I'm currently on a ortho inpatient's placement at the moment and had a spinal patient who had a farming accident on a 4 wheeler with her child on the back. Only the mother got seriuosly injured and the child got away with cuts and bruises.
The patient's family came to visit, including the child, and saw that she had a spinal brace and halo on. This scene was too much for the child who was so distressed seeing her mother in that situation that she passed out and collasped in her room. Although not serously injuring herself, its quiet amazing to see how emotional some kids get in the hospital, especially for this child who was in the accident but got away relatively injury free.
If this situation were to ever present itself again, a distressed child seeing their parent in a hospital bed, I would sit down and talk to the kid in laymens terms, explaining what has happened to their parent and answering any questions that they have.
Has anybody come across a similar situation throughout there pracs this year?
Sunday, November 9, 2008
Saturday, November 8, 2008
Isolated prac
For the first time throughout this prac year i felt completely isolated and on my own when i was on rural prac. my supervisor was there 3 days a week but when whe was there she was in conferences and meetings and from day 1 she told me that she preferred if i worked things out on my own than asking for help. i dont mind independent learning but i find that i work better if i can bounce ideas off people and discuss patients and different ways of treating problems. i was the only physio in the hospital and i was thrown into doing peri US and looking after 20+ patients on the wards in only 4 or less hours as the rest of the tme was spent in outpatients or taking exercise classes. i struggled on this prac because i felt that some of the patients in the hopsital required more than a 20 minute session a day but due to time constraints thats all i could give. i had many patients with chest infections which would have benefited from 2 visits a day, one day i spent nearly 2 hours with the pneumonia patient mentioned in my previous blog so i was unable to see some of the other patients and i wsa informed i needed better time managment skills. there were at least 5 patients who were in hospital for rehab due to strokes and complicated fractures, i found myself so frustrated by the lack of effective treatment i was able to offer these patients who deserved more than a 20 minute rush through exercise plan. i found myself having to go back to the hosptial after i'd finished in outpatients at 5 to write up all 20+ notes as i couldnt afford to take 5 minutes out of the patents treatment sessions. although i did actually love rural prac after i became more confidnet in myself and i did learn alot from the vast number of patients i saw, i still think i could have learnt so much more about different treatment options and conditions if i'd had an interactive supervisor or another student/physio to exchange ideas with. i have a much greater appreciation for team environments than ever before!
Pneumonia patient
whilst on rural prac, a man was admitted to the hosptial in his mid twenties with pneumonia. to complicate the situation the patient had a severe form of cerebral palsy, was unable to communicate, follow instructions and his muscles were so spastic that he was curled into a foetal position so effective positioning for airway clearance was virtually impossible. the family of the patient were desperat for the patient to be transfered to RPH because they had a younger son with CP who had also had pneumonia a few years earlier and ended up spending 3 months in RPH ICU as he got so sick. however, the doctors persuaded the parents to let the son stay for a while to see if the antibiotics helped and sent me a referral for chest physio to "beat the stuff out of his lungs". when i went to see the physio in the morning he was on 12L oxygen via a hudson mask, the oxygen was leaking out the mask into his eyes which were so sore he wouldnt open his eyes anymore. his sats were low 80s and there was no way to increase his oxygen as the hospital has no form of humidified oxygen or NIV. the patient's ches was so full of sputum that you could hear it gurglin in his throat, there were tactile secretions sternally and you could hardly hear air entry in the lungs due to the added sounds of sputum. the patient was too weak to take deep breaths/cough and unable to follow instructions. we tried nebs every half an hour to help loosen the secretions, percussion, vibes, positioning but nothing was improving the patient's condition. the parents were asking me if they should take their son to perth and even though i thought it was the only thing they could do i couldnt say it to them, i documented my findings and spoke to the ward coordinator that i was extremely worried about the patient and that he was getting exhausted due to WOB, the nurse agreed but said it was up to the doctor and he wanted to wait another 24 hours. maybe it was due to my prac in ICU but the only other option of treatment i could think of was a nasopharngeal tube to clear the secretions - this idea was rejected by the nurses in charge and i had noone to back me up. the patient ended up having to be air lifted to RPH as 2 o'clock that morning and is on full ventilator settings in ICU and the doctors have advised the parents to turn off the machine as too much damage has been done. does anyone have any ideas on how i could have treated this patient more effectively or communicated more effectively? my supervisor was not there that day and no other physios either. it was so frustrating knowing that i was being completely ineffective with this patient who needed much more experienced help than i could give and noone would listen to me, the doctor asked me to just "keep banging the crap out of him".
ICU patient
during my cardio prac in ICU, i was looking after a patient who'd had a CABG and many complications since the operation including the bypass graft becoming blocked and multiple organ failure. he was ventilated for the first few days in ICU then had a trachi inserted to help maintain the airway and keep him ventilted. he was on a cocktail of drugs of which one was warfarin so the site around his trachi was very oozy and the nurses did not change the dressings as they were hoping that it would eventually clot and by continually changing the dressing, the bleeding increased. the patient improved enough to start to SOOB for a few hours everyday, the patient started off being a slide transfer but as the weeks progressed we progressed to s stand transfer. the transfer required 5 peoples assistance to watch the lines and assist the patient. since it was my patient i'd been in charge of allocating people to the various jobs and positions and controlling the transfer - which had all previously run smoothly. it was my last day of prac, we'd all just been given feedback and it was time to go home. the patient mentioned above was about to be transfered back to bed after a day of SOOB when he wrote a note (as he could not speak due to the trachi) asking if he could please stand up and do the transfer as he was really proud of his progress. one of the other physio students on prac offered to help me so we decided to do it before we left. the nurse was in charge of the lines (ECG, IDC, ventilator tubing, arterial line), 1 orderly was in charge of moving the chair away and the bed in behind the patient, another was assisting the other physio student and i with the patient. the patient stood up and as he stepped across to the bed, the whole trachi tubing came out of his throat, the nurse who was watching the tubing didnt notice and as we sat him down i felt the tubing blowing air down my arm. i panicked, unsure of whether to attempt to put the tubing back into the gaoping hole in his neck as the now had not been ventiltated for nearly a minute. i shouted out for a doctor and luckily bein in ICU there are always doctors around whilst the other physio student tried to get the patient to breathe independently. the doctor came in and decided that the patient should be put on NIV and to see how he went overnight. he said the patient was becoming too dependent on the ventilator and it was time for the patient to "sink or swim" as because they had been trying to wean him off it for a few days and we'd just gone and "skipped a few steps". we had to fill out an AIMS form which was really scary as looking back on what happened, none of us could pin point how, why or when it happened and we had all the bases covered for the transfer so if i had to do it again, i'd do it the same way. this was a horrible way to end a great prac, espacially as i'd not be able to see the outcome for the patient. my supervisor sent me an email saying that the patient was able to maintain his sats on niv and would probably end up leaving hospital a lot earlier than if the incident hadnt occurred. i learnt from this incident that even though there were so many people helping out with the patient and it had been done successfully so many times before, that you cant control everything and things still go wrong - constant vigilance in required when working with patients!
Friday, November 7, 2008
Passing away
it's near the end of our the year and prac is nearly finished. I thought about all my patients that i have treated throughout the year and thought to myself "hmm, i've been so lucky that none of the patients i have treated have passed away (while i was there on prac at least)" I actually said that to my supervisor. He says "hope your record stays clean :) "
You know those moments when you realised you shouldn't of said what you said? Yeah, this was one of those. The next day a pt on the ward had passed away. He was really my pt, i saw him once and at that time he was too unwell to be seen. So i don't think it counts. Anyway, this pt had a CVA and then developed pneumonia and passed away due to resp. reasons.
There were lots of family members present to say goodbye to this man. I've never seen something like this happen. The pt was still inside his room. I was really curious and wanted to see what was happening. Everyone else on the ward continued on with their jobs as normal. I kept walking pass the room and looked inside. I guess it was the kind of curiosity when something happens for the first time, you wanna know what happens, and that was me. i guess i wanted to know what happens after.
The family spent the whole morning there and said their goodbyes, the pt was finally taken away in the afternoon. It is always sad to see such events, and such events are part of life.
I guess what i learnt was i know what happens when a pt passes away.
I keep thinking about the event.
You know those moments when you realised you shouldn't of said what you said? Yeah, this was one of those. The next day a pt on the ward had passed away. He was really my pt, i saw him once and at that time he was too unwell to be seen. So i don't think it counts. Anyway, this pt had a CVA and then developed pneumonia and passed away due to resp. reasons.
There were lots of family members present to say goodbye to this man. I've never seen something like this happen. The pt was still inside his room. I was really curious and wanted to see what was happening. Everyone else on the ward continued on with their jobs as normal. I kept walking pass the room and looked inside. I guess it was the kind of curiosity when something happens for the first time, you wanna know what happens, and that was me. i guess i wanted to know what happens after.
The family spent the whole morning there and said their goodbyes, the pt was finally taken away in the afternoon. It is always sad to see such events, and such events are part of life.
I guess what i learnt was i know what happens when a pt passes away.
I keep thinking about the event.
Grabbed the wrong part.
I've been doing my prac in Geriatrics. Recently came across a 75yo Croatian lady. European, and family was brought up quite wealthy. Her diagnosis was a subarachnoid haemorrhage. She has had prolong stay in ICU and have been on the geriatrics ward for about 1 month now. Pre-adm status (according to the family) was (I) amb and all ADLs. This lady didn't speak english at all, luckily she has 7 daughters, and they all rotate to visit her. Basically there was a family member available from 9am - 9pm each day. They were useful for interpreting. Well that's what we all thought.
Now there are 2 main routes for discharges in hospital from geriatrics- Home or Nursing Home. This 75yo lady's current status is 1x(A) with Amb and T/Fs. She is terrified of falling and walks with a really funny posture. She is fully flexed at hips and her weight are on her heels, so basically she is falling backwards most of the time. It normally takes us 15mins just to convince her to walk. The family negotiates with her...... and this patient is a talker. She just keeps talking even when the family is not there and that we don't understand her.
It was one of the first time i saw her and wanted to get her up and walking, so i went in and told her my plan (Daughter interpret) after 15mins of talking, she agrees to go for a TINY walk, not long! I went to assist her stand, she keeps falling back into the chair not shifting her weight onto her feet (due to fear of falling forwards). So i went to place my hand onto her ischial tuberosity to facilitate the movement. She just went OFF! Point her finger at me. I knew she was telling me off for touching her bottom. I went to ask the daughter what she said, and she says "Oh, she is saying how thankful she is to get physio and think you have beautiful eyes" .... my thoughts were "Bullsh*t!" (seriously). This scenario becomes a common occurence, what the pt said was not what it is relayed back to me. That affects treatment greatly. I did gathered there was a cultural difference, that a 75yo european lady would find it offensive for a 24yo male to be touching her bottom. I continue to treat this pt for the next 5 days and couldn't get any gains. She was later transferred to another ward and was treated by a female PT instead and it seems to be working out better.
With this scenario, i've learnt about cultural differences. It can really affect your treatment
-male treating female
-incorrect interpretation. The family is really nice and didn't want to offend me by what the pt has said (i'm sure it was rude). And that affects treatment, because if i didn't read her non-verbal language and continued to facilitate from ischial tuberosity, i would really put her off physio and further offend her.
-family values: sign of disrespect to send your mother to a nursing home, regardless how dependent she may become.
So for next time, identify the signs earlier and try different avenues (ie. PT of the same sex).
Now there are 2 main routes for discharges in hospital from geriatrics- Home or Nursing Home. This 75yo lady's current status is 1x(A) with Amb and T/Fs. She is terrified of falling and walks with a really funny posture. She is fully flexed at hips and her weight are on her heels, so basically she is falling backwards most of the time. It normally takes us 15mins just to convince her to walk. The family negotiates with her...... and this patient is a talker. She just keeps talking even when the family is not there and that we don't understand her.
It was one of the first time i saw her and wanted to get her up and walking, so i went in and told her my plan (Daughter interpret) after 15mins of talking, she agrees to go for a TINY walk, not long! I went to assist her stand, she keeps falling back into the chair not shifting her weight onto her feet (due to fear of falling forwards). So i went to place my hand onto her ischial tuberosity to facilitate the movement. She just went OFF! Point her finger at me. I knew she was telling me off for touching her bottom. I went to ask the daughter what she said, and she says "Oh, she is saying how thankful she is to get physio and think you have beautiful eyes" .... my thoughts were "Bullsh*t!" (seriously). This scenario becomes a common occurence, what the pt said was not what it is relayed back to me. That affects treatment greatly. I did gathered there was a cultural difference, that a 75yo european lady would find it offensive for a 24yo male to be touching her bottom. I continue to treat this pt for the next 5 days and couldn't get any gains. She was later transferred to another ward and was treated by a female PT instead and it seems to be working out better.
With this scenario, i've learnt about cultural differences. It can really affect your treatment
-male treating female
-incorrect interpretation. The family is really nice and didn't want to offend me by what the pt has said (i'm sure it was rude). And that affects treatment, because if i didn't read her non-verbal language and continued to facilitate from ischial tuberosity, i would really put her off physio and further offend her.
-family values: sign of disrespect to send your mother to a nursing home, regardless how dependent she may become.
So for next time, identify the signs earlier and try different avenues (ie. PT of the same sex).
Thursday, November 6, 2008
a Prac in Singapore
The reason as to why I chose to do my practical in Singapore was because I am a Singaporean and my journey in Australia after four long years is about to come to an end. Thus I decided to have an insight to the world of physiotherapy back home. I was very excited and was looking forward to this experience. Initially i was a little apprehensive about commencing this practical as I had no notion of how the health care system functioned in Singapore having done all my practicals in Perth thus far. This practical was also an experience as it was a paediatrics practical and I have not had the opportunity to work with children before.
Upon arrival at this hospital, I was slightly taken aback at how unfriendly the staff was towards me. It seemed as though everyone was too busy and caught up with their own work. This was a different experience for me as in Perth; most staff are very friendly and accommodative to students. A possibility to this is most certainly the cultural difference as Singaporeans tend to be more conservative. However as time went by they did warm up to me.
Physiotherapy in Singapore is still not well established and as a result, the patients that had come to the physio department sometimes seemed unaware of their purpose and only attended as they were told to do so by a doctor from the hospital. A lot of times educating the patients as to the benefits of physiotherapy seemed essential and important so as to produce a positive effect with the therapy they were to receive.
Working with children has also been very challenging as it is difficult to command a child without a rebellion. Thus the sessions had to be ‘fun’ and at the same time productive. This kept me on my toes as I had to come up with various activities to encourage the children to engage in their rehab. I must admit I thoroughly enjoyed the experience of working with children. It most certainly was very rewarding.
This prac was definitely an interesting and eye-opening experience as it gave me a glimpse at what physiotherapy is like in Singapore. I must say after being in Australia for so long I seem to have needed time adjusting to the way things work in this pseudo westernised country that is still very much preserving traditional school of thought.
Upon arrival at this hospital, I was slightly taken aback at how unfriendly the staff was towards me. It seemed as though everyone was too busy and caught up with their own work. This was a different experience for me as in Perth; most staff are very friendly and accommodative to students. A possibility to this is most certainly the cultural difference as Singaporeans tend to be more conservative. However as time went by they did warm up to me.
Physiotherapy in Singapore is still not well established and as a result, the patients that had come to the physio department sometimes seemed unaware of their purpose and only attended as they were told to do so by a doctor from the hospital. A lot of times educating the patients as to the benefits of physiotherapy seemed essential and important so as to produce a positive effect with the therapy they were to receive.
Working with children has also been very challenging as it is difficult to command a child without a rebellion. Thus the sessions had to be ‘fun’ and at the same time productive. This kept me on my toes as I had to come up with various activities to encourage the children to engage in their rehab. I must admit I thoroughly enjoyed the experience of working with children. It most certainly was very rewarding.
This prac was definitely an interesting and eye-opening experience as it gave me a glimpse at what physiotherapy is like in Singapore. I must say after being in Australia for so long I seem to have needed time adjusting to the way things work in this pseudo westernised country that is still very much preserving traditional school of thought.
Subscribe to:
Posts (Atom)