My Initial Clinical Experience

Virtual Simulations:

The virtual simulation activities were very helpful and got me thinking about how to put all the pieces of a PT acute assessment together. It was encouraging because I realized a know more at this point than I thought I did. I noticed that my clinical reasoning got better after I did the first patient. I feel like I have a better grasp on how to differentiate which skills and assessments to look at based on the individual’s specific case.

My primary weakness in both cases was in communication with the collaborators. I was quick to “speak with” a health professional, even if they did not have insight pertinent to the patient. I also realized that I did know what questions to ask the specific health care professionals (in particular, the PA, case worker, and nurse). The diagnosis section of the assessment was my second worst score. I initially chose too many diagnostic impairments and realized I was making inaccurate assumptions. For example, I automatically assumed someone with a total hip replacement would have balance deficits. I quickly learned that making these broad expectations about how a patient would present was not helpful.

In terms of strengths, I was able to accurately select and complete assessments and skills. I was surprised by how well I was able to observe the patient performing a task and gather the necessary information. Additionally, in both cases, I was able to improve and reach a “mastering competency” score after working through the areas I did not fully understand the first time. I also realized a strength was gathering all the learned information together and making a plan of care for moving forward.

Live Simulations:

It was difficult managing the complexity of the cases and handling situations on the spot that we had never been exposed to before. For example, seeing certain lines and leads for the first time and problem solving through the logistics of mobilization was challenging. One area I realized I need to focus on is cuing. I was able to encourage the patient well, but constructive feedback and cuing in the moment was lacking. I knew what I wanted the patient to do, but I had a hard time explaining how I wanted her to move in a concise way that she was able to understand.

I was surprised by how well I was able to stay calm despite the stressful situations. For example, when the pts. SpO2 started to fall (85%) when I got them standing, I did not immediately sit them back down. I thought my instinct would be to panic and force the pt. to the EOB as quickly as possible. However, I was able to calmly instruction the pt. through pursed lip breathing and provide postural cues to open the thoracic cavity. The pts. SpO2 returned to 90% after a minute and we were able to continue with the treatment. I also liked how well my group problem solved together. Though the simulation did not go how we planned, we were able to improvise on the spot and make adjustments. We divided tasks well and maximized efficiency. It was great experience working with someone else and helpful as we prepare to work with our CIs, PT techs, OTs, other students, etc.

I am excited to go into week 2 of this initial clinical experience. I am more confident than I was prior to the simulations and feel ready to put what I have learned into practice. I know that I tend to second guess myself and underestimate my ability to successfully complete the skills we have learned. Therefore, I was to focus on challenging myself to step into situations outside my comfort zone. I want to maximize the opportunity to work with a CI in the acute care setting at the VCU hospital.

A week in the VCU Hospital:

I am very happy with the progress I made towards achieving my objectives. I was able to accomplish all of my written goals heading into the week including completing a subjective evaluation, recognizing gate deformities, completing MMTs, reflecting on my experience, and explaining ther ex/precautions to patients.  The greatest challenge I faced was adapting on the spot and completing evaluations/treatments in an order other than what I had practiced. For example, there were patients I saw that we mobilized prior to completing MMT due to pts. needs to go to the bathroom. In order cases, we ended up asking A&O questions as the final part of the subjective. With one non-verbal patient who was also HOH, I had to get creative in how I asked questions. In other pts, it was clear that they simply said “yes” or “no” randomly, so the information they were providing could not be trusted. My CI taught me to throw in random questions to see if the pt. was understanding and following the questions. For example, she would say, “are we on the beach right now?” or “Do you have 25 fingers?”. While I felt like being flexible on the spot was one of my greatest challenges, my CI encouraged me and said that I did a great job jumping in and adapting the plan on the spot.

I was surprised by how much I enjoyed being in the acute care setting and by how much of the evaluation I was able to do on my own. On the first day, my CI asked if I would like to lead the first eval. I was surprised, that I agreed to and even more surprised by how smoothly things went. I did not get flustered by curve balls and lines and leads that I had never seen before. The neuro ICU setting was very eye-opening. I was surprised by the wide range of functioning within a specific unit. Some patients were mobile and simply there for monitoring. Others were in critical condition and had undergone neurosurgeries and had many lines/leads. With these patients, the session was more focused on gathering SH from friends/family and pt. repositioning. I also surprised myself the day I was in the psych ward. I did not realize that a PT’s main goal in this setting is to education and simply get the pt. OOB and moving. I was able to build report with the patients and get them up for a walk, even when they were convinced that were unable to do so.

One APTA Core Value that my CI demonstrated (alone with other CI’s I worked with during this experience) was compassion. The APTA describes the quality as the desire to identify with or sense something of another person’s experience. When a person displays compassion, they are caring and considering of the needs and values of another person. My CIs consistently put the concerns of their pts. first. They did whatever necessary to make the pts. comfortable and feel seen and heard. This including many things outside their “required” job such as hygiene care, food help, contacting care partners/others, sharing photos/games, and simply listening to pts. stories and desires.

During my next clinical experience, I hope to expand on this initial opportunity and increase my confidence in working with medically complex patients. I recognized that I am not great at working with angry or “mean” pts. However, I know this is something I will run into, I hope to improve on my ability to communicate with pts. that are rude or angry. I am recognizing that sometimes, it is necessary to be harsher and push patients beyond what they want to do.