Final Entry

Five weeks at Osborne Park Hospital on the stroke and general rehab ward are over and I’m pleased with my efforts over this time, but glad that it’s over. I found this placement to be a very beneficial one, as I predicted in my initial entry and feel that I’d be performing at a graduate level for working with stroke patients. I believe that most of my initial entry predictions were fairly true and I definitely started off pretty nervously, but I certainly grew into the position as time progressed and become more and more confident that I could handle the different scenarios that were thrown my way. I found I was able to call on my knowledge from PHTY 314 pretty well, although at times I was able to call on the knowledge but not able to put it to good use with my treatment, which I was disappointed in. My supervisor identified this as well, so I will definitely be making a greater effort in the future to know clinical implications or relevant treatment techniques for situations where I am able to identify specific abnormalities about a patient. Overall though, I was very pleased with how I performed on this placement.

My predictions about the nature of the placement were close to spot on, where I started off with a smaller case load and more supervision and progressed in the final weeks to a larger more complex case load with minimal supervision. For example, in my first week, I would see on average around 4 patients per day, consisting of 2 stroke unit and 2 general rehab patients. My stroke patients had all been on the ward for quite a while, but my tasks in the first week were to conduct initial assessments on them as if they were new admissions. This was also done with my supervisor present. By the end of the placement, I was generally seeing 3 or 4 stroke patients and 3 or 4 general rehab patients a day, plus attending up to 2 meetings a day, so my case load increased significantly, meaning that my time management skills had to improve as well, which they certainly did. In my final weeks, I was entrusted to perform initial assessments independently, which was a good indicator for me of my growth over the placement.

I had 2 supervisors for this placement, 1 for my stroke patients and 1 for my general rehab ones. Both made sure that my progress was tracked well along the guide for the placement that has been provided on blackboard. It was very well set out and focussed initially on assessment techniques, then on treatment techniques in the 2nd week and on improving and progressing these areas in the final weeks. This was shown by the SOAPIERs that I had to hand in at the completion of my first 2 weeks. The first was quite short and focussed more on the objective assessment and then analysis sections. While the second that I handed in was almost 3 times as long as it was much more detailed in the O and A, but also included a comprehensive plan, intervention and evaluation. My supervisors told me at this point that my growth and improvement were fitting in well with the placement guide and their expectations of me. One of the things that was very much consolidated in my mind during this placement was the importance of accurate assessment. I learnt that through a thorough and effective assessment you can easily identify what the patient needs help with, consequently making your treatment objectives very easy to identify. This is definitely something I will take forward with me into the future.

My prediction that I would feel like a part of the team as time progressed also turned out to be correct, which was demonstrated well in my final journal entry. It wasn’t just because I knew people’s name or that they knew mine by the end of the placement, it was the fact that I was able to make valuable contributions to the team, enabling better patient care for both my stroke and general rehab patients. The example I used in my third journal entry was a good one, where it was my confidence to feed my findings back to the medical team that enabled them to get a better understanding a patient’s thoughts and feelings and subsequently help manage her treatment the way she wished for it to be handled. Although on this occasion it wasn’t really a favourable outcome, as the patient essentially had decided to decline any further treatment, it was still a good lesson for the positives of an effective multidisciplinary team.

My initial concerns about starting a neuro placement were not a great issue in the end. As I previously mentioned, I felt I did well when recalling on required knowledge, but at times it was just the application of this knowledge that let me down. I didn’t really have any problems with my neuroanatomy because I found that an accurate assessment will outline your treatment goals irrespective of the anatomical site of damage in stroke patients. I also learnt that in a neuro setting, the patient will often have impairments that you as the physiotherapist cannot treat directly, but that we do have strategies that can help to reduce the implications of these impairments. For example, visual field defects, inattention, dysphasia and dyspraxia are all impairments that have considerable implications for providing treatment, but by identifying them, you can incorporate strategies into your general treatment to try reduce the impact of them. By being aware of them, you can use single commands for dyspraxia or encourage the patient to turn their head and be aware of the side where they may have visual defects or inattention. All of these things can be identified through simple assessment techniques, but play large parts in the structure and methods you use during treatment.

My final concerns about case load and time management, weren’t large issues in the end either. They both increased and improved pretty naturally as I became more confident and familiar in the environment and developed good routines. For example, many of my general rehab patients would be in pain before physio treatment, so if they were written up for pain relief medication then I would advise them to get some to enable rehab effective time with me. I learnt that by checking on the patient and their pain levels 20-30 minutes prior to your scheduled session time with them, you can get them to have the required relief and come back when it has begun to act. This minimises the amount of wasted time spent waiting for the patient’s pain levels to be manageable. In the time in between I could either see another patient or write up my notes. It was little things like this that I picked up over the duration of the placement that improved my time management.

The initial concern of supervision also proved to be something I need not have worried about. Both of my supervisors were always there to lend support whenever I needed it, but at the same time left me to be quite independent as soon as they felt I was capable. I mentioned previously that the level of supervision was initially very high, which was good while I found my feet, but then as time progressed I saw more and more patients on my own. I felt I handled these situations well, but was also able to call on assistance whenever I felt I needed it, which was good for my development as a student therapist.

At the end of the 5 weeks at Osborne Park Hospital I am pleased with my performance on the stroke ward, but I am also glad that it is over. I found it to be pretty challenging and a different environment and certainly different patients to what I was used to. At times I found it hard when I was seeing such little progress with my patients because of the extent of their impairments. I found it even harder when patients that had worked so well for an extended period of time, only to move backwards in terms of their rehab status. This was the case with one of my patients who was almost ready for discharge, when they had another stroke in my final week and subsequently were set back a long way. I suppose I just have to get used to difficulties such as this being present in areas of the physiotherapy and general health care line of work. It also continues to surprise me how tired I am at the end of a working week, but I am slowly getting used it. I will certainly enjoy some quieter time this week plus extra time to prepare for my next placement.