My last placement was women’s health and during my time there I had a conversation with my Curtin supervisor about private and public patients. As I was on placement in a public hospital and my supervisor worked elsewhere in a private hospital, she made the comment that often we see patients in the private sector more enthusiastic to learn what a women’s health physio has to educate them on, more so following childbirth, than in the public sector, as patients in the private sector had to pay for the service to see a physio.
Whereas in the public sector, well in the facility I was at, we got a blanket referral to see all the patients on the ward and if there were any patients with specific complications needing intervention then we would of course see them for that particular complication. In the beginning I thought that this was quite an over generalisation, but as the weeks went by it became more and more clear those patients who were of a higher socio-economic status in the public hospital were more inclined to take on board the information provided and ask questions and consciously practice the exercises because they could clearly see the benefit of doing it correctly, than those who presented with relative disinterest to the topic of conversation. I know that women’s health is the nicest topic of conversation or education however it is so much more important to try and somehow develop rapport with those disinterested patients to help even bring to their attention some health issues that they may never had heard of or cared about previously because they are the ones, more often than not, who are at a greater risk of women’s health issues later on in life.
From that placement I think I most importantly learnt how to read patients non verbal communication signs better than most of my other placements, and those patients who were interested obviously gained the most out of the education session, but it’s a reminder that we can not forget about the other relatively disinterested patients, in all areas of physio, because these are the patients that actually have the most to gain even out of a simple 10 minute education session.
Monday, September 1, 2008
Importance of Passive Movements
I'm currently on my cardio placement and in the ward that i'm on there is a high dependency unit, which is mainly used as a step down from ICU or for patients who are ventilated. One of the patients there is a 37 year old man who has motor neuron disease. He was diagnosed only 18 months ago but it has very rapidly progressed. He is now completely chair/bed bound, a full hoist transfer, and has had a permanent nasogastric tube inserted as he has pretty much lost his swallowing. I was asked to see him by my superviser for some upper and lower limb passive movements and muscle stretches.
As I am on my cardio prac I thought that doing passive movements and muscle stretches is a little bit of a waste of time, but of course I will do what i'm told! The patient has lost a lot of his ability to project and articulate words and as a result is very difficult to understand. From the conversation I was able to have with him and his family he had told me how much the passive movements and muscle stretches actually do make a difference to him. He had said that they really do make him so much more comfortable and he feels so much better after having them done. As he has been told that he only has 6-8 weeks to live, he was extremely grateful for us taking the time out to do this for him.
This experience has just shown that something that we find a little tedious and somewhat unneccessary can actually make a really big difference to someones life. So even though we dont think we're doing much, a patient is very appreciative of it as it may do a lot to increase their comfort and, in this case, his quality of life for the time he has left. This has definately given me a different perspective to doing simple passive movements as a treatment.
As I am on my cardio prac I thought that doing passive movements and muscle stretches is a little bit of a waste of time, but of course I will do what i'm told! The patient has lost a lot of his ability to project and articulate words and as a result is very difficult to understand. From the conversation I was able to have with him and his family he had told me how much the passive movements and muscle stretches actually do make a difference to him. He had said that they really do make him so much more comfortable and he feels so much better after having them done. As he has been told that he only has 6-8 weeks to live, he was extremely grateful for us taking the time out to do this for him.
This experience has just shown that something that we find a little tedious and somewhat unneccessary can actually make a really big difference to someones life. So even though we dont think we're doing much, a patient is very appreciative of it as it may do a lot to increase their comfort and, in this case, his quality of life for the time he has left. This has definately given me a different perspective to doing simple passive movements as a treatment.
Sunday, August 31, 2008
How much pain is too much?
I have a patient whi is 4/52 post carapl tunnel release and jus tin the pat 1/52 or so, her pain has increased to the point where she only has to lightly touch herhypothenar eminance or palmer aspect of her writs and it can shoot terrible terrible pains. is this normal, i felt too inexperienced to advise her whether she needed further review fom her surgeon or just to reassure this that this is normal and thoug movement is painful, it will do no harm, and the pain should start to resolve with regaining of function. I havent seen many carpal tunnels, and certainly arent an expert on hand therapy, am i missing something. She has gone backto work full time caring for a boy with CP which involves alot of manual handling so i gave her a splint just to provide protection, keep wher wrist inneutral and remind her not to use it too much really. It was great for the first week but her symptoms seemed to have worsen since she has been coming to see me. Am i stirring her symptoms up by too much gentle mobilisation. I am a little stumped and would appreciate any advice, or comments by those who have seen similar presentations.
I have liased witht he OT's who have lots of experience in the area, and they seem to think im doing all the right things, but my query is given the surgeon doesnt visit very often and only takes priority cases when he does, should i refer back for an opinion on this excessive pain, or keep going the way i am?
I have liased witht he OT's who have lots of experience in the area, and they seem to think im doing all the right things, but my query is given the surgeon doesnt visit very often and only takes priority cases when he does, should i refer back for an opinion on this excessive pain, or keep going the way i am?
communicating with aboriginal patients
Hey guys,
Thought I might share with you some specifically remote experiences i have had that i have found challenging. I know we did a section at uni on indigenous health adn have designed various programs "culturally sensitive" for various assignments, but it is not until you get out and make a few mistakes that those lectures etc. kick in!
A fair few of my patients are indegenous and my best advice... your subjective and objective ax is NOT the priority. For practitioners to establish rapport with our patients we are taught how important body language, eye contact and communication. Well i tried it and failed miserably, a thorough history is important, but sometimes you dont have to retrieve it so formally, or even in one session. In fact, the most success i had was talking about the footy, looking at the gorund, having a play with the affected areas and discovering patellofemoral symptoms. Specifics abou pain, mechanism of injury, past history of similar things, aggravaitng factors were just not attainable, and holding their attention was short. Also, management through exercise was what i wanted to achieve, but i have discovered promoting this striaght up with education ++ is too much and I was more successful with hands on manual therapy and as they got to know me, then introduce simple exercises (one at a time) was amore successful approach.
Does anyone else have any advice about cultural sensitivity? do you agree/disagree with my approach?
Thought I might share with you some specifically remote experiences i have had that i have found challenging. I know we did a section at uni on indigenous health adn have designed various programs "culturally sensitive" for various assignments, but it is not until you get out and make a few mistakes that those lectures etc. kick in!
A fair few of my patients are indegenous and my best advice... your subjective and objective ax is NOT the priority. For practitioners to establish rapport with our patients we are taught how important body language, eye contact and communication. Well i tried it and failed miserably, a thorough history is important, but sometimes you dont have to retrieve it so formally, or even in one session. In fact, the most success i had was talking about the footy, looking at the gorund, having a play with the affected areas and discovering patellofemoral symptoms. Specifics abou pain, mechanism of injury, past history of similar things, aggravaitng factors were just not attainable, and holding their attention was short. Also, management through exercise was what i wanted to achieve, but i have discovered promoting this striaght up with education ++ is too much and I was more successful with hands on manual therapy and as they got to know me, then introduce simple exercises (one at a time) was amore successful approach.
Does anyone else have any advice about cultural sensitivity? do you agree/disagree with my approach?
Physio Vs Nurse
Hey gang, hope prac is going well
In my placements so far i have been lucky enough to be working with very friendly,helpful and knowledgable nurses. On placement at the moment i had my first bad experience with a nurse.
A dependent patient was to be hoisted from their recliner chair into bed following a PT session. Another physio student and I returned the patient to the room and we saw the nurse was busy so we volunteered to hoist the patient back into bed. It was something that i have not come across in my previous placements or been exposed to at uni but at placement we had a brief introduction to hoists and how to use them. Therefore, we proceeded to place the material underneath the patient and then hoist the patient back into bed. When we placed her down the patient was slightly off centre in the bed and the nurse stormed over and proceeded to abuse both of us for the transfer and address us in a derogatory manner. She labelled us "bad physios" and "not to let physios do a nurses job"and was confrontational for the rest of the week.
My initial reaction was one of anger as i thought we had done quite well for something that was essentially new to both of us as the patient was hoisted safely back to bed but just needed some simple realignment. Thus, my instinct in this case was to become confrontational as i felt there was no need for her to criticise us.
Taking a deep breath i did what i needed to do to realign the patient and then once she was stable left the room without saying anything to the nurse. I knew the right thing to do was to maintain a professional demeanour as becoming confrontational would only ignite the situtation and not be of benefit to anyone involved.
This type of situtation is something i have learnt a lot from. I know now that if something similar happens in the future the best way is to maintain your cool and deal with the situation at hand.
In my placements so far i have been lucky enough to be working with very friendly,helpful and knowledgable nurses. On placement at the moment i had my first bad experience with a nurse.
A dependent patient was to be hoisted from their recliner chair into bed following a PT session. Another physio student and I returned the patient to the room and we saw the nurse was busy so we volunteered to hoist the patient back into bed. It was something that i have not come across in my previous placements or been exposed to at uni but at placement we had a brief introduction to hoists and how to use them. Therefore, we proceeded to place the material underneath the patient and then hoist the patient back into bed. When we placed her down the patient was slightly off centre in the bed and the nurse stormed over and proceeded to abuse both of us for the transfer and address us in a derogatory manner. She labelled us "bad physios" and "not to let physios do a nurses job"and was confrontational for the rest of the week.
My initial reaction was one of anger as i thought we had done quite well for something that was essentially new to both of us as the patient was hoisted safely back to bed but just needed some simple realignment. Thus, my instinct in this case was to become confrontational as i felt there was no need for her to criticise us.
Taking a deep breath i did what i needed to do to realign the patient and then once she was stable left the room without saying anything to the nurse. I knew the right thing to do was to maintain a professional demeanour as becoming confrontational would only ignite the situtation and not be of benefit to anyone involved.
This type of situtation is something i have learnt a lot from. I know now that if something similar happens in the future the best way is to maintain your cool and deal with the situation at hand.
Friday, August 29, 2008
Questions in subjective
I had two patients with Parkinson's disease in this week in different days at my placement. Both of them were females and I and another student had to conduct subjective, objective, and treatment to these ladies.
I am sure you already have experienced how important the relationship is which built between your patient and you during the subjective and that would affect onto your treatment. In truth, I had been having difficulty conducting subjective in most of my placements, but these PD patients made me realized more so than any other patients.
I know I don’t use the phrases that most English speakers use. I have tried to learn and use them, but the words seemed not to come out my mouth easily. Plus many phrases are still new to me.
During subjective with first PD patient, I was asked what I meant by her many times. As the subjective went along, I could tell the patient got frustrated by my questions. Then another student took over from the middle of subjective. As you can guess, the subject part went well smoothly. When it came to the objective, the patient looked at another student all the time and I have got the impression that I was not there. Which was understandable, but I felt I was useless at the same time. Another student and the patient, of course, were having a good conversation in following sessions, but not happening to me. The same thing happened again with the second PD patient.
At this stage, I kind of reluctant to see these patients as I know what is coming. I keep trying to have normal conversation with them, but the answers are always going to the different direction. To listen to the conversation what the patient and another student have makes me to compare myself more. I just want to know how I can make the questions easy to understand in general. Does anyone have any idea or suggestions? I just need to have some strategies I could use for future patients.
I am sure you already have experienced how important the relationship is which built between your patient and you during the subjective and that would affect onto your treatment. In truth, I had been having difficulty conducting subjective in most of my placements, but these PD patients made me realized more so than any other patients.
I know I don’t use the phrases that most English speakers use. I have tried to learn and use them, but the words seemed not to come out my mouth easily. Plus many phrases are still new to me.
During subjective with first PD patient, I was asked what I meant by her many times. As the subjective went along, I could tell the patient got frustrated by my questions. Then another student took over from the middle of subjective. As you can guess, the subject part went well smoothly. When it came to the objective, the patient looked at another student all the time and I have got the impression that I was not there. Which was understandable, but I felt I was useless at the same time. Another student and the patient, of course, were having a good conversation in following sessions, but not happening to me. The same thing happened again with the second PD patient.
At this stage, I kind of reluctant to see these patients as I know what is coming. I keep trying to have normal conversation with them, but the answers are always going to the different direction. To listen to the conversation what the patient and another student have makes me to compare myself more. I just want to know how I can make the questions easy to understand in general. Does anyone have any idea or suggestions? I just need to have some strategies I could use for future patients.
Wednesday, August 27, 2008
aggressive patients
In my new placement at ward 1 Shenton Park we often have to deal with patients that have altered cognition and behavioural problems as a result of their head injury. A patient that I was asked to help out in the gym was known to have issues with aggression and being instructed what to do and didnt often actually turn up for his sessions. I tried to help him with starting his exercises but it became quite clear that he didnt feel he needed help and resented being told what to do. I decided to step back and let him do what he wanted and was going to come back later. On returning I found him doing some exercises that he should not be due to a recent clavicle fracture. I therefore tried to explain that he should not be doing this exercise due to this but was continuely cut off by the patient whose answer to everything was that someone told him he couldnt do it so he was going to anyway. This patient did not like females telling him what to do and would do everything that he was told he should not. As I continued to try to reason with him he got more worked up and was not doing any exercises. At this point I decided to walk away from the situation and let the supervisor try to further talk to the patient. It was finally the male physio assistant that got through more to the patient but he still left the gym withthe same attitude and not really acheiving much withthe situation.
Looking back at this I dont think I handled the situation veyr well but I also don't know what I could have done differently to try to make it more effective. The patient clearly did not respect me or anything I had to say and his long standing attitude was unchanging. Does anyone have any circumstances where they have had to deal with similar patients or any ideas on what I could have done?
Looking back at this I dont think I handled the situation veyr well but I also don't know what I could have done differently to try to make it more effective. The patient clearly did not respect me or anything I had to say and his long standing attitude was unchanging. Does anyone have any circumstances where they have had to deal with similar patients or any ideas on what I could have done?
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