Week 3 3

We were told that there was a wii console at the nursing home, which was bought for the OTs but hasnt really been used and that the residents dont like it ans cant use it, according to the OTs.
Jenna and I thought we would suss it out and see how it works and how hard it was.
We worked out how to set it up and played each game and worked out which games we thought would be able to be used by some of the residents. We then showed the PT and PTA and they gave us permission to run a class the next morning.
We got together some male residents and they played on the Wii. The game that we first thought would be easy for the residents to play was actually the hardest and the game we thought was going to be too hard, the residents could play.
It was really good that there was a lot of residents participated, since we were told that none of them liked it or used it. We didnt have much trouble finding patients who wanted to come down and we talked to other patients about it who are going to give it a go next week.
I found it easy to tell the patients what to do and how to do it and I can do it myself but I found it hard to help them to do it when they have the controller in their hands. This is something that i need to learn to do better so that I can help the resident when they are playing the game.
I was happy that we chose to explore this because we had patients that really enjoyed it and it got them exercising.
We had a patient with parkinsons disease who played golf and played very smoothly and who normally doesnt talk, but he was telling us about different golfing terminology.
It felt good to know we made patients happy and got them exercising.

Week 3 2

Today I did a lymphatic massage on a resident. I had watched the massage on this patient 2 weeks ago and then watched a lympathic massage on a different patient last week. I was a bit unsure about what was the correct way to do the massage, since both patients have the massage done differently, but i did the massage from what I had seen on this patient before. This patient goes reguarly to the lymphatic clinic in perth and has intensive massage and treatment, as well as regular weekly massages by our physio department. I think it was interesting to see the difference in the patients, since the other lympathic patient refuses to go to the clinic in Perth and she is in a worse state than this patient.

The massage is a light tough moving from the shoulder down the arm and back up again, then across the chest. This is because the lympathic system isnt working properly and it needs assistance to get the fluids moving.

I thought that it felt weird to do this massage for the first time because it is such a light touch and so slippery with the massage oil.

I had attempted to warm up my hands before I started, while Jenna massaged the other shoulder, however if I was to go straight in there and start massaging the patient I think that I would need to put my hands on a hot pack or something because they were freezing and werent going to get warmer by a quick rub.

I felt happy and confident after I had started this massage, I just became a bit unsure on how long to massage each part, because this lady's condition had been dealt with so well and you couldnt see the worse parts of her arm, unlike the other patient we had with this condition

Week 3 1

Today we visted a patient who we had we had been walking 2 person assist with a walker. We had previously walked her on the thurday last week, however when we went to walk her on Friday she had had a fall in the morning and so we were unable to walk her. In the fall she hadnt injured herself and so we talked to the nursing staff who said she had stood when they were getting her changed in the morning and that we were able to take her for a walk.

When we went to take her for a walk in the afternoon she had a vistor with her and so we didnt get to see her until late in the afternoon. After talking to her for a long time and demonstrating what she had to do we attempted to get her standing.
We placed her feet in the correct position and her arms on the wheelchair position for her to push up. She would nto keep her feet in the right position, so it made it very hard to get her to stand. She keep lifting her feet off the ground and out in front of her, so she was never going to stand up.

We took time to talk to her since she hadnt walked since her fall, however her dementia plays a huge part in her not walking. She is capable of weight bearing and walking but it takes her a long time to get going.

I was feeling excited to see how she would go walking today after her fall on friday and her progress on thursday. After the first attempts at standing up we realised that we werent going to get her standing. We should of taken the weight belt to put around her so we had a better grip on her and we will try to walk her in the morning like we have been previously since she seems to be more attentive in the morining.

Today we got through all our patients plus more, except for actually walking this patient. Today in the group session I got thrown in the deep end when the PTA said now you can do some more exercises with the scarf. It made me realise how it is all about adapting what you know with what you have and making it fun. It is good to have a few things ready in your mind before you start.

Week 2 3

We walked a patient who has been using a hoist to get out of bed and into the toilet. She doesnt like using the hoist. She had been walked the previous 2 days by the PT and PTA. I was walking her withe the PTA. The previous days she had walked about 4 m. She wouldnt walk unless she had no shoes on and was outside.
The biggest issue we were going to have was to communicate with this patient as she has dementia, which we beleive is the reason she isnt walking, opposed to not being able to walk.

The PTA and I got her standing and with the RN walking behind with the wheelchair we began walking. Teh patient was doing very well and seemed steady, so we loosened our grip on the weight belt and eventually let go completely. I was hesitant at first to let go, as I didnt want the patient to fall, but once I felt confident that she was safe and that we were still there to support her it was easier to release grip.

The patient walked the whole length of the corridor (15m or more) and half of that was without us holding on to the belt. This was also teh first time we got her walking inside and with shoes on.

In the future I would make sure she didnt get too quick, since she began to pick up pace once she was steady. I also think that a seated wheeler would be a future option for her, as she had been walking around on one prior to being admitted ~4/52 ago. THis would probably be a better option for her since she kept commeting on the frame and refering to her old frame style.

I was happy with the way today went with this patient, since it was the furtherest that she had walked in her time at the placement.

Week 2 2

Today we went to walk a pateint who we had walked the day before. The previous day there had been an incident where the patient was a bit embarrassed. With this in mind we wanted to walk him again today so he knew we were confortable with him and happy to continue to walk him. We went in to talk to this patient who was sitting in the lounge room, to see if he wanted to go for a walk. He seemed very cheerful and happy to go for a walk so we wheeled him out to get his frame and take him for a walk.

I was happy with the way we communicated with this patient and allowed him to feel confortable with us. In the future we need to get him to push up off his chair rather than on the frame since it could tip.

This patient is easy to work with since he is very friendly and wants to have his daily walk. We are begining to build a good rapport with him and feel very confortable around him

When walking other patients we should not allow them to stand without pushing up off the chair,rather than the frame. We could ensure this by making it clear before we start and be reinforcing it.

Today we partcipated in manutension training. This allowed us to revise our postures and actions. It made me realise how well we learnt it at uni and how it has become second nature.

Week 2 1

This patient has a left side affected stroke and memory loss. I was feeling confident since we had been in to do this patient the previous day and had been with her many other times in group classes. We knocked on her door and called and her name before entering. We heard a response so we opened the door. We then stuck ur head in the door and told her we had come to take her for a walk liek we had said yesterday. We then got a response that "Do we mind she was trying to go to the toilet". We replied with that was fine we will be back later and left the room.
When we went back later the patient refused to go for a walk, because she beleived that people were trying to force her off the toilet to go for a walk. We left her then, as she wasnt going to go for a walk or do exercises.

I am unsure how to improve that situation, since we had done the right thing by knocking and waiting for an answer before we entered. Maybe next time if we open teh door after knocking and see noone in the room we could immediately say that we see the patient is busy and that we will come back, rather than explain what we were coming for in the first place.

I was feeling confident to begin with, but this incident allowed me to see how patients personalities change for day to day and that you cant presume that patients will always be the same compliant person you have seen the day before.

Next time we see this patient we wil ensure that we are friendly and understanding of this patient.

I was happy with the way today went, I beleive as the placement is progressing teh confidence and trust I have with patients is building

End of Week One

1. I was feeling confident with walking this patient as we had walked her with the supervisor the day before. We had to be aware of her small, quiet voice and stay close to her. Our aim was to walk this patient to get her legs moving and weight bearing. This patients goal is to not have 'lazy legs', so she was very happy to get up and walking. We had a baseline distance which she had walked the day before and were aware of the amount of assistance that she needed, so using that as a baseline we had an idea of her capabilties. We have to stay close to the patient and talk clearly and make sure we are close to the patient so we can hear her.

2. I think that we managed the patient well. We took her for a walk and took her back to her room. SHe didnt walk as far as the previous day, as we noticed she was fatiguing and so we walked her back to her chair. Next time before we start walking we could get her to do some marching on the spot to get the stepping action happening

3. I was feeling very confident and confortable. I think that Jenna and I had good hold of the patient if she was to fall. This patient was a friendly patient and enthusiastic to do her daily walk, so it was an easier patient to treat.

4. Next time and with other patients we could do more preparation for walking exercises to ensure correct gait pattern.

5. With other patients we could make sure that when we are walking them we stop when we need to talk to them, as I have noticed that when we go to talk to them and they are walking they stop and need to concentrate on what is being said.

6. I was happy with the way today has gone as we now have our own patients and are becoming more familiar with patients. This allows us to know which patients need what treatment and allows the patients to be more confortable with us. THis week has been an enjoyable week

post 2

1. I was feeling a little unsure about how walking the double amputee patient would go, since he hadnt walked very far over the past 12 months. He has just got new prothesis' and hasnt been wearing them very often . We walked him on the parallel bars for 2 x 6 up and back. we then took him out to the corridor and got him standing using a pulpit frame. We then 2 person assisted him to the end of the corridor, which is the furtherest he had walked in 12 months. I think that at the outset we underestimated how much this patient could do

2. I was happy with the way I stayed close to the patient. Next time we could try to get him to walk further and to get his left leg in a more normal gait pattern. His left leg tended to get caught on his right leg because he was taking in across midline.

3. I was feeling pretty confident that i was close to the patient and if he was to fall i would be there. I became a bit nervous situation when the patient wants to go "bull at a gate" and tries to rush before anything has been explained

4. Next time we will hopefully get to walk the patient more by ourselves, rather than with the supervisor coordinating the movement

5. Next time I think I should be more reassuring and positive about the patients progress, since he was doing so well.

6. I was happy with teh way today went as we got to put hands on more patients and be more involved

Day 1

1. I was feeling a bit nervous in the group exercise class by myself at first, as I was a bit unsure about what to say to the patients initially and trying to accommadate for all different levels of patients. I found it hard when the patients were asking me what we were going to do today in the exercise class when I didnt really know myself. After talking for a while I was feeling more confortable, it also helped when there were a few patients who were very friendly.

2. Once the group started, I was happy with the way that I became more confortable with the patients. At the end of the class we played a game throwing around a balloon and I became more involved with organising the activity rather than ust participating.
After the group activity session I was walking patients to bingo and on my way back I found a man who was a bit lost and so I walked him to where he was meant to be and I didnt get lost on my way back!
If i was to redo the exercise class I think I would try and assist patients more, rather than just participating, but that will come with time, since this was my first day
Next time we run this exercise class it will not be as rushed, since this class had to cut short due to "big bingo"
Towards the end of the exercise class I was feeling more confident than I was when I started

3. In future exercise classes I hope to contribute more in running them. I would like to correct the patients techniques more, as the aim was just to get them moving rather than with correct technique

4. For my first day I think that today has gone well, It was good to just be able to talk to patients and let them get to know me and get to know them

5. I can be more active in what I do and be more confident

Exams over = prac soon

1. Record any thoughts and feelings going into this clinical unit

I am feeling very excited to be going on prac, but also a little nervous, this is our first time with real patients after we have some more knowledge from second year.
I am glad that I have a gerontology placement after learning so much and having practice in labs this year.
I am looking forward to communicating with the patients and practicing all the things we have learnt in labs and to see if the way we compensate for different diseases works as well as it worked on each other in labs
I am expecting to learn a lot of knew things on this placement and learn to be confortable with real patients
I am concerned that i could do something wrong which could result in bad consequences for the patient

2. Describe how you see the physiotherapist working with other physiotherapists and health care professionals in the setting of this clinical unit

I see the main physio at my nursing home being the person who prescribes the treatment to the patients and the PTA will follow through with the treatment throughout the week. This is the way that the physio system ran when I was on 4P in a nursing home.
I see the physio working within a multidiscinplary team especially with the nursing staff and carers in this nursing home