During my last weeks prac I was so busy finishing my last SOPIE report, preparing for my cardio presentation, that I had no time to do any PCR preparation. That includes musculoskeletal and neuro subjects.
The good thing that came out of this cardio placement that I feel that I am fully prepared for PCR exam and don’t really need to do any extra work. Although other two subjects definitely need some more revision to do.
Anyway my friends this is a short reflection on my last weeks experience as I have to rush to do my final PCR preparation and catch up on same sleep, as I want to have my brains functioning in full capacity during PCR.
Can’t wait for the graduation dinner to see you all there, and have same time off before our rural placement begins.
Just lastly want to wish you all the best luck for PCR.
See you at graduation dinner!
Monday, March 5, 2007
Saturday, March 3, 2007
Discharge Discharge Discharge
I have recently had some big issues in which I have had to advocate for patients and their safety when they are about to be unsafely discharged by the doctors.
This is a very pationate issue for me as I feel that we are there to do a very important job of ensuring that the patients mobility status is safe before they are discharged home (unless there are other options such as rehab). So if this is our job, then how come some of the doctors (all that I have met this week) don't take it seriously!
I have done my best this week (and probably stepped on some toes) to keep a couple patients in (or make other arrangements for them) that I truly felt were a huge falls risk if they were discharged to their home. Not to mention that these patients had a had strokes and both of them were expected to leave two days post stroke!! Even if they were farely minor strokes they had huge balance issues! (not to mention a million other risk factors)
I was beginning to question my judgment on Friday when I was in the middle of advocating for another patient who had been admitted two days ago with a severe exacerbation of MS and complete loss of previously independent ambulation. As I spoke to the resident and she said to me "oh, well it's "ONLY MS" and "it wasen't a stroke" and "she'll get better without physio" ummmmm..................the ward clerk came over to tell me that my patient sho had been discharged against my judgment yesterday was back down in the ED as he was "not coping at home". Ummmmmm, can someone please tell me why I feel so educated??? Where are we saving money here??
p.S. That dosen't include my spelling
This is a very pationate issue for me as I feel that we are there to do a very important job of ensuring that the patients mobility status is safe before they are discharged home (unless there are other options such as rehab). So if this is our job, then how come some of the doctors (all that I have met this week) don't take it seriously!
I have done my best this week (and probably stepped on some toes) to keep a couple patients in (or make other arrangements for them) that I truly felt were a huge falls risk if they were discharged to their home. Not to mention that these patients had a had strokes and both of them were expected to leave two days post stroke!! Even if they were farely minor strokes they had huge balance issues! (not to mention a million other risk factors)
I was beginning to question my judgment on Friday when I was in the middle of advocating for another patient who had been admitted two days ago with a severe exacerbation of MS and complete loss of previously independent ambulation. As I spoke to the resident and she said to me "oh, well it's "ONLY MS" and "it wasen't a stroke" and "she'll get better without physio" ummmmm..................the ward clerk came over to tell me that my patient sho had been discharged against my judgment yesterday was back down in the ED as he was "not coping at home". Ummmmmm, can someone please tell me why I feel so educated??? Where are we saving money here??
p.S. That dosen't include my spelling
Grumpy old nurse
Hello all!
Just wanted to share a run in I had with a nurse this week. First, I'd like to say that until now I have got along really well with most of teh nurses and see it as a definite benefit to work with them on our team.
So I discretely noticed one day, this new nurse, who was treating a couple of my patients. He had left my patient (who has global aphasia and is not cognitively fully there) in his wheelchair by an open door (to the public hallway) completely pantless and exposed. I was trying to find him (the nurse) anyways but when I saw this I rushed to find him. I found him wlaking out of another paients room who was way down the hall!!!! I decided not to say anything but asked him what his plan was with the patient as I was wanting to take him to physio when he was ready. He said he was showereing him and told me to come back in 1/2 hour. I thanked him and went on to my next patient.
The next thing I know, the ward was crazy, patients were being reshceduled left right and center and my schedule for the morning was thrown out the window. This, as I'm sure all you can relate to, is something that happens all the time! So anyways when I went by him in the hall a little later, he rudely asked me if I was going to see the patient. I said "yes, as soon as I could find the other physio as he was a double so it might be a while". He then said "well that's great! I bent my back over to get him ready for you and you;'re not even going to see him now, thanks alot!". I was quite surprised at this! He was obvioulsy in the process of showereing the patient in the first place (as he was half naked) and I really didn't understand how he could yell at me like that.
Anyways, no real moral to the story as I never saw him again. But some people can be so grumpy and try to ruin your day for no good reason. Jeez!!
Nic
Just wanted to share a run in I had with a nurse this week. First, I'd like to say that until now I have got along really well with most of teh nurses and see it as a definite benefit to work with them on our team.
So I discretely noticed one day, this new nurse, who was treating a couple of my patients. He had left my patient (who has global aphasia and is not cognitively fully there) in his wheelchair by an open door (to the public hallway) completely pantless and exposed. I was trying to find him (the nurse) anyways but when I saw this I rushed to find him. I found him wlaking out of another paients room who was way down the hall!!!! I decided not to say anything but asked him what his plan was with the patient as I was wanting to take him to physio when he was ready. He said he was showereing him and told me to come back in 1/2 hour. I thanked him and went on to my next patient.
The next thing I know, the ward was crazy, patients were being reshceduled left right and center and my schedule for the morning was thrown out the window. This, as I'm sure all you can relate to, is something that happens all the time! So anyways when I went by him in the hall a little later, he rudely asked me if I was going to see the patient. I said "yes, as soon as I could find the other physio as he was a double so it might be a while". He then said "well that's great! I bent my back over to get him ready for you and you;'re not even going to see him now, thanks alot!". I was quite surprised at this! He was obvioulsy in the process of showereing the patient in the first place (as he was half naked) and I really didn't understand how he could yell at me like that.
Anyways, no real moral to the story as I never saw him again. But some people can be so grumpy and try to ruin your day for no good reason. Jeez!!
Nic
Expressive Aphasia, 2nd
As some of you might remember, I put a post up last month about conversing with expressive aphasic patients.
A thank you to those who commented on it. You were absolutely right, the more practice I got in interacting with aphasic patients the more I felt comfortable in finding the right balance between helping them out finding the word or just waiting for the right word to come out. I also found with two of my patients that over the period of my placement I got a lot better in understanding their non verbal language and was able to adequately respond to it.
It has been a great experience and I think I just want to reinforce again that it is very important to take time to listen and make sure that what they say is really what they intend to say.
Edith
A thank you to those who commented on it. You were absolutely right, the more practice I got in interacting with aphasic patients the more I felt comfortable in finding the right balance between helping them out finding the word or just waiting for the right word to come out. I also found with two of my patients that over the period of my placement I got a lot better in understanding their non verbal language and was able to adequately respond to it.
It has been a great experience and I think I just want to reinforce again that it is very important to take time to listen and make sure that what they say is really what they intend to say.
Edith
Almost Done reflections
It feels incredible for most of us to have completed the three major clinical placements. I got up Friday morning and felt excited for the very first time in a long while. Feelings such as excitement and euphoria have been hiding dormant, suppressed by the stress of living under the microscope for far too long. Now it is onto the PCR for Curtin to find that final straw to break our backs. Sorry, I am just dragging things out here.
I was very happy with my last placement being neural. Of all three placements, I feel neural brings out the most Bobby Flynn in all of us. Cardio made me feel like a technician, musculo is where my interest lies and brought out the pragmatic in me, but neural required that I dig deep and quickly develop astute observational skills and a high degree of touch. I had to really feel for patient’s movements (or lack thereof) and reciprocate further movement such that it would achieve the outcome I wanted, almost like a dance. I found that to be as near an art form as anyone can hope for as a physiotherapist. Overall, it was a positive experience.
A correction is also is order. Earlier, I discussed a couple articles that came to the conclusions Bobath techniques were either less or equivalent in effectiveness compared with motor relearning. After using Steve’s methods to analyse the articles, design flaws marred the researching findings. In short, both studies were unable to adequately ensure one group received true expert Bobath or motor relearning approaches. That teaches me to jump to conclusions too quickly, whether it be out of frustration or not.
Thanks for the interesting forum discussions everyone.
I was very happy with my last placement being neural. Of all three placements, I feel neural brings out the most Bobby Flynn in all of us. Cardio made me feel like a technician, musculo is where my interest lies and brought out the pragmatic in me, but neural required that I dig deep and quickly develop astute observational skills and a high degree of touch. I had to really feel for patient’s movements (or lack thereof) and reciprocate further movement such that it would achieve the outcome I wanted, almost like a dance. I found that to be as near an art form as anyone can hope for as a physiotherapist. Overall, it was a positive experience.
A correction is also is order. Earlier, I discussed a couple articles that came to the conclusions Bobath techniques were either less or equivalent in effectiveness compared with motor relearning. After using Steve’s methods to analyse the articles, design flaws marred the researching findings. In short, both studies were unable to adequately ensure one group received true expert Bobath or motor relearning approaches. That teaches me to jump to conclusions too quickly, whether it be out of frustration or not.
Thanks for the interesting forum discussions everyone.
Real Time Ultrasound
On the last day of clinic we got a small going away present. Our tutor took us over to the real time ultra sound lab to give us a demo, and to let us use the machine so that if we encounter one later in our careers we'll know how to use it. It works really well as a feedback tool for TAs multif and pelvic floor, so I it was good that we got to learn how to use it.
Friday, March 2, 2007
Giving supervisors feedback
Being the last week of clinic....I'm sure we've all received feedback on how we've performed. Some of our supervisors may have even asked us for feedback as mine did.....
I personally haven't had a problem with the supervisor on the clinic.....the first week she really spoke very 'patronisingly' to us...to which I took offense...but then realised that's how she speaks to everyone - literally...so then I decided not to care. She also didn't ask us what we've done before or anything like that.....which again I didn't care...but the other student on prac with me did.
I was a little concerned giving her feedback.....as I think SOMETIMES it can be useful....SO when she asked for some feedback I just very politely let her know that with the GEMs it might be an idea to have a brief discussion of what we've done before.....to which she replied when she has had that discussion and people have told her what they've done or what skills they have....they've been 'full of shit' (direct quote). I really appreciated her honesty - and I think it's true that some of us are guilty of thinking we're the bees knees having held certain positions in our previous 'careers' if we got that far. So - just to let you know and also it's a word of warning not to be 'full of shit' as new grads...cos somehow, at sometime...they'll catch you!!
Mads
P.S. I was too scared to tell her she speaks to people in a very patronising manner!! but if she was my student I certainly would have! isn't the power difference great? M
I personally haven't had a problem with the supervisor on the clinic.....the first week she really spoke very 'patronisingly' to us...to which I took offense...but then realised that's how she speaks to everyone - literally...so then I decided not to care. She also didn't ask us what we've done before or anything like that.....which again I didn't care...but the other student on prac with me did.
I was a little concerned giving her feedback.....as I think SOMETIMES it can be useful....SO when she asked for some feedback I just very politely let her know that with the GEMs it might be an idea to have a brief discussion of what we've done before.....to which she replied when she has had that discussion and people have told her what they've done or what skills they have....they've been 'full of shit' (direct quote). I really appreciated her honesty - and I think it's true that some of us are guilty of thinking we're the bees knees having held certain positions in our previous 'careers' if we got that far. So - just to let you know and also it's a word of warning not to be 'full of shit' as new grads...cos somehow, at sometime...they'll catch you!!
Mads
P.S. I was too scared to tell her she speaks to people in a very patronising manner!! but if she was my student I certainly would have! isn't the power difference great? M
Supportive Supervisors
I just wanted to take this opportunity to reflect on how much a clinical supervisor can positively impact your method of learning. I just finished my most recent placement and could not believe how much I had learned from my clinical tutor. The amount of time and effort she put into each student was beyond the call of duty. She always made time for each of the six students on this placement and never once made any one feel like he or she was interrupting if a question needed to be answered. She was always available and provided an array of excellent resources for the students to consolidate our learning. It was such a refreshing change from the usual “go and learn this” attitude that so often comes across on clinic. My clinical tutor took the time to really help sort things out if we had a question and never made it seem like something was too silly to ask. I think what I learned most though from her on this clinic is to keep feeding my drive to learn and to ask questions from those who are more experienced so I can (as she put it today) “soak up the knowledge”.
Good luck with PCR study and see you at the grad dinner!
Good luck with PCR study and see you at the grad dinner!
Thursday, March 1, 2007
Bribes
I'm sure that title got your attention. Quick quesiton. Is it standard practice to get a little something for your clinical supervisor after your clinic?
Calvin
ps it's not really a bride cause you give it to them on the last day after your assessment is done.
Calvin
ps it's not really a bride cause you give it to them on the last day after your assessment is done.
Musculo Placement Comparison
I'm on my musculo now at the Curtin Clinic, and from what I've been hearing the placement there is quite different from other musculo placements. On our placement we have a 1 hour time slot for ongoing patients and 1.5 hours for new patients. Before we see our patient we have to go through the plan for our subjective and objective assessment with our supervisor. We do our subjective which is about 5-10 mins and have to ask specific questions about their pain (present, since last Rx, aggravating factors, easing factors, time to ease/increase) post Rx effect, and how they coping with their home exercise program. After the subj we pop back out to talk to our supervisor about it, and then discuss what we're going to do on our obj.
The objective consists of AROM (PROM) with P1 P2 R2 and the rest of that good stuff. Then PIVM, PAVM, NTPT, appropriate musc length and any other stuff that may be appropriate (eg neuro testing, specific tests), then an assessment of how they perform their home exercises. After that you pop back out to talk to supervisor, and tell her what you want to do as Rx, and how you want to progress your home exercises. She makes her suggestions, and you use a combination of them and your own (mostly hers) :)
After EVERY Rx you reassess something. If your Rx is left and right PAIVM you reassess after your left and then again after your right. After the Rx you write up their home exs and make a photo copy of it to put in their notes, and you book them in for their next appointment. That pretty much takes 45-60 mins and then you find time to do your notes.
Other than Minh and Nicole (who have had the same placement) does anyone else do anything comparable to that on thier musculo. If heard that some people only have to do 1 paragrapg of notes, and don't have to check in with their supervisor during their Rx, or only have 30 min for Rx.
Enjoy studying for the PCR.
Calvin
The objective consists of AROM (PROM) with P1 P2 R2 and the rest of that good stuff. Then PIVM, PAVM, NTPT, appropriate musc length and any other stuff that may be appropriate (eg neuro testing, specific tests), then an assessment of how they perform their home exercises. After that you pop back out to talk to supervisor, and tell her what you want to do as Rx, and how you want to progress your home exercises. She makes her suggestions, and you use a combination of them and your own (mostly hers) :)
After EVERY Rx you reassess something. If your Rx is left and right PAIVM you reassess after your left and then again after your right. After the Rx you write up their home exs and make a photo copy of it to put in their notes, and you book them in for their next appointment. That pretty much takes 45-60 mins and then you find time to do your notes.
Other than Minh and Nicole (who have had the same placement) does anyone else do anything comparable to that on thier musculo. If heard that some people only have to do 1 paragrapg of notes, and don't have to check in with their supervisor during their Rx, or only have 30 min for Rx.
Enjoy studying for the PCR.
Calvin
Hey people,
Hope everyone’s last week of prac is going well.
This week Ive had 3 new patients all with impingement/frozen shoulder type disorders. The 3 of them each presented in a similar fashion; decreased AROM, pain and weakness. I have found that these presentations are hard to treat and often respond slowly to treatment. However I just wanted to say how surprised I was went I tried using slings and pulleys. They actually work!! Each patient I have used them with have increased both their PROM and AROM significantly during the treatment. Its such a simple concept and I think all to often we over think things. I really thought back in first year, learning those techniques was a waste of time but I have been pleasantly surprised!!! (Aren’t I good finishing on a positive note)
Luv Jess
PS Good luck with PCR and have fun on rural!!!
Hope everyone’s last week of prac is going well.
This week Ive had 3 new patients all with impingement/frozen shoulder type disorders. The 3 of them each presented in a similar fashion; decreased AROM, pain and weakness. I have found that these presentations are hard to treat and often respond slowly to treatment. However I just wanted to say how surprised I was went I tried using slings and pulleys. They actually work!! Each patient I have used them with have increased both their PROM and AROM significantly during the treatment. Its such a simple concept and I think all to often we over think things. I really thought back in first year, learning those techniques was a waste of time but I have been pleasantly surprised!!! (Aren’t I good finishing on a positive note)
Luv Jess
PS Good luck with PCR and have fun on rural!!!
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