character clashes

Whilst on my rural prac at a fairly large hospital, I developed a character clash with one of the physios in the department who happened to be fairly senior. I am sure everyone has found out that rural pracs are very hectic, and you are thrown in there and just have to get on with it straight away. My orientation to the hospital was good, but obviously you cant get through every small detail of the wards and the physio department in a few hours, and most supervisors and physios are aware of this and expect you to forget things and ask a hundred questions. I was responsible for being in the hydro pool twice a week, and that was all I was told. One of the days of the week, I was in the pool with the physiotherapist I clashed with. She was a lot older than all the other physios in the department, and was not the most welcoming person I have ever met. So on my first day of hydro, I was not quite sure of where all the patients paperwork was, or who was responsible for getting all the paperwork out etc. Unfortunately I was about to discover that that was my job, I just had not been told it on orientation. Also, on this day, for some reason the PTA had overbooked the pool. The physio then went on to give me a lecture on my responsibilities and to basically blame me for the mess. I tried to explain that I really had no idea that that was my job, but she would not hear of it. It was very embarrassing because all the patients were already in the pool. Anyway eventually we got on with the class and I was moving around the pool amongst the patients, and stopped for a second to stretch one of my hamstrings. At that moment she turned around and said that the pool time was for the patients to exercise, not me. I felt yet again so embarrassed and felt that she was now just targeting me for no reason. I felt that she thought I was incompetent, even though I had had good feedback from all the other physios, and I felt she was only seeing bad in me and not anything good that I did.

After the session I was very upset and spoke to my supervisor who was a fairly new grad. She told me that this physio was generally rude to everyone, and that I shouldn’t take it personally. She said that it didn’t really matter in the end what this physio thought of me because she wasn’t assessing me, but I still felt like I wanted her approval. In the end I realised that it wasn’t a personal thing, after I observed her being rude to a number of people that day. But I realised that as a student, it is probably better to just find out as much as you can from your supervisor about what your responsibilities are if you are required to take classes or hydro, so that you are always well prepared. In future I will make a point of finding these things out and clarifying what I am meant to do, so that if I am accused of not doing something I can support myself and say that I had asked but was told that I was responsible for the said job.

difficult patients

Whilst on my orthopaedic placement, I encountered a difficult situation with an elderly man who was about to be discharged after a total hip replacement. Prior to discharge patients are required to safely ascend and descend a flight of stairs in the physio gym on the ward. The patient in question had been a bit difficult from the start, not really paying much attention whenever I went over the precautions and positions to avoid after a hip replacement. I would often come into the room and he would be lying in bed with his legs crossed or lying on his side, and he did not quite seem to grasp why these positions should be avoided. Teaching him how to partial weight bear was a nightmare, and I had to ask my supervisor to help me out a few times to just reinforce to him that these precautions really were important and it wasn’t just that I was a student who was being overly cautious.

The situation occurred while I was taking him through the stairs. It was his second day of trialling the stairs, and I had gone over the order of “good leg first, then the bad leg and then the crutches” for going up the stairs, and “crutches first, then the bad leg and then the good leg” for going down. He was able to repeat this with each step, so after the second trial I stopped repeating the order out loud. The man then decided to try put his good leg down first on the way down the stairs first, meaning that his bad leg was supporting him, and I immediately stopped him and tried to get him to stand up again. He was in a lot of pain understandably, but then he got angry with me because he thought I should have just let him go down as he was. My supervisor was present and came over to help. I explained to him that if he had carried on any further his bad leg would not have been able to take the weight that it was about to take, and that he probably would have fallen. My supervisor agreed and supported me, which made me feel so much better.
He was still quite angry though, and that made me really mad because he had already been so non-compliant and disinterested in listening to instructions, and I had just been waiting for something like this to happen but was kind of mad that he had the audacity to blame me. Anyway I kept my thoughts to myself and he was ok in the end.

I spoke about it with my supervisor afterwards and she was very supportive and said she would have done the same thing. That did make me feel a lot better as I was worried that my decision had been the wrong one. But what I learnt from the whole thing is that even if you think patients understand instructions and you feel that you have been repeating yourself all day, when it comes to safety it is better to just keep repeating the instructions, rather give too much than too little. So in future that is what I will do, especially with non-compliant patients. I also think that you need to tell people that failure to follow the precautions and safety instructions will lead to damage to themselves, and make it very clear from the beginning. And it also might be useful having two people around for patients like this.

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.