Category: Physical Therapy

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By Pauline Tran-Garcia 0 Comments Physical Therapy, PT school

Clinical Rotation Series – Part 4 of 4

Year 3 – Skilled Nursing Facility – 12 weeks

I currently work in outpatient ortho but this clinical rotation alone made me love PT in a skilled nursing facility as well. Maybe it was the whole rehab team that made this rotation and setting so special. On my first day, the staff teased me that I’m in for a special treat at lunch. I was nervous because they wouldn’t tell me what it was. To my surprise, the “treat” was their ongoing tradition to play hacky-sack during lunch. If you’ve been following my page for a while, you’ll know I have very little to no coordination. We never missed a day.

I had two-CI’s but mainly worked with one. She was so respectful, warm, and kind to all of her patients. She had a smaller frame than me but she made transfers look so easy. All of her patients loved to work with her and she would always make them smile. She had a way of sweet-talking even the grumpiest patients participate in physical therapy. I think we were turned down maybe 1x the entire time I was there.

I felt myself looking forward to each day because I had so much fun with the team there.

This reflection really showed me how much I valued the team I work with and want to enjoy my time at the place I work.

One of the most memorable moments in this rotation was a time when working with a patient s/p R CVA. He had been living in an adult foster home and was admitted requiring MaxA for transfers and bed mobility. He was oriented x3 but often had his eyes closed during transfers and when we were talking to him. We had been working with his sit to stand transfers in the parallel bars and progressed to a few steps in the bars with 2 person assist using max verbal and mod tactile cueing for step initiation. We had been working with this patient for a few weeks. One day his daughter who was in college came to visit and observed our session. We helped this patient ambulate with CGA with WC following using FWW for approximately 5 feet. She was brought to tears. She even took her phone out to start recording us. When he sat down in the chair, she went up to him, held his hands, and cried. She told us she hadn’t seen him walk in many months. Obviously I had tears.

I truly value our profession and the power we can give to our patients.

Consistent hard work and effort can help a person walk again. Achieve goals that maybe people didn’t expect. My CI never gave up on her patients and was always so encouraging. Her ability to help patients with her kindness, support, knowledge, and mighty strength inspired me to be the same with my patients. 

 

By Pauline Tran-Garcia 0 Comments Physical Therapy, PT school

Clinical Rotation Series – Part 3 of 4

Year 3 – Outpatient Ortho – 12 weeks

I was fortunate to have my last two affiliations back near home in Oregon. My PT program was located in Pomona, CA. My last day in Cali was a final and a celebration with my class (there may have been a party bus) and when I got home, I woke my husband up (around 3 am), took a 30-minute nap while he showered and we hit the road. 18-hour drive back to Oregon.

 

My last affiliation was at a private practice run on the 30’s. We worked 4-10’s and it was perfect and I loved the schedule because we had 3-day weekends. I learned so much in these twelve weeks. My CI enjoyed being challenged with clarifying questions and would give me mini-assignments that if I didn’t know an answer to a condition, he’d have me look it up and tell him the next day. I’ll never forget Marfan’s syndrome/EDS because that was one of the many things he assigned. 

Instead of telling me what those conditions were, he had me seek out the answer myself.

 

We co-treated for most cases and he was amazed at how fast I could type. Our teamwork was so fluid that by the 6th week, it took little effort to organize and plan out our schedules. He was in the treatment room with me for nearly every patient and I preferred it that way. He’d always use the phrase, “can we talk shop?” to the patient when he’d pause for a teaching moment. 

I learned from him as a PT but also with his expertise in finance.

 

He was the first person to get me interested in learning about how to manage my money. He had me start with “Rich Dad, Poor Dad” by Robert Kiyosaki which I hadn’t read before. He shared with me his strategies and a side business of rental properties which had inspired me to get smart about investing instead of spending.

I am grateful for the time with him because he challenged me in the clinical perspective but also in life skills and sparked an interest that I never had before. When I told him that I bought my first house 2.5 years later, he responded, “Congrats. Where? When da party?”

 

By Pauline Tran-Garcia 0 Comments Physical Therapy, PT school

Clinical Rotation Series – Part 2 of 4

Year 2 – Outpatient Ortho – 12 weeks

My CI was the clinic director. She had specific programs for each body region including manual therapy (STM and joint mobilizations) and exercises. Every person with a shoulder problem got the same shoulder protocol and low back pain followed the same low back protocol. She had built a lot of rapport for her patients and it wasn’t until week 5 or 6 before she let me lead some patient cases. She had told me from the beginning that she usually only takes 3rd-year students and that I wasn’t ready. So the first half of the rotation was observation and documentation. I would scribe for her during her treatments/evaluations. 

 

And when I tried to do something out of the protocol, she’d let me try it but then she’d recommend something that she’d normally do. So I learned early that it’s better to do it her way. And that’s okay.

She had been working for almost 10 years and I didn’t want to disrupt her groove. 

 

What I valued most about her was her ability to market to doctors. She had time blocked out of her schedule to deliver goodies to doctors’ offices and make an appearance. One time, I attended a lunch meeting that she scheduled with a doctor’s office and staff. She so easily made friends with the staff and started recommending bachelorette locations in Vegas for one of the nurses. On the car ride back to the office, I remember her saying something along the lines of,

“We don’t need to talk about physical therapy. They know what we do. But they won’t easily forget that conversation about Vegas.”

This is true. The marketing lunches between PT offices may blur together but she used casual/easy conversation that was memorable to stand out.

 

I’ve done marketing meetings with MDs in my outpatient PT job and if I’m leading the lunch, I tend to take her approach. I would rather connect with the doctor by sharing more about me as a person and my values and vice versa.

 

By Pauline Tran-Garcia 0 Comments Career, Physical Therapy, PT school

Clinical Rotations Series – Part 1 of 4

At WesternU, we had 4 clinical rotations in total. One two-weeker first year, one 12-weeker second year, and two 12-weekers at then end of third year. I’ve created a series to share my key takeaways from each experience and share tips on ways you can take advantage of yours.

Year 1 – Inpatient Rehab – Acute/ICU – 2 weeks

This was my first rotation and I was crazy nervous. I reviewed vital norms and had a cheat sheet in my pocket to refer to. My CI was very sweet and popular with the nurses. She mostly let me observe the first week and carry her DMEs around. In the second week, we started to go through the checklist of skills that my school had provided me. She passed me with flying colors however I wanted to get more hands-on skills.

Clearly I was over-eager and she could sense it.

She offered me to observe a surgery. What?? I can do that?? She scheduled a day for me to observe a Total Knee Arthroplasty (TKA) and a Total Hip Arthroplasty (THA). Being in the operating room was so interesting. I watched the staff layout the prosthetics, post x-rays and then wheel the patient in. There was one member of the staff that stood with me, in the beginning, to explain what was going on. I stood off to the side and watched from afar. The table was already crowded with the essential staff. Both surgeries were back to back and in the morning. So then by the end of the second procedure, I reported back to my CI. We had lunch and then later that SAME DAY, we got the patient with the THA out of bed, post-op day 0.

If you have an inpatient rotation, I strongly recommend you to ask to observe a surgery. If I were to choose between the two, I’d recommend the TKA because the surgeon flexes the knee and so much more is exposed.

I’m grateful to have such an amazing experience for my first rotation and an amazing CI to give me the opportunities I didn’t know I had the option for. Check out my YouTube video on how to better prepare for your rotations.

By Pauline Tran-Garcia 0 Comments Career, Physical Therapy, PT school

How To Build Trust With A Patient

Communication Tips for PTs

“It is recommended that every health professional establishes a therapeutic relationship with a client-centered approach with empathy, unconditional regard and genuineness.”

A key mentor of mine referred me to read “Chapter 3: Communication and the Therapeutic Relationship” from Maitland Vertebral Manipulation Management of Neuromusculoskeletal Disorders.

 

This is important to all clinicians because the relationship and tone set from the initial evaluation carries throughout the rest of the patients’ care. I have highlighted the areas that stood out most to me and will elaborate on my own personal reflection/experiences of each of these points. Some of these, I had discussed in my YouTube video prior to reading this chapter.

 

Goals should be created with instead of for the patient. During the subjective, goals should be determined based on current functional limitations. Discussing the parameters (time, level, or pain) should be established collaboratively with the patient. Goals should also be discussed between treatment sessions to ensure there’s progress towards the end goal instead of only at the initial evaluation and progress notes. 

 

Communication should be given at the patients’ level of thinking. Speaking in medical terminology may reduce the patients’ engagement. The use of metaphors or analogies have been helpful for me to describe a PT diagnosis. Be aware that patients may feel embarrassed to ask you to clarify something if the topic has already brushed over. Ensure there’s time taken to give patients time to ask questions before the end of the session. 

 

Clarify meanings versus assuming. Although we, as PTs, have a symptom list readily available, the patients often do not and have a hard time describing it. Ensure that you fully understand what it is they’re trying to say by asking specific clarifying questions rather than assuming.

 

“Hearing is passive, listening is active” 

 

Should pain be a topic of discussion? Some patients fixate on pain and measure their progress only by pain. So it is a choice for the clinician how to present this as a question and how often to discuss this topic. As a new grad, I used to ask patients their pain level at every session. I realize the number was slow to change. When I started asking about functional progress, I started to realize a faster change and fortunately, the patient would too. 

 

Letting the patient have a say in the decision on the intervention. I implement this technique after establishing a few sessions and if I’ve used different treatments, I will share with the patient my “agenda” for the day. I’ll list my plan for interventions and purposefully leave one out and then ask the patient if there’s something they’d like to incorporate. Sometimes they ask for the intervention I leave out, sometimes they go along with my plan. It empowers them to make decisions within their care or be able to voice if they’d rather change the direction.

 

Attention needs to be given not only in what is said but how it is said. Emphasis on keywords can be very impactful on a person. If you emphasize “abnormal,” the individual may fixate on that. Or, the tone in how a sentence is given can be interpreted differently between individuals. Also be mindful of body language because there’s a lot to be said with how your body is positioned, what your hands are doing, down to even the wrinkle between your eyebrows. 

 

Ensure the patient knows what and why tests/interventions are performed. I will never forget the one time I was being mentored and taking a patient through an exercise. My mentor asked my patient, “do you know why you’re doing that exercise?” The patient responded, “because Pauline told me to.” My eyes got so big and I felt so embarrassed. This was a big learning moment for me because I know why I gave the patient that exercise, but it’s equally important the patient does too. If the patient knows how that exercise is going to help him/her, the more likely he/she will do it as part of their home exercise program.

 

This chapter provides other insightful and researched evidence for the art of communication. This write up is to share my perspective and experiences on what I found to be key points. Please refer to the reading for more details.