PROFILE OF LEARNING OPPORTUNITIES ACUTE STROKE UNIT

Transcription

1 PROFILE OF LEARNING OPPORTUNITIES ACUTE STROKE UNIT Rehabilitation Department Completion Date December 2005 Review Date December 2007

2 CONTENTS 1. Learning Zones 2. Area Profile - Location - Work Patterns - Staffing 3. Placement information 4. Learning Objectives - Core Skills - Clinical Skills - Management / Organisational Skills - Observational Opportunities 5. Recommended Reading 2

3 LEARNING ZONES LEARNING OPPORTUNITIES Senior stroke Physiotherapy Medical Team in Ward 14 Ward 14 nursing staff Stroke consultants MDT meetings Cognitive and perceptual assessment - OT Video fluoroscopy Acute Stroke Unit Stroke specialist nurse Home visits with OTs Speech and language therapists Community Stroke Team Stroke Discharge Team Viewing CT scans Involvement with families/carers Moving & Handling Team 3

4 AREA PROFILE Welcome to the Acute Stroke Unit. We are a unit caring for patients following acute stroke events, from all of the Newcastle area as well as occasional patients from the surrounding areas that present to any of the three central Newcastle hospitals (NGH, RVI, Freeman) The Acute Stroke Unit is made up of an MDT team based on ward 14 at the Freeman Hospital. All patients admitted with a diagnosis of stroke are admitted to the unit. This includes TIA s through to TACS, which means that there is a huge range of abilities dealt with. There is a thrombolysis service available for those patients that present and can be CT scanned within three hours of onset of symptoms. The role of the team is to stabilise the patient medically, intensively observe the patient, provide respiratory care as required, carry out initial physiotherapy / occupational therapy / speech and language therapy assessments. An early (within 7 days) decision is made within the team as to the most appropriate input for the patient; Discharge home with or without community follow up or support, fast stream rehabilitation, slow stream rehabilitation, continuing care or palliative care. After this decision has been made, if rehabilitation is required this process is started on the unit with all the therapists involved. LOCATION We are situated on Ward 14 at the Freeman Hospital. Clinical Area We have a small treatment room on the ward, with a desk, plinth, adjustable height table and basic equipment. Learning Resources There is a resource file for students kept in our room, as well as the resource file belonging to the Senior 1 physio. There is also access to the Freeman Hospital library. Telephone Number extn Address daniel.harvey@nuth.nhs.uk WORK PATTERNS The hours of work are Monday Friday. The work is ward based and therefore a flexible pattern of work is essential. 4

5 Due to the heavily dependent state of many patients following stroke it is necessary to work in pairs and sometimes even more. As the placement progresses students will be expected to lead a treatment session with a patient using a senior physiotherapist as an assistant. SOURCES OF REFERRALS All patients, following a stroke, are assessed by a physiotherapist, unless they are rapidly deteriorating and expected to die in the near future. STAFFING PHYSIOTHERAPISTS Senior 1 Senior 2 Assistant (TI) ½ time Care of the Elderly Team Leader as required covering absence. EDUCATORS Daniel Harvey Julia Moffat CONSULTANTS There are four dedicated stroke consultants who rotate onto the unit on a monthly basis: Professor Ford Dr Louw Dr Davis Dr Dyker 5

6 PLACEMENT INFORMATION On day one you will be orientated to the unit environment, then you will spend the majority of the day shadowing and assisting your clinical educator. Some degree of patient handling (not advanced facilitation), and moving and handling skills are expected (e.g. use of hoists). Toward the end of the day your clinical educator will go through the elements of an acute stroke assessment, and hopefully you will have had the opportunity to observe a new assessment during the day. On day two you will be expected to carry out a supervised assessment of a patient. Depending on previous experience and confidence, this may be an existing patient, or a new patient. You will then be expected to write up the assessment and produce a Problem, Impairment, Plan analysis (the format for this will be explained on the first day). On day three you will treat the previous day s patient under supervision, and assess another new patient. As far as it is possible with the nature of the patients we will try to build up an individual caseload for you, however there will still be a lot of work in pairs with other senior physiotherapists. You can expect to assess a new patient most days. As your confidence and skill improves you will be less closely supervised, but again due to the heavy nature of work in stroke there is often requirement to use your clinical educator as an assistant. By the third and fourth weeks of the placement you will be expected to take the lead and direct the session fully, with little or no reference to the educator for advice. There are twice weekly MDT meetings, where you will be expected to contribute in terms of discussing the patients that you are looking after. With a few exceptions teaching tends to be on an informal, discuss it as we find it, basis. There is an expectation that you will follow up these sessions with some reading of your own. Topics that are likely to be covered are: Outcome measures in Stroke. Basic neuro-anatomy / neuro-physiology with respect to production and control of movement. Balance assessment. Gait assessment. Pathology and risk factors relating to stroke. Pusher syndrome. The main differences in expectation for 2 nd and 3 rd year students relate to ability to handle and prioritise a caseload, and the amount of supervision required in the early phases of your placement. A basic timetable will be provided on the first day of your placement, however due to the flexible nature of ward work this will only cover things such as objective setting, midway and final assessments, and time to spend with OT and SALT. (More detailed information will be provided on your first day) 6

7 CORE SKILLS LEARNING OPPORTUNITIES Communication verbal and non-verbal with members of the team. To work as part of a team working together with other members. To develop effective organisational and managing own caseload. To develop skills of empathy, sensitivity, assertiveness with patient and carers. Time management skills having responsibility for assessment and treatment. To be involved with the day to day management of a department contributing to tidiness. To put into practice knowledge of anatomy, physiology and pathology. RESOURCE / PERSONNEL Physiotherapists, OTs, SALTs, Consultants, Medical Team, Nurses, Support workers, Dieticians, Admin staff. -As above- Educator, Physiotherapists and Assistants Physiotherapists, OTs, Nurses other students Educator, other Physiotherapists Physiotherapists Knowledge of pathology will be continuously assessed through informal supervision. Experiences with clients from a variety of ethnic background with varied ages. Use of internet, and computer for getting access to information. Medical Terminology. Common Pathologies. Interpreting services Physiotherapist Administration staff Medical dictionary/ Inservice training. Library at the Trust. Background reading. 7

8 CLINICAL SKILLS LEARNING OBJECTIVES Assessment of patients following Stroke. Development of Problem, impairment, plan analyses. RESOURCE/PERSONNEL Physiotherapists, Supervised assessments. Observation of other physiotherapists. Clinical Reasoning formal / informal sessions. Treatment of patients Following Stroke. Re-evaluation and treatment modification Facilitation of normal movement. Planning safe discharge for patients following stroke. To enhance / apply skills of manual handling. Physiotherapists, Consultants, OT s, SALTs, Nurses Physiotherapists Practical sessions with physiotherapist Observation of physiotherapists treatment sessions. Physiotherapists, OTs, Nurses, SALTs, Consultants, Medical Team, Community Stroke Team, and Stroke Discharge Team This will be done through supervision and practical sessions and working with Senior Physios. Evidence Based Practice Apply knowledge of pharmacology to patients. In consultation with the MDT decide on most appropriate destination for patient. Dealing with patients with severe communication difficulties. Relate knowledge of neuro-anatomy, neuro-physiology and pathology to clinical presentation. Through evidence used with patients and case studies completed. Resource file, internet, library Pharmacists, Physiotherapists, BNF Internet / Intranet MDT, Physiotherapists Physiotherapists, SALTs Physiotherapists, Consultants, OTs, SALTs, Radiologists, Stroke Specialist Nurse. 8

9 MANAGEMENT / ORGANISATIONAL SKILLS LEARNING OPPORTUNITIES Prioritising caseload / time management Management of own clinical caseload including assessment / treatment. RESOURCES/PERSONNEL Physiotherapists/ Clinical Educator Physiotherapists/Clinical Educator Effective management within the team which means asking for assistance appropriately. Accessing patient notes investigations / interpretation of these with regards to future management e.g. CT/MRI scans. To be responsible for day to day departmental tidyness. To take responsibility for own training needs and identifying areas of weakness. To manage time effectively and use free time appropriately. Physiotherapists, Assistants, Nursing staff Physiotherapists, Doctors, Stroke Specialist Nurse. Physiotherapists Library, Resource file, Physiotherapists/ Clinical Educator Physiotherapists, Library, Resource file

10 OBSERVATIONAL OPPORTUNITIES LEARNING OPPORTUNITIES Physiotherapy Assessments RESOURCES/PERSONNEL Physiotherapists doing assessment / treatment with the student. Observe functional assessments, cognitive and perceptual assessments, home assessment visits Occupational Therapists Observe swallow assessments and video fluoroscopy. Speech and Language Therapists Clinical trials - discuss ongoing clinical trials on the unit and advances in medical management. Nursing care care of the patient following acute stroke. Medical management acute medical care for the patient following admission. Stroke Research Nurses, Stroke Specialist Nurse. Nursing Staff Consultant, medical team U:\Web stuff\physio\physio old website\nht\rvi\polo NHT PT RVI Stroke Unit.doc

11 RECOMMENDED READING MATERAL BOOKS Motor Control: Theory and Practice Shumway-Cook and Woollacott, 3 rd Ed. ARTICLES Development of a consensus and evidence-based standardised clinical assessment and record form for neurological inpatients: The Neuro Dataset. Crow J.L and Harmeling B.C, Physiotherapy (2002), 88(1); Classification and natural history of clinically identifiable subtypes of cerebral infarction. Bamford J et al, The Lancet (1991), 337; Understanding and treating the Pusher Syndrome. Karnath H & Broetz D, Physical Therapy (2003), 83(12); U:\Web stuff\physio\physio old website\nht\rvi\polo NHT PT RVI Stroke Unit.doc