As stated in my previous post, I decided to postpone my blog updates until after the placement had been completed. So... here I am, placement completed and ready to give you a very rough recap of my time on ward 6B Older Persons Health.
But before I do, I'll give you some insight into my life admin. Life admin is something that we all have to do and in many ways, it shapes our experience of work/placement. As with many students, sorting accommodation in their fourth year needs to be strategic, particularly if placements are to occur in multiple cities. nb those in the Dunedin centre usually posts students between Dunedin and either Timaru or Invercargill. This is the first of two papers I need to re-sit this year to graduate, and I am placed in Dunedin hospital (the next placement is in Timaru's hospital). The challenge (as with anywhere in the country) is securing temporary accommodation for six weeks at a reasonable cost. I had an opportunity to live in a family friends batch/crib/holiday house in Karitane (30min north of Dunedin) for $x per week, so I took it. As with traditional holiday homes, it didn't have internet, nor did it have a large hot water cylinder or even a washing machine. Funnily enough, these weren't a problem; Dunedin has laundromats, short showers in the morning kept me on time, the early commute in allowed me to get a park nearby with UoO internet from a nearby hall of residence. I even found the drive enjoyable; great views, passing lanes, pretty good radio reception. In Karitane I had access to a couple of kayaks, surfboard (tried it once and decided 'no thanks') and bodyboards. When I wasn't in the water, I was enjoying a walk on the beach, a run around the bay or a photography mission somewhere with a nearby outlook on the landscape. I was pretty lucky!
 |
| Lookout point over Karitane (sunrise) |
 |
| Walking track view in Karitane |
 |
| Kayaking! |
 |
| Photography excursion (sunrise) |
The first two weeks of placement in 4th year is professional studies week. I've explained this before when I was at the Christchurch centre (see last year's blog entry). In retrospect, the highlights of this PSW (professional studies week(s)) was a visit to the gym to mingle with my peers in a game of social netball, dodgeball and badminton. We had the usual introductions: expectations, a lecture on mental resilience, and field preparation (amongst other things). My field prep included a visit to ISIS to familiarise with the patient notes and assess/treat a patient. Every patient seems like a memorable one, and this person was no different. They wrote poems daily to practice upper limb function (handwriting). The poems were expressive/descriptive of their experiences throughout the recovery process. The poems were powerful and really conveyed the patient perspective in rehabilitation, which touched on ideas of hope, despair and patient care. The PSW weeks finished with a shared lunch. Within those weeks I had contacted my supervisor (by phone, as I had left emailing them a bit late, oops!) to find out where I was/ what time I began and some prep things they would like me to do before starting.
There's a useful website about mental resilience you should checkout (see below):
http://www.robertsoncooper.com/improve-your-resilience/i-resilience-free-report-preview
There's a useful website about mental resilience you should checkout (see below):
http://www.robertsoncooper.com/improve-your-resilience/i-resilience-free-report-preview
Ward 6, Older Persons Health sees a variety of older persons who need an intense rehab / extra bit of time to recover. The stroke rehabilitation unit is on ward 6B. I saw patients on wards 6A and 6B (soon to merge into a single ward). I didn't see anybody on Ward 6C (older persons mental health ward).
The physiotherapists (my supervisor, a rotational physiotherapist and another physio for ward 6A), occupational therapists and rehab assistants (RA) base themselves in the physiotherapy gym. This is where we start our day with a combined PT/OT/RA allocation of our services to patients for the day (including handovers and discharge planning to coordinate our services). There were many good laughs were had at these meetings (actually, whenever these professionals were in a room together there was usually laughs to be heard). I managed 6-8 patients autonomously on the ward (with supervisor + rotational PT supervision/collaboration) when required. At 11am each work day there was a group exercise class run by the RA/PT/me! These exercise classes had patients sitting around the parallel bars to complete chair/standing strengthening/brain gym 'coordination'/quizzes/balance activities. I recall movements to a macarena dance being taught to the participants by the rotational physio (with accompanying music) and all four staff members doing actions in front of an amused (?bemused) group of patients - I think we had them too embarassed to participate. The exercise class really lightened the spirits of many patients (and definitely the staff), especially with some of the answers given by the patients to our quiz, so needless to say that I enjoyed these classes each day.
Morning tea and lunch breaks were necessities for the older person's health team. Wednesday morning tea has a rotating schedule of staff named to cater for it each week. This was one of the first things I was orientated to on the ward. With only the New Years space not filled on the roster (detox?) it is a rigorous planner highlighting its importance. On the last week I brought along chocolate muffins and a container of dried fruit. Morning tea takes place in the staff cafe, so we got lots of practice walking up and down the stairs from sixth floor to ground floor. On another occasion, the OT/PT/RA staff went out for lunch outside of the hospital as a social treat for ourselves (possibly celebrating a couple of things, I can't quite remember now).
I attended a health expo at the Edgar centre for a few hours earlier in the placement, where the plan was to get as much free stuff as we could (sugary treats were of higher importance than pens). There were a range of items on display; from toilets that wash and dry your bottom after use, wheel chairs, hoist systems, walking-cane with object proximity vibration alert, frames with laser markers for persons with Parkinsons to step over, the list goes on... At one exhibit I found myself having a go on an inflating device that gets people up off the floor. The person running the exhibit appreciated that I was a student and offered to supply the School of Physiotherapy with one of these devices for students to practice with free of charge, he took my details and I gave him direction to go about contacting a person from the school to donate one of these devices to, but I haven't heard of any outcome. At the time I thought this was a win for the day!
Each week there is either an in-service or a peer review completed with the PT/OT up on ward 6. I presented for the peer review in my second week, and gave an in-service in my last week of placement. The peer review is an opportunity to present a case, often a tricky situation you've experienced and showcase how you dealt with it. I presented a current case at the time which was useful because the feedback from the group offered me a different perspective about how I should approach the situation. The peer review is counted as continuing professional development, so the team signed me off as having completed it. Interestingly the 4th year students do a different kind of peer review, whereby we identify areas of development we think is important for ourselves to improve on in our own practice, then another student observes us with a patient and gives feedback about our performance in relation to our goals. In the last week gave a presentation about the research my PHTY459 group completed; we had good discussion about greater societal challenges like balancing activity restriction with participation; our human nature to complete tasks with 'old habit' strategies and take risks; educating caregivers about how they can best support their older person etc. More laughs were had as the staff shared their own personal and professional experiences.
A particularly enjoyable feature of the placement was working alongside a student occupational therapist on their last placement before graduating. There was a common understanding between us and mutual respect. I found her to be a great resource for discharge planning and identifying additional activity related problems to investigate at a body, structure and function level. I was able to assist with some of the OT sensory tests (involving perceptual tasks e.g. depth perception, and problem solving tasks) namely the OT-Adult perceptual screening tool. I assisted the OTs with a couple of breakfast clubs (oversimplified: patients make their own breakfast). The PT-OT information gathering role overlaps considerably (a holistic approach), however their assessment didn't follow SOTAP style, instead was more descriptive/storytelling. It was interesting to shadow the OT student with their subjective assessment, and a useful time-saver for me because I was able to chip in to ascertain information in more depth as it related to physiotherapy when necessary. To save time, in another experience, I doubled up with the trainee intern (medical doctor) for their subjective assessment.
I was allowed to watch an interesting assessment of swallowing, a video fluoroscopy, completed by the speech language therapist. This procedure had the patient eat fluids of varying consistences / thickness / viscosity whilst a series of xray images were taken in quick succession to form a video. The fluids had a chalk-like product that made viewing the swallow very easy to observe.
The social worker on the ward was very social. I got to know him and his role earlier in the placement when we arranged a time to chat about it. From that point on we span many good yarns and we got to help him with his further studies involving the ICF model (interestingly to me, social workers aren't necessarily exposed to this model in their training).
The staff provided weekly tutorials on things like outcome measures, TENS, manual handling etc which were somewhat useful. A neurological physiotherapy interest group hold meetings at the school of physiotherapy once a month, of which I attended one of those meetings. The topic of the meeting was patient centred care, and we reflected upon our experience and what was perhaps an ideal vision for patient centred care. The group noted a few constraints in achieving this ideal, discussed the role of 'hope' and somewhat quashed the SMART goal setting tool. The article was: Are physiotherapists comfortable with person-centred practice? An autoethnographic insight, by Suzie Mudge, Caroline Stretton & Nicola Kayes (2013; Journal of Disability and Rehabilitation).
Interesting website about neuro-related outcome measures:
I had the opportunity to attend some 'home visits' that the OT and RA usually do with the patient to establish whether it is feasible for the patient to return home (the visit home also gives insight as to whether the MDT service can provide any additional support e.g. bed levers, raised toilet seat etc). The home visit was an eye opener to the real world challenges that simply aren't there on the wards, one such challenge talked about by the OTs were hoarders i.e. persons homes that were cluttered with things, some homes were reported to be so cluttered that common access ways into rooms like the kitchen or bedroom were blocked (patient had previously climbed over these piles of clutter). I was fortunately able to follow a patient from her initial admission to ward 6 to her discharge (including attending a home visit), then see her with the EDRS (Early discharge rehabilitation service) team for community PT follow-up.
There was a guest speaker from Wellington, a psychotherapist, who spoke to the allied health team about mindfulness. This talk covered familiar territory for us, but it was interesting all the same. We appreciated the talk. The interesting things I got about mindfulness came from the rotational physiotherapist on ward 6 after the talk; she talked about the Auckland University CALM website (http://www.calm.auckland.ac.nz/index.html ) and the app available on Apple/Android devices called 'Headspace'. It's definitely worth checking out!
 |
| St Patrick's Day! |
As you've probably ascertained from reading the blog so far is that the staff are very flexible and friendly. There was no exception to this rule on St Patrick's day where I was allowed to wear a green shirt and the rotational physiotherapist made St Paddies stickers saying 'Top ol' the morning to ya' or 'Potato, potato, potato', 'happy St Patrick's day' and my sticker said 'fiddle dee dee'. Very Irish.
The most useful tip came from my clinical educator mid-placement. It would be better if I said "You're going for a walk and I'm coming with you" instead of "we're going for a walk". Making the patient's take ownership for their own rehabilitation is important, and I won't be going home with them when they're discharged, so it's better that they go for walks by themselves on the ward and not feel so dependent on physiotherapy services. I'm sure there may be exceptions to this rule, but as a general rule I like it.
I don't think I'll need to mention patients this round, other than to say they were all great people.
I had a great experience and I think this reflected in my grade. Yay! Passed the placement with a good grade!
 |
| Sunrise in Karitane on day of departure |
Below are a few photos from the Physio Gym! I'm loving the quotes!
 |
| Augmented mirror therapy (computer - video tech based) |
 |
| Motomed. Arm and leg cycle ergometer |
Next placement is at Timaru Hospital. I'll be on the orthopaedic/surgical wards.
I'll be staying in Waimate (30min drive to Timaru) with my parents.
Last placement, lets hope it goes as well as OPH at Dunedin Hospital.
