Sunday, November 16, 2008
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.
Wednesday, November 12, 2008
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?
Tuesday, November 11, 2008
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.
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.
Sunday, November 9, 2008
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.
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.
Thursday, November 6, 2008
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)
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
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.
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.
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