China

For my international placement I was in China working in a children's rehabilitation centre. Working at the centre was a lot more different than I expected. Obviously i thought treatments would be quite different, but i didn't realise that the way the staff actually treated the children would be so different to what I am used to. On the first day at the centre I was quite shocked out how the centre was run, where children take part in therapy all day every day. Each day they do the same things in a therapy based way rather than incorporating it into play to make it more practical and interesting for the child. Many of the newer staff were also really physical to the children. Yelling, pulling and pushing was seen every day. I felt like I just wanted to change everything they were doing because it wasn't the way I have learnt. After being at the centre for a few days, I became more patient and learnt ways to show the staff alternative treatment methods without actually telling them. They were really observant in our treatment methods and really picked them up well. One thing we were suprised about was that they were also picking up our passive and calm way of treating the children and how we made therapy fun as well. This experience really made me see that you shouldn't always judge people at first glance. It also helped me develop different ways of showing people different methods of treatment and you shouldn't judge peoples ability to observe what you are doing.

Lazy Handover Forms

I feel I was extremely lucky to have a rehab in the home elective placement and have it after my main three cardiopulmonary, neurology and musculoskeletal placements. This meant I was able to challenge myself in other ways which RITH, having many extra safety and problem solving issues, was excellent for. Another major challenge for this placement was trying to decipher referrals/handover forms which were missing information such as the actual contact number for the patient (you have to ring them up before you go in the morning) and various bits of their past medical history (I mean why would I want to know that this patient who was being treated for post op joint replacement had diabetes…) I encountered forms that were missing the 2nd sheet where the various therapy goals and home risk factors for the therapist were, there was one patient who apparently had her (R) hip done on one part of the form and (L) hip done on the other and another who’s form didn’t say a word of her problems with vertigo, just that she had a history of falls. This on top of generally no notes from the hospital made going to a complete stranger’s house to treat their problem a whole lot harder, which at RITH is never easy even when you’re completely organised. Although I haven’t had a hospital placement after RITH I have vowed to make sure even if I am in a rush to lunch or to another patient that I fill out forms correctly and with overboard information rather than the bear essentials. It’s not just something that will be part of the job; it’s a major safety issue and can be a Big hassle and waste of time to the next lot of people treating the patient chasing the information up. In saying all this, I did become very good at calling up hospitals and chasing up little bits of information that was missing, so if the same happens to you just call the hospital and ask for either the referrer or ask straight up for the hospital to page (whatever the pager number on the form is) and if that parts missing start square one with the patient number and name, you cannot fail. If it is you writing the form don’t forget that you have been seeing the patient for a while therefore little bits of information may not seem relevant but imagine you haven't seen the patient and are only getting your referral.

Support for Healthcare workers

I had my cardio placement on the oncology ward at royal perth hospital. This was a challenging placement as a few of my patients passed away whilst I was there. Each of the patients are facing an uphill battle and many are palliative. These are huge considerations with any treatment that we as physiotherapists may carry out. Many of the patients are in the hospital for extended periods or are frequent visitors to the ward as they come in for their chemotherapy treatments. You get to know the patients quite well as you see them fairly often and strong connections are built. When or if these patients pass away it makes it very difficult to deal with. It's easy to say not to get too personally involved but we're in a profession that involves caring for people and we just can't help it sometimes. Mostly we are able to deal with the death of a patient in a professional manner but occasionally this may affect you on a deeper level. As I have said, a few of my patients passed away. I was able to deal with these pretty well. I felt supported in the knowledge that there was a nurse councellor on the ward and that if I needed anyone to talk to about this I could. I just thought that it would be a good point to mention to other students that there should always be some form of councelling available in most workplaces and it's would be a good idea to find out where this support can be gained before you need it. I think that I was able to deal with my patient's passing away as I knew that there was this support in place if I needed it. So as students and even when we are finally out there in the workplace find out where your support networks lie!!

Aboriginal Health

Whilst on placement at Royal Perth Hospital I had the pleasure of treating a middle aged aboriginal male.

I think that we as health care students in australia are given a lot of information on treating aboriginal people and how we should respect their culture and a million and one other considerations we need to observe. This is great and all of this information is very useful but I have found that it has made me quite nervous every time I have an aboriginal patient to treat.

This particular patient was great. I went in to treat him and after being in his room for about 5 mins soon realised that it's great to know all of these things about aboriginal culture and how to treat aboriginals but they are just the same as any culture. There are some people who are more traditional and others who are less strict about thier cultures. This particular man was hilarious fun and asked me to call him Robbie Williams!! He had a great sense of humour and his family were always around, which can on occasion be a deterrant to treatment but in this case it was great they were really proactive with his treatment and also a lot of fun. I really enjoyed going in to treat him everyday.

My advise is to learn and know all of these things about aboriginal culture but to also just treat the individual. Start with a more respectful approach but try to guage who your patient is and treat them as is appripriate for them. This would go for any culture!!

Trusting your own clincial skills

(sorry, this is week 3s Blogg!)

For those that have had a cardiopulmonary prac, you would know that our suctioning proceedures are very hiegenic and precise! We must remember to wipe the intubated/NP tubing with an alcohol wipe to remove germs prior to suctioning, must double glove, and make sure we do not touch the catheter with any surface other than the clean double gloved hand. We go down the patients airways further than most nursing staff and our suctioning technique is often different.

On my current cardio prac however, I found it very frustrating to be in the process of perfecting this skill and have nursing and other staff ask things such as "what are you putting a second glove on for" "thats a weird way of doing it" and even staff telling me I was doing it wrong! Some staff tried to show me how to do it 'right' (which often included re-using the same catheter tubing rather than getting a clean one each time, touching dirty surfaces with your 'clean' hand, and not going far enough down the patients airways to even elicit a cough reflex!!) I found this awkward as I'm sure they've been suctioning for far longer than me, but at the same time it is in the patient's interests to suction hiegenically and effectively, which is not what they were doing.

I found the best way to deal with these situations is to simply explain that we had been taught differently before the nurse could jump in to 'give me a demonstration', and encourage staff to leave me to do it as I had been taught. I would also explain why we were taught that way, hopefully this would cause them to think more about perfecting their own techniques a bit aswell. I also spoke to my supervisor to make sure I was indeed suctioning the correct way, and she assured me that although others have different views on technique its important i use the most effective and up-to-date method.

So although as students we will often come across situations when more experiences health professionals are trying to show us less-optimal methods of treatment we must understand that we are given the most recent and effective techniques and should have enough confidence to follow the methods we know will maximise the patients wellbeing.

De-stressing Yourself!

((Whoops, sorry guys apparently my blog from last week didn't actually get published, so its a bit late. here it is now!))

As mentioned previously, I am currently on placement at ICU. It is a daunting-enough experience to simply LOOK at most patients - ventilated, with drains everywhere and the appearance of what has been fittingly described to me as a "christmas tree". Needless to say I was extremely nervous of treating my first intubated patient, it looked as though to even breath on them might have fatal consequences!!

I learnt one lesson very quickly however. The first time i did MHI and suction a patient, I turned their ventilator off only to find that the tubing was stuck and i couldnt disconnect it to attach the MHI bag!! It took so long that we had to restart the ventilator (so the patient could breath!!) and fix the tubing before beginning again. Following this, I found it took so long to organise suctioning equipment (and took my 2 attempts as it is hard initially to learn the 'clean' method of suctioning) that the pre-oxygenationing effect of MHI had run out by the time i was ready, and we had to pre-oxygenate again prior to suctioning!!

So from now on, I make sure I PREPARE thoroughly before beginning my treatment with intubated patients. I lay out my suctioning equipment (putting on saftey glasses, getting tubing, alcowipes, a box of clean gloves) on the bed to be used immediately following MHI. And before I turn the ventilator off I twist the tubing and loosen it so it can easily be taken apart to attach the MHI bag. I can't stress how much better my treatments are since I have begun this proceedure, and I did pass my final assessment today so it must be good! Furthermore, I feel so much more relaxed and in control of my treatment sessions now.

Taking the time to prepare really does de-stress my treatments!!

Kids in walkers

On my Paeds placement, I have come across a few different experiences with walkers for children. One child we assessed at school in a walker, in order to approve him for funding to have his own at home. I had seen him previously in his wheelchair, and although he seemed content, he didn’t seem happy or enthusiastic about much. However seeing him in a walker, he was like a different child. He stood up tall through his legs (with a seat support and trunk supports) and took steps independently, mostly toe walking but occasionally achieving heel strike and good step lengths. As he zoomed around the corridors, he looked so excited at the prospect of seeing people from the same position he was in (standing!) and took in everything he could at his new eye level. It was the most wonderful thing to see a child gain some independence and feel like ‘one of the others’.

Another child we assessed in a walker at an external clinic who provide walkers for children. His mum, myself, my supervisor and two Physio’s from the clinic were all present. This child’s mother had been pushing for a long time for her child to be put in a walker, against the recommendations of my supervisor and the Physio’s at the clinic (who believed there would be very little benefit from a walker as he had severe spastic quadriplegia CP). When the child was placed into the walker, he hung on the seat and trunk and arm supports, with his head flopping from flexion to extension (as he had very poor head control). He occasionally achieved some movement by using mass extensor tone through his head and trunk although had no real desire to walk or attempt to stand. His mother burst into tears, realizing that her child was not suitable to use a walker. It was quite a traumatic event for her, having pushed so hard for him to try, that her child could not walk or even maintain standing with the help of a walker.

It made me realize that although parents are often extremely keen for their children to “just be able to walk”, they often need thorough education as to reasons why it would not be suitable or realistic for their child- rather than just that they are ‘not suitable’. I think this approach prior to having a trial (which may be the only way to show the parents what their children are capable of) may have made it a little less traumatic should the trial not be as successful as they had hoped.