ICE Reflection

ICE Reflection

Part 1:

1.Going into the virtual simulations, I was not expecting the cases to be so realistic and challenging. I do think it was beneficial to treat such complex cases in an educational setting before having to treat real patients in similar situations. Overall, I learned a lot during this week and I am very excited to implement all I have learned with real patients next week. I think some of the strengths I identified for myself during this week are: I always tried to educate the patient on why we were doing what we were doing and why it was going to make them better. I also think I had a good didactic understanding related to the cases which made planning and safety considerations easier. Lastly, I was able to recognize when something in my initial plan was not working and pivoted towards something else. Some areas of improvement I recognized included not always knowing the right thing to say in every situation to comfort the patient. Additionally, I think my room set up and planning could overall be improved. Lastly, I need to work on making sure my directions I give a patient are simple and easy to follow.

2.I learned a lot through these live simulations. One huge thing I took away is the importance of communication between healthcare professionals as well as PT and patients. In every simulation it was evident how much communication played a role in how the session was going. Additionally, I also took away how important it is to go in with a plan, but also be able to adjust the plan as needed because it will most likely not go exactly as planned. I think one of the biggest takeaways from this was that it is okay to take a moment, slow down, and regroup when something is not going well. Some other things I will remember in my future clinicals is the importance of maintaining eye contact with the patient as well as ensuring that the basic needs of the patients are met to get the most out of their session. I found it challenging trying to give clear instructions to a patient with a brain injury. Additionally, I found it challenging to identify if this patient was actually understanding or not. I think safety for my group went very, very well. That was always my top priority, especially with the ventilator.

3.I am feeling more confident about week 2 now than compared to before the live simulations. I am in an inpatient setting compared to an acute hospital so I anticipate I will not face all the same challenges as these hospital simulations. Additionally, in a neuro setting I anticipate there will be a very large psychological component to each session. These patients will have gone through life changing injuries and I am not as confident in my ability to comfort them. I think one reason for this is I have not yet taken a neuro PT course and I am not aware of the different prognosis and outcomes for different neurological disorders.

Part 2

1.I felt very excited heading into week 2 of this ICE. This semester I have become increasingly interested in the neurological population and was excited to get the opportunity to work more with this population at SAI. Additionally, I have never been in the inpatient setting so I was not entirely sure what to expect, but I was excited to get to see a new setting.

2.My behavioral objective goals were:

  1. The student will be able to choose appropriate therapeutic exercises for patient with correct cues and assistance provided with minimal assistance from CI after one week.
  2. Student will be able to complete an initial patient interview by the end of the week with clinical instructor supervision.
  3. Student will be able to demonstrate ability to independently perform transfers with stand by assistance from clinical instructor by end of week.
  4. The student will be able to ambulate a patient with supervision from clinical instructor after one week.

I am very happy that after a week at SAI, I was able to achieve all 4 of my goals. During my last day I was able to come up with a few therapeutic exercises for two of the stroke patients I was working with. I discussed with my CI if they would be appropriate, taught the exercises to the patients, and then cued the patients on technique and assisted them. Next, I was able to observe an evaluation on my first day at SAI and then on the fourth day I was able to complete two patient evaluations which included interview, mmt, sensation, bed mobility and transfers, and outcome measures. Throughout my week at SAI I performed many transfers which included sit to stand, stand pivots, squat pivots, and stand to sit ranging from CGA to total A. Lastly, I ambulated with almost every patient I had at SAI throughout the week, providing assistance as needed.

3.From a physical therapy perspective I found I struggled with grading outcome measures then I was anticipating, so I think this is an area I will work on in the future to appropriately evaluate my patients performances. Additionally, I did require more assistance than I initially would have thought to come up with appropriate interventions for these patients as well. From a non PT perspective, some of the patients I saw, especially on the brain injury unit, did go through some very traumatic injuries. I saw a young patient who had a gunshot wound through their head and was unable to walk, talk, or do anything independently. Additionally, I saw a young mother who had to go through 8 minutes of CPR which resulted in an anoxic brain injury. This was particularly hard to see because she was completely unresponsive but would cry uncontrollably when she heard the voice of her daughter. Although these were hard cases to see, I think it was beneficial to observe how the therapist treated these patients. Although they were extremely sad cases to see, it was a good reminder that we are there to help the patients to increase their functional mobility and independence. It is appropriate, and we should show empathy to our patients, but it is important not to become emotionally attached and to stay focused on the physical therapy aspects while also showing compassion.

4.Something that surprised me a lot during this clinical was how motivated the patients were! Almost every patient we had was excited to get the opportunity to work with PT, work on their walking ability, and wanted to push themselves which made me very happy to be a part of. Additionally, I was really surprised at how functional a lot of the SCI patients were. I think I was expecting to see total SCI, but was surprised when a lot of them were able to walk with assistive device Mod I or completely independent.

Part 3

One APTA core value that I saw my CI exhibit with every patient was compassion and caring. My CI took the time to get to know every patient, identify their goals and needs for physical therapy, and go above and beyond in giving them the care they needed. She encouraged her patients to push themselves and achieve their goals. One patient we had was in excruciating pain (10/10) and because of this was not being very kind to the staff, understandably. My CI still treated this patient kindly even though he was not reciprocated. She did her best to try to get his pain to calm down, tried to do some exercises in bed, tried to repositioning, educated him on the importance of moving after surgery, and advocated to his doctor on his behalf. I think being able to identify your patients needs and show every patient you work with kindness and empathy is a great example of compassion and caring value.

 

Part 4

I really, really enjoyed my time at SAI. This experience definitely made me more interested in working with individuals in the neurological population! I also found I really like the inpatient setting! I think it is a nice mix of medical knowledge, some acute care elements, and I love the intensive therapy component that each patient receives. I learned a lot and think I gained a lot of knowledge and skills in this one week. Upon my next clinical, I wish to improve upon a few aspects. First, I would like to become more confident in my decision making. I do think this will come with more time in the clinical setting, but I would like to be more confident in my clinical reasoning. I would also like to improve on selecting appropriate therapeutic interventions for my patients. I found it a little difficult at SAI because they did have so much amazing technology to help their patients and I was not familiar with a lot of it. Along with this, making sure I can give my patients the perfect challenge, pushing them so they will improve but not making the exercise too difficult. Lastly, my CI and I ran into some difficult situations with patients (extreme amount of pain, suicidal talk, uncontrollable crying) and my CI did a wonderful job at educating the patient and appropriately referring them to medical psychiatry. If I was not with my CI I do not know what I would have said to the patient in order to comfort them and provide appropriate education. So I think it would be beneficial practicing having those harder conversations before going to my next clinical.

One thought on “ICE Reflection

  1. Mary,

    I enjoyed reading the detail about your experiences and patients and I think your CI seems great at getting to know their patients. I relate to what you said about outcome measures, they are a little tricky to score sometimes and tend to change based on how the patient presents that day. I am happy to hear that you enjoyed working with your patient population.

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