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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Painting my Future Plan!

It appears I have been absent for a month or so from the blogging scene, so it is nice to finally have chance to sit and write a new post. On my last post I was just starting my new permanent rotational band 5  job in Derby. Taking on a new job is an exciting and scary time and I did wonder whether I had made the right decision….will I slot  into the teams, will I enjoy the rotations, how will I cope with a bigger commute and will I drive myself mad living back at home with my parents? All I can say is so far this post and my current situation has been far from a disappointment. We make our own luck and certainly everything appears to be falling into place.

So where to start…. My first rotation is on elderly medicine which is due to finish at the end of April to move to respiratory medicine and on call training (eeeeek!). I have felt so welcomed within the teams at Derby Hospital and they have really been pushing my personal development and quality of care for patients. I have now begun the Preceptorship process and regularly meet with my supervisor to plan and take action on future aims and objectives. My objectives on this rotation aim to cover 4 tasks set by the preceptorship programme (which a scheme to create a seamless transition from Student to Band 5 physiotherapist minus the 6 month incremental pay!).

Task 1: Working with Patients and Groups. 3,2,1.

Task 2: Working with Colleagues and Other agencies. 2,4.

Task 3: Written Communication 2,3.

Task 4: Using local Clinical Policies relating to working practice. – Identifying risk and creating a follow up plan. Carrying out a notes Audit.

The numbers following each task, cross reference to my objectives which I will use as evidence for each task.

My Objectives 06/01/2014- 22/04/2014.

1. i) To be able to identify appropriate patient’s for humidified Oxygen. ii) To be able to set up a humidified oxygen circuit independently.

2. i) To be able to explain the range of rehab options for any given patient. ii) Identify the most appropriate referral. iii) To be able to complete a timely referral.

3. i) To complete a comprehensive + patient specific new  Ax. i) To create a specific and comprehensive problem list. ii) Treatment Plan. iii) Smart Goals.

4. To lead case load management on ward, delegating to BS/ PTA’s and other qualified members of staff.

5. Present an in-service training session for the therapy team.

NB: How I will evidence this is recorded in my Portfolio.

This just gives you an idea of the sort of things I am looking at as a Band 5 physiotherapist. I plan to update my progress post rotation…. What I would do differently? Are there any other objectives I should be including? What went well? And what am I hoping for in my next rotation?

Since starting at Derby I have been given the  opportunity  to continue my work for the CSP as I been selected to sit on the Industrial Relations Committee as the Newly Qualified Rep.

The Industrial Relations Committee (IRC) have special responsibilities in relation to decisions on Pay, Terms and Conditions. Members of the IRC have Leadership and Governance roles to support CSP members.  This may involve inspiring, engaging and empowering members in relation to the work of the IRC and wider trade union issues and campaigns.

In brief the IRC aims to consider all matters and develop policies and strategies, relating to salaries, employment, labour utilisation and conditions of service for Chartered Physiotherapists, Associates and other persons represented by the Society.

I am trying to find the best way to keep in touch with Newly Qualified physiotherapists to put their view across. I have posted a link on iCSP

http://www.csp.org.uk/icsp/topics/calling-all-newly-qualified-physiotherapists?networkid=226045

to see if this generates some interest. I would like New grads to come forward with any issues affecting them in the work place (NHS or Non NHS), which they feel needs to be taken further than Steward and H&S rep level. Local issues can normally be resolved through Stewards and H&S reps. However, if a problem is of a national scale or you feel other New Grads may be facing a similar situation please get in touch.

KEY COMMUNICATIONS MESSAGES- IRC MEETING 5TH FEBRUARY 2014 

New IRC Chair – Jill Barker elected as new IRC Chair.  IRC paid warm tribute to outgoing chair Alex MacKenzie.

Wider Environment – Important to track what’s happening in the wider economy.  Changes to benefits, public services, living standards etc. All impact on profession and patients.

Lobbying Bill – now passed by Parliament.  Strenuous campaigning secured some improvements, but still a big step backwards in terms of democratic rights. CSP to assess how best to mitigate the impact on our ability to lobby and campaign on behalf of members.

NHS Pay, Pensions & Conditions

  •  Pay Review Body (PRB) recommendations on this year’s pay lift, and the Government response, now expected in March. Also likely to be big challenges ahead, issues such as incremental progression.
  • Changes to Agenda for Change terms and conditions in Wales to go out to member consultation once position re doctors clarified.  While not welcome, they represent a significant shift from those originally proposed.
  • First report of joint employer/union working group on implications of staff working longer due out next week. CSP represented on the group.
  • Discussions taking place on very difficult issues around the future funding of the NHS and other public sector pension schemes.  Widening access to the NHS scheme for non-NHS members delivering NHS services represents a concrete success

NHS Social Partnership Working – CSP now has a seat ‘at the table’ in all 4 countries, giving access to information and key decision makers

Competition – new cross-CSP group to be set up to steer CSP’s future work on competition, including learning lessons from early initiatives.  Outcome of current negotiations on an EU-US trade treaty could have big impact.  TUC lobbying making some headway in ensuring public consultation on treaty takes place.

Safe Staffing Levels – CSP employment and professional functions working together on key issues for profession raised by the Francis report, in particular guidance for members on safe and effective staffing levels and the duty of candour.

TUC ‘For a Future that Works’ campaign – IRC agreed to support next major national demonstration planned for October, and to encourage maximum member participation.  Also to support the new Robin Hood Tax petition and video.  Aim of both initiatives is to present the practical alternatives to austerity. Rally’s are a way of organisations/unions showing solidarity on a campaign.

http://www.tuc.org.uk/about-tuc/britain-needs-pay-rise-%E2%80%93-tuc-mass-demonstration-autumn

http://www.csp.org.uk/professional-union/union-support/future-works

Organising – formal CSP recognition secured at the Percy Hedley Foundation in the North East. Welcome precedent.  New briefing on CSP employment services for members working outside the NHS in preparation.

NB This is only a snapshot of the meeting and the comprehensive range of papers tabled.

The weekend after the meeting I was also fortunate to be invited to the Student Rep Development Weekend (which I attended as a student CSP rep). It was strange being on the other side but this years Student Executive Committee have done a great job ensuring the student voice remains . There were many great speakers from the conference which generated a lot of interest on twitter! The transcript for the event can be found here:

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?hashtag=SRDW14&fdate=02-06-2014&shour=0&smin=0&tdate=02-09-2014&thour=23&tmin=43&ssec=00&tsec=00&img=1&page=2&page=1

And Analytics here:

http://www.symplur.com/healthcare-hashtags/SRDW14/analytics/?hashtag=SRDW14&fdate=02%2F06%2F2014&shour=0&smin=0&tdate=02%2F09%2F2014&thour=23&tmin=43&ssec=00&tsec=00&img=1

If I was to talk about all of the speakers from the weekend you would be here reading all night ! Ella a student physio summarises and reflects on the weekend very well ( a great blog from a student physio)

http://aphysiostudent.wordpress.com/2014/02/09/student-rep-development-weekend-2014/comment-page-1/#comment-4

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The key points I took away from the weekend in bullet form:

  • If you want something go after it! Don’t wait for something to happen, go make it happen. Simon Shepherd brought this to life talking about his life story.
  • Some very interesting links from Simon Shepherds talk: http://www.firstbeat.com/ http://www.firstbeat.com/work-well-being/investing-in-well-being-pays-off#Individual
  • “Take a chance, don’t make a plan”, following Karen Middleton’s interview on her career from Student to Chief Executive, it highlighted that we should be flexible in our career path and grasp opportunities made available to us. She talked about pushing the boundaries of her work by working out of her comfort zone. She demonstrated the ability to develop coping strategies whatever she turned her hand to. (Note this is my interpretation of the interview).
  • Aspire to be the best you can be. Set yourself Goals and write a mission statement.
  • Network, Network, Network a useful place to start in Linked IN or Twitter. Networking can open many opportunities start now.
  • Remember you are upholding your profession on Social Media Platforms. Mitigate the risks and engage!
  • Learn about power poses! http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html how can you implement this into practice?

I always come away from each Student Rep Development weekend feeling truely inspired by leaders of the profession, the speakers and the energy from the student reps. Physiotherapy is such a dynamic profession and the more I put in the more I get out.

My action points following the development weekend are:

  • To learn more about motivational interviewing and power poses.
  • To write a personal development plan for the next 5-10 years (as a guide)
  • To find a mentor to help me to refine my leadership skills.

Below are a few photos from the event.

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And so all I have left to do now is to write my Mission Statement:

“I will always strive to achieve excellence in my work and life. I will continue to help others and guide them to opportunities within Physiotherapy. I will always remain open-minded and will take others opinions into account to inform my decisions in practice. I will continue to promote Physiotherapy to my service users, commissioners, and wider network of colleagues to provide a sustainable future for  the profession as a whole.”

Thanks for taking the time to read my blog if you have any comments please feel free to leave one below or tweet me @LCphysio

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