Evaluation Of Cpd Evidence

Evidence 1. Evaluation of MSK placement

In between July-August 2017 I attended a 6-week placement in a private MSK clinic which was my first period of adaptation experience in order to obtain the HCPC registration. Due to the nature of a private outpatient clinic, the majority of injuries I was treating were: whiplash, ankle sprains, shoulder impingement syndrome or tennis elbow. My caseload was gradually getting bigger the more experience I had.

From the second week of practice I started to perform initial assessments independently with patients, suggesting the personalised, person-centred SMART goals and treatment plans. With increasing confidence I was planning individualised treatment programmes for patients based on the current evidence and clinical reasoning skills.

I have learnt how to work effectively, efficiently and independently with my patients with varied MSK injuries or conditions. Every 1st treatment including assessment was taking 45 mins while a regular treatment was taking 30mins. I found it challenging to complete a single treatment and make the record of it within such a short time frame but this was improving every day.

I have read a lot of research papers related to various shoulder injuries and whiplash, which enabled me to be more aware of various injury representation and symptoms. I had a review of the current evidence and national guidelines for management and treatment of MSK conditions. This helped me to support my decision with best evidence.

I have learnt how to write SOAP notes and identify a problem list as well as set appropriate SMART goals. Based on my anatomical and physiological knowledge, I was able to analyse my findings and information collected. I was always engaging with my patients into the treatment and discussing the treatment plan and goals individually for each patient.

I have also learnt how important it is to review the effectiveness of treatment and explain to the patients every step of the therapy plan which helps to build a trusted relationship between the therapist and the patient and achieve therapy goals.

Key learning points:

1/ Undertake the appropriate MSK assessment and plan person-centred goals.

2/ How to treat various MSK injuries

3/ How to manage well with time restrictions and provide an effective treatment

Evidence 2. Undertaking physiotherapy in neurology placement in London Hospital.

In between May-July 2018 I completed a 6-week placement on the stroke ward in London Hospital as another part of my HCPC adaptation process in order to obtain professional registration. I spent that time with a Band 6 physiotherapist who was supervising my practice.

I gained professional experience in:

Undertaking comprehensive neurological assessments

Complex therapy provision for patients following cerebrovascular accident with cognitive, physical, emotional or communication difficulties

Cooperating with other disciplines, e.g. Occupational Therapists, Nursing Staff and Social Workers

Complex discharge planning

Participating in multidisciplinary and family meetings

I had a chance to see and treat various patients after cerebrovascular accident who required different, individual and person-centred therapy plans. Due to the scope of stroke complications, I treated a number of patients with cognitive and emotional difficulties. I developed my communications skills and learnt how important it is to be a precise physiotherapist and pay attention to details. I found this placement beneficial because treating such complex patients improved my self-confidence and broadened my professional and transferable skills such as good time management and team work.

Key learning points:

1/ Undertaking neurological assessment

1/ Methods of gait re-education

2/ Improved verbal and non-verbal communications skills

3/ How different disciplines work and how we can all work together towards patient’s goals

4/ The discharge pathway options available which enabled me to think more holistically

Evidence 3. Evaluation of cardio-respiratory placement

In September 2018 I started my last, cardio-respiratory, period of adaptation. I spent 8 weeks on the medical and surgical wards as well as on ITU. I came across various abdomen surgeries, respiratory conditions and ITU environment with patients after road traffic accidents, with acute health deterioration and complex post-surgery complications. I found time spent on ITU most challenging as those patients were at highest risk of deterioration. It took me some time to feel more confident and believe in my skills and appropriatness about decisions I was making. I have also improved my manual handling skills and learnt how to plan the whole treatment in advance to make sure pain medications are given before therapy, all the equipment is in place and all lines or attachments are safe. My experience from ITU taught me also about the importance of team work and communication between therapists and nursing staff to make sure patient’s safety is a priority. On medical and surgical wards I had lots of involvement in discharge planning which broadened my knowledge about various community support available. I was also attending multidisciplinary meetings and daily board rounds which I found improved my communication skills and confidence when discussing complex patient’s needs within the MDT.

Key learning points:

1/ Increased confidence when treating complex patients on ITU and post surgeries.

2/ Improved knowledge about the role and side effects of various medications.

3/ The importance of interdisciplinary communication and collaboration.

4/ Improved manual handling techincs.

5/ Discharge pathway options available.

Evidence 4. Evaluation of the BiPAP, CPAP, High Flow Nasal Oxygen study Day

In November 2018 I participated on a study day on non-invasive ventilation (NIV) treatments available for patients in my Trust. As I am currently working on a respiratory ward, getting more information and experience with different types of NIV methods was crucial to enable me to practice safely and gain an in-depth understanding of various respiratory conditions and their treatment pathway. I can now recognize symptoms of respiratory deterioration a lot more easily, understand blood gases results and am able to go through the weaning process with confidence. It also benefits my patients as I can provide them with effective and safe physiotherapy treatment while their oxygen requirements remain high.

Key learning points:

1/ Indications and contraindications to oxygen therapy

2/ How to set CPAP/BiPAP/Hi Flow Nasal Oxygen

3/ How to recognize improvement and deterioration signs

Evidence 5. Shadowing COPD nurses in the community

On 25th September 2018 I shadowed the COPD nurses in the community to get more insight of how patients manage with this chronic condition at home. I met four patients, each of them at different stage of the COPD and different approach to self-management at home. There was one particular patient that I remember most, Mrs A, as she was declined to have long term home oxygen due to smoking insi de the property. Usually on the ward oxygen therapy is commonly used in the hospital setting for patients with COPD due to type 2 respiratory failure. Mrs A had already been to the hospital few times due to exacerbation of COPD and was given oxygen whilst inpatient. From a professional point of view quiting smoking would be an obvious decision for me to make. For the first time I personally came across patient’s conscious decision to continue smoking although this was worsening her breathlessness and taking away possibility of oxygen therapy at home. I found it challenging not to be able to provide her as much support as there was available although I had to accept the patient’s decision.

Key learning points:

1/ Accept and agree with patient’s conscious decision to decline available support.

2/ Think holistically about patients and their difficulties they face in everyday life that I cannot observe while working on the ward.

Evidence 6. Evaluation of respiratory on-call training for junior physiotherapists

In between October- December 2018 I attended numerous respiratory on-call trainings to build up my competencies before undertaking independent on-call shifts. Through those intense sessions I have learnt about various methods of secretion clearance and devices I can use to help patient’s breathlessness. I have gone through various on-call scenarios which helped me think more objectively when undertaking my first autonomous on-call. I had a senior support through the first couple of on-call shifts which helped me to assess the appropriatness of each call as sometimes I need to decide not to come if the treatment will not be in patient’s best interest. I also found the training sessions helpful when I started respiratory rotation as since then I have been working with patients with chronic and acute respiratory conditions on daily basis. I felt confident when approaching complex patients on my own which I had found challenging before the on-call training.

Key learning points:

1/ Increased knowledge and awareness when treating complex patients with respiratory problems.

2/ Improved sterile suction technique.

3/ Critical evaluation of the respiratory physiotherapy treatment appropriatness.

Evidence 7. MSc course transcript and evaluation of research proposal

I have been planning to work in rehabilitation setting since graduation. I began my MSc in Rehabilitation eighteen months ago and, so far, I successfully completed all compulsory modules. The reflective practice module I found particularly helpful in my current practice as it improved my self-development skills by learning and reflecting on past experience. Having learned about reflective practice, I could recapture and reevaluate my experiences to learn from them and develop my professionalism further. Moreover, as reccomended by Howatson-Jones (2016), I peformed personal reflection after every experience with the patient to have abetter understanding of my interaction with the patient and its implication for the next interaction with another patient. With regards to reflective writing, an evaluation of critical events at work improved not only my knowledge but self-confidence amongst the multidisciplinary team and the quality of practice I deliver to my patients. For instance, using the Gibbs reflectve model, I wrote a 3,000 word essay reflecting on the multidisciplinary conflict at work, which enabled me to understand both sides of the argument in greater depth and learn about different methods of problem solving. I found it very helpful in everyday practice as I can now manage difficult situations and conversations a lot more easily. The critical thinking module allowed me to critically appraise evidence and become more objective when choosing the appropriate therapy plan for my patients.

I undertook a literature search and critique on the benefits of acquiring a pet dog into a family with children with autism. Accoridng to Bernard (2013) literature search entails a systematic identification of literary sources for various uses including a review of literature to support evidence-based practice. Henece, part of the literature review was to identify and evaluate evidence on the the benefits of keeping pet dogs in families of children with autism, and presented these evidnece on a poster with the research results to other MSc students as well as a 3,000 word report of teh study findings in which I scored high marks. This work improved my presenting and literature searching skills but also broadened my knowledge. I would like to work with children with learning difficulties in the future.

I decided to undertake a qualitative study for my Masters dissertation aiming to evaluate the role and perceptions of junior physiotherapists in a district general hospital. As a professional qualified overseas I experienced some difficulties at the beginning of my professional career due to differences in the curriculum and I am hoping this research will reveal some issues that could be improved to refine the service in the future practice. I have already gained neccessary ethical approvals and aim to conduct 1:1 semi-structured interviews soon.

Key learning points:

1/ Increased knowledge about current policies

2/ How to critically evaluate evidence in practice

3/ The importance of reflection in everyday practice

4/ How to write a research proposal and conduct a qualitative study

Evidence 8. Presentation and notes prepared for in-service training session on cancer

In February 2019, whilst working on the oncology ward, I gave a presentation about oncology to my team consisting of physiotherapists, OT’s and therapy assistants during in-service training. I found that for the therapy team there was not much training about cancer treatment although patients with diagnoses of cancer appear on most inpatient wards. I prepared all the information about progression of the condition, latest treatment methods updates and the role of therapy services in cancer treatment. The team found it very useful as due to various treatment side effects and stage of the disease the amount of rehabilitation team input can vary and it is crucial to understand the process of disease progression to deliver high-quality person-centred care. I found the preparation for in-service training broadened my knowledge about cancer and improved my literature searching skills. It directed my study to identify the correct information and sharing the results of my work to the team improved my self-confidence, communication and presenting skills.

Key learning points:

1/ Increased confidence when presenting in front of the group

2/ Improved knowledge about cancer treatment and physiotherapy support available

3/ Importance of good time management when presenting to the group

Evidence 9. Reflective account of critical event

While studying the Reflective Practice module for my MSc, I was familiarised with the Gibb’s Reflective Cycle model to help reflect on challenging situations and draw conclusions to improve future practice. A copy of a reflective account of a critical situation at work is attached separately. Reflecting on events has improved my practice and quality of care delivered to my patients as I believe I can learn from these situations and manage similar occasions better in the future. This benefits my patients and work colleagues as by sharing or reflecting on challenging experience I can learn how to handle difficult situations and manage conflicts more effectively.

Key reflective points:

1/ Never be scared of discussing patient’s case with medical team

2/ Do not wait with handing over to the doctor when first signs of deterioration are noted

3/ Improved confidence when discussing complex patients with family members

4/ Importance of discussing complex patients or difficult decisions with senior colleagues.

Evidence 10. Reviewing and making comments of respiratory guidebook for junior physiotherapists

In between February-April 2019 I was asked to review and comment on 3 chapters (respiratory medicine, surgical and oncology) of an educational respiratory physiotherapy book to improve and fit the writing style and content for the benefit of newly qualified physiotherapists. I found it a challenging experience but also a great opportunity to learn about about writing a guidebook for junior colleagues. This experience has improved my critical thinking and literature searching skills as it required me to evaluate evidence, value and form of the content for junior physiotherapists’ benefit. Due to the educational context of the book, I have learnt about various surgical procedures and oncology treatment options which broadened my knowledge and improved my practice by better understanding of medical conditions and indications and contraindications for physiotherapy.

Key learning points:

1/ How to write a professional guidebook for junior physiotherapists.

2/ How to critically evaluate the content of a guidebook for the reader’s benefit.

References

Howatson-Jones, L. (2016). Reflective practice in nursing. Los Angeles, Calif. : SAGE : Learning Matters.

Bernard, H. R. (2013). Social Research Methods: Qualitative And Quantitative Approaches. Los Angeles, Sage Publications.