Self- Reflections Post Assesments
Assesment 1 Reflection
How I applied feedback from practice assesment 1
The feedback I received post practice assessment 1 was to focus more on transferring my weight to assist the ease of performing exercises. I implemented this feedback during assessment 1 by transferring my weight backwards through a split stance when I rolled Paul onto his side. However, I feel adjusting the plinth to be higher would have allowed better utilisation of weight transfer to assist me in this exercise. Additionally, I utilised weight transfer during the sit to stand exercise by adjusting my weight distribution from my front to my back leg and bending my legs to improve the ease of performing the exercise. I also received feedback that I should be careful to not utilise Physiotherapy jargon in my communication with the patient. This feedback was implemented throughout assessment 1 to enhance the clarity of my communication and ensure the patient understood what I was saying, allowing for informed consent. Additionally, I received feedback from the practice assessment that I should adjust the draping to focus on the medial proximal thigh and pelvis region rather than the leg, which would allow for better movement and exposing the hip joint to ensure I could clearly see I was performing all movements correctly. However, due to the nature of this assessment I was unable to implement this feedback.
Things I thought I did well
In assessment 1 I felt I overall performed well and displayed professionalism in my appearance and communication completing the assessment in an organised manner within the allocated time frame. During this assessment I stated the purpose of the task clearly to Paul and ensured I had informed consent before I began my allocated exercises. I think my gentle positive tone assisted in addressing Paul’s anxiety throughout the interaction. Despite being unintentional my frequent hand gestures aided the clarity of my communication with Paul and displayed professionalism. For the most part I feel I addressed risks posed to the patient and myself adequately throughout the assessment. I attended to the risk of Paul fainting or becoming out of breath through checking up on Paul regularly and assuring him we could stop at any time to take a rest. I also checked that Paul had taken his Nurofen for his knee pain to ensure he didn’t experience unnecessary pain. Along with this I checked the environment for tripping hazards which would pose a risk to myself and the patient. Additionally, I performed hand hygiene prior to interacting with the patient and avoided language which would increase Paul’s anxiety such as, “I won’t let you fall”. In particular in regard to treatment I feel I performed the sit to stand with Paul well as my handling was appropriate throughout and my communication was clear allowing for the task to be performed with ease.
Aspects I feel I could of improved on
In regard to communication during this assessment whilst I aimed to build therapeutic alliance with Paul, I feel asking more specific questions based on his clinical notes rather than surface level questions would have improved my therapeutic alliance and conversational skills. In addition, whilst in conversation with Paul I feel if I focused on active listening rather than responding based on a pre rehearsed set of responses, would have allowed me to build stronger therapeutic alliance. In regard to my risk management during the assessment, I feel if I adjusted the plinth to be higher when transferring Paul from supine to sitting on the side of the bed this would have been more appropriate and resulted in a better posture and ability to transfer my weight making it safer for me as the therapist. Despite incorporating rests for Paul during the session, I feel including a rest in between each sit to stand, would of help to better ensure Paul didn’t get out of breath or dizzy during the unstable standing position. Additionally, I feel that prior to the sit to stand activity the wheelchair should have been positioned closer to Paul as he had to step back slightly to have the back of his knees touching the wheelchair seat. Whilst overall I felt my treatment of Paul was good, when bending his knees in preparation for bridging I felt that beginning by bending the leg furthest away from me would have made the handling smoother. Additionally, my handling was a bit grippy and a lumbrical grip would have improved Paul’s comfort. On reflection considering Paul’s condition, allowing him to assist me to get his knees bent, in particular, his left leg, would have allowed for the session to be more collaborative.
Goals for Assesment 2
My first goal I seek to achieve for the assessment in week 14 is to improve my posture when working with patients by adjusting the plinth to a more appropriate height. During this assessment I adjusted the plinth height, however, I feel it was a bit low during transferring Paul from supine to sitting on the side of the plinth. This resulted in unnecessary bending over whilst working with the patient, in the long term a risk to my back. I will seek to change this through recording during class when I’m practicing activities and then watching these videos back, allowing me increased awareness of whether the bed height is appropriate so I can change this on future exercises. I will also notice feeling more comfortable performing exercises with patients when I have a better posture. My second goal for the next assessment is to improve my ability to make casual conversation with patients, helping to enhance my therapeutic alliance and collaboration between myself and the patient. I can improve this by looking through patient medical notes in more depth and preparing questions which are more out of the box rather than basic surface level questions, this in turn also allows more opportunities for me to demonstrate empathy. Its important I practice this in class and in the lead up to the assessment as these conversations will help me to become more comfortable in conversing with patients. I will be able to tell I have improved my conversational skills as the conversation will feel less awkward and I will likely feel greater enthusiasm from the patient. My last goal for week 14 is to improve my active listening skills as upon watching the video of assessment 1 I feel I wasn’t active listening and rather listening to reply based on a pre-emptive script in my head. Active listening will enhance my rapport with the patient and ensure I don’t miss out on important details which can help me address the client’s needs. I can improve my active listening skills in practical class through increasing my willingness to practice with a variety of people. This will improve my active listening as ‘patient’ responses across people will differ, forcing me to think more about what they are saying rather than thinking from a predesignated response script. I will be able to tell I have improved my active listening skills as I will be following less of a script when interacting with patients and feel more genuine in my interactions.
Assesment 2 Reflection
How I applied feedback from assesment 1
In assessment 1 I received minimal negative feedback, however, regarding therapeutic alliance and communication I was told I made genuine attempts to create therapeutic alliance and had a calm communication style. In assessment 2 I aimed to continue with this calm communication style which I feel I successfully did. In assessment 2 additionally I intended to improve my ability to build therapeutic alliance, by not following as much of a pre-emptive script interacting with the patient and rather thinking of questions on the spot which related to their hobbies, to help build a more authentic therapeutic alliance. However, due to still needing to develop this skill following less of a script effected my flow of communication so it’s important I keep practicing having casual conversations with ‘patients’. Additionally, I was told I displayed clear communication which was tailored well to the patient. I aimed to replicate this in assessment 2, however, at times in particular when I realised I was running out of time I feel my communication wasn’t always clear. Additionally, regarding risk management, I was told in assessment 1 that my manual handling was performed well and that I managed risks appropriately. In assessment 2 I strived to once again clearly manage risks, something I believe I achieved. Additionally, regarding manual handling of the patient, I feel I did this well and also allowed for the patient to assist me, making the session more collaborative.
Things done well
Overall, regarding communication and therapeutic alliance I did well to ensure the session was less expert driven by giving the opportunity to the patient to demonstrate they could perform movements, an important part of teaching, along with allowing them to assist me in the transfer to sitting on the side of the bed. I also felt I considered patients’ information well in particular when I checked if Stephanie was able to see demonstrations, this accounted for her short sightedness. Along with this I mentioned their delivery driving and cycling utilising this to develop rapport and giving her a goal to motivate her throughout the session. Additionally, throughout the session I checked up on the patient regularly and utilise positive encouragement to motivate the patient. Regarding professionalism I felt during assessment 2 I maintained a high level of professionalism both in appearance and also by being respectful, friendly and not dominate patient in my language even when they did things wrong. Generally, I felt I addressed all risks well in particular through ensuring anti sickness and pain medication had been taken prior to the session to prevent nausea and unnecessary pain. I also communicated to the patient prior to starting that they should let me know if they were feeling in pain or faint, however, that I would be monitoring them throughout, giving Stephanie trust in me and easing any anxiety felt. I addressed environmental risks by clearing the area of any tripping hazards and setting up a rest chair in case the patient felt nauseous. I also felt my handling was comfortable for the patient maintaining a lumbrical grip during bed transfers. Regarding treatment I felt my teaching method was effective and succinct. When demonstrating how to use a walking aid I demonstrated and practiced with the patient all required aspects of using a Zimmer frame. Whilst the patient used the walking aid, I felt my positioning supported the patient’s movement and didn’t hinder movement. I felt I also facilitated sit to stand well with the patient.
Aspects I feel I could improve on
Regarding therapeutic alliance and communication, I felt when the patient tried to continue to walk forward it would have been better to not stop them, as this would have allowed for the session to be more collaborative and less instructional. Additionally, I felt I could have displayed greater empathy in interactions with the patient. Generally, I took into account all patient notes well; however, I didn’t mention the osteoarthritis in Stephanies knees which would have been good to check up on to ensure Stephanie was coping hopping on one leg. Additionally, at times I felt my instructions were confusing, especially when I began to rush at the end of the session, in future I should work on remaining calm under pressure to ensure clarity in my communication. Regarding professionalism, I feel my nerves could have been better controlled as at times stuttered, in particular when I had to correct myself from using the jargon of plinth to instead say bed. Generally, I felt I managed risks well; however, I forgot to let Stephanie know she would be using the frame being for one week until moving onto another frame. This would have helped assure her she was heading home as soon as possible reducing her likelihood of using her sore leg. Additionally, I felt firmer contact with the patient when walking alongside them would have better addressed the risk of falling and getting injured. I also took one of my hands off the patient when they felt faint which presented a risk of me not being able to prevent them falling, I should have positioned the Zimmer frame closer so they could reach when instructed rather than me having to grab it. Throughout I could have monitored the patients face more regular to check for signs of faintness or pain to increase safety, as I felt spent most of the time checking they were hoping on the right leg and moving the frame properly. I also spent a lot of time gesturing where the patient would be going which at times could have been dangerous as I took my hands off the patient.
Goals for Semester 2
My first goal for semester 2 is to have more collaborative sessions with my patients this will be evident in improved flow during the session and should help to make the patient feel more comfortable. I can do this by giving the patient more time to reply to questions rather than rushing into my pre-emptive response this will also improve my active listening skills. Through recording during practice, I can watch back to assess how collaborative the session has been and continually to improve collaboration. Additionally, I can achieve this by recording myself interacting with different ‘patients’ in class to see how I respond to differing communication styles I may experience during the assessment. My second goal for semester 2 is to improve my ease of communicating in particular under pressure when I am worried due to time pressure or having done something wrong, this will be apparent in my clarity of communication. I can achieve this by ensuring during class practice I keep on going even when I do something wrong or if I’m not sure of what to do this will give me the most practice in staying calm under pressure. Additionally, working with people I’m not comfortable with close to assessment time will help me to replicate the pressure felt during assessments through pressure felt due to fear of judgement. My final goal for semester 2 is to improve my clarity when communicating tasks, I’m wanting the patient to perform. Improved clarity of communication will be apparent as I won’t have to correct the patient as much and will have more clarity myself on what the client is doing, allowing me to feel calmer. I can achieve this through explaining what is going to happen briefly before the session begins, allowing me to achieve consent is greater informed. Additionally, during assessments where I am bound to use different plinths which has a different set up, during reading time I can plan the setup of the tasks I will be completing with the patient. This will allow clear communication when I speak with the patient due to having more clarity of mind on my own plan.