Reflective Journal

Five weeks all done. Wrapped its over, however felt pretty emotional and kinda guilty leaving. Mainly because as i was saying my goodbyes, particularly to the young blokes, i realised that these guys were here indefinitely and i just got into my car and left.Its pretty hard to explain but anyway. In hindsight, I'm stoked i had this placement-because as one of the OT's said to me "its a life changing experience..." and its true, it really was. Made me realise how much I take for granted and how insignificant some of the things i stew over and get worked up over. Then you talk to people who will never walk again and there just stoked that their still alive. May sound corny and clechay (no idea how to spell that word) but its true. Apart from all the emotional side of this placement i also learnt a massive amount. Some of which is very specific to the area i.e. tilt tables, quad cough, wheelchair positioning etc and also very general things such as communication, note taking etc. Probably the biggest thing i learnt was transfers, positioning and manual handling. Signing off from the Quad Centre and now going to leave you with a little preach session-if you want a reason never too drink drive, speed, not wear a seat belt or do stupid things on the piss then spend one day in the quad centre. Choi.

Week 5 #3 (13/11)

Very normal day at the Quad Centre today. Was put in charge of the place for the morning session. All went pretty smoothly, with the exception of one transfer whcich went a little pair shaped. Was doing a pretty unconventional transfer with this bloke (definitely not one you'd see in Bertoti), anyway the PTA was assisting because he's a pretty tough patient. Anyway i was supporting his back and my foot got caught in his wheelchair. As i went to unhook my foot i lost concentration on supporting his back and he fell back onto the plinth.No harm done to him but did cause a moment of panic. Because he is (like a lot of the patients) quite frail so doesn't take much to brake a bone. Anyway i suppose most improtantly i learnt how important it is too stay focused whenever your holding a patient (particularly in a Gerentology prac exam). But it was straight after the fall that i learnt another important lesson, because in the panic the first thing i did was to try and pull up the patient. The PTA quickly stopped me from doing this because i was putting myself in danger (mainly my back) because my posture was all over the place. He said to leave the patient because he was in no immediate danger. Anyway lesson was just not to panic (easier said then done though). Just tried baking some cookies as a thankyou to the PT department and OT department, but they dont look real special. May have to make an emergency visit too the bakery in the morning. Could be vital for my end of placement assessment. IS anyone still reading, and if so what sorts of presents/bribery are you giving to your supervisors? Andy did you make cookies as well?

Week 5 #2 (11/11)

Three days to go. Fell out of a wheelchair today, on my way to basketball courts and leant too far back. Pretty embarrasing, OT had a good laugh. Didn't tickle either-would suck if this happened too you ever week, which it does for many of the young blokes in there. They have to pass an assessment to prove they are road worthy. No joke.
Spent the afternoon in allied health meeting, which was very interesting and also very time consuming. Was really intersting to see how each department was directly affected by what was happening in other departments i.e. if nurses were short staffed then it meant that patients were not taken out of bed on time in the morning which meant they missed their am PT session. Then they would come in the afternoon and the PT department would be chockers and each person would not get the quality and quantity of treatment they require.
Had two young fellas return to the quad centre this week after spending three months in China and India receiving stem cell treatment. Only one of them has attended the PT department so far and from what ive been told and read he has made pretty amazing improvements i.e. he couldnt even SOEOB independently before and now he can. Hes going back for more in March. OT's and PT's are fairly hesitant about supporting the use of stem cell, suppose because its a relatively new treatment option and they dont want to raise people expectations. Very interesting though.

Week 5 #1 (10/11)

First day of week five down.
Worked for a couple of hours with one of the young blokes today. Spent first 30min doing weights then went outside with him and the OT to practice his car transfers. Being able to independent car transfers is a major hurdle that needs to be crossed before he can go home. Was interesting to see the different techniques that were trialled (feet in or out of the car etc). Spent about an hour doing car transfers, takes a fair bit of strength to be a able to lift from the chair up and across the gap and into the car. The OT in the quad centre is great, she gave him all the different options and let him trial them and decide what he felt most comfortable with. The other thing that has to be considered with car transfers is the variation in height and distance that is evident in different makes and models of cars. I assissted where i could and made suggestions which the OT and the patient took into account. Was a very interesting session.
Also had to present a full soapier to my supervisor today, he seemed pretty happy with it all. However, i made one big mistake-i wrote it up on laptop and printed it off at home and didn't even think about the confidentiality issue. I just thought because i wasnt talking to anyone about it or sending it to anyone it wouldnt be an issue. Bit of a wake up call. So have to delete that when i get home.

Week 4 #3 (7/11)

Another week down. One to go. Was a pretty rego day at the Quad Centre but had a couple of interesting experiences. This morning we spent a couple of hours in the spinal rehab gym at RPH in shenton park. Was interesting to see the comparison between the Quad Centre gym and the gym at RPH. The RPH gym is used in a more acute setting, so there patients with Halo traction on which was cool to see (a metal frame screwed to their skull, to keep their cervical spine immobilised), also there was a much greater focus on maximising independence i.e. there was no hoist at RPH, whereas as hoists are an absolute necessity in the Quad Centre. Suppose this reflects the goals of more independent transfers at RPH.
Most of the afternoon was spent chasing patients up to do vitalograph tests. Had top go into their rooms, some patients who we had not met before. Think we conducted the tests pretty well, not that there is too much to it. But was good to see patients outside of the gym, which is where we spend 99% of our time and also to chat with new patients. Then went to the nursing post to chase up a list of meds that one the patients is on (need it for an assessment our supervisor has asked us to do), couldnt believe how many meds this person was on. But turns out this is pretty rego for spinal injury patients. Probably the most important meds in spinal injury patients are anti spasm meds such as baclofen. Anyway thats my story from today, nothing too special but its all ive got. Have a good weekend (not sure if anyone actually reads these, or if they do they probably lose interest and dont make it this far. but if you do then thanks and have an especially good weekend)

Week 4 #2 (6/11)

Was given full reign with one of the young guys in the rehab session today (this is a two hour timeslot where the young patients have run of the gym and its pretty hardcore in terms of physio. Heaps of transfers etc). Thought i had a pretty productive session with this guy-did lots of balance work, chair to bed transfers, lifts and strengthening work.
One thing i really took from the session was to look at the big picture-i was doing four point kneeling with him and then the OT came over and suggested we do this another time because he had cut his knees the other day) but i was so concerned about doing the actual exercise that i hadnt noticed the pressure it was putting on his cuts.
Also realised with this bloke how chatting with a patient can often come at the expense of being productive. Becuse some patients wil talk non stop and even use it as a distraction to get out of doing physio. And you dont want to dismiss them but at the same time you need to keep them on task. Suppose you just have to pretty smart about it and diplomatic. I decided to use the rest times in between exercises for chatting. Anyway nearly week four down. Missing all you guys so much xo

Week 4 #1 (6/11)

Was given a great learning experience yesterday. Got to do a full assessment and treatment on one of the ventilated patients at the Quad Centre. Assessment consisted of a subjective component (asking about SOB, cough, secretions etc), then auscultation and palpation of chest wall. Treatment consisted of hooking up the cough assist machine and connecting that too his trache. All was going well but then it was time to suction, this is where you put a catheter down the trache and suction up the secretions. Has to be done quickly and smoothly because patient cant breathe will this is happeneing. Anyway wasnt my best performance, first catheter had to be thrown out because as soon as i took it out of the package i let hit hit against the bed rail=infection risk. Then did two more which weren't that successful because i didnt do it quick enough or deep enough (much to the amusement of my supervisor).
Felt my communication, subjective assessment and auscultation were all pretty good however my suctioning skills need a lot of improvement. Sure that would come with practice though. Had to write up the session in his patient files-didnt do a great job. Learnt how important it was to be specific when writing in patient notes i.e. which lobe you felt the secretions in and how many rounds of cough assist you did and what were the settings on the machine.
Probably the most interesting thing i took from the session was how prominent secretions can be in the lungs. Because with palpation of the chest wall you could feel the rough areas that had secretions in them. Never realised how obvious they could be.

Week 3 #2 (30/10)

Throughout my placement at the Quad Centre i have taken several subjective histories from patients. Up until yesterday these had all been informal histories, which i had taken through general conversation with the person as i was treating them. However, as part of my mid placement assessment I had to take a subjective and objective assessment.
As soon as i began taking my subjective history from the patient i realised how different it was to take a subjective history in a formal setting, where you are actually trying to record what you are being told. Although i think i did a fairly solid job i found myself consciously thinking about what to ask next instead of listening to what i was being told. I'm almost sure the patient picked up on this and it made the situation a little incomfortable.
Next time i take a subjective assessment i will endevour to pay much more attention to what im being told and let that guide the questioning, instead of trying to follow a strict structure/plan.
Had an interesting experience today with my supervisor. One of the patients has been having pain in her backside and the source of the problem has been found to be a tight piriformis. My supervisor asked me what was a stretch for the piriformis and i showed him what i believed to be an appropriate stretch. However, he disagreed that this was not a correct stretch. Didn't know if i should stick to my guns or just nod and say yes. I decided to follow what i believed was right and we agreed to disagree. Its a tricky one though, because i didnt want to come across arrogant and rude however at the same time i wanted to get my opinion across. Good times. Anyone got any similar experiences (dont what this to be a whinge session on supervisors, just if anyone has similar experiences and how they dealt with their situation)

Week 3 #1 (28/10)

Had a couple of interesting experiences today that tought me a couple of pretty important lessons.
Was treating one of the older ladies-just doing her regular stretches (which i have done many times before) and trying to position properly in her chair. Anyway she seemed to think what i was doing was wrong and she had no problems letting me know. As her criticism continued i began to lose patience and was very close to having a go at her. Don't know how but i resisted the urge. Learnt how important it was to be patient and to bite your lip and also to try and understand the positon the patients are in and try and see it from their point of view. Also the importance of avoiding conflict and using other means to solve the problem.
The second situation was when i attended a admission meeting for a new patient. All the health and admin team were present. It was very interesting to see the interactions between the diff staff members and the internal politics that im sure exists in all facilities. Made me realise in public facilities like the Quad Centre how important it is to keep solid relationships with other members of the team and keep in close contact with them all.

Week 2 # 3 (25/10)

Been doing a lot of subjective history this week. Trying to do it with every patient, and it is normally pretty informal. Just via chatting to them as we treat them, because there is no acute patients at the quad centre, the subjective history doesnt really affect our treatment. Some patients are a lot more comfortable disclosing their history and this makes it very easy, however others are much more apprehensive. This is fairly understandable because getting a history usually involves the patient recalling the accident/incident that caused them to be a quadriplegic. For some of them this incident is only very recent and is a very fragile topic for them to discuss. Its hard to know how to respond because there is no way i know how they feel and i dont want to sound patronising. At the same time its nearly impossible to put a positive spin in their situation or to give them some sort of false hope. What ive decided is that its just best to listen because this is all that a lot of them want, because they get pretty lonely.
Anyway thats my thoughts.

Week 2 #2 (25/10)

Another week down. Definitely feel the second week went a lot quicker then the first. Pretty much doing everything at the quad centre, the reidents come in and if we're not busy we set up their sling, use the hoist to transfer them to their plinth/tilt table and then do stretches before setting up their tilt table. Feel pretty confident with most of the treatment procedures and feel my communication skills are pretty good. Because we see the same patients every week its a great opportunity to build up rapport with the residents and each time they come in i try and chat to them about what they have told me they are interested in.
Wrote up our first patient notes in the second half of this week-this may seem a little bit delayed compared to the rest of you guys but at the quad centre the physios very rarely write in the patient notes unless there has been some sort of big change in the patient situation. This is mainly because there is no time in between treatment procedures, you just go from one patient to the next. so id probably work with about twenty patients a day.
Main aim for the third week is to get my manual handling and hoisting skills 100% tip top. Just so I am confident enough to do it without getting a staff member to give me the all clear before lifting, think its just a little bit of fear because if its not right then the consequences can be pretty severe (i.e. their is one resident who has a broken leg because he fell out of his sling)
Anyway thats next weeks goal and also to write in as many patient files as i can.

Week 2 #1 (21/10)

What up fellow bloggers. Hope all is going well on prac.
Pretty interesting day at the Quad Centre today. Went to visit the two ventilated patients, watched on as our supervisor suctioned and used the assissted cough machine. we will be expected to do it on our own next week, which is pretty cool and also a little scary. Because during these processess the patients ventilator is disconnected and so they cannot breathe.So have to move pretty efficiently and precisely. and as we found out today things can go wrong-when the ventilator was reattached after suctioning the alarm on the machine went off because the ventilator wasn't working-anyway for about 30sec the patient wasn't breathing before the nurses got him bagged(attached an oxygen back to his trache). Bit of panic but all was fixed pretty quickly.
working fairly independently-just about mastered hoists and wheelchair positioning and transfers. Wheelchair positioning is really important with quadriplegics because they are unable to shift their weight and thus pressure sores are a major risk.
learnt quad cough technique today. Thought i performed pretty well at it. attached the nebuliser prior to doing it. just with saline solution to assisst with sputum removal. quad cough involves a forced compression of the patients abdomen during expiration to force the diaphragm up and move the sputum. can definitely get a lot better with my timing of the compression, hopefully that will come with practice.
but all going well and feeling much more confident.
over and out.

Week 1 #3 (19/10)

First week down, and pretty relieved. Was a fairly intense week, learnt heaps and was given a fair bit of autonomy. But found it really draining, both physically and emotionally.
Mainly involved with maintaining the residents ROM and strength in the muscles they have remaining. Manual handling and transfers is major component of our work at the Quad Centre, getting patients from their chairs to the plinth or onto the tilt table. Hoists are a necessity. Also chest physio is a major component because the residents are in their chair pretty much all day. So trying to maximise their lung function and prevent build of sputum, use a forceful technique called quad cough where you use your fists to push down on their stomach to force their diaphragm up. Ash learnt it this week and its my turn next week.
Think i went fairly well this week but heaps of room for improvement. Was shown up a few times by supervisor, mainly for not having answers to questions. So need to spend more time studying to brush up what we have learnt in previous semesters, annoying how quickly i forget stuff from last semester. I know its in their somewhere, just need to pull it out. Think my communication skills were my strongest asset this week. making it appropriate for the client, i.e. for an older person or for one of the younger people.
There is no social workers/councilers/psychologists at the Quad Centre so the residents tend to tell anyone who's willing to listen about how they are feeling or how they ended up in a chair. Get some pretty heavy stories and some pretty depressed patients and its hard to know what to say. Thats probably the hardest part to deal with it at this stage.
Anyway week two awaits. Good luck to all and hope its all going swimmingly.

Week 1 #2 (16/10)

Fairly action packed packed few days at the Quad Centre. We're been given a fair bit of autonomy and getting our knowledge tested regularly, not always with great results. Quad centre is a real eye opener and very confronting. Spend two hours everyday with the young blokes, all about my age, (car accidents, beach accidents etc) who are now in wheelchairs for the rest of their lives, as corny as it sounds it makes you realise how lucky you are.
Anyway, tell you about one of my experiences today. Its not 100% physio related but very relevant. One of the young blokes (19) asked me if id like to go and play basketball with him after lunch, the OT thought this would be a good idea. So after lunch i jumped in one of the spare chairs and set of for the basketball courts. Spent 45min in the chair and arms were pretty spent afterwards. Was a agreat opportunity to build some rapport with this bloke and we got one pretty weel. Hopefully i will be able to use him for my Subjective and objective assessment and treatment plan, which is a requirement of our placemenmt. My communication skills were the key factor in building rapport with him, but i found thus fairly easy as we were in the same demographic. At times i found myself being over sympathetic and probably patronising. Butt think he enjoyed having a "staff member" of a similar age. Found this to be a great experience, however it all kinda hit home when at one stage the basketball rolled out into the grass, there was no way he could of got it so i just got ou of my chair and walked over and grabbed it. Made me realise that i'm in the chair for 45min while he, and the rest of the residents, are going to be in a chair for the rest of their lives.
Anyway thats my story, know it doesnt exactly follow the set out in our manual but just thought it was worth telling. Good chat.
Hope all is going well for everyone.

Week 1 #1 (14/10/08)

I was presented with a situation today that got me pretty frustrated. I was doing some arm stretches with a patient on a tilt table (plinth that can be raised to vertical while the patient is strapped in), while my supervisor was doing similar treatment to a patient on a tilt table next to me. As tilt tables are a major part of the treatment procedure in the Quad Centre and this was my first experience with them, i asked my supervisor what were the main benefits of using a tilt table. He asked for my opinions and i told him my suggestions, which were wrong.
Anyway he kept me and Ashlee guessing for about 45min.
I felt pretty frustrated and felt pretty stupid in this situation, if i had known the answers i wouldnt have asked in the first place. It put a bit of a dampner on the rest of the day and makes me pretty apprehensive about asking questions in the future.
After thinking about it this evening, i realise he was just trying to make us think about it and use our knowledge. Think ill keep firing out the questions, however if im going to have to go through this process everytime then ill probably save my questions and find them out from books.
For those interested, the main benefits of tilt tables are

• with blood pressure, because most of the patients are in their chairs all day, when they get out of bed in the morning it is very common for the to collapse due to orthostatic hypertension. so by spending 30min in the tilt table each day it keeps the baroreceptors in their blood vessels acitve
• increase their lung volume, because their diaphragm and lungs get a chance to relax and spread out while in an upright position

Good chat, talk soon. Hope everone is killing it (and not their patients)

Belated initial thoughts

Prior to start of placement, at the Quadraplegic Centre i was pretty eager to get into it. I decided there was no reason to be nervous. because i knew if i did id get myself too worked up about it. I was just going to treat it as an opportunity to learn and to put a few of the things I have learnt into practise. My main concern was that i didnt know enough and my supervisor would ask me questions that i had no answers too. Then i thought thats really part of the experience.

I expected the physio at the Quad centre to work mainly with occupational therapists in trying to maximise the independence levels of the patients. I suppose they would also have to work with community services to ensure the patient has access to the facilities they need in the community.