personal experiences

I was seeing an elderly patient on my last prac and had just positioned her out of bed and were going though some deep exercises etc. A relatively new doctor to the area came over and began to look at her nursing notes sitting on the table at the end of the bed. The patient starting to get very agitated and scared saying she didn't like that doctor and he was not to come near her etc. The doctor hadn't even said anything to the patient before she was begging me not to leave her alone with the doctor and was crying/shaking etc. I had to reassure the patient over and over with help of the nurse, that the doctor was here to help her and he would do no harm. It took around half an hour to settle the patient before she would allow the doctor to see her. The patient revealed later it was the doctor's appearance/nationality that had caused her outbursts, which i found strange and a bit difficult to comphrehend but it did alert me to the that a lot of elderly people have had personal experiences in the past that affect how they interact with people today.

students and health professionals

Hi all,
just wanted to share an experience i had with a nurse during my last prac. I had gone into the room where the nurse was and began my assessment. I was auscultating and making sure i respected the privacy of the patient (she was female). The nurse suddenly interrupted me and began to lecture me on how i was being inappropriate and rude as i hadn't shut the blinds whilst examining. I had made sure the patient was covered the entire time throughout my assessment and explained this to the nurse but she continued to disagree and lecture me in a quite condescending manner. In the end, I did what she said. I felt as a student, she was very intolerant to me. I mentioned what happened to my supervisor and she agreed with me, but did think it was just easier to comply with the nurse. I'm sure everyone has had a similar experience with some other health professional but any suggestions on how we can change this 'student' status? and how others perceive students?

Tough one!

Hi guys,
sorry for the late post. Just with regards to a patient I saw on my cardio placement. He was post aortic valve replacement and was progressing along fine the first few days post op. After the first few days though, he started to plateau, his main problem was dyspnoea, but he was also having dizzy spells and getting sort of a tingly feeling in his hand when he was really short of breath. His ex tol was decreased and Sp02 was dropping when amb'ing. The doctors t/f'd him to Bentley for more rehab before he went home and myself and my supervisor told them several time that there was something not right about his presentation and we couldn't quite figure it out. In the end he came back to the ward and after many more tests they discovered a phrenic nerve palsy! Obviously as a student it is not my role so much to be pushing my point to the doctors but i was just wondering as a professional how much would you make your point to the doctors before giving up? Especially if your not sure what the actual problem is??

Communication with parents

I have found it difficult on my paediatric placement sometimes, to be taken seriously by the parents of the clients I see. Particularly with infants I occasionally get the impression that they think I am too young and inexperienced to know what I'm talking about (which isn't too far from the truth sometimes). Some are quite happy to be seen by a student but then speak directly to the supervisor rather than me. I try to sound confident and talk to them about ideas to help their child at home, but my supervisor will always jump in with something more relevant or effective. I'm trying to power through but I feel because of the set up I'm not being given a chance to show what I know.

Positive Support Reaction and Sit to Stand

Hi Everyone...half way there!!

Although my prac is outpatient neuro, a couple of us have had the opportunity to go down to Ward 2 which is a ward dedicated to intensive neuro rehab for inpatients. A common presentation for some stroke patients is the positive support reaction where the unaffected side is over-active and when weight is transfered to the unaffected side (e.g. in standing) the unaffected lower limb would push away towards the affected side. As part of the sit to stand retraining, the physios make the patient follow a specific pattern that causes the patient to transfer the weight to the affected side and stand through the affected side.

This technique seemed very effective to ensure patients are able to sit to stand and not have a positive support reaction from the unaffected side, however my question is, does this technique not lead to a poor pattern of movement down the line?

thanks for any input

Lumbar Rotation

Prior to my country placment i found the most challenging technique to be lumbar rotation- i found it so hard on my body. So I thought that I would like to alert everyone to a way of doing a lumbar rotation technique which I found to be far easier on my body than the one we have previously been taught at uni. Apparently this is the original Maitland way of doing lumber rotations:

Grade 1: patient side lying with both knees bent up (bend up more for low lumber or less for high lumbar), no rotation through trunk, therapist stands behind the patient in stride stance with both hands hooked over the iliac crest, line of push is down the femur, Grade 1= gentle movement, really good for acute disc/facet injuries!

Grade 2: same as above except the top hand is placed on the patients belly button (some trunk rotation) and the amplitude of movement is greater as it’s a grade 2. If done correctly the top shoulder and the pelvis should be moving in opposite directions with the oscillations.

Grade 3: same as above except the bottom leg is straightened and the therapist supports the top arm at the shoulder (fixates it)

Grade 4: same as grade 3 except the movement is just at the end of range

I found it to be a really useful technique from really acute injuries to chronic conditions. And if the patient find the technique too uncomfortable you can just drop down a grade or likewise you can go up a grade if the technique isn’t forceful enough.

Different ideas...

On my last placement at a private practice I had a ‘clash’ of ideas with my supervisor. At this particular clinic 4 of the clinicians had over 35 years of experience each- so I found that with a few different principles and clinical reasoning we had very different ideas. I know that they had a lot more experience than me but they were totally unaware of some of the various principles/tests that I had learnt at university. For example = the differentiation between the diagnosis of a lumbar facet sprain and a lumbar disc protrusion. Many of the key sings that would have alerted me to a disc problem i.e. mechanism of injury, presence of neuro symptoms, they said would indicate a facet joint problem. I obviously wasn’t going to argue but I did state the typical signs that we had learnt at uni and they said that they all could indicate either. I know that essentially both conditions are treated in the same way anyway but it was just interesting to see their provisional diagnosis compared to mine.