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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#Physio14: Where will the next 100 years take us?

This post has been slightly delayed partly due to me gallivanting in Vietnam for 2 weeks but also due to my change in shift pattern on Trauma and Orthopaedics I have less time in the evenings to sit and write my blog. This post will mainly cover my trip to Physiotherapy UK and will touch on future exciting developments in the pipe line.

Attending Physiotherapy UK was a relatively last minute decision. I had been to the conference for the last 5 or so years as a student and newly qualified, however this year with me going to Vietnam for a couple of weeks I was definitely counting my pennies.

I can tell you the decision not to go did not last long as everyone kept messaging me  asking “Are you going to Physio UK?” and in the end I just didn’t want to miss out! It was a great 2 day event which was credit to the organisers  and council, a truly inspiring event with lots of learning to take away. I have written this blog  in blocks so you can skip to the presentation summary you want,( I have not included all of the presentations as I would be here all night). Each one will be divided by a horizontal line.

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Rob Webster- Meeting the 201 Challenge: Opportunity and Threat. NHS Confederation.

It was great for Rob Webster, Chief Executive of NHS Confederation, to come and deliver a talk at Physio UK. Rob really did set the scene for the challenges faced by the NHS in the near future and where Physiotherapy can play its part.

So the current Challenges:

  • Generational Challenge- A society becoming dependent on the health service.
  • Ageing Population- An increasing demand on the Health service.
  • NHS Reform
  • Funding Cuts
  • A population with multiple issues.

We have a leadership role to be optimistic: 7 Themes the NHS needs to address.

  1. The Need challenge-changing population
  2. The Culture challenge
  3. The Design Challenge
  4. The Finance Challenge
  5. The Leadership Challenge
  6. The Workforce Challenge
  7. The Technology Challenge.

So we need ambition for the future- Where is the NHS going?

The vision and asks: The 2015 Challenge Manifesto a time for action.

  • Start with Prevention
  • Long Term Conditions- supported self care
  • Seven day services- local hospitals
  • Hyper acute trusts to save your life in need.

Things we need to remember as Physiotherapists and other Health Professionals.

  • We are guests in other peoples lives. We need to put ourselves in our patients’ shoes to truly understand what they are going through.
  • Our outcomes should be theirs.
  • We should organise around them and not our professional egos.

The Opportunities.

  • Integration working as one team across community and across organisations
  • Cost effective- using and promoting the work being done by Physio Works.
  • Right Person, Right Care.

Threats

  • Misunderstood Role- we need to learn to shout a bit louder about our profession.
  • The Heft of Status Quo.- “If you always do what you have always done you will always get what you have always got”
  • Visibility- Do commissioners know what we can do?
  • Unintended consequences of safe staffing
  • Plurality.

My take home message: We are facing a challenging environment within NHS whether it be cuts, increasing pressure to meet demands or trying to make Physiotherapy heard. We could easily just sit on our laurels and wait for someone to make a plan for us however we all have a responsibility to push our profession forwards and demonstrate how we can be a major part of the transformation of the NHS.


Centenary Founders Lecture 1912-2014 Karen Middleton.

I think I must have done 3 blog posts including a speech from Karen but each time I take away something different. The lecture was focused on how Physiotherapy has transformed over the last 100 years. How we take for granted our Autonomy and need to look back at how our founders over came the challenges to achieve this. Physiotherapy has a great future if we continue to push the boundaries of our profession.

Karen’s Leadership Lessons.

  1. Take Responsibility for your own development- I have taken this forwards by finding a mentor to guide my development.
  2. Things that Karen reflects on: What are you known for? What do you want to be known for? What challenges you? What have you learnt? What have you recently added to your CV? Why should anyone be lead by you?
  3. We need to be flexible! Learn to live with a bit of mess!
  4. What level of risk can you accept? What can you get away with?
  5. Learn to act quickly but not rashly. Don’t over think.
  6. Leadership takes guts
  7. Speak out when others are silent when integrity is at stake. Would you stand up for Physiotherapy?
  8. Everything in your body will tell you you can’t do it. Imposter syndrome we diminish our own value.
  9. We must be authentic
  10. People need a reason to follow you. People need to feel empowered.

If you want to see the video to Karen’s inspirational lecture please click the link below.

http://www.csp.org.uk/news/2014/10/10/karen-middleton-calls-action-stop-physiotherapy-sleepwalking-obscurity


Supporting People with Long Term Conditions- Prof Ann Ashburn

Patients need:

  • Support, Information, choice- patient preference, self-management, Information about their condition, prevention+ health promotion, psycho-social, point of contact when things go wrong, feedback from patients for service improvement and Training for all.

The Strengths of Physiotherapy

  • Active participants
  • Targets set and agreed
  • Collaboration
  • People views of Physiotherapists.

Challenges

  • Limited Research
  • Psycho-social aspect
  • Leisure activities- health promotion
  • Utilising Technology

Disempowerment and Psycho-social factors in long term conditions

  • Attention
  • Diminished concentration affects learning
  • Not being given enough time to think
  • Too many instructions
  • Background noise
  • Fatigue
  • Day to day variability, medication cycle & sleeping patterns. Affected by dehydration (as a result of slowness to swallow,concern about bladder control) so could have headaches, fatigue, constipation all of which will affect performance.
  •  Answering phone – better face to face

Empowerment

  • Allow patients to achieve
  • Recognition of previous life and the patient as a person
  • Choice
  • Support

The final part of Ann’s presentation looked at some of the health promotion activities that Physiotherapists could be involved in such as a scheme called Life after Parkinson’s. For example they set up a dance group for patients with PD . This was just one example of how we need to be creative to improve patient experience and that there is life after a diagnosis of a long term condition.


Assessment and Treatment Planning for MS- Dr Jenny Freeman

Symptoms of MS

  • Fatigue
  • Weakness
  • Poor Coordination
  • Spasticity
  • Sensory Disturbance
  • Visual Disturbance
  • Poor Swallow
  • Bladder and Bowel etc

Some questions and top tips for people with MS.

What are you currently doing to manage your health? What exercise?

Is there anything putting you off?

Do you ever Fall? Impaired  balance during Transfers, STS, Turning./Delayed motor response/Alteration of 2 sensory inputs/use of walking aids.

Exercise is proven to be beneficial and is not associated with relapse. Transient symptoms should settle down.

Should be aiming to complete Resistance training 2-3/week at mod intensity 60-80% 1rep max 1-3sets for min 8 weeks. Aerobic training 2-3 times a week 30 mins 4x a week.

Some of the balance interventions: Increase sway in quiet stance, delayed anticipatory + autonomic postural adjustments. Evidence suggests the benefits for balance interventions.

Current Outcome Measures Used.

10m Timed Walk, Single leg stance, lateral reach, confidence scale ABC, MS Walking scale, Activities specific MS, Grip strength, 9 hole peg test.

Useful Resources: Rehabilitation Measures Database- Neurology/ MS edge outcome measures database.


Measuring Respiratory Symptoms in Advanced MS? What’s the point? What’s the evidence? What are the options? by Rachel Moses.

This was a regular problem when I was working on an acute respiratory ward, MS patients being picked up too late for respiratory Ax. If these patients are caught early there are many interventions which can be taught to prevent admission to hospital but the new NICE guideline for MS have removed speech/swallow and respiratory management from the guidelines even though anecdotal evidence suggests there is a need.

MS pulmonary dysfunction and function 

  • Marked expiratory dysfunction – poor cough
  • Severe diaphragm weakness ? Indication or higher cervical cord lesion.
  • Limited ability to maximally exhale
  • reduced vital capacity for patients who desaturate over night.
  • MS- abnormalities in breathing control, resp muscle weakness, bulbar dysfunction.

What’s the Point?

So when we are assessing a patient we want to be looking at their peak cough flow. If the patients peak cough flow falls below 270ml then it is likely they will need some support to have an effective cough.

  • Lung Volume recruitment bags would be the first port of call this aids breath stacking to increase lung volume for a more effective cough.
  • If LVR isn’t enough some patients may need a Manual assisted cough as well.
  • The final port of call would be manual Insufflation: Exsufflation. This is a machine which delivers a volume and then switches the pressure release the volume and augment a cough. MI:E has been shown to be a cost effective admission avoidance strategy for patients with advanced NMD.

From this presentation it reiterated the importance of early respiratory assessment to prevent acute admissions. It also highlighted a need to educate commissioners on the benefit of respiratory management for patients with MS.


The Dementia Challenge- Iain Lang

What is Dementia?

  • A set of symptoms, progressive condition.
  • Not easy to differentiate between different types of dementia
  • variable condition day to day.

Why is dementia important?

  • Common
  • It’s frightening- most feared health condition, reliance on others
  • £26 billion cost to UK Economy
  • people with dementia stay an average five days longer in hospital.

How can we respond to the challenge?

  • Diagnosis more than 1/2 of people with dementia are not diagnosed.
  • Treatment- drugs are used to reduce symptoms and deal with psychosis, anxiety or depression. No current drug developments.
  • Understand how to communicate with patients with dementia- now mandatory training.
  1. Prevention- managing other commorbidities  HTN, Diabetes.
  2. Don’t smoke this increases the risk of dementia
  3. Eat a Mediterranean diet
  4. stay engaged prevent social isolation, learn new things
  5. Exercise best evidence to prevent dementia

Implicit memory- how you do things?

  • Evidence suggests the way forwards
  • error less learning
  • positive experience
  • repetition guiding what you want.

Implicit vs Explicit

  • Priming
  • errorless learning
  • repeated constant practice
  •  avoid multitasking

Dual Tasking

  • Capactiy overaload
  • Structural interface- sensory overload- for example during standing use fingers instead of hands to support patient.
  • be patient
  • don’t overload senses
  • one thing at a time
  • may choose to do this as part of rehab.

Communication

  • Dementia questionnaire inpatient- what do they enjoy?
  • Smile
  • Understand where people come from.

Pain

  • Very overlooked
  • most unable to verbalise
  • unable to process pain
  • unable to identify pain
  • unable to understand why they are in pain
  • What were they taking before?
  • Pain scale- Abbey pain scale.

People with dementia should be given the opportunity to maximise their potential.

  • Approach from the front good eye contact
  • think about what they are called
  • short commands and being courteous
  • keep hand movements open
  • use positive tone
  • goal based- lets go and look out the window
  • stand up tall
  • use gesture or tap where
  • avoid jargon
  • use of equipment be aware may not understand how to use.

I have been able to take this learning into practice in the acute setting by adapting my communication and limiting sensory bombardment, in turn I have found my patients with dementia have made good progress. Sometimes you need to be patient and try and build rapport  before asking them to do something but if you can get them on your side you will make your job a lot easier. I have also found that by reducing my handling has encouraged patients to be more active during the treatment session which has limited the manual handling load for me.


So that was just a review of some of the presentations I attended whilst at Physio UK. During the event I was able to catch up and network with many different people who I aim to stay in contact with. Physio UK always offers a great opportunity to speak to new people who share a similar interest to you whether that be Management, Education, MSK, Respiratory, Neurology and more. Whilst at the drinks reception I got talking to Paula Manning, outgoing Vice Chair East Midlands Regional network and Catherine Pope, Vice Chair of council. They asked me whether I would be prepared to stand as Vice Chair for the East Midlands Network. I was ecstatic to have been asked but I suggested that I would need to confirm this with my manager. My manager has now agreed to support me and I have been selected to run as Vice Chair of EMRN. The role will be a challenge but it will give me valuable experience which can be transferable to my professional developent. I have lots of people to support me so I am looking forward to taking the role forwards into 2015.

One final thing in the pipe line, I have been asked by the CSP student reps to speak at the annual rep development weekend.  I am really looking forward to sharing my experience as a new graduate with reps and hopefully inspiring them to do great things and take the future of our profession forwards.

Apologies for the length of this blog, but Thank you for taking an interest. Wishing everyone a Merry Christmas and a Happy 2015! Any comments or questions please leave a message below or tweet me @LCphysio.

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.

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