I am on my final prac now and I am 1 week of being a curtin new grad... YAY. Working amongst new grads of Notre Dame I sometimes see a bit of competitiveness between those form the differing universities. I feel that competitiveness can often excell individual performance, however it definately hinders a team approach.
When confronted with a strong, stubbourn fellow student/ staff member who wants to do things their way I tend to always step down and let them lead an assessment or treatment. I think in fear of creating a competitive environment I wont continue to explain or clinically reason my ideas for treatment or assessment. This is something I would like to change once I am no longer a student. I have an open mind to the opinions and beliefs of others and enjoy discussing different ideas yet I know I must voice my own more.
Anyone have comments on this issue?
Sunday, 16 December 2007
Tuesday, 11 December 2007
Live what we preach?
So days as a physio can often be spent motivating pt's to do exercises or live a more healthy lifestyle. I find that often I myself will not exercise the 30mins most days as recommended... I dont count walking to bus/ train stops or walking in hospitals at work :)
I have had one pt ask... "well what do you do?" and I had to be honest and say that I only exercise properly 2-3 times per week (walk/gym/run/swim). Then I begain thinking why that was the case and excuses to do with time and energy came to mind... I dont even have kids or have to do the house/ garden alone like many of my pt's!!! Eeek!
After this motivation I found myself easily fitting in time to exercise and exercised 4-6 times per week. It was not until I could tell my pt this that he began to listen to me. I disscussed with him the most suitable times of day for him to fit in ex in his schedule. Which we went about in a manner similar to what I had to do to get my ex regime into gear.
This proved to be much more successful that simply edu a pt what they need to do but properly setting goals and developing plans for a healthy lifestyle...
So how much ex do u all do?
How do u motivate pt's to change their lifestyles?
I have had one pt ask... "well what do you do?" and I had to be honest and say that I only exercise properly 2-3 times per week (walk/gym/run/swim). Then I begain thinking why that was the case and excuses to do with time and energy came to mind... I dont even have kids or have to do the house/ garden alone like many of my pt's!!! Eeek!
After this motivation I found myself easily fitting in time to exercise and exercised 4-6 times per week. It was not until I could tell my pt this that he began to listen to me. I disscussed with him the most suitable times of day for him to fit in ex in his schedule. Which we went about in a manner similar to what I had to do to get my ex regime into gear.
This proved to be much more successful that simply edu a pt what they need to do but properly setting goals and developing plans for a healthy lifestyle...
So how much ex do u all do?
How do u motivate pt's to change their lifestyles?
Creativity
It is great when you have a grasp of standard effective treatment options taught to us throughout uni. However, I still find it hard to vary these exercises when required to keep pts interested. I feel like that the creative area of my brain is a bit on the rusty side!! Doing multiple aqua classes and treatment in the form of games for children can get challenging to find new ideas over and over. Does anyone have some fabulous ideas for aqua aerobics or playing with children to add to my exercise brain bank? Thanks :)
Yellow flags
Hi all, on my last prac. Piecing all my knowledge together. Yet I have found there are just some patients where physio skills just cant beats lots, lots and lots of life coaching, listening, empathising and simply being a person who cares to a very distressed/ troubled/ depressed pt. I have found that providing this to a pt with yellow flags is very benefitial to them. However they then can get quite attached to you as their primary support network. Also as a student it feels quite silly spending so much time on subjective and speaking endlessly over massage and heat/ US when u are trying to demonstrate your skills to a supervisor.I have suggested councilling or joining social clubs to such pt's which I find hard to do at times. What approaches have you made in such a circumstance?
Monday, 19 November 2007
pt refusing assessment
Setting: RPH Oncology ward
Patient: 56 yo Indigenous female
Dx with cervical cancer and admitted for radiotherapy
Prev R CVA 10 ago; treated at shents but discont Rx as missed family
NIDM, smokes 15/day, asthmatic, obese
lives 5hr from Perth
prev non amb (owns W/C), use of quad stick and AFO for STS and T/F with one assist
lives with 2 sons who have helped her since CVA
pt would cont say things like "dont bother me, bother someone else". "No u cannot play with my leg or arm". "They dont work leave em alone, physio cant do nothing".
The concern was that the pts prev mobility would decline due to cancer related fatigue, weakness from RIB etc. The pt was content to just lay in bed all day and do nothing. It was easy to see the contractures already forming in the affected hand.
There was limited time for me to devote to developing rapour with the pt, she was not a priority on the ward. Her English was slightly limited, edu her was difficult, functional reasons required. What would u do to speed things up and Rx this pt effectively?
Patient: 56 yo Indigenous female
Dx with cervical cancer and admitted for radiotherapy
Prev R CVA 10 ago; treated at shents but discont Rx as missed family
NIDM, smokes 15/day, asthmatic, obese
lives 5hr from Perth
prev non amb (owns W/C), use of quad stick and AFO for STS and T/F with one assist
lives with 2 sons who have helped her since CVA
pt would cont say things like "dont bother me, bother someone else". "No u cannot play with my leg or arm". "They dont work leave em alone, physio cant do nothing".
The concern was that the pts prev mobility would decline due to cancer related fatigue, weakness from RIB etc. The pt was content to just lay in bed all day and do nothing. It was easy to see the contractures already forming in the affected hand.
There was limited time for me to devote to developing rapour with the pt, she was not a priority on the ward. Her English was slightly limited, edu her was difficult, functional reasons required. What would u do to speed things up and Rx this pt effectively?
Intellectually impaired cardio pt
Setting: RPH Oncology ward
Patient: 38yo male with a congenital intellectual impairment (not classified)
admitted with pnemonia (3/52 Hx)
on a b/o progressive lung cancer with bony mets
The pt could not speak so the subjective was taken form his supervisor of the hostle he lives at. The pt was prev amb with a W/S and was independent will all ADL's.
The pt can understand language just not verbalise it.
Pt could maintain sats on RA, had widespread insp crackles LZ, R MZ
It was hard to gain the trust of the pt and he would not cough or breathe deeply on command. He would cont to take off a neb if applied (face mask).
Often he would hide under his covers and he would not cont to sit upright if put in sitting would slouch down in bed and tuck chin.
Much time was needed to gain trust before treating him. This was very detrimental to the length of treatment for other priority pt's.
The rationalised best treatment for his chest would be to amb. He had standby STS and good static standing balance, tests of dynamic where limited due to poor attention and compliance!
Upon amb with a WZF 1 standby assist the pt looked steady and had a good gait pattern.
Then due to his intellectual impairment? the pt took his toes off the floor, crouched and tired to sit on the floor.
I had to assist a decent to the floor so the pt did not fall...
I felt the only option for the pt to amb safely was with 2 mod assist. yet the effect of increasing tidal volume and mobilising secretions was minimal.
I reverted to simple STS and bed mobility ex to mobilise secretions which were effective (sm amounts of P3 sputum) but not enough to clear the majority of secretions. The pt also hated doing this.
I let the staff know about all this and enco the N/S to still try nebs and sit up.
I felt very sad for the pt and his family and carers, also a little hopeless in this situation.
Could you suggest other Rx strategies?
Patient: 38yo male with a congenital intellectual impairment (not classified)
admitted with pnemonia (3/52 Hx)
on a b/o progressive lung cancer with bony mets
The pt could not speak so the subjective was taken form his supervisor of the hostle he lives at. The pt was prev amb with a W/S and was independent will all ADL's.
The pt can understand language just not verbalise it.
Pt could maintain sats on RA, had widespread insp crackles LZ, R MZ
It was hard to gain the trust of the pt and he would not cough or breathe deeply on command. He would cont to take off a neb if applied (face mask).
Often he would hide under his covers and he would not cont to sit upright if put in sitting would slouch down in bed and tuck chin.
Much time was needed to gain trust before treating him. This was very detrimental to the length of treatment for other priority pt's.
The rationalised best treatment for his chest would be to amb. He had standby STS and good static standing balance, tests of dynamic where limited due to poor attention and compliance!
Upon amb with a WZF 1 standby assist the pt looked steady and had a good gait pattern.
Then due to his intellectual impairment? the pt took his toes off the floor, crouched and tired to sit on the floor.
I had to assist a decent to the floor so the pt did not fall...
I felt the only option for the pt to amb safely was with 2 mod assist. yet the effect of increasing tidal volume and mobilising secretions was minimal.
I reverted to simple STS and bed mobility ex to mobilise secretions which were effective (sm amounts of P3 sputum) but not enough to clear the majority of secretions. The pt also hated doing this.
I let the staff know about all this and enco the N/S to still try nebs and sit up.
I felt very sad for the pt and his family and carers, also a little hopeless in this situation.
Could you suggest other Rx strategies?
Inappropriate behaviour
During my neuro placement on G66 I had a pt with a R CVA and presented with inappropriate social and sexual behaviour.
For example, after ending one session the pt said thanks gorgeous and smacked my behind in front of his wife.
His wife looked very shocked and upset and I did not know the best thing to say or do at that particular time . I simply said something similar to "careful, don't do that please" and left the room in a flash.
Obviously I needed to discuss with the wife later (alone), that behavioural changes occur in some pt's that have strokes.
However how do you think you would handle the immediate situation better?
For example, after ending one session the pt said thanks gorgeous and smacked my behind in front of his wife.
His wife looked very shocked and upset and I did not know the best thing to say or do at that particular time . I simply said something similar to "careful, don't do that please" and left the room in a flash.
Obviously I needed to discuss with the wife later (alone), that behavioural changes occur in some pt's that have strokes.
However how do you think you would handle the immediate situation better?
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