Final Entry

Even though this possibly wasn't the best place to be sent out to and initially i wasn't too enthusiastic about this placement, the experience of actual hands on physio was so much better than just learning all the theory all semester. I wish that I had more oppurtunities to do more patient assessments and see the supervisor doing physio work but this prac was good in the sense that it has consolidated lots of information we learnt this semester. Going on prac and having this practical experience really suits my learning type as actually seeing patients with diseases such as parkinsons and stroke is so different than just reading about them.

From this prac i've really learnt a lot about patient communication and i believe this was an excellent first prac to go on to rather than go out somewhere where i would be more challenged with difficult cases but instead i've established the basic building block of being a physio; communcation. From the people at UCH, i've learnt the importance of getting to know your patient as an individual not a disease or problem which needs to be fixed.

day 24

I believe i've really gained experience with my communication over the last few weeks. In today's 'Men's Group' and even yesterday's 'No-Falls Group', i've noticed myself communicating with the residents on a different level. Everything was very chillaxed and the classes ran smoothly. I believe by having more confidence in myself while taking these classes, the residents can feel a difference and are willing to challenge themselves more and listen to my directions. I approach people in different ways depending on their personality and character which seems to work well. I also take notice of how they react to exercises and offer them easier or harder options. Some residents require more attention then others and I need to make an effort to talk to them about random things (the weather, lunch, the weekend, family) and others like getting the instructions and following it exactly and wait for the next cue. So to some this learning experience up, it is importnat to get the know the patients as individuals and play off their personalities to achieve optimum results. We always hear lecturers talking about 'building rapport' this and 'building rapport' that but to actually spend that little extra amount of time with your patients and learning that they are actual real people not 'a weak quad' or 'poor balance patient number 3' really make a difference in the long term picture to the patient and yourself.

day 22

Today i recieved an email from Jo reminding me about the only three reasons to break confidentiality – pt at risk of harming self or others, threat to the wider community or in case of court order.

Back to the discussion on confidentuality a few days ago, I believe i did act in the best way due to the fact in the first case the patient had injured herself and I could see her bleeding through a tissue and it didn't look like it was going to stop and she wasn't going to report it herself as she felt like she was going to hassle people. In the second case, I realluy think i acted well as what the resident told me made me believe she had the intention of harming herself physically. If i was to turn back time i would have done the same thing.

Jo also told me to reflect more on my performance and skills.
So i'd like to bring forth a case of a lady in the nursing home. This client (Mrs V) is in her late 90's and bed bound. Tim and I do passives to her daily. Since the second week, Tim and I have started taking cases separtely mainly to optimise our own learning experience here and also to cover more patients in a day.

When I have Mrs V on my own she doesn't respond to me well as she would if i was with the other PTAs or Tim. She moans and only yells NO! when i talk to her.
For example:
Me: Hello Mrs V!
Mrs V: Nooooooooooo!

Me: How are you feeling this morning Mrs V?
Mrs V: Noooo!

Me: You look pretty in pink!
Mrs V:...mmm.

I'm fairly sure I've always been polite and never hurt her or ignored her in anyway. These passive movements are very important for the residents in the nursing home as they don't move around at all except to be repositioned to prevent pressure sores. So it wasn't like i could just not do her or only give her to Tim. Instead I decided to watch how other carers talked to Mrs V and approached her. I talked to the supervisor who just said that it could be anything from the colour of my hair to the sound of my voice. One thing i did pick up on was that Mrs V was rather religious in her youth and enjoys singing... so i said to myself, "You know many songs and you have a gorgeous voice" so yes i did sing to Mrs V the next day. I also approached her differently. Rather than approaching her first and saying hello, I walked confidently into the room and said loundly and enthusiastically "Good Morning Mrs V!". I received a positive response from her (Mrs V: Yes...) and even a sentence (Why is there a couch on the wall?). This was amazing as she was talking! (incoherently yes, but still talking!). This case taught me a lot abount communication and figuring out different ways to approach people. It also showed me that if something doesn't work one way, don't give up instead try again. By just doing some little research and observing other people, I was able to find common ground on which I could build rapport with Mrs V.

day 21

Last week!

After running exercise classes for 4 weeks now i have really learnt and improved my communication skills and group leading skills i believe. For example today during house 3 group exercises I paid attention to how the residents were feeling that day. One resident (who suffers from Parkinsons) had just taken her meds so i knew i had to keep an eye out on her progress during the session. I always gave two options when doing the exercises. The initial one (easy) and a progression for the residents who were more abled. (Eg bouncing the ball in front and catching it or if you want to, try clapping before catching the ball!) Also another client (Mr A) was looking very tired and kept nodding off during the warm up. He also has shoulder pains past 90 degrees flexion. I made sure when i did arm exercises to say "take it as far as YOU can without any pain". This made him give the exercises a go whereas a couple of weeks ago when I last took this group, he just sat and watched all the upper arm exercises. I also accomodated with different size/weight/colour balls depending on the groups capability that day. I've also learnt that this group doesn't respond well to making team games to compete against ewach other while house 2 (which i do on fridays) really enjoy. I cater for this by just keeping the exercises to whole group exercises in a circle. This includes individual (bouncing own ball) and group (bouncing ball to each other) but NOT splitting the groups (lederball).

day 19

I'm feeling very easy and at home here now on prac. I know the majority of every residents name in this facility so walking down the hallways i'm greeted with a lot of very friendly hellos!

The residents are getting use to seeing me day to day so there's no more struggles to get them to walk with me any more. Some people in particular i may have to sit and talk to them for 5-10 mins before bring up the subject of walking but I enjoy the little chats!

The cold weather really affects the residents and they experience all sorts of pains and won't get out of bed or their homes due to the coldness. Mr W was my only walker who declined today and I let it pass due to fact that I have to apprently go easy on him as he just got out of hospital but mainly because he said the following to me. "Tomorrow after our walk, could you please leave the walker behind so I can walk on the weekend?" This is a huge development for Mr W as he never ever gets out of bed and rarely leaves his room. I've spent a lot of time building rapport with this patient and it feels awesome when he actually gets out of bed for me or even thinks about it! We'll see how he goes tomorrow!

Hopefully this weather clears up again as the effects weather has on the older patients could be quite detrimental in the long run. I guess thats why so many residents die during winter.

Yesterday i forgot to mention that we got to practise using the hoists! April set up situations and the PTA's, Tim and I had to safely get the patient back into their chair. My situation was that the patient had fallen within the parrallel bars. We first couldn't decide the best way of how to manuver the hosit around the bars then with April's hints, we decided to slide sheet the patient across onto the floor (open space) and proceed per usual from there. It was a very useful learning X and I hope to use the hoist again soon! (without sounding like I want a resident to fall over and not get up)

day 18

Today I experienced some complicated confidentuality issues. There were two cases where I saw/was told something by residents and then further told to "not tell anyone" where I thought attention was required. This put me in an akward situation which I discussed what to do with one of the PTA's who told me to talk to my supervisor. In the first case the issue was resolved when another PTA saw the same injury (one resident hurt herself and was unwilling to get medical attention or notify anyone) and went to find the hostel nurse but by the time they both got back another staff member was treating the injury. The second case was more complicated as I recieved some information from a resident after I walked her. This information made me feel uncomfortable as the resident specifically told me to not tell the head nurse or anyone else. I felt very uneasy but thought it was best to discuss it with my supervisor incase anything further was to happen. I couldn't locate my supervisor so after I explained my uneasyness to the PTA she advised that if I felt really uneasy about this predicament I was best to speak to the head nurse and break the confidentuality of the resident. I did do this and was told by the nurse that I did the right thing and that this resident quite commonly became depressed but she'll keep a closer eye on her.

So this was not a situation I really thought I'd come across in this placement and I still don't like the feeling of breaking the confidentuality pact between professional and patient but I still feel I acted in the best way possible.

day 17

Melbourne Cup Day! (No lady luck for me. Tim got 1st and 2nd place!)

It was very very busy at UCH today with everyone running around for the lucheon event. Everyone dressed up in their bests today and all staff brought in hats to wear! 

Yesterday, Tim and I recieved our mid-prac assessments from April and I was pleased with how I am going. Although April believes I communicate very well with the residents and that I am able to build a good rapport with everyone I meet, I apparently need to work on slowing down when speaking and also bring up more topics that the residents like to talk about (ie their family).

I am suprisingly really enjoying this placement so far. The staff are all very friendly and most of the residents are really sweet (I do have my favourites though). It is really good how we've been given alot more responsibilty lately as we've been running all the exercises by ourselves (taking turns). Every X group i take i find i'm becoming more confident and learning more about the things these older people can and can't do and what they enjoy/dislike doing.

day 16

just a quick post.

Mr D fell on the w/e. I believe this just shows how an older patient can be improving so much and just suddenly crash. The ups and downs of the older generation. It seems we'll have to work extra hard on his balance when he returns from hospital and especially look at how and why he fell.

This makes me feel pretty bad as i thought we had made really good progress with Mr D and I hope his falling wasn't our fault from working him too hard or not progressing his X's so they weren't hard enough or functional enough.