2012 - Final Entry - I'm Still Standing

It seems like a really long time since I wrote the initial entry. The routine of work can become a bit of a grind at times. Although I am sad to be leaving the placement, the patients and the staff, I am satisfied with my efforts and the confidence that grew in me. The daunting nature of a neurological placement seems distant as well – although not nearly mastered, certainly well apprenticed.

As always I made communication my first goal. I feel it is an imperative part of being a therapist and all situations are improved if used effectively. Poor communication can lead to countless errors, poor safety and resource wastage. On this placement I was exposed to direct communication with patients, allied health professionals, family members and the general public. There is a great art in being able to slide into different roles. Health professionals need succinct information that is relevant without the chit-chat. Family members require a more friendly, approachable professional who is also able to deliver top-notch service. The level of communication then varies greatly when it comes to patients who have suffered a stoke. Some patients are able to comprehend their condition and are either fully communicative or have a flat effect. Others have a vague awareness of what is going on and can only follow one stage commands. Some can become emotional if given too much praise while others depend on the positive feedback. Being able to cover all these bases within a morning can be exhausting but becomes easier with time and reflection. Starting each day with a warm, friendly and humble attitude seems to go a long way in the right direction. Another important aspect of this is good written documentation from other professionals in contributing to the understanding of the patients communication needs. It keeps everyone on the same page, as it were. When you read in the integrated notes that a patient becomes emotional when speaking about their condition but calms if distracted by the footy, this can save much needed therapy time. Recorded conversations with family members or consultants can piece together the structure of how this patient is being supported.

This placement has gone a long way to showing me what a physiotherapist can be to a patient and how fragile that relationship is. Working so hard with someone and finding out their medical and social history, meeting their families and getting them to place their trust in you and your colleagues – and then having to leave – it almost seems neglectful to assume that others can fill the void. A good hand-over needs to include a social aspect that may get lost in the medical jargon and it is why the S in SOAPIER is so important. It can be used for more then “Valid verbal consent”. It should express the patients mood, their feelings and their complaints as these really are the ultimate goals – improve their mood (and health), improve their feelings, minimize their complaints.

I was going to write a whole bit on time management and safety awareness but these seem to have taken care of themselves. My shoes held up, thanks for asking. Good form, good function. Building a great physiotherapist from the ground up.

  

2012 – STARES 3 – Presentation

Situation - Week three of our five week placement at a stroke rehab hospital ward. My fellow neuro student and I were settling in to a routine. We each had a couple of patients to make plans and give treatment and assist the other during their sessions. Life was good, life was predictable…

Task - Having initially been told that students would not be required to give a presentation, our supervisor decided it would be worthwhile if we reviewed some literature, made some notes and delivered it to a room full of physios…like a presentation. While they gave it a friendly sounding name “Journal Club”, it may as well have been called “Torture Club” or the “Sympathetic Nervous System Club” – yes – that’s the “Fight-or Flight Club”.

Action - In week one we had attended a presentation on dyspraxia that was a little hard to follow.  Since that time we had been given a patient with severe dyspraxia and were constantly looking for alternatives to assess their function and give treatments that they could follow. We decided that our research time would be best spent looking up some articles to further our understanding and perhaps help other therapists who may also need some information. We found three relevant articles and a supporting assessment form to present to the group. I spent the week making up a table from the articles that gave treatment ideas for therapists treating dyspraxic patients. My student colleague would handle the assessment side of the presentation and demonstrate how other conventional assessments could fall down when a patient may have other problems like receptive dysphasia. We tested the suggestions with our patient with positive results. It required us to keep the treatment area free from clutter, breakdown tasks into simple sequences and keep conversation to a minimum. We found these elements hard as physio areas can be quite cluttered, simple tasks have many different pathways and cutting conversation out of a session can feel a little unfriendly. Nether the less, the patient was responding well.

Armed with all this information and three hectares worth of photocopied journals to hand around (one of the requirements)

Result - The main outcomes from this task was that it showed us that not all conditions are well understood by health professionals, having a relevant patient can motivate research and understanding and being well prepared can take a lot of pressure out of a presentation. The room responded well to our presentation and although our photocopying skills left a lot to be desired, the therapists felt better equipped to assess and structure a treatment session for a patient with dyspraxia.

Evaluation

I felt our presentation was delivered professionally and with confidence. We gave the other therapists a workable frame of ideas to structure appropriate assessments and treatment sessions for patients with dyspraxia as well as differential diagnosis if the patient didn’t fit the picture. Our supervisor was impressed with our research and allowed us more freedom to plan treatment sessions with the patient with dyspraxia.

Strategies - In the future, if asked to present a journal I would definitely ask for more instruction on how to use the photocopier. A double-sided print that was collated would have saved lots of time and resources.

Have confidence in the material you are presenting and the resources you add to it. I had not included the table I had made up as a handout to the group. They all requested a copy that, while making me feel positive about the presentation, made me realize that further time has been wasted and I looked like a student lacking confidence in my work. I made my table look fantastic and emailed it around with much gusto.

Having someone else to present with makes it a lot easier. I also spoke with several other physiotherapists during the week prior to our presentation asking them about their experiences with public speaking. This made me feel a little more relaxed when I stood up in front of them to present. They knew what I was going through and I felt connected with the audience.