Gettin' the hang of things...

 Another week down! It's been a transition to get back into out-patient after acute care. I'm not used to juggling patients, but I'm already starting to get better at handling more than one patient at a time. On Tuesday my CI left for Australia and she will be gone for almost 2 weeks! I'll be a completely different student when she gets back. In the meantime, I get to work with the owner and the other clinician, which will be nice. They both have more experience and so it has been good to get input on things. On Thursday morning the owner was filling in and I ended up seeing almost all the patients in the morning. I'm not sure if he did it on purpose to see if I could handle multi-tasking, or if it was because he isn't familiar with everyone. I think I did pretty well with trying to keep multiple people going at once. But, like I said, it's a transition from being in acute care and seeing one patient at a time. It's been a source of stress for me and I'm beginning to feel like I'm never going to get the hang of it again!

     I also got to spend some time with the respiratory therapist to see how she works her half of the pulmonary rehab. This has been really cool. I have gotten to sit in and help with two evaluations so far. It's really neat to see how they use the 6 minute walk test to determine how to start an exercise prescription for a patient. Although, they do the walk test on the treadmill, which is sort of odd. The clinic also got a new telemetry unit on Thursday afternoon and only myself and the owner were there to learn how to use it, so on Friday when the owner wasn't in the office, I got to teach the respiratory therapist how to use her new system. 

     Another neat thing that's going on while my CI is on vacation is that some professors from my school are filling in!  It was nice to see one of my professors in the clinic. He's really good with patients. I hope that when he is in on Wednesday he will get to see me work with more patients and see how much I've grown as a therapist. (I was with the respiratory therapist for most of the day on Friday, so I didn't get to work much on the "PT side" as I was helping with aerobic exercise and vitals!) And next week two other professors will be coming in as well. This is the first clinic I've been in that has had a relationship with the professors at my school and it's so nice to see my professors with their clinician hats on!

Back in the clinic! ClinEd 3 begins!

Today was my first day of my clinical experience at my new placement, which is an out patient clinic that specializes in pulmonary rehab. It was a long one (10 hours!) Big shift from doing acute back to out patient. The clinic is small, but it seems nice. My CI is young (she graduated from the same school as me 3 years ago!) and is actually a year younger than me in age. That doesn't bother me as long as I can learn from her.  The clinic serves about 50% out patient and 50% pulmonary rehab. I'm really excited about the pulmonary rehab aspect.The respiratory therapists work on aerobic conditioning (they work the patients up to 20 minutes on 3 different machines TWICE a visit [2 hours of aerobic work!!!]) then PT works on strengthening, balance and reiterating what the RT's teach (like breathing techniques, energy conservation, etc.) I had forgotten that Medicare Part B does not allow students to provide treatment to patients, so I was a little bummed because a lot of the patients today (especially the pulmonary patients) were Medicare and so I wasn't allowed to treat them. Although, it was nice because I did get to sort of observe and see how things happen. I am just hoping that there will be a good number of non-Medicare patients in the pulmonary rehab program for me to treat, since it was the reason I wanted to come to this clinic. Besides that, the day was ok. I got a little prepping on the computer documentation (which is, of course, a new program than I've dealt with previously) and some more information on billing. My CI had me write down three goals for this experience... I said that I wanted to become comfortable and competent with cardiopulmonary patients in this setting (since I am competent in the acute setting), to become independent with orthopedic patients (again), to become better at time management and multi-tasking, and to continue to excel with documentation. My CI seems very open and told me that I can ask her any questions or if I get overwhelmed or not challenged enough to let her know.  I think I am her first student, so it should be interesting for both of us as this goes. 

Back to school...

Ugh... Back into the classroom today. Although I am glad that acute care is over, there are certain things I will miss about being in the clinic. Just a few more classes and then I am done with all of my schooling! This semester is supposed to be a whirlwind, it's only 7 weeks long and there's a lot to fit in. I have Dysfunction of Multiple Systems (lovingly referred to as Multi-Systems) and my final Research course (time to write that systematic review!), as well as a professionalism course.

It looks like a ton of busy work, but I was happy to see my friends. I'm looking forward to getting these next few weeks out of the way so that I can go on vacation!

Oh! The best part about today is... I'M A THIRD YEAR STUDENT!

So excited to have that designation... Woohoo! :)

It's over! No more acute care!

Holy cow! My LAST day. At times, this clinical seemed to be dragging, but really, overall it went by so fast. I really can't believe it. I'm done with my second clinical! Only two more to go before graduation! WOW! Today was a really good day. Yesterday, my CI and I started going over my final evaluation and then we finished it up today. I was really happy with all of her comments and suggestions. I really have grown a lot and she definitely recognized my hard work and I definitely feel rewarded for it. I did have a good experience, it was a little hard at different times, but overall it was good. I learned a lot, and the staff at the hospital are so nice and helpful. 

The best part of today was one of my patients was also discharged! Much like my lady who was post-open heart with complications, so was this particular patient, although much worse. He ended up having sepsis and multi-organ failure, including the need to be on continuous dialysis for awhile. It was really sad for quite some time because it appeared he was maybe not going to pull through. But within the last week or so he has been doing so much better medically. He is starting to talk to us a little and today he got his foley cath out, the last line.tube holding him back! So, we went in to see him and I told him it was my last day and we talked a bit and I told him how proud I was of how far he had come, etc. It was a really nice, special "goodbye" (He has been in the hospital since May 9!!!) Well, later in the afternoon when my CI went to check off my progress note for him it came up he had been discharged to the nursing home!!! It was so exciting!! And perfect timing! :)

Well, I guess it's time to put another experience in the books and call it a day. I had a nice experience, but I'm glad to be done and ready for the next step! 

Substitute CI for the day...

Today my CI was off, so I got to be with a different therapist for the day. I got to work with one of the part-time therapists. It was a really good day. She is really nice and kept telling me how impressed she was with my skills/knowledge. It felt good! She even bought me a coffee at lunch time! ;) I was proud of myself because I fought for a patient who hasn't been doing well in the ICU and she wanted to discharge him, but I convinced her not to, since he isn't normally her patient. I keep hoping that he will make a turn and come around the other side, but it seems like every day he is worse. My CI and I had discussed discharging him last week, but we were worried that he may fall through the cracks if he does get better and then he will lose out on therapy he desperately needs. 

I can't believe I'm in week eight. I will be so glad to finish this clinical because it has been a lot of hard work and I've learned a lot! I have been working really hard on my in-service and I think it's going to be really informative for everyone. We've had so many patients (my CI as well as other therapists) with brachial plexus symptoms following open heart and it has been a really long process of researching over everything and I'm currently trying to find some treatment ideas now. I feel like I'm sort of "stuck" but I haven't given up yet! My CI seems like she is pleased that I'll be doing my in-service on this topic and I hope that she enjoys it (as well as everyone else) when I give it. We still need to pick a date to do it, though. 

Well, two more days til the weekend! :) Then, onto week 9!

I made it through the week!

 This whole week ended up being pretty good. I was excited because yesterday and today we randomly were assigned some evaluations on the Transitional Care Facility (it's a short term skilled option for some patients instead of going to a different facility... sort of like a subacute/nursing home setting.) And it just so happened that the two patients we were assigned to evaluate were two patients I had evaluated acutely and recommended for TCF. So, the evaluations were pretty smooth and I actually got to do MORE testing! I did some balance testing and the TUG with both patients. The patient today I did the TUG with and without an AD and you would've thought I won a million dollars. And, I got to do "real therapy"! Real exercises! It was a lot of fun! I think I may like that better than acute, but there are some positives of acute. Regardless, after feeling a little down and tired I had a pretty good week. I am excited that this is the end of week six and I'm working on applying all of the suggestions my CI and I discussed over midterm, so I hope that I continue to grow. We have another patient that is my favorite, she is a sweet older lady who had open heart surgery and then had a questionable stroke. They have yet to determine that she had one but have decided she has had a clinical stroke. She was nonverbal and really low-level for quite some time and in the past few days she is really starting to come around. Today, when we went in her room I asked her how she was and without skipping a beat she answered "ok". I almost fell over! :) They are working on getting her medically stable to go to a nursing home and I am really going to miss her when she goes. She was admitted on April 30th, so I feel like I have been treating her almost the entire time I've been at the hospital. But, it's also exciting to see her finally beginning to make (very slow) progress. Happy Memorial Day weekend!

Well, still going strong...

  Today I had a pretty good day, and since I've been feeling blah, I thought I'd write in this journal. Overall, the day was busy. The few consistent patients we have were all out for testing or up for discharge (hurray!) so we did a lot of "checking in" and talking with the nursing staff. One of our regular patients that wasn't at testing fell asleep when we sat him up on the edge of the bed. I didn't know that was possible, but I guess he wasn't kidding when he said he was tired today. We had some evaluations too and most of them went well. We had the first patient with wrist restraints this morning (dementia, combativeness, hitting/biting and trying to pull out lines), but luckily when we got into her room she wasn't using them and was really calm for us. She has a 1:1 staff with her and she will do anything that girl asks her to do, so we just worked through her to see how she was moving around. We ended the day with an interesting evaluation... the patient was asleep when we got there and we tried to wake him up but he never really did wake up the entire time and ended up singing a song that we couldn't understand all of the words in answer to every question we asked him. It was pretty interesting and we decided we would let him go back to sleep and we will try to see him again tomorrow. The day went by pretty fast and I hope that the rest of this week does and the next 5 weeks til it's time to move forward. :)