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.

Keeping Focus

On my paediatrics placement, I had the opportunity to work with several children aged between 5 and 12. I found the experience challenging and rewarding, and I constantly had to come up with new games. One child in particular, aged 5, would only partipate if the task was a game or 'fun' activity - often he would make them intricate!

During my second week, I came to watch the end of a treatment session he had with a second year physiotherapy student. I realised that while she was trying so hard to come up with fun activities and play the childs intricate games, she was sacrificing the actual purpose of the activity. She was concentrating so hard on the game that she wasn't noticing when the child was leaning on a chair the whole time instead of using his postural muscles to maintain 2pt positions, etc.

It was a great reminder to me that we need to step back at times and keep focused on our actual roles as physiotherapists, as well as having fun with paediatric patients! I think it made my future treatment sessions far more effective.

Preparing for work and life?

Starting work in less than four weeks is to me a very daunting task, and one that will flash by without a moments thought. With this new responsibility, time load and case load I have had to think a little bit about myself. Over the year of placements I have had to struggle with the usual stress of being on placement, not being familiar with the place/people/supervisors, but also with my personal battle with arthritis. I remember days in agony that I went to prac, so as I didn’t appear to be slacking off, but really couldn’t perform to my potential because of it. With this in mind and my current pain level 3/10 sitting here writing this, I had a decision to make as to where my professional life would lead. Given the amount of emphasis placed on how much we will learn in the first year out puts some stress on choosing the right position. When reading over contracts I had to consider whether there was an appropriate emphasis on my future learning rather than target patient numbers/month, continuing education, insurance and last of all the type of physio treatments accessible and appropriate for myself. Due to my condition and possible longevity with the profession, it was important for me to analyse what environment would be able to accommodate my needs and help me treat the when and how I can- to me hydro and gerontology will hopefully be an integral part of my client base, mainly due to my interest in both areas but that I can physically handle them in large doses. Then looking into the future, being diagnosed within the first year of my physio degree and the progression being faster than I’d have anticipated, the unfortunate task is thinking about future studies that I may need to complete to continue working. No drastic decisions to make now, but just food for thought- I guess I may just add to those statistics of people who only hang around in the profession for 5-10 years!!

Reflection on blogging?

Struggling to find a topic that has not previously been discussed has been a major issue with my blogging thus far; so instead a reflection on this process I thought was invaluable for your comments! I must admit it has been useful to share my sometimes elaborated stories and incidents with you all- but it has also been refreshing to see that what I considered an issue to be blogged about, someone else had already done. Although we believe our clinical placement experiences are somewhat individualised this process has illustrated that we go through the same situations only in different locations. I have valued the opportunity in having the time to sit down and reflect on what difficult situations have occurred, but with this I have realised that I haven’t necessarily had many moments during my placements where I have had to strategise how to deal with things. However, with writing these blogs hopefully when working if I have issues that arise I have a way of dealing with it- even if I just have to write it down and read it back to myself to gain an understanding as to how momentous or how small the issue really is. Writing these blogs have given us an avenue to reflect on our personal reactions to situations and feelings we have experienced that I know I don’t often do in my normal life.

Prison procedures

Many of us don’t really think of what our patients do in their normal day-to-day lives or what type of person they are, but with one of my patients I had an extremely interesting shock into reality. The patient, on my first day at prac, was wheeled into physio on his wheelchair shackled by his ankles. My initial reaction was ‘Cool, this will be interesting,’ but on reflection I thought what am I signed up for? I had a brief read of his notes, the normal gun shot head wound, lives in prison, IVDU… Despite my reservations the patient is really nice (despite potential frontal lobe behavioural alterations anyone?) and responds well and appropriately during treatment sessions. This leads me to my ethical issue: Following procedures this man requires being shackled to his wheelchair and has been whilst he has severe LL tone, no voluntary control of his LL (now progressing to minimal-mod control) and doesn’t have the ability to STS or stand let alone walk without assistance. Is this cruel? Apart from this I had a brief but momentous reflection on what my own limits of safety were. Obviously, this patient caused me no problems, but it got me thinking that in some situations certain patients could inflict serious harm especially when working in such close proximity to them, and even more so when treating in ways that may be challenging to their psychological situation or physical situation. It also begs to differ whether or not the university should allow some sort of reprieve for students in treating certain patients. So just a word or warning- always be on your toes, because unfortunately looks can be deceiving.

being a supervisor

The other day I was thinking about if I would be a good supervisor or not because Im sure one day I will eventually have to supervise students or other physios. On my placements I have recognised the good and the not so good things about my supervisors and what I would do differently if I were in their position. I would definatly want to make the student feel welcome and a part of the team and to gain a good rapport with them. I spose in saying all this, not only has our placements developed our knowledge and clinical skills, on a deeper level its made us unintentionally learn other skills like supervision simply from our good and bad experiences of our relationships we have with our supervisors. I hope that makes sense??

Judging patients

Sometimes it is hard to not judge your patients on either who they are or the reasons for why they were admitted into hospital. I was on a burns unit and there are many ways people sustain burns including work and home accidents but also self harm. Its sometimes hard to not get carried away with what the notes say and how other staff members percieve the patient. Anyway I had a young male patient who I built really good rapport with and our treatment sessions were always good fun and effective. For some reason or another I missed in the notes that he had a history of IV drug use but no longer did it now. When I went back and read the notes again and noticed this, i started judging the patient because of this. Luckily this passed when I went and saw the patient the next time and I carried no judgement with me. This experience made me think about our role of physios of treating every patient equally and to the best of our ability. What the patient has done in the passed or is doing should be in the back of our minds when treating the patient but in no way should it make us treat the patient less or with less quality. Sometimes judgement does gets the better of us and can affect our treatments but learning to deal with this is so important for us as well as the patient's well being!

11 year old stroke patient

Whilst on placement one of my patients was an 11 year old who had a stroke! I have a niece who is a year older ad I teach kids that age swimming, which made me absolutely shocked that you can have a stroke at any age nowadays, especially with the increase in junk food and decrease in exercise. This child was fairly obese and it was so hard watching his parents and nanny give him “oxygen” (little sweets) to get him to do the exercise. Being a student from another country I did not feel I could try get the parents to stop this practice, especially since the physios didn’t seem to have been successful in doing it themselves, the child was too spoilt and although the parents spoke English the nanny did not. From talking with my supervisor about it I was told it was slowly being cut back as originally he was having at least 10 sweets a day, however due to the need to exercise and get as much recovery as possible they had not cut it out completely. I came up with games as bribes during my sessions rather than letting him have sweets, sometimes having half games half treatments to keep the child’s motivation up. Bribery is always the best motivator in children and I mentioned a few times to the mother that using computer game time would be a great motivator but unfortunately I don’t know if that will ever happen. By the end of the placement the child had recovered so quickly, he had improved balance and had started walking and his pain levels were also decreasing in his arm. It was quite upsetting seeing him like most kids forming an attachment to us then having to say goodbye but with his age he has a very good chance of making a better recovery and I can only hope that they can get on top of his diet and become firmer with him and his two siblings (both also overweight). I really hope this is the only child I will every have to treat for a stroke as it was heartbreaking to see the confusion and pain it caused this poor kid to have “fallen down”.

Group stroke sessions

The hardest thing at the start of my international placement was dealing with taking group classes for stroke patients; a group who could walk and a group where some couldn’t even sit without support. At first I stuck to my ways and kept thinking it would be so much better to use this time for one on ones but as I got drawn into the group atmosphere and the fact that in a country where people are hidden away if they have any impairments, a place to go and meet with people who are impaired like you is a massive moral booster. They encouraged each other, joked, socialised before and after class and even the most depressed patient who had given up at least did not get any worse and maintained what they had from the classes. I started to realise when you’re the only stroke specific organisation in the area with physios pretty much working as volunteers the best you can get is enough to keep your patients from deteriorating. Many exercises done for strengthening and balance can be done better in a group setting due to the motivation from other patients. I have realised what I have learnt does work very well for physical recovery but other things can also work and include the emotional side of healing from a stroke.

Language barriers

During my International placement I was faced with not just one patient who had no idea what I was saying but nearly all my patients having no clue. There were at least 8 different languages spoken with only 5 or so patients being able to speak fairly good English. This was difficult for the one on ones and extremely difficult for the first week of group classes. To overcome this I started picking up some words from the phrase book I had bought and listening to the carers and trying to see the reaction of the patients for certain words. In the one on ones I actually tended to be silent using demonstration and guidance along with a few key words like relax, pain?, roll, sit up/stand up, up/down, left/right, keep going and of course thank you. By just learning these few words in the primary language spoken the compliance level rose immensely. During group class exercises were grouped together so that when repeated, the patients would pick up that they were doing something they had done before. I made use of those who could speak English, either learning words or getting them to explain exercises. By the end of the second week there were fewer patients doing completely different things and by then they trusted me enough to just let me do my treatments and pick up what I wanted through guidance. I just had to trust my own manual handling and demonstration skills and think of at least 5 different ways to explain or demonstrate a task... simple as that.

Dealing with no sleep, full time placement and being a tourist on the weekends

On my International placement I found out how hard it is to stay focused on the placement and not become burnt out. firstly the workload is heavy, It was a group placement so 2 2hr classes of bridges, squats, weights etc a bit like going to a gym each day. Secondly you are in a place where you have never been before and cannot just drive to get somewhere. The busses had no numbers and the destinations were in another language, they had no schedule and half the drivers were illegal immigrants therefore missed stops to prevent getting caught. Then there’s all the touristy things beckoning you to do them… like climbing a famous mountain on the weekend then having work the next day. Or going to a beautiful island only to get badly burnt and yet again having work the next day i.e. trying to do bridges with a sore back. Lastly when you did get to bed, there was no such thing as quiet, either street kids, markets or the call to prayer put on loud speaker throughout the city around 12 and 5. Basically it was all work, all explore and no sleep. Along with the rich food, this caught up me in about the 3rd week. From there all the patients were annoying when they didn’t do the work, or the kids saying hello to you (very cute) was just really repetitive and I was half asleep and sick the whole week. I finally decided I had to do something otherwise I would go through the rest of my placement missing everything due to no sleep. I ended up one night putting ear plugs in, skipping dinner, not doing any preparation and going to bed at 5. I had to make the decision to put a basic need before going to the markets or staying up to talk to all the different backpackers. By doing this the next day I perked right back up. I sought out western food the whole day and from there I was fine both energy and stomach wise. I know that this will apply for the first few years of working, although there may be times when you want to fit more stuff in you have to realise sleep and looking after yourself is essential to put in the long haul.

Last placement ever!

Today as I reached the end of my last clinical placement of my undergraduate physio degree it was a funny feeling. My first thought was whether I am really read to step into the world as a physiotherapy expected to care for patients safety and help them on their journey to wellness. I probably dwell to much upon my inadequacies and don't see enough of what we have to offer as soon to be physiotherapists. When I look back to the start of this year I realise that there has really been a lot of skill development that has occurred. This is amplified if I think back to the amazing amount of knowledge that we've crammed into our heads since the start of this course.
As physio's we bring a unique perspective and skill-set to manage patients conditions. We are also in the priviledged position of spending a lot more one on one time with patients than some other health proffessionals. This means that our understanding of the patients viewpoint is another value attribute that we can bring to their management team. We also have a very extensive knowledge of anatomy (we are taught more than med students) as well as normal movement. Don't forget just how much we have to offer!
I am planning to work in the public hospital system for a couple of years to gain further experience before deciding what I'd like to do long term. I don't want to judge myself against all the physio's we've had as supervisors throughout the year because that's not who we are yet. They have all had years of experience to develop their skills and we are only just starting out on that journey. Congratulations everybody for nearing the end of this tough course. I wish you all the best in your lives and physio careers :-)

Supervisor going through personal problems

I was put in an interesting situation while on a recent placement. I was under the direct supervision of one physio and did fairly routine work day to day. I began to feel like the physio was being a bit distant with me and wasn't giving me adequate supervision but just put that down to the routine nature of the area and the personality of the supervisor.
It was only towards the end of the placement that I discovered that a member of the physio's family was going through some serious medical issues. I wasn't sure how to react to the information. She had obviously decided not to tell me about what was happening so I decided that she probably did not want to draw any attention to what she was going through.
I decided that the best way to react was to continue as normal as if I had not received the information. I continued with the work that I was given for the week or so until the end of the placement. I guess the thing that I learnt from this situation was to take into account things that our supervisors might be going through before judging them. We are beginnning to develop this skill of empathy with our patients but I think this is something that should carry over into our dealings with other health professionals as well.

Fast or slow?

On my current placement I had one patient who had been an inpatient for more than a month after contraction pneumonia and acute on chronic cardiac failure. He spent 9 days in ICU on a ventilator and had been transferred to my hospital for rehabilitation to regain his strength due to the prolonged period of bed rest. Finally he was discharged from the hospital and had been referred for Easy Breather classes to further improve his limited exercise tolerance. My job was to do a pre-assessment prior to him starting the classes.
Everything was going well with the assessment until I measured his heart rate before starting the 6 minute walk test. I wasn’t sure whether to believe the reading on the oximeter which told me that he had a heart rate of 39. I confirmed this by palpating his radial pulse and decided to talk to a nurse who had treated him as an inpatient before doing anything else. The nurse came to and confirmed the slow heart rate and was considering admitting him to the hospital again. I planned to contact his doctor to discuss the slow heart rate and then allow him to decide what to do. We were discussing this with the patient and decided to check his heart rate at the same time to make sure things weren’t making a turn for the worse. Upon palpation his heart rate was now around 82 bpm and it slowed down when he wasn’t doing anything but just sitting in his chair. After discussion with the nurse and my supervisor we decided to do the 6 minute walk test because his heart rate responded well to increased stimulation and returned to a normal level. The test went perfectly and his heart rate staying within a reasonable level during the whole test.
The main thing that this experience taught me was the ability to utilise and work with the other health professionals around me to ensure a patients safety. We worked together as a team and determined that the patient was safe to join the Easy Breather class.