- 27 March 2019
- 20 min read
Physiotherapy placement experience
Matticus has just completed his placement as a Physiotherapist on the Isle of Wight, working in cardiovascular respiratory CDR. In this video and blog he talks about his experience - what he liked, learnt and the people he worked with.
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As most of you guys know I've been on a six-week placement at Saint Mary's Hospital on the Isle of Wight.
I've been working on the branch of physiotherapy known as respiratory or cardiovascular respiratory CDR.
I've been staying in some nice accommodation it's called Sovereign; most of the staff that don't live on the Isle or are not from the Isle originally actually go and stay there.
The accommodation is actually quite nice; the room is really nice, the kitchen is quite big, it's just the fridge space is a little bit limited but you get car parking as well.
Another thing to add is that the university paid for my accommodation up front so I haven't had to pay for the accommodation, which is good!
Anyway today I want to talk a little bit about my placement - the things that I got up to and the things that I've learned.
If you're thinking of becoming a physiotherapist, read this blog on how to qualify for and find a job as a physiotherapist.
What I did on placement
Mostly I've been based on ITU which is the intensive care unit there.
Throughout weeks 1 to 4, I was actually based on more of a surgical rotation, so I would see patients who'd had a laparotomy, hysterectomy or some sort of operation.
Most of what I did was seeing patients, introducing myself saying who I was, you know ‘I’m Matticus’ or I'd say ‘Matt’ because that's more professional.
Most of it would consist of listening to their chest if they need to have their chest assessed so you do an A to E assessment, and then I'd also get them moving.
If they wanted to get up they'd have to get consent so they can get up and walk around the ward.
Getting the patient's mobile is probably one of the most important things, as I've said.
Getting them to do active bed exercises so like just straight leg raises, knee bends, knee extensions, and toes up and toes down, and just keep moving.
When I was on ITU it was a lot different because some of the patients were in intubated and sedated, so they'd be on like some sort of oxygen therapy, so in that sense there wasn't that much to do as a physio except for suctioning which is where you put tube down someone's airways and make them cough, and then suck up all the sputum which is absolutely delightful…!
In ITU it would just be listening to their chest, potentially performing suction and monitoring their vitals.
If they were awake then you've got to do some active bed exercises with them, some active cycle breathing techniques so deep breaths or deep breathing exercises to increase thoracic volume and help the patient breathe, which is quite important.
If they were able to we would get them out of their bed and get them walking because that is key for everything - you will get the patient up and walking!
So the first few weeks were mainly me sort of getting my bearings on things, so week one was pretty much almost an induction and writing some notes.
Week two and three were sort of starting to see patients by myself and week four was pretty much seeing patients completely independently and like clinically reasoning why I should see a patient and what treatments I'd do and formulating a plan, so like analysing my findings and coming up with like a treatment plan for the issues that the patient had.
So if they were short of breath or if they had some sputum intention then I'd get them to do the active cycle breathing techniques, the deep breaths to increase lung volume and the huffing to help clear the secretions.
I got to look at some chest x-rays as well of some of the patients that I was seeing so that was good because I remember I can see that, if for instance if there was a lot white on the chest x-ray it could just be that the x-ray was underexposed but more often than not there would be some sort of consolidation in the patient's lungs, so you could you could like clinically reason this patient has some consolidation in the lungs that means some chest physio for this.
The first three weeks initially was supposed to be spent on more surgical rotations obviously, so ITU and then surgical so seeing people who had an operation, but I actually ended up staying an extra week on this surgical rotation, and only in the fifth week of my placement did I start seeing more medical patients.
I was on a ward called Coalwell Ward, and on MAU and A&E, and that was really good because I got to see kind of how important the physiotherapist’s role is, not just in rehab and seeing patients that have had operations but also in patients who have, for instance, collapsed from an exacerbation of asthma.
As the weeks went on I was given more and more independence to see the patients, which is really cool.
I spent a lot of times refining my assessment skills, so the A to E assessment of a patient and actually ended up doing two full A to E assessments on two different patients - one in I think the first week or the second week which was really slow, really awkward because I kind of didn't know kind of what to do, and I was just like ‘I need to do this and then I need to do that, and then I need to check the blood pressure’ and I was all over the place!
By the fourth or fifth week when I had to do another A to E assessment it was really like BOOM-BANG on, so that shows progress which is quite good.
The physio that I'd be with in the afternoon occasionally would teach me more about analysis and he’d be like ‘your assessment’s okay, it's good, it's pretty solid, now you need to start thinking about your analysis, so look at your findings what have you found, what do you think the issue is, clinically reason it and come up with a plan because the analysis ultimately feeds into a plan for treatment and that's kind of the most important thing.’
There'd be times when I'd see a patient and I'd auscultate their chest, which is where you use the stethoscope and you listen to their chest.
Their chest would be clear so then I'm just like, very well, the chest is clear, no concerns so physio input.
There are times when you have to take a step back and be like, it's probably better for us not to do anything with a patient and if they're unconscious, for example, to let them fight off the infection for a little bit, you know if they need some suctioning fine, keep monitoring their vitals but actually they don't need any chest physio until they've woken up.
So sometimes it's best to leave things as opposed to trying to force some sort of therapy that they might not really need, plus there's not really much you can do with a patient when they're unconscious.
I've actually just finished week five of my placement and I'm going into week six, this video has been made in advance, so I actually had my halfway two weeks ago and I'm past my halfway.
I got pretty decent marks from halfway and I'm pretty confident that I'm gonna pass this full way and I've improved on the things I needed to improve on, so I should aim high and get pretty high marks.
Even though in placement, for whatever reason, for us MSC physios it doesn't really count, so it's a pass or fail.
By the time you've seen this video I would have finished my placement and would be close to starting my second placement which is at Southampton General Hospital working on the cancer care unit.
That is what I have been doing on the Isle of Wight at St. Mary's, just learning to be a really good physiotherapist in acute care.
Working on the Isle of Wight
So I've talked a little bit about what I did and now I want to talk about what I've liked about being on the Isle of Wight on placement.
The first thing is it's quite a nice getaway from Southampton - the Isle of Wight is quite quiet and it's a really nice place to go when you're old and retired and you want to live in like a bungalow overlooking the sea, like that's definitely something I'll note!
The Isle of Wight is also a bit warmer than the mainland I've really liked living on site on the hospital because it's meant that I have not had to wake up as early as I would have to do.
It's meant that I've not had to wake up as early to commute like Andover or Portsmouth, which is like a 45 minutes to one hour drive or whatnot.
It's literally a two or three minute walk from my accommodation so I've not been late a single day, and that just shows you that actually most of the time I leave in good time and the only reason I'm late it's because of rush hour and traffic, not an excuse it’s just a reason.
I found that the people on the Isle are actually really quite relaxed and down-to-earth and loving.
They're all lovely people and everything is really close together, like the gym I go to is literally like a five minute drive from where I am.
There is still traffic on the Isle which does give me a bit road rage but it's less so than other places.
I've really enjoyed working at the hospital, I think it's a lovely little Hospital - I say little, it's still a big Hospital but compared to some, in general, it is pretty small.
I felt that St. Mary's is quite like relaxed in terms of they’re not so high paced and stressed out all the time and this has been good because it's meant that I've been in an environment where I feel comfortable to learn like it's a great learning environment.
"Although it's understaffed, the physio team put the care of patients first no matter what. I found it so impressive"
I've been comfortable to make mistakes because ultimately that's how I learned, I make mistakes and I learn from them.
I have been very hands-on with some of the patients and that's been really good for me, like I've not had to sit and watch and shadow because I kind of find shadowing a bit boring - I like to kind of watch to see what I need to do and then get straight into it, get stuck in and start seeing patients and start clicking into this physio mode.
Also all the staff I worked with, especially the physio team that I have been with have all been really kind, really welcoming and really inviting.
The other people I can see myself working with in future, if I did decide to work on the Isle of Wight, it has a really supportive atmosphere where everyone's kind of got each other's backs.
One thing I've noticed about physio on the Isle at st. Mary's is they are like quite understaffed and they have loads of wards to cover and loads of people have so many patients to see, yet even when a lot of people were sick from the flu - I got sick from the flu so I was off for like two days - but even when they were even more short-staffed than usual because people were ill or people were on annual leave, the physios was still able to plan things and see all the patients by the way they prioritize things.
It was really really good to see that they're making the most of what they had and I just thought it was really quite impressive, like they didn't even have the most of the staff or the resources but they still give the patients the best care they can, and it's nice to take a step back from the busyness and all the stress of the things on the mainland.
What could have been better?
I want to talk about some of the things that could have been better on the Isle of Wight.
There's not really that much more that I could have asked for placement wise.
The staff room that we always had lunch was a really cramped and was really warm, and there was just too many people for a room that was really small.
They might need a bigger staff room, especially since they’re starting to hire more staff as well.
So the only other thing that I can complain about is that in the first week I did actually write to their occupational health.
I've made it clear that I have a skin condition - I have pompholyx eczema, I'm allergic to sodium lauryl sulfate in soap which is the stuff that makes soap bubble up.
I let these people know that I had this allergy and I asked them to get some special soap for me and they hadn't done anything about it so that's really irritating.
So my hands have been blistering and cracking, I've tried to like not use too much soap so I've tried to only wash when I needed to wash, instead I’ve been using more hand gel which doesn't appear to dry out my hands as much, strangely enough.
In terms of some of the disadvantages of life on the Isle, at the moment I don't know if I could live on the Isle permanently.
The reason for that is there's not really that much to do in the sense that they don't have a Nando's on the Isle, they don’t have a Wagamama’s, they don’t have major shopping outlets and they only have like two cinemas and they have a trampoline park, but in winter there's not really that much to do and that's one thing I've noticed.
If it was summer I’d go to the beach every day and I'm sorted!
I absolutely love swimming or doing flips and then parkour outside and just being outside in the sun, on the sand, that's just absolutely my dream.
But in winter is just so cold and rainy and horrible and there's not really much you can do, even though it's really nice to have that space, that kind of getaway that stepping back from everything going on on the mainland it's really weird not having my mates around the corner.
You're on the Isle pretty much by yourself and obviously, I have made some new friends and the people I live with are nice, the people I work with are nice and I do have friends in the Isle that I've been going to dinner with on some of the weekends and just having a great time with because they're just lovely, like-minded people and I'm going to miss them very much.
For the stage that I am in my life at the moment, I feel like the Isle of Wight, if I live there, I think I'd get quite bored.
What has this placement taught me?
I want to talk a little bit about what I've actually learned from this experience.
I really enjoy what I'm doing.
For me to take a step back and be like, actually what I've got here, even though some other things in my life might not have lined up properly or might be a little bit not where I want them to be, I am so blessed already.
I get to be a physiotherapist, like in one year's time I will be qualified, I'm going to be looking for a physiotherapist job, I'm going to be doing what I've been called to do.
After doing this cardiovascular respiratory placement I've learned that actually this is quite interesting as well and there's a lot more to it than I thought.
It's not just patients coughing up phlegm which is not really that pleasant to deal with, but you get used to it.
You wear gloves and you have the apron on, you don’t have to touch the phlegm it’s fine, just don't touch it!
I have also learned that there are times when my really laid back, soft approach is not enough for a patient.
If we need to mobilize them in their best interest because they've been lying in bed for like five days, there is consent obviously because the patient needs to consent to it but if they're either not in a fit state to consent or you know that it's going to cause them a lot of harm in the long run, you have to see them in their best interest and sometimes you have to kind of really persist or even like kind of force them to get up.
So we had a lady, I'm not going to use her name for anonymity so we’ll call her Mrs X.
Mrs X had been lying in bed. She’s a lovely lady, I think she had dementia, and she might had a urinary tract infection.
She had not been up in days, she'd been lying in bed and everyday we'd go to see her.
I think this was week 3 or week 4 of my placement, we go and see her, we try and get her out we'd be like ‘Mrs. X, it would be so good for you to get up’ and she kind of beat around the bush and didn’t want to get up.
If you are over 80 and you lie in bed for like ten days or something it's equivalent to 10 years of muscle ageing.
I remember just going to this lady, I was very pleasant towards her I just absolutely adored her and she was never horrible to me, apparently she was a bit mean to some of the nurses, but I remember asking her like ‘Mrs X, I think we should get you up’ and she beat around the bush.
So I didn’t think I’d be able to get her up, so I said to her ‘okay Mrs X, well we'll leave you for now and then I guarantee you at some point we're gonna get you up out of bed’.
She just turns to me, with her glasses on, she just goes ‘listen you old bugger, how many times do I have to tell you I'm not getting out of bed?’
I wasn't expecting that and no one's ever called me a bugger!
So my supervisor had to come and be like ‘sorry, you need to get up’ and we did manage to get her up eventually, which was really good.
She sat in the chair and we got her back to bed and we got her like transferring and mobilizing with a lot of assistance but it was really good to just get her out of bed.
On a more serious note, I've had to deal with the very real facing of death.
There was this patient, this lovely man who I started seeing with one of the band 5 physios on the first week.
I saw him on the second week and even after that band 5 physio, who was also a lovely girl, actually left to do a different rotation I was still seeing that man with another physio.
It got to a point where I was seeing him write independently, do some band exercises so I got to know him quite well and he had a family.
He passed away very recently meaning this last week my supervisor told me of this patient who passed away, I was shocked.
It was quite unexpected; I know he was very sick and he was in palliative care, but it hits you hard when when some new you known for the while who you've got to know quite well relatively as with a patient and therapist, relationship when they pass away you're just shocked.
I'm finding it really hard to express what I felt really.
"I had to face death... It's hard to express how I felt"
When I spoke to my supervisor she was like ‘actually, you don't need to see this patient there are other patients that you could also see, it wouldn't take that long to see him’ but I actually kind of enjoyed going to see him and just to know that in some way I was making his life a little bit better by just choosing to go and see him and get him to do these shoulder exercises.
He was really compliant he really enjoyed doing them, we had some good chats and I hope wherever he is now I hope that he is resting in peace.
I know death happens, I know people die I know it's just something you have to get used to.
I know if I was a doctor or medical student this would be something that I have to deal with even more but even as a physio student, in the future when I'm in physio I know if I work and I keep care especially, there are going to be people who I meet and who I really love to care about and they just they just die.
I have enjoyed my placement at St. Mary's, I feel like it's a very relaxed, very chilled out environment, I've been very hands-on with some of the patients, I've had a lot of Independence, a lot of support but also a lot of Independence from the staff that I've been working with.
They're all lovely people but it's just been a great learning environment.
This would be my favourite placement so far and I think one of the reasons for that it's not necessarily because CDR is my favourite out of the three disciplines but because of the staff.
I've been able to stress less from not having to commute which has been great and also the Isle is just a lovely place to be - it's a bit boring! I made some good friends and I know that when summer comes I will have people to go and see, and now I know the Isle a lot better I'd like to go to the beach at the Isle of Wight because in Southampton we don't have any beaches, even being by the sea which is really quite depressing.
Physio students, nursing students, healthcare professional students; take the opportunity to ask questions, to learn, to just grow because that's honestly what placement is for.
I do want to wrap up this video here but before I go there is something I like to share.
This first is from Luke chapter 13 verses 22 to 24 and it reads ‘then Jesus went through the towns and villages teaching as he made his way to Jerusalem. Someone asked him, ‘Lord are only a few people going to be saved?’ he said to them ‘make every effort to enter through the narrow door because many I tell you will try to enter and will not be able to.’
I sincerely hopefully you've enjoyed this video, if you have them please give this a thumbs up as it really does help the channel out.
Don't forget to check out Healthjobs.co.uk for physiotherapist jobs if you are a physio looking for work, and if you would like to see more videos like this and follow me on my journey to becoming a physiotherapist then why not consider subscribing by clicking on the subscribe button down below?!
I will see you guys very soon.