Physiotherapy Works!

Last Friday I was fortunate to be able to attend the Physiotherapy Works Locally event as part of the East Midlands Regional Network. I have been asked by the network to be a core part of the committee. This will hopefully allow me to build some momentum with social media and help get students and newly qualified members involved. This will aid the discussion regarding key decisions about the region and society which can be fed back to council. The Physio Works locally event was a joint event between East Midlands and Yorkshire/ Humber  Regions. The event was a fantastic success with a lot of social buzz and pledges being made.

Photos from Anne Jackson CSP

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The event kicked off with Karen Middleton CEO of the Chartered Society of Physiotherapy giving a talk on: “The Case for Change”

Whenever I listen to a speech by Karen I feel so empowered, I want to run outside and tell everyone how fantastic we are as Physiotherapists and that we can really make a difference to peoples lives. Her talk was powerful and to the point. She said that we as Physiotherapists need to start talking about the benefits of Physio before we miss out on our golden opportunity. The health climate in 2014 is creating an environment where people are living longer. This creates a society with patients with more long term conditions and people needing to be fit for work for longer.

 

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Physiotherapy can influence all of these groups!!

So what are you going to do about it?

The quality of a service is essential to achieve positive outcomes. We need to be effective, collect outcomes, safe and develop positive patient experiences.  However, how are we going to do this? We have less money available and a dependent medicalised society. So what innovative ideas can we take forward? The profession of physiotherapists is far too modest regarding what we can bring to the table in terms of healthcare. Overcoming this apprehension will enable us to take our ideas forward and make them reality before it is too late.

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So here are few of the things Karen suggested we should be doing:

  • See opportunities and take them.
  • Realise our potential as leaders.
  • Come of age as autonomous practitioners.
  • Use CSP support, materials and tools.
  • Make a lasting difference to patients.
  • Nobody will do this for us.

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So some tips:

  • Be flexible.
  • Connect, build, link and network!!!!
  • Think ahead and talk solutions.
  • Know how local decision makers think.
  • Use the evidence.
  • Show our impact through data collection.
  • Talk about money as well as outcomes.

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Action Point:

Think about becoming a pioneer for Physiotherapy Works –  for more information:

Web: www.csp.org.uk/physioworks

Twitter: #physioworks

Email: physioworks@csp.org.uk 

  • So what?  Now what? What difference does it make? Be Brave, Physiotherapy Works.

 

Change is the Only Constant- Alison Hughes NHS ENGLAND

Alison Hughes was another fantastic speaker of the day. She is currently Director of West and South Yorkshire and Bassetlaw Commissioning Support Unit.  She was initially a physiotherapist and an advocate for clinicians leading the NHS. As physiotherapists we are ideally placed to lead. We are able to diagnose, listen, work as an individual and as a team.

However the change you want to see starts with you!

And you need to be clear on what success looks like.

To me success looks like : Everyone in the general public knows what a Physiotherapist is and what they can do.

What are your barriers to change?

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I thought this image summed up a lot of clinicians anxiety to change. Mostly due to hidden barriers created by a Top down  organisational structure created by management. To overcome this we need  to be brave and inform management of the challenges faced by front-line staff and the solutions to overcome these difficulties (this may be where physiotherapy comes in)

Alison referred everyone to a book by Robert Kegan- Immunity to change. Which links to the image above. http://www.amazon.co.uk/Immunity-Change-Potential-Organization-Leadership/dp/1422117367 n

When planning a strategy for change, below is a great diagram to help you organise your contacts so that you target certain individuals to help promote specific campaigns.

Importance of Stakeholders

Influence of Stakeholder

Unknown

Little/ No importance

Moderate

Significant

Unknown
Little/ No importance
Moderate
Significant

So in summary:

  • In creating change we need to clarify what success looks like.
  • Set realistic goals
  • Grow and use the support you have.
  • Understand stakeholders
  • Understand hidden competing commitments for yourself and others.

 

Physiotherapy Works- Make Every Contact Count. Knowing Your Service.

The principles of this focused on:

  • The context of change
  • Knowing your Service
  • Knowing your Population
  • Knowing your Evidence.

Know where you fit in our healthcare system.

Knowing your service

Quality is based on:

  • Effectiveness
  • Patient Experience
  • Patient Safety

+COST

Quality +COST= Value.

The CSP is developing tools to give bite size pieces of evidence to show the value of Physiotherapy. This will be based on for every £ spent on Physiotherapy will save the NHS…. compared to without. The cost of Falls Tool will be launched alongside Older Peoples Day on the 1st October 2014 (and more to follow).

Knowing your Population

A population is made up of – current users of the service and future users of your service.

Accessing Health Profiles can give you  information regarding the demographics and problems in your region.

http://www.apho.org.uk/default.aspx?QN=P_HEALTH_PROFILES

Knowing the Evidence

  • Published research
  • National guidance
  • Local data- audit, patient experience, satisfaction, outcome, KPI’s
  • Other
  • This can be used to challenge the status quo!

There was a great emphasis on developing your service and having your elevator pitch in mind, so if you were stood next to a commissioner in a lift you could quite happily deliver your message.

My service is…

Delivers to this population…

Based on this Evidence…

At this price!!

So you might be thinking where do you go from this… So the next steps might be..

  • Why do you need to change?
  • What will you do differently?
  • When?
  • How can you improve?
  • Who will you influence?

This will give you a starting point for change !


In the afternoon the Physio Works team did a great job in setting up mini workshops to get us thinking about innovative ideas which could form part of our future NHS!  We looked at regional health profiles, developed  ideas and then presented them to the group. There were some great ideas being thrown around the room and it was an effective way which made everybody feel ready to go and talk about how versatile the profession of Physiotherapy really is.

The East Midlands (@CSPEastMidlands) and Yorkshire and Humber (@CSPYorksHumber) Regional Networks did a great job in organising the event and are always looking for more members to attend regional meetings, I would actively encourage you to attend. More information can be found here:

http://www.csp.org.uk/nations-regions/east-midlands

http://www.csp.org.uk/nations-regions/east-midlands-regional-priorities

http://www.csp.org.uk/nations-regions/yorkshire-humber

http://www.csp.org.uk/nations-regions/yorkshire-humber-regional-priorities

http://www.csp.org.uk/your-health/physiotherapy-works

 

Thank you again for taking an interest in my blog. As always please feel free to leave a comment below or tweet me @LCphysio.

Finally the first part of my campaign was to get my Mr to make a pledge!

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Respiratory Rotation Tick!!

This post has taken me so many attempts to write, I am not sure if it is because the last couple of weeks have been a bit relentless mainly with me flapping thinking “Oh God this week I am on call”. It doesn’t matter how much prep you do or how much everyone tells you that you’ll be fine you still don’t feel ready. Being quite a reflective person I like to analyse every possible option before doing something (which I think enhances my anxiety of on call thinking will I ever make a decision!), however, I am also a born pragmatist which means once I know what I am doing I get things done and with the fab support I have had from my team during supervision sessions and clinical work I now feel I could reason through my options and make a sound clinical judgement! So this post is going to look back on some of the success’s and challenges I have faced on this rotation. I am now on-call competent and I have just completed my first on call (pheeewww) so I will try to explain the things which were going through my head and how I came out the other side!!

So Firstly the competencies, to be competent on call there are certain skills which need to be reviewed to ensure safe practice is maintained. These include:

  • Understanding of Arterial Blood Gases.
  • Interpretation of Auscultation
  • Interpretation of Chest Xray’s
  • Understanding of Oxygen Therapy
  • Ability to use cough assist and clearway
  • Ability to use Intermittent Positive Pressure Breathing.
  • V/Q matching and positioning
  • Humidification
  • Use of Manual Hyperinflation
  • Suctioning
  • Assessing an acutely ill patient
  • Tracheostomy care
  • Time on ITU/Paeds/Surgery/HDU/Medical Wards

I have to say I was glad to see the back of them, doing more work after work meant sometimes feeling mentally and physically exhausted but I had great support from my supervisor Emily Stranney and team throughout which made things a hell of a lot easier. I am not going to go into each competency as I will be here all night but these are some of the things that would be expected of you at Derby.

I think one of the best ways for me to sum up my experiences is to give you my Top 10 tips on how to survive your respiratory rotation. For me I was fortunate to have experience on ITU on placement and when I worked in Birmingham but I can understand how daunting it can be if you were going in blind. For example on my first day of my the rotation I was quite happily being showed around to familiarise myself  when one of the nurses called us over to say a patient needed urgent chest physio… So off we went straight into a emergency situation good job I had already had experience in suctioning and my supervisor was taking control…way to break me in gently or throw me into the deep end I am not quite sure :-). So my tips based on my experience on medical respiratory wards and I hope some of them may be useful.

1. Take a 24 hour approach to your patients. For patients with long term respiratory conditions they may physically be able to complete the tasks separately but when you put everything together washing and dressing themselves, making breakfast, walking to the shop even they may be exhausted for the rest of the day or even the next. This is where you may need to liase with occupational therapists, oxygen nurse, rehab coordinators or pulmonary rehab to assist with formulating a seamless discharge for your patients.

2. If they need oxygen therapy have you considered it as a tripping hazard? Many patients will be elderly and you don’t want a long line of oxygen tubing to be another reason for another admission to hospital. So maybe trial a long lead of oxygen as part of your treatment session to carry out a risk assessment?

3. You sometimes need to wait a bit longer before you pick up a physio referral. For example sometimes some of the COPD patients come in with type 2 respiratory failure and they need  NIV to rectify blood gases before you start pushing their exercise tolerance to the limit. (This may not always be the case speak to the nurses are they productive of sputum or not?)

4. If opportunity allows opt to do some joint treatment sessions with more senior physiotherapists and get them to compare what you are auscultating etc to see if your treatment plans match up. Different physiotherapists work in different ways so it is good to work with a variety to aid your own clinical reasoning.

5. Get into the habit of checking patients Chest Xray’s, if a recent one has been taken to help guide your treatment. Also the more practice you get the easier they will become to interpret… as no one wants to be scratching their head at 3am in the morning.

6. Know your indications and contraindications for treatment this will help formulate your treatment plan. I would advise to carry around a notebook with these in because if your mind goes blank you have something to back you up. My on call book has useful phone numbers, door codes, equipment locations, indications and contraindications for treatment, typical patients for each treatment and some of the useful values you may need as part of an assessment.

7. Break each respiratory patient down simply. What is the main problem? Sputum retention? Reduced Lung Volume? or Increased work of breathing? What can you change or help with and this will formulate your treatment options.

8. As always don’t be afraid to ask questions or your seniors or Doctors question their clinical reasoning so you are understand why you are doing something. You will be amazed at how many times as a physiotherapist you are the first one to notice that a patients target SpO2 need adjusting.

9. Like with anything in physiotherapy if something is outside of your scope of practice ask for help. For example I have been faced with the situation where a patient has aspirated on their vomit and I asked for my senior to treat the patient with me because I had never dine nasal suction before. ( You are not seen as incompetent you are seen as safe)!

10.Be aware of the neuro-muscular patients, they have the potential to go off spectacularly due to poor lung volumes and cough effort. And just because you can’t hear anything doesn’t mean secretions aren’t lurking. The likelihood is that secretions can’t be heard due to poor lung volume creating turbulence.

Finally just relax… easier said than done I know, but, you are better to take a deep breath take your time and reason through what you are doing.

I hope some of these tips will be useful, I feel so much more confident with my respiratory skills post rotation and I would advise anyone to develop the skills as you never know when they may come in handy ( it will probably be me reviewing the odd respiratory patient when I move to T+O next :-S)

So those were my top 10 survival tips for your respiratory rotation. I will now go onto my first on call situation and some of the tips which brought me out the other side.

I can honestly say this day had been looming for a long time…. but I kept thinking oh it’s fine I’ve got ages yet (it won’t happen to me)! To oh wait I am on call tomorrow oh Cr*p!! The night before I definitely did not sleep at all waking up every hour thinking am I meant to be on call tonight? when I wasn’t. So the day finally arrived, I had arranged to stay with a colleague as we have to be at the hospital within  40 mins, so from Chesterfield I would be pushing it! I was lucky in someways to be completing my first on call during my time on respiratory as it meant I had the opportunity to talk things through with my supervisor and also suss out if there was any poorly people lurking about on the wards. Through the week there had been no call outs so I was testing my luck not to be called out but I guess I kind of wanted to be called in just to get the whole thing over and done with. So I settled into bed about 9pm… set my alarm for the morning, straightened out my uniform next to bed alongside my on call book and a pen. As I did the night before I wasn’t sleeping well looking at the clock every hour…. but by the time I got to 3AM I thought you know what maybe I have been saved and tonight is not the night so I drifted off to sleep.

04.30AM The phone rings!! ” Hello this is the switch board can we direct a call through to you”

Me: “Urghh urghh Yes hold on let me just find a pen”

“Hello its the registrar …. The patient has this, this, this and this can you come in for emergency physio”

Me: ” Hold on a second  can you just repeat that I have just woken up” So by this point I had found my little book and was able to take some details down. One thing I would say is make sure you take the time to slow the referrer down and clarify the patient in your head (Don’t forget to find out the patient’s name and location as you don’t want to be running round the hospital at night)

So I had got the details I needed, got dressed, got in my car and drove to hospital all the time thinking should I be doing this or this. By the time I had made it to the hospital I headed to the patient’s location took a deep breath went through the notes, looked at their Chest X-Ray, asked if they were for escalation for a higher level of care, checked blood results and then started to conduct my assessment. I went through logically my treatment options and formulated my treatment plan. As a first on call it wasn’t really a physio problem to solve but it allowed me to reason this through and at least I got called out and lived to tell the tale.

So my top tips for on call based on my limited experience:

1. Make sure you are competent! There is a reason we are set competencies and this is to make sure we are safe and clinically effective.  So take the time to put the work in so when it comes to being called out at 3am in the morning you are prepared.

2. Be organised! Have everything ready so that the only thing you have to do is get dressed and turn up at the hospital.

3. Don’t be afraid to challenge the referrer for the reason for the call out. Not all call out’s need a physio so you may be able to offer advice over the phone to rectify the problem.

4. Take your time read through the notes, check the patients observations, check blood results (INR and platelets especially), check recent X-Rays and breathe.

5. Familiarise  yourself with your environment, take the time to have a walk around the areas you don’t normally work in. Or if it is area you haven’t had much experience in ring the ward physio’s in the morning and see if they have any patients you might want to treat before you are on call to get to know them.

Finally breathe, the best piece of advice I have been given on the run up to my on call is to look at it as you are only offering an opinion. At the end of the day it is the consultant who has the final say on the patients care and sometimes as a physiotherapist you cannot do anything more and have to step away.

I hope this piece has reassured physio students and new grads that being on call isn’t as terrifying as you think and the hardest thing is just that initial thought of waiting to be called out!! But once you have done it you have a real sense of achievement  that you have been able to help someone in need and the fear disappears. I mean if I can come out the other side then anyone can!!

So my next rotation takes me to Trauma and Orthopaedics in a couple of weeks time. I have only ever done T+O outpatients so I am intrigued to learn more about it and see where it takes me. My next blog post will focus on the recent Physio Works locally event I attended in Nottingham for the CSP and I hope to share with you some of the keys themes of the day!

Thank you again for taking an interest. Any comments please feel free to leave one below or tweet me @LCphysio.

This time last Year!

How crazy around this time last year I was starting to write my blog. Now a year qualified looking through my posts it is crazy to think how much I have achieved in that time. So this blog post is going to update people on my progress through rotations and will also touch on a recent course I have been on for Strength and Conditioning combined with Physiotherapy.

Currently I am working within the Specialist Medicine team at Derby, covering one of the acute respiratory wards and the High Dependency Unit. My first impression of starting my respiratory rotation was although respiratory physiotherapy isn’t my comfort zone, it was a skill I needed to develop. I naively thought “well at least I won’t have the same level of social sort out as elderly medicine….” (How wrong I was). You forget that elderly people may also have a respiratory condition and even if they are not elderly you may have to deal with breathlessness management, oxygen requirements and anxiety to prevent people being readmitted to hospital. Initially I found myself being very slow with my assessment an acute ward is very different from ITU. On ITU a lot of the patients did not necessarily have predisposing respiratory conditions (not all of them) or they were intubated so management was focused on chest clearance and early rehab. Whereas on an acute ward you are looking at how patients will manage at home with ADL’s, the need for long term oxygen therapy, occupational therapy involvement and  the need for social services involement. On the ward we work closely with the OT, one of the things we look at is equipment to help with energy conservation, as this can help to maintain a patients’ independence.

On the ward we have around 28 beds including a 4 bed High Dependency Unit. The high dependency unit has 1 nurse for 2 beds and is mainly for patients who are needing Acute NIV, Tracheotomies who need regular management, patients who have the ability to deteriorate who need escalation to ITU and patients who have reached there ceiling of care on HDU (so they are not for escalation to ITU if they deteriorate likely because their respiratory function is limited due to predisposing lung condition). The sort of patients I have been exposed to on HDU are Spinal cord injuries, Stroke, Neuro-muscular conditions such as GBS , acute exacerbation of COPD, vasculitis and severe pneumonia (So a range of conditions to get stuck into). In HDU all the patients have the ability to go off quickly so you have to keep your eye on the ball, however, it is worth noting that not all of the patients in HDU need physio. For example the patients dependent on NIV who do not have sputum retention normally just need time for their blood gases to normalise so we would hold off unless they need us for mobility Ax.

So objectives I have set myself on Respiratory:

1. To be able to carry out a Subjective and Objective Assessment on a:  i)Critically unwell patient ii)Ward Based patient iii) create a problem list and Rx plan.

2. To be confident using different Rx techniques and demonstrating clinical reasoning. i) Mechanical devices ii) Manual techniques iii) Suction iv) Advice and Education v) Postural Drainage.

3. To be confident in interpreting observations i) HDU charts ii) Auscultation iii) ABG’s

4. Prioritisation of a respiratory ward. i) HDU II) Ward Management iii) Discharge planning.

5. To be on call competent and safe

Through this rotation I will spend half of my time on the ward with HDU and half of my time on a general respiratory ward. To become on call competent through supervision sessions I am slowly working through my competencies. So far I have been fortunate for the experiences I have gained which will set me up for going on call.  However, I don’t think you can ever be prepared for the adrenaline kick of an on call situation. I think the best advice I have been given is always to go back to basics and question why someone has ended up in the situation they are in. What can we have an effect on? And what can’t we have an effect on? What is the main problem: Lung volume, Sputum or work of breathing or both? (This is how I would look at my patients but obviously everyone has different methods you would also complete a thorough respiratory assessment to reach your conclusion).

So slowly but surely my confidence with respiratory is slowly increasing and I am hoping to be ready for the September rota eeeek!! I will try to keep you updated with my progress.

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So very much away from respiratory physiotherapy. I recently attended a course: The Integration of Strength & Conditioning and Athletic Screening to the Management of the Sporting Client: Recreational to Elite Level. The course was run by Harborne Physio and was taken by Simon Noad (West Brom Physiotherapist) and Ray Jackman (S+C coach based on Uni of Birmingham). I wanted to attend this course because there is a known gap between physio and S+C. We should be working in partnership to help athletes or clients achieve their goals. So I wanted to gain a bit more knowledge of S+C and how this would fit into my practice. Just to say people may have differing opinions regarding this process this is just one example. How I have written this up may be a bit jumpy because I have jumped through different principles discussed on the course.

The course was fantastic and it is the first combined S+C/ Physio course in the UK. Simon and Ray were great teachers and explained the principles and practical elements very clearly. The course highlighted that we should be focusing on training athletes not specific “Footballers, rugby players or runners”. The process of S+C is to help develop an individual to perform at the best of their ability.Obviously you will reach a point where you need to be looking at sport specific requirements but we must create foundations first. Is the athlete fit to undertake a training regime without breaking down. There are many elements which must be incorporated into a training regime to account for this for example: Nutrition, Speed, Strength, Power, Recovery,RSA, Endurance, Injury prevention, Flexibility, Anaerobic, Research. If we just breakdown recovery we should be looking at: Sleep (10 hours for an athlete), Hydration, Nutrition, Foam rolling, Mobility work, compression, ?Ice Baths so all of the elements can be deconstructed to create a comprehensive Ax and Plan.

So back to athletic profiling things to consider?

1: When do we screen:Pre season, End of season, following significant injury, return to training or objective Ax. There is no right or wrong answer.

2. Where?: Where do you work, what are you trying to measure?

3. How?: Single station, multi-station, single practitioner or multiple, number of athletes.

After devising a plan we should be doing a medical screen, if you do not have  medical support. This may highlight risks such as Cardiac problems which may need to be screened. http://www.c-r-y.org.uk/ . If in doubt refer to a Doctor or advise client to seek GP advice. (No your scope of practice).

The Screen

Habits/ Daily activities- may lead to motor control restrictions. This links to Poor training regimes which may cause soft tissue restrictions and finally previous injuries which may lead to movement dysfunctions linking back to habits.

How we are born to squat

Some of the things we may include in a initial screen are a Squat, Lunge, Single leg dip, box drop, forward hop and a combination. We should be marking these against normal movement to pre-empt restrictions and weakness. The testing must be standardised and you don’t have to include all of the movements to get what you want (look at the specifics of the sport).

Then we would move onto NMSK assessment some of the tings you might look at. (Not an extensive list)

  • Spinal position
  • Spinal AROM
  • Ankle ROM
  • SIJ mobility
  • Prone internal rotation
  • Thoracic Spine AROM
  • Hamstring AROM
  • ITB length
  • Hip flexor lengthon
  • Groin Strength
  • Quadriceps length
  • Hyper mobility
  • Motor/Core Control- looking at timing of muscle activation

There was a lot of practical elements looking at exercise prescription and how you would take your data forwards into a profile. The process I will incorporate into my practice will look at:

  1. Mobility
  2. Motor Control
  3. Functional Patterning.

We can incorporate this method into practice to formulate a comprehensive treatment or exercise prescription. It is difficult to demonstrate this in a blog post but basically the rational for this is because quality stability is driven by quality proprioception. And Quality functional movements cannot occur with restriction. So we should be addressing restrictions in RX, fire up the NMSK system and then consolidate learning with functional patterning.

For mobility we should be addressing myofascial length and Joint Range this links back to muscle slings which may impact of an athletes training. I am not going to go through the different slings and predisposition to different injuries as I will be here all day but some good examples can be found here: http://www.mobilitywod.com/#[/

or in the book “How to become a Supple Leopard”

After Mobility we can address motor control which is looking at stabilisation working in the new range of movement you have achieved. Some of the things which may be included are: Rolling, Dead lifting and chop and lift. This element demonstrates perfectly how much of MSK physio can relate to Neuro physio.

Finally we look at motor patterning using new control and range and incorporating them into functional movements. Something people might want to read around is Reactive Neuromuscular Training.

Your client should now be ready for S+C training however the whole process falls under the broad umbrella of S+C so there are links between the two, highlighting the need for more integration and a holistic approach.

The second part of the course focused very much on the principles of S+C incorporating RAMP principles into training. Work by Ian Jeffery’s comes into this. Elements we should be including within S+C are :

  • Needs Analysis: Requirements of the sport, movement Ax and Physiological Ax.
  • Warm Up: Raise- Increase HR etc, Activate- key muscle groups, Mobilise- look at movements not muscles and  Potentiate- sport specific drills.
  • Have an understanding of SPORT and FITT principles (not just giving 3x sets of 10)

So this was just a whistle stop tour of the course and this blog is not an exhaustive program of what you would consider but may give you some prompts to look at different elements of your practice. The main learning points I took away from the course are:

  1. When, Where and How to conduct an athletic screen and profile.
  2. The importance of looking at Mobility>>Motor Control >> Functional Patterning
  3. RAMP principles
  4. The importance of specific and tailored training regimes.
  5. The importance of understanding the needs of your athlete.

Thank you for taking an interest in my blog.  Next week I will be attending the CSP industrial relations committee meeting at CSP head quarters so my next blog is likely to be centred around that.

If you have any comments please post to my wall or tweet me @LCphysio

Everything happens for a Reason!

So I have now written this post 3 times because things keep changing so quickly. So just to catch up on what I have been doing the last couple of weeks (I hope I can remember everything).

Last week I attended my first training session with West Bromwich Albion, which was more of an induction to get to grips with how things were run. I was working with a physiotherapist called Mel as Nathan the main man was called out with another player in hospital. As a physiotherapist I was involved in the Prehabilitation of players during their warm up, this involved:

  • Sport specific skills including proprioception some of the exercises included were:
  • Hopping to four points with one foot, at each point volleying a football back to the feeder on inside foot, laces and knee/volley. On the return to the middle point the player had to head the ball.
  • Using a wobble cushion dribbling the ball to four cones whilst standing on one foot.
  • Jumping onto wobble boards with cushion upmost. Jumping two feet and one foot.
  • Foam Rolling, quads, hamstrings, ITB, gastroc’s

It is important to encourage injury prevention within the academy and to illustrate its importance. The activities involve challenging core stability and sports specific proprioception. I really enjoyed the session as I haven’t had the opportunity to work on prehab before and I think me and Mel were both thankful for the extra pair of hands as more players turned up than usual. Having enough physiotherapists to players is key to ensure form is correct throughout.

There is now good evidence that a prevention program consisting of a mixture of: Balance training, landing with increased flexion at the knee and hip, controlling body motions especially in deceleration and pivoting manoeuvres, can significantly reduce the number of ACL injuries. So for these players who are at the start off their careers it is vital to educate them on the use of prehab (Brukner, 2012).

http://www.peterbrukner.com/acl-injuries-preventable/

Since my induction I have been on my first proper session which was fantastic. Again the session focused around Prehab at the beginning, some of the exercises we used were:

  • Hopping on one foot onto 6 wobble cushions in a line.
  • Hopping onto on a wobble board cushion side up, jumping onto the ground same foot and then bounding a mini hurdle.
  • Using an agility ladder each player tied their legs together with an elastic band and side stepped through the ladder.
  • Hopping over hurdles in a zigzag pattern and volleying a ball back to the feeder.

We then were able to follow up certain players who needed specific rehab which was great to learn about some sport specific. Next week I will be leading on prehab with another physio and will be assisting with injury prevention screening using Functional exercise movement patterns. So I will follow up with a post on this.

With regards to job interviews I have had two recently, one for Bank work with Nottinghamshire Healthcare NHS trust and one for a private company called APOS Therapy. So first for Nottingham, I really was feeling a bit deflated about NHS interviews but I knew it was an opportunity for interview and although it was bank it covered all the rotations I wanted so I knew I had to give it everything. The night before I organised my CPD folder to match the person spec for the job (but of course they didn’t look at it…. Sods law) but anyway, I went in to the interview feeling a lot more relaxed than previous ones (I think it was because I was a bit half-hearted about it all… but it somehow calmed me down). The questions I got asked were:

  • Tell us about your biggest achievement to date?
  • How do you cope with stress? And how does it affect you personally?
  • Tell us about a time when you didn’t meet a deadline? What were the repercussions?
  • Why this trust?
  • What would you assess objectively for a patient with anterior knee pain?
  • How would you go about assessing a patient who has been admitted following a fall? What would you need to know subjectively? Objectively? And what would your management plan and goals be?

There was a few more which have slipped my mind.

From previous interviews I have realised the importance of not getting your hopes up.  On this interview I ensured I paused and composed my thoughts before speaking and I provided comprehensive answers for the two clinical questions. I got home that afternoon and looked at my phone; I had two missed calls from an unknown number followed by a voice mail. It was the therapy lead asking if I could call her back….. So of course I did and was subsequently offered the position! I was so ecstatic, the job was close to home and they were very positive with my feedback which was a real confidence boost. Of course I accepted the offer and then tried to prepare for the next interview still grinning.

Apos Therapy is a fast growing international company which focuses its treatment on correcting biomechanics by wearing some special boots. The product is fantastic and has had some great reviews see website for more information: http://apostherapy.co.uk/en/home . The interview was ok but it did demonstrate the simplicity of my knowledge for biomechanics but it was very interesting. Apos Therapy are very good at investing in people and providing intensive training but I was concerned as a new graduate that specialising to early would not help me to develop my hands on skills as a physiotherapist. So I decided that although I had got through to the second stage of interview at this time the job was not going to work for me, but if an opportunity arose at a later date it would definitely be something I would consider.

So I had decided the Nottingham job was for me and even though I had secured some bank work at Walsall healthcare. Nottingham would mean I could save some money. But then you will never guess what happened next….. Me, Gerard Greene and Tom Astley were just about to head out for drinks in Harborne (about 9pm) when I got a phone call from an unknown number. It was Janet Hallam from the QE ringing to say they could offer me a fixed term contract until the end of January, which could become more permanent if funding became available. I was in complete shock!! So I said I would call back in the morning! Of course I took the job it was the place I wanted to work for from the start and even if nothing comes of it, it is 6 months of NHS work on my CV J!!!

So although I have written this post three times due to circumstances changing, I can honestly say that everything happens for a reason! So hopefully my future blogs will now consist of my experiences as an employed graduate!! On a final note who’s to say networking won’t get you anywhere. Next weekend I will be working with England U19’s Cricket to assist with their injury prevention screening so hopefully this will open even more doors.

Thank you for taking an interest in my blog, feel free to comment or tweet me @lc_physio.

Pictures from the final Rugby Camp at Ellesmere College:

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Make your Weaknesses your Strengths!

I am writing this post following a roller coaster of a week. I feel completely emotionally and physically drained, and I even started question why I am putting myself through this. I know that is stupid I’ve only had 4 interviews (which I am completely thankful for) , but I think after 4 rejections in such a short space of time it does knock your confidence.  But as the title of the post claims you need to make your weaknesses your strengths and carry on.

Tough-Day-At-The-Office

So  I started on Monday with an interview at Derby Hospitals NHS trust. Due to me working with Worcester Warriors Community again this week, I had arranged my interview for 8.30 am so I could do both. Most people who know me, know I like to be organised and on time. I think I got a bit excited as I appeared to be waiting outside the interview room at 7.30 am (but better to be an hour early than 5 minutes late). So the Derby interview was based on a series of scenarios. There were 4 rooms, 3 scenarios and 1 personal interview , each room had 2 practitioners (I felt like I was on the apprentice and Lord Sugar was going to come out and say your fired or hired!!).

The first room I was in was the personal interview which I was thankful for to break the ice. Some of the questions I got asked were:

  • Tell us about you?
  • What do you think about customer service?
  • Tell us about a situation where you have had to motivate a team?
  • How do you deal with stress?

There was a few more questions but I can’t remember them all. From my previous interview at the QE I felt I shut off and needed some prompts to keep speaking (I think the nerves probably got the better of me). So on this interview I tried to keep speaking until they shut me up.

The second room was a respiratory case study (resp and neuro tend to be my weaker areas mainly because I have had less experience in them) but I felt I was able to work through the case study fairly. There were things when I came out that I could have included but I suppose when your under pressure some things don’t always come to the front of your mind.

The third was MSK, which if do say so myself I blasted. Typical presentation of a frozen shoulder but with a past medical history of a mastectomy (which can have an impact on the shoulder due to radio/chemotherapy sometimes causing tightness) so they wanted some discussion around this.

Finally was a neuro case study. They wanted to know what you know about stroke? What your goals for discharge would be? What would you do if a patient was being discharged by a doctor but you weren’t happy? Again there were some others but I can’t remember the rest.

So overall I felt a lot more comfortable in this interview but I sometimes felt I deviated from the point in the personal interview. So we were due to hear feedback on the Wednesday but I didn’t hear anything. One of my friends had already received an email to say that unfortunately they had been unsuccessful, so due to not hearing anything I thought I would be in with a chance…..But no phone call…..I rang the trust today to find out the decision but unfortunately I had been unsuccessful.  I think I had got my hopes up as I had felt comfortable in the interview and due to others receiving emails… but they just hadn’t sent mine. So as you can imagine I was pretty gutted. The feedback I got was that sometimes I was not concise in my answers for the personal section (which at the QE I was too concise and closed) so I need to find a happy medium. The only other point they made was that I could have been more evaluative in my respiratory case study (which I suppose comes with experience). They were positive in saying I was employable (BUT THEY DIDN’T EMPLOY ME GAHHHH HAHA) but unfortunately they said it was very competitive. On the other hand I did get the offer of bank work off the back of it so fingers crossed that might lead to something else (fingers and toes crossed).

I have another interview for Nottingham CIC bank 4th September so I can let you all know how that goes (I think soon I will have had an interview at every trust it feels…. so I will be the guru of interview questions).

From my previous post, I had discussed my interview at the QE, which I received feedback for on Monday. I scored 23/51 on the question paper again did well on MSK (but lacked some detail, for example I might have said ROM exercises but not specified which ones) and to my surprise respiratory was OK but I wasn’t detailed enough in the orthopaedic question.  They said I came across well in the personal interview but just missed some of the buzz words and sometimes required some prompts (more nerves than not having enough to say). But again I am on reserve list for 3 months so hopefully something might come up.

So for my next interview things I will be working on:

  • Preparing points for generic interview questions so I can be more concise.
  • Ensuring my CPD folder is linked to the post.
  • Learn to relax!!!
  • Finally work through some more respiratory and neuro case studies.

Like I said above I have been back at the Worcester Warriors this week, but working with under 12’s. It is fair to say under 12’s are a lot more demanding, not necessarily in relation to injuries but more in relation to their behavior, but we have great staff at the camps and  everything got done in the end. I am back at the camps again next week for a final week so I will update you then. Tomorrow I will be up very early to head over to West Bromwich Albion Football Club for an induction, so I am looking forward to that (but maybe not the early start after this week). But again you have to embrace opportunities that come your way.

Thank you again for taking the time to read my blog. If you have any questions feel free to comment or tweet me @LCphysio !

Time to Reflect!

So I am feeling in a reflective mood following a hectic week  (I have to apologise to my boyfriend as he told me to reflect a bit to early on when everything was a bit raw and I wasn’t very grateful for his advice, but I have come round). When I last posted I had one interview at Birmingham. Since then I have received 3 more! At Nottingham, Derbyshire Community and Derby Hospitals NHS Trust.  This week I have had one at Nottingham, one at Birmingham  and a telephone interview with Derbyshire community. Fair to say it has been quite stressful and I feel physically and emotionally exhausted. I am going to talk about my Nottingham and Derbyshire community interviews as those are the ones I have heard back from which unfortunately have been unsuccessful, but like the title of the blog is it’s time to reflect.

So I had my Nottingham interview on the Monday, luckily for me my mum volunteered to drive me so I could chill out and focus on the interview. With the interview being in the afternoon I had spent all morning pacing up and down so I had kinda wished my interview had been in the morning to get it over and done with. When I got there I had to go straight to HR to give in documents which was a fair distance to walk and not very easy to find so I was glad I gave myself plenty of time, though I was so flustered when I finally got back to the reception to wait for my interview.

So the interview came around, I had two female interviewers who were both very pleasant and took it in turns to ask questions. The questions I can remember were:

  • Why did you want to work for the trust?
  • What attributes would you bring to the post as a band 5?
  • How would you differentiate between acute hamstring and sciatica? Treat one of them.
  • You have a patient who has a left sided infarct. What would you expect to find on assessment and what would you tell your colleagues to help them if they were going to be treating them?
  • What are your learning needs to be able to go out on respiratory on call?
  • Questions on trusts values and behaviours.
  • You have a patient who has dementia the team is happy for him to go home but you have concerns how would you deal with it?
  • How would you show a patient they were cared for?
  • What would you do if your senior wasn’t using the proper hand washing technique?
  • You are on an orthopaedic ward with 28 beds. What would you do if you were the only qualified member of staff because your senior is off sick?

I’m sure there were more but these are the ones I can remember. I am yet to receive feedback as I have to wait 2 weeks, but on reflection one of the big questions I messed up on was the orthopaedic ward one! (which I will be gutted about if that was the only thing I didn’t do right as I have been having nightmares about it). Basically I answered it by talking about getting handover, having a team meeting to see who could help out and then work from there. If I had my brain switched on I would have talked about the importance of prioritising patients and delegating to the physio assistant which I didn’t gahhhhhhh!!!!!!!!

Another question I could have gone into more detail about was my learning needs to go on call. Not only do I need more experience in dealing with respiratory patients along with the mandatory training. But I also could have talked about being trained on equipment such as mechanical ventilation etc. Hind sight is a great thing!!! There maybe more things I could have done but I will await feedback and will post as soon as I do.

This Thursday I had 2 interviews. I had Birmingham in the morning and a telephone interview in the afternoon as part of a short listing process for the community post. Like I said before I will talk more about the Birmingham interview when I get feedback not holding out too much as there was only 1 post available and 8 candidates were internal!!! Urggh physio is sooo competitive. So for my telephone interview I was asked 4 questions. This job would have been ideal as it is 5 minutes from my house but anyway. All candidates were asked the same questions the first 3 I coped with fine and the interviewer didn’t have any comments to make on them and because they were OK I can’t for the life of me remember them. I think there were:

What makes a good band 5 physiotherapist in the community?

How would you go about maintaining safety in the community?

I can’t remember the 3rd one!

But the 4th one I remember clear as day because I completely fluffed it!!! I was asked to talk about a neurological patient I had seen and to talk about there management and treatment. Now this sounds a straight forward question and it would have been if I had been asked it again but at the time I was so drained from my previous interview that my brain yet again failed me. My pure neuro placement had been my first 2nd year one and I felt I would have been to vague with my answer to discuss one of my patients because it was such a long time ago so I decided to go with one of my patients I had seen on my second to last placement (who actually really wasn’t a true neurological patient so I really shot myself in the foot). This was the question that prevented me getting shortlisted and if I was asked the same question again I would have answered it completely differently. I would have talked about one of my stroke patients, the patient’s symptoms, physio treatment, outcome measures, and MDT involvement but my brain wasn’t quick enough to process the question.

So all in all I was pretty gutted about the Nottingham post as it looked a great hospital to work at, but a better physio was found on the day. I still have the QE to hold out for which is my number one place to work but after hearing there is only one position I am starting to doubt myself :(!

So anyway lets end on a positive so apart from interviews today I have had the opportunity to attend a meeting with West Bromwich Albion Football club with Head Academy Physiotherapist Simon Noad. My role with the club will be on a voluntary basis and will involve assisting the part time physiotherapists with any of the U16 players… a foot in the door you might say. I am really grateful to Gerard Greene for passing on my CV to Simon and I look forward to telling you about my experiences.

So although I am not telling you how happy I am about securing a job I am back on a positive mind set after writing this piece and I am just taking that those jobs were not meant for me. I start the camps with Worcester Warriors next week so watch this space 🙂 !! Again if anyone has any comments please post them on here or tweet me at @LCphysio xx