This placement allowed me to learn so much. This placement was more of a Urogynae placement, rather than an obstetrics placement. Though we did get some experience in obstetrics. Instead of running post natal classes like I thought in my initial assessment, we ran a ward. We gave information to patients post op (Urogynae/oncology patients).
Having a tutor was amazing we spend 2 half days with 2 tutors and learnt so much. The tutor was able to educate us greatly on different things and situations that we weren’t seeing daily on the ward. We then would go and see some if those things with the tutor.
I was able to see surgery – I saw 3 c sections and one assisted delivery, but the day I was meant to see urogynae surgery I couldn’t go in due to complications and they were running late. That was a shame since we had worked on the ward that got those patients post op.
I didn’t become emotionally involved, there was only once when a sick cancer patient “got” to me a bit, but it is your job.
I learnt so much on this placement and I am further excited about women’s health. I learnt all about treatment for incontinence, giving post op advice, giving post natal advice, subjective in urogynae, breast US, peri Ax, identifying and writing referrals just to name a little.
Friday, August 28, 2009
Third Stares
Assessment
Situation
It was an out patients patient coming in to see the Continence Physio. She was a new patient coming in after a feeling of a prolapse when her baby was around 8 months old.
Task
I was to complete her subjective assessment. I was aiming to do her initial assessment to work out what the problem was and then give her some education before she came back for her second appointment the week after.
Action
I did her subjective assessment, on the continence Ax form. I used a ‘cheat’ sheet to cue me what questions to ask and what to note as important. Throughout the assessment I gave her a few education tips and used charts to explain some things.
Result
During the assessment I discovered that the patient was moving back to England in 2 weeks time. We normally would send her home with some education and a bladder chart to do. But since she was moving away she was given more education than we would normally do on an initial Ax. This isn’t ideal since you don’t want the patient overloaded, but due to the circumstances we had to.
Evaluation
After I had done the assessment, I could think of so much more education I could have done while I was going, rather than at the end and my supervisor doing a lot of the education at the end (also because she was leaving so more was done). However, once my supervisor talked to me and I thought about it, I did the subjective fine and managed some education – which is a post grad level. I think that I need to be less hard on myself. With practice I would become more fluent and be able to give education throughout better. I was happy with education that I did put in there and being able to know and understand what her answers meant.
Strategies
In the future I would become better with practice. I would use a cheat sheet again when doing the subjective. It was really good that that patient came in for second appt on my last day so I go to follow her through and do real time US to see what was happening (she wasn’t emptying properly, she had small volumes, residual urine, recurring UTIs and urgency). It was good to see that what I had thought of from her subjective was proven with her bladder chart and RTUS. I think that being able to follow patients through is a good strategy to see how effective your questioning was.
Situation
It was an out patients patient coming in to see the Continence Physio. She was a new patient coming in after a feeling of a prolapse when her baby was around 8 months old.
Task
I was to complete her subjective assessment. I was aiming to do her initial assessment to work out what the problem was and then give her some education before she came back for her second appointment the week after.
Action
I did her subjective assessment, on the continence Ax form. I used a ‘cheat’ sheet to cue me what questions to ask and what to note as important. Throughout the assessment I gave her a few education tips and used charts to explain some things.
Result
During the assessment I discovered that the patient was moving back to England in 2 weeks time. We normally would send her home with some education and a bladder chart to do. But since she was moving away she was given more education than we would normally do on an initial Ax. This isn’t ideal since you don’t want the patient overloaded, but due to the circumstances we had to.
Evaluation
After I had done the assessment, I could think of so much more education I could have done while I was going, rather than at the end and my supervisor doing a lot of the education at the end (also because she was leaving so more was done). However, once my supervisor talked to me and I thought about it, I did the subjective fine and managed some education – which is a post grad level. I think that I need to be less hard on myself. With practice I would become more fluent and be able to give education throughout better. I was happy with education that I did put in there and being able to know and understand what her answers meant.
Strategies
In the future I would become better with practice. I would use a cheat sheet again when doing the subjective. It was really good that that patient came in for second appt on my last day so I go to follow her through and do real time US to see what was happening (she wasn’t emptying properly, she had small volumes, residual urine, recurring UTIs and urgency). It was good to see that what I had thought of from her subjective was proven with her bladder chart and RTUS. I think that being able to follow patients through is a good strategy to see how effective your questioning was.
Wednesday, August 12, 2009
2nd Stares - Communication
Communication
Situation
We were paged (along with our tutor) to Rx an emergency out patient, with engorged breast. This patient had her 5 day old baby, her 1 year old son and her husband with her. Her husband took the 1 year old. It was then discovered that the patient was non English speaking.
Task
The patient had been sent up from the breast feeding clinic to be treated, so she could go back down to feed her baby after treatment. The aim was to ease the patients discomfort and help the breasts to become softer to allow better let down of milk
Action
Due to the patient being unable to fully communicate with us or our tutor, the Subjective Ax was limited. Our tutor went on to do the objective Ax, finding 2 very engorged breasts. The patient didn’t understand “is that sore?” but she could understand the word “pain”. It was decided that ultrasound to both whole breasts would be needed. US was given by both Jenna and I at the same time, while the tutor tried to get an interpreter on the phone. The patient’s baby then was upset so the tutor had to nurse the baby and change the nappy
Result
The patient received the treatment which was possible because there were 3 of us. She received a total of 45 mins on each breast. If there was only one physio then it would have been hard to give the treatment for 90 mins and look after an upset baby. No phone interpreter was available, so communication was very hard. An explanation was given of the treatment and what she should feel, however it was very hard to know if she really understood.
Evaluation
We had to keep communication to simple words, like “Pain” and “cold”, which the patient seemed to understand. She was an anxious mother about her baby and didn’t want her baby to get cold
Strategies
Since it was an emergency out patient, an interpreter couldn’t be previously organised. The husband didn’t seem supportive and wouldn’t take the baby, let alone interpret for his wife. I don’t believe that we could do any more in the way we and our tutor communicated, besides refuse her treatment if we didn’t believe she had informed consent. It was very hard to gauge if she really understood and therefore if it was informed consent.
Situation
We were paged (along with our tutor) to Rx an emergency out patient, with engorged breast. This patient had her 5 day old baby, her 1 year old son and her husband with her. Her husband took the 1 year old. It was then discovered that the patient was non English speaking.
Task
The patient had been sent up from the breast feeding clinic to be treated, so she could go back down to feed her baby after treatment. The aim was to ease the patients discomfort and help the breasts to become softer to allow better let down of milk
Action
Due to the patient being unable to fully communicate with us or our tutor, the Subjective Ax was limited. Our tutor went on to do the objective Ax, finding 2 very engorged breasts. The patient didn’t understand “is that sore?” but she could understand the word “pain”. It was decided that ultrasound to both whole breasts would be needed. US was given by both Jenna and I at the same time, while the tutor tried to get an interpreter on the phone. The patient’s baby then was upset so the tutor had to nurse the baby and change the nappy
Result
The patient received the treatment which was possible because there were 3 of us. She received a total of 45 mins on each breast. If there was only one physio then it would have been hard to give the treatment for 90 mins and look after an upset baby. No phone interpreter was available, so communication was very hard. An explanation was given of the treatment and what she should feel, however it was very hard to know if she really understood.
Evaluation
We had to keep communication to simple words, like “Pain” and “cold”, which the patient seemed to understand. She was an anxious mother about her baby and didn’t want her baby to get cold
Strategies
Since it was an emergency out patient, an interpreter couldn’t be previously organised. The husband didn’t seem supportive and wouldn’t take the baby, let alone interpret for his wife. I don’t believe that we could do any more in the way we and our tutor communicated, besides refuse her treatment if we didn’t believe she had informed consent. It was very hard to gauge if she really understood and therefore if it was informed consent.
Wednesday, July 29, 2009
Initial STARES: Intervention
Situation: Pt presented with nipple trauma day 4 post natal. Discharged from hospital day before. Was Rx’ed with LASER Rx day before on ward. Baby not getting good attachment, expressing milk for 24 hrs before seeing the lactation/breast feeding clinic next day. Also has 2 yr old, expressed for 3 months with that child. Wants to breast feed this child. Hx of post natal depression, currently being managed
Task: On Subjective Ax patient complained that (L) nipple was the problem and that LASER treatment on the ward the previous day had helped extremely. On Physical Examination, (L) nipple had horizontal crease, with small scab. Desired outcome is to decrease pain and increase healing in preparation for breast feeding and lactation clinic
Action: Laser treatment to the (L) nipple, along the crease line and over the scab. Explanation of treatment, contraindications and risks given. Glasses put on, warning sign on door and all reflective material removed. Machine set up and turned on. Patient is seated in chair, I was in a half kneel position. Turn on the LASER and treat the area
Result: Patient happy with treatment, no redness cited
Evaluation: I was happy with the way I delivered the treatment, especially it being the first time in using LASER. Just before the treatment started the patients partner called in distress with the baby in emergency awaiting test results and the 2 yr old chucking a tantrum. This meant that the patient wanted to get to him to help him out quickly, so we only treated the 2 worst points on the crease. If I was to do again I would like to have more time with the patient.
Strategies: The LASER has to be perpendicular to the treating area and you must stay very still. I was happy with my position, however after the treatment when the machine was turned off, I got to practice in different positions and I found that if I held it as a pen I was more stable, so if given the opportunity again I would try that hand grip
Task: On Subjective Ax patient complained that (L) nipple was the problem and that LASER treatment on the ward the previous day had helped extremely. On Physical Examination, (L) nipple had horizontal crease, with small scab. Desired outcome is to decrease pain and increase healing in preparation for breast feeding and lactation clinic
Action: Laser treatment to the (L) nipple, along the crease line and over the scab. Explanation of treatment, contraindications and risks given. Glasses put on, warning sign on door and all reflective material removed. Machine set up and turned on. Patient is seated in chair, I was in a half kneel position. Turn on the LASER and treat the area
Result: Patient happy with treatment, no redness cited
Evaluation: I was happy with the way I delivered the treatment, especially it being the first time in using LASER. Just before the treatment started the patients partner called in distress with the baby in emergency awaiting test results and the 2 yr old chucking a tantrum. This meant that the patient wanted to get to him to help him out quickly, so we only treated the 2 worst points on the crease. If I was to do again I would like to have more time with the patient.
Strategies: The LASER has to be perpendicular to the treating area and you must stay very still. I was happy with my position, however after the treatment when the machine was turned off, I got to practice in different positions and I found that if I held it as a pen I was more stable, so if given the opportunity again I would try that hand grip
Wednesday, July 22, 2009
First Entry - Third Yr Prac
Well here we are again, prac time!
I am going on a womens health placement at KEMH
I am very excited to be going on this placement, It is an area which I have enjoyed throughout 313 this semester and something I would like to explore for future experience.
From this placement I expect that I will be able to learn alot and also gain hands on experience in an speciality area that we are unable to experience hands on all the time at uni.
I think that we will be shown things, like post natal classes and then i hope that we will be able to run classes rather early in the prac, especially since I had experience in that last time I was on prac. Between Jenna and I we also have 2 tutors. This will be a different experience, since neither of us have had a tutor before. Hopefully we will be able to work with the tutor to gain more knowledge.
I am looking forward to hopefully being able to see surgery and births. My concern for this prac is that I will become too emotionally involved especially seeing mothers who may have sick babies or women with cancer on a daily basis.
But most of all I am very excited!!!
I am going on a womens health placement at KEMH
I am very excited to be going on this placement, It is an area which I have enjoyed throughout 313 this semester and something I would like to explore for future experience.
From this placement I expect that I will be able to learn alot and also gain hands on experience in an speciality area that we are unable to experience hands on all the time at uni.
I think that we will be shown things, like post natal classes and then i hope that we will be able to run classes rather early in the prac, especially since I had experience in that last time I was on prac. Between Jenna and I we also have 2 tutors. This will be a different experience, since neither of us have had a tutor before. Hopefully we will be able to work with the tutor to gain more knowledge.
I am looking forward to hopefully being able to see surgery and births. My concern for this prac is that I will become too emotionally involved especially seeing mothers who may have sick babies or women with cancer on a daily basis.
But most of all I am very excited!!!
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