Clinical Education I – ICE Reflection
During the virtual simulated activities, I learned about the importance of educating patients and collaborating effectively with other medical professionals in the acute care setting. For example, one of the virtual simulations included a patient unwilling to comply with some of the physical therapist instructions, the patient being highly enthusiastic about returning home immediately when this was not warranted. After reviewing the virtual simulation and discussing this case with peers/teachers, I gained an appreciation for the way in which patient education can work in a physical therapist’s favor. Often, for compromised patients in similar situations, it can be critical to understand that discharge to a more involved facility like inpatient rehab can expedite the recovery process and return to functional independence, as compared to immediate return home where problems may linger and maximal independence will be further out of reach.
From these modules I learned that I could use some work reading through medical charts thoroughly. Doing so would allow me to ask fewer and more effective questions to both healthcare collaborators and the patient. On the other side of this, I learned that I have a decent understanding of most of the components that comprise a full patient evaluation.
The live simulations were extremely helpful in testing my acute care evaluation skills. In my notebook I wrote down 52 takeaways. These include the importance of short/concise patient directions, line/lead management of a chest tube and ventilator/trach tube, chair draping to set the nursing staff up for success, telemetry management, Hoyer pad/lift utilization as a transfer back-up, gait belt placement when a chest/PEG tube is present, and the importance of cuing the patient to try something first rather than the PT immediately helping. Some challenges in these simulations included room organization with a vent/trach tube, motivating unenthusiastic patients, and complex line/lead management during bed mobility/transfers/gait. The simulations were all difficult; however, my classmates and I were able to discuss these challenges as they appeared and work around them. If anything, these simulations taught me the importance of collaborating with other healthcare professionals and taking your time when patient cases are highly complex.
After a full week of both virtual and live simulations, I am feeling more confident than the week prior. Obviously, the stakes are higher when dealing with real lines and leads, though I am still excited to interact with real patients. During my clinical rotation, I believe I will need to work on SOAP note development, concise/clear patient instruction aimed at making the patient work (before I aid them), effective room organization, and lines/leads management.
Heading into my clinical rotation, I felt confident in my abilities to interact with patients in the acute care setting. Through both acute care centered practicals and live simulations, we had more than enough practice to refine our skills. The objectives I made for myself, which include creating a SOAP note, managing a minimum of 2 lines/leads, instructing patients on proper precautions, and conducting an examination, all with stand by supervision, were met. The most difficult of these was writing a SOAP note on my own and this goal therefore took me the longest to achieve. The computer program Epic took some time to get used to as well as the various intricacies of acute care notation specific to PT. In particular, the assessment portion is the most challenging for me and could use some work. Assessment writing requires the ability to take an entire patient evaluation/treatment and pick out what is most essential to individual function and discharge planning; I need more than a week to fine tune this skill.
How much I enjoyed being in the acute care setting is what surprised me the most. Up until this experience I had only been in the ICU, here I didn’t feel as comfortable and I personally didn’t enjoy it. However, with this most recent clinical rotation, I was now on the med tele floor where the medical complexity is not as high. This unit was more tailored to my current set of skills and confidence level, and I felt more comfortable here. Because of this, I was able to further enjoy the patient interactions and fine tune my skills. Now that I have this experience in my history, I believe I would fare better in the ICU and potentially enjoy it.
My clinical instructor (CI), along with all of the OTs we co-treated with, embody the APTA core value of inclusivity, among others. Regardless of the patient being seen, she treated everyone with the utmost respect, dignity, and compassion. At one point in the clinical experience, I began to question my CI about the misfortune that rural clients with limited healthcare access face due to newer hospital policies that prioritize productivity and shorter hospital stays. The result of the conversation turned into a lesson in treating every patient with the best care we can provide. She even cited research showing that minority populations feel undervalued in healthcare settings, especially in acute care, and that we as PTs can make a big impact on these groups simply by walking into their room and giving them the best energy and care we can. This was one of my biggest takeaways. It goes without saying that treatment should be inclusive, but I still found this lesson salient and powerful.
My CI is an extraordinary acute care PT clinical instructor. I was lucky to work along side her and catch some of her passion for inpatient rehabilitation. She was a master of patient/family education, teaching me that educating your patients is just as important as the evaluation/treatment we provide. Not only must PTs be fluent in the art of assessing a patient’s deficits and addressing them, we must also have the social tact to figure out how to best reach a patient and teach them and their families what will be safest for them upon discharge. A few times throughout the week we walked into rooms with family members present and Lynn took these opportunities to instruct them on new safety precautions they should be taking with the patient as well as potential discharge locations and what happens at each of these. She clearly has a strong understanding of the healthcare system in general, a skill I have learned is important for education and adherence of guidelines.
In closing, in my next clinical experience I would like to improve upon my patient education skills as well as assessment writing.