Situation: I went on to the Obstetric ward at King Edward Memorial Hospital to give Post Natal Education to patient. Patient A is a 31 year old women who has just given birth to her first baby the day before. The baby was born by spontaneous vaginal delivery, where patient A sustained stitches for an episiotomy. The labour was not long and the baby's birth weight was 7 pound 9 oz.
There was no other complications or history to report on. The husband was also in the room at the time I saw the patient.
Task: My role was to provide post natal education to patient A, prior to her discharge.
Action: I began my introducing myself and my tutor to the patient and finding out if it was a suitable time to have a discussion. My postnatal education began with a discussion on how they were going and how her stitches and perineum felt. I then continued to discuss the role and function of the pelvic floor, how to perform a pelvic floor contraction and gave her an exercise prescription. I then when on to talking about bladder function, finding out about any previous bladder problems, discussing what is normal frequency and fluid intake. After that I discussed with the patient about bladder, I chose to move on to talking about the patient's tummy muscles. I explained the role of the tummy muscles, checked for a diastasis and taught Transversus Abdominis exercises. I briefly explained the problems problems that can occur with the breasts and explained how physiotherapy can help if problems arise.
I then when on to discuss exercise with the patient. I enquired about previous exercise levels, explained what has happened to the tummy muscles and pelvic floor and why we recommend no high impact activities for at least 6-8 weeks. Educated her that walking is great and to begin gradually and progress the time she walks for. I also explained the Post Natal exercise classes that are run at the hospital in outpatients. I then discussed activities of daily living and posture and informed her how to access help and gave her pamphlets to read later for further advice.
Results: I was successfully able to educate this first time mother and father about a variety of points to consider post natally. I found a good time of day where the patient was alert would be able to take in a good portion of my education. Having the husband there worked to my advantage as he would be able to remind the patient of points I have raised when they are discharged home.
Evaluation: I believe I did a reasonably good job for my first post natal education. I was able to discuss a variety or areas in with a reasonable amount of detail. There were a few points I missed, for example not to do sit ups, about baby slings, maybe delegating jobs etc. There were also a few areas where I believe I could have been more specific and use examples to aid further understanding by the patient. When discussing the Pelvic floor, I asked the patient if she had ever heard of the pelvic floor and asked if she understood their location and function. When she replied yes, I did not continue to explain, but in retrospect I believe I should have gone through that detail anyway, just in case her understanding was completely wrong. But for my first try, I think I did a good job and gave her a decent level of education but there are ways I could improve.
Strategies: The strategies I believe will help me to perform a more thorough post natal education. I think further study in this area would help, along with verbally practising with the other student. I think the more practice I get the better my education will be. I understand that I need to be more specific, especially in the area of activities of daily living and posture. I discussed feeding, lifting, bathing, and change tables, however I believe I did not give the patient enough alternative options that she can apply at home. For example, changing the bath at a friends house in kneeling. I also could have discussed baby slings, prams, and car capsules, however I believe I didn't know enough about these areas. That is where further study and exposure will come into play.
All in all though, I believe I did a good job for my first post natal education, but there was definately room for improvement.
Saturday, May 29, 2010
Saturday, May 15, 2010
Topic 1- Communication
Situation/ 51 year old woman day 3 post total abdominal hysterectomy (removal of the uterus and cervix) and bilateral removal of the fallopian tubes and ovaries, secondary to cancer. She has a past medical history of type 2 diabetes Mellitus and asthma. No other relevant history was noted. The operation was successful with no complications. The patient has good support at home including her 2 sons.
Task/ My role was to provide this patient with some going home advice post operatively whilst she was on the ward.
Action/ I went in to see the patient day 1 post op and gave her a post operative advice see to have a read of and advised her that I would be back the next day to go through it in detail with her. Due to her history of asthma, I decided it would also be a good idea to quickly check her chest. I checked her chest expansion and huff, which was clear. I educated her on the need to do some deep breathing exercises hourly along with ankle pumping for her circulation.
I returned the following day to discuss the going home advice however I noticed the patient was pale, restless and sweaty. Upon questioning she reported she was in pain, very nauseated and unable to empty her bowels. The nursing and medical staff were aware and when I check the medical chats she was due for some pain relief in 20mins. The patient was not comfortable and you could tell she would not interested in listening to me talk for 20-30mins, so I decided it would be better for me to return the next day.
The following day the patient was feeling much better and was happy for me to have a chat to her. The main parts of the going home advice discussed included rest, not lifting anything heavier than 2kg, having good posture, not driving for 4 weeks, discussing support at home, pelvic floor exercises, general exercise advice and good bladder and bowel habits.
Results/ I successfully educated the patient on what she can and can't do once she goes home. I explained the importance of rest for wound healing and the importance of not lifting anything heavier than 2 kg for 6-8 weeks. The patient had done pelvic floor exercise before so I did not have to focus on this as much. The patient was very fit and active before surgery and so I educated her to begin with short 5-10minute walks and gradually build up and to avoid high impact sports for 6 months. I believed one of the most important things to address with this lady was good bladder and bowel habits. I addressed normal limits for fluid intake/output, frequency for bladder and bowel, fibre intake and good toileting dynamics.
Evaluation/ I think I did a good job with my communication skills for this task. I was clear and used simple language. I had a calm manner and built a good rapport with my patient. I address all of the content I needed to address and answer all of the questions my patient had, making her confident to go home and do the right thing. The only criticism I had on my performance was that some of the information I needed to make more relevant to the surgery that this patient had done, for example in terms of when to commence pelvic floor exercises. I also needed to explain more "why" certain pieces of advice were important, for example that it is important to stand and sit up tall for scar alignment and stretch.
Strategies/ Strategies I could use to improve the points above would be to revise the different urogynae/ gynae procedures and understand what they have had done and when pelvic floor exercises could be commenced. I could also ask my supervisor of explanation and also ask each of the consultants what their protocols are post op. I know I understood the reasons 'why' certain information was important and there where just a couple times I did not relay this education, so for future I know to relay as much information as possible, because if patients understand the reasons why they can and can't do certain things, they are more likely to be compliant. I think it would be a good idea to do practice scenarios with the other physiotherapy student of placement here at King Edward Memorial Hospital, using different surgeries and having patients with multiple co-morbidities and practicing tailoring the information for them. But for my first time giving going home advice to this group of post operative patients, I believe I did a relatively good job.
Task/ My role was to provide this patient with some going home advice post operatively whilst she was on the ward.
Action/ I went in to see the patient day 1 post op and gave her a post operative advice see to have a read of and advised her that I would be back the next day to go through it in detail with her. Due to her history of asthma, I decided it would also be a good idea to quickly check her chest. I checked her chest expansion and huff, which was clear. I educated her on the need to do some deep breathing exercises hourly along with ankle pumping for her circulation.
I returned the following day to discuss the going home advice however I noticed the patient was pale, restless and sweaty. Upon questioning she reported she was in pain, very nauseated and unable to empty her bowels. The nursing and medical staff were aware and when I check the medical chats she was due for some pain relief in 20mins. The patient was not comfortable and you could tell she would not interested in listening to me talk for 20-30mins, so I decided it would be better for me to return the next day.
The following day the patient was feeling much better and was happy for me to have a chat to her. The main parts of the going home advice discussed included rest, not lifting anything heavier than 2kg, having good posture, not driving for 4 weeks, discussing support at home, pelvic floor exercises, general exercise advice and good bladder and bowel habits.
Results/ I successfully educated the patient on what she can and can't do once she goes home. I explained the importance of rest for wound healing and the importance of not lifting anything heavier than 2 kg for 6-8 weeks. The patient had done pelvic floor exercise before so I did not have to focus on this as much. The patient was very fit and active before surgery and so I educated her to begin with short 5-10minute walks and gradually build up and to avoid high impact sports for 6 months. I believed one of the most important things to address with this lady was good bladder and bowel habits. I addressed normal limits for fluid intake/output, frequency for bladder and bowel, fibre intake and good toileting dynamics.
Evaluation/ I think I did a good job with my communication skills for this task. I was clear and used simple language. I had a calm manner and built a good rapport with my patient. I address all of the content I needed to address and answer all of the questions my patient had, making her confident to go home and do the right thing. The only criticism I had on my performance was that some of the information I needed to make more relevant to the surgery that this patient had done, for example in terms of when to commence pelvic floor exercises. I also needed to explain more "why" certain pieces of advice were important, for example that it is important to stand and sit up tall for scar alignment and stretch.
Strategies/ Strategies I could use to improve the points above would be to revise the different urogynae/ gynae procedures and understand what they have had done and when pelvic floor exercises could be commenced. I could also ask my supervisor of explanation and also ask each of the consultants what their protocols are post op. I know I understood the reasons 'why' certain information was important and there where just a couple times I did not relay this education, so for future I know to relay as much information as possible, because if patients understand the reasons why they can and can't do certain things, they are more likely to be compliant. I think it would be a good idea to do practice scenarios with the other physiotherapy student of placement here at King Edward Memorial Hospital, using different surgeries and having patients with multiple co-morbidities and practicing tailoring the information for them. But for my first time giving going home advice to this group of post operative patients, I believe I did a relatively good job.
Saturday, May 8, 2010
Initial Entry 3
I am about to commence my third rotation at King Edward Memorial Hospital (KEMH). I will be working in the are of Women's Health. I am so excited about this placement. Women's Health is an area which really interests me, and would be an area that I would be interested in studying post graduately. Whilst on my placement down in Collie, I was exposed to some Women's Health physiotherapy for example, antenatal education classes, antenatal lower back pain, post natal education, and laser for cracked nipples. I was also lucky enough to see a caesarian in surgery. These experiences I believe will help me on this placement but this placement will allow me to expand my knowledge even further.
I do not have many concerns upon commencement of this placement. I have done a large about of revision and preparation for this placement so I feel my knowledge is sound for an undergraduate level. I understand that this is predominately a post graduate area and so I am prepared to learn a lot from not only the physiotherapist that work at KEMH but also from the doctors and other members of the multidiscipliary team. I understand that I will be seeing post-op patients which is an area that was not covered much by the university and so I just hope my knowledge is at the level that they expect at the beginning of this placement. I have done some research in this to try and prepare myself as much as possible.
I expect to see women mainly in an inpatient setting, however I am aware that we may get to sit on some outpatient appointment as well. I expect to see women post-op (hysterectomy, prolapse, bladder surgery etc.), after birth, antenatal classes and post natal classes, and women with incontinence, just to list a few. I believe my role in this placement will mainly be educating patients, teaching pelvic floor exercises and possibly having a role in running antenatal and post natal classes.
As mentioned before, I can not wait to start this placement tomorrow. I believe it will be a large opportunity to expand my knowledge in this broad area, meet lots of new people and colleagues and using the skills I learnt during my time at university. I am also hoping to get the opportunity to see more surgery during this placement.
I do not have many concerns upon commencement of this placement. I have done a large about of revision and preparation for this placement so I feel my knowledge is sound for an undergraduate level. I understand that this is predominately a post graduate area and so I am prepared to learn a lot from not only the physiotherapist that work at KEMH but also from the doctors and other members of the multidiscipliary team. I understand that I will be seeing post-op patients which is an area that was not covered much by the university and so I just hope my knowledge is at the level that they expect at the beginning of this placement. I have done some research in this to try and prepare myself as much as possible.
I expect to see women mainly in an inpatient setting, however I am aware that we may get to sit on some outpatient appointment as well. I expect to see women post-op (hysterectomy, prolapse, bladder surgery etc.), after birth, antenatal classes and post natal classes, and women with incontinence, just to list a few. I believe my role in this placement will mainly be educating patients, teaching pelvic floor exercises and possibly having a role in running antenatal and post natal classes.
As mentioned before, I can not wait to start this placement tomorrow. I believe it will be a large opportunity to expand my knowledge in this broad area, meet lots of new people and colleagues and using the skills I learnt during my time at university. I am also hoping to get the opportunity to see more surgery during this placement.
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