Lessons Learned: Clinical Education 3, weeks 1 and 2

 

So the original plan was to do this twice per rotation from now on, but I’m in acute care now which is markedly different than outpatient and still substantially different than rehab. I go in having spent maybe an hour or two in a hospital in the last decade. I also go in knowing that experiences can be drastically different from hospital to hospital and luckily I have some special people that I can discuss those differences with.

New state, new rotation, same (smart-ass) Sam.

 

  1. We should have practiced more than SCI and amputation transfer attempts in PT school.

The reality is I probably just didn’t pay attention to anything else because they seemed so easy. I’m a champ at transferring SCI. Please just make them flaccid and I’ll put them in that chair smoother than oil on a hot pan. Any other type and the patients want to help though and for some people that’s all the treatment is. There’s nothing quite like your patient having a death grip on a bedside commode that makes your transfer impossible and his knees buckle every once in awhile and you already know he is desaturating like he’s on Mars. Oh, and he’s pooping now.
Or when you’re transferring a 98 year old max to total assist lady who nobody has gotten out of bed and she’s NWB on one arm and one leg, severe dementia and whose neck has been hurting like the dickens so she can’t rest her head on your shoulder. Good times.

 

 

     2.        Families need to ask questions about returning to home.

Therapists are invariably going to be some of the nicest people you will find in a hospital even though they get flack all the time. See, “you the pain and torture people?” But we are human and are trying to do our best to manage large caseloads. We try to cover our bases and think of any barriers to home; however, nobody will know home better than the patient and their family though. Some of the easiest patients to treat are the ones whose family is involved and engaged during the therapy sessions and asks a lot of questions. By asking questions the patient’s family will feel better prepared and the therapist is able to make a better educated decision on where to send them. This is of course one of the many components of family involvement.

 

    3.         Acute care PTs get their steps in.

I don’t even change floors where I am and I still get in a ton of steps. Based on some other people’s experiences I thought I would get tired of walking people while I was here. To the contrary, every person I go on a stroll with is a blessing from above. It makes my notes easier to write and it’s less stressful than a lot of the alternatives we could be doing.
You can be a thick mamma jamma acute care PT for sure, but you’ll almost certainly be a mamma jamma with all the steps you get in.


4.        Documentation is more strenuous.

Again, this might just pertain to us. Entire books could be written about this.

Outpatient documenting I definitely picked up and learned faster. You usually only have to focus one one aspect or one joint of the body and stick with it. Acute you’re looking at living situation and taking a more extensive look at their function beforehand and medical history. I’d say outpatient documentation is more about crossing your “t’s and dotting your i’s whereas acute care PT is more about decision making. What equipment do they need and where can they go after the hospital to serve them best? Versus, was this test positive?

 

    5.        I miss manual therapies.

One lady was doing fairly well after a hip replacement and was likely going to be discharged in the next 24 hours. Her chief complaint was her gosh darn neck. She was very locked up and in a lot of pain when she tried to turn to the right. We worked on some other things while we were there and then I asked my CI if I could work on her neck. I tilted the recliner as far back as it could go and then went to work doing some different contract/relax and massage techniques. I teared up a little behind her because hot damn it felt good to be effective with my hands again. It is something special. Her being super appreciative after was a nice touch too I guess.

 

I feel confident enough to say I’m a cog in the hospital machine and learning a lot along the way. Just need to find some grease to keep me going for another eight weeks

Ramble on,

Sam

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