It’s crazy to think how fast these four pracs have gone! I’ve been enjoying the journey of course, but oh so looking forward to getting to this final year of the degree. Cant believe I’m 98% of the way to it’s completion.
I had a few reservations prior to this placement, somewhat different to those I had before any other placements. My biggest concern was that I’d not yet done a musculoskeletal-specific placement. Naturally there are always musculo elements to each and every presentation, but my anxiety related to my final placement being solely musculo. During the placement, my reservations were allayed, as the experience was one of a well-supported and mentored nature. The supervisor was great at understanding the students experience and never gave undue pressure during our sessions. The supervisor would not partake in the sessions and would be in the room but not involved. He would jump in if he felt it needed, and I would ask him if there were anything further he would like to explore. This supported but discrete mentoring allowed me to find my own style of questioning, assessment and treatment, while having that backup on hand if needed. The actual layout of the practice probably forced this, as it’s a single treatment room. This horrified me when I first walked in on day one as I thought each and every flaw of mine would be seen! Again, this was far from the case, as the supervisor understood the student experience and our inability to have the much-desired experience of a long-term practitioner (we’re not going to be perfect as students).
The placement was a private practice but also serviced the Augusta hospital and community, so I did see a number of presentations as expected. There was still the high number of cases like low back and thoracic pain, but I also got to see some neuro cases and the elusive conversion syndrome (which was queried at the time but I’ve since learnt has since been diagnosed).
I was relieved to be driving the short 20 mins to Margaret River for this placement, the one prior involved many kms and hours driving, and being in the latter part of my pregnant state, the prolonged sitting in the car I was thankful not to do. On the pregnant note, the placement included a number of patients with pelvic floor issues, and postural issues – breastfeeding-related. I found rapport with these patients was natural given my own state, but I also had a warm response from all of the patients, to my obvious belly. I was concerned before the placement that I would not be able to manage the high velocity manipulations that I would no doubt be required to do. I did manage these with success, and only once did I have to let my supervisor know I was not fit to do one, as the patient was a 100kg 6ft man. I did attempt to manip this patient but I was happy to pass the patient over to the supervisor (all others were successful!).
I was hoping it to be the case, and this last placement turned out to be a fantastic networking opportunity. I’ve always treated every person on prac as a potential employer or colleague. I met numerous other allied health people and physios and will maintain these contacts as I am now a part of the local community down here. I look forward to graduating and integrating into this community, as it’s one my husband and I both love living in and hope to do so for a number of years. This point I think also added to my experience on placement. My supervisor always introduced me as a local living down here (you’re only local if you’re born here apparently!) and the patients I think enjoyed seeing a student that was “local” and they may in fact see again, rather than a once off.
My placement turned out to be cut short. On one (my final) Friday, my supervisor sat me down and complemented me on my assessment and treatment style and verbally offered me work once I was ready post baby. He had been very supportive and thoughtful throughout my placement (considerate of my wellbeing due to being pregnant), but I was astonished to be given such wonderful feedback, and an offer I could only hope for. I left that Friday afternoon so pleased, and a little shocked to be honest. It was midnight that night I went into labour, and was flown to Perth via the RFDS. It was lovely that the hospital staff at the local hospital were all familiar to me as it was where I had called into on numerous occasions on placement, and where I had intended to give birth. That following week I was to be helping my supervisor cover the regular physios work at the hospital as he had gone on leave. I became the patient rather than the professional, which I thought was I little humerous at the time.
Over the placement, I became more at ease with the musculoskeletal process, and I look forward to building on that in the future (It’s amazing what (very) little experience can do for a students confidence). Even with the unexpected early arrival of my baby, the whole placement was a wonderful experience. Seeing the various (often relevant to myself) presentations, building relationships with the locals, and being a part of the community made for a fantastic experience, a time in my life of such relevance and emotional importance (due to the birth of my baby and my life at that time).
Sunday, August 8, 2010
Monday, June 28, 2010
Week 1 Entry
Communication
Situation
A 23yr old female patient presented to the facility who, with a ten year history of Fibromyalgia, had a neuro-toxic reaction to a drug to address the said condition. She had a relatively sudden reaction to the drug, and had a sequence of events that lead her to being hospitalised and confined to a wheelchair due to the drugs physical affects on her nervous system. Her recovery had been slow, going from a highly active and functional university student, to being unable to walk, with debilitating choreiform movements associated with the nervous system’s interruption. She was admitted to a city hospital at the time of her fall (as a result of the medication effects), and saw numerous medical staff and specialists, all of whom were unable to diagnose her current physical state. According to her, she was often used as an “interesting case”, and saw numerous professionals, throughout which she felt she was a learning tool for others, rather than being treated with respect and discretion. She was considered to have conversion syndrome at one stage, and had psychiatric assessments and judgements made, based on her unusual mental state (grossly confused as a result of the drug), and anorexia was also assumed because she was of a small physical frame. She had expressed frustration at the treatment to date by the relevant hospital and its staff, and was cautious of again being shunted around with incorrect information and diagnoses.
Task
I was to prescribe a strengthening program for the patient, as it is known that for patients such as this, a resistance exercise program is highly beneficial. I was also to help write correspondence to the relevant parties at the city hospital and other allied health staff she was involved with, updating them on her current status, and clarify the various streams of information (that lacked a common understanding of the problem).
Action
Research was done on the (uncommonly known, but widely documented) adverse drug reaction, and an objective measure of her chorieform movements was given to the patient to complete, rating the severity of the affects and her eventual progress. After contact with the Fibromyalgia physio at the relevant hospital she was first treated at, it was determined that this objective measure had not been used before for this particular patient or others. Much discussion was had with the patient, and plenty of support given, ensuring the patient knew that everything would be done to fine tune the paper and information trail, making it very clear that what she had was in fact legitimate, and that all relevant parties were aware of this (and it wasn’t in fact Conversion Syndrome, as was randomly written with query in her files and correspondence).
Result
Letters were written to staff, education to local allied health staff stating she was not in fact “that freak”, and a common understanding and agreement between professionals and specialists of her condition was achieved. A validated objective measure was brought to the attention of the Fibromyalgia physio, and was now used to measure the patients physical affects as she progresses. Some education was needed for those the patient came into contact with, and strategies given for times when she has occurances such as freezing. For her return to the city, and subsequently being under the city hospital’s care again, we faxed all possible relevant parties of her status and progression, making sure to exclude the “conversion syndrome” (CS) term. This questionable diagnosis (CS) was completely discredited after speaking with one of her specialists in the city, who failed to remove it from her correspondence (though without question stated she did not have the disorder).
Evaluation
From the outset it was clear this patient had been through an anxious, frustrating and scary period in her life, which was made worse by the lack of understanding and particular treatment given to her by many medical staff. She had to take time off her studies because of the drug reaction, and postpone exams, all while her long term partner was overseas. She had stayed south with family for a length of time to focus on her recovery, which is why we saw her in the private facility. She expressed to us that for the first time she actually felt listened to, and that she finally felt she was working with professionals to get her back on track. It was clear that much distrust and frustration occurred previously. Because we were students looking after her down south, I was initially wary that perhaps she’d had enough of sharing with others (she certainly was not obliged to us as students), but she was happy to have a real connection with us, given we had clearly researched the drug reaction, and validated everything she had been going through. She had responded well to the strengthening program, and had returned to us for a progression of those activities. She vocalised her relief and appreciation for our attention to her situation.
Strategies
I think the best strategy used in this situation was listening, and follow-up action. The patient stated she did not have CS, yet her correspondence was not clear on that. We followed up on this, and proceeded to “set the record straight” once it was absolute. Building a trusting rapport was also vital in this situation, particularly since she had been treated as a condition first, person second. Genuine attention to her concerns also went a long way, we weren’t just filling time with her until she returned to the city, leaving others to continue along the miscommunication highway. My own discretion was also vital as it was in fact the same university we attend, and she specifically asked that any correspondence I did, did not include any personal details, given the sheer size of the university and likelihood of cross-communication. So in writing this, I have endeavoured to express what I myself have learnt from this situation, while respecting her requested anonymity and confidentiality.
Rapport, seeking out further information when needed, and following through with the patient were imperative in this situation. An already horrific and stressful time in her life was made worse by a medical model of treatment. I’ll remember this story and try to avoid repeating that same poor treatment.
Situation
A 23yr old female patient presented to the facility who, with a ten year history of Fibromyalgia, had a neuro-toxic reaction to a drug to address the said condition. She had a relatively sudden reaction to the drug, and had a sequence of events that lead her to being hospitalised and confined to a wheelchair due to the drugs physical affects on her nervous system. Her recovery had been slow, going from a highly active and functional university student, to being unable to walk, with debilitating choreiform movements associated with the nervous system’s interruption. She was admitted to a city hospital at the time of her fall (as a result of the medication effects), and saw numerous medical staff and specialists, all of whom were unable to diagnose her current physical state. According to her, she was often used as an “interesting case”, and saw numerous professionals, throughout which she felt she was a learning tool for others, rather than being treated with respect and discretion. She was considered to have conversion syndrome at one stage, and had psychiatric assessments and judgements made, based on her unusual mental state (grossly confused as a result of the drug), and anorexia was also assumed because she was of a small physical frame. She had expressed frustration at the treatment to date by the relevant hospital and its staff, and was cautious of again being shunted around with incorrect information and diagnoses.
Task
I was to prescribe a strengthening program for the patient, as it is known that for patients such as this, a resistance exercise program is highly beneficial. I was also to help write correspondence to the relevant parties at the city hospital and other allied health staff she was involved with, updating them on her current status, and clarify the various streams of information (that lacked a common understanding of the problem).
Action
Research was done on the (uncommonly known, but widely documented) adverse drug reaction, and an objective measure of her chorieform movements was given to the patient to complete, rating the severity of the affects and her eventual progress. After contact with the Fibromyalgia physio at the relevant hospital she was first treated at, it was determined that this objective measure had not been used before for this particular patient or others. Much discussion was had with the patient, and plenty of support given, ensuring the patient knew that everything would be done to fine tune the paper and information trail, making it very clear that what she had was in fact legitimate, and that all relevant parties were aware of this (and it wasn’t in fact Conversion Syndrome, as was randomly written with query in her files and correspondence).
Result
Letters were written to staff, education to local allied health staff stating she was not in fact “that freak”, and a common understanding and agreement between professionals and specialists of her condition was achieved. A validated objective measure was brought to the attention of the Fibromyalgia physio, and was now used to measure the patients physical affects as she progresses. Some education was needed for those the patient came into contact with, and strategies given for times when she has occurances such as freezing. For her return to the city, and subsequently being under the city hospital’s care again, we faxed all possible relevant parties of her status and progression, making sure to exclude the “conversion syndrome” (CS) term. This questionable diagnosis (CS) was completely discredited after speaking with one of her specialists in the city, who failed to remove it from her correspondence (though without question stated she did not have the disorder).
Evaluation
From the outset it was clear this patient had been through an anxious, frustrating and scary period in her life, which was made worse by the lack of understanding and particular treatment given to her by many medical staff. She had to take time off her studies because of the drug reaction, and postpone exams, all while her long term partner was overseas. She had stayed south with family for a length of time to focus on her recovery, which is why we saw her in the private facility. She expressed to us that for the first time she actually felt listened to, and that she finally felt she was working with professionals to get her back on track. It was clear that much distrust and frustration occurred previously. Because we were students looking after her down south, I was initially wary that perhaps she’d had enough of sharing with others (she certainly was not obliged to us as students), but she was happy to have a real connection with us, given we had clearly researched the drug reaction, and validated everything she had been going through. She had responded well to the strengthening program, and had returned to us for a progression of those activities. She vocalised her relief and appreciation for our attention to her situation.
Strategies
I think the best strategy used in this situation was listening, and follow-up action. The patient stated she did not have CS, yet her correspondence was not clear on that. We followed up on this, and proceeded to “set the record straight” once it was absolute. Building a trusting rapport was also vital in this situation, particularly since she had been treated as a condition first, person second. Genuine attention to her concerns also went a long way, we weren’t just filling time with her until she returned to the city, leaving others to continue along the miscommunication highway. My own discretion was also vital as it was in fact the same university we attend, and she specifically asked that any correspondence I did, did not include any personal details, given the sheer size of the university and likelihood of cross-communication. So in writing this, I have endeavoured to express what I myself have learnt from this situation, while respecting her requested anonymity and confidentiality.
Rapport, seeking out further information when needed, and following through with the patient were imperative in this situation. An already horrific and stressful time in her life was made worse by a medical model of treatment. I’ll remember this story and try to avoid repeating that same poor treatment.
Saturday, June 19, 2010
Last Placement Initial Entry
Last one!!! Can’t believe it!!!
I’m off to do another rural placement, but this time it’s my musculoskeletal prac. I’m a little anxious of this placement as none of my previous placements over the last 2-3 years has been musculo oriented (specifically). Most placements obviously involve your general anatomy and physiology knowledge, but it’s been a while since doing the specific assessments etc. To add to my apprehension, I’ll be seeing my own patients from day 1. This is to be expected I guess, given we are so close to becoming qualified practitioners. I hope it’s not expected though to be as fluid as a graduate, as only experience will allow that, none of which I have in this particular field.
I’m guessing I’ll see a variety of presentations on this placement, and given it’s pruning season down here (on the vineyards), there might be some tendonopathies and over use injuries of the upper limbs? As my study over the clinical prep week as indicated, there may also be a high prevalence of low back pain in the patient mix, given there is a high percentage of the population that has it at any one time.
I’ve heard positive things about the supervisor at this placement. He apparently has students year-round, and I believe has recently won an award for his contributions for doing so. I hope to make the most of such a mentor, as I’m basically a clean slate with no experience and I can only learn from such an experienced practitioner.
It will be a relief not to have to drive so far for this placement. It’s relatively close, with trips to Augusta weekly. I believe Augusta is more of a retirement location than being an industry driven locale, so again there may be an older demographic representation of Augusta patients? This might bring in a broader range of presentations related to that age group.
While I am certainly intimidated by the coming placement, I really hope to absorb as much of the experience as possible, and get comfortable with the muscluoskeletal process. I hope to work in the region eventually, and these are obviously skills I’ll need and be proficient at whichever field I work in. In comparison to my last placement, this time I’ll get to be hands on in a traditional physio way, making diagnostic calls and treatments accordingly.
I also hope to make the most of the networking opportunities during this prac. Physio is a relatively small industry as it is, and to have access to contacts and potential collegues/employers is an invaluable aspect of this final rural placement. I look forward (maybe?) to binge thrown in the deep end, and seeing how I respond to that, lets hope I come out the other end knowing more about the musculoskeletal process (and myself).
I’m off to do another rural placement, but this time it’s my musculoskeletal prac. I’m a little anxious of this placement as none of my previous placements over the last 2-3 years has been musculo oriented (specifically). Most placements obviously involve your general anatomy and physiology knowledge, but it’s been a while since doing the specific assessments etc. To add to my apprehension, I’ll be seeing my own patients from day 1. This is to be expected I guess, given we are so close to becoming qualified practitioners. I hope it’s not expected though to be as fluid as a graduate, as only experience will allow that, none of which I have in this particular field.
I’m guessing I’ll see a variety of presentations on this placement, and given it’s pruning season down here (on the vineyards), there might be some tendonopathies and over use injuries of the upper limbs? As my study over the clinical prep week as indicated, there may also be a high prevalence of low back pain in the patient mix, given there is a high percentage of the population that has it at any one time.
I’ve heard positive things about the supervisor at this placement. He apparently has students year-round, and I believe has recently won an award for his contributions for doing so. I hope to make the most of such a mentor, as I’m basically a clean slate with no experience and I can only learn from such an experienced practitioner.
It will be a relief not to have to drive so far for this placement. It’s relatively close, with trips to Augusta weekly. I believe Augusta is more of a retirement location than being an industry driven locale, so again there may be an older demographic representation of Augusta patients? This might bring in a broader range of presentations related to that age group.
While I am certainly intimidated by the coming placement, I really hope to absorb as much of the experience as possible, and get comfortable with the muscluoskeletal process. I hope to work in the region eventually, and these are obviously skills I’ll need and be proficient at whichever field I work in. In comparison to my last placement, this time I’ll get to be hands on in a traditional physio way, making diagnostic calls and treatments accordingly.
I also hope to make the most of the networking opportunities during this prac. Physio is a relatively small industry as it is, and to have access to contacts and potential collegues/employers is an invaluable aspect of this final rural placement. I look forward (maybe?) to binge thrown in the deep end, and seeing how I respond to that, lets hope I come out the other end knowing more about the musculoskeletal process (and myself).
Thursday, June 17, 2010
Placement 3 Final Entry
This rural paediatric placement concerned me a little before I started. It was the first time the facility had had a student, and I had no clinical mixes or previous experiences to go off.
I had presumed the nature of the placement would encompass the biopsychosocial model, and it certainly did like no other placement I’ve had. The whole thread of what the therapist does is woven into and dictated by the familys circumstances in every regard. The school visits were an eye opener, as there are so many factors to consider for a child with severe and complex disabilities. The home visits were the same again, but there was a real respect needed for the family, in allowing a stranger to enter their home and sanctuary, with the hope of improving its function and quality somehow. I did my best at being appreciative, understanding and respectful when interacting with the families, and found the majority of families were happy to have a student in their home/working with their child (they certainly didn’t have to be).
The gravity of what these families have gone through had an interesting affect on me. I didn’t pity them, I just an astounding respect for what they go through, albeit having only seen a pinch of their lifetime and its struggles. I think they would have found it offensive to elicit pity or sympathy. Empathy instead I think came naturally to me. Given my current physical condition (birth of own child impending), the realisation that things don’t always go as we’d hope, and that it can in fact happen to any one of us was a stark reminder. They too had the same hopes and ambitions for their children as I do, disability doesn’t pick selectively.
Prior to starting, I had predicted the travel to be a little demanding. That was probably an understatement. While I knew I’d be travelling a lot, the nature of the placement is one of a dynamic and changing nature, therefore I found myself doing a lot of km’s on the road. This was somewhat compensated for with start times, but as mentioned to my supervisor when asked, I think it might be best if the next student is based a little closer to the facility most visited. That in mind, I got so much from the placement that I would do the same again.
The conditions I experienced on the placement were a little different from what I expected. There were random chromosomal disorders, plenty of CP clients, and autism children also. I saw a wide variety of conditions, and even ones that differed within the same diagnosis. Each child was different, and had a different set of requirements. I have a great appreciation for the struggles that rural children and their families have to deal with, purely by living in the country. This was one of the things I was looking forward to on this placement, that satisfaction of helping those clients that really do survive on the help of rural allied health members. One mother travelled 2 hours each way to get her son to the hydrotherapy classes that he loves. That’s the closest facility that offers the specialised service allowing his condition, and that weekly activity is a vital part of his and his families quality of life. Allied health really does have an impact on these families lives.
Not sweating the small stuff and having a respect for the families that struggle every day to do the smallest and seemingly insignificant tasks, is what I got out of this placement. It was a very rewarding placement and an area that I could see myself working in in the future. Having the ability to get along with differing characters and personalities is vital in such a role, one that I think perhaps I might have. We’ll see how the next (oh so contrasting) placement goes – private practice musculoskeletal, oh you have a sore knee!!!! Bless, we each have our roles, all of which are just as important. I’ll always have a respect for those doing it tougher than the rest of us, for that I’m thankful.
This rural paediatric placement concerned me a little before I started. It was the first time the facility had had a student, and I had no clinical mixes or previous experiences to go off.
I had presumed the nature of the placement would encompass the biopsychosocial model, and it certainly did like no other placement I’ve had. The whole thread of what the therapist does is woven into and dictated by the familys circumstances in every regard. The school visits were an eye opener, as there are so many factors to consider for a child with severe and complex disabilities. The home visits were the same again, but there was a real respect needed for the family, in allowing a stranger to enter their home and sanctuary, with the hope of improving its function and quality somehow. I did my best at being appreciative, understanding and respectful when interacting with the families, and found the majority of families were happy to have a student in their home/working with their child (they certainly didn’t have to be).
The gravity of what these families have gone through had an interesting affect on me. I didn’t pity them, I just an astounding respect for what they go through, albeit having only seen a pinch of their lifetime and its struggles. I think they would have found it offensive to elicit pity or sympathy. Empathy instead I think came naturally to me. Given my current physical condition (birth of own child impending), the realisation that things don’t always go as we’d hope, and that it can in fact happen to any one of us was a stark reminder. They too had the same hopes and ambitions for their children as I do, disability doesn’t pick selectively.
Prior to starting, I had predicted the travel to be a little demanding. That was probably an understatement. While I knew I’d be travelling a lot, the nature of the placement is one of a dynamic and changing nature, therefore I found myself doing a lot of km’s on the road. This was somewhat compensated for with start times, but as mentioned to my supervisor when asked, I think it might be best if the next student is based a little closer to the facility most visited. That in mind, I got so much from the placement that I would do the same again.
The conditions I experienced on the placement were a little different from what I expected. There were random chromosomal disorders, plenty of CP clients, and autism children also. I saw a wide variety of conditions, and even ones that differed within the same diagnosis. Each child was different, and had a different set of requirements. I have a great appreciation for the struggles that rural children and their families have to deal with, purely by living in the country. This was one of the things I was looking forward to on this placement, that satisfaction of helping those clients that really do survive on the help of rural allied health members. One mother travelled 2 hours each way to get her son to the hydrotherapy classes that he loves. That’s the closest facility that offers the specialised service allowing his condition, and that weekly activity is a vital part of his and his families quality of life. Allied health really does have an impact on these families lives.
Not sweating the small stuff and having a respect for the families that struggle every day to do the smallest and seemingly insignificant tasks, is what I got out of this placement. It was a very rewarding placement and an area that I could see myself working in in the future. Having the ability to get along with differing characters and personalities is vital in such a role, one that I think perhaps I might have. We’ll see how the next (oh so contrasting) placement goes – private practice musculoskeletal, oh you have a sore knee!!!! Bless, we each have our roles, all of which are just as important. I’ll always have a respect for those doing it tougher than the rest of us, for that I’m thankful.
Week 5 Blog Entry
Communication
Situation
My supervisor and I were to do a home visit to a 3 yo girl who has cerebral palsy. She has spastic hemiplegia, currently pushes herself backwards along the floor to get around, and also uses a Mulholland walker at home. She currently uses no sleep systems for her night-time posture, and displays a gross lack of trunk extension and stability, limiting her ability to be upright. She is non communicable, but is able to express her distress with high-pitched noises. Her father is the sole carer for her and her 2 yo brother. The exact details are unclear, but the mother is no longer present in the home, and as indicated by the child’s father, is abusive towards him and the children and has issues with drugs and alcohol. Before each home visit, there is a risk assessment form that is filled out, alerting any allied health member to be aware of any risks that may be incurred whilst at the family home. This clients risk assessment did not have anything notable, but my supervisor expressed her concerns regarding the fathers own mental health, and his unusual behaviour and tendencies to confabulate during conversations. He has not been coping as sole carer at home, and his daughter’s health is a concern to the allied health team, as she is not getting the early intervention strategies required for such a condition. The fathers stories change each time my supervisor visits, and it is apparently clear the daughter’s condition is deteriorating because of the lack of intervention.
Task
I was to conduct an informal gross motor assessment of the child in the home (mainly for practice and to allow my supervisor to chat with the father), while my supervisor discussed current issues and concerns with her father. As this organisation is greatly based on family partnerships and the essential rapport between the therapist and client, my supervisor wished to delicately nut out some concerning issues she’s come across, regarding the status of his child’s health and her management. My supervisor also wanted to broach the subject of perhaps involving social work during this visit, due to his inability to cope with the current family demands, as indicated by phone calls and previous assessments.
Action
We entered the home and after greeting the father and thanking him for letting me visit his home, I proceeded to the floor to interact with the young girl with the CP. My supervisor took a seat at the couch, along with the father and 2 yo and began chatting. While I was doing my motor assessment with the child, the father expressed his ongoing concerns regarding the inappropriateness of the behaviour of the children’s mother. He stated Homeswest would have a modified home ready soon in Perth to suit his child’s needs, but says he’s” not racist, but doesn’t like all those muslims in the city”, so probably won’t move (even for the obvious benefit of his child). When questioned as to how his daughter was doing of late, he said she was fine, and that she had a whole T bone steak after her own dinner just recently. The father spoke constantly throughout the visit, and indicated that all was well with his daughter and the family at the moment, except the issue of their mother. He spoke enthusiastically and appeared quite wound up, using overt hand gestures, and only managed to stay seated for short periods. When he was seated he rapidly tapped his foot.
Result
When the issue of possible social work involvement (to help address any social issues) was raised, the fathers’ mood immediately became defensive and he quickly shut down the conversation with my supervisor. He declined any social work involvement and again indicated everything was fine at the moment. Repeated visits have resulted in conflicting information from the father, and this visit was no different. On leaving the house, my supervisor stated she was not keen to push the issue of social work further during this visit, as she felt the fathers tension had risen to un inappropriate level. The visit had obviously been cut short by this topic being raised.
Evaluation
My supervisor expressed her frustration about this case. The child is clearly not doing as well as she could be, regardless of the fact she’s made every attempt to help manage her condition as her therapist. Grants are applied for mobility equipment for the child to improve their quality of life and function. On looking at the walking frame retrieved from the back room of the house, it was obvious she was not spending the recommended amount of time in the frame, and missing out on the physical and emotional benefits of doing so. My supervisor stated the child was obviously not able to eat a steak, along with her own dinner, and said this was an example of the unusual information the father would pass on. My supervisor questions the possibility of the father having a mental illness himself, though this is obviously not something she herself can raise, as she is the. The most notable issue for the therapist in this case is the importance of communication. It is clearly frustrating to have a case such as this, where they are on the organisations files, but they decline any involvement or intervention. An agreement to something/course of action one day, does not always translate into reality. I actually think the visit went as best as it probably could of. It would be wrong not to offer the family some social help (particularly for helping organise specialist appts, housing issues etc). Because of the fathers dynamic personality/mental health, it’s a tough case to manage. Overall the child health is suffering, but I don’t think its a result of therapist issues, more likely intrinsic family issues.
Strategies
I’d be unqualified to assume knowledge on this subject, but from what I gather in a case such as this, the trust and rapport you build with the family is vital. You may not agree with everything they are doing, but having some common ground or connection may end up making a huge difference on the quality of the child’s life. Being flexible to the familys needs is also important, as being rigid with visit times or compliance of therapy (for example), may only ostracise the family. For the child’s sake, subtle persistence will be required. A window of opportunity where the father agrees to a therapy may not be present now, but it may open up in the future at some time. I believe being understanding of each individuals case is important. The father clearly feels he’s doing as best he can for his child, we are just there to help facilitate that if possible. In the end, if a family refuses treatment then that’s their choice (we can’t force them), but it should an informed choice, regardless of how much they may not want the help. As long as we (as therapists) have exhausted every avenue and remained diplomatic and open on all fronts, only then should we concede their position. It’s such a complex and dynamic process, one I’ve learnt from certainly.
Communication
Situation
My supervisor and I were to do a home visit to a 3 yo girl who has cerebral palsy. She has spastic hemiplegia, currently pushes herself backwards along the floor to get around, and also uses a Mulholland walker at home. She currently uses no sleep systems for her night-time posture, and displays a gross lack of trunk extension and stability, limiting her ability to be upright. She is non communicable, but is able to express her distress with high-pitched noises. Her father is the sole carer for her and her 2 yo brother. The exact details are unclear, but the mother is no longer present in the home, and as indicated by the child’s father, is abusive towards him and the children and has issues with drugs and alcohol. Before each home visit, there is a risk assessment form that is filled out, alerting any allied health member to be aware of any risks that may be incurred whilst at the family home. This clients risk assessment did not have anything notable, but my supervisor expressed her concerns regarding the fathers own mental health, and his unusual behaviour and tendencies to confabulate during conversations. He has not been coping as sole carer at home, and his daughter’s health is a concern to the allied health team, as she is not getting the early intervention strategies required for such a condition. The fathers stories change each time my supervisor visits, and it is apparently clear the daughter’s condition is deteriorating because of the lack of intervention.
Task
I was to conduct an informal gross motor assessment of the child in the home (mainly for practice and to allow my supervisor to chat with the father), while my supervisor discussed current issues and concerns with her father. As this organisation is greatly based on family partnerships and the essential rapport between the therapist and client, my supervisor wished to delicately nut out some concerning issues she’s come across, regarding the status of his child’s health and her management. My supervisor also wanted to broach the subject of perhaps involving social work during this visit, due to his inability to cope with the current family demands, as indicated by phone calls and previous assessments.
Action
We entered the home and after greeting the father and thanking him for letting me visit his home, I proceeded to the floor to interact with the young girl with the CP. My supervisor took a seat at the couch, along with the father and 2 yo and began chatting. While I was doing my motor assessment with the child, the father expressed his ongoing concerns regarding the inappropriateness of the behaviour of the children’s mother. He stated Homeswest would have a modified home ready soon in Perth to suit his child’s needs, but says he’s” not racist, but doesn’t like all those muslims in the city”, so probably won’t move (even for the obvious benefit of his child). When questioned as to how his daughter was doing of late, he said she was fine, and that she had a whole T bone steak after her own dinner just recently. The father spoke constantly throughout the visit, and indicated that all was well with his daughter and the family at the moment, except the issue of their mother. He spoke enthusiastically and appeared quite wound up, using overt hand gestures, and only managed to stay seated for short periods. When he was seated he rapidly tapped his foot.
Result
When the issue of possible social work involvement (to help address any social issues) was raised, the fathers’ mood immediately became defensive and he quickly shut down the conversation with my supervisor. He declined any social work involvement and again indicated everything was fine at the moment. Repeated visits have resulted in conflicting information from the father, and this visit was no different. On leaving the house, my supervisor stated she was not keen to push the issue of social work further during this visit, as she felt the fathers tension had risen to un inappropriate level. The visit had obviously been cut short by this topic being raised.
Evaluation
My supervisor expressed her frustration about this case. The child is clearly not doing as well as she could be, regardless of the fact she’s made every attempt to help manage her condition as her therapist. Grants are applied for mobility equipment for the child to improve their quality of life and function. On looking at the walking frame retrieved from the back room of the house, it was obvious she was not spending the recommended amount of time in the frame, and missing out on the physical and emotional benefits of doing so. My supervisor stated the child was obviously not able to eat a steak, along with her own dinner, and said this was an example of the unusual information the father would pass on. My supervisor questions the possibility of the father having a mental illness himself, though this is obviously not something she herself can raise, as she is the. The most notable issue for the therapist in this case is the importance of communication. It is clearly frustrating to have a case such as this, where they are on the organisations files, but they decline any involvement or intervention. An agreement to something/course of action one day, does not always translate into reality. I actually think the visit went as best as it probably could of. It would be wrong not to offer the family some social help (particularly for helping organise specialist appts, housing issues etc). Because of the fathers dynamic personality/mental health, it’s a tough case to manage. Overall the child health is suffering, but I don’t think its a result of therapist issues, more likely intrinsic family issues.
Strategies
I’d be unqualified to assume knowledge on this subject, but from what I gather in a case such as this, the trust and rapport you build with the family is vital. You may not agree with everything they are doing, but having some common ground or connection may end up making a huge difference on the quality of the child’s life. Being flexible to the familys needs is also important, as being rigid with visit times or compliance of therapy (for example), may only ostracise the family. For the child’s sake, subtle persistence will be required. A window of opportunity where the father agrees to a therapy may not be present now, but it may open up in the future at some time. I believe being understanding of each individuals case is important. The father clearly feels he’s doing as best he can for his child, we are just there to help facilitate that if possible. In the end, if a family refuses treatment then that’s their choice (we can’t force them), but it should an informed choice, regardless of how much they may not want the help. As long as we (as therapists) have exhausted every avenue and remained diplomatic and open on all fronts, only then should we concede their position. It’s such a complex and dynamic process, one I’ve learnt from certainly.
Sunday, May 16, 2010
Rotation 3 Week 1 Blog Entry
Communication
Situation
I was with my supervisor conducting a home visit to one of the disabled children the practice provides services to. It was after school and the childs mother had just gotten home from work herself. The appointment time was the only one available given the other commitments of both parties. We arrived at the home, and the husband who works on a mine in the far north, was home at the time. He has a fly in fly out roster of two weeks on, one week off. It was clear from when we arrived that there was some tension in the family household. The mother answered the door flustered and somewhat perturbed. The mother, father, disabled child, and her sibling were all at home, along with myself, my supervisor, and the occupational therapist. The family had not long moved from Perth, and were temporarily living in a small unit, until the building of their specially built home in a nearby area was completed. The two and a half year old sibling seemed to be agitated and wanting attention from his mum, who’d not been home long herself. The visit was limited in time due to the OT needing to be back at the office within a restricted time frame (own childs appt).
Task
Our objective of the visit was to alter parts of the wheelchair foam which required replacing, check the childs AFO’s, and problem solve what other requirements the child may need in her new (temporary) home. I was to assist in the measuring of the wheelchair and childs dimensions, but also observe, given it was my first week, and it being the first meeting of the family with the full allied health team. I was keen to observe what sort of questions were asked, and begin to familiarise myself with the different needs disabled children have, and the various services available to families eg funding organisations for specialist equipment.
Action
Because the unit was so small with the number of people present, and the obvious tension between the mother and father at the time, I made sure I kept myself well clear of being in the way, and attempted to subtley distract the younger sibling by flicking through one of his nearby books etc, to allow the mother to discuss with the OT and physio what her concerns are currently. The OT and my supervisor clearly revised their aims of the session (as discussed in the car on the way), and spent some time listening to the mother and generally allowing her vent her frustrations.
Result
Because the mother was primarily the one looking after the child, many of the concerns came from her. She mentioned a number of pieces of the childs specialist equipment from her last school in Perth, did not come down to her new school as it was meant to. This was a great frustration to the mother and it appeared that numerous of her own phone calls were unable to locate the “missing” equipment. The result of that concern was that the OT would seek out where exactly the equipment had found itself, and update the mother as soon as possible. Another concern was that the mother was still manually lifting her child from her chair into the shower. This was causing her some physical stress, yet upon assessment, the bathroom was not large enough to allow a hoist to assist with transfers. My supervisor stressed to the mother the importance of looking after her own back, and offered a refresher on manual handling skills, which she agreed to. One of her concerns also included the small size of the unit. This was obviously temporary, and not something that OT or physio could address, but she mentioned it and it was subsequently acknowledged.
Evaluation
It was clear in this situation the importance of the “family-centred approach” and the “biopsychosocial” model in assisting this family. Emotional stressors were a large part of this situation, some of which could be addressed with the allied team help, others could not be. The team had to adapt as to what would be achieved during this visit. It was more important to connect with the mother and family and listen to her/their needs. Rapport building is so important in situations such as this, as a negative experience with therapists inadvertently affects the child who really needs the help. After listening and discussing with the mother, she became more relaxed, and expressed her apologies in her regard on our entering the house. I saw the team really working with the mother. Had they gone in guns blazing with solutions and advice without listening, I’m sure it would have been a different outcome.
Strategies
While I had minimal input in this situation (I couldn't have done anything more really), I certainly took note of how this situation was managed, and how it could well have turned out differently. Listening skills were utilised here, as you would in most situations, but I think it really was effective listening. Allowing the mother to vent her concerns, without being interrupted by therapists with obvious solutions allowed the mother to feel acknowledged. Being supportive throughout the visit (without being false or patronising) appeared to appease the mother and soften her mood. I think keeping in mind that any tension felt from the mother, may in fact have nothing to do with you, as they have their own lives and all of it’s variables is also important. I saw non verbal communication ie open body language, being used in this instance, and it being reciprocated by the mother (after some time). Being adaptable to a changing situation was vital also. The foam was replaced on the childs chair and AFOs checked, which was enough achieved given the situation. Apart from seeing the above unfold, I myself kept the younger sibling entertained during the visit. This was one minor contribution I could actually make, and I think it did in fact help with the mothers space and ability to chat freely, without him all over her. Overall the importance of appropriate and effective communication was clear in this instance.
Sunday, May 9, 2010
Rotation 3 Initial Entry
Initial Entry
Well I’m off on a rural/paeds placement and I’m a little uncertain of what to expect. It’s the first time this facility has had a student, so I’ve no clinical mixes, or any past experiences from other students to go off.
I think this placement particularly will encompass the biopsychosocial model we’ve been learning about throughout the degree. I’ll be doing home and school visits, so all aspects of the childs life will need to be taken into account, particularly any social influences and restrictions they may have. I’ll be very careful and aware of being a stranger in a child/familys home, and I’ll endeavour to bring some respect and understanding to their situation, to best build a rapport and thus service their needs adequately.
I’m expecting to see more chronic conditions on this placement, in that if a child were in an acute situation, they’d more likely be at a hospital. That’s not to say that I wont be seeing some seriously ill children though. I have always enjoyed being around and working with children, and with the impending birth of my own child quickly nearing, I think the gravity of some childrens situation may emotionally affect me more than it would have previously. I hope to use this empathy in a positive way by assisting the families as best I can, rather than give them sympathy and a reminder of their childs prognosis (they need understanding and skills, not a stark reminder of their situation – particularly from a student!).
I expect the travel required for this placement to be a little demanding. Given my location, I’ll be driving over an hour each way to work, plus the home and school visits throughout the day. I intend to use time in the car to hone in on my nursery rhymes (listening to CDs), and make sure I get plenty of rest outside of the working hours. The travelling is in fact fine though, as I’ve now moved down south permanently (to be with husband), and I’ve always travelled a lot on weekends etc anyway.
I’m a little worried in that we’ve not done paeds specific conditions since second year at uni (?). It feels so long ago since learning this info, but I’ve done some revision and hope that the one-on-one learning I’ll be doing will consolidate that knowledge. I’m such a practical learner, and I know once I “see and experience” these conditions, they’ll live with me.
I’m really looking forward to this placement. I’m from the country myself and I intend to live in the country here on in, and think that rural residents just don’t have the same access to services as metro residents do. I think a service like the one provided is crucial to their quality of life. I think I’ll relate to these people just by having an understanding of what it’s like to live rurally, and all the factors that impact on that. Again, I think the social side of things will play a big part in the families, magnified just by living rurally.
Most of all I hope to walk away with a more consolidated understanding of paediatric conditions, see them in context, and use the invaluable (individualised) problem solving skills that we physios (students) have to help improve their situations.
Well I’m off on a rural/paeds placement and I’m a little uncertain of what to expect. It’s the first time this facility has had a student, so I’ve no clinical mixes, or any past experiences from other students to go off.
I think this placement particularly will encompass the biopsychosocial model we’ve been learning about throughout the degree. I’ll be doing home and school visits, so all aspects of the childs life will need to be taken into account, particularly any social influences and restrictions they may have. I’ll be very careful and aware of being a stranger in a child/familys home, and I’ll endeavour to bring some respect and understanding to their situation, to best build a rapport and thus service their needs adequately.
I’m expecting to see more chronic conditions on this placement, in that if a child were in an acute situation, they’d more likely be at a hospital. That’s not to say that I wont be seeing some seriously ill children though. I have always enjoyed being around and working with children, and with the impending birth of my own child quickly nearing, I think the gravity of some childrens situation may emotionally affect me more than it would have previously. I hope to use this empathy in a positive way by assisting the families as best I can, rather than give them sympathy and a reminder of their childs prognosis (they need understanding and skills, not a stark reminder of their situation – particularly from a student!).
I expect the travel required for this placement to be a little demanding. Given my location, I’ll be driving over an hour each way to work, plus the home and school visits throughout the day. I intend to use time in the car to hone in on my nursery rhymes (listening to CDs), and make sure I get plenty of rest outside of the working hours. The travelling is in fact fine though, as I’ve now moved down south permanently (to be with husband), and I’ve always travelled a lot on weekends etc anyway.
I’m a little worried in that we’ve not done paeds specific conditions since second year at uni (?). It feels so long ago since learning this info, but I’ve done some revision and hope that the one-on-one learning I’ll be doing will consolidate that knowledge. I’m such a practical learner, and I know once I “see and experience” these conditions, they’ll live with me.
I’m really looking forward to this placement. I’m from the country myself and I intend to live in the country here on in, and think that rural residents just don’t have the same access to services as metro residents do. I think a service like the one provided is crucial to their quality of life. I think I’ll relate to these people just by having an understanding of what it’s like to live rurally, and all the factors that impact on that. Again, I think the social side of things will play a big part in the families, magnified just by living rurally.
Most of all I hope to walk away with a more consolidated understanding of paediatric conditions, see them in context, and use the invaluable (individualised) problem solving skills that we physios (students) have to help improve their situations.
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