hey guys, i just started my musculoskeletal placement and it's been a really fun and enriching experience so far. i felt that it was quite a fair difference though moving from cardiopulmonary inpatients to musculo-o/p though and i suppose one of the main things is just that in cardio i/p we manage our time and arrange to see the patients whenever we please (of course taking into consideration things like lunch/investigations) but with musculo o/p we're more dependent on the patients coming to us.
just in the last week, i think the total 'no-show' and cancellations were more than 10 at the clinic i am doing my prac at. as a result, i was just thinking what we could do to decrease those numbers? for example, the patients are all given an appointment card in the first session but many fail to bring it or use it thus leading to them forgetting their appointment times for example. as a result, the number of 'do not attend' and cancellations increase. i was thinking then in the future if it would be feasible to maybe send alerts/messages to their mobiles to remind them of their appointment the day before? (perhaps through an automated program if there are any?) or if anyone has any ideas, please do share. thanks
Sunday, February 10, 2008
Another blog on importance of communication...
Hi everyone,
This week I have started my placement in Musculoskeletal. It has been a really interesting week with various different patient conditions coming up. My blog this week is on a patient who stood out to me and I learnt something from.
This patient was a 69 yr old male who presented with “excruciating pain” 9/10 at the lower buttock with referred pins and needles down his entire posterior leg. His aggravating factors were any loading positions such as walking or standing- his pain increased to 9/10 within ~2mins. At rest, he had a constant ache which was 2/10 pain levels. On Ax he had slight reduced ROM with significant hinging at L2-3- his pain symptoms were reduced with flexion & lateral flexion away from painful side (i.e. opening up the spine reduced symptoms), very hypomobile Lx spine (L1-L5) on PAIVM findings, normal neurological signs (power, sensation & reflexes) and +ve NTPTs.
After consulting my supervisor about his symptoms we diagnosed him as having an inflamed nerve at possibly L3/4 L4/5 which was causing his referred pins and needles as well as his severe levels of pain. This patient has been seen by various other health professionals prior to coming to us- including Doctors, various Chiropractors and an Occupational Therapist all which did not have any affect. The Dr however, had diagnosed him with possible sciata and booked him in to have injections into his facet joints 4 days later to help reduce his inflamed nerve. I wasn’t sure what the best way to treat this gentleman was, as I knew that his symptoms could change significantly after his injections. I decided that physical therapy would not help him at this stage so I decided to go with the management option and not actually treat him as such. I educated him about why he was getting the pain and strategies he can use to help relieve the pain (i.e. flexion to open up the area where the inflamed nerve exited). We spent awhile discussing this and he was so thankful that he finally understood what was going on with his symptoms and why he was getting the pain. He stated that of all the therapists he had seen no one had bothered to explain why he was getting the pain.
This experience showed me that communication with patients is so very important in explaining to them the causes of their symptoms. This post supports Bini’s post earlier and again highlights the importance that we as physiotherapists have in educating patients about their conditions and our role in helping them to regain function.
Hope everyone enjoys their next wk of prac- not long to go now :)
Debs
This week I have started my placement in Musculoskeletal. It has been a really interesting week with various different patient conditions coming up. My blog this week is on a patient who stood out to me and I learnt something from.
This patient was a 69 yr old male who presented with “excruciating pain” 9/10 at the lower buttock with referred pins and needles down his entire posterior leg. His aggravating factors were any loading positions such as walking or standing- his pain increased to 9/10 within ~2mins. At rest, he had a constant ache which was 2/10 pain levels. On Ax he had slight reduced ROM with significant hinging at L2-3- his pain symptoms were reduced with flexion & lateral flexion away from painful side (i.e. opening up the spine reduced symptoms), very hypomobile Lx spine (L1-L5) on PAIVM findings, normal neurological signs (power, sensation & reflexes) and +ve NTPTs.
After consulting my supervisor about his symptoms we diagnosed him as having an inflamed nerve at possibly L3/4 L4/5 which was causing his referred pins and needles as well as his severe levels of pain. This patient has been seen by various other health professionals prior to coming to us- including Doctors, various Chiropractors and an Occupational Therapist all which did not have any affect. The Dr however, had diagnosed him with possible sciata and booked him in to have injections into his facet joints 4 days later to help reduce his inflamed nerve. I wasn’t sure what the best way to treat this gentleman was, as I knew that his symptoms could change significantly after his injections. I decided that physical therapy would not help him at this stage so I decided to go with the management option and not actually treat him as such. I educated him about why he was getting the pain and strategies he can use to help relieve the pain (i.e. flexion to open up the area where the inflamed nerve exited). We spent awhile discussing this and he was so thankful that he finally understood what was going on with his symptoms and why he was getting the pain. He stated that of all the therapists he had seen no one had bothered to explain why he was getting the pain.
This experience showed me that communication with patients is so very important in explaining to them the causes of their symptoms. This post supports Bini’s post earlier and again highlights the importance that we as physiotherapists have in educating patients about their conditions and our role in helping them to regain function.
Hope everyone enjoys their next wk of prac- not long to go now :)
Debs
Saturday, February 9, 2008
Patient Education
Hello there :)
On recurring theme I have found in all my pracs, and brought to my attention by my last couple of supervisors is the importance of clear and consice education for patients on a number of issues. This message has been brought home again in my third placement, cardio inpatients on a medical ward. I have found that many paitents are interested in the assessments you are conducting, the treatments carried out and why, what exactly if wrong with them and what impact what you are doing will have on their condition. I have found that a lack of education on the physio's behalf can result in a flat-out decline of physio treatment from the patient, only for them to come around and be much more open when a simple explanation of the aforementioned topics is offered.
We have all learnt to include our patients in their treatment and to provide education and explanations as to what we are doing, and I really thought I was doing this adequately, and it was only after being specifically questioned by a couple of patients, both who were quite upset, that I realised I should be putting in some more effort. So I am now trying to make a concentrated effort to fully explain what the purpose of our physio sessions are and how this was benefit the patient, at least on the very first treatment session as I believe this builds rapport and increases patient compliance.
Cheers
Bini
On recurring theme I have found in all my pracs, and brought to my attention by my last couple of supervisors is the importance of clear and consice education for patients on a number of issues. This message has been brought home again in my third placement, cardio inpatients on a medical ward. I have found that many paitents are interested in the assessments you are conducting, the treatments carried out and why, what exactly if wrong with them and what impact what you are doing will have on their condition. I have found that a lack of education on the physio's behalf can result in a flat-out decline of physio treatment from the patient, only for them to come around and be much more open when a simple explanation of the aforementioned topics is offered.
We have all learnt to include our patients in their treatment and to provide education and explanations as to what we are doing, and I really thought I was doing this adequately, and it was only after being specifically questioned by a couple of patients, both who were quite upset, that I realised I should be putting in some more effort. So I am now trying to make a concentrated effort to fully explain what the purpose of our physio sessions are and how this was benefit the patient, at least on the very first treatment session as I believe this builds rapport and increases patient compliance.
Cheers
Bini
Patients with aphasia.
Hi all,
I begun a neuro outpatient clinic this week and just wanted to share some experiences to date with aphasic patients and maybe seek some solutions to communication difficulties.
A couple of my patients have suffered (L) TACIs with one of the impairments being aphasia (both receptive and expressive). Being the first session with the patients I have found it very difficult to communicate and establish that rapport that you need in the beginning. One 44 year old gentleman in particular was very frustrating. He had been coming to the clinic for 6 months and had established a long file of notes. In the file it mentioned his aphasia (mainly expressive) but did not mention his communication book that helps him to communicate. In the first session whilst he was on the tilt table, I attempted to start up some conversation and I could see that he was keen to communicate. I could understand much of what he was saying but I could also tell that there was much more that he wanted to say but just couldn't. I could see he was getting frustrated and often resorted to the loud expletive 'f#*k' every 10 sec or so. He kept on pointing to another room where he had left his bag, but I didn't think anything of this. Eventually I went and got his bag and he pulled out a communication book with pictures of varous aspects of his life. This immediately broke down much of the communciation barrier, and I started posing many questions related to his favourite football teams, family, former occupation etc. He became less frustrated and we had a great session with plenty of laughing.
On detailed examination of the notes it did mention the book earlier on but this was not really highlighted. So, what I learnt from this was experience was how important it is to thoroughly read the notes and put this information regarding the book in future transfer summaries. Also from my experience to date with these patients, I have often found that if you give them time to respond they can usually communicate what they want to say. I know one of the solutions to effectively communicating with these patients is to pose only closed questions to them, but are we as Physios denying them a chance of developing their communication skills?. If you have the time (such as when the pt is on a tilt table) then just be patient. It would be interesting to get some more ideas from a 'speechie' on this, so if anyone has sat in on a session with a 'speechie' and an aphasic patient please let us know.
Cheers
Nico
I begun a neuro outpatient clinic this week and just wanted to share some experiences to date with aphasic patients and maybe seek some solutions to communication difficulties.
A couple of my patients have suffered (L) TACIs with one of the impairments being aphasia (both receptive and expressive). Being the first session with the patients I have found it very difficult to communicate and establish that rapport that you need in the beginning. One 44 year old gentleman in particular was very frustrating. He had been coming to the clinic for 6 months and had established a long file of notes. In the file it mentioned his aphasia (mainly expressive) but did not mention his communication book that helps him to communicate. In the first session whilst he was on the tilt table, I attempted to start up some conversation and I could see that he was keen to communicate. I could understand much of what he was saying but I could also tell that there was much more that he wanted to say but just couldn't. I could see he was getting frustrated and often resorted to the loud expletive 'f#*k' every 10 sec or so. He kept on pointing to another room where he had left his bag, but I didn't think anything of this. Eventually I went and got his bag and he pulled out a communication book with pictures of varous aspects of his life. This immediately broke down much of the communciation barrier, and I started posing many questions related to his favourite football teams, family, former occupation etc. He became less frustrated and we had a great session with plenty of laughing.
On detailed examination of the notes it did mention the book earlier on but this was not really highlighted. So, what I learnt from this was experience was how important it is to thoroughly read the notes and put this information regarding the book in future transfer summaries. Also from my experience to date with these patients, I have often found that if you give them time to respond they can usually communicate what they want to say. I know one of the solutions to effectively communicating with these patients is to pose only closed questions to them, but are we as Physios denying them a chance of developing their communication skills?. If you have the time (such as when the pt is on a tilt table) then just be patient. It would be interesting to get some more ideas from a 'speechie' on this, so if anyone has sat in on a session with a 'speechie' and an aphasic patient please let us know.
Cheers
Nico
Wednesday, February 6, 2008
creepy patient
Hi all,
Throughout my four weeks in neuro OP I was treating a pt (~50 yo male) who had a R LACI approx 12 months ago. For the first few treatments there was the general chit chat that we have with most pt we see and he seemed like a really nice guy… after I’d seen him a few times he started with some offhand comments like “I’m really glad you’re my physio, your hands are so soft…” or “ you’re very nice to look at” and things like that, which I just kinda let go with a thankyou and didn’t think much more about it. Those sorts of comments kept coming over the next few sessions and I’d find that he’d stare at me while I was treating him, and I’d really have to try hard to make him concentrate on what he was doing instead of what I was doing and it started to creep me out.
He never said or did anything that was really inappropriate but it was just a feeling that I got about him and made me very conscious of how I was with him during treatments. I never felt unsafe or anything around him, and because the gym was open with no curtains or anything it was fine, but I guess because physio is very hands on and there is a lot of close contact that we have with patients sometimes, we just have to be careful about some patients like this who are a bit “friendlier” than most. Especially when we’re treating pts of the opposite sex we have to be very careful that they don’t get the wrong idea, and that there’s always someone else around that can see what’s going on if needed. I hope no one else has had a pt like mine!
Tara
Throughout my four weeks in neuro OP I was treating a pt (~50 yo male) who had a R LACI approx 12 months ago. For the first few treatments there was the general chit chat that we have with most pt we see and he seemed like a really nice guy… after I’d seen him a few times he started with some offhand comments like “I’m really glad you’re my physio, your hands are so soft…” or “ you’re very nice to look at” and things like that, which I just kinda let go with a thankyou and didn’t think much more about it. Those sorts of comments kept coming over the next few sessions and I’d find that he’d stare at me while I was treating him, and I’d really have to try hard to make him concentrate on what he was doing instead of what I was doing and it started to creep me out.
He never said or did anything that was really inappropriate but it was just a feeling that I got about him and made me very conscious of how I was with him during treatments. I never felt unsafe or anything around him, and because the gym was open with no curtains or anything it was fine, but I guess because physio is very hands on and there is a lot of close contact that we have with patients sometimes, we just have to be careful about some patients like this who are a bit “friendlier” than most. Especially when we’re treating pts of the opposite sex we have to be very careful that they don’t get the wrong idea, and that there’s always someone else around that can see what’s going on if needed. I hope no one else has had a pt like mine!
Tara
Tuesday, February 5, 2008
appropriate goal setting
Hi all,
I’ve finally completed my neuro placement last Friday and I was assessed on the new patient who I had two sessions with.
He had a ponto-cerebellar bleeding in 1989 and significantly deteriorated in Sep last year. His main issues are severe ataxia trunk and upper limb worse than lower limb, decreased tone in his UL&LL and poor righting/equilibrium reaction in both sitting and standing. Based on my assessment, I’ve started bed exercises including bridging, sit-ups, AI/RS in 4pt kneeling and arm/leg lift in 4pt kneeling. My plan was to improve sitting posture and balance prior to work on his standing balance and gait. After one and a half hours of exercises, he was totally worn out and was not able to continue the last exercise that I planned which was balancing in sitting on fit ball. Also, he told me that he would be on weekend leave in the afternoon, so he wanted to practice walking and stairs which was what he needed when he goes back home.
I realized that I should have discussed what patient’s priority is and integrated into what I think he needs to improve. I learned how important communication skills with patient are as well as between the staff which I posted about last week.
Hope everyone learned a lot during the placement and good luck with next one!
I’ve finally completed my neuro placement last Friday and I was assessed on the new patient who I had two sessions with.
He had a ponto-cerebellar bleeding in 1989 and significantly deteriorated in Sep last year. His main issues are severe ataxia trunk and upper limb worse than lower limb, decreased tone in his UL&LL and poor righting/equilibrium reaction in both sitting and standing. Based on my assessment, I’ve started bed exercises including bridging, sit-ups, AI/RS in 4pt kneeling and arm/leg lift in 4pt kneeling. My plan was to improve sitting posture and balance prior to work on his standing balance and gait. After one and a half hours of exercises, he was totally worn out and was not able to continue the last exercise that I planned which was balancing in sitting on fit ball. Also, he told me that he would be on weekend leave in the afternoon, so he wanted to practice walking and stairs which was what he needed when he goes back home.
I realized that I should have discussed what patient’s priority is and integrated into what I think he needs to improve. I learned how important communication skills with patient are as well as between the staff which I posted about last week.
Hope everyone learned a lot during the placement and good luck with next one!
Monday, February 4, 2008
Communication/Interpretation (Daria's Post)
Hi All,
During my neuro placement I have learnt how important is communication both verbal as well as written. There are many reasons for this such as benefit of patient, from the legal point of view, better team work and relations with other health professionals.
One of my patients is after PCI with severely impaired posterior circulation presents with very ataxic gait. This patient balance varies sigificantly from day to day or even during the same day, for example one day patient can maintain his static standing balance with eyes open then closed for 60 seconds, another day can not perform these tasks at all. I have noticed that patient's balance and functional level were generally worse after weekend as patient hasn't have chance to "experiance"/practice his balance and walking. Other factors that influence on patient's balance are mediacations, especially sedative ones that patient receives if he is restless and "significantly impaired memory"(assessment performed by OT).
The patient that I mentioned above is at a hospital ward therefore nursing staff rely on information regarding functional level of each patient provided by physio. Functional level assessment is assessed/reviewed on daily basis and has to be documented in the notes and on functional chart in a patient's room. Then any changes have to be handovered to nurse who looks after patient as well as to co-ordinator nurse. When I have assessed my ataxic patient functional level and I found his balance deteriorated a lot that I wasn't able to walk him on my own (for mine and my patient safety) I asked another physio student to give me hand. After session I have reported my concern about patient's balance to medical staff.I documented in notes my assessment, findings and changes in functional level then I changed information on functional chart in patient's room ( ambulation: 2 A max). I was very suprised when I showed/informed coordinator nurse and I found that her interpretation was different to what I meant. When I have written "ambulation: 2 A max" (this is commonly used abbrivation used on this ward) I meant that patient can ambulate with maximun assistance from two staff members. The nurse understood that patient needs assistance maximum two staff members ( can be less than two but not more than two). It was good lesson!
Daria
During my neuro placement I have learnt how important is communication both verbal as well as written. There are many reasons for this such as benefit of patient, from the legal point of view, better team work and relations with other health professionals.
One of my patients is after PCI with severely impaired posterior circulation presents with very ataxic gait. This patient balance varies sigificantly from day to day or even during the same day, for example one day patient can maintain his static standing balance with eyes open then closed for 60 seconds, another day can not perform these tasks at all. I have noticed that patient's balance and functional level were generally worse after weekend as patient hasn't have chance to "experiance"/practice his balance and walking. Other factors that influence on patient's balance are mediacations, especially sedative ones that patient receives if he is restless and "significantly impaired memory"(assessment performed by OT).
The patient that I mentioned above is at a hospital ward therefore nursing staff rely on information regarding functional level of each patient provided by physio. Functional level assessment is assessed/reviewed on daily basis and has to be documented in the notes and on functional chart in a patient's room. Then any changes have to be handovered to nurse who looks after patient as well as to co-ordinator nurse. When I have assessed my ataxic patient functional level and I found his balance deteriorated a lot that I wasn't able to walk him on my own (for mine and my patient safety) I asked another physio student to give me hand. After session I have reported my concern about patient's balance to medical staff.I documented in notes my assessment, findings and changes in functional level then I changed information on functional chart in patient's room ( ambulation: 2 A max). I was very suprised when I showed/informed coordinator nurse and I found that her interpretation was different to what I meant. When I have written "ambulation: 2 A max" (this is commonly used abbrivation used on this ward) I meant that patient can ambulate with maximun assistance from two staff members. The nurse understood that patient needs assistance maximum two staff members ( can be less than two but not more than two). It was good lesson!
Daria
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