Are you going to be the solution or the problem?

This blog has taken me a while to write because there has been so many fantastic accounts by Physiotherapy Students and Physiotherapists alike. Here are a few links below apologies if I have forgotten any.

https://aphysiostudent.wordpress.com/2015/02/10/student-rep-development-weekend-2015/

https://cuspblogs.wordpress.com/2015/02/10/having-a-voice-and-making-a-difference/

http://liamdoylestudentphysio.blogspot.co.uk/

http://www.csp.org.uk/blog/2015/02/12/physiotherapy-students-are-already-leaders-innovators

Lucy Cocker

It was at the back end of the year when I was asked to give a presentation, from a graduates perspective as part of the Physio works programme. The theme of the event stemmed from making a case for change. The event challenged the status quo and asked students to step outside the box and ask the question where will the future of Physiotherapy go? And where do we fit?

My talk gave a personal account of my journey and hopefully planted a seed to enable students to push the boundaries of their personal development. I really wanted students to think about doing things differently and not just going through the motions of student life.

“If you always do what you’ve always done, you’ll always get what you’ve always got.“

– Henry Ford (1863-1947), American founder of the Ford Motor Company

Lessons I have learnt along the way

  • Network, Network, Network! -Many of my previous experiences have come about through networking  and have got me where I am today so keep in contact with people you meet.
  • Karen Middleton: “Learn to live with a bit of mess”-Prioritisation is a key skill to develop sometimes some of the things you do don’t need to be perfect to get the job done but it is important to prioritise the things that really do need to be perfect.
  • Learn to say no-You are only one person and you can’t do it all without sending yourself into melt down so learn to delegate.
  • Interviews are a skill- Don’t worry if you struggle in your first few interviews they are a skill to develop which you may read through my blog.
  • Don’t forget about your degree- This links back to prioritisation your degree should be a priority and then work in opportunities around it.
  • Look at challenges as opportunities-There are many things i have done which I have thought I’m not sure about this but at the end of the day you don’t know until you try and if it doesn’t work what have you lost?
  • Take a positive attitude everywhere you go-You will sometimes hit problems along the way with university, placements, jobs. Take a backwards step and look at the problem holistically what can you influence and break the problem down into small chunks.

Thinking outside the right box.

  • When you are faced with barriers you need to find a route around them.
  • What are you trying to achieve? Is the thing you are doing going to provide a solution?
  • Don’t do something because it will look good on your CV.
  • “Take a chance don’t make a plan” Emma Stokes.

The event was fantastic as always and I learnt a lot from the student reps as well as the key speakers. The main thing I took away was during Karen’s and Ieuan’s talk on influencing. If you want to influence someone you need to work out what makes them tick but not only that you need to go with solutions not problems. I want to take this opportunity to thank the CSP students for inviting me to the event and I look forward to see where your journeys take you!

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Physiotherapy Works-providing evidence for solutions to problems.


So on a different note I am also going to share with you the report from the Industrial Relations Committee. I sit on this committee as a newly qualified physiotherapist and it has really been an eye opener to the campaigns and background work done by the CSP and ERUS. Below is my interpretation adapted from the key messages provided by Claire Sullivan.

Committee membership: The committee co-opted two new members; Stephanie Heasley for Northern Ireland and Chris Manning for Higher Education

TTIP: Owen Tudor, Head of European Union and international relations at the TUC, joined the meeting to give a presentation on TTIP (the transatlantic trade and investment partnership) and in particular its implications for the healthcare sector. Owen identified 3 things that CSP members could do on this issue:

  • Lobby your local MP and MEP on the issue and specifically on the need for the health sector to be excluded
  • Ensure that the CSP does the same with the relevant Secretaries of State and Shadow Secretaries
  • Raise awareness of the proposals with friends and family

TTIP is a very complex concept but in basic terms on how TTIP could affect us:

  • Investor state dispute settlement could allow for individual companies to take state/government to independent tribunal where they can sue for compensation. This is only open to foreign investors (which is an unreasonable power grab on global organisations). For example if there was a breach of expected profits from a future contract eg a private foreign company could take Government to a tribunal if an NHS contract breached the expected profit.
  • Public Service-Public services are normally protected from Free Trade Agreements, However, because the NHS is now, in part, provided by commercial companies, it will only be protected from TTIP if it is explicitly excluded from the treaty (which currently it is not).
  • Health and Safety at work under this agreement would be affected. ISDS will give any US company operating in the UK health market the right to sue the government if it introduces new public health regulation, or health protection and health promotion policy measures that might affect these companies’ future investment or profit opportunities. So evidence for safer or more effective treatments, or advances in clinical knowledge, could not be put into practice (at least without the risk of being sued) if this affected the anticipated profits of existing providers. At the same time, harmonisation of health and safety regulations is likely to mean the downgrading of UK public health measures governing the use of food labeling, pesticides, chemicals, the presence of hormones in meat production and so on.
  • We still don’t know what is in TTIP yet and there is a presumption of secrecy (we won’t like what they are offering).
  • More info can be found here: http://www.patients4nhs.org.uk/eu-us-free-trade-agreement-or-ttip/
  • https://secure.38degrees.org.uk/pages/ttip_home

Vision for UK Physiotherapy: the committee received a presentation and video on the draft ‘Vision for UK Physiotherapy’ which had been developed and seen by Council members in December. The agreed overall statement is ‘Transforming Lives, Maximising Independence, Empowering Populations.

NHS Pay in England: the revised pay offer for 2015-16 was considered by the committee. It was agreed that members would be consulted on the offer through stewards, with a recommendation to accept on the basis that the offer is the best that can achieved through negotiation (as there was no commitment to industrial action from members). Committee members acknowledged that the new offer is worse for a proportion of higher paid CSP members but noted that nonetheless it is significantly better for the large majority.

Workforce planning: members and managers are reporting significant difficulties in recruiting at both Band 5 and Band 6. Further examples of this should be fed in to Kate Moran at the CSP. I can forward this on if needs be.

Reports from the Countries: the committee considered updates from Northern Ireland, Scotland, Wales and England. In particular it was noted the substantial difficulties still being faced my members working in, or trying to obtain work in, Northern Ireland.

‘Freedom to Speak Up’ Review: the report into Robert Francis review into whistleblowing in the NHS will be published in 11 Feb and can be accessed athttps://freedomtospeakup.org.uk/

Members working outside the NHS: CSP SNO Neil Lark updated the committee on a range of issues affecting members working outside the NHS, including in higher education, the Ministry of Defence, in companies including Nuffield Healthcare and Spire and in social enterprises.

TUC Women’s Conference: this year’s delegation of members attending Womens’ TUC was ratified by the committee. The members are Kim Gainsborough, regional steward in the east of England, Gwawr Jonas, a steward in Wales and Louise Wright, regional steward in Wales.

October 18 ‘Britain needs a pay rise’ demonstration: the committee reviewed the attendance at the events in London, Glasgow and Belfast and thanked everyone who came along. The committee agreed that for any future similar events, encouragement to attend would start with CSP core activists and others who had previously expressed an interest in the relevant area.

ERUS workplan: the committee considered the progress that had been made in 2014 towards key objectives and also reviewed the draft workplan for 2015. The committee was supportive of a more streamlined version focussing on the two key priorities of ‘organising’ and ‘negotiating’.

Future meetings: priorities for the next meeting were identified and included:

  • Recruitment difficulties
  • Feedback from the workforce data modelling and safe and effective staffing levels projects
  • Post General Election wash-up
  • Inviting an outside speaker to talk about fair taxation

Thank you for taking an interest in my blog, I have been overwhelmed with positive comments which continues to drive me to write more. As always if you have any questions or comments leave a post on here or tweet me @LCphysio

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Better Together!

Hi everyone this post is really just to give you a bit of a background of the work being done by the Industrial Relations Committee. The last meeting was on the 1st October at CSP head quarters. It was a really productive meeting and the key messages were produced by Claire Sullivan ERUS Director (See below).

Key messages arising from the IR Committee.

1. Members agreed to take it in turns to contribute a ‘guest blog’ on an area of interest to them, for the IRC news bulletin each month. Jill Barker and Kim Gainsborough will be covering October and November.

2. Lesley Mercer joined the committee for lunch and a presentation of thanks on her first full day of retirement from the CSP as ERUS Director!

3. The new Director, Claire Sullivan, talked briefly to the committee about some of her ideas and plans and some of the likely key challenges ahead.

4. Elaine Sparkes (currently SNO for the East Midlands) has been appointed as interim Assistant Director. The post will be recruited to permanently next April

5. Heledd Tomos has joined the committee as the nominated representative for Wales, replacing John Walpole. The committee is also seeking a new directly elected member for Northern Ireland and all ideas and expressions of interest are welcome

6. A number of issues have been thrown up by the recent exercise to update the CSP membership lists for a possible industrial action ballot. These will be discussed in more detail over the coming months. Please can I just encourage people to access their online CSP account and update your details. The stewards have been doing a great job to update membership lists but it has been a big struggle for them on a national front.

7. The committee considered the current position regarding NHS pay across the UK. It was agreed to continue to update the membership lists for NHS members in England and to convene a meeting of the pay reference group in late October to review whether or not the CSP wishes to proceed to ballot members for industrial action short of strike. Feedback and views from members on this issue continues to be mixed. It is worth noting some of the successes from previous action the link below provides a small summary.
http://www.csp.org.uk/frontline/article/making-commitment-jill-barker-industrial-relations-committee

  1. In relation to Wales the committee agreed to consult members over any offer of a longer-term deal and then to refer the outcome of that to the pay reference group for further consideration9. In Northern Ireland, the committee agreed that we should continue to apply concerted pressure for a Ministerial decision as there has still been no announcement as to whether or not NI will implement the PRB recommendation

    10. The committee agreed that we should gather information on vacancy procedures and long recruitment delays through both stewards and managers. Also, that members would be encouraged to feed in information about recruitment difficulties to the CSP

    11. It was agreed to request a slot to hold an IRC fringe meeting at ARC on future sustainability of the NHS

    12. It was also agreed that an ‘easy guide’ for members should be drawn up on future sustainability of the NHS

    13. The committee agreed to promote the TUC’s video encouraging young workers to join unions to the SEC and wider student community and also to seek a delegate to attend the TUC Youth Conference in 2015 (delegates need to be under 26) and interested volunteers are welcomed

    14. The committee agreed a number of action points arising out of the TUC Congress this year, which had been attended by 5 first time CSP member delegates. These included:
    • to publicise to members the new online petition to repeal part of the health and social care bill and the value of lobbying MPs locally ahead of a debate on this private member’s bill on 21st of November.
    • to be aware of, and support, the Stand up for Justice campaign. The justice system is currently undergoing extensive privatisation and fragmentation and this is resulting in deleterious effects to quality services and accountability
    • to publicise a new film called ‘Pride’ to CSP members. The film, which has attracted excellent reviews, is about the role of LGBT members in the 1984/5 miners’ strike.

15. Don’t forget the TUC march this weekend Oct 18th: Britain Needs a Pay Rise- see video below and reasons to go.

http://www.csp.org.uk/news-events/events/march-rally-18-october

The main message to take away from this blog is that we are better together. The society needs members to engage and update their memberships details so that we can we truly represent what members want. Likewise if you have suggestions  you would like to take forward to CSP council please attend your regional network meetings so that regional council members can take your ideas forwards.

Thanks for taking an interest in my blog any questions or comments please leave a message below or tweet me @LCphysio.

My next post will give a round up of Physiotherapy UK 2014.

The end is only the beginning!

Merry Christmas everyone!! Well how quickly time fly’s I feel I have only just started a new post and  I am now moving on. On the 6th of January I will be starting my new permanent band 5 post at Derby Hospitals NHS Foundation Trust and I can’t wait! As promised I wanted to give everyone an idea of what my first experiences were as a band 5 . I have been fortunate in some respects because although I have not yet completed a full rotation, I have had 2 mini ones, which has meant I have seen and learnt a lot in a short space of time. The downside to this is I have learnt a little about a lot and I now need to build on my experiences to progress my development.

So starting from the beginning my first rotation was on Critical Care Rehab. It was difficult coming onto this rotation as it had only just been made available to band 5’s and it was ideally suited to someone who had done a rotation on ITU previously. Luckily for me I had been on the same area as a second year student so at least I knew some of the team. The rehab team mainly worked with patients who had been ventilated for more than 10 days or who were likely to be a slow wean. Due to me not having completed my respiratory competencies it was difficult for me to be just given a caseload and the majority of patients we were working with were complicated rehabs. At the beginning of the rotation my senior and I set realistic objectives to be achieved by the end of the 6 weeks (It was almost like having another placement except I was qualified and no one to countersign my notes).

The sort of objectives we set were:

To be able to carry out a basic baseline respiratory assessment of a ventilated and non ventilated patient.

To have an understanding of the complex needs of critical care patients during and post admission.

To be able to formulate a problem list, treatment plan and goals for rehab patients.

To be able to develop competencies on specialist equipment.

It doesn’t seem like I had many objectives but I had to be realistic in the time I had. Throughout the rotation I was fortunate to attend weekly in service training, one to one teaching sessions with my senior and I was able to observe more senior physiotherapists in practice as well as treating my own patients. I found the one to one teaching sessions very useful as it gave me the opportunity to clarify points in my own mind. When initially setting my objectives I was asked on a scale of 1-10 how confident  I was  in carrying out a respiratory assessment which I answered 4/10. I find respiratory quite difficult because the problem is internal and not particularly visual. However following completion of my rotation I am now able to take a backwards step from my patient and work through my assessment systematically.

  • Firstly what has lead the patient to end up on critical care?
  • If they are post surgery did they have any risk factors pre- surgery i.e. Past medical, smoking, obesity, trauma, previous exercise tolerance.
  • Were there any complications during surgery?
  • Were they an emergency admission and is there any contraindications to my treatment?

So this is the sort of stuff going through my mind before even reaching the patient. Next I would spend time to read the notes thoroughly to see what lead them to be on critical care. After reading the notes you can already hypothesise reasons contributing to the patients condition.

Reduced FRC

  •  Anesthetic- reduced mucocilliary clearance
  • Pain- are they reluctant to deep breathe
  • Sputum- due to past medical condition or due to reduced mucocillary clearance
  • Position
  • lung consolidation
  • lung collapse
  • respiratory muscle weakness
  • Drowsy from sedation or opioids

So what can we help with?

  • Analgesia for pain and assistance with supported cough.
  • Sputum- ACBT, manual technique, suction etc..
  • Re-positioning to assist with V/Q matching
  • Ventilator support
  • reduction of sedation.

So we have a few things we can adopt as treatment options and this list is not exhaustive.

On critical care patients are normally under hourly observations so the next step of my assessment would be to interpret them. When writing my first initial assessment I would document:

Subjective

  1. Presenting Complaint- what did they come in with?
  2. History of presenting Complaint- why did they end up on critical care?
  3. Past medical history. Is there anything relevant which will affect their PC?
  4. SH- What was there pre-admission state what support do they have at home?
  5. What has been said by the MDT or any critical events?

Objective

  1. Temperature- every degree increase in temperature increases the patient oxygen demand by 10%
  2. Cardiovascular system: Blood pressure,Heart Rate, CVP and MAP . Are they stable does this restrict or treatment?
  3. Respiratory- Method of ventilation what support are they using? Why are they on this mode?
  4. Respiratory rate do they look distressed or have increased Work of Breathing? Why do they have increased WOB?
  5. Oxygen Saturation. Why are saturation’s low? is it due to shunt? diffusion problem? V/Q mismatch? hypoventilation?
  6. Arterial Blood Gas . What does it show? What is compensating if any?
  7. Renal- Urine output and fluid balance. Are they in organ failure? Are they overloaded with fluid?
  8. IV drugs. Is there blood pressure or heart rate being supported? Are they sedated? Do they have an epidural need to be careful of postural hypotension.
  9. Abdomen- is the gut absorbing nutrients? Is the abdomen distended?
  10. Neuro- Glasgow coma scale?
  11. Auscultation- Air entry? Added sounds? tactile fremitus? Thoracic expansion.

Treatment

  • What is the problem? What are your treatment options?

Analysis

  • What is the patient limited by? What were the results of the treatment?

Plan

  • Physiotherapy treatment plan
  • Recommendations for staff

I have not attempted to go through modes of ventilation and treatments as I could write for days but a clear understanding of the reasoning for different ventilator modes and treatments in essential to formulate and clinically reason an appropriate treatment plan. So the above is the method I would use to assess a respiratory patient. By being systematic it means you are unlikely to miss something critical as a band 5 and with experience your clinical reasoning will become stronger.

So in summary of my first rotation I can now say my confidence has gone from a 4/10 to a 7/10 however, I think I would benefit from having a further rotation on critical care to consolidate my learning.  From completing my rotation I am now able to perform multi system assessments of ventilated critical care patients to generate problem lists and appropriate plans for treatment. I have demonstrated effective skills in the respiratory treatment of ventilated and non ventilated patients. I have also gained experience of treating longer term ventilated patients, developing rehabilitation programmes and acting as the patient’s key worker at weekly goal setting meetings.

Onto my Second Rotation Medicine. I was prepared for a change in culture but the first week really was a shock to the system. Compared to critical care we had a big case load to get through each day and there was a real need to prioritise your time. At the QE we work through a traffic light system (without having the sheet in front of me this gives a basic outline of prioritising patients)

Red= Acute respiratory, Discharges, Falls.

Amber= new patients, patients who have had a decline in mobility or those requiring ongoing rehab.

Green=  Patients safe with or without aids being monitored.

From coming from critical care this was a bit of a shock because I was used to seeing all of my patients daily but on medicine it is impossible to see everyone as the priorities must get done. So my objectives for the four weeks I was on medicine were:

  1. Effective prioritisation of medical caseload using prioritisation tool.
  2. Timely and Seamless discharge planning or patients in line with multidisciplinary team goals.
  3. Appropriate referral to other services and MDT.
  4. Appropriate use of physiotherapy paperwork and documentation in line with CSP and trust standards.

Again my objectives would be a lot different if I had been working on the area for 4 months but I had to be realistic to get the most out of it. Through the 4 weeks I have developed my skills in prioritisation ensuring all patients were seen in a timely manner, I am able to contribute to MDT meetings and I have referred patients on to relevant services. Again I believe I need another ward based rotation to consolidate my skills but I feel in the short space of time I have achieved the objectives I have set.

For anyone who is about to embark on there first physio job or to any qualified physiotherapist my top 5 tips would be:

  1. Don’t be afraid to ask questions, you’re not meant to know everything
  2. If you have a complicated patient don’t be afraid to ask your senior to review them with you remember you need to be within your scope of practice.
  3. Don’t be afraid to say no if people are putting too much responsibility on you straight away or you are feeling overwhelmed.
  4. Take up opportunities to observe more senior physiotherapists.
  5. Make sure you read patient notes thoroughly to carry out an effective assessment and treatment. You don’t want to cut corners.

Thank you for taking the time to read my blog, I will be starting my new job in Derby soon which will allow my blog posts to continue. Please feel free to leave any comments or tweet me @LCphysio

 

Every Contact Counts!

So since my boyfriend is being boring playing Fifa, I now find myself writing another blog post. So since finishing University I have felt a bit lost in translation but, at the same time have relished the fact I can take any opportunity that comes my way. A bit of a downer on the NHS job front all of the applications I submitted got rejected 😦 !! However, I did ask for feedback and the only comments I received were I didn’t have HCPC registration (which I now have finally so no stopping me).

I had received some information regarding some bank work at Walsall Manor hospital which was positive. However, again being back at home I am limited by my current location in Chesterfield and have no funds to rent anywhere.

A little side story: when I was sorting out my application for bank work I was in bed when I had an emailed pinged from NHS jobs saying that Walsall Manor Hospital had a permanent band 5 post (I have only just realised that NHS jobs email you at the end of the day rather than the morning for any new jobs). So lying in bed I thought oh its fine it has only just gone up so I can apply in the morning…. Rookie error by 11 am the  job had gone gahhh!! At this point I had put in quite a few applications so I was getting a bit impatient, so being the keen bean I am I rang the line manager to check it was due to the number of applications (which it is was). However, the manager was really nice and said if I have my HCPC I could be put through to interview from being on the bank. Unfortunately at this point I didn’t have it and had to face another turned down application. But it does show if you are really interested in a post which you have missed it is worth calling the manager after to  discuss whether it was due to the number of applications.

So on a brighter note being an unemployed graduate has worked in my favor. Gerard Greene who I work for doing CPD course admin at Harborne Physio had spotted a job opportunity through one of the clinics he follows on twitter. He suggested it to me which I grasped with both hands.The job is at Worcester Warriors acting as physio for the junior and senior camps over the summer. To get the post I had a skype interview with the clinical director and one of the clinical specialists at the Markland Clinic.  I was a bit rushed for my interview, (which for people who know me is not like me, as I had stayed at my boyfriends in Sheffield so I felt a bit flustered for the interview). Tip 1: arrive to your interview with plenty of time and prepare for your interview!! The sort of questions I got asked were:

What do you know about the Markland clinic?

Talk us through how you dealt with a sporting injury?

Tell us about your strengths + weaknesses?

How would you deal with a player who’s family lived away from the camp who needed to go to hospital?

How would you deal with a difficult player?

What approach would you take with the parents, coaches and players?

And some more which I can’t remember…

Once the interview got started I felt a lot more comfortable and it went fairly well which resulted in me getting the job!! I am so excited for the opportunity and I will update you with how it goes. I am sure I will have a few stories with me being the only physiotherapist on site.

Another contact who was very helpful was my course mate Ciara Horne (http://www.ciarahorne.com/) who is a track rider for Welsh cycling. Ciara also rides on the roads for the Breast Cancer Care Cycling Team who were short of a Soigneur (sports massage therapist ) for the Krasna Lipa Tour de Feminin in the Czech Republic. So when Ciara asked me I jumped at the chance to go as you never know what other opportunities may come of it. So I spoke to the manager booked my train tickets to London to set off for a very long drive to the Czech Republic. So a brief introduction to life as a Soigneur can be found below.

Day 1:I caught the train down to London to meet Rene Groot the manager and Colin Baldwin the other Soigneur. To start our journey we took the Euro tunnel and headed through France, Belgium, Holland (unintentionally) and Germany where we stayed the night before travelling further to the Czech Republic. We had set off from London about 1.30pm  and arrived in Germany about 1.30 am so a fair trip (this included food, toilet and pick up stops).

Day 2: We had to travel over to Dresden in Germany to pick up the team as some of the riders are based in Belgium where Scottish cycling lease a house and some of the others who had flown over to meet us. So in total we had 7 riders, 1 mechanic, 2 soigneurs and the manager.  From Dresden we headed for Krasna Lipa, Czech Republic to register the riders for the race. After registering we headed to the accommodation, which was an old school, luckily we were one of the lucky teams who had a communal area which meant we could set up the massage tables (shame we were on the 2nd floor as there was a lot of unpacking).

Day 3,4, the riders had a stage race and had pre and post massages for the event. The girls on the team were lovely and I learnt the job of Soigneur from the best, as Colin had previously worked with the likes of Bradley Wiggins and Sarah Storey. As this race was my first cycling race I had been to watch, a lot of it was all new to me, for example, during stage races riders were given more drinking bottles at feeding stations (which me  and Colin found difficult to find sometimes) but I learnt very quickly and all the girls managed to take fluid and mix from us at the stations. I can’t tell you the adrenaline rush of a group of cyclists speeding past you and you hoping you don’t drop their bottle during the race. So apart from sports massages and feeding, Soigneurs were also responsible for pretty much any other task the riders needed for example we did the supermarket shop, carried bags, first aid and a shoulder to cry on if any one needed it. It was fair to say both me and Colin fancied a glass of red at the end of the night.

Day 5 Was the time trial (TT) race in the morning and another stage race in the afternoon. I must admit I never knew how complicated bikes could be in terms of types, height, different saddle, mechanics  etc…. I thought horses were complicated.

Day 6 Was the final stage race in the morning before packing up for a long journey back to London. We set off at 3.30pm and I finally arrived back home about 3.30pm the next day, I suppose the only negative of going to these events but luckily I managed to get some good sleep through the 6 countries we traveled through. I think if you want to start working in sport you have to know how to fall asleep anywhere quickly.

See some pictures below of the trip!!

So that is me all up to date, I graduated last Wednesday which was a lovely day with all the physios and I am now just waiting on 4 NHS job applications to see where I go from there.

IMG_0513 IMG_0520 IMG_0537 IMG_0556 IMG_0562 IMG_0572IMGP5966 P1010738 P1010810

https://www.facebook.com/BreastCancerCareCyclingTeam

https://twitter.com/BCC_CT

http://www.marklandclinic.com/

http://www.warriors.co.uk/home.php