Final Entry

My 5 weeks at Fremantle Hospital were tiring, but a great learning experience for me. As with all my previous placements I started off pretty nervously and tended to stand back initially, but as time progressed I became more confident and took on more and varied roles and duties. I had one main supervisor for the placement, however I got to spend time on many different wards and subsequently spent time with a number of different physios working on the wards, which was great to learn and get varied opinions and treatment styles from the different people I was working with.

My initial comments about a more thorough preparation for this placement compared to others turned out to be spot on and I feel that because I did have a good grasp on the theory component I was able to make better clinical reasoning judgements. My solid preparation this time around empowered me to show my supervisors my full potential both from a practical and theoretical standpoint. A nice gesture from my supervisor was being complimented a number of times on my sound theoretical knowledge of the cardiorespiratory system that is applicable to this domain of physiotherapy, which was pleasing and rewarding to hear.

I ended up working in a number of the different areas that were listed in the orientation outline. The majority of my time was spent on the general medical ward, but I also saw at least one patient from each of general surgical, cardiothoracics, intensive care unit and haematology and oncology. I had to approach my patients on these different wards all the same way, it was just that the scope of patients varied from ward to ward with exactly what they were presenting with. As I predicted in my initial entry, things did start off slowly with more supervision and progress to less supervision and more patients under my case load. I was also introduced to the “peer-coaching model,” in which I was paired with Monique and for most of the first week we saw all the patients together. This worked really well I believe, because it enabled us to develop our own styles but also observe how the other was going about things. Monique and I were a good team, constantly encouraging each other but also offering constructive criticism when it was due. One of our strengths while we were working together was that after assessing each patient we decided we would leave the room to discuss a prioritised problem list and treatment goals before actually providing the treatment. I found that this thinking out loud, discussion and planning worked really well and we were able to provide the appropriate management for each of our patients and provide good quality treatments.

After the first week where we were paired together, Monique and I were split up and given our own patients. Initially we were seeing around 4 patients a day, but as time progressed and we became more efficient with our patients, we were able to see 9-10 patients per day by the end of the placement. As the placement went on I also feel that I was contributing more to the multidisciplinary team. For example liaising with the medical team about how a patient was progressing towards their pre-admission level of mobility and nearing discharge, which was something I developed during the placement, whether it was by phone or in person. Towards the end of the placement I was also attending more team meetings and giving input to the team about my patients, where I initially was not doing this as much as I wasn’t too sure about where I stood as a member of the team. This was something I’m very glad I developed from this placement, as I wrote about in my third entry.

I wrote in my initial entry that I was concerned about my time management skills in a clinical situation and how I would cope with a large case load and initially I did struggle with this. I found myself leaving late at the end of the day and having less time for lunch. When this happened a few days in a row I went to my supervisor to tell him about my problem and asked if he had any suggestions that would help me. He was really helpful and we had a pretty long discussion about a lot of it just being an experience factor and it would be something that I would just pick up, but he still offered me some solutions. He suggested that when I get my patient list in the morning that I prioritise it and then plan my day on a time sheet. In doing this, he suggested that I should allocate certain amounts of time for each patient and then not run over this time. That night I created a blank timetable on the computer and made copies to use. From this point on I immediately saw a difference in the number of patients I was seeing when using my timetable and I didn’t have too many more late finishes either, which was good. I was very pleased with my own growth and development in terms of my ability to manage a large case load and do it effectively, but also efficiently over the course of my placement at Fremantle Hospital.

My other pre-placement concern about the practical application of some techniques didn’t end up posing a problem. I was exposed to all the examples that I mentioned (percs and vibes, suctioning, mechanical ventilators and patient lines and attachments) initially either with my supervisor or with Monique, so I was quickly able to get a good grasp on how to do those sorts of things. Monique and I had a patient with bronchiectasis, who had lots of difficulty clearing her secretions independently. We decided on percussion for a treatment technique. The woman informed us that her husband had performed it on her for the past 30 years and she knew what worked well for her and she was able to tell us so that we were able to emulate this and subsequently were able to clear large amounts of sputum daily with this patient. The point I took from this is that often patients know what works well for them and what doesn’t and that within reason it’s always worth listening to and considering the patient’s response when ask them what they do want. After seeing this patient I tried to ask all my future patients if they had previously received treatment and if so what and how was it performed? I found this worked well, particularly with things such as percs and vibes which can tend to administered very differently from patient to patient.

Finally, I was pretty quickly able to develop a tolerance to constantly seeing sputum. Although I will admit that there were a few uneasy moments early on in the placement when getting patients to clear their sputum and then inspecting it to classify it, but it was nothing that a few deep breaths couldn’t resolve.

All in all I found this placement to be very beneficial to my development as a therapist, although it did prove to be quite tiring work running around the wards all day. Amongst many things, I believe the main thing I will take from this placement is the importance of having a good sound knowledge base to work from and knowing your assessment techniques. Effective assessment technique is not only efficient in terms of time but it enables you to clearly identify what treatments you need to perform with the person in front of you because your assessment has just provided you with the information to know what their problems are. The beauty of this as well is that it applies to all domains of physiotherapy and it is something I will take with me into the future no matter where I end up.