I'm back in Nelson, ready to begin my first round of placement.
In prep for the placement I had a glance over some notes from 2nd and 3rd year - I even thought about making some info cards with normative values / prompts and have them laminated. There was a neuro preparation sheet with case studies and procedures to practice saying and doing - I chipped away at that too. The other thing I will need to keep on top of is my clinical portfolio (reflective statements etc). This year's portfolio is much more detailed and has a few new sections than in previous years.
Assessment, Treatment & Rehabilitation (AT&R) is my neuro placement at Nelson Hospital. AT&R has an inpatient ward for patients who have been discharged following an acute admission but whom are not quite ready to return to their previous living situation. AT&R also has an outpatient aspect, of which the patient is referred by their local GP. The AT&R team may refer the patient to a community service (community physiotherapist or MDT). We also coordinate with the OT's and send referrals for equipment. The current team tries to refer patients with ACC claims to a private physiotherapist to accommodate the growing patient waiting list for this service.
Okay, so the first day was really good. I was a bit overwhelmed with all the names of the staff I needed to remember - I've started a list on my phone. I shadowed the physio with two patients today; one I will see weekly for the duration of my rotation in AT&R, the other was a more complex case.
Physio is more than just assessing and treating, it is also involves organising and admin tasks. I got to organise a weekly shuttle for my patient (St John shuttle). In future sessions I will be doing a triage via phone call, then booking patients in to see me. One phone call I made was to a lady whom answererd the phone but was so hard of hearing she couldn't understand a word I said. She passed the phone to her husband whom had some level of dementia. This made for an interesting phone call. On the topic of phone calls... my student desk space is right next to the phone, so I'll get to play secretary for the AT&R gym too.
We had a shared lunch with all the physiotherapists and physio assistants - everyone is super friendly. There appears to be an infinite number of things to do, so it's important to stop for lunch - otherwise you'll only wear yourself down. On Wednesday one of the physio assistants made scones to share with the team! YUM! Lunch is usually had at the AT&R gym or up at the physio 'hub' on 5th floor.
On Tuesday evening I practiced writing a referral to the Community Care Coordination Centre (aka the C, C, C, C.... ) for a patient who needs a wheelchair upgrade, read an article on Parkinsons and research stroke rehabilitation specifically for regaining sensory input. Tomorrow I have my first solo patient encounter - I'd better bring a black ink pen!
Physio is more than just assessing and treating, it is also involves organising and admin tasks. I got to organise a weekly shuttle for my patient (St John shuttle). In future sessions I will be doing a triage via phone call, then booking patients in to see me. One phone call I made was to a lady whom answererd the phone but was so hard of hearing she couldn't understand a word I said. She passed the phone to her husband whom had some level of dementia. This made for an interesting phone call. On the topic of phone calls... my student desk space is right next to the phone, so I'll get to play secretary for the AT&R gym too.
We had a shared lunch with all the physiotherapists and physio assistants - everyone is super friendly. There appears to be an infinite number of things to do, so it's important to stop for lunch - otherwise you'll only wear yourself down. On Wednesday one of the physio assistants made scones to share with the team! YUM! Lunch is usually had at the AT&R gym or up at the physio 'hub' on 5th floor.
On Tuesday evening I practiced writing a referral to the Community Care Coordination Centre (aka the C, C, C, C.... ) for a patient who needs a wheelchair upgrade, read an article on Parkinsons and research stroke rehabilitation specifically for regaining sensory input. Tomorrow I have my first solo patient encounter - I'd better bring a black ink pen!
There are some quirks around the hospital... such as 'Coffee Happy Hour' at the cafe, a 'breakfast club' (an OT kitchen set-up for assessing patients), a 'staff social club' and an emergency stash of chocolate for 'pick-me-ups' in the AT&R gym.
I'm quite excited about utilising the hydrotherapy pool in treatments! There is also a staff gym with pool (not the hydrotherapy pool), underground bike racks (and we can use the shower at the physio department early in the morning if we are sweaty from biking to the hospital!) "When was the last time you were in a hot pool with a handsome young man?" There's a bit of tongue and cheek between staff and patients... the quote above was mentioned to a 98 year old lady on Tuesday when I brought my togs along.
There are in service meetings, and we're encouraged to be always engaging with staff and patients... leaving all our study and portfolio work to be done in our own time. This is probably a good thing because we've been challenged to be involved in everything... and if there's something we want to see or need to see more of, then all we have to do is ask. Pretty sweet deal!
 |
| AT&R gymnasium! View from my desk! |
On Tuesday I got to see my first stroke patient and complete the subjective, objective & treatment. If all patients are like this one, then there'll be lots of clinical reasoning involved. I thought I done a satisfactory job, there were times when I wasn't in control of the conversation and my patient rambled on. I had to fight myself from rudely interrupting - rather I had to take some time to think how I was going to pull the conversation back on topic. There is skill involved to stay interested and keeping your patient on topic... otherwise you tend to zone out and seem disinterested. So that was my outpatient experience for the day.
Earlier I mentioned that there was an inpatient service through AT&R too (it is, after all, an inpatient ward in the hospital). My daily routine will mostly begin with a ward meeting, then working with patients in the hydrotherapy pool, then working with patients in their room (or the AT&R gym), an inpatient service (or an MDT meeting, or an allied health 'scheduling'... scheduling is to prevent the OTs and PTs fighting to see a patient at the same time). The afternoon will consist of outpatients and possibly the odd inpatient session. Today for example, the last thing I done was a dynamic gait index (assessment of falls risk) for an inpatient... we changed her red tag to a green tag!! That is, the tag we put on frames and walking aids to indicate whether they can use them independently (green), whether they need supervision (orange) or assistance (red). To be upgraded to a green tag suggests that you're likely to be discharged from a physiotherapy perspective very soon. On Friday I completed the Dynamic Gait Index again on this person and they got 24/24 marks. Perfect! This was my first patient discharged from AT&R and I felt like I had been helpful having worked with her daily throughout the week.
Earlier I mentioned that there was an inpatient service through AT&R too (it is, after all, an inpatient ward in the hospital). My daily routine will mostly begin with a ward meeting, then working with patients in the hydrotherapy pool, then working with patients in their room (or the AT&R gym), an inpatient service (or an MDT meeting, or an allied health 'scheduling'... scheduling is to prevent the OTs and PTs fighting to see a patient at the same time). The afternoon will consist of outpatients and possibly the odd inpatient session. Today for example, the last thing I done was a dynamic gait index (assessment of falls risk) for an inpatient... we changed her red tag to a green tag!! That is, the tag we put on frames and walking aids to indicate whether they can use them independently (green), whether they need supervision (orange) or assistance (red). To be upgraded to a green tag suggests that you're likely to be discharged from a physiotherapy perspective very soon. On Friday I completed the Dynamic Gait Index again on this person and they got 24/24 marks. Perfect! This was my first patient discharged from AT&R and I felt like I had been helpful having worked with her daily throughout the week.
The rest of the week went well. The fire alarm went off on Wednesday, an inpatient must have thought it was the emergency button for getting a nurse... anyway we had firemen come in to the gym. It's great how staff make a joke out of everything. In this case it was to a patient "look, we've arranged some handsome young men to come in just for you. We should make a calendar."
My new inpatient consultation was a challenge, namely because I had some preconceived ideas about what my clinical educator wanted and conflicting ideas about what was necessary for admission onto the AT&R ward. I got through it, but I'm not at all happy with how I performed. The other small incident was a miscommunication between the patient and a nurse - I should have read the nurses notes before seeing the patient. My flatmate said this quote "Customers are always right, patients are always wrong" and it sums up that particular experience very well. The patient told me they independently showered in the morning so I wrote it in the patient notes. It turns out that the patient had not showered independently, and this nurse sure let me know. Next time I'll be sure to read the notes and check in with the nurse. This was a good 'first week in' lesson. You do not want to upset the nurses.
Patient education analogies.
- Your brain is like a tree. When you cut off a branch, energy is no longer transferred from the top leaves of that branch to the roots. A small clot acts like hedge trimmers.
- Nerve receptors in the hand are like a flower garden - all closely planted together. Nerve receptors on your thigh are like an orchard, planted or spread more widely apart.
- Explain everything to your patients, e.g. "We need to test your sensation, like your ability to feel pain, so we know you will be safe."
- Demonstrate stuff to your patients e.g. exaggerate a demonstration of what might happen if the patient doesn't follow safe standing up using a frame protocol.
Quick tips & quirks!
- If you scribble in your notes, you've got to sign your initials next to the scribble. One document I wrote up had lots of my initials on it! Turns out, it's best to put a simple line through any mistakes you write.
- How do you adapt a walking frame for an older person with a humerus fracture? Duct tape a stick across the handles.
- Patients will inspire you. I had an outpatient amputee patient who is writing a facebook blog about his recovery. He is super motivated. I also had an inpatient cerebral palsy patient who is also very determined to make a full recovery. Said person has an improving ataxia, so we played a game of checkers with a large peg board (I was gutted to have lost the game!), a bit of ping pong by sliding towels on a table to push a tennis ball between each us, and practised some dance movements 'standing to positioning on the ground'. Next week we'll build on the dance moves, as she's a professional dance teacher and I'm sure she would like to get back to this asap!
 |
| Leaving work on Friday, I'm ready for the weekend. |
 |
| I finally got around to becoming a student member of Physiotherapy New Zealand (it's free for physio students... how have I not signed up earlier!!) |
On Saturday I updated my portfolio - clinical diary and reflective statement.
On Sunday I went in search of Whispering Falls, up the Hackett Valley in Nelson...
 |
| Climbed up the side of Whispering Falls, Nelson NZ |
No comments:
Post a Comment