PT Clinic Reflection Journal

10/30/06

Today was a slow day. My patient that I worked on last week called and cancelled, so I worked with two other first year students working on a patient that I have worked on in the past. Only this time working on that patient I felt more comfortable. I was really comfortable transferring and doing the
ROM. I found I still need to work on positioning the patient and also knowing how hard to push the patient. I find that when I see this patient is in pain or discomfort, I back off the stretch right away. Not challenging the patient does not help them. When chatting with the patient and joking around with her, she seemed to relax more. It also helped take her attention off of what we were doing, so we were able to get more ROM.

Documentation went well today. We wrote the note during the treatment. We just had to write the assessment and plan portions after the treatment. For the second hour, I really had nothing to do because the second year’s patient cancelled and the note was already done. Hopefully next week is a little busier.

10/23/06

Today, another first year and I worked on a new patient by ourselves. The patient had MS. We had to work on balance, stretching, and strengthening the right side. It was a little scary because a lot of what the patient was working on was things we haven’t learned yet. It turned out to be a good learning experience.

 It showed me I need to practice reading the charts better. While we understood some things about the patient we did not get the whole picture. I also need to work on explaining what I want the patient to do better. The patient actually talked us through almost the whole treatment. At first this was really humiliating because I felt so unprepared and that I didn’t know anything. But after talking with my instructor I understand it is okay because this is meant to be a learning experience. Also the patient has been coming to the clinic for a long time and understands that we are learning.

 When we first started the treatment, a second year student sat with us and answered questions we had, which was really helpful. The PT student also had some time off and showed us how to do PNF D2 exercise. That was really cool. I really like the PT student who was working with us. She took the time to explain things to us and checked in on us to make sure everything was going okay. The patient also taught us how to do PNF D1 exercise. It really helped that the patient was really laid back and tolerant of us. She also told us what she wanted. That was nice.

Writing the progress note went okay too. I want to work on writing the note faster. It is still taking about an hour to write. Also, I need to make sure to include the reason why things are done. Overall, it was a great learning experience today.

10/16/06

Today I was shadowing the second year again. It is interesting to see how much of the treatment I am able to understand now. After just a couple months of being in the program I am able to understand a whole lot more than the first couple clinics. We saw one patient that I have seen many times before. It’s cool to watch this patient progress a little more each time I see her. We also saw a new patient today. This patient had a CVA a little over a year ago. It was hard to watch this treatment because the patient was not happy about his progression. It made me realize that I need to learn how to deal with patients who are not happy about their conditions. I felt I would not have known what to say or how to react to the patient. I realize I would need to help the patient focus on what they have accomplished while listening to their concerns and what they want to do. But knowing what to say in a situation like that will take some practice for me to be able to feel comfortable.

10/9/06

Today in clinic, I did basically did the same treatment with the same patient as last week. This week however I felt better about my performance. The other first year student and I decided to change the treatment a little. We decided to do all the range of motion first. I felt better about this aspect of the treatment because we were able to complete all the ROMs this time with out the patient becoming agitated. On the other hand, because of this we had less time with the tilt table and the patient wasn’t as tolerant of this part of the treatment.

I got to do a lot of the transfer today, which was really neat and good practice. It was really different from practicing on my class mates. I found the areas I need to work on during transfers. I need to make I am blocking the patient’s knees, so they can not slip away from me. That was the biggest problem I had. Also, I need to practice more. That way I can be more confident in transferring the patient.

I was still not completely happy with the way the treatment went. I need to practice transferring and position patients on the tilt table. These two areas took away a lot of our time with the patient, which resulted in a longer treatment time. With this patient a longer treatment time is not the best because the patient gets tired and becomes harder to work on. It also caused us not to be able to do as much as we wanted to do with the patient.

I felt good about writing the progress note today. Of course, our note was not perfect, but I am really starting to understand how the treatment needs to be documented. This is really important because documentation is extremly important.

For next time, I really want to decrease the time spent on transferring and positioning, so I am able to work with the patient doing ROM and tilt table longer.

10/2/06 Today I worked on my first patient with another first year student. It was a little frightening. We worked with a patient who went into tachycardia resulting in anoxia to the brain. The patient can move extremities a little, but has developed a lot of contractures. The patient is not able to speak, but does communicate through facial expressions. The fact that she can not talk made me a little nervous to work on her as my first patient with out a second year student there.

Are plan was to perform PROM and work with the patient on the tilt table. The patient was very active today, so the range of motion turned to active assisted. She was really able to move in the lower extremities and R upper extremity. That was really exciting because the last time I worked with this patient she slept the whole time. I was a little nervous knowing the patients limitation with PROM, so the fact that the patient was awake and helping was relieving.

When we started working with the tilt table I really felt out of my comfort zone because we were multi tasking. This was hard because I felt I wasn’t effective in the treatment. It was hard to make sure the patient was comfortable, not feeling any pain, and trying to move the patient’s upper extremities. We definitely over worked the patient today.

Next time I would change some things in terms of the order of the treatment. I would first do the passive stretching first and then work on the tilt table. I think this would help focus the treatment, so we could get more done. I think it would also help with not overworking the patient. It would make me feel more comfortable with what I am doing. I felt I was spreading myself to thin today. I also want to work on reading her expression more to know how she was doing.

I felt more comfortable with the documentation today. I still have some questions of course, which I probably will for quite some time, but I think we did a fair amount of the note by ourselves. It wasn’t my best day in clinic, but it showed me things I need to work on for future treatments.