Final Entry – Final Placement – Final Year

This does not feel like only the end of a placement, but the end a degree, and the start of a career. It has been five long years and I don’t mind taking a brief moment (and a few extra words on the word count) to celebrate. Yahoo!!

As for the placement itself it has been a rewarding experience that allowed me to move between different wards in the hospital and able to communicate with and learn from other physiotherapists within their particular specialty.

Of particular benefit was being able to follow the process from a patient with an acute exacerbation of COPD on a medical ward, to an outpatient assessment to a pulmonary rehabilitation class. This was a process that I had not had the opportunity to be a part of on other placements and it reinforced the duty of care that is given to patients in the health care system. I do believe that physiotherapists play an important role in the management of patients with pulmonary diseases and provide an evidence base for improving the service.

My assessment and problem list skills really took shape on this placement as I became less worried about the text book and more concerned with the patient and their presenting complaint. Having a knowledge base has helped get me this far but learning to let go and clinically reason what a patient needs will take me the distance. Paperwork and time management have always tripped me up in the past and I finally managed to stay on top of the workload with some memory strategies and a clear documentation layout.

Having had some experience on a mental health ward came in handy as many patients exhibit signs of delirium post-surgery and during acute medical conditions. Being able to recognize and manage these conditions within the multidisciplinary team is a worthwhile skill and extremely important for any healthcare professional. This is particularly important when a patient has to give consent for a treatment and they are acutely confused. There is a vast legal minefield in healthcare. Knowing the patient’s rights and when family input is required is very important.

This placement has been an excellent rounding to my practical knowledge. I was able to attend ICU treatment sessions, run pulmonary rehabilitation classes, and treat a number of respiratory conditions. My orthopedic knowledge was challenged and many elderly patients had co-morbidities with residual neurological deficits to be aware of.  I was constantly challenged and filled in my knowledge gaps early to allow for a positive outcome. I felt extremely comfortable with the staff and the environment in the hospital and recommend the placement for any student wishing to have an all round experience. Many thanks to all those who have helped me achieve this degree.

STARES 2 – Pulmonary Rehabilitation Class - 2013

Situation

Week 3 at a Secondary hospital covering surgical, medical and medical assessment wards chest and mobility reviews and appropriate physiotherapy treatment.

Task

Run the pulmonary rehabilitation group in the hospital with PTA assistance. Closely monitor a new patient during the class. Complete all paperwork and manage the equipment.

Action

I gathered the medical files for the patients that would be attending the class. There had been a couple of patients that had called in and cancelled so we would be expecting six participants. I inspected the pulmonary rehabilitation trolley to make sure it was in order and had the appropriate equipment. I asked the PTA to bring 2 full portable O2 cylinders to the walking session in case of an emergency. At the walking area (inside the hospital) I ensured I knew where the emergency button was located and asked the PTA to be on the other end of the corridor with the second O2 cylinder. I recorded the SpO2 and heart rate of the patients at rest as well as obtaining a subjective breathlessness indication (1-10) by showing them a modified BORG. The patients then each take a timer and a set of counting beads and begin walking at their own pace. The patients all have different levels of exercise tolerance and two use 4 wheeled walkers. One patient is on a constant supply of 2 litres oxygen via nasal prongs. After a few laps some patients require a rest due to shortness of breath (SOB). They give a reading on the modified BORG and I recheck their SpO2 and HR. This is not recorded but the patient is informed of their SpO2 level and how it is reflected by their SOB. At the end of the 20-minute walk I recheck and record each patients SpO2, HR and SOB on the Modified BORG. I also record how many laps they have completed. The class then moves to the outpatient gym area where a number of upper limb, lower limb and cardiovascular activities are completed. The patients are encouraged to choose their own weights and repetitions, but also encouraged to progress the exercises if possible. The patients record this data on to their class sheets. The class is casual with time for patients to chat to other patients and to various physiotherapists in the room. There is a new starter so I closely monitor his SpO2 during the session as he tends to desaturate quickly on exertion. The patient has a diagnosis of COPD and pulmonary fibrosis from working conditions. I recorded the attendance in the patient hospital files and assisted in packing up the equipment at the end of the class.

Result

All patients that attended have completed a moderate rate of exercise for approximately 45 minutes. I managed the paperwork with assistance from my supervisor (and at times, the patients).  I assisted the patients’ re-assess their vitals during the class and provided education about their condition and the benefits of pulmonary rehabilitation classes.

Evaluation

During the walking session when I was required to measure and record the patients prior to them commencing their walk, I felt rushed and occasionally made errors in the records. The patients were keen to start their walk and felt more in control of the session than I did. There was a sense of confidence and competitiveness that I was not expecting. I enjoyed the gym class more because there was time to talk with the patients and give them tips about their form and motivate them to try a little harder.

Strategies

Allow the patient to be in control of their session. Self-efficacy is one of the key benefits of pulmonary rehabilitation classes.

Be prepared to move fast with the paper work – jot down notes and then fill in the form when the patients are walking.

Monitoring the SpO2 of the patients while they are exercising gives a good indication as to their exercise tolerance and perceived SOB.

References

Garrod, R., & Backley, J. (2006). Community-based pulmonary rehabilitation: meeting demand in chronic obstructive pulmonary disease. Physical Therapy Reviews, 11(1), 57-61. doi:10.1179/108331906X98958

Halding, A., Wahl, A., & Heggdal, K. (2010). ‘Belonging’. ‘Patients' experiences of social relationships during pulmonary rehabilitation. Disability & Rehabilitation, 32(15), 1272-1280. doi:10.3109/09638280903464471