Stares 2 rotation 3

Stares 2 rotation 3

Situation:

Mr J was my first patient from admission, during my first week at Carinya. He was an 81 yo male, three months post CVA (stroke). He had extensive left sided involvement. His main problems were impulsivity, left neglect, poor coordination and timing, as well as poor balance. He was functioning independently, despite looking a little unsafe. To achieve his goal of returning home, I decided the main areas of therapy focus should be improving safe, functional, independent mobility and ambulation. In this reflection will review my treatment planning and execution over the first two weeks of Mr J’s rehab.

Task:

Rehab this patient aiming for the optimal goal of returning home. As this was my patient from his admission this would involve laying the foundations of his rehab program at Carinya.

Action:

Rather than form a comprehensive treatment plan, the document I filled out on assessment was more of an overall look at what I planned to address. As I had no clear frame work to follow, I tended to formulate treatment plans daily. Although I feel I had many fresh ideas, they would usually come to me sporadically and I would try them out for something different as I went along. This meant Id often changed treatment aims from one day to the next or even within the one session. One day I might be doing some strength work, followed by some balance work, the next day Id focus the whole session on something functional such as a transfer or ambulation.

Result:

By the start of the third week I started to feel as though I was running out of new Ideas and I had to go back and revisit some of the old activities I had done. I also began to feel that the patient did not have much of a sense of achievement or progression.

Evaluation:

As Mr J was very impulsive and was always excited to try anything new, I feel I was spurred on to try new things all the time for fear of the sessions becoming boring. In hind-sight, this may have been to the determent of the patient. The sessions lacked direction and flow. Now, although I feel the patient has progressed, I feel he has a decreased sense of just how far he has come.

Strategies:

· Formulate long term and short term goals in the initial treatment plan, rather than general goals.

· Further refine this in your own notes breaking down goals into daily, weekly and monthly aims. -Perhaps using a grid style document to achieve this.

· Have one particular focus for each session.

· Make some aspects of the program documentable on a daily basis, some sort of quick test such as distance cycled in a certain time on stationary bike or distance of functional reach test.

Stares 1 rotation 3

Stares 1 rotation 3

Situation:

I had been given a patient who was in her last three weeks of rehab. I was told to follow on from the previous therapist who had been in looking after Mrs R. According to her program plan Mrs R’s main problems were independent mobility and endurance with ambulation. The aim was to address these problems with the aim of discharge home. I had seen this patient twice at this stage, with her husband present. Mrs R was fairly obliging during these sessions although did complain of pain. Her husband was very supportive, providing Mrs R allot of encouragement.

Task:

Continue rehab of Mrs R with the goals of increasing independent mobility and ambulation.

Action:

Third day of therapy: Went into see Mrs R, her husband was not present as he had renovations to attend to at their house which would last two weeks. Mrs R she flatly refused to move from her room, saying she was in far too much pain to do anything. I accepted this planning to come back the next day.

Fourth day of therapy: I received much the same response as the third day. I sought advice from my supervisor who told me that Mrs R was very hard to get motivated at times, particularly when her husband was not present. She also told me that there was nothing physically wrong with her that could explain her reluctance to engage in rehab.

Fifth day of therapy: Mrs R refused again when asked if she would come to the gym for exercise or go for a walk, however after much encouragement agreed to do some work within her room. Once I was able to get Mrs R started on her exercises in her room, she then agreed to come for a walk and we were able to do a full session of rehab.

Result:

Two days of rehab had been wasted. It is more than likely that all the mobility Mrs R had done in the two days she was not seen was walk 10 m to the dining room and back for her meals. Though I do not think the patient regressed, she certainly didn’t progress in the two days with no therapy. On top of this, once she became engaged in the therapy she actually enjoyed it, asking if I could come by tomorrow.

Evaluation:

It is my opinion that I perhaps did not know enough about this patient in the first place to know how hard to push her. However, I should have sought advice from the start, rather than letting the patient go for two days without therapy. Reflecting on the type of patients the facility takes on, I think this will not be the only time I will come across this type of patient on this rotation. I think I need to be more firm with these types of patients in the future. In the end this lady actually enjoyed her session in the end, as well as bringing her a little closer to her goal of returning home.

Strategies:

· Invest more time communicating the importance behind the therapy.

· Tap into the goals of patients and use to engage them.

· Develop a clear plan with goals. Present the plan to the patient so that they can see what needs to be achieved to reach their goals.

· Invest in stakeholders – In this case I could have contacted the husband.

Initial entry rotation 3

Initial Entry

Having gone to a placement in an acute setting in a tertiary hospital, and a community setting I am excited to see what things I will learn from a transitional care facility such as Cariniya.

From what I understand so far, Carinya provides permanent high care beds as well as transitional care service (TCS) beds to frail and elderly people. The Physiotherapy department has an ongoing (group based?)program in place as well as individual programs for residents. I suspect the main aims of these programs would be to optimise and maintain the residents’ physical mobility and fitness.

I only have one main concern at this stage. That is some of my peers and one supervisor at my last prac have given me some negative impressions about the prospect of going to a ‘nursing home’ for this rotation, however I am still optimistic about the placement. As a prospective new graduate it is my thinking that, with our aging population, it is likely that these types of positions will become very important in the future for physiotherapists. Therefore it is important for me to have a good understanding of how these facilities are run. This rotation will provide me with that opportunity.

In addition to this, I believe this placement will give me the opportunity to cement some of the important knowledge I have already gained this year. In particular, communication with older adults, making exercise fun and engaging, confidently running group situations and liaising with HCPs from other disciplines.

In my time at Carinya, I would like to further develop my specialist gerontology skills. I imagine as a base line, I will be expected to know how to professionally and successfully conduct both subjective and objective gerontology assessments, as well as some basic treatments. I hope to build on these expectations on this rotation by achieving the following skills: Accurately prioritising gerontology assessment (S and O), detailed analysis of patients’ impairments, activity limitations and participation restrictions, a well as taking a more holistic approach to treatment planning.

I hope that in going on a rotation at Carinya, where the patients are not acute, I will get the opportunity to do allot of my work independently as I know that I work best when I am forced to problem solve through situations as they arise, and am sometimes put off by having a supervisor looking over my shoulder. (Although I am aware this is a necessary part of assessment on occasion).

Overall, I am optimistic that if I have the right attitude towards the placement I hope I can get allot out of it. I am looking forward to Monday to see exactly what type of case load and responsibility I will have at Carinya.