P4R1W7: The long and winding road

With a few road works around, traffic has been a bit slow.... more time to enjoy the view!

On Monday an older female patient was discharged after three or so weeks in the hospital. On a daily basis (not weekends), she would spend time receiving physiotherapy with me. This is the lady that I joined for morning tea in her room to have a general catch up a few weeks ago. Anyway, she was discharged today and stopped by the AT&R gym to specifically say goodbye, thank me and wish me well (and she gave me a hug). I wished her all the best with her return to home. What a heart warming moment - all that work had paid off.

I've got another nice older lady that I'm working with, and we've established a good love-hate relationship (in a comical sense). She would spot me and give me the look like "you had better not be getting me up". I would, naturally, go do the opposite - we would have a joke about it. She's awesome because she is very motivated to get herself down the long hallway to the gym - her room is the furthest away from the gym on that corridor. Once in the gym, she would walk herself down the long parallel bars. Good on her. ...later in the week my supervisor and I were discussing her de-conditioned legs. The patient said "deconditioning, you just made that up - it's probably not even in the dictionary" to which my supervisor replied "deconditioning is in the dictionary... it's right next to air-conditioning".

On Tuesday I attended an evening seminar "How to walk off your Parkinson's symptoms" by international guest and author John Pepper (book tittled Reverse Parkinson's Disease). John has PD, but has used high intensity walking and conscious movements to overcome his parkinson symptoms. Although I didn't learn anything new, it was nice to hear this man's story - it always appreciated more coming from a person with first hand experience. The AT&R crew (physios and physio aids) all attended this seminar. Following the seminar we popped out to The Free House for a beer.

Sitting in the AT&R ward lounge, looking through to the dining room...

Wednesday was a quiet day. We had quite a few overflow patients from the medical ward which we agreed made the AT&R ward look like a retirement home village. I had the community physiotherapist sit in on a session with a patient whom I have referred to him. We will hopefully have a home visit with her next week (I'm just tagging along). Otherwise, I took my patients for extended sessions in the gym.

Backtracking to Wednesday morning after hydrotherapy, I returned a patient to her room. She was sharing a room with another lady who usually does hydrotherapy with us, however she was being discharged in an hour or so (thus not at the pool with us). As I was wishing her well for her return home she told me how she was scared the first time she went into the hydrotherapy pool, in particular using the water controlled hydrolic hoist (it rattles and shakes sometimes). She had a very sore hip and hadn't been in the pool for a long time. Between those three things, she was a little bit anxious. Anyway, she recalled a firm hand being placed on her back and a sense of safety for what was happening. That firm hand was mine, I was in my togs, in the pool along side her. Her thanks was very sincere - that firm hand on her back had made all the difference, that first day of hydrotherapy. Yay, another heart warming moment!

A date scone baked by our wonderful physiotherapy assistant... the delicious Wednesday tradition! Yum!

Things to watch out for on AT&R

1. Catheters and patient's exercising can be a recipe for disaster.
2. If you stand on the sensor mat by accident, you can rest assure it won't be a secret and the nurse will come. P.s. a sensor mat alerts the nurses that a patient has probably fallen or is trying to wander without assistance.
3.  Hand hygiene audits... On Thursday we were all under the watchful eye of a nurse carrying out the monthly hand hygiene audit. Early in the morning I walked passed my supervisor who was being followed by this nurse. He was firing cheeky comments her way until I happened to walk passed. He then said "follow him", and she turned around to follow me down to the patient's room. I was taking a patient back from the pool to their room thinking 'it's going to be a good day, this nurse is ready to take the patient from me to give them a shower'. I was wrong.

Thursday was St Patricks Day, and only one person dressed in green with a big green hat...that was our ever so cheerful morning toast lady. We call her bubbles and she volunteers each morning to cheer up our patients and give them toast. Today she gave me a green mint, egg-shaped, piece of chocolate. And on the discussion of chocolate, there was another patient's birthday and the family brought in two cakes of white choc for us to nibble at whilst we write our notes.

I had my clinical educator in on Thursday. With minimal new patients to practice new assessments with over the week, all I could do was to try my best with a Medical Ward overflow patient... a patient in AT&R just because we had an available bed. ...Another non-neuro patient to assess. I've had a poor run with very few new patients to assess this placement. I've done my best, but there's no way I'm up to the standard the assessors are after. I've decided it's not all my fault, there's nothing I can really do about it. The clinical intervention really has not helped at all - I feel that it's all very well having an intervention, but with no consistent new people to practice new assessments on there is little point. In addition I've had a confusing few patient assessments with my clinical educator - a few communication and expectation mismatches, so really I'm at a point where I know there is no coming back from this situation. I'm now prepared to fail this placement... having talked to my clinical educator and my supervisor about it, I have put my mind at ease. I feel a little hard-done-by, but I'll get on with the last week, next week, and try and finish on a high note (I'll dedicate this week to myself and my neuro patients...) Failing a paper means that I will be back for another neuro placement next year.

Friday was a fairly good day. I had my usual patients in the morning, two amputees in the afternoon (both of these patients have recently received their prosthesis from Wellington Limb Clinic) and I had my peer review (again... because it was recommended that the physio student watch me do an initial assessment). This was done without too many problems. Initially I wasn't sure whether I was going to get to do the assessment... due to it being an afternoon admission to AT&R and my supervisors finishing earlier on in the afternoon. Anyway, we got there in the end.

...Bring on my last week of neuro placement for the year... lets end it on a high note!

Next week I will also be providing an in-service presentation and probably a plate of food to share to say thanks to the healthcare team and my supervisors in AT&R.

P4R1W6: Brighter on the otherside.

Shipwreck in Motueka.

I've had to create myself a clinical improvement plan. Basically I've got to prompt myself to ask myself 'why'... What am I observing, why is it doing this? Why can't the person do this? (Make a problem list). Is it important to do something about it, why or why not? Why, why, why!?! ...I actually thought I was doing this already, but not to the extent that I should be (apparently). I'll keep trying my best and hopefully pass this neuro paper. Only two weeks to go, and lots to improve on!

On Tuesday I got to be a guest physio and help out at a falls prevention programme run by the PHO (Public Health Organisation). The main educational session took place in another room, and we had took individuals one-by-one to discuss their recent falls, home/life situation and to preform a timed up and go test. As you'd expect, most of the attendees were older persons. One key message that I got from them is that they are truly frightened of having another fall. (Also, they don't know how to correctly fit their walking sticks). There was some irony in holding a falls prevention programme in a pub. Maybe we could balance their anxiety of falling with some liquid courage (...might put them at a higher risk of falling though).

Timed up and go setup in the restaurant!

Hospital mysteries

1. Wheelchair wheels getting flat... there are no sharps lying around!!
2. Wheelchair cushions... not many on the ward now... they must grow legs and walk out.
3.  The lift that randomly opens on the ground floor with nobody on it and nobody waiting.

A patient lied to me (again... sort of). I asked them about their past medical history and specifically asking whether they had any problems with their heart. They said no. They mentioned that their legs get swollen, and sometimes their stomach does too - fluid retention. Looking at their legs, they were pretty swollen! Fluid was indeed retaining. The patient said they had been previously quite active, but when asked specifically they walked 10-15min most in one go, once a week. So, not as active I would like. I didn't think too much of all of this... the person was so very kind or 'lovely' as we call kind older persons (this one was >95years old). After the consultation I have a look at the patient's notes... it turns out they have chronic heart failure, with atrial fibrillation, hypertension, gastro-osophageal reflux disorder, epilepsy, have had a transient ischaemic attack and total knee and hip replacements.... it goes to show that patients don't share all that we need them to. Moreover the person said their clavicle had fractured... turns out it was their neck of humerus! Close, but no gold star!

A former patient delivers apples to some departments in the hospital every other week during apple season!!

A family member of a patient brought a dog in to visit the patient... We were lucky to get a bit of 'dog therapy' in the nurses station between writing up patient notes.

We had issues with keeping patients on the ward (alarm bells were ringing from all corners of the ward this week). We give some patient's sensors that cause alarms to go off when they wander out, or if they open a door that's suppose to be closed. I caught one leaving the ward via the main entrance  mid-week with a frame that I suspect was taken from another patient... it was miles to small for this very tall gentleman. This happened as I was leaving, so I had to take him back, slap a red ticket on his frame, adjust it (with no other name tag on it, it was his for the taking) and inform the nurses about this before I left.

I've started a job in Motueka. It's a support role for a young patient in the community. We're hitting up the gym in Mot and accessing the community every second weekend.

This week flew by so fast, so that's it - a very short blog post.

P4R1W5: Trouble in paradise

This week was a bit of a roller coaster. We're halfway through our first rotation, and I'm not ashamed to say that all is not always well. I'll detail this in a paragraph at the end. Anyway, here's a spiel about the week that has just been.

But before I get into it all, you should all check out Touch Compass dance company. 

https://www.youtube.com/user/touchcompass

http://www.touchcompass.org.nz/

I got to observe a treatment by an OT specialist in skin care. I also got to sit in on a doctor's neurological assessment. My supervisor loaned me a DVD "The brain that changes itself" to have a look at in my own time (it's about neuroplasticity). I got to sit in on an Allied Health meeting, which unfortunately had a theme of 'underfunding and coping with under-resourced services'. We had a physio team meeting too, which was pretty interesting to sit in on - a wide range of topics were covered (too much to go into). All of these experiences were pretty cool - as a fly on the wall!

Multidisciplinary team (MDT) meetings are a bit of an emotional roller coaster. Each team member usually has some input for each patient, and we all really get involved to understand the patients life - how best to get them home and to understand the requirements / constraints of their life situation. There is usually a good laugh about somebody, usually a family member of a patient or the patient themselves, who has a good sense of humour. Then there are the heart felt discussions about patients who have a less optimistic prognosis. The team really cares for each patient. It's such an inspiration to be involved in the rehabilitation, although I'm dreading growing old!!

On Monday we spent some time with a Richmond Physiotherapy Clinic recapping Mechanical Diagnosis and Therapy (also abbreviated as MDT). All of the physiotherapists at this clinic have done some training in MDT, in fact it's fair to say that this is a speciality clinic of MDT therapists. One physio there has her diploma in MDT, which is a lot of additional training! Only two people had their Diploma in MDT in the South Island; her and a staff member at the UoO School of Physiotherapy. MDT was developed by Mr  Smith and Robin McKenzie - he's the 'Treat your own back' legend... I've mentioned him in a previous blog post before. I hope to spend some time during my community placement at the clinic.

Physio banter.

• There is a lot of banter that goes on at the hydrotherapy pool. The quote of the week is from an older lady to the older gentleman (another patient using the pool) within ear shot of us staff (two females and myself) "Why do you get two lady's and I only get one man? to which the gentleman replied "it comes with experience". Classy! 
•  I had a patient with expressive dysphagia. When asked how they thought their walking was, their reply was "looks stupid", then they back tracked and they really meant to say "looks good"... their sentences are all jumbled up.
• I heard from another physio who receives semi-precious rocks (gem stones) from a patient. The patient makes the rocks shiny by rubbing 'nose fat' on the rocks.... I think we all know there's no such thing as nose fat... 
• It was entertaining to briefly join a group of Drs sitting out in the sunshine and exclaim (with a joking undertone) that you've lost a patient... they generally like a bit of humour.

Top five fashion accessories for physiotherapists

1. Walking (transfer) belt... a bit like hand-cuffs, watch out! We might take you for a walk!
2. Personal protective equipment... whole body camouflage / blending in with other health professionals
3. Stethoscope... when worn around the shoulders, it is like wearing a very smart suit jacket.
4. Stopwatch... the sports medallion, hanging around your neck on a piece of string.
5. Pens... they fit nicely into shirt button holes or clipped on pockets.

I'm a karate black belt, red tip... naa, just got my walking belt on!

Lunch out in the rehabilitation outdoor area is always nice, sunny and we bring out the walking frames with the built in seats. Perfect! Morning tea is usually had on the go. On Wednesday I caught up with a patient of mine in her room before her rehab session, taking the time to make myself a hot Milo and yarn with her whilst she had her own morning tea. I joked that I was hidden, and that I should use her room to escape doing any work. The other quiet spot on the ward is the Breakfast Club room.

Breakfast Club room!!

And sometimes food or hot drinks are left on my desk - I love it!

We're half way through rotation one now (week three of placement in AT&R). We've had our mid-way review from our clinical supervisors (the people on the ward with us everyday). In addition, we have completed our peer review (our peers observe us perform an assessment or treatment and provide feedback too). I haven't really had the opportunity to assess many new patients with my supervisors watching, so I hope to cram as many as I can in to the last three weeks! In order to fill my working day up, I've made a timetable which will stay on my student desk so I can book in outpatient and inpatients there, and my supervisors can add more patients (if I haven't already done so myself). That way, we all know that I'm experiencing lots of new stuff, managing my time effectively and have the opportunity to improve my clinical and professional skills.

To elaborate more on my progress so far... three weeks in and I feel that I haven't learned much at all. The team; my supervisors, physio aides, OTs, medical staff including nurses are super kind. They make turning up for placement each day worthwhile. The patients, the ones I can effectively communicate with, are lovely too. The main bee in my bonnet is that the quality of new patient assessment experiences I have had have been poor (or non-existent), especially with people that cannot communicate effectively. I would love to get better at this. Although neuro isn't my favourite aspect of physiotherapy, I would still like to be a pro - one day I would like to work in a hospital. Lets hope I can bring myself back on track to pass the paper and more importantly assess and treat people with severe and acute neurological conditions... I'm feeling pretty glum, which isn't like me at all. I'm choosing to filter the details out of this blog to keep everything above board, other than to say let me watch few real new patient assessments, talk me through why you're doing what you're doing, and then let me complete a new patient assessment myself (then give me feedback). I've had enough patient follow ups - I'm already good at these! Frustrating stuff, lets sort it out already.

We farewelled a new graduate physiotherapist (she's been working for NMDHB for over a year). We went out to Stag and Fern on Thursday for pizza and drinks, and on Friday (her last day) we had a morning tea for her. She's our sock poster girl! Best of luck in Wellington Alex!!

I might need some red socks for this neuro rotation...


This weekend I'm volunteering as a massage therapist at the Nelson Relay for Life.

7pm Saturday to 1am Sunday, non-stop massage. ...And there were 10 of us massaging!

P4R1W4: Tough Love

On ye bike, it's Monday!

The DHB has two orientation days for all staff. This is very similar to what was done in CHCH for preclinical weeks. Here's an outline of some of the things we sat through for a second time... Health, Safety & Wellbeing, Fire training, Maori health, Infection & control, I.T. training, Policies/Procedures/Guidelines, Patient centred care, Smokefree training... I also went on the tour of the hospital (found that there is an underground passage between the clinical and administrative sides of the hospital)... and I managed to skip the first aid training (and zipped back to AT&R to work through the afternoon). 

"Would you treat them any different?" We should be empathetic in every interaction, whether it be in a healthcare or any other setting. Powerful message. Worth a watch.

So I've now got a @nmdhb.govt.nz email address! When I first logged on, there were emails sitting there from a few weeks back (... 22 emails in total).  There are a few perks to working for a DHB - staff discounts for example! There's a staff gym (with squash court) and pool for ~$100 per year (access is for staff families too!). We have online learning systems which I am pretty sure I will need to sit down some day soon and complete a module on smoking cessation and privacy. Apparently we can hire bikes at a cheap rate and get massages at work (for a reasonable rate). On the intranet there's a buy/sell/swap, a list of continuing professional development courses, and of course a link to our patients notes.

Most of the time we write on lined paper like this...

Wednesday I was full on busy. Starting with hand-over at 8:30, hydro-pool for half an hour (I didn't get in), three patients before lunch, a physiotherapy refresher course on emergency procedures in the hydrotherapy pool (I got to pretend I was having a seizure), I had a brief catch up with the Physiotherapy team leader whom I hadn't met until now, I had a DNA (did not arrive) and an outpatient in the afternoon (plus patient notes... I managed to leave them all for the end of the day). I caught up with my I.T logins and cleared out the unnecessary emails then I was off... by this time it was 5:30pm. It was a pretty cool day - the person I admitted to the ward last Thursday is set for discharge on Friday. I played a bit of Nintendo Wii (bowling) with a patient. And I fitted a boxia ankle support on a patients shoe. Cool eh!

Thursday was busy. We started with a manual handling session at Franklin Village seminar room (across the road from the hospital). Following this we all picked up our NMDHB ID cards / swipe to access cards. Then it was back on to the ward to treat two patients before lunch. I couldn't get a new patient for my clinical educator to watch me assess, so she watched me perform two treatments on patients I had seen yesterday - one was the person with the ankle support (we decided the support was doing nothing, so we discontinued its use). The second person had a code brown when we arrived, so there was a slight delay - bowel motions are a good thing. Earlier in the day I had taken this person to the gym to begin a programme but the person's catheter connection to the bag got caught when they were trying to shift, and it broke free leaving urine on my treatment table. Shit happens. This week my session with my educator went really well. I was challenged to clinically reason, and sure I didn't know some things, but I can now direct my own learning to know more about it. I was buzzing throughout the session, it was great!

 

On Thursday I also recorded my bike trip from my flat, to the hospital. 

Currently there is only one paid male physiotherapist at Nelson hospital (that I've seen). With two male physio students there we have increased the male physiotherapists there by 200%

Tough love is:

• Mobilising (walking) a patient even if they've got severe pain linked to anxiety. 
• Throwing you into the deep end of patient assessments for the growth of your professional and clinical skills.
• Keeping a patient on a walking frame over the weekend even though they might be safe to walk without it.
• Discontinuing an intervention when it's no longer indicated, even if the patient likes it.
• Waking up a patient for physiotherapy.

Quotes & stories from the ward.

• "We're losing fish faster than we're losing patients this week" Referring to the fish tank by the reception desk... " 
• A nurse told me yelling down the corridor was the normal method for finding people (including staff) that you've lost...
• One morning this week we had a laugh during the morning handover about a patient who had emptied their catheter into an empty large can of peaches at the OT's breakfast club...
• A story from an OT about a home visit where they were given drinks of tea in large bowls the patient had provided. The OT apparently commented about the tea being in a soup bowl as 'quite a large drink'. A caregiver was present also, who mentioned that it was probably more soup than tea, given the dirty towel the patient had previously used to clean the bowls.

On Friday after placement I  drove down to attended my friend's wedding in Queenstown (Glenorchy). After a 10h drive (including torrential downpour, lightening, fallen tree on the road and waterfall gushing over the road between Haast and Fox Glacier) I made it by 4am for a few hours of sleep. The weather was perfect for my mates wedding, a stellar day! On Sunday I drove back up to finish writing this blog (final touches). [Pictures are not of bride or groom]. Time for some sleep!!

P4R1W3: Assessment, Treatment & Rehabilitation

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!

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.

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. 

Other lessons learned:

• 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've now got the pin code for the secure bike storage area and the men's showers (so I can bike to placement and have a shower before starting at 8:30am)!

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

P4R1W2: Snippet of Chch

 

Second week of pre-clinical started with Waitangi Weekend. I was fortunate to have my parents up for the Sunday. We made a trip to Akaroa, which is an hour away from Chch - I felt it was time to get out of the city. Akaroa is a beautifully located town. It was super busy and we struggled to get a carpark around the town area. Moreover, the streets were very narrow - making for an interesting drive through (damn, and we thought we had escaped Chch. Haha!)

We heard that the Wellington centre had a presentation from Brian Mulligan last week (I'm very jealous!!)

Between lecture snack at The Boat Shed

Here's a quick overview of the second preclinical week...

Tuesday: I had a tutorial with others in the same rotation to prep us for our neuro placement. At the beginning of this tutorial each of us done our MRSA swabs... we learnt another piece of anatomy, our 'Natal Cleft' - which is another name for buttock. Next up for the day was a group meeting with my research group and our supervisor - we have three supervisors, one was physically present, another away on study leave and the third (the dean of the School of Physiotherapy) phoned in and we had a very brief chat over speaker phone. In the afternoon us physio students were grouped with the 4th year medical students (whom are also on their second week of orientation in Chch) for a run down on infection control.

Wednesday: We had a lecture on presenting, which we will require for our community paper (PHTY458). There were lots of useful tips and a few humorous stories and strategies thrown in. "I don't have time to go in detail on that now, lets chat about it after the presentation" coupled with 'avoiding said person after the presentation' is the best strategy for avoiding a question whilst sounding professional. Representatives of the CDHB come and spoke about fire and emergency procedures - this included a demonstration of the fire extinguisher. I had a great chat to the hair dresser in the Christchurch Hospital ground floor 'mall' area (seriously, there's down-scaled / miniature mall there... and I did happen to need a hair cut). She was very friendly, and obviously customer service by means of chatting was seen as more important than quickly getting the job done, so I was there for an hour (the cut could have been done in 15min) - I was more than okay with this as I had the whole afternoon free. It occurred to me that her role was a lot more than a hair dresser, and  I got to hear about her experiences and a bit of her life story. I would definitely go back (in addition, it is a very convenient location!!)

On Wednesday I got myself a metro card (for the Chch bus system) and I went to visit a friend at New Brighton Pier / beach! It took me a little bit of time to figure out, but overall a very reliable and helpful service. It cost me $10 for the card and the minimum topup is $10. Each of the yellow and orange buses cost me $2.50 for the first two trips, and the third trip was free. If you're exchanging between two bus lines then you can get a slip to take on to the next bus to continue your journey for free too. We returned to the New Start area which is a shipping container mall built shortly after the 2011 Christchurch earthquake. Christchurch city centre has a lot of construction underway, it's going to look great once it's all rebuilt. My bus trip was interesting because I missed my 'get off bus stop' and ended up having a 10min run back to the place I was staying. The bus driver was helpful there giving me directions amongst some general Chch chat.

New Brighton Pier

Thursday we had tutorials on ethics, social media, performing patient hand-overs, an in depth discussion on our assessment rubric. In the evening we went to check out the noodle night market.

 

 Friday we made our way back to Nelson!