supervisor, as we really believed that with intensive therapy he would be able to achieve a level of functioning that would enable him to return home to the care of his wife. Initially the decision was made that he was awaiting a place in rehab, and we were all very pleased with this outcome. Then on our last week we found out that they had changed their minds and thought that a high care aged facility would be more appropriate. The other student and I were really disappointed with this news, as we felt that all our hard work, including the patients, had all been for nothing. We knew that in a high care facility he would not get any rehab to the level that he needed, and the thought of him lying around all day really saddened me.

I spoke with my supervisor about this and she said that it happens a lot, and that at the end of the day the decisions are made in conjunction with the family for the welfare of everyone involved. I realised that his wife probably would have really struggled to care for him, and it would have put undue stress on her. I think it just highlights the importance of not becoming attached to patients, and to try separate yourself from the emotional aspects, to an extent, so that it doesn’t affect your treatment. The supervisor also said that it is just our job to keep on working really hard with the patient until their discharge because every gain we make will make a huge difference to them. I will always take this approach from now on.

Parent Interference

I recently finished my paediatric placement. Those of you who have worked with children, know you have to spend a lot of your time explainining your activities and hep to the family/parents. One particular patient I had from Malaysia was accompanied at all times by a private teacher, a private carer and as some times his mother.

Although we have to spend a lot of time explaining what child's behaviours we need to facilitate or change, I learnt from this particular client that it is also important to observe the parent's behaviour. These particular carers were still spoon-feeding him, they constantly carried him, when he took to long to get off the floor or wasn't doing an activity correctly, they would simply do it for him. It explained a lot, as during my sessions when the child had problems with balance or doing a task, he would simply flop to the ground. I could see then, how he was just expecting me to pick him up or do the task for him.

After learning this, I spoke to the carer's/family and explained how I would like them also to alter their behaviour, and how that would benefit and strengthen the child. I feel this had a great improvement on the childs saving responses, balance and overall strength and development. I feel I learnt that you must be aware of the entire picture of your patient's lives, not just the short time you spend with them during physiotherapy sessions!

Safety incidence

On my ICU prac, I was involved with an incident where I assisted another physiotherapy student in transferring a cardiac patient from a chair to a bed. He had a tracheostomy in situ and was on CPAP via ventilator. We also had 2 orderly staff and a nurse involved in looking after lines/attachments and assisting us.

During the transfer, every student's nightmare happened... somehow his tracheostomy was pulled out of his neck... so that it was dangling down in front of his chest. When we saw this, we had a few panicky moments where i knew myself and the other student (who were leading the transfer) thought "what do we do?" and I recall the other student saying "we should put it back in" (luckily we never went through with that idea)

The patient (quite comfortably) said "I'm alright!", following which we immediately sprung into action, sitting him down and sending an orderly to get a doctor immediately. The doctor was very pleasant, simply putting a bandage over his bleeding wound where the trachy used to be, and saying "well, you got off the ventilator 1 or 2 weeks early!"

I believe we froze for a few seconds because we were still in that "student" mindset - that the more experienced nurse or orderly staff would solve the problem. Although this situation resolved well, it did remind me to be vigilant and we should have acted and got help immediately, as we were the ones responsible for the situation. Although we were students we were still the ones leading the transfer, and obviously the other staff were waiting for our cues to act.