Final Entry

After a hectic five week placement, I have definitely learnt a lot. The placement was a lot more than I anticipated and I was quite overwhelmed particularly within the first week. However, by third week I was more comfortable and adapted to the environment as this was the first clinical placement I had at a hospital.

I was given my own patient case load and became the primary physiotherapist for these patients as opposed to taking more of a therapy assistant role. As a result of my hands on experience, I became more aware of patient needs and was able to build my communication skills as the weeks progressed which allowed me to develop a greater rapport with my patients.

My communication skills also developed as I participated in multidisciplinary team meetings and was able to provide input to patients and become involved with discharge planning.

I learnt how to perform ortho-geriatric initial assessments effectively and safely, as well as implement treatment plans for patients based upon initial assessment. My documentation skills also improved as I began documenting my assessments and treatments in a formal manner.

I found that I had an issue with time management and found it difficult to organize my patient load as my plans never carried through, and I learnt to deal with adjusting them.

Overall, it was a good educational experience, particularly as I had never been in a hospital environment before and I was unsure what to expect. I learnt a lot about different treatment ideas, how to manage patients (particularly when they refuse physio), and how to liaise with other multidisciplinary team members.

Week Five

S: This week I was presented with a 74 yr old female with a right dynamic hip screw 13/8 after a #NOF following a mechanical fall. The patient had a history of CVA, dysphasia, dementia, and a previous left hip and right knee replacement.

T: My task was to perform an initial assessment on the patient as she arrived to the ward

A: I gathered all the required information for the subjective from the patient notes and proceeded with my subjective history. I then proceeded to perform an initial mobility review as well as an overall upper and lower limb strength and range assessment.

R: I was able to gain an idea of the patient’s history but not exactly how the fall happened due to the patient’s dysphasia and dementia. The upper limb range and strength were within normal limits. The patient’s right lower limb strength and range was less than the right, which was expected post op.

E: I found it very confronting to try and perform an initial subjective history on a patient with dysphasia and dementia. It was difficult for me to gain a rapport with the patient and find out details as the patient became very frustrated due to the dysphasia. I was able to complete the assessment but found it challenging.

S: I was able to establish through my initial assessment that the patient responded well to one stage commands during my assessment and employed these clear, simple commands throughout the remainder of my treatment sessions.

Week 3

S: This week I was given an 82 yr old female who presented with chronic bilateral back pain whilst hanging out the washing and upon examination it was found that the patient had bilateral pelvic fractures but with no history of falls. The patient had a history of cardiac failure and a failed L TKR which resulted in a fixed knee extension deformity. The patient also had a complex medical history of diabetes, anxiety and depression, low motivation, and was reluctant to participate in physio.

T: My task this week was to carry out a treatment session based on my initial assessment, which included improving the patient’s balance and ambulation

A: I had to use my communication skills to encourage the patient to participate in the physio session and explain the benefits of it. I explained that changes will take some time and tried to motivate the patient. Once I got the patient’s consent, I continued to encourage and reassure the patient during the session as she became very anxious and apprehensive.

R: The result of my communication to the patient enabled patient consent to physio and to participate in the session

E: Although I was able to gain consent from the patient, the physio session was not as productive as the patients apprehension and anxiety proved to be a large barrier towards treatment.

S: I was able to ask my supervisor for advice on how to manage a patient with low compliance and apprehension and employ these to encourage the patient.

Week One

S: This week I was given a 90 yr old male patient with a history of CRF and two AV replacements that needed rehabilitation after deconditioning as he had been hospitalised for the last 2 months. He was able to walk approximately 10m with a wheeled zimmer frame with one standby assist before fatigue.

T: My task was to perform an initial assessment of his mobility, muscle strength, muscle ROM, and balance in order to begin a treatment plan.

A: I performed the relevant assessments required using outcome measures to qualify my assessments. I used the Oxford scale for muscle strength, measure relevant muscle ranges with a goniometer and performed the Berg Balance Scale as an assessment for balance. To also assessed his static and dynamic sitting and standing balance and ambulation.

R: After carrying out these assessments, the patient received at least 3/5 for each relevant muscle regarding muscle strength, and a Berg Balance Scale of 40/56 indicative of a falls risk. He was safe in his static and dynamic sitting and standing balance

E: The main issue I had carrying out the initial assessment was during my Berg Balance testing. I found it difficult to ensure I was able to perform the assessment safely, and in particular, the latter parts of the assessment such as picking an object off the floor and reaching forward.

S: I asked my supervisor for assistance during those later parts of the Berg Balance assessment to ensure the safety of the patient and myself. I also was able to find out the best positions to place my body to ensure the assessment was safe and practice these throughout the week to build my confidence in performing the assessment and make sure I was being safe.