On my womens health placement I initially had a bit of trouble getting my head around all the things we had to say and educate the patients on. Some of the things we had to teach were quite sensitive issues (e.g. perineal pain, bowel and bladders problems). I had sat in with the other physios when they were seeing patients and they seemed to go over these issues with no problems.
Eventually after I had done a few post natal educations of my own I realized that after birth patients are so used to people asking about their bowel and bladder habits and their perineum that it does not bother them anymore and they are more than happy to disclose the details to a physio student. Also as a result of all the antenatal edu pts get many of them know the technical terminology associated with womens health which makes it much easier. However some patients did not understand English very well and therefore did not understand what ‘Have you opened your bowels yet’ or ‘Did u have any constipation during your pregnancy’ meant. Initially this was difficult but I soon realized that if you didn’t get embarrassed or make a fuss about it the patients always thought it was funny if you re- phrased it and asked them ‘if they’d done a poo’.
This prac has show me that even if you are embarrassed about the things you are asking if you act confidently and are not immature then patients are less likely to be embarrassed and more likely to divulge important information to you.
Wednesday, December 3, 2008
Conversion Disorder
On my womens health placement I had a very interesting pt. This pt had had a home birth with a 5 page detailed birth plan, however everything did not go to plan when she retained her placenta and her and her newborn had to be rushed to hospital. When in hospital she lost sensation and power in her LL and pelvic pain. Within a few days of giving birth this pt was unable to walk without max assistance. She also AS and a number of other problems, all of which were self diagnosed. However with all these issues the pt was not phased at all and came across very cheerful, whereas the husband was very emotional and teary. The doctors had no idea what was wrong with this pt and blood tests and MRIs showed nothing.
Initially I found it difficult to see this pt as there was no apparent reason for her neuro symptoms and I cant help but think that maybe the patient is just being dramatic and making it up.
After talking to the other physios I learnt that this pt may have conversion disorder which is where the patients develops symptoms, such as this pt had, however there is no neuroligcal cause for these symptoms. It is thought to be brought on by psychological stress or trauma which would include childbirth, especially when the pt is rushed to hospital immediately after.
After learning this I found it easier to see this pt and it reinforced the (obvious) fact that diagnosis is not the be all and end all of physiotherapy and that we should not purely treat based on our Ax and not the diagnosis or lack there of.
Initially I found it difficult to see this pt as there was no apparent reason for her neuro symptoms and I cant help but think that maybe the patient is just being dramatic and making it up.
After talking to the other physios I learnt that this pt may have conversion disorder which is where the patients develops symptoms, such as this pt had, however there is no neuroligcal cause for these symptoms. It is thought to be brought on by psychological stress or trauma which would include childbirth, especially when the pt is rushed to hospital immediately after.
After learning this I found it easier to see this pt and it reinforced the (obvious) fact that diagnosis is not the be all and end all of physiotherapy and that we should not purely treat based on our Ax and not the diagnosis or lack there of.
Tuesday, December 2, 2008
Ortho pt on Cardio prac
When I was on my Cardio placement on a surgical ward all my Cardio patients were going well and then I was given an outlier pt who had had a TKR. The only orthopaedic placement id had were the 3 hours ones in second year when you were on placement with 5 other people and didn’t learn a lot because you spent the whole time doing subj and obj.
I knew basic things like ROM exercises and IRQ/SQ etc but other than that I didn’t have much idea what I was doing. To make it even more complicated the pt was so far behind on her pathway because she had had a PE post surgery. I had to see this pt twice a day for 3 days which took up a lot of my time when I should have been seeing cardio patients.
I did this until I my supervisor asked how I was going with everything and I told her that I felt like I had no idea what I was doing with this pt. Immediately after this she took the pt off me because it was my Cardio placement and I shouldn’t have had to see ortho patients.
This has shown me that if id just spoken up earlier then I could have saved myself 3 days of feeling useless and the pt would have prob got better treatment from a physio/ student who knew what they were doing
I knew basic things like ROM exercises and IRQ/SQ etc but other than that I didn’t have much idea what I was doing. To make it even more complicated the pt was so far behind on her pathway because she had had a PE post surgery. I had to see this pt twice a day for 3 days which took up a lot of my time when I should have been seeing cardio patients.
I did this until I my supervisor asked how I was going with everything and I told her that I felt like I had no idea what I was doing with this pt. Immediately after this she took the pt off me because it was my Cardio placement and I shouldn’t have had to see ortho patients.
This has shown me that if id just spoken up earlier then I could have saved myself 3 days of feeling useless and the pt would have prob got better treatment from a physio/ student who knew what they were doing
Friday, November 21, 2008
judging pts
Ive just had a womens health placement in a public hospital and in the last 4 weeks I saw a variety of patients from different socio- economic groups. A number of the patients I saw were also very young. After reading their notes I just assumed that because they were so young that they would not be interested in a physio student coming to give them 25 mins of post natal education. Many of them also had complex social histories so I thought physio would be the last thing on their minds.
I went into their rooms just expecting them to tell me that they couldn’t be bothered listening so to just leave the physio info sheets there. However almost all of my younger patients were the ones who were most keen to listen and asked the most questions. It didn’t occur to me beforehand that these are the patients that are probably keen to learn the most because they haven’t been taught anything like this before. It was nice to have patients that were actually interested in what you were saying and it showed me that you shouldn’t judge patients just on their notes because they can suprise you
I went into their rooms just expecting them to tell me that they couldn’t be bothered listening so to just leave the physio info sheets there. However almost all of my younger patients were the ones who were most keen to listen and asked the most questions. It didn’t occur to me beforehand that these are the patients that are probably keen to learn the most because they haven’t been taught anything like this before. It was nice to have patients that were actually interested in what you were saying and it showed me that you shouldn’t judge patients just on their notes because they can suprise you
Building Rapport
Whilst treating a patient this week I learnt the benefit of being polite but firm with patients. I was seeing a lady who was 3 days post C- section to give her some post natal education. She was complaining of mod pain however refused pain medication as she preferred more natural remedies. This pt also had a very interesting PMH and the nursing staff had warned me that she could be very difficult and wouldnt do anything she doesn’t want to.
So the first time I went to see her, I tried extra hard to be nice and build some rapport with her so that she would be compliant. Which meant that I let her brush her hair, put on some hand cream, helped her walk very slowly to the toilet etc. However this meant that I had already spent 15 minutes with her before id even started my education. She was extremely friendly with me and listened to my advice and asked questions. By the time Id finished, an education that should have taken a maximum of 25 minutes had taken just over 45 mins.
From this I learnt that whilst building rapport with the patient is essential, we still have to be in control of the treatment session because our time is very precious, especially next year when it would have been just me on the ward.
So the first time I went to see her, I tried extra hard to be nice and build some rapport with her so that she would be compliant. Which meant that I let her brush her hair, put on some hand cream, helped her walk very slowly to the toilet etc. However this meant that I had already spent 15 minutes with her before id even started my education. She was extremely friendly with me and listened to my advice and asked questions. By the time Id finished, an education that should have taken a maximum of 25 minutes had taken just over 45 mins.
From this I learnt that whilst building rapport with the patient is essential, we still have to be in control of the treatment session because our time is very precious, especially next year when it would have been just me on the ward.
Pschology
On my paeds placement i became very interested in the psychological effect of parenting a child with a disability.
I came across a lot of parents on my placement and it was interesting to see how different people managed different scenarios. I researched a whole heap of journal articles regarding stress, depression and illness amongst parents of people with disabilities and gave a presentation to the staff.
We get given some advice to manage parents whilst we're treating their children, however I don't think it is highlighted enough. I've finished my placement and I'm still not sure how to manage a depressed parent, I don't think anyone is sure how to manage the situation. However I do know that we need the parents to continue with home exercise programs for their children and therefor we need them to trust us and be in the right frame of mind.
In my brief placement I learnt that active listening was effective especially for people who just need to vent and talk, However for people who are more at risk of depression its not the be all and end all. People manage stressors best when they have an internal locus of control and a sense of self mastery. Its not about always being "feel good" and "lovey dovey" you need to empower these people to take control of their life to break the depression cycle, be a motivator not just someone who tries to empathise with them.
I came across a lot of parents on my placement and it was interesting to see how different people managed different scenarios. I researched a whole heap of journal articles regarding stress, depression and illness amongst parents of people with disabilities and gave a presentation to the staff.
We get given some advice to manage parents whilst we're treating their children, however I don't think it is highlighted enough. I've finished my placement and I'm still not sure how to manage a depressed parent, I don't think anyone is sure how to manage the situation. However I do know that we need the parents to continue with home exercise programs for their children and therefor we need them to trust us and be in the right frame of mind.
In my brief placement I learnt that active listening was effective especially for people who just need to vent and talk, However for people who are more at risk of depression its not the be all and end all. People manage stressors best when they have an internal locus of control and a sense of self mastery. Its not about always being "feel good" and "lovey dovey" you need to empower these people to take control of their life to break the depression cycle, be a motivator not just someone who tries to empathise with them.
Red Tape
On placement with a government department, not a hospital.
I have never seen so much red tape in an organisation before. These people will hold meetings and achieve nothing, they discuss their policies and procedures more than they practise and the whole environment is inefficient. It was hard to swallow how many resources this organisation squandered.
I finished my placement and I am glad i experienced it, I learnt the effects that red tape had through all levels of staff, It breeds inefficiency. I know better understand that a workplace needs to have the right balance between policy and procedures and freedom for individual thought and decision making.
Has anyone else found a placement to be a poorly run organisation?
I have never seen so much red tape in an organisation before. These people will hold meetings and achieve nothing, they discuss their policies and procedures more than they practise and the whole environment is inefficient. It was hard to swallow how many resources this organisation squandered.
I finished my placement and I am glad i experienced it, I learnt the effects that red tape had through all levels of staff, It breeds inefficiency. I know better understand that a workplace needs to have the right balance between policy and procedures and freedom for individual thought and decision making.
Has anyone else found a placement to be a poorly run organisation?
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