Final entry

My placement at SAMU (SCGH) was pretty similar to what i had expected it to be like. I found working in a major teaching hospital like Charlies to be a wonderful learning experience. As i expected there was regular continuing education sessions and it was a great environment to practice my skills. Most of the time we were also working alongside other students (OT, nurses, doctors) which made the experience a lot more comfortable. I never felt scared to ask questions as everyone was willing to help teach. I think my cardio skills improved significantly on this placement, particularly assessment skills such as auscultation, reading x rays but also analyising the implications of my findings i.e. what different added sounds in auscultation represent. I also learnt a huge amount just on the way hospitals work i.e. discharge planning which should hold me in good stead for further hospital placements. This placement has only strengthened my desire to work in the public hospital system.

Week 4

S// This entry revolves around a 78yo female Pt who was BIBA following a 5/7 Hx of worsening respiratory function, symptoms including SOB, reduced ex tolerance, reduced functional mobility which meant she was no longer able to complete ADL's without assisstance. PMH included angina, HTN, chest infection, stroke. SHx-Pt lives alone in single story home is I with most ADL's has some assistance from family for shopping.
T// I was asked to complete an initial Ax on this lady and then make a plan for continuing rehab. To complete a thorough initial Ax i needed to reed through her notes thoroughly, look at her blood results and other investigations from the computer. I then made a list of the information i needed to get from my Ax. This included subjectively-why in hospital, level of function since admission, level of function prior to deterioration and social history. Objectively-Full chest Ax (sats, chest expansion, auscultation, cough) and mobility Ax (transfers and ambulation)
A// After introducing myself I began my subjective Hx taking and realised immediately it was going to be difficult. I had read in the notes that Pt had expressive dysphasia following her stroke, however i didn't realise the level of the impairment. This Pt had severe expressive dysphasia and it made understanding her responses extremely difficult but i persevered. However, i had to keep asking her to repeat herself which i began to realise she was finding frustrating (and understandably slow). My objective Ax was fine and got all info i needed.
R// I left the session with all the info i needed to make an ongoing plan for this lady however i did have a few gaps in my sunjective where i could not understnad her answers.
E// On the most part i collected everything i needed from my initial Ax but i made hard work of it (both for me and for the Pt). My glaring weakness was my communication skills with this patient. And this was only a problem because i had read the PMH from the notes thoroughly but had not attached enough significance to the implications of expressive dysphasia. I believe my chest and mobility assessment was good.
S// After speaking to my supervisor and also the OT's i learned that the key to questioning with a Pt with expressive dysphasia is YES/No questioning or closed questions rather then open ended questioning. It seems so obvious now but as this was the first time seeing a Pt with this impairment I was unsure. I was also a little naieve in the extent of communication difficulties a Pt with expressive dysphasia can have. At least i know for the future. And everytime I have seen the Pt since i have used the yes/no questioning with great results.

It was my firs

Week 3 entry

S// I have been seeing a 75y.o Pt this week for ongoing management of hip and leg pain. The Pt was BIBA after waking up with intense 10/10 hip and leg pain that prevented him from weight bearing. The Pt lives alone and is normally independent with all ADL's. He has had previous incidents of similar pain but nothing as bad as this and the pain usually eased with pain meds. PMH-parkinsons
T// I had to conduct an initial Ax of the Pt and then make a plan for treatment which after getting my supervisors approval could put my treatment plan into place. As this was a MSK case i had to conduct a detailed history of the patients pain i.e. description, intensity, aggrav and easing factors etc. It was a great opportunity to put my lumbar spine knowledge into place.
A// After completing my subjective Ax (which had to be extremely thorough in order to get the information i needed to make a suitable treatment plan) I then sat down with the information i had gathered and made a plan. I checked the patients investigations which showed NAD. I made the decision that this patient had a pain dominant problem and that my immediate goal of treatment was to help with his pain. So I found the active movements that provided pain relief to this patient and repeated these movements. My baseline for measurement of effectiveness was trunk extension, and with continued sustained treatments into the pain relieving position the patients level of trunk extension improved. I also educated and provided support to the patient so he understood his problem and the path to recovery.
R// The results of my treatment choice were mixed. His level of trunk extension (which was limited by pain) has gradually improved and the Pt feels like he is getting better. However, on FWB the Pt continues to report 10/10 pain and i have still yet to find any positon that centralises the patients pain.
E// I believe my communication skills were appropriate for this Pt and helped me gather the appropriate information i required to make a treatment plan. However, i think i could have gathered a lot more specific information related to mechanism of injury. My treatment is appropriate for this patient however as i am not making significant improvements i am beginning to question my methods and wonder what more i can do.
S// I think i could improve my performance by being more confident in my treatment plan and this will give more confidence to my patient. Also, to consider alternative treatment options i.e. TENS and consider broader options (going to trial a TENS next week).

Week One

First week of prac completed and so far I'm really enjoying my placement. Been given a lot of independence and learning loads about a whole variety of issues, ranging from chest management to amputee physio. The area I am in is Sub-acute med unit, so as the name suggests there is no-one who is acutely ill, which means my supervisor was confident in giving us a fair bit of independence from about the second day.

S// One of my patients was an elderly man with recent onset of SOB which after appropriate tests has been linked to pneumonia and asthma. He has a hearing impairment and speaks english as a second language,which meant my communication had to be spot on.
T// I had to go in and assess his chest and mobility to provide an update to my supervisor. I could then plan my treatment and after my supervisors approval treat him as planned.
A// I conducted an initial subjective assessment making sure to speak clearly, concisely and also loud enough so he could understand. I then assessed his cough, auscultated and watch him perform transfers and walk. My treatment consisted of ACBT (including TEE and huffs) and a walk.
R// I reassessed his cough (which was non-productive initially) and auscultation followng treatment. However, his cough remained unproductive and he continued to have an inspiratory wheeze following treatment.
E// I believe my comunication skills were very good with this man and I managed to get him motivated for treatment. Although, his markers did not change following treatment, i believe it will take more then one session for these to change.
S// I believe my auscultation skills can improve significantly especially in regards to what added noises i can hear and what pathophysiology they point too. Can definitely also improve my skills in teaching ACBT.

Initial entry

Im off to the sub-acute medical unit at SCGH. Although feeling a little nervous I am looking forward to my placement. Am happy to be going to one of the major teaching hospitals as I expect it will be a great opportunity to work with some really experienced Pt's but also with some new graduates. Also will be great to get experience in how the whole public hospital system works, as i definitely intend to spend time in the public hospital system upon graduating. Not entirely sure what the sub acute unit will have instore, apparently a fair bit of cardio and also a fair bit of gero skills. I am expecting to be given have a lot of independence from a pretty early stage, however no doubt the first few days will be getting the swing of things. As i said a bit nervous, suppose mainly because I will be in a completely new environment and also some fear of not being up to scratch with my skills. Ah well all part of the experience i suppose.
Good luck to all!!!