How do you provide constructive feedback to a supervisor who admits they have “confidence issues” and comments that “I don’t feel like I’m being a very good supervisor”? I took the easy route and blamed my lack of enjoyment of the prac on the “busyness of the ward” and “not feeling well”. Here’s my brief, edited version of the story:
Day one of prac, feeling very nervous as I was the only student on the ward at the time, but calmed by the fact that the previous student on prac here enjoyed their time.
Met my supervisor: “sorry the ward is just too busy to be able to do your orientation today, we’ll get to it later, for now just follow me”. Thus began two horror weeks for me. It was my first time in a ward environment (apart from a couple of half day placements) and I had no idea how they ran, where anything was, nurses and supervisors too busy to be able to help me out. With no clear objectives set or any time for tutes to be conducted, I coped as best as I could. Due to extenuating circumstances my supervisor gave me my mid placement feedback on the Monday of week 3 as they had to take the following two weeks off. The comments I felt were unfair, and harsh based on the lack of learning opportunities and supervision over the past two weeks. Too upset and emotional at this point to defend myself or clarify and understand the reasoning behind the comments, I left that afternoon with a huge blow to my confidence and that feeling you get occasionally “why am I studying physio…is this all really worth it….” The fact was I wasn’t learning anything here.
I met with my Curtin Clinical Tutor and Clinical Coordinator to discuss my concerns and strategies to cope, however the next two weeks were much easier and actually enjoyable.
I know that we don’t get along with everyone due to differences of personality, but what does a student do when they’re not coping with a situation brought about by their supervisor, who due to a heavy case load admitted was “at times unable to cope with their own case load”, let alone have time to supervise a student.
In the end, I got through it, although it is not an experience I enjoyed. The problem however I had was how to give feedback to my supervisor about better (or different) ways of supervising a student on the ward in future?
Wednesday 30 May 2007
Monday 28 May 2007
Under what circumstances should treatment be refused
I had a really interesting and challenging patient in my last placement in hand therapy in a public hospital. The first impression I received from this patient was in the waiting area where he was swinging his thermoplastic splint with his right hand which was his fractured hand . He was talking loudly, unconcernedly in very inappropriate terms in front of several other patients. From a physiotherapy point of view, the patient was a little disoriented.
When I introduced myself, and guided him to the treatment area, he had a strong alcoholic smell. When queried in the subjective, does he drink, the patient became really defensive and gave a defiant 'no' and insisted that he has never touched it in his life ,which is typical with a patient under the influence of alcohol. The patient then quickly changed the topic and decided that he wanted a blue splint, not the current black one. I felt like I was not in control as the patient tends to ignore my questions and rapport would continuously revolve around the need of a new blue splint.
The patient was presented to hospital post arrest in the city as during the ruff handling, the patient complained of sharp pain in his R hand. X-ray showed displaced fracture to 2nd metacarpal which was ORIFed 2 weeks prior to physio. Subjectively, the patient refused to give much details in regards to the arrest, as this would allow me to work out his mechanism of injury (ie which direction was the force and hence the displacement of the fracture). He complained that he was not able to do anything with his R hand and his L hand was sore too and wanted a splint for his L hand as well. Objectively, the scar from the ORIF was red, swollen and TOP.ROM is decreased in the MCP, PIP and DIP. PAM- AP and PA of MCP of index finger were both stiff but not painful. P-DPC ( pulp to distal palmer crease which is when you make a fist, is the distance from the pulp of the finger to the distal palmer crease (start of your life line)) was 2 cm for index finger. During assessments, it was difficult for the patient to position his hand still and when I asked him to make a fist so I could assess the function of his hand, we entered into another frustrating discussion.
The patient constantly reported that he's not going to punch anyone so why was there a need to make a fist. I tried using different tactics to explain the rationale behind the fist. I used diagrams, I demonstrated, I even borrowed staff member to demonstrate but this only aggravated him even more, so I steered away from this. This was when my supervisor butted in and spoke to him very firmly and courteously that we are here to help you and if you don't want to be here and continuously behave like the way you are doing so, then don't come in to see us because there is little that we could do. The tough approach from the supervisor knocked some compliance into the patient however it only lasted for 10 min or so.
I ended up completing the Rx based on my findings and given him a set of exercises to take home, but I know after this ordeal that this patient will not be compliant and consequently fail physiotherapy. I didn't feel the whole assessment was adequate because he was such a difficult case. I had a chat with my supervisor later on that day in terms of how I could have managed that patient better, what approaches should I have taken to begin the assessment etc. I was given the impression that a patient like him should receive 'short and sweet' Rx because of their short concentration span. However, if he continuously behaves inappropriately then you have the right to refuse to treat him. After our little discussion, I dwelled on the question would it be unethical to refuse this patient treatment even though he was a grossly delusional from alcohol and from my clinical judgement I know that the patient will not get better with physiotherapy. This time could have been used more effectively on compliant patients who has the desire to improve, especially in a public system which is difficult to book in appointments. Under what circumstances should we draw the fine line in refusal to treat?
When I introduced myself, and guided him to the treatment area, he had a strong alcoholic smell. When queried in the subjective, does he drink, the patient became really defensive and gave a defiant 'no' and insisted that he has never touched it in his life ,which is typical with a patient under the influence of alcohol. The patient then quickly changed the topic and decided that he wanted a blue splint, not the current black one. I felt like I was not in control as the patient tends to ignore my questions and rapport would continuously revolve around the need of a new blue splint.
The patient was presented to hospital post arrest in the city as during the ruff handling, the patient complained of sharp pain in his R hand. X-ray showed displaced fracture to 2nd metacarpal which was ORIFed 2 weeks prior to physio. Subjectively, the patient refused to give much details in regards to the arrest, as this would allow me to work out his mechanism of injury (ie which direction was the force and hence the displacement of the fracture). He complained that he was not able to do anything with his R hand and his L hand was sore too and wanted a splint for his L hand as well. Objectively, the scar from the ORIF was red, swollen and TOP.ROM is decreased in the MCP, PIP and DIP. PAM- AP and PA of MCP of index finger were both stiff but not painful. P-DPC ( pulp to distal palmer crease which is when you make a fist, is the distance from the pulp of the finger to the distal palmer crease (start of your life line)) was 2 cm for index finger. During assessments, it was difficult for the patient to position his hand still and when I asked him to make a fist so I could assess the function of his hand, we entered into another frustrating discussion.
The patient constantly reported that he's not going to punch anyone so why was there a need to make a fist. I tried using different tactics to explain the rationale behind the fist. I used diagrams, I demonstrated, I even borrowed staff member to demonstrate but this only aggravated him even more, so I steered away from this. This was when my supervisor butted in and spoke to him very firmly and courteously that we are here to help you and if you don't want to be here and continuously behave like the way you are doing so, then don't come in to see us because there is little that we could do. The tough approach from the supervisor knocked some compliance into the patient however it only lasted for 10 min or so.
I ended up completing the Rx based on my findings and given him a set of exercises to take home, but I know after this ordeal that this patient will not be compliant and consequently fail physiotherapy. I didn't feel the whole assessment was adequate because he was such a difficult case. I had a chat with my supervisor later on that day in terms of how I could have managed that patient better, what approaches should I have taken to begin the assessment etc. I was given the impression that a patient like him should receive 'short and sweet' Rx because of their short concentration span. However, if he continuously behaves inappropriately then you have the right to refuse to treat him. After our little discussion, I dwelled on the question would it be unethical to refuse this patient treatment even though he was a grossly delusional from alcohol and from my clinical judgement I know that the patient will not get better with physiotherapy. This time could have been used more effectively on compliant patients who has the desire to improve, especially in a public system which is difficult to book in appointments. Under what circumstances should we draw the fine line in refusal to treat?
patient concern
Hello Blog group. I am doing my Rheumatology placement (my elective) at Shenton Park and I have come across a patient case that I have found a little tricky. The patient is actually physically not that difficult, she is an inpatient with osteoarthritis and mild rheumatoid arthritis and is medical reasons. She is independent with all mobility and ADLs and only needs general strengthening and some specific strengthening for her shoulder. The problem then is the things she says.
A consult from clin psych has already been requested because she expressed suicidal intentions. I have read the results of their assessment and they are concerned but don’t feel suicide is an immediate concern. During my assessment and treatment time with this patient she has repeatedly expressed desires to kill herself. She also says things like she would like to take a hammer and bang her joints back into place.
Obviously I am very worried about her behaviour and I always detail these incidents in the notes. I am sure clin psych will manage her psychological condition but in the meantime I am unsure how to react to these comments. It has been reported in the notes that she feels she is being attacked because the staff are not respecting her religious views on her rights to suicide. So presently I am just trying to ignore these comments, just saying “that’s not the way you should be thinking” etc and changing the subject because I don’t want to antagonise her.
But is this acceptable? If I don’t jump in strongly and say “no that is a terrible idea” will she think I am offering my support? Or is it just an attention seeking behaviour that is best ignored? Should clin psych be giving the other health professionals advice on how to handle this behaviour in the way that we give other staff advice on how to handle an individual’s mobility and transfers? Any suggestions would be greatly appreciated.
A consult from clin psych has already been requested because she expressed suicidal intentions. I have read the results of their assessment and they are concerned but don’t feel suicide is an immediate concern. During my assessment and treatment time with this patient she has repeatedly expressed desires to kill herself. She also says things like she would like to take a hammer and bang her joints back into place.
Obviously I am very worried about her behaviour and I always detail these incidents in the notes. I am sure clin psych will manage her psychological condition but in the meantime I am unsure how to react to these comments. It has been reported in the notes that she feels she is being attacked because the staff are not respecting her religious views on her rights to suicide. So presently I am just trying to ignore these comments, just saying “that’s not the way you should be thinking” etc and changing the subject because I don’t want to antagonise her.
But is this acceptable? If I don’t jump in strongly and say “no that is a terrible idea” will she think I am offering my support? Or is it just an attention seeking behaviour that is best ignored? Should clin psych be giving the other health professionals advice on how to handle this behaviour in the way that we give other staff advice on how to handle an individual’s mobility and transfers? Any suggestions would be greatly appreciated.
LBP from Simon Liu
Hey guys, hope you had a good weekend, here is my blog, enjoy it:)
X.L was a 28 yo guy presented to CPC with LBP. He has a history of back injury 3 month ago. He was moving furniture at home with another guy. When he tried to lift a washing machine with his friend, he felt something “pulled” in his lower back. Since then he had dull aches (2-3/10) in L his lower back near L5/S1, L buttock and his L lateral leg. He saw a GP days after the injury and was given voltaren rub which doesn’t help too much (he refused oral analgesia from the GP). Now his L leg pain has resolved but his L lower back and buttock pain were 3/10 constant dull ache. Walking, sitting still and standing for more than 30 minutes makes his pain worse(4/10, take 20 min to reduce back to 3/10 if he moves or rest). Lifting his foot off the floor either side increases his pain to 4/10).
On Palpatoin: Tender in L L5/S1, SIJ and L buttock (mid point of piriformis).
Fx test: lifting foot off floor (putting pants on): R=4/10, L=3+/10 sharp
AROM: Mainly restricted in Lx extension (30 R1, 40 ยบ P1)
Combined mvt: pain 4/10 sharp L flexion + extension
Special tests for SIJ:
Tortion tests negative, destraction/compression negative, posterior shear test negative,
ASLR: L positive 2/10 dull, R positive 3/10 dull pain in the L lower back (improve with compression on R side, otherwise no change with any added technique) and buttock, obs: poor initiation of R ASLR.
Hip: reduced piriformis length on both sides. Positive quadrant test on both side and negative fabers test.
PPIVAM in L4/5 and L5/S1 area: reduced fl’x in L4/5 and ext’n in L5/S1
PAIVM: reduced PA glide on L5/S1, reduced L unilateral glide on L5/S1 with pain.
Dx: L4/5 closing pattern
Classification: mechanical
Stage: chronic
First treatment for him was a GIII L unilateral glide on L4/5 for 30 second then 1 min since patient improve his pain score by 1 in Fx tests( however, during treatment, patient was complaining pain in lateral side of his lower leg). Home ex was heat pack 5 minutes for every 2 hours.
Second treatment: patient was due back in 2 days and c/o walking was more aggravating (reduced onset time) and the dull ache in lateral side of his left leg had come back since last treatment. Fx tests and ASLR are still same as before the first treatment. STM and H/R for piriformis on both side was given, improvment in piriformis length was noted, a GIII PA glide on L5/S1 for 30 second and then progress to GIV for 30 second. Pain score from ASLR was improve by 1 in both sides. Fx test has improve by 2 in pain score. HEP is active extension in Lumbar spine in standing (2-3 times, 5-10 reps) and piriformis stretch.
Now my question is based on these findings, can anyone come up with a different diagnosis and what other tests do you think needs to be done? I am treating this guys signs and symptoms at the moment which appears to be OK but I dont have a good understanding of the mechanism of injury and the pathology developed, I will progress my PA glide in next treatment section with him but any suggestion for treatment?
Please discuss away, thanks
Simon
X.L was a 28 yo guy presented to CPC with LBP. He has a history of back injury 3 month ago. He was moving furniture at home with another guy. When he tried to lift a washing machine with his friend, he felt something “pulled” in his lower back. Since then he had dull aches (2-3/10) in L his lower back near L5/S1, L buttock and his L lateral leg. He saw a GP days after the injury and was given voltaren rub which doesn’t help too much (he refused oral analgesia from the GP). Now his L leg pain has resolved but his L lower back and buttock pain were 3/10 constant dull ache. Walking, sitting still and standing for more than 30 minutes makes his pain worse(4/10, take 20 min to reduce back to 3/10 if he moves or rest). Lifting his foot off the floor either side increases his pain to 4/10).
On Palpatoin: Tender in L L5/S1, SIJ and L buttock (mid point of piriformis).
Fx test: lifting foot off floor (putting pants on): R=4/10, L=3+/10 sharp
AROM: Mainly restricted in Lx extension (30 R1, 40 ยบ P1)
Combined mvt: pain 4/10 sharp L flexion + extension
Special tests for SIJ:
Tortion tests negative, destraction/compression negative, posterior shear test negative,
ASLR: L positive 2/10 dull, R positive 3/10 dull pain in the L lower back (improve with compression on R side, otherwise no change with any added technique) and buttock, obs: poor initiation of R ASLR.
Hip: reduced piriformis length on both sides. Positive quadrant test on both side and negative fabers test.
PPIVAM in L4/5 and L5/S1 area: reduced fl’x in L4/5 and ext’n in L5/S1
PAIVM: reduced PA glide on L5/S1, reduced L unilateral glide on L5/S1 with pain.
Dx: L4/5 closing pattern
Classification: mechanical
Stage: chronic
First treatment for him was a GIII L unilateral glide on L4/5 for 30 second then 1 min since patient improve his pain score by 1 in Fx tests( however, during treatment, patient was complaining pain in lateral side of his lower leg). Home ex was heat pack 5 minutes for every 2 hours.
Second treatment: patient was due back in 2 days and c/o walking was more aggravating (reduced onset time) and the dull ache in lateral side of his left leg had come back since last treatment. Fx tests and ASLR are still same as before the first treatment. STM and H/R for piriformis on both side was given, improvment in piriformis length was noted, a GIII PA glide on L5/S1 for 30 second and then progress to GIV for 30 second. Pain score from ASLR was improve by 1 in both sides. Fx test has improve by 2 in pain score. HEP is active extension in Lumbar spine in standing (2-3 times, 5-10 reps) and piriformis stretch.
Now my question is based on these findings, can anyone come up with a different diagnosis and what other tests do you think needs to be done? I am treating this guys signs and symptoms at the moment which appears to be OK but I dont have a good understanding of the mechanism of injury and the pathology developed, I will progress my PA glide in next treatment section with him but any suggestion for treatment?
Please discuss away, thanks
Simon
Judging peoples ability
Im currently on a community physiotherapy placement in which i travel around to many different community centres to take exercise classes for the elderly population. The classes range from Abilities for patients post stroke, mobilities for patients with multiple conditions and an increased falls risk as well as aqua/hydrotherapy classes. One particular abilities class i attneded last weeek consisted of 27 participants of different fitness levels, mobility, ROM and strength. In the first week i participated in this class and observed details such as how the classes were run, what activities were used, the aims and objectives of the class and how the instructor catered to everyones needs.
As it is now coming into the second week, i am now expected to take component of the class appropriate to the group. I am struggling to determine how i will take a class without knowing which individual patients have what pathology, limitations and safety requirements. Having 27 people in a class as a student is quite intimidating when i haven't had a chance to meet everyone or do even a mini asesment to determine what their problems are and how their balance is. I understand that i am to base my classs from what the physiotherapist has done as she obviously understands the group dynamics but it is hard for me to do so at this stage.
In considering this thought, i have decided to arrive early to the class to thoroughly read through that available notes to give me a better understanding of all the patients as well as notifying any that may present as a higher falls risk and need more supervision when possible. I plan to discuss these patients with my supervisor to see if she aggrees or if i need to change any of my patient lists accordingly. I would also like to show her my lesson plan so as to ensure i have interpretted her first class correctly and that the exercises i have chosen are appropriate. If possible, i would like to speak to some of these patients so i can determine what they percieve their problems to be. I hope that this will provide me with more insite into the level of the class and the requirements of me as the group leader.
As it is now coming into the second week, i am now expected to take component of the class appropriate to the group. I am struggling to determine how i will take a class without knowing which individual patients have what pathology, limitations and safety requirements. Having 27 people in a class as a student is quite intimidating when i haven't had a chance to meet everyone or do even a mini asesment to determine what their problems are and how their balance is. I understand that i am to base my classs from what the physiotherapist has done as she obviously understands the group dynamics but it is hard for me to do so at this stage.
In considering this thought, i have decided to arrive early to the class to thoroughly read through that available notes to give me a better understanding of all the patients as well as notifying any that may present as a higher falls risk and need more supervision when possible. I plan to discuss these patients with my supervisor to see if she aggrees or if i need to change any of my patient lists accordingly. I would also like to show her my lesson plan so as to ensure i have interpretted her first class correctly and that the exercises i have chosen are appropriate. If possible, i would like to speak to some of these patients so i can determine what they percieve their problems to be. I hope that this will provide me with more insite into the level of the class and the requirements of me as the group leader.
Sunday 27 May 2007
Motivating Patients
On my last clinic (cardio), I was finding it difficult to be able to motivate some of my patients. My supervisor advised that we need to educate patients so that they know why we treat people and the benefits of physio treatment. Often I would educate my patients, and they would still refuse. One particular patient was especially difficult. He was an 87 yo man admitted to hospital with pneumonia, the main problem being impaired airway clearance. This was the second time he had been admitted in a few weeks, and the second time that I had seen him. He told me several times that he was very stubborn, which he certainly was. On one particular occasion, I wanted him to go for a walk, however he was flatly refusing, because he said that he didn’t want to waste his breath. I taught him ACBT and dyspnoea strategies as well (as he also was having trouble with SOB), however, he flatly refused to go for a walk no matter how much education I gave him about the benefits of ambulation. I found it quite frustrating because I had done all I could in giving him the information, and I felt as though I was failing in being able to motivate patients (as in that particular week I had many patients who being very difficult). However, I got talking to this patient, developing rapport with him, and after having more of a conversation with him he was more compliant with going for a walk, and we actually were able to go for a walk. When we did go for a walk, he was quite surprised that he was able to do as much as he could. This experience showed me that rapport with patients is very important. Getting to know your patients is a really good way of increasing compliance. They are much more likely to do what we want when they see us as more of a person rather than just a physio come to annoy them when they’re sick.
Saturday 26 May 2007
Difficult Patient+++
I am currently on my musculo prac and have encountered a very complex patient who presents with complex regional pain syndrome (CRPS). My understanding of this syndrome was limited so I managed to find some handy info from www.podiatry.curtin.edu.au/encyclopedia/crps1. Although it helped with my understanding of the syndrome, I could not find much info from other sites regarding ways that physiotherapy would help recovery.
The pt is an obese female who is in her late 30s who sustained musculotendinous injury to her (R) gastrocsoleus and Achilles after her dog ran into her 3 months ago. Initial Rx consisted of pressure bandaging, icing, gentle gastrocsoleus soft tissue massage and gentle AP/PA glides to improve ankle DF and PF. Initially she rated her pain as 10/10, and it remained this severe for the following 3 weeks. From this point onwards the pain began to improve and currently she has a pain rating of 5/10 (without analgesics at rest), however does report occasional night pain which may worsen to 10/10, which then requires her to take analgesics. Her main source of pain currently is the (R) Achilles tendon and calf, which is restricting her active DF (0deg DF) and WB DF (5deg DF). In my initial session with her my treatment consisted of AP mobs of TCJ (pain free at 0deg DF) and soft tissue massage of gastrocsoleus. Compounding her problem of CRPS is the fact that she also has chronic fatigue syndrome, limiting the amount of exercise she can do at home to improve her ankle joint ROM. Her personality is also quite cynical and cares very little for her health. She is a heavy smoker and claims that she does not have time to prepare healthy meals for herself as McDonalds is much more convenient. My supervisor has recommended that I encourage her to be more active and that the line ‘no pain, no gain’ may actually apply in her case. How do I go about educating my patient to be more proactive in her recovery and convince her to take up a healthy lifestyle?
The pt is an obese female who is in her late 30s who sustained musculotendinous injury to her (R) gastrocsoleus and Achilles after her dog ran into her 3 months ago. Initial Rx consisted of pressure bandaging, icing, gentle gastrocsoleus soft tissue massage and gentle AP/PA glides to improve ankle DF and PF. Initially she rated her pain as 10/10, and it remained this severe for the following 3 weeks. From this point onwards the pain began to improve and currently she has a pain rating of 5/10 (without analgesics at rest), however does report occasional night pain which may worsen to 10/10, which then requires her to take analgesics. Her main source of pain currently is the (R) Achilles tendon and calf, which is restricting her active DF (0deg DF) and WB DF (5deg DF). In my initial session with her my treatment consisted of AP mobs of TCJ (pain free at 0deg DF) and soft tissue massage of gastrocsoleus. Compounding her problem of CRPS is the fact that she also has chronic fatigue syndrome, limiting the amount of exercise she can do at home to improve her ankle joint ROM. Her personality is also quite cynical and cares very little for her health. She is a heavy smoker and claims that she does not have time to prepare healthy meals for herself as McDonalds is much more convenient. My supervisor has recommended that I encourage her to be more active and that the line ‘no pain, no gain’ may actually apply in her case. How do I go about educating my patient to be more proactive in her recovery and convince her to take up a healthy lifestyle?
Challenging patient
Whilst on a Musclo prac I came across a patient, whom I felt a little tricky to deal with. She had previously been treated by a private physio, with whom she felt comfortable with, and the only person she trusted to touch her neck. She no longer went to this physio, for financial reasons. She had come for treatment of a neck problem; this made it very difficult to assess her. Subjective questioning did not help, as she did not see the point of all the questions, or what they had to do with her neck problem. I was unable to get a clear pain diagram as she was there for treatment of the left side of her neck and therefore would not give me details of the problem on the right (which was an “entirely different problem”). Pain scores were another area which she felt unable to report. Objective assessment found reduced left cervical rotation, due to pain and stiffness. She consented to a neck PAIVM assessment, which revealed several stiff segments, which I felt required mobilisation. She did not consent to neck mobilsation treatment, and therefore initial treatment consisted only of a very light and superficial neck massage. She came back the next treatment session reporting that I had made her worse in that she had been walking with a friend for a hour later that day, her friend was on her left and so she was looking towards the left for the majority of that time. Towards the end of the walk she went to look towards the left once more and felt a ‘crick’ in her neck… the kind of one you get when you move your head too quickly and causes a lot of pain. She felt as though she was going to have to be hospitalised, telling her friend to call an ambulance if need be and list her allergies. After telling me this it was decided to take a ‘hands off’ approach, concentrating on her posture, which in my opinion wasn’t the best, but she said she thought it was good, as well as specific strengthening. I left the room to chat to my supervisor about my new plan, as I left the room she shouted out ‘What no mag’s?’ As in why hadn’t I given her magazines to read whilst I was not in the room. I replied I was terribly sorry, got her the ‘mag’s’, and then proceeded towards the supervisor.
In the end I treated her for the remainder of my time on prac, at which time she was taken over by one of the senior physio’s. I decided not to push the issue of pain scores or diagram’s as this made her upset. I didn’t touch her neck for the remainder of the time, except to demonstrate deep neck flexor exercises, however I made sure to get clear consent before each time. Also I agreed that her posture was good, however the chin poke and hunched shoulders could be improved on by the exercises I gave her. Giving reason’s why this could be contributing to her pain. After a few sessions I believe there was a good physio/patient relationship, I was even asked to mobilise her neck, if I felt it appropriate... I did not. In future, with similar patient’s I don’t think I will touch the neck at all.
In the end I treated her for the remainder of my time on prac, at which time she was taken over by one of the senior physio’s. I decided not to push the issue of pain scores or diagram’s as this made her upset. I didn’t touch her neck for the remainder of the time, except to demonstrate deep neck flexor exercises, however I made sure to get clear consent before each time. Also I agreed that her posture was good, however the chin poke and hunched shoulders could be improved on by the exercises I gave her. Giving reason’s why this could be contributing to her pain. After a few sessions I believe there was a good physio/patient relationship, I was even asked to mobilise her neck, if I felt it appropriate... I did not. In future, with similar patient’s I don’t think I will touch the neck at all.
Wednesday 23 May 2007
Something to comment on
If you are reading this well done. It means that you have managed to log onto your blogsite and can start the process of reflecting on clinical placements. To start the ball rolling and give you something to think about and comment on I have a reflection below that was posted by a student in the past.
Happy Blogging
Peter
Too Sick To Stay?
The past few days I've been feeling a bit crook. So I took Tuesday off as I was throwing up Monday night. I went in today, which was Wednesday as I had my final assessment and a presentation to do. I still felt sick, and I wasn't all there, but I really thought I was well enough to not miss clinic. Well anyway in my less than normal state I missed some stuff in the notes that I shouldn't have. So my question is, as a student how do we tell when to draw the line on feeling well enough to go in to clinics, without giving the physios you work with (who you are trying to impress) the impression that you are just not toughing it out?
Comment 1:
I’m sorry to hear you’re not feeling so well. Although, it’s completely understandable as it is easy to get run down doing this course.
I think you’ve raised a very good issue. I think what you have to ask yourself is, are you putting the patient’s treatment at risk? Do you think that in the state you are in you are able to clinically reason appropriately and provide your patient the best level of care you can provide as a student? Also, are your patients who may have decreased levels of immunity while in hospital at risk for developing the “bug” you’re currently carrying? All important questions when trying to determine if you are “too sick to stay”.
Comment 2
I am so sorry to hear that you are/were sick! And I can defintely relate to what you are feeling as I too got very sick on my cardio placement. I was bed riden for a day and a half but was told by my supervisor that if I missed another day that I would have to redo the whole prac. Now, I know that there if a reason for that rule (of only missing a certain number of days) but I agree with you that's there is a thin line between needing to go into prac and knowing that you shouldn't. I was quite surprised when my supervisor said that, as she clearly new that I was sick and that if I came in I would be working closely with these immune depressed patients. So, I braved it out, because who in there right mind, or "sick mind" for that matter, would choose to stay in bed if they new they had to repeat a whole prac? I just tried really hard not to breath on the patients and washed my hands lots...hey is there any research on that?.....
Happy Blogging
Peter
Too Sick To Stay?
The past few days I've been feeling a bit crook. So I took Tuesday off as I was throwing up Monday night. I went in today, which was Wednesday as I had my final assessment and a presentation to do. I still felt sick, and I wasn't all there, but I really thought I was well enough to not miss clinic. Well anyway in my less than normal state I missed some stuff in the notes that I shouldn't have. So my question is, as a student how do we tell when to draw the line on feeling well enough to go in to clinics, without giving the physios you work with (who you are trying to impress) the impression that you are just not toughing it out?
Comment 1:
I’m sorry to hear you’re not feeling so well. Although, it’s completely understandable as it is easy to get run down doing this course.
I think you’ve raised a very good issue. I think what you have to ask yourself is, are you putting the patient’s treatment at risk? Do you think that in the state you are in you are able to clinically reason appropriately and provide your patient the best level of care you can provide as a student? Also, are your patients who may have decreased levels of immunity while in hospital at risk for developing the “bug” you’re currently carrying? All important questions when trying to determine if you are “too sick to stay”.
Comment 2
I am so sorry to hear that you are/were sick! And I can defintely relate to what you are feeling as I too got very sick on my cardio placement. I was bed riden for a day and a half but was told by my supervisor that if I missed another day that I would have to redo the whole prac. Now, I know that there if a reason for that rule (of only missing a certain number of days) but I agree with you that's there is a thin line between needing to go into prac and knowing that you shouldn't. I was quite surprised when my supervisor said that, as she clearly new that I was sick and that if I came in I would be working closely with these immune depressed patients. So, I braved it out, because who in there right mind, or "sick mind" for that matter, would choose to stay in bed if they new they had to repeat a whole prac? I just tried really hard not to breath on the patients and washed my hands lots...hey is there any research on that?.....
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