Finished!

Woot!

Obviously pretty pleased to have finished the placement, somewhat exhausted after 5 weeks fulltime work. Feel as though I've improved as a future physio, despite the fact I haven't been able to implement all aspects of my knowledge base. I feel a lot more confident and relaxed acting on a physio-patient basis. I've had a great insight into the wrokings of the physio profession aswell.

If I was to say the most important thing I've learned while on placement, even more so than clinical skills, it would be that I've got a much greater appreciation for the role of the multidisciplinary team. Amputees is an area where this is most evident, where the whole team ha to work together to facilitate the patients progress and discharge planning. I feel I also came along well with my SOIER writing, which was done everyday. Finally, as I've mentioned before, I think an important element of the prac was learning how to better deal and interact with indigenous patients, as during the Amputee placement I dealt with quite a few Indigenous ladies and I was able to incorporate what we were taught prior to going on prac.

Week 5 Day3

Really feel my interaction skills with indigenous patients has come on well since the start of placement. Aboriginals are over-represented (as far as a population goes) amongst amputees, which means I have dealt with a few aboriginal ladies over the past 5 weeks. Its really shown how helpful the lecture we had presented to us was. Today we had a new lady who has had a trans radial amputation who is from far outback WA. Over the past few weeks I've developed quite a rapport with some of these ladies, and it was interesting to see how I could develop a rapport from an inital assessment. It is important not rush straight into the assessment and try and make them as relaxed as possible. It was this lady's first time out of her ward, and it was clear she was somewhat disorientated. As far as subjective assessments go, it is helpful to try and take an interest in their history and interests/hobbies to try and engage them in the Ax. Often at shenton park, the physio will show an aboriginal patient a map of WA and get them to show where they are from. This lets the patient know that we are interested, and it lets them feel a bit more at ease with us. Today, HJ and I got along well ( I think), but eye contact was fairly minimal but this is common amongst indigneous people (as we know from the lecture). The techniques I employed today worked well in my opinion, as I think HJ and I developed a good rapport, her sense of discomfort eased as the session grew on and she performed the exercises I gave her with good compliance.

Week 4 Day 5

Pretty pleased with how I handled a patient today. This guy was a 19yr old, Left TFA who has been staying at the well-tell accomodation at the hospital (well tell is an independent accomodation located at shenton park for patients from outer metro/ regional areas to stay for 3 weeks of daily rehab). This afternoon was his discharge day, and he is at a level where most things are fairly easy for him, albeit that he is still getting used to his prosthesis and needs to improve his agility and ability to walk unaided. Prosthetic modifications have allowed him to perform better in the last couple of days, so I had to quickly choose activities that were appropriate as progressions and that reflected the fact that he was about to (re)return home. I'm pretty sure it has been one of his most intensive exercise sessions, at least ones that I have attended. I was pleased as to how I handled this situation, and I think I chose good exercises for an amputee of that age. Hopefully this was a sign that I am integrating the exercise prescription and clinical reasoning skills I have developed on placement.

Week 4 Day 4

No real activities that warrant a mention today, as it was pretty quiet and what I did I did not feel unsure of. Main thing today was a SOAPIER/handover style report presentation to the weekly physio team meeting/continuing education session. Was somewhat nervous presenting to a group of qualified and experienced physios, but it turned out really well. They all listened attentively and told me they though it was a good presentation afterwards. Basically it felt good to be somewhat accepted as a future peer, as I hadn't really felt that upto this point.

Week 4 Day2

Almost opposite experience from the last one. Afternoon session in the amputee gym yesterday, had finished with a patient I had been dealing with and noticed one of the new patients sitting on the bed not doing any exercises. She is a middle aged aboriginal lady from the country with somewhat limited english skills. What I've learnt from my limited experience with the aboriginal amputees from the country is that they particularly don't like being indoors for extended periods (like many people) and love being in the sun. Anyway, I asked the lady how her exercises were going, and was not getting definitive responses. What was definite however, was that she wanted to have a rest outside in the sun. I said ok, on the rationale that she'd go outside for 5 minutes and come back to complete the rest of her exercises. in-between helping other patients out, I went to check on her, only for her to refuse to come back inside and that she would either stay in the sun or go back to her room. Looking back I probably didn't stress enough the importance of doing her exercises. I know I would have been butting my head agaisnt the wall (as of today it turns out she no longer wants a prosthesis anyway and will be returning to Kalgoolie soon), but there would have been no harm in giving her the blunt facts (no exercises = poor prosthetic outcome). At the moment we have a few aboriginal ladies, so I will be sure to use the lessons I learnt from this.

Week 3 Day 5

Pretty good day yesterday, was dealing with one of the regular outpatients at the gym. He is in his forties, has had poorly controlled type 1 DM, cardiac myopathy, peripheral neuropathy and retinopathy. He is a TTA and is terrified of falling. Inside the parallel bars, he can walk reasonably, but outside of the parallel bars, and especially outside of the gym, he is very timid and lacks confidence, even when walking with 2x sticks. So it has been kind of difficult thinking of ways to progress his treatment and rehab. Before, I suggested we go outside to walk and walk on an uneven surface suchas the grass, but decided agaisnt it as he was clearly nervous about falling.

Yesterday I realised he is capable of doing it, just his nerves are getting the best of him. So I treid to increase his confidence and initiate positive feedback and encouragement. And of course he could do it! I guess at first I was nervous about making the patient nervous. Today was useful as it showed a firsthand way how physios can be important motivators during rehab, and that simply employing positive feedback and encouragement can overcome patient fears.

Week3 Day2

I was providing standby assist to a man who was walking around the gym in 2x sticks. This guy is a fairly emotional person who has been finding it hard to get used to the TFA a month or so ago. I know that he often expresses his experiences at being an amputee and it obviously makes him feel better when he has someone to listen. However he stopped halfway through his lap of the gym to continue telling me about his stump and phantom pain. In some ways this was my 'fault', because I was trying to engage the patient and build a level of rapport with him to try and make him feel comfortable around me. I guess the negative aspect of this was the fact that he stopped for a couple of minutes to let out his feelings, ultimately to the detriment of the gym session. Looking back, I should have allowed him a short period to rest, but re-focussed on his gait training and got him walking again, 'forcing' him to talk to me as we walked. However, as he left the gym, he mentioned he had decided to leave shenton park and not attend the afternoon session (he had driven from Northam this morning for rehab) as he had had enough physically and emotionally. The physios pointed out that to achieve his goals it is in his best interest to attend the gym. He recognised this fact and appreciates what the physios do for him, but he still decided not to attend. I guess sometimes al we can do is motivate and educate, and ultimately it is up to the patient to engage in the service.