SITUATION
I have a female client who is recovering from a right sided CVA. Her left side is affected (upper limb more so than the lower limb). The stroke occurred approximately 4 months ago. Her left arm has no functional movement and is supported by a sling, however her left leg has had some recovery and she is able to ambulate with a quad-stick approximately 50 metres. This client is not safe to ambulate by herself, and must have somebody to walk with her and assist. She has decreased control of her left foot, creating a high falls risk situation as she cannot always place it in the correct spot on the floor. This client has been slowly improving using the quad-stick and one of my supervisors suggested we try a pulpit frame instead.
TASK
I had to assist this client to transfer from her bed into a wheelchair. Once we were out in the main corridor there was another transfer to perform as the client stood up and held onto the pulpit frame. I then had the task of assisting her to walk with the pulpit frame. This required two people (one each side of the client).
ACTION
I used verbal cues and minimal hands on assistance to help the client transfer from the bed to the wheelchair. I was more a “stand-by assist” in case she needed it. While the client is capable of performing this transfer, it is not always performed correctly and can be unsafe if nobody is there to help. Once in the wheelchair we went out into the main corridor. This was chosen so we had a long, straight distance to practice walking with the pulpit frame. I helped her stand up from the chair (with minimal hands-on assistance) and hold onto the frame. I then went through where the brakes were and how to use them. As this client’s left arm has no movement, I had to help steer from my side. I was also trying to help her place her left foot in the correct spot.
RESULT
Ambulating with the pulpit frame was difficult for this client as she could not see where her left foot was being placed. As she has decreased awareness of where this foot is in space she normally relies on her vision to know where to place it while walking. When she could not see her foot she had difficulty putting it in the right spot, and it was often placed too close to the midline. This was unsafe as it could cause her to trip, resulting in a fall. There were a few times her right foot was caught behind her left foot. The client managed to walk approximately 20 metres with the frame.
EVALUATION
I didn’t think this was particularly successful as it did not feel safe for the client. While there were two people there to assist her there was only very small risk she would fall. It would not be possible for her to do this by herself. Due to this, I do not believe it was a functional task. It may have improved her gait pattern (particularly the swing-through of her right left) but when the client returns to the quad-stick I don’t think it would have made much of a difference to her gait. There is more of a chance of this client walking independently with a quad-stick than a pulpit frame so I think it would be better to spend time practicing with the stick. My other supervisor agreed the pulpit frame may not the best option as the client has difficulty when she cannot see her foot. This supervisor suggested sticking to the quad-stick. My other supervisor (who suggested trying the pulpit frame) thought it would be worth pursuing this option and spending time practicing. As this lady is my client it was ultimately up to me, however I found it confusing with my supervisors saying different things. Both had good reasons for what they said, however I spent time thinking of my own reasons (both for and against) each mobility aid. In the end I decided to stick with the quadstick. Some of my reasons were as follows:
1. It is likely to be more functional for the client in the long-term (important for her discharge)
2. Often I am working with the client by myself and it could be difficult to find someone else to help (as it needed one person on each side)
3. The client said she didn’t like the pulpit frame as she couldn’t see where to put her foot (and the client’s opinion is very important)
4. The pulpit frame did not seem like the safest option
STRATEGIES
In the future when I have supervisors suggesting different ideas there are a few strategies I can utilize to help me make my own decision. I think these strategies also apply in situations where a supervisor suggests a treatment idea and I have a different idea of how to treat the client. The strategies are:
1. Research: I can research the topic and see what evidence there is. I would feel more confident with my choice if I have evidence to back it up.
2. Pros and Cons: I think making a list of reasons for and against all the options or choices is a good idea. It certainly helped me make my decision in this situation.
3. Client: Asking the client what they would prefer. It is also important to find out why the client chose a particular option (as their reasoning may be very different from yours!)
Saturday, February 27, 2010
Sunday, February 14, 2010
Week 1
SITUATION
I am currently on prac at a rehab place and every morning a general exercise class is run by the physio assistants. I was asked to watch a class while the physio assistant was in charge, with the plan being for me to run it one day a week (on Wednesdays) from then on. I have had lots of experience running classes (both from previous prac placements and part time jobs) so I wasn’t too worried about it. I watched the first class which consisted of basic exercises with a warm up and cool down. I thought I would then have a week to prepare for the class I was going to run and was going to come up with a plan of what I would do. The following day however a different physio assistant asked if I could run the class for her as she had something else important to do. I agreed and felt fairly confident I could do a good job of it. I still had clients to see that morning before the class, so I didn’t have much time to plan for it.
TASK
I had to run a general exercise class aimed at an older age group of clients. I had a fair bit of equipment to choose from (such as therabands, dumbbells, noodles and balls). The class was chair-based, so all of my exercises had to be performed sitting down. It was a general exercise class with the aim of overall conditioning and rehab, rather than focusing on specific conditions (as the clients were quite varied). The class was approximately an hour long.
ACTION
I didn’t have much time to plan for the class so I quickly wrote down all the warm-up exercises I could remember from watching the previous class. These included things like marching in the chair, shoulder shrugs and knee extensions. I planned to keep that piece of paper in my lap during the class so I could refer to it in case I forgot what to do next. I then looked through all the available equipment. The physio assistant had used therabands the day before so I needed to find something different. I chose dumbbells as it was fairly easy to come up with exercises for that equipment. I also used two balls with soft spikes (for easy grip) and a set of quoits. I used the balls in an exercise where they are passed around the circle from person to person above their heads and we played a game of quoits at the end where the spoke was set in the middle of the circle.
RESULT
The class started off well as I ran through the exercises I had written down for the warm up. It was going well until I ran out of exercises! The ones I had written down did not take as long as I thought they would, and I had time to spare. I thought of some exercises on the spot but couldn’t think under the pressure and moved on from the warm up to the main exercises with the dumbbells. Again, these exercises did not take as long as I thought they would. I thought about doing a greater amount of repetitions for each exercise but the participants in the class were getting tired and could not handle it. I changed over to the ball-passing game and after passing the two balls around the circle four or five times it was time to move on. We played a few rounds of quoits and the group was having so much fun with it I continued with this, filling in time before the cool down. For the cool down I ran through some basic stretches and breathing exercises and finished the class right in time for lunch.
EVALUATION
I thought the class was successful and ran fairly smoothly. I received positive feedback from the participants who said they loved the new games and ideas. I was glad they had enjoyed it as sometimes it is hard to convince them to come to the class. If they consider it a fun activity rather than an “exercise class” they are more likely to want to come. I found it a little stressful trying to think of ideas of exercises on the spot. My weakness was definitely not working well under the pressure, however I believe my strength was not getting flustered. I continued on with what I had planned and went with what worked (such as running the quoits game longer than I had planned). I was glad I had written things down however I should have thought of more exercises prior to the class. The class did run for the required time and the participants enjoyed it and had a good work-out so overall it was a success.
STRATEGIES
In the future I will have a whole list of exercises written down, and make sure I have more ideas than I think I will need! I have also thought of some games (such as balloon volleyball) to make the classes more enjoyable so the participants can have fun while still exercising. I will continue to seek feedback from the group so I can make the class more appropriate for them and their needs.
I am currently on prac at a rehab place and every morning a general exercise class is run by the physio assistants. I was asked to watch a class while the physio assistant was in charge, with the plan being for me to run it one day a week (on Wednesdays) from then on. I have had lots of experience running classes (both from previous prac placements and part time jobs) so I wasn’t too worried about it. I watched the first class which consisted of basic exercises with a warm up and cool down. I thought I would then have a week to prepare for the class I was going to run and was going to come up with a plan of what I would do. The following day however a different physio assistant asked if I could run the class for her as she had something else important to do. I agreed and felt fairly confident I could do a good job of it. I still had clients to see that morning before the class, so I didn’t have much time to plan for it.
TASK
I had to run a general exercise class aimed at an older age group of clients. I had a fair bit of equipment to choose from (such as therabands, dumbbells, noodles and balls). The class was chair-based, so all of my exercises had to be performed sitting down. It was a general exercise class with the aim of overall conditioning and rehab, rather than focusing on specific conditions (as the clients were quite varied). The class was approximately an hour long.
ACTION
I didn’t have much time to plan for the class so I quickly wrote down all the warm-up exercises I could remember from watching the previous class. These included things like marching in the chair, shoulder shrugs and knee extensions. I planned to keep that piece of paper in my lap during the class so I could refer to it in case I forgot what to do next. I then looked through all the available equipment. The physio assistant had used therabands the day before so I needed to find something different. I chose dumbbells as it was fairly easy to come up with exercises for that equipment. I also used two balls with soft spikes (for easy grip) and a set of quoits. I used the balls in an exercise where they are passed around the circle from person to person above their heads and we played a game of quoits at the end where the spoke was set in the middle of the circle.
RESULT
The class started off well as I ran through the exercises I had written down for the warm up. It was going well until I ran out of exercises! The ones I had written down did not take as long as I thought they would, and I had time to spare. I thought of some exercises on the spot but couldn’t think under the pressure and moved on from the warm up to the main exercises with the dumbbells. Again, these exercises did not take as long as I thought they would. I thought about doing a greater amount of repetitions for each exercise but the participants in the class were getting tired and could not handle it. I changed over to the ball-passing game and after passing the two balls around the circle four or five times it was time to move on. We played a few rounds of quoits and the group was having so much fun with it I continued with this, filling in time before the cool down. For the cool down I ran through some basic stretches and breathing exercises and finished the class right in time for lunch.
EVALUATION
I thought the class was successful and ran fairly smoothly. I received positive feedback from the participants who said they loved the new games and ideas. I was glad they had enjoyed it as sometimes it is hard to convince them to come to the class. If they consider it a fun activity rather than an “exercise class” they are more likely to want to come. I found it a little stressful trying to think of ideas of exercises on the spot. My weakness was definitely not working well under the pressure, however I believe my strength was not getting flustered. I continued on with what I had planned and went with what worked (such as running the quoits game longer than I had planned). I was glad I had written things down however I should have thought of more exercises prior to the class. The class did run for the required time and the participants enjoyed it and had a good work-out so overall it was a success.
STRATEGIES
In the future I will have a whole list of exercises written down, and make sure I have more ideas than I think I will need! I have also thought of some games (such as balloon volleyball) to make the classes more enjoyable so the participants can have fun while still exercising. I will continue to seek feedback from the group so I can make the class more appropriate for them and their needs.
Sunday, February 7, 2010
Initial Entry - Carinya
When I first found out I was going to Carinya for my first placement I was nervous as I had never heard of it before and there were so many unknowns. I thought that if I found out more information I’d feel more comfortable and prepared. Using the clinical mix form, information from the placement and information from talking to the clinical ed team and previous prac students, I came up with the following expectations:
1. I think Carinya is a rehabilitation place for people who have been discharged from hospital and aren’t quite ready to go home, but are too good to stay in hospital. Carinya is a place where they can continue their rehab and still receive care.
2.For this reason I expect to do a lot of rehab and discharge planning. I know previous students have had lots of fracture rehab so I expect my patients will be similar. I am also expecting stroke rehab, and anything neuro related (as this is classed as a neuro placement).
3.The staff are really friendly, supportive and knowledgeable. I was concerned that they would expect me to know everything and manage on my own but other students have said the staff are helpful and understand we are students. I am prepared to put in the work and brush up on anything I have forgotten! It sounds like the staff will facilitate the practical side of my learning if I know the theory.
4.As a student I will be left to deal with my own patients a fair bit. I have the understanding I will have my own patients (and see around 6-7 per day by the end of placement) as well as run classes. I have had lots of experience running group classes (generally rehab ones) from previous placements so I am not worried about this.
5.As a student I think my role will be to carry my own caseload and run classes. I imagine I will be attending discharge planning meetings. I plan to make the most of this placement and learn as much as I can from my supervisor and other clinicians working there. I may see some unusual conditions I haven’t dealt with before (especially on the neuro side of things) so it would be great to learn from their experience.
I also have some concerns. Hopefully these will be addressed quickly at the start of the placement to ensure it's smooth sailing for the 5 weeks. My concerns are as follows:
1.I am not sure if there is a whole allied health team working at Carinya. It would make sense if there was, and I am prepared to work within a multi-disciplinary team (MDT) but I will have to wait and find out. I have worked in an MDT while on previous placements so have experience with this. It’s all about communication and being prepared before team meetings so you have something to offer. As I am expecting to do a lot of discharge planning it would be great to have input from other professionals aside from physios.
2.I am a little concerned I won’t see many neuro patients. I would really like the experience of treating neuro conditions as this is the only neuro placement I get.
3.I am not sure on the structure of Carinya or who works there. Hopefully this will become clear within the first week. From previous placements I know it’s not just the physios who can teach me something so it would be great to get to know everyone who works there and learn as much as I can from them.
4.I am concerned about finding my way around. It normally takes me awhile to get used to the place I’m working (slightly directionally challenged!) and sometimes it can be embarrassing when I get lost! I’ll pay extra attention during my orientation.
I am feeling confident and prepared for prac tomorrow. Once I know what type of patients I am seeing I can do some extra study on particular conditions. I am taking my notes and ILPs with me so I can look up anything I need to. I have gone over the areas I think I will need to know. I am feeling less nervous and now really excited about tomorrow.
1. I think Carinya is a rehabilitation place for people who have been discharged from hospital and aren’t quite ready to go home, but are too good to stay in hospital. Carinya is a place where they can continue their rehab and still receive care.
2.For this reason I expect to do a lot of rehab and discharge planning. I know previous students have had lots of fracture rehab so I expect my patients will be similar. I am also expecting stroke rehab, and anything neuro related (as this is classed as a neuro placement).
3.The staff are really friendly, supportive and knowledgeable. I was concerned that they would expect me to know everything and manage on my own but other students have said the staff are helpful and understand we are students. I am prepared to put in the work and brush up on anything I have forgotten! It sounds like the staff will facilitate the practical side of my learning if I know the theory.
4.As a student I will be left to deal with my own patients a fair bit. I have the understanding I will have my own patients (and see around 6-7 per day by the end of placement) as well as run classes. I have had lots of experience running group classes (generally rehab ones) from previous placements so I am not worried about this.
5.As a student I think my role will be to carry my own caseload and run classes. I imagine I will be attending discharge planning meetings. I plan to make the most of this placement and learn as much as I can from my supervisor and other clinicians working there. I may see some unusual conditions I haven’t dealt with before (especially on the neuro side of things) so it would be great to learn from their experience.
I also have some concerns. Hopefully these will be addressed quickly at the start of the placement to ensure it's smooth sailing for the 5 weeks. My concerns are as follows:
1.I am not sure if there is a whole allied health team working at Carinya. It would make sense if there was, and I am prepared to work within a multi-disciplinary team (MDT) but I will have to wait and find out. I have worked in an MDT while on previous placements so have experience with this. It’s all about communication and being prepared before team meetings so you have something to offer. As I am expecting to do a lot of discharge planning it would be great to have input from other professionals aside from physios.
2.I am a little concerned I won’t see many neuro patients. I would really like the experience of treating neuro conditions as this is the only neuro placement I get.
3.I am not sure on the structure of Carinya or who works there. Hopefully this will become clear within the first week. From previous placements I know it’s not just the physios who can teach me something so it would be great to get to know everyone who works there and learn as much as I can from them.
4.I am concerned about finding my way around. It normally takes me awhile to get used to the place I’m working (slightly directionally challenged!) and sometimes it can be embarrassing when I get lost! I’ll pay extra attention during my orientation.
I am feeling confident and prepared for prac tomorrow. Once I know what type of patients I am seeing I can do some extra study on particular conditions. I am taking my notes and ILPs with me so I can look up anything I need to. I have gone over the areas I think I will need to know. I am feeling less nervous and now really excited about tomorrow.
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