Patients Physical Incompetence - Assignment Example

As a part of the clinical experience I had an opportunity recently to work at the physiotherapy and sports medicine department of Nanavati Hospital, Mumbai, India for four weeks. The physiotherapy and rehabilitation department at Nanavati Hospital deals with Musculoskeletal and Neurological disorders apart from respiratory disorders and sports injuries. The department consists of 43 physiotherapists all of who are females except for the head of the department. My experience at Nanavati was very educative and enriching in various ways. This essay will reflect on the contextualization of the learning environment, critical review of personal learning and how this occurred, identification of personal and professional goals, evidence to support learning and reflection, and its implications for future practice. The four weeks at the Mumbai hospital helped me hone up my professional and personal skills. The first learning came from the environment itself. Although there were many cultural and professional differences, it was not difficult for me to adjust as I knew the local language. What was truly astonishing though was that while the other therapists were friendly and helpful they would not interact with me when others were around. I wonder whether it was a bias against gender or their reputation would be at stake if they were seen talking to a male physiotherapist. It could also be my nationality and background that disturbed them. Most of them could communicate in English although Hindi was the preferred language. Nevertheless, I did find them friendly, which conveys that humanity is above caste, creed and religion; it is the person that is important and not the nationality. On the professional front, I found that the plinths (beds) within the department were wooden and the height could not be adjusted according to the patient’s or therapist’s requirements. I often had to use a stool to step up. What was even more shocking was the manual handling techniques that were used to move the patients. The patient was picked up by the ward boys by putting their hands under the armpit of the patients. This was something truly ridiculous and then the chair on which the patient was seated would be pushed around by the ward boy from one place to another. The wheelchairs were fitted with brakes but the patients had to use them without the brakes. Irrespective of the presence of a physiotherapist, the department should have the basic equipments and standard facilities (Physiosa, n.d.). It is impractical and expensive to transport patients to a high-level care facility. It is cost effective and assures quality service if facilities and equipments are available at all levels. Personal learning proved to be interesting too. Interaction is a vital element of physiotherapy (Parry, 2004) and I started learning initially by observing how the other therapists interacted with the patients, assessed their needs and treated. It is important for a physiotherapist to provide the patient with explanation and information, according to Parry, and this is what I learnt while at Nanavati. Patients should be fully involved in the treatment process and not just be passive players following the instructions of the therapist. I assisted other therapists by applying electrotherapy treatments to patients. Thereafter, I was given my own patient load and was attending to the same patients everyday or every other day. This was not the general practice at the hospital because most patients did not have any fixed schedule of visiting the department. As a result the same therapists did not attend to them on their visits. I personally feel it helps the patient if he is treated by the same therapist as an understanding develops between the two. According to Parry, bodily incompetence is important during conduct of physical treatment activities. Implications of incompetence could include patient’s efforts in therapeutic activities and even failure of cooperation with the therapist. The likelihood of such a situation increases when the patient has to face a different therapist each time, as was the case at Nanavati. It was rewarding for me as I had the same set of patients to deal with. Apart from the experience in patient treatment, I learnt from the interactive sessions held everyday after lunch when the head of the department met the juniors. There used to be lectures on different aspects of physiotherapy and on other related subjects like yoga, spirituality and meditation. These were practical sessions where we practiced the advanced techniques in physiotherapy. One of the most interesting sessions was when he explained the procedure and techniques he used for preparing the national cricket team before they stepped into the grounds. It was interesting to learn that different techniques are used for play at different times of the day and also with different players. For instance, the technique used with a fast bowler would differ from others. Besides, post match attention and treatment was different too. The only draw back was being a single male therapist in the group. I strongly feel I would have benefited more from these sessions had there been at least one more male therapist. The personal and professional goals that I had set for myself at the start of the elective placement included learning musculoskeletal assessment and treatment techniques, to apply some of the physiotherapy techniques used in sports, assessing and treating patients independently (have own work load), spending time at different wards within the hospital to gain an overall knowledge of the physiotherapy practice and spending time with a physiotherapist of a local football team. My tenure at Nanavati helped me attain all of my goals and I emerged enriched and contented. I was fortunate enough to learn and practice the assessment and treatment techniques under supervision. It always helps to first observe and then be observed. Some patients were booked under my name and I attended to them on a regular basis. Having my own work load meant the onus of success of the therapy was on me. This made me even more alert and conscious of discharging my responsibilities promptly and accurately. I realized that having independent charge inculcates a sense of responsibility in an individual and I was prepared for it. My experience as a therapist included a range of patients from a simple office worker to a national football team member and to a very famous actor. I found the work extremely interesting and rewarding. My goal to learn and apply the physiotherapy techniques for sports was achieved as the head of the department has been the physiotherapist for the national cricket team for more then 10 years. Physiotherapy has to be applied on patients who have other ailments. Buzzard (1999) agrees that physiotherapists tend to be involved in all aspects of health care from health promotion to tertiary care. Physiotherapists need to be qualified to work with individuals and encourage health and well being. For this it is important to have a thorough understanding of the musculoskeletal system, cardiopulmonary, and neuromuscular systems, and are skilled in biomechanics, kinesiology and exercise. With this in mind, I spent two hours every morning, Monday to Thursday, in different wards along with other physiotherapist who were working in those wards. I gained experience and developed skills in the neurological, respiratory, pediatric, orthopedics, ITU and general hospital wards. A senior physiotherapist from the department was training a football team who took part in the national league. I jumped at this opportunity and spent two weekends observing the training sessions. Preventive programs for the players are essential in injury prevention in sports (Harringe, Renstrom, & Werner, 2006). Injuries among the sports team can occur at any stage – it could be at the time of training or even during the warm up exercise. Research has also shown that most of the injuries occur towards the end of the session which implies that fatigue or stress has a negative impact on the motor control and thus leads to injury. Attending these sessions was extremely beneficial for me as I realized that the team has to be physically and mentally prepared to avoid injuries. Overall, I feel very positive about the experience and knowledge that I gained at Nanavati. The experience was invaluable as I also happened to interact with a cross section of people from diverse backgrounds. I feel privileged that I had an opportunity to treat a couple of national football team players as well as a national squash and a cricket player. Besides, my understanding of some of the techniques used in physiotherapy especially the Maitland’s has deepened. I used several other treatment modalities like electrotherapy, stretches and exercises. Most importantly, I enjoyed having my own workload which inculcated a sense of responsibility, accountability, and helped formulate and maintain strict time schedules. Nevertheless, I also believe that education is never complete and one should be well equipped to respond to the ever changing demands of technology and the society. Robertson et al (2003) suggest that continued education is essential. General physiotherapists should continue to acquire higher levels of academic knowledge, clinical skills and experience beyond the level of an entry-level graduate. Physiotherapists today are primary health care practitioners. Hence, one has to be responsive to changes in the health sector and adjust to the demands of the situation. My stint at Nanavati enabled me to develop profession-specific skills and competencies in dealing with patients amidst challenging circumstances. I learnt team working skills in a professional environment and had a useful professional development opportunity. I realized that is important to continuously develop the expertise in this field. References: Buzzard, B. M. (1999), Physiotherapy for the prevention of articular contraction in haemophilia, Haemophilia (1999), 5, (Suppl. 1), 10-15 Harringe, M. L. Renstrom, P. & Werner, S. (2006), Injury incidence, mechanism and diagnosis in top-level teamgym: a prospective study conducted over one season, Scand J Med Sci Sports, DOI: 10.1111/j.1600-0838.2006.00546.x Parry, R. H. (2004), The interactional management of patients’ physical incompetence: a conversation analytic study of physiotherapy interactions, Sociology of Health & Illness Vol. 26 No. 7 2004 pp. 976–1007 Physiosa (n.d.), Minimum Requirements for equipments and physical facilities in Physiotherapy Services at all levels of Care, 13 OCt 2006 Robertson, V. J. et al (2003), Taking charge of change: A new career structure in physiotherapy, Australian Journal of Physiotherapy 2003 Vol. 49 Read More