Organisation: Canberra Hospital and Health Services Medicine
Job Title: Health Professional Level 2 – Physiotherapist
Word Limit: 5 Criteria Responses no limits on words
Location: Canberra Hospital and Health Services Medicine
Proven ability and experience in assessing patients, planning and implementing physiotherapy treatment programs including appropriate patient/carer education
My ability and experience in assessing patients, planning and the implementation of physiotherapy treatment programs is well illustrated during my tenure as a physiotherapist at the Canberra Hospital.
Consistently providing accurate and timely assessments followed by appropriate treatments, I provide a high standard of patient centred care and assistance in facilitating timely discharges. My valuable experience and skills in assessing and treating patients with a wide variety of conditions, such as amputees, Multiple Sclerosis (MS), Guillen Barre Syndrome, Chronic Obstructive Pulmonary Disorder, Bronchiectasis, renal failure, cardiothoracic surgeries (thoracotomy, coronary artery bypass graft, valve replacements), orthopaedic surgeries (fractured neck of femur, total knee replacement, total hip replacement), gastrointestinal/urological surgery (via laparotomy), stroke, spinal cord injury, Parkinson’s Disease, ENT surgery (tracheostomy) and bariatric patients has given me an extended expertise in appropriate patient and carer education, including the ability to administer group treatment sessions for heart failure, balancing bellies, pulmonary rehabilitation and cardiac rehabilitation.
By way of example, during my rotation on 6a, I treated a 70-year-old female who had suffered a fall, leading to a cervical spine fracture and spinal cord contusion. During my initial assessment I monitored her respiratory function and completed a chest assessment (SpO2, cough, CXR, auscultation, LBE, palpation, observation) as well spirometry and a peak cough flow. I also performed a neurological assessment including strength, range of motion/muscle length, sensation, spasticity, function and the motor assessment scale. Following this assessment, I identified a number of problems including decreased ventilation, decreased strength/sensation and calf spasticity. I closely monitored her condition due to her high risk of deterioration due to a decreased cough strength and immobility. To maintain the patient’s respiratory function, I provided her with deep breathing exercises in combination with positioning (sling transfer to sitting out of bed/high sitting). As the patient had grade 0-1 strength in her left lower limb, I fitted a resting foot splint, and educated the nursing staff on its application and use. I also provided the nursing staff with education about how to apply the patient’s “Miami J collar”, including when it was required to be worn.
I also worked with the patient to identify several short and long term goals, providing the patient with a bed/seated exercise program to improve her strength. Additionally, I implemented a lower limb position program to ensure that the patient did not develop contractures. As part of ensuring her participation, I educated her family on how to assist with the programs. I took the patient to the gym to practise static sitting balance, progressing this to dynamic sitting when appropriate. I performed regular reassessments to monitor the patient’s progress and adjusted my treatment accordingly. To provide the patient with a holistic approach to care, I referred her to the occupational therapist (OT) for wheelchair prescription and upper limb therapy. In addition, I communicated with the patient, her family and the MDT the benefits of inpatient rehabilitation, to assist in achieving the patient’s goals.
In another example that demonstrates my broad range of assessments and treatments skills, I worked with a patient with an exacerbation of CF related bronchiectasis. I conducted regular respiratory assessments to monitor the patient’s progress, including his oxygen saturation levels and amount/appearance of sputum produced. As the patient was reporting difficulty clearing secretions, I provided him with humidified nasal prongs. After reviewing the patient’s use of his pep devices (flutter and pari-pep), I discovered that he was performing his treatment ineffectually, so I educated and demonstrated to him how to perform his treatments more effectively. I also utilised a pressure manometer to provide feedback regarding the use of his pari-pep and educated him on the benefits of timing his treatment with nebulisers and inhalers to aid in secretion clearance. I combined the use of his pep devices with positioning and manual techniques (percussion). In addition, I educated the patient on the importance of including regular aerobic exercise as part of his treatment, providing him with a stationary bike. Through this high level of focused education, the patient reported that he felt he was more effectively able to manage his condition independently.
My experience also includes other cardiothoracic treatment skills, including mobility, active cycle of breathing technique, postural drainage, high flow nasal prongs, pep devices (therabubble, acapella), suction [via yanker, guedels, nasopharyngeal, tracheostomy (open and closed)] and am extending my expertise by currently completing the competencies regarding the cough assist machine and the management of patients with tracheostomies. I am experienced with non-invasive ventilation (BiPAP/CPAP), proprioceptive retraining, dual task training, balance activities, cueing strategies (Parkinson’s disease), contracture and spasticity management (positioning, appropriateness of Botox). My experience also includes competency in the use of electrical stimulation, splints (AFO) and slings (shoulder subluxation), and various other equipment (lift pants, treadmill, gait harness, slide boards).
In other patient populations I am also competent in the prescription and progression of mobility and gait-aids as well as applications of various splints/braces (ROM braces, air-cast, camboot, immobiliser slings). I deliver a high standard of appropriate evidence based education to the patient, carers and staff assisting patients in understanding their condition and aids in self-management. Examples of the education I have provided includes recovery post cardiac surgery, types of pain/pain management/rehabilitation post amputation, and techniques to reduce/manage shortness of breath/warning signs of infections to patients with chronic lung conditions. I also utilise appropriate patient handouts. Another aspect of my holistic approach to patient care includes early consideration of discharge planning. This includes referrals to other members of the MDT [e.g. social worker (SW), speech pathology, dietician, incontinence nurse] and to rehabilitation facilities (e.g. 12b, ACRU, TTCP, falls clinic, pulmonary rehabilitation).
2. Demonstrated effective communication and interpersonal skills, including the ability to work as a member of a multi-disciplinary team
My communication and interpersonal skills are amply demonstrated through my ability to effectively employ various communication styles according to the situation and the person with whom I am communicating. These styles include written, non-verbal (facial expressions, gestures and body language), and verbal. My written communication includes accurately documenting in the patient’s file using the ISOAP format in a timely manner in accordance with the requirements of the organisation. Documentation is an important communication tool which I utilise to communicate with the MDT; it also provides a record of past events. I have also demonstrated my ability to use written communication through the use the department’s “red books”, weekend lists, transfer/discharge summaries and other correspondence (emails, CHI referrals) to provide concise handovers to other staff.
I employ skills in conflict resolution, problem solving and decision making utilising these skills on a daily basis to improve patient care. Recently, for example, I had occasion to use my interpersonal, communication and conflict resolution skills while treating a patient with MS who had suffered an ankle fracture post fall. Initially the patient’s participation in physiotherapy was low. Through the use of open communication, I identified that this was secondary to her anxiety about falling. I then worked closely with her to develop a trusting relationship, build her confidence and provide her with strategies and education that increased her participation and safety. Due to her MS, the patient’s progress was slow, so I suggested that she would benefit from further rehabilitation in 12b. Initially, the patient and her husband were resistive to this due to a previous bad experience so I organised a family meeting with the MDT to educate the patient of the benefits of rehabilitation. I also took her to visit 12b to help her become more comfortable there and reduce her anxiety. These actions of mine led the patient and her husband to agree to rehabilitation. During this time, the medical team communicated that they felt the patient was appropriate to discharge. However, on the patient’s behalf, the OT and I advocated that she was unsafe for discharge and would receive further benefit from rehabilitation. Using conflict resolution skills, I was able to negotiate and persuade them of the importance of ongoing allied health input.
On a daily basis, I work collaboratively with the MDT to provide patients with the highest standard of care and achieve our common goals. Being respectful, flexible and working efficiently with other team members, I liaise with the medical team and nursing staff to communicate pertinent information. This includes, for example, changes in a patient’s condition and mobility status, and if the patient is cleared for discharge or requires ongoing physiotherapy (rehab). I also work closely with nursing staff to ensure that patients receive a high standard of care; for example, timing treatment with nursing care (showering). On a daily basis I work with other allied health members including SW, OT, speech pathologists, dieticians and prosthetists. For example, in performing joint treatment sessions for new amputees with the OT, communicating with the OT and SW a patient’s need for equipment or support/services, and discussions with the speech pathologist regarding patients with tracheostomies and the appropriateness of cuff deflations.
3. Demonstrated ability to maintain high professional standards and meet organisational requirements for record keeping, data collection and clinical services
My high professional standards are reflected in my conformance with the relevant legislation, including the “Health Practitioner Regulation National Law (ACT)”, as well as the professional standards outlined by the Australian Health Practitioner Regulation Agency (AHPRA) and the APA. These include respect for the individual, patient centred care, confidentiality, evidence based practice, risk management and ongoing learning/professional development. I routinely practice these standards on a daily basis as part of my duty of care and desire and passion to provide the best possible service to my patients. Being fully aware of and supporting the organisation’s and the department’s priorities, I provide the best possible patient centred care while also supporting the staff as part of being committed to evidence based practice, Quality Improvement (QI), research and professional development. I comply with and support the Acute Support Physiotherapy Department Charter, which outlines that we strive to provide a high quality service. Further, I encourage equity, positive leadership, respect, collaboration and work to people’s strengths with a positive focus on workplace diversity and lifelong learning.
Demonstrating my high level of commitment to professional standards, I conduct myself professionally by being punctual and well presented. Consistently demonstrate my understanding of patient rights and consent, I ensure I gain consent (in accordance with ACT Health guidelines) prior to treating a patient or prior to involving another person (MDT or family) in their care. Further, I respect the patients’ rights, including those of privacy and refusal of treatment. I also maintain a high level of confidentiality and privacy for my patients, as per the ACT Health policy and ensure that no confidential patient information is available for others to inappropriately access. I communicate openly with patients and staff, including actively listening, valuing others’ opinions and treating people with respect. I aim to provide an ethical, legal and culturally sensitive practice and consistently demonstrate my ability to work collaboratively and flexibly with others as a team member to provide a high and equitable standard of care/clinical services. This includes working with other physiotherapists and as part of the MDT. Furthermore, I strive to identify and acknowledge others’ strengths when working collaboratively to achieve common goals.
Documenting every involvement with patients (direct or indirect) in a timely manner utilising the ISOAP format, I ensure that my documentation meets the requirements of the Australian Physiotherapy Association (APA). This includes writing notes in a legible manner and recording the date and time, consent, history and assessment, intervention, adverse events, goals, plans for discharge and my signature. This is demonstrated by the following example. I recently treated a patient who had suffered a stroke and whose progress had plateaued after several weeks. By completing a file review, I was able to provide the patient and their family with a detailed treatment history. As I had clearly documented my assessments, treatments and goals, the treating team and I were able to identify the patient’s lack of progress. Following a family meeting, the patient acknowledged that she had reached her potential and a plan for a safe discharge home was implemented.
4. Demonstrated commitment to and experience in quality improvement activities such as clinical governance, research programs and health promotion in relevant areas
My commitment to Quality Improvement (QI) activities is well demonstrated by my active involvement. As a responsible physiotherapist regarding clinical governance, I provide a positive patient experience promoting health, safety and security of patients/carers. Further, I support the “Service Innovation and Redesign Framework” which outlines a commitment to change and improvement that is patient centred, clinically effective and safe. I utilise the QI cycle in my everyday practice, including continuously measuring, implementing treatment, remeasuring and adjusting my treatment as needed.
My experience in several QI projects relating to health promotion demonstrates this. At the Rehabilitation Independent Living Unit (RILU), I was involved in the planning stage of a project regarding education amputees received during the rehabilitation process. The aim of the project was to develop a booklet for patients about their progression from the acute to rehabilitation setting, including the MDT’s role. I conducted a literature review to determine if there were any existing guidelines regarding the education amputees should receive as well as the progression through the rehabilitation process. I then compiled a summary of the literature to provide evidence for conducting the project and also completed the relevant application documents and supported a colleague in the development of a survey to determine what education patients were already receiving and what else they wanted to know.
To illustrate this, during my orthopaedic rotation there was a discrepancy between two departments regarding the use of axillary crutches for patients with peripherally inserted central catheter (PICC or PIC line) lines. To ensure that patients were provided with consistent information, I conducted a literature review and completed benchmarking against other primary Australian hospitals to determine best practise. I then presented this information to my senior, who provided it to the other department for discussion. I was also involved in the data collection for a project involving the use of IMT in pulmonary rehabilitation. Completing the objective measures and questionnaires, I recorded the data in a spreadsheet for analysis. In addition, I make sure I am aware of the standards addressed in each QI project I am involved in. Finally, I have demonstrated my commitment to health promotion through assisting to facilitate the outpatient classes of heart failure, cardiac and pulmonary rehab and balancing bellies.
I was also involved in the accreditation of Thiocarbonic dihydrazide (TCH) against the 10 national standards outlined by the National Safety and Quality Health Service Standards (NSQHSS). This involved attending department meetings regarding the standards and working to meet these standards in my everyday practice. During the accreditation, I was involved in service development regarding the use of the new patient care plan and its implementation on the ward. I attended and actively participated in the department’s QI planning in-services and education sessions post project completion. Now during my rotations, I always enquire about any QI projects being run and become actively involved. I am aware of several of the department’s QI research projects. These include early mobilisation in ICU, inspiratory muscle training (IMT) in ventilated patients and IMT in heart failure. I have assisted patients with their IMT (ventilator study), collected ASIF data and assisted my seniors with their clinical workload to ensure they have time to complete QI projects.
5. Demonstrates a commitment to work, health and safety (WH&S) and the positive patient experience and displays behaviour consistent with ACT Health’s values of Care, Excellence, Collaboration and Integrity
I consistently demonstrate my commitment to Work Health and Safety (WHS) by understanding that WHS is my responsibility and vital to ensure the safety of myself, patients, carers/family and other members of the MDT and staff. I am acutely aware of my role and responsibilities regarding WHS, including the effective implementation of risk management processes, being accountable for my own safety and managing environmental risks to ensure the safety of myself and others. I comply with the legislation pertaining to WHS, for example the “Work Health and Safety Act of 2011” and the “Work Health and Safety Regulations 2011”. I actively support the “Safety and Quality Framework 2010-2015” and have completed the mandatory training regarding WHS including “manual handling”, “infection prevention and control, occupational medicine and waste management”, “basic life support” and “fire and emergency training”. I have experience utilising “Riskman”, the organisation’s incident reporting system, and am aware of the “Incident Reporting SOP”. On a daily basis I comply with WHS legislation, policies and procedures to ensure the safety of myself and others. This includes infection control (hand washing, PPE, waste disposal) and the use of appropriate manual handling skills
Demonstrating my commitment to the organisation’s values of care, excellence, collaboration and integrity, I treat patients with compassion and empathy and provide a safe and supportive environment. I maintain my patients’ privacy, particularly when dealing with sensitive information. I am also attentive to people’s needs and communicate in an open manner as demonstrated by the following example. While at the TTCP, a patient quietly confided in me that she had been incontinent since her surgery. I empathised with the patient that this was a stressful situation for her and, in a privacy setting, I educated the patient on some simple pelvic floor exercises and some simple strategies to improve her safety (as she reported falling over when rushing to the toilet). In addition, with the patient’s permission, I informed the treating team to ensure that the patient’s concerns were addressed.
I continually demonstrate excellence by consistently working to improve my knowledge and expertise with continuous learning, evidence based practice and quality improvement. To enhance patient management, I research the best quality evidence, and then apply that knowledge. For example, during my rotation on the vascular ward, I treated a number of patients with phantom limb pain post amputation. When educating the patients, I was initially unsure of what information it was best to provide so I extensively researched the topic and presented a mini in-service. This included that patients would benefit from education regarding the difference between stump pain/phantom pain/phantom sensations, how a variety of physical, psychological, environmental and social factors could influence the pain experience, and self-management strategies including the importance of controlling swelling (RRDs, shrinker) and the use of desensitisation strategies. Following my in-service, I was able to implement this education to treat patients more effectively.
