reflection- clinical placement

I really enjoyed my clinical placement and felt that it really helped improve my confidence in terms of manual handling and communication with patients. I think the most important thing I have learnt from this unit is how to apply theoretical knowledge to a real situation. I realised no matter what theory you may learn, in a clinical setting you often have to make modifications according to the situation that you are presented with and you will come across many different people and problems that sometimes you may not know how to handle. I also learnt about the importance of effective communication and collaboration with other health professionals and how this communciation can aid what you do as a physio. You can also learn a lot from other professionals!

week 5 2nd post

On my last day I got the chance to write a referral letter (for outpatient physio) for the patient I had been seeing with osteoporosis. I thought I did a good job at sounding professional and also did well by including some important details from the patients history, etc that the physio I was referring him to would need to know. However I went over it with my supervisor and realised i needed to summarise it and there was a lot more very relevant information that needed to be included! It was good to be able to see what needs to be included in a referral letter and also to see how health professionals communicate in a clinical setting.

week 4 last post

towards the end of last week I saw the patient who had fractured his ankle. He too was given permission to WB. Again i felt quite nervous about getting the patient walking however he had been mobilising with a wheelcahir as well as a pulpit frame and hopping on is unaffected side so there was less risk of him feeling dizzy and less chance of him falling. However this patient was a lot taller than the patient with osteoporosis that we had to get up earlier in the week so I was a bit concerned about this in case he did fall I couldn't support him. Although I asked my supervisor to follow with a wheelchair behind to be safe and so that the patient could rest when needed. This patient was also a lot more nervous in comparison to the previous patient I have mentioned which in turn made me feel a bit worried! I thought I did well though in encouraging him and making sure he knew he was safe which seemed to help with his confidence (and mine!). I felt like I handled this situation better than I did with the patient before and thought it all went well. I think next time I get a patient up I will make sure they have pain relief a while before seeing them as this time round he only received it just prior to the session and was in a lot of pain!

last week I did some strengthening and balance exercises with an 89 year old lady who had a fractured NOF in the parallel bars. I felt confident with prescribing exercises and with the safety aspect as I had seen a patient the week before and done a few things in the bars with them so it was a bit more familiar. I thought I gave good feedback about correcting the movement pattern of her affected leg during some exercises however for some exercises I needed to do that right from the start because initally the weren't very effective as the movement wasn't correct. The patient felt a little concerned that the knee of her affected leg was clicking and was slightly painful and I felt I gave her good reassurance and a sound explanation as to why it could be doing that. I think in a similiar situation i'll be a little firmer about ensuring the exercise is achieving what it should but without being too picky and that way the patient and their muscles can get the most out of an exercise session! I did some revision about fractured NOF's and fracture healing to make sure I know about any risky positions/movements that shouldn't be done,etc.

week 4

last week I saw the patient with osteoporosis, he was given permission by his surgeon to weight bear on both his legs and through his elbow but not through his wrist just yet so I had to get him up onto a pulpit frame after being in a wheelchair for 6 weeks! I was feeling very nervous about it for lots of reasons, mainly because I dint want him to fall and refracture anything and because I had never been faced with this situation before. However I went over all the safety aspects about getting this patient up and walking with my supervisor beforehand which put things into perspective and decided there probably wasnt much harm in being overly safe! I thought I explained all the saftey aspects well to the patient but could have checked the patients understanding a bit better especially as the patient is keen to rush his rehab and requires lots of prompting in regards to saftey. I felt I monitored how the patient was feeling ( pain, dizziness, etc) during the walk effectively and started to feel slightly more confident towards the end of the session. I thought overall it went well but I needed to speak up a bit more and take control such as by giving the patient constructive feedback and this way I think I'll feel more confident.

week 3 - 2 posts

1. Last week I came across a bit of conflict with a patient! The patient felt that the exercises being done were not doing much in terms of strengthening and had unrealistic expectations about his recovery and how much we could do with him in terms of physio. As he has osteoporosis and many fractures, I had to explain to him the level of exercise we were doing is appropriate to the stage he is at in terms of bony healing,etc and because he is NWB, options for exercises have to be limited somewhat. I think when explaining this to him I could've communicated a lot better and made my explanation short and simple but instead did not explain it in terms that were clear, this resulted in the patient becoming slightly frustrated as I did not explain myself well. I spoke to my supervisor and shortly after went back to the patient and I found I explained everything much more effectively than I did before and this seemed to ease most of the patients concerns. I definately learnt from it as if I had communicated better the first time the situation would probably have not come about although I also learnt you have to be understanding of what a patient may be going through personally and to not always attribute it to something you may have done!

2. I met a 54 year old patient who had recently suffered a stroke and had quite severe expressive dysphasia but could understand everything being said to him (which I soon discovered after speaking to him a little too slowly and got a funny look back!). I found it difficult at first to establish signals or actions with the patient that he could use to communicate where pain was, etc. I found I had to ask very short, simple questions to communicate effectively and to get yes or no answers from the patient just to get a baseline for how the patient was feeling that day. So communicating with him was challenging! I also briefly went through a neurological assessment with my clinical tutor which we haven't covered yet so it was very interesting to go through but I also struggled to carry it out for this reason and did not feel very confident!
Overall I thought I could have developed a bit more of a rapport with the patient before conducting the assessment and am going to observe another physio with this pt to see how to go about communication.