Reflection On Clinical Observation

After sustaining a knee injury that required for surgical intervention while in high school, I struggled with recurring ailments throughout my intercollegiate career. It was not until my father, who is an Osteopathic physician, was performing manipulation on me did we begin to diagnose the potential causes. The issue was muscle imbalance and limited flexibility in certain areas of my body that was shifting majority of my weight onto my knees while performing certain movements. This went unnoticed by physicians because while performing examinations the scope was concentrated on the immediate areas around my knee. With the knowledge I obtained through manipulation I have been able to treat my knee ailments by strengthening and lengthening muscles throughout my body. Having this experience helped solidify that if I am to be the physician I aspire to be, it is imperative to be trained in this form of medicine.

My first clinical experience for this nursing program was completed at New England Rehab Hospital. I walked in with some clinical experience but no experience in the realm of nursing or certified nursing assistants (CNA). During that first semester we followed CNAs to understand their job and gain basic nursing skills like bathing patients, bed making and other daily tasks. It was useful and I’m still happy we were able to have that experience. A situation that made me uncomfortable during that semester that one particular CNA never sanitized his hands when entering and exiting a patient’s room. In most hospitals and nursing facilities there is a “pump in, pump out” rule to abide by when entering and exiting a patients room rule to ensure health care workers are not spreading bacteria to themselves and other patients. This particular CNA admitted to me that he pretends to push the hand sanitizer and rub his hands together without actually getting any sanitizer in his hands. His reasoning was that he found it overly drying to use the sanitizer so frequently despite the hospital providing lotion as well.

Throughout my clinical experiences, there have been quite a few circumstances I have been placed in that have remained with me whether good or bad. All of them have been learning experiences for me whether it is how to improve and to do better next time from a mistake, for me to learn that this is or is not how a patient should be treated, how to handle family situations, and many others. One experience that I was able to participate in that will remain with me because I had not experienced this before was during my critical care rotation in the fall of 2015. This patient was dying and we were implementing comfort care for him.

Life can change in a split second when an unanticipated injury or disease hinders someone’s normal daily life. Modern medicine, physicians and families can only do so much but physical therapy can help recoup the life many of us take for granted. It often isn’t until we lose something that we as humans realize what we had such as the value of our body’s ability to take us through each day. A physical therapist is the person who stays with a patient for the duration of the rehabilitation process. A physical therapist leads the patient through the process of regaining physical strength and helps the patient regain control of their future. Much like many careers that involve interaction with individuals, physical therapy reaches beyond

OrthoOklahoma is an orthopedic medical clinic with a physical therapy branch that provides outpatient physical therapy care. The facility has a staff of three licensed physical therapists and a physical therapy assistant along with four physical therapy techs. I was able to observe all three physical therapists, Megan Ripley, Joe Ogle and Ken Roberts. At OrthoOklahoma, the most common patients are post-surgery from repairs of muscles, bones or joints. While shadowing these therapists, I observed cases of total knee replacement, total hip replacement, ACL/meniscus repair, rotator cuff repair, frozen shoulder, labrum repair, and other ailments from wear-and-tear and aging. This experience allowed me to talk to physical therapists about the ins and outs of their job, learn about different exercises and routines for treatment of injuries, and really get an idea of the work it takes to become a well-respected physical therapist.

This clinical rotation I was assigned to observe at the operating room, where they conduct various surgical procedures. The night prior to the clinical, I have to admit, was every bit unnerving. Especially, the fear of not knowing what to expect was daunting. There must have been a thousand scenario of what to expect or what might possibly go wrong playing through my head that night. However, after being introduced to the nurse I would be following, and meeting the surgeon and the rest of the team; my nerves settled down. The surgery scheduled was for a ventral hernia, which seemed routine, but complicated by a previous bowel realignment previously. The whole operation, from beginning to end, lasted a little over four hours. Although, the procedure lasted that long, it did not bother me even bit. In spite of standing for the whole duration of the observation, I never felt tired nor gotten bored. Notably, watching the surgical team working cohesively is like watching an artists who have

The patient is a 12 year old female who presented to the ED with thoughts of self harm and cutting behaviors. The patient denies suicidal ideation, homicidal ideation, and symptoms of psychosis. The patient reports that she has been sad lately. Per- documentation the patient reports to peers at her school that she was trying to kill herself, which the school sent her to DayMark. Further, Daymak IVC the patient and requested further evaluation.

My clinical day of week 3 started pretty much with the same routine. I had to shadow a CNA preceptor and helped her throughout her assignment. By late morning, I have encountered a patient that at first refused to have a conversation with me despite my efforts of searching the right therapeutic questions that will make her open up to me. I founded the situation to be a little bit frustrated and made me feel unsuccessful that I was not be able to form a relationship with the patient. I did not know what to do or what to say. She just kept staring outside the window without saying anything. At lunch time, she surprised me when she approached me and expressed her apology for her earlier behavior.

In January 2015 a patient observation was conducted on an inner city psychiatric male admission ward commencing at 10.30 am and concluding at 11.30am. The observation was carried out by the ward manager and the patient advice liaison service (PALS) manager.

Conversely at SHU, I have visited our DPT students every year across the country as they interned in various clinical environments. Nevertheless, being rooted within the MSI, OMT, and bio-psychosocial framework would define my more than 25 years of (20 years in musculoskeletal) PT practice experience. Graduating with a DPT degree from USC, I am a fellowship-trained, board certified (OCS since 1999) Full Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT) since 2003, having graduated from the Southern California Kaiser Permanente Manual Therapy Fellowship program. Notwithstanding having an “in press” commentary and “under review” revised manuscript, I have 2 JOSPT (heralding 2 new techniques or treatment approach paradigms) and 1 Journal of Hand Therapy published journal articles and authored/co-authored almost 40 peer-reviewed orthopaedic and manual PT presentations nationally [Combined Sections Meeting (CSM) and AAOMPT] and internationally (World Confederation for Physical Therapy and the International Federation of Orthopaedic Manipulative Therapist). Anchored in clinical reasoning, OMT, MSI, bio-psychosocial

S: How was your clinical experience this week? This week was an okay week. I spent most of my time trying to get back into the swing of things. I was a little rusty at the beginning of the week but it got better as the week went on.

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

My reflective clinical practice experience was based on my eight weeks placement in an acute mental health ward in a hospital. I was not sure of what to expect because I have never worked or placed in an acute ward and this was my second placement. Before starting my placement, I visited the ward and was inducted around the ward. This gave me a bit of confidence and reassurance about working in an acute ward.

I observed two different math classrooms for my clinical observation. The first classroom was in an urban school setting, grade two. The second classroom was in a more suburban school setting, fifth grade math. The second grade class period was ninety minutes long, the students rotated in groups to the teacher table and did a mini lesson there for about 15 minutes, while the rest of the 90 minutes was spent on a math website. The fifth grade class period was only 45 minutes long and the majority of what I saw was the teacher working with the students on correcting homework.

Also, the objective is to find patient’s document finding and correlate it with chronic disease process of elderly adults. With this reflection, I will discuss what I’ve learned, and my strengths and weakness in my clinical experience.