Prior to my ortho inpatients placement i had only ever had outpatient placements so it took a bit of adjustment for me to get used to the frequent interaction between the many members of allied health and fast pace of the system. I have never enjoyed being in a hospital environment and have always maintained that once i graduate i might do a short stint in a hospital but would ultimately not end up in one. However since working at the hospital i have found that my views have changed slightly, and as such i feel that it wouldn't be such a bad thing if i ended up in a hospital.
I think the main factor that has swayed my opinion is the interaction with other members of the allied health. At first the thought of this made me quite nervous as i did not know haw to interact with the other staff was worried that i might make an idiot of myself by showing how little i knew about the hospital system. These concerns have since passed and i now find that i thoroughly enjoy the interactions with the other staff. When working in inpatients you are part of a massive group of staff and it is a very social environment. Obviously you get a few not so friendly types but generally i have found that most of the staff i work with are pretty nice and are easy to get along with. I think the social stimulation that you get from inpatients is something that you miss out on a bit when working in outpatients. Although there are obviously some other physios that you will get to know you don't gertt a chance to work as closely with the doctors, nurses and the OTs. I actually thoroughly enjoy the inpatients environment and find that i'm always in a good mood, as there is nothing that makes you feel better than walking past someone in the corridor and getting a friendly greeting. Also you're constantly making new relationships as there is steady influx of new staff to the ward.
Sorry if my post is a bit short but i think it pretty much sums up how i feel about the social environment when working in inpatients. I don't know if anyone else has noticed the same thing??
Thursday, June 19, 2008
Code Black
The other day at my ortho inpatients placement there was an incident that made me think about a couple of things. The first was personal safety and the second was whether we're doing the right thing by not allowing people to leave hospital if we don't think they are safe.
The incident involved a patient on theward who desparately wanted to go home. The patient had sustained a head injury but was independent and could walk around without any walking aids. I don't know the exact reason why this patient wasn't allowed to leave as he wasn't my patient, but i assume that the staff involved did not believe that he would be safe to go home or thathe didn't have a safe home to go to. Anyway after one of many loud attempts at convincing the nurses at the nursing station to allow him to leave the patient began to throw files off the desk. When his watcher (this patient had to have some one watching him in his room to prevent him from wandering) tried to stop him the patient swung out at the watcher. He then picked up a large metal drip stand and tried to hit the watcher with it. After chasing his watcher away he substituted the drip stand for a portable O2 tank stand and began hitting the walls with it and chasing anyone who came close to him. His aggression was not directed at anyone in particular but he seemed to pick people at random to chase after. A code black was called as soon as the man had thrown the first file but it took about 20 minutes for security to arrive. Once security arrived the man seemed to calm down and the security guardxs were able to subdue him quickly and without much more fuss.
The first thing that occurred to me following the incident was how strange it was to feel like my safety was threatened while i was at work. I will admit that in my younger years i was involved in quite a few brawls and never really gave it much thought, but the difference is that previously i have never expected anything like this incident to happen while i was at clinic. I've seen all the posters that discourage violence towards staff but always thought it was to protect the smaller nurses and didn't really think that a patient in an inpatients ward could pose much threat. It had never occurred to me that a patient might try to use a weapon capable of inflicting serious injury.
After i got over the initial excitement of the incident i began to feel extremely sorry for the patient involved. I personally don't enjoy being in hospitals and would hate to have to live in one.
Other factors that would have compounded the issue were the fact that the patient was a smoker and was being denied access to ouutside areas to smoke, and the fact that i never once heard anyone explain to the patient why he was being kept there despite the patient constantly asking the nurses why they wouldn't let him go home. From the perspective of the patient it must have literally felt like he was being kept prisoner for no reason. I assume that the patients head injury must have lead the staff to believe that he was not mentally fit to make his own decisions, as surely the final decision to stay or go would otherwise lie in the patients hands.
I found this incident quite disturbing, as to me the patient didn't seem to be mentally impaired and yet the medical staff clearly weren't allowing him to make his own decisions. Even if this man had been to confused to make his own decisions i can think of other incidents where medical staff have bullied patients into staying at the hospital when they are desperate to leave.
The incident involved a patient on theward who desparately wanted to go home. The patient had sustained a head injury but was independent and could walk around without any walking aids. I don't know the exact reason why this patient wasn't allowed to leave as he wasn't my patient, but i assume that the staff involved did not believe that he would be safe to go home or thathe didn't have a safe home to go to. Anyway after one of many loud attempts at convincing the nurses at the nursing station to allow him to leave the patient began to throw files off the desk. When his watcher (this patient had to have some one watching him in his room to prevent him from wandering) tried to stop him the patient swung out at the watcher. He then picked up a large metal drip stand and tried to hit the watcher with it. After chasing his watcher away he substituted the drip stand for a portable O2 tank stand and began hitting the walls with it and chasing anyone who came close to him. His aggression was not directed at anyone in particular but he seemed to pick people at random to chase after. A code black was called as soon as the man had thrown the first file but it took about 20 minutes for security to arrive. Once security arrived the man seemed to calm down and the security guardxs were able to subdue him quickly and without much more fuss.
The first thing that occurred to me following the incident was how strange it was to feel like my safety was threatened while i was at work. I will admit that in my younger years i was involved in quite a few brawls and never really gave it much thought, but the difference is that previously i have never expected anything like this incident to happen while i was at clinic. I've seen all the posters that discourage violence towards staff but always thought it was to protect the smaller nurses and didn't really think that a patient in an inpatients ward could pose much threat. It had never occurred to me that a patient might try to use a weapon capable of inflicting serious injury.
After i got over the initial excitement of the incident i began to feel extremely sorry for the patient involved. I personally don't enjoy being in hospitals and would hate to have to live in one.
Other factors that would have compounded the issue were the fact that the patient was a smoker and was being denied access to ouutside areas to smoke, and the fact that i never once heard anyone explain to the patient why he was being kept there despite the patient constantly asking the nurses why they wouldn't let him go home. From the perspective of the patient it must have literally felt like he was being kept prisoner for no reason. I assume that the patients head injury must have lead the staff to believe that he was not mentally fit to make his own decisions, as surely the final decision to stay or go would otherwise lie in the patients hands.
I found this incident quite disturbing, as to me the patient didn't seem to be mentally impaired and yet the medical staff clearly weren't allowing him to make his own decisions. Even if this man had been to confused to make his own decisions i can think of other incidents where medical staff have bullied patients into staying at the hospital when they are desperate to leave.
The trooper
I am always amazed by the effect that an optimistic patient can have on their own outcomes. I have completed a neurology placement and am currently on an ortho inpatients placement. During these placements there have been several patients that have greatly impressed me with their optimism and ability to see positives when their situation appears bleak. I belive that it is incredibly beneficial for patients to have some level of optimism, as these patients generally achieve far better results than others who let their disabilities get to them.
There are two patients that spring to mind, who are perfect example of the trooper patient.
The first was a man who suffered from multiple sclerosis, who was treated by another student and myself. This man had very little power in his lower limbs, could not stand and struggled to maintain sitting balance when unsupported. Despite having this disability and knowing that it would only get worse this man had the most positive outlook on life. It would be totally understandable for someone in his position to sink into depression and become completely dependent on others, however this man was completely independent. He lived in a caravan with his wife in which they had done a lot of travelling, and as he was unable to walk my patient used to crawl around on the floor of the caravan. For transport outside of the caravan this man drove a gopher. When the other student working with him commented on some large cuts on the patients knee, he casually reported that he'd rolled his gopher that morning which "took a bit of bark off".
The other patient is a 67 year old lady who i have been treating at my ortho placement, who has just had a total replacement of her (R) femur and a revision of her (R) total knee replacemet. She also has recently had her (L) hip replaced. Prior to the replacement of her femur she had a "girdlestones" operation on her (R) hip, which i still don't fully understand but apparently it is an out of date operation where thay remove the head of the femur and just allow the shaft to float around in the hip joint. Doesn't sound too good, anyway before this lady had her total femur replacement the surgeons removed her femur and she had to live for a week with no femur in her (R) leg !!!! Can you imagine how difficult that would be. She then underwent an enormous operation where they put an entire prosthetic femur in her leg and revised her total knee replacement. Such an operation would knock about the most healthy of us let alone a 67 year old lady, yet this lady is one of the most calm and cheerful patients i have come across. When i first went to see this patient my supervisor warned me that she would be very slow progress and that we probably would struggle to stand her given her history (Hasn't been full weightbearing on her (R) leg for years) and her operation. When we visited her we found her to be in a great mood although feeling slightly ill. She calmly vomited into a bag and then told us that she would be happy to try to stand. As we got ready to stand her i noticed that she had the most deformed feet i've seen and i remember wondering how she was going to be able to stand on them.Any way we stood and walked her with a pulpit frame, asfter which my tutor informed me that this lady should not be able to walk after what she has been through.
Three days after my initial visit the patient had progressed to being able to walk independently and safely with elbow crutches. I put her success down to her optimism and her willingness to try to improve despite everything that was against her. I have seen other patients that are youngerand stronger but have had less than positive attitudes and have progressed slower.
From my experiences with these patients i've learnt how how much a persons rehabilitation potential depends on their attitude towards life. As a physio I thinks its important to recognise patients who are more likely to allow their situation to get the better of them, and to try to steer them away from the type of thinking that suggests that they have no control over their outcome.
There are two patients that spring to mind, who are perfect example of the trooper patient.
The first was a man who suffered from multiple sclerosis, who was treated by another student and myself. This man had very little power in his lower limbs, could not stand and struggled to maintain sitting balance when unsupported. Despite having this disability and knowing that it would only get worse this man had the most positive outlook on life. It would be totally understandable for someone in his position to sink into depression and become completely dependent on others, however this man was completely independent. He lived in a caravan with his wife in which they had done a lot of travelling, and as he was unable to walk my patient used to crawl around on the floor of the caravan. For transport outside of the caravan this man drove a gopher. When the other student working with him commented on some large cuts on the patients knee, he casually reported that he'd rolled his gopher that morning which "took a bit of bark off".
The other patient is a 67 year old lady who i have been treating at my ortho placement, who has just had a total replacement of her (R) femur and a revision of her (R) total knee replacemet. She also has recently had her (L) hip replaced. Prior to the replacement of her femur she had a "girdlestones" operation on her (R) hip, which i still don't fully understand but apparently it is an out of date operation where thay remove the head of the femur and just allow the shaft to float around in the hip joint. Doesn't sound too good, anyway before this lady had her total femur replacement the surgeons removed her femur and she had to live for a week with no femur in her (R) leg !!!! Can you imagine how difficult that would be. She then underwent an enormous operation where they put an entire prosthetic femur in her leg and revised her total knee replacement. Such an operation would knock about the most healthy of us let alone a 67 year old lady, yet this lady is one of the most calm and cheerful patients i have come across. When i first went to see this patient my supervisor warned me that she would be very slow progress and that we probably would struggle to stand her given her history (Hasn't been full weightbearing on her (R) leg for years) and her operation. When we visited her we found her to be in a great mood although feeling slightly ill. She calmly vomited into a bag and then told us that she would be happy to try to stand. As we got ready to stand her i noticed that she had the most deformed feet i've seen and i remember wondering how she was going to be able to stand on them.Any way we stood and walked her with a pulpit frame, asfter which my tutor informed me that this lady should not be able to walk after what she has been through.
Three days after my initial visit the patient had progressed to being able to walk independently and safely with elbow crutches. I put her success down to her optimism and her willingness to try to improve despite everything that was against her. I have seen other patients that are youngerand stronger but have had less than positive attitudes and have progressed slower.
From my experiences with these patients i've learnt how how much a persons rehabilitation potential depends on their attitude towards life. As a physio I thinks its important to recognise patients who are more likely to allow their situation to get the better of them, and to try to steer them away from the type of thinking that suggests that they have no control over their outcome.
Monday, June 16, 2008
Just Pondering
I’ve noticed a number of other students are posting and commenting about having to deal with death and disease in our line of work (placement, at the moment), and finding a balance between emotional attachment and detachment. I’d also like to mention that my placement is making me think a whole lot more about the value of life, and figuring out when enough’s enough..
I’m on a post-acute/long term rehab neurosurgery ward where there are numerous cases of patients with head injuries who have hugely varied impairments and level of dependency. I’m finding it intriguing the way patients who have experienced similar motor vehicle/bike accidents, can recover at completely different rates – some with simply a few scratches, and some that can’t even hold the weight of their own head. I saw a patient last week who has no voluntary movement, contractures so extreme that a bone in his foot is almost breaking through the skin, and he can only communicate occasionally via eye blinking ‘yes’ and ‘no’ in response to pain. This patient has been in this condition for eight years.
What surprises me in this situation is that this patient’s parents are present at just about every physio session and are always in a bright and happy mood, and discuss their son’s condition openly and with no hint of sadness. Obviously, the couple have had eight years to come to terms with their son’s condition and have learnt to manage and care for him and I think it’s really encouraging the way they handle the situation. I’ve not come to any conclusions about these issues, but I’m certainly wondering about the quality of life these patients and their family have. Of course, if something similar happened to one of my family members, I would not think twice about caring for them in the same way, but this prac has certainly made me ponder whether, say, if I was in the same situation, I would want to be kept going if I was living life completely dependent on others and unable to communicate or get my personality across in any way. I do not want to sound pessimistic or discouraging, simply putting down some thoughts that this placement has evoked in me…
I’m on a post-acute/long term rehab neurosurgery ward where there are numerous cases of patients with head injuries who have hugely varied impairments and level of dependency. I’m finding it intriguing the way patients who have experienced similar motor vehicle/bike accidents, can recover at completely different rates – some with simply a few scratches, and some that can’t even hold the weight of their own head. I saw a patient last week who has no voluntary movement, contractures so extreme that a bone in his foot is almost breaking through the skin, and he can only communicate occasionally via eye blinking ‘yes’ and ‘no’ in response to pain. This patient has been in this condition for eight years.
What surprises me in this situation is that this patient’s parents are present at just about every physio session and are always in a bright and happy mood, and discuss their son’s condition openly and with no hint of sadness. Obviously, the couple have had eight years to come to terms with their son’s condition and have learnt to manage and care for him and I think it’s really encouraging the way they handle the situation. I’ve not come to any conclusions about these issues, but I’m certainly wondering about the quality of life these patients and their family have. Of course, if something similar happened to one of my family members, I would not think twice about caring for them in the same way, but this prac has certainly made me ponder whether, say, if I was in the same situation, I would want to be kept going if I was living life completely dependent on others and unable to communicate or get my personality across in any way. I do not want to sound pessimistic or discouraging, simply putting down some thoughts that this placement has evoked in me…
educating patient
As I posted before, currently I am on gerontology placement. Most of patients have balance problem and fall but recently I have a patient who has LBP without any neurological symptoms. Her main problem is localized pain on (R) low back. Before this time she has been several physiotherapy clinics. However, she reported that the treatments were too expensive and she didn’t have any improvement.
I found that she is doing too much for house working and the patient is really diligent and active everyday. She is doing all the house working for her husband and herself. Sometimes she cooks for her whole family which is really big meal. That’s why I recommended her to reduce house working and shear with her husband for her LBP. And I tried to teach Low Back care and correct posture etc.
One week later I checked her for LBP, unfortunately no improvement. She still complains LBP that I think she is doing too much working in poor posture and poor working pattern. I thought the best way to reduce her symptom is education for her posture and reducing her working load but I think it is really hard to change her working pattern and posture even though she feels LBP.
Because she is old lady and has been house working in poor posture since long long time ago. Recently I gave her handout and showed demonstration for correct posture and working pattern but still I am not sure she is going to change her working pattern and poor posture.
Is there any good way to change her working pattern or reduce working load that is really affective for this kind of patients?
I found that she is doing too much for house working and the patient is really diligent and active everyday. She is doing all the house working for her husband and herself. Sometimes she cooks for her whole family which is really big meal. That’s why I recommended her to reduce house working and shear with her husband for her LBP. And I tried to teach Low Back care and correct posture etc.
One week later I checked her for LBP, unfortunately no improvement. She still complains LBP that I think she is doing too much working in poor posture and poor working pattern. I thought the best way to reduce her symptom is education for her posture and reducing her working load but I think it is really hard to change her working pattern and posture even though she feels LBP.
Because she is old lady and has been house working in poor posture since long long time ago. Recently I gave her handout and showed demonstration for correct posture and working pattern but still I am not sure she is going to change her working pattern and poor posture.
Is there any good way to change her working pattern or reduce working load that is really affective for this kind of patients?
Positive Thinking
Whilst on an international prac in Fiji the third world health standards and lack of resources meant that patients would die of conditions that would have been medically managed in Australia. Due to this death was a regular occurrence on the daily ward round.
However another aspect that compounded this already difficult issue was the cultural difference from what we are accustomed to in Australia. Personally I found it extremely confronting to see the Indian/Fijian people grieving from the loss of loved ones. After the death of a patient on my ward it was extremely difficult to carry on as normal whilst the late patients wife was sobbing behind the patients curtain cradling the body. Fijian hospitals don’t have the luxury of private/ separate rooms, all patients are in a large room separated only by a thin curtain. This makes it extremely hard for other patients and staff when somebody passes away as the mourning of the family is witnessed by the entire ward.
Due to the poor Fijian health standards the hospital is regarded as a death sentence by patients. With so much death around the role of the multidisciplinary team relies heavily on morale boosting. I have learned the importance of a positive outlook in such a challenging environment. Although personally tis positive attitude is extremely difficult to maintain the benefits gained by the patients was enough reward to continue my struggle. I have so much admiration for the Fijian physios for their ability to deal with the daily challenge to maintain this patient hope and motivation.
However another aspect that compounded this already difficult issue was the cultural difference from what we are accustomed to in Australia. Personally I found it extremely confronting to see the Indian/Fijian people grieving from the loss of loved ones. After the death of a patient on my ward it was extremely difficult to carry on as normal whilst the late patients wife was sobbing behind the patients curtain cradling the body. Fijian hospitals don’t have the luxury of private/ separate rooms, all patients are in a large room separated only by a thin curtain. This makes it extremely hard for other patients and staff when somebody passes away as the mourning of the family is witnessed by the entire ward.
Due to the poor Fijian health standards the hospital is regarded as a death sentence by patients. With so much death around the role of the multidisciplinary team relies heavily on morale boosting. I have learned the importance of a positive outlook in such a challenging environment. Although personally tis positive attitude is extremely difficult to maintain the benefits gained by the patients was enough reward to continue my struggle. I have so much admiration for the Fijian physios for their ability to deal with the daily challenge to maintain this patient hope and motivation.
Resources Lacking
Whist on an international prac in Fiji travelling with an Australian surgical team we would frequently attend the morning ward rounds with the local doctors and surgeons. At ward rounds we would get the history of patients and develop rapport seeing them each day. Due to te poor health conditions in fiji a patient with a fractured NOF was put on 3 weeks bed rest. This management was decided upon due the lack of anaesthetic drugs available for surgery. Due to this patients who were is need of surgery were put on bed rest until the country was able to aquire a new supply of surgical drugs.
This man who was put on bed rest died after 3 days due to the inability to receive the level of medical management he required. As a student in a first world country this was extremely hard to comprehend that people were dying due to a lack of resources.
This experience made me appreciate how fortunate we are to have the resources we do in Australia. It demonstrated how much of a difference resources can make to peoples lives. The Fijian physios are inspirational with the level treatment they can provide with the limited resources they have available. This experience taught me to think on my feet and utilise the environment around me taking nothing for granted.
This man who was put on bed rest died after 3 days due to the inability to receive the level of medical management he required. As a student in a first world country this was extremely hard to comprehend that people were dying due to a lack of resources.
This experience made me appreciate how fortunate we are to have the resources we do in Australia. It demonstrated how much of a difference resources can make to peoples lives. The Fijian physios are inspirational with the level treatment they can provide with the limited resources they have available. This experience taught me to think on my feet and utilise the environment around me taking nothing for granted.
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