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Transcript of Women’s Health Physiotherapy Student Placement Wansbeck ... · Physiotherapy Student Placement...
Women’s Health
Physiotherapy Student Placement
Wansbeck General Hospital
PRE – PLACEMENT PACK
Northumbria Healthcare NHS Trust- general information
Location map.
Hospital map.
Women’s Health Placement details. Pro forma and additional information
INDUCTION PLAN
Learning objectives and weekly plan.
Women’s Health Physiotherapy role.
Weekly diary.
Experience record.
Recommended reading.
Portfolio of learning opportunities.
Clinical Placement Information
Placement/speciality: Wansbeck General Hospital -Women’s Health
Clinical educator/s: Christine Taberham/ Hillary Lynch/ Jayne Thompson
Contact address: Physiotherapy Dept, Wansbeck General Hospital,
Woodhorhorn Rd Ashington, Northumberland, NE63 9JJ
Telephone: Direct line : 01670 564010, 01670 521212: Ext 6010
Email: [email protected]
First day: Report to: Chris Taberham
Where: Physiotherapy staff- room, WGH
When: 9.00 am
Working hours: Between 8.30 & 4.30 to be negotiated with clinical educator.
Access: Bus: From Ashington centre X31/X33 Road:A197/A189:
See map.
On site parking: Free: (Contact Gloria the Physiotherapy secretary for permits) On
the first day put a note on your windscreen to say you are a student
and can be contacted via the Physio department.
Uniform requirements: Regular uniform.
Lockers available: Please supply your own padlock.
Canteen facilities: Yes
Common conditions to be treated: Gynaecological surgery/ postnatal exercise/ pregnancy back
pain/pelvic dysfunction / incontinence/ antenatal education.
Suggested pre reading:
CSP, Clinical guidelines for the Physiotherapy management of females with stress urinary
incontinence. CSP 2001
Chiarelli P, Women’s Waterworks: curing incontinence, Gore & Osment 1998
Haslett S & Jennings M, Hysterectomy and Vaginal Repair. 4th Ed, Beaconsfield 1997. 8
Polden M, Mantle J, Physiotherapy in Obstetrics and Gynaecology. Butterworth Heinemann
1990.
ACPWH Rotational Physiotherapist Handbook of Women’s Health. ACPWH 1997
Sapsford R, Bullock- Saxton J, Marxwell S. Women’s Health for Physiotherapists. WB
Saunders 1998.
Students can expect to treat patients on: day 2/ 3
Average number of patients student will be expected to treat each day 4-6
PHYSIOTHERAPY DEPARTMENT
WANSBECK GENERAL HOSPITAL
WOODHORN ROAD
ASHINGTON
NORTHUMBERLAND
NE63 9JJ
01670 564010 FAX: 01670 564012
Student Physiotherapy Placement. Women’s Health.
Staff Christine Taberham Senior 1 Physio 27 hrs M, W, Th.Fri
Hilary Lynch Senior 1 Physio 21.5 hrs M, W, F.
Jayne Thompson Senior 1 Physio 18 hrs T, W, F.
Gillian Bolton Physio Assistant 12 hours
Sites Physiotherapy out patients 6010
Women’s health room 6811
Ward 16 (Gynaecology) 6839
Ward 11 (Maternity) 6868
Gynaecology clinic (Chris Young) 6142
Ante-natal Clinic / Health centres
Service Provision
Specialist Women’s Health physiotherapists provide health promotion, advice and treatment for
women at all stages of their life
Physiotherapy input to Maternity and Gynaecology wards and the antenatal clinic.
Pregnancy back pain service which provides an open access back class every 2 weeks and
fast access direct referral for back pain or pelvic dysfunction.
Continence clinics offering assessment, pelvic floor muscle reeducation and behavioural
techniques supported by electrotherapy and biofeedback.
Antenatal education classes at 9 Health Centres including 3 evening sessions for couples.
TENS for labour loan service for mothers booked at Ashington.
Resource for other Health Professionals to advise on post natal and post operative exercises
and continence.
Preparation for Women’s Health Placement.
Please prepare by reading the enclosed advice leaflets and assessment sheets. They provide a core
of essential information, which you will be encouraged to apply during your clinical experience.
Prepare to be a mum advice during pregnancy.
Back care pregnancy and children.
Post natal exercises following vaginal and Caesarean Section.
Gynaecology post operative exercises and advice.
Pelvic floor exercises.
Gynaecology pre/ post op assessment sheet.
Incontinence assessment sheet.
Lumbar Spine Assessment Sheet.
Essential text book.
Either/ or: (See Reading list)
Polden and Mantle Physiotherapy in Obstetrics and Gynaecology 1990
Sapsford, Bullock-Saxton and Markwell, Women’s Health. A textbook for Physiotherapists.1998
Student Induction Plan:Womens’ Health Placement.
Learning Objectives:
1 To develop an understanding of Women’s health Physiotherapy.
2 To experience work as part of a Multi disciplinary team.
3 To develop and apply knowledge and skills related to assessment and treatment of patients
undergoing Gynaecological Surgery, ante and postnatal back and pelvic pain, and incontinence.
4 To gain experience in delivering health education sessions working with ante natal,
pregnancy back pain and Gynaecological surgery patient groups.
Learning plan Week 1 Day 1 Orientation to the department and wards and to the Women’s health Physiotherapists role.
Housekeeping, personnel, policies, procedures, protocols, health and safety, library and
learning resources, documentation.
Observe clinical educator - introduction to wards, out patient clinic, antenatal classes.
Discuss learning outcomes, areas of interest/ concern. Preferred learning style.
Overview of the proposed learning experience.
Discuss previous experience, identify gaps in knowledge.
Day 2-5 Progress from observation to assessment and treatment of 2 or 3 patients.
Set additional learning outcomes for the placement.
Timetable dates for half way and end of placement report; case presentation or review; tutor
visit.
Observe patient assessments, treatment and participation in antenatal classes.
Introduction to MDT- nursing staff, midwives, health visitor, doctors.
Introduction to care pathways and clinical guidelines.
Guided subjective patient assessments.
Guided pre operative assessment, post -operative and post- natal treatments and advice.
Daily feedback to review performance and progress.
Weekly independent study time.
Week 2 Progress to responsibility for a small in- patient case load.
Day1-5 Complete documentation for ward daily caseload with supervision.
Progress to independent subjective assessment and guided objective assessment of in -
patients.
Deliver and adapt treatment programmes to in – patients following discussion with educator.
Observe home advice sessions and antenatal classes and pregnancy back classes and prepare
to deliver a selected area of these classes in weeks 3, 4 and 5.
Visit labour ward to observe and develop understanding of the care of a mother in labour and
the process of birth.
Tutorial to review knowledge of spinal assessment and pelvic girdle dysfunction.
Independent study time. Select a subject for presentation in final week.
Attend in service training and team meetings.
Week 3 Progress to an out patient case- load and classes.
Day1-5 Subjective and objective assessments of out patients under close supervision.
Development of goals and treatment programmes: explain exercises.
Deliver pre-selected sections of classes: back care, exercises for pregnancy, relaxation,
Gynaecological surgery discharge advice.
Visit to theatre to observe surgery and to gain insight into the development of appropriate
post -operative advice.
Visit to cystometry clinic to develop understanding of bladder function and diagnostic tests.
Half way formative assessment and feedback. Opportunity for self reflection.
Week 4 Increase responsibility for in patient case load to develop organisation skills
Development of assessments, goal setting and treatment programmes.
Comply with documentation standards and complete assessment forms appropriately.
Discuss treatment options and devise progression of treatments.
Demonstrate ability to adapt treatment to individual circumstances.
Week 5 Review additional learning objectives and organise additional experience.
Present case study/ review.
Final assessment and grade for placement.
Student assessment of placement.
Progression and the degree of supervision will be adjusted according to the year group, ability of
the individual student and prior clinical experience.
THE ROLE OF THE SPECALIST WOMENS HEALTH
PHYSIOTHERAPIST
Women’s Health Physiotherapy aims to provide assessment, treatment and advice including
general health promotion for women of all ages.
Service provision to 3 main areas:
In- patient physiotherapy for Maternity and Gynae wards.
Outpatient service for women’s health referrals.
Community based antenatal and postnatal advice classes.
Staff 2 full time posts shared by 4 staff.
Chris Taberham: Clinical Specialist.
Jayne Thompson: Senior 1.
Hilary Lynch: Senior 1.
Gillian Bolton: Physiotherapy Assistant.
The physiotherapist attends the wards every morning on weekdays or can be contacted in the
physiotherapy department on ext 6010/6811or bleeped via the operator. Bleep the on- call
Physiotherapist at weekends.
Gynaecology Wards
Pre-operative assessment, health screening and advice.
Aim to minimise postoperative complications, facilitate independent function and early
mobilisation.
Breathing and circulation exercises.
Positioning and how to transfer in ways that reduce strain on the wound and minimise pain.
Initiate graded exercises to prevent de-conditioning of important stabilising muscle groups
(abdominal and pelvic floor), and restore normal mobility and function.
Post- operative. Usually seen on the 2nd
post-op day.
Exercises facilitated and mobility encouraged.
Respiratory problems, circulatory or mobility problems can be seen on the first day if they are
referred, preferably before 11.00am.
Home advice prior to discharge. This is usually given in a group to provide a forum for
discussion and support. Topics include when and how to progress exercises and functional
activities, general back care and ergonomics.
Post op advice is based on tissue healing time, the development of tensile strength and time to
recondition muscles as well as on the general condition of the individual. The guidelines are 6
weeks to 12 weeks depending on the type of surgery and the degree of activity.
Other input
Bladder training and TENS neuromodulation.
Soft tissue injury (haematoma) can be referred for electrotherapy and advice.
Maternity Wards
Post-natal assessment, advice and exercises
Aim to facilitate recovery and promote health and fitness following pregnancy and childbirth.
The emphasis is on specific abdominal and pelvic floor exercises and advice on posture and
ergonomics to reduce musculoskeletal strain during activities of daily living.
Aim to see all new deliveries but priority is given to Caesarian and assisted deliveries and to
those with identified musculoskeletal problems such as back or pelvic girdle pain, diastasis rectus
abdominus, incontinence or more severe soft tissue trauma and pain. Pulsed short-wave
diathermy, ultrasound and laser treatment are available.
Outpatient review and contact numbers are provided when necessary.
Antenatal referrals
Assessment and management of musculoskeletal problems.
Outpatient services. Wansbeck Physiotherapy outpatients provide access to physiotherapists
specialising in women’s health.
Referrals from consultants, GPs, and health professionals for pregnant women and up to 12
weeks postnatal, with musculoskeletal, continence problems, mild prolapse or chronic post
operative pain.
Back and pelvic girdle dysfunction..
The aim is to reduce chronic pain and disability with appropriate early advice and reassurance.
(CSAG guidelines for the management of low back pain. CSP SPD guidelines.)
Pregnancy back pain advice classes.
First and third Wednesday every month. 1.00-2.30. WGH
Provide information on the physical stresses of pregnancy and how to minimise strain on the
spine and pelvis with instruction in safe back care and pain management.
This is an open access class to encourage early attendance within the first 6 weeks of onset.
Physiotherapy for acute cases should be identified as urgent on a referral card and will be
assessed and treated individually. A phone number should always be supplied.
TENS for labour –loan service. Phone 564010 or booked at the antenatal class.
14 units available for mothers booked at Ashington.
4 week loan from 2 weeks prior to EDD.
Antenatal classes. In collaboration with Midwives and Health Visitors we run 9 health centre
based classes (5-day time and 3 evening.)
Physiotherapists assist mothers to cope with the physical stresses of pregnancy, labour and
motherhood. They specialise in teaching drug free methods of coping with childbirth such as
relaxation, breathing awareness, positioning, movement, massage and TENS.
Continence Service.
Assessment, treatment and advice for stress and urge urinary incontinence.
Colorectal problems (incontinence or obstruction.)
Treatment is selected according to the presenting symptoms and assessment of the muscles on
vaginal examination.
Pelvic floor re-education (awareness, activation, isolation, co-ordination, strength and endurance
exercises)
Bladder training to re-educate healthy voids patterns and appropriates fluid intake.
Supplementary treatment options:
Electrical stimulation ( Hospital PRS or home-use units NTS or TENS)
Biofeedback.
Vaginal cones.
78% of patients show some improvement in symptoms with physiotherapy but longstanding and
severe problems are less responsive to conservative treatment so early referral is encouraged.
STUDENT DIARY WEEK BEGINNING ……………………………………
AM
PM
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Womens’ Health Student Placement – Experience Record
To aid communication between supervisors it is important to record your daily observation and practice. It is expected that you will observe procedures once or twice Depending on your previous experience and then apply them yourself.
Experience Record the date and the Supervisor’s initials
Observed by student
Satisfactory application by student
Comments from Supervisor
Gynae pre-op 1 2
Gynae post-op 1 2
Gynae home advice 1 2
Post natal advice normal/assisted delivery
1 2
Post natal – C section 1 2
TENS 1 2
PSWD 1 2
Continence assessment Subjective
1 2
Continence assessment Objective
1 2
Continence treatment 1 2
Back/pelvic girdle Assessment
1 2
Back/pelvic girdle Treatment
1 2
Other
Observation (Selected areas of classes may be applied by the student)
ANC
Back class
Gynae pre-op clinic
Cystometry
Delivery
Theatre
Record any additional experience below:
Womens’ Health - Recommended Reading.
Essential reading.
CSP, Clinical guidelines for the Physiotherapy management of females with stress urinary
incontinence. CSP 2001 *
Chiarelli P, Women’s Waterworks: curing incontinence, Gore & Osment 1998 *
Haslett S & Jennings M, Hysterectomy and Vaginal Repair. 4th Ed, Beaconsfield 1997. 8
Polden M, Mantle J, Physiotherapy in Obstetrics and Gynaecology. Butterworth Heinemann
1990. *
ACPWH Rotational Physiotherapist Handbook of Women’s Health. ACPWH 1997 *
Sapsford R, Bullock- Saxton J, Marxwell S. Women’s Health for Physiotherapists. WB Saunders
1998. *
Further reading.
Bailliers (Ed) Bailliers Clinical Obstetrics & Gynaecology. 14, 2, Harcourt 1999. *
Brayshaw E, Wright P. Teaching Physical skills for the childbearing year. Books for Midwives
Press 1994.
Charielli P, Markwell S, Let’s get things moving: overcoming Constipation. Gore & Osmett 1992
*
Lee D, The Pelvic Girdle: An approach to the examination and treatment of the Lumbo-pelvic-
hip region. Churchill Livingstone 1999.
McKenna J ed. Obstetrics & Gynaecology, Churchill Livingstone 1998.
Mitchell L. Simple Relaxation. John Murray 1987 *.
Millard R. Overcoming incontinence: a practical guide to better bladder control. Thorsons 1993
*.
Noble E, Essential Exercises for the Childbearing Year. John Murray 1995 *.
Polden M ,Whitford B, The Postnatal Exercise Book, 3rd Ed Frances Lincoln 1992.
Priest J, Schott J, Leading Antenatal Classes; a practical guide. Butterworth Heinemann 1991.
Richardson C, Jull G, Hodges P, Hides J, therapeutic exercises for Spinal Segmental Stabilisation
in Low Back Pain. Churchill Livingstone 1999.
Schussler b, Laycock J, Norton P, Stanton S Eds. Pelvic Floor Re- Education. Principles and
Practice. Spriger- Verlag 1994.
Articles, Protocols and Standards *
Key articles related to the above subjects are available in files located in the Women’s Health
office.
* Indicates these are available for loan but must be returned.
Portfolio of Learning Opportunities.
Placement : Women’s Health Base : Wansbeck General Hospital Ashington Northumberland Clinical Educators : Chris Taberham Hilary Lynch Jayne Thompson POLO Learning Zone Middle: Zone 1 : (physiotherapy) Wards - Gynaecology surgery - Maternity care Out patients – Continence and musculoskeletal
- WGH - BCH - MCH
Back advice in pregnancy education Tens loan for labour Community Antenatal education classes 8 sites Health education and promotion
Zone 2 : ( MDT awareness) Antenatal clinic Gynaecology clinic Midwifery care, community, Pregnancy assessment unit, postnatal ward Labour ward Gynaecology surgery Obstetric surgery Gynaecology nurse specialist
Zone 3 : (Support services) Health Visitor Psychologist Urodynamics Colposcopy Ultrasound scanning Nurse continence advisors Paediatric Physiotherapist Physiotherapy assistant CSSD Aquanatal Zone 4 : (Equipment)
Product suppliers Electronics department JELS Zone 5 : (other) Patients Audit Specialist interest group/society Library resources
KEY ELEMENT
Specialist Knowledge.
LEARNING OPPORTUNITIES
RESOUCE/RELEVANT
PERSONNEL/DEPARTMENT
Physiotherapy- role within the
MDT and approaches to assessment
and rehabilitation in Obstetrics,
Gynaecology and continence.
Surgical
Role of the surgeon and the
gynaecology nurse.
Role of the Obstetric surgeon
Maternity
Role of the midwife in the
community, antenatal clinic,
pregnancy assessment unit, delivery
ward and postnatal ward.
Health Visitor role within the MDT.
Paediatric Physiotherapist Role within MDT and role in the
assessment and treatment of
orthopaedic and neurodevelopment
paediatric problems in Neo-natal
special care
Continence nurse specialists
Role within the MDT
Urogynaecologist / Urologist
Role in the assessment and referral
of continence patients
Urodynamics
Investigation of bladder problems
Clinical Educators and other members of
the team as appropriate.
.
Clinical educator
Chris Young Specialist nurse
practitioner surgery pre assessment
Theatre Sister
Gynaecology Consultants
Richard Sill
Tony Sproston
Tony Lavin
Paul Franks
Sheonagh McKenzie
Community midwives
Clinic midwives
Labour ward midwives
Community health visitors attached to
GP practice
Paediatric Physiotherapists
Emma Burn
Gill Oliver
Special Care Baby Unit
Mary Oswald Continence nurse advisor
Lynn Freeman “ “ “
Nurse led continence clinics
Mr Sill/ Mr Feggetter
Out patient clinics
Cystometry clinic
Other clinics
Gynaecology clinic
Antenatal clinic
Ultrasound scanning
Amniocentesis
Colposcopy
Well women
Aqua-natal class
Wider appreciation of obstetric and
gynaecology practices and
procedures and understanding of the
duties and roles of other MDT
professionals.
Psychologist
Role within MDT
Orthotist assessment and provision
of orthotics
Appropriate senior staff/clinic
Henrietta Batchelor
KEY ELEMENT
Clinical Skills
LEARNING OPPORTUNITIES
RESOUCE/RELEVANT
PERSONNEL/DEPARTMENT
Women’s Health musculoskeletal
outpatients
Continence management
Gynaecology surgery pre and post op
Antenatal and postnatal care
Antenatal education classes
Pregnancy back and pelvic
dysfunction
TENS for labour
Clinical educators. Clinics at WGH,
MCH, BCH
Clinical educators. Clinics at WGH,
MCH, BCH
Clinical educators
Gynaecology clinic/ Chris Young nurse
specialist.
Ward 16-Gynae.
Clinical educators/ PAU, ward 11
Clinical educators- 8 community based
classes
Clinical educators
Clinical educators / assistants
KEY ELEMENT
Organisational and Managerial issues
LEARNING OPPORTUNITIES
RESOUCE/RELEVANT
PERSONNEL/DEPARTMENT
Managing a caseload
Organisational skills
Delegation skills
Prioritisation skills
Time management
Standards of care
Giving information to
Physiotherapy staff
Patients
Relatives/carers
Doctors
MDT members
Clerical staff
Resources
Administration of special equipment
Re-stocking information leaflets.
Managing risk
Policies and procedures
Equipment safety checks
Daily environmental checks
Infection control
Moving and Handling
Emergency situations
Cardiac arrest
Fire
Room alerts
Staff Development Reflective Practice
In service training
Clinical Educators
Clinical Educators
Clinical Educators/ protocols
Clinical Educators
Clinical Educators/Standards file
Clinical Educators / written information
Clinical Educators
Clinical Educators
Clinical Educators
Clinical Educators
Clinical Educators/ assistant / TI's
Policies and Procedures file
Clinical Educators/equipment reps
Clinical educators
Infection control policy/ nurse
Clinical Educators/Moving and handling
file
Clinical Educators /refer to relevant
procedure documents
Clinical educator
KEY ELEMENT
Interpersonal skills
LEARNING OPPORTUNITIES
RESOUCE/RELEVANT
PERSONNEL/DEPARTMENT
Use of telephone
Answering calls
Making calls
Taking messages
Talking to:
Physiotherapists
Patients
Relatives/ partners
Doctors
Other members of MDT
Groups
Writing reports
Clinical Educators
Assistant
Clerical staff
Clinical educators / assistant /MDT
members
Clinical Educators/standard report
formats