I am very relieved that I passed this placement although I only scraped through by the skin of my teeth. I have a very idea now of how I can improve my performance thanks to the input of my clinical supervisor Maxine and clinical tutor Nicke. Now that the pressure and paranoia is off I can see how everybody was trying to help me. I am working full time at Shenton Park from Monday, and my clinical supervisor has suggested that I write clinical notes and soapiers for the people I see even if I don't have access to their clinical notes, I think this will be a very good strategy for me. I have a meeting next week with Jo to discuss further strategies. Another strategy suggested at the next placement is to ask the superisor at the end of each week what is expected in terms of patient workload, and expected knowledge outcomes at that point in the placement part of my problem during this placement related to not being sure what was expected.
The most important thing I have learned in this unit is the importance of following things through thoroughly in the SOAPIER format and not making leaps of logic for assessing patients.
I am expecting my next placement to be a better experience.
Friday, November 14, 2008
Wednesday, November 12, 2008
Week5 day3
Today I had another visit from my clinical tutor. I went through my plan with the tutor about what I would assess and why with a new patient and I think I did this quite well. I did a subjective assessment, 6m walk test and COVS assessment. One of the issues identified by the tutor is that when I explain things to the patient my instructions are not always clear so I need to concentrate on simplifying my language when dealing with patients.
The second patient I saw had a patella # and surgical neck of humerus # I wasn't quite as well prepared for this patient as I had been expecting to visit a different patient but they were unavailable for treatment. I had a look at the X-Rays and did a COVS assessment for this patient and assessed ROM and was a bit thrown by what to do with the #humerus. I didn't do the Assessment of ROM very well and could have done it a lot better, I wasn't very systematic with it. I hope that I get another opportunity to show that I can do it better. However the tutor did say that I had improved significantly since mid placement, however I feel will still need to work very hard over the last two days of placement. I also need to overcome a propensity to be a bit inhibited when a supervisor is supervising and take charge instead.
1) Need to practise clear instructions
2) Need to try not to get flustered and inhibited when supervised
3) Need to continue with existing strategies to follow a more logical approach
4) Need to speed up
5) I actually know how to do an assessment I just need to do it.
The second patient I saw had a patella # and surgical neck of humerus # I wasn't quite as well prepared for this patient as I had been expecting to visit a different patient but they were unavailable for treatment. I had a look at the X-Rays and did a COVS assessment for this patient and assessed ROM and was a bit thrown by what to do with the #humerus. I didn't do the Assessment of ROM very well and could have done it a lot better, I wasn't very systematic with it. I hope that I get another opportunity to show that I can do it better. However the tutor did say that I had improved significantly since mid placement, however I feel will still need to work very hard over the last two days of placement. I also need to overcome a propensity to be a bit inhibited when a supervisor is supervising and take charge instead.
1) Need to practise clear instructions
2) Need to try not to get flustered and inhibited when supervised
3) Need to continue with existing strategies to follow a more logical approach
4) Need to speed up
5) I actually know how to do an assessment I just need to do it.
Week5 day2
Today was fairly hectic I had two new patients to see and two for discharge one on Wednesday and the other on Thursday. The first patient I was to do a dicharge COV's assessment, however the Gerontology assessment form was missing from the file, apparently quite a few documents have been misfiled as we have had a turnover of several ward clerks since I have been working there. This made some extra work for me as I had to re-assess the patents ROM and recall what the COVS entries were originally, this was one of the first patients Elle and I saw on prac, "originals lost" were then entered on the form. I filled in a problem list, treatment aims, patient/discharge goals and discharge summary as part of the gerentology assessment form for the two patients being discharged and a discharge summary form.
One of my strategies for improving my clinical reasoning with a more logical approach as mentioned in my blog last week is to write out new patients details from their file as if I was giving a handover, then prepare a potential problem list from the information gleaned from their notes and write a list of what I will assess and why based on what I have identified. This is similar to the A and P in a SOAPIER. Unfortunately one of my other issues is that I am slow with paperwork and all this writing made me even slower so that it was a rush to get everything completed and my notes written and signed by the end of the day and I felt bad that everybody had to wait around for me.
Despite this I think it is a worthwile exercise for me and has helped me to order my thoughts, particularly writing shortened SOAPIERS before entering a SOIER in the patient notes. However I still need to become more efficient at reading patient notes and faster with the paperwork.
One of my strategies for improving my clinical reasoning with a more logical approach as mentioned in my blog last week is to write out new patients details from their file as if I was giving a handover, then prepare a potential problem list from the information gleaned from their notes and write a list of what I will assess and why based on what I have identified. This is similar to the A and P in a SOAPIER. Unfortunately one of my other issues is that I am slow with paperwork and all this writing made me even slower so that it was a rush to get everything completed and my notes written and signed by the end of the day and I felt bad that everybody had to wait around for me.
Despite this I think it is a worthwile exercise for me and has helped me to order my thoughts, particularly writing shortened SOAPIERS before entering a SOIER in the patient notes. However I still need to become more efficient at reading patient notes and faster with the paperwork.
Thursday, November 6, 2008
Week4 day4
Today was a much better, I prepared an analysis of what I would assess and the reasoning behind it for my supervisor, she was pleased with my logic. I did SOAPIERS for all the patients I saw today and had positive feedback from my supervisor. My time management has improved today and I was able to see most of my patients before lunch. One of my patients who was discharged came back as a day therapy patient in the physio gym, she had cancelled a booking on Tuesday and almost cancelled todays session, she became more motivated during the session and enjoyed it looking forward to returning next Tuesday. This was very satisfying.
I also treated a patient who had a #distal femur in the parallel bars with gait retraining (touch weight bearing) she gained a lot of confidence with ambulation and felt positive about her progress which she imparted to me this made me feel confident in what I was doing. Tonight I am going to practise some A + P's from SOAPIERS and think about what I am going to do with my patients tomorrow.
I also treated a patient who had a #distal femur in the parallel bars with gait retraining (touch weight bearing) she gained a lot of confidence with ambulation and felt positive about her progress which she imparted to me this made me feel confident in what I was doing. Tonight I am going to practise some A + P's from SOAPIERS and think about what I am going to do with my patients tomorrow.
Week4 day3
Today I sat down with the clinical tutor with a SOAPIER I had prepared and went over the analysis and plan the tutor was pleased that I a logical problem list that related to my objective assessment and a good plan that related to my problem list.
It had helped that my clinical supervisor had me write full soapiers for all the entries that I made in the clinical notes taking special note of the A and P. I also wrote down a summary of admission for each patient that both Elle and I had been dealing with which helped clarify in my mind the details required for a thorough and logical analysis and plan see below.
Age
Sex
Dates of admission to hospital Dates of admission to this hospital
Diagnosis including
Xray/CT
Dates and details of surgery/intervention
Complications
Past medical history
Medications
Social history + previous mobility and aids
Precautions
I am feeling a little more positive now due to some positive feedback but am still apprehensive.
It had helped that my clinical supervisor had me write full soapiers for all the entries that I made in the clinical notes taking special note of the A and P. I also wrote down a summary of admission for each patient that both Elle and I had been dealing with which helped clarify in my mind the details required for a thorough and logical analysis and plan see below.
Age
Sex
Dates of admission to hospital Dates of admission to this hospital
Diagnosis including
Xray/CT
Dates and details of surgery/intervention
Complications
Past medical history
Medications
Social history + previous mobility and aids
Precautions
I am feeling a little more positive now due to some positive feedback but am still apprehensive.
Week4 day1
Jo came to see me today after driving down from Northam. I carried out part of an assessment on a new patient with a fractured distal femur with involving manual muscle testing and ROM, I was very nervous and did a poor assessment which was disorganised. Joe pointed out what I need to get a handle on by the end of the week. I am not feeling all that positive at this stage I will feel better when I start getting some positive feedback from my supervisor that my performance is improving. On Wednesday I will get an extra visit from my clinical tutor.
week3 day1
Today was not a great day as I only scraped through my mid place assessment, my clinical supervisor has put a plan in place with my clinical tutor to sharpen up my clinical reasoning and take a more logical approach to assessing a patient. It is difficult to focus on the job at hand as I am obsessing about passing the unit and have lost some confidence, I will need to work really hard to remain focused in the moment. I can expect extra sessions from the clinical tutor and a visit from Joe next week. Hopefully I can improve enough to get over the line.
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