P4R4W1: PSW Community Edition

Rapaki Marae, Christchurch

This PSW week for our 4th rotation started similarly, with student presentations from those who just completed their community placements. We were privileged to reviews on shoulder assessment, taping (McConnell vs K-tape) for patello-femoral syndrome, localised vibration for chronic spasticity, and return to work programmes / contracts with ACC.

We were in for a treat on Tuesday when we visited the Rapaki Marae. We had a traditional powhiri / welcoming onto the marae with some rich ancestry and historical significance given about the Maori people and the Rapaki area. We also engaged in some activities such as flax weaving - the teachers were most knowledgeable, to the extent of giving us gardening skills to grow / maintain healthy flax bushes. In between we went around the group and said a quick mihi, and had lectures about Maori culture from a physiotherapy perspective. We had two high school students join us who were interested in physiotherapy, as a part of the Kia Ora Hauora initiative. Kia Ora Hauora is a programme that aims to increase the participation of Maori in the healthcare sector. If you're a high school student of Maori descent and want support to become a physiotherapist (or other health care specialist) have a look at their website. Check it out here: http://www.kiaorahauora.co.nz/

Wednesday was a day of area prep. Those on their community rotation had a tutorial about the associated project and presentation associated with the paper. Later we had a tutorial on abstract writing for our research projects.

Thursday morning was spent hearing about the PSA, public service association, a union that represents healthcare professionals particularly those in district health boards.  Following this, we had a presentation from a UoO careers advisor about creating a CV / cover letter and interviewing tips. To finish the morning, a representative of the Chch physiotherapy team told us a bit about the interview process for getting a job at Chch hospital, the new grad rotation system. It sounds like the interviewers enjoy the 'assessment centre' approach to job interviewing. Assessment centres are a style of interviewing where all interviewees are put together to work on a challenge, and the interviewer walks around making notes on leadership, teamwork etc. There's a presentation component to the Chch process whereby applicants get creative to present why they want to be a physiotherapist working at Chch DHB... apparently people have been known to write poems, songs and even strip off their clothes (to illustrate their journey as a physiotherapist, each stage represented by a layer of clothing).

Here's my revamped CV (with all the contact details blacked out)

Some employment info from Chch DHB: http://www.cdhbcareers.co.nz/Allied-Health/Physiotherapy/

I zipped back to Nelson on Thursday afternoon. It was lucky that I was carrying chains for my car, as there was snow on the road on the Lewis Pass. The road-crew were also busy sweeping the road and spreading grit. Tip for placement in Nelson - to carry chains when travelling Lewis Pass to/from Christchurch.

P4R4W0: Venturing into the snow (Holiday!!)

I returned home to Waimate over the week break, stopping in Hokitika to visit my sister, aunt & uncle. On the way we stopped to walk over the longest swing bridge in  New Zealand, caught some glow worms in Hokitika, carved some Greenstone and popped up to the Devils Punchbowl in Arthur's Pass.

My attempt at a greenstone knife

Once in Waimate we went for a quick walk / run, enjoying the sunshine. We decided that it would be good to catch some snow... and because I like tramping, what better place to visit than Mt Cook. We also stopped in Tekapo and Kakanui for some day adventures.

View from the White Horse monument, Waimate.

Church of the Good Shepard, Tekapo

^Lake Tekapo

^Hooker lake (left) & Tasman lake (right)

Hooker Lake, Mt Cook

Tasman Lake, Mt Cook National Park

All day bay, Kakanui (near Oamaru).

P4R3W7: Treatment complete, no further action required.

The last week of my MSK physiotherapy outpatient placement rolled around very quickly. Here are my top five highlights of the week.

1. Passing the practical aspect of the MSK placement. My clinical portfolio is still being marked.
2. Demonstrating some good physiotherapy skills to my clinical educator. Up until this week I have had some poor performances, mainly due to being anxious when faced with questioning and being put off track by some lines of questioning. This week I was able to get into the flow of assessing and treating and I felt really happy that I was able to show my clinical educator the skill level that I had been achieving throughout the placement (we only have a 2h window to demonstrate our skills to our clinical educator each week).
3. The shared lunch on Thursday... it's tradition for students to provide some baking at the end of a placement to thank the staff which have accommodated them over the placement. I brought in some home-made brownies (the receptionists thought they might have been magic brownies). Other staff and students gathered in the acute allied health room and shared what turned into a massive lunch.
4. Getting well wishes from your clients.... lots of gratitude and thanks.
5. Treating some interesting case presentations this week. The first case of interest had a referral for a full thickness rotator cuff tear (supraspinatus) and bursitis of the shoulder. Pretty typical clinical picture, right? Wrong. It was somewhat interesting that the client had no pain given the bursitis. What was more interesting was that the client had a flicker of biceps activation (super weak) and limited supination with no known mechanism of injury. The second interesting case was that of cervicalgia (a sore neck) and severe headaches. Upon assessment I managed to aggravate the headache (woops!!) so much that I had the lights turned off in the treatment room. I was then able to adjust the neck in to a position that was known not to provoke any neck pain and apply some PA mobilisations which quickly eliminated the headache. Pretty interesting cases.

 "Treatment complete, no further action required."

The phrase 'treatment complete, no further action required' was a theme of my final Friday of placement. Instead of spending the day in ED, I was up on 5th floor writing my patient discharge summaries. This statement is one that we can select when writing a discharge summary. I feel like this now applies to me (for a couple of weeks anyway)... placement complete, no further action required.

Time for a week break!!

The mountains have had a good dumping of snow over the last week... time for some exercise!

P4R3W6: Nelson lights.

This week flew-by!!

I had the usual workload in the outpatient clinic and two hydrotherapy sessions which I assisted with (I have a small patient case load to look after in the pool). There were two new clinical highlights / activities I participated in this week - pre-op hip replacement education class and an education class for the use of TENS at home.

I was able to attend a pre-op hip replacement education class over one lunch break. The class essentially described some anatomy and the hip prosthesis they surgically insert into the hip, the post-operative plan starting at day zero (day of the surgery) to discharge on the second or third day post-op, the precautions and devices they can use at home to assist daily activities and for mobilising. Walking aids were issued and techniques for using them were taught at the end of the session.

The TENS class was held on the maternity ward. The physiotherapy department issues TENS machines for females to ease the pain of labour. Before they are issued, the recipients have to attend an information session on how to use them and how TENS works. I got to lead the section on how TENS works and be the model for how to apply the TENS machine to the body. TENS is a very soothing modality, I would have been happy to keep wearing it all day!

Friday was my last session in ED. Next week on Friday I'll be writing up discharge summaries and hand-overs for my supervisor to continue treatments. Anyway, today I spent the morning shadowing and helping my supervisor on the medical ward - they were a bit short staffed. The afternoon in ED was ankle injury after ankle injury and no fractures in sight. In between patients I finished off the information sheet (some adjustments were needed) on gout (I've attached it to a previous week in this rotation).

I was fortunate to sit in on a hand therapy appointment this week too. The person had their extensor pollicis longus tendon replaced by their extensor indicis tendon... basically this means the muscle that lifts the second finger now lifts the thumb. Odd, but cool.

Nelson light festival was on this weekend. According to their website, it is run every two years. It showcases an amazing array of light exhibits and performances. So much art and culture spanning a couple of blocks - Queens gardens and NMIT campus. Artworks included set pieces made of recycled bottles (see the tap and the ocean images below), glow in the dark / illuminated pieces from children in the Nelson community, projected textures on buildings to give the building a completely different appearance, fire dancers, a techno-light performance 'Neon Robot' (the tune is still in my head!!), and more!! It's free, and very popular. A wonderful excuse to get out this winter. P.s. this doesn't feel like winter (Dunedin is much colder!!)

I also went with my flatmate up to the summit of Mt Arthur, 1795m altitude in Nelson's great backyard. Took us just over 3h to reach the top.

P4R3W5: The Trimalleolus fracture

It was another good week up on 5th floor, NMDHB physiotherapy outpatient clinic.

Here are my top three small successes of the week:

1. I discharged a couple of clients who I assessed and managed from day one. For one with of these clients with shoulder instability, I even sent a letter to the GP advising them of our treatment findings and outcomes.
2. My chronic non-specific whole back pain client had some great success in the hydrotherapy pool. We're making progress in leaps and bounds... small bounds.
3. I'm assessing and treating patients independently, mostly. I'm still giving a debrief of assessment findings and treatments to my supervisor after each treatment. I'm happy with my supervisor listening through the curtains too and hearing the odd voice pop up to tell me things. Also, the other physical therapist has a good listen in too and will often pop her head through the curtain to have a good chat with clients she's seen before.

Our two hydrotherapy sessions are given to eight people per session. Patients work on their own programmes or follow a orthopaedic protocol such as for a knee replacement or a hip replacement. I'm currently looking after 2-3 clients per morning session on a Thursday. I've discharged a client from the pool session. They had a knee replacement. This person had achieved their goals, managed their pain so well that it was no longer a problem and could flex their knee to ~120 degrees and fully extend their knees. They were physically active and were now using the public pools twice per week. Perfect! They were very happy to have had the chance to use the hydrotherapy pool, describing it as 'wonderful' and 'heaven'!

On Thursday I had a peer come in to watch me assess a new patient. Yes, it's peer assessment time again! I had an older person with neck pain, spondylosis. I thought it went very smoothly. So now I've got some paper work to do, and some reflections to make about experiences had on this placement so far - I'll have to put my thinking cap on!

Friday in ED was great. One interesting case was of an older person with osteoporosis on holiday in Nelson. This person tripped and fell on a step causing a bi-malleolus fracture of their left leg. The doctor actually called it a tri-malleolus fracture because the posterior tibia also had a fractured fragment. Having googled trimalleolus fracture, I've discovered that it is actually a term used. I thought the doctor simply had a good sense of humour! Anyway, I was allowed to help put a cast on - by holding the leg. Small job, but important! haha! This person was having a good old laugh and was upbeat throughout my assessment process and was still upbeat some hours later when we had an orthopaedic consultation and tested their mobility on crutches, then opting for a frame when they realised that the cast was very heavy. Patients like these make the hours fly-by... probably not for them though.

I've had a couple of DNA's this week (did not arrive), which is a bit disappointing given that there is quite a few people on the waiting list who may have benefited from that timeslot...

This Saturday is a social outing for those keen NMDHB physios - Indian food at Indian Cafe in Nelson. I'm planning on heading along for that.

Two more weeks to go!