Week 1 Day 4 Entry 2

Today I was allocated a different supervisor in the Day Hospital Outpatients Clinic as a replacement for my Parkinson's supervisor, who is away at a conference. Unfortunately it was also this lady’s first day in her new position, so again my interaction with the patients was mainly observational with limited hands on experience.

One of the clients we saw in the day hospital was an 80 yo man who was referred from inpatients for further rehabilitation following a fall. After reading the medical notes I came across the underlying reason for his fall, according to his initial assessment he fell "after consuming two bottles of whisky on the election night." Therefore I already had alarm bells ringing about possible alcohol issues. In addition the patient was obese, and seemed to have significantly decreased range of movement and mobility due to his size. The patient's size did have me worried about the how the treatment could be carried out, the patient's safety in the case of a fall, and the ability for my supervisor and I together to be able to handle the man. The man lacked a great deal of insight and perception particularly when considering possible risks and safety issues. He seemed to rely heavily on his 4ww whilst not using it in (what I consider) a safe manner. Therefore a large part of the treatment session was spent attempting to educate the patient about safe and appropriate use of the aid. I also suggested to my supervisor that we should consider a less complicated, safer, and more supportive walking aid (such as a ZF). However, due to the patient's other cardiorespiratory co-morbidities (frequent episodes of AF, dizziness, and SOBOE) it seemed necessary to have the seated walker.

When reviewing the man's home exercise programme, the patient was particularly impulsive and non-responsive to commands or feedback. Nevertheless, he did appear to know what the exercises were even though they were not performed with the best possible technique. The patient also expressed the need for a "whisky break" during the treatment session. Obviously this was inappropriate behaviour, yet once my supervisor discussed this with him he did respond to the request and he didn't mention it again.

My supervisor and I concluded that it would be a good idea to direct this man back to his GP concerning his possible alcohol issues and educate him on the detrimental effects that alcohol will have on his well-being. I also discussed with my supervisor how it was better to be maintaining the patient's exercises and activity as much as possible to prevent a decline in his physical condition, even though the exercises were not performed with the perfect technique.

On reflection of the treatment session, maybe I would try to include the wife in the education and instruction of the exercises. This may have improved the effectiveness and technique of the man's exercises. I think it was a difficult situation, and I believe it was handled in the most appropriate way for the circumstances.

Although I didn't feel confident, as I have never had a patient similar or been in the same situation, I still felt comfortable and in control throughout the session.

What I learnt from this experience was mainly the importance of education and discussion when confronted with difficult situations. Even though it is essential to ensure there is sufficient intervention and treatment of patient's during a session, I am becoming increasingly aware of the need to incorporate education as a strategy for dealing with many situations.

Overall I think today was good as I got the chance to observe a different area of physio and work with another very experienced and knowledgeable supervisor. Yet, I feel as though I should ask my supervisors if I could have more hands on experience tomorrow. I tend to learn best when combining VRK strategies. When it comes to learning practical skills, however, I don't think there is a better way then actually practicing and applying the skill so hopefully I will have more of an opportunity tomorrow.