One more week to go-time!

I’ve been prepping for classes and working on a draft of my semester research plan.  For Patient Care Skills I have a co-instructor and I have a teaching mentor – I’m excited about this one as it reminds me of having St. Kate’s first-year ICE students.  For Advanced Clinical Problems I’ll be a co-instructor with another faculty leading and another co-instructor from the PT community.  The students have recently finished their first clinical experience; again, it reminds me of St. Kate’s and also being able to take them from the beginnings of their clinical experience and building upon that with a bit of freedom with guidance to increase clinical reasoning.  While it will be a full semester, I’m looking forward to what lies ahead!

I still need to meet with my scholarly activity mentor, but I’ve written a draft of my plan so I can keep on top of it (while trying not to bite off too much!).  As I’ve written before I’m interested in adherence to exercise, and in hip fracture rehab. I’m trying to find out what I can glean from CMS in their data sets – it is pricey but if I can find the info needed it might help.  This article from January 2016 PTJ about more therapy after a hip fracture improves outcomes most of the time (my phrase) is interesting and hopefully I can find data to help find answers and drive more questions.  Did you know that hip fracture mobility recovery appears to follow a sequence?  For a HEP, you might want to consider giving them functional exercises.  Interested in blood flow restriction training (BFR)?  See how it works. California has looked at mortality after a hip fracture which I found interesting (at least the key findings).

Advertisements

Changes ahead

We moved from MN to CA in June, and I am transitioning into academia next month.  How it happened is for another post, but I gave up a really sweet position with St. Therese and St. Kate’s (a great company and setting, with a wonderful partner for clinical education as Clinical Faculty and Clinical Instructor) for an unexpected opportunity I could not pass up.  I will be teaching (Patient handling skills, Ther Ex, Geriatrics, and Advanced Clinical Problems – the pro bono clinic) and doing research at University of the Pacific in Stockton, CA.  I am honored and excited by the opportunity.

So what does that mean for the blog?  Well, it will still be primarily about older adults, but will also include a bit more about teaching and research.  I’ve been off the blog and most of SM as we transitioned from the Twin Cities to Stockton; I plan to pick it up after we get settled at home and I get in the groove of things at UofP and find clinic work on the side.  Stay tuned!

“Responding to the Reluctant Patient”

How do you respond to a patient that doesn’t want to participate in therapy?  This is a paper from the August 2016 PTJ, but I only read it just recently.  I had my current student read it, and would highly recommend anyone in the SNF/TCU or acute care (or even HH) read it.  It really opened my eyes to how better interact with the reluctant patient.

Delany C, Anderson L.  From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation.  Phys Ther (2016) 96 (8): 1234-1240.

If you are thinking of working in a SNF/TCU…

I’ve had some students recently ask me about searching for work in the TCU.  I love the TCU setting – the medical complexity, the rehabilitation for all different diagnoses (ortho, cardiopulm, neuro), getting people back home.  If you are looking at TCU’s, these are some of the things I’ve considered when looking for work:

  1. The Medicare rating – 4 and 5 stars is a good starting point; I’ve worked at a 3 and where I was at until July was a 1 for a while (upgraded to a 2 currently) and I would still willingly work there, so I wouldn’t automatically cross one off your list because of this. [edit 5/2: my Dad is now in a TCU in Tennessee – tough searching from a distance.  Consider looking at the ratings also for health inspections and for outcomes – the ones I looked at I’d rather have a higher outcomes rating than a health rating as it looked like the health ratings were issues with documentation, food temp, etc and tended to be isolated incidents vs percent of residents with pressure sores, not returning to prior functional level, etc).]
  2. In-house vs contract therapy:
    1. Productivity will probably differ; from my observation in-house productivity is relatively lower (see my blog post https://geriatricpt.wordpress.com/2016/01/28/thoughts-on-productivity/ ).   Find out what their productivity expectations are, and what they might have to help you achieve it.
    2. Employee satisfaction: I work at a place with low turn-over – we could get more pay elsewhere possibly, but at what cost?  What is employee satisfaction like? (ask current employees away from the interview time – if you know any prior grads at a TCU ask what they think of their company, or go to a PT Pub Night, or ask classmates what companies and locations they interned at and what they thought about the corporate culture).
  3. Will you be at one site, floating as needed between sites, or doing HH as needed?
  4. Get a sense of how important rehab is to the facility – if they put money into the rehab dept (as it is where a facility makes its money) it makes a real difference.  If the gym is in the basement with no windows and little equipment, it may be depressing to you and to the patients.
  5. What is the con-ed budget?  Companies may offer CEU’s through ACP (the modalities company) or Medbridge and have less of a discretionary con-ed budget.
  6. Mentoring – is there a PT you can turn to as a new grad if you have questions or need help?  Ideally an official mentor, but that doesn’t happen really in this setting (or rarely).
  7. Will you be all alone as a new grad?
  8. Will you be responsible for a PTA (or two???) as a new grad?
  9. What is the typical day like – treatment times, diagnoses generally seen, etc.
  10. How much is TCU vs LTC vs OP?  (I have been in a combined setting most of my career thus far).
  11. Holidays and weekend – how many do you have to work, or are you on call, etc?
  12. Dress code?
  13. Weekend pay differential if you are required to work weekends?
  14. Do they reimburse licensure? (pretty rare in TCU)
  15. What is the nursing: patient ratio (and the NAR: patient ratio)

Motivational Interviewing

I’m presenting a CEU with a colleague and the director of the residency program tomorrow on balance and falls.  Part of my portion is on adherence to fall risk recommendations – I can’t go in depth in this CEU as I have at other times (when the topic was specifically adherence), and it has been a while since I’ve really dug into the literature on adherence in general other than monitoring it via PubMed’s weekly update email.  One of the adherence models used is the Transtheoretical Model (stages of change), which uses Motivational Interviewing, or MI.  In refreshing my memory, I found two good videos on this that I’ll post here.  Watching them reminded me how I found the TTM and MI intriguing, and that I’d like to take a class on it to get better.

Motion Analysis Software

In the clinic I use my iPad and HudlTechnique (basic is free) for showing a patient what I’m noticing in their movement or for me to slow it down so i can see better.  I thought I would pass along a new one I just found that is Windows-based.  I haven’t played with it yet, but it looks like it would be a great resource so I’m passing it along –  Kinovea is open-source.

Compendium for teaching professional level PT content (neuro focus)

From an email I received earlier this month.  If you are an instructor this is a great resource for neuro-related coursework ideas.

*************************************************

The Academy of Neurologic Physical Therapy is pleased to announce the
release of the updated *“Compendium for Teaching Professional Level
Physical Therapy Content, v. 2016”*. This compendium is an update of the
previous compendium published in 2000 and edited by Margaret Schenkman PhD,
PT and Kathleen Gill-Body, MS, PT, NCS.

The purpose of the Compendium is to provide examples of high quality
teaching and learning strategies that have been developed and refined by
the contributors. Some activities include detailed patient cases and/or
grading rubrics, which can be difficult and time-consuming to write. These
will be useful for novice faculty who are seeking innovative ways to
deliver content. In addition, experienced educators will find new ideas
and alternative teaching strategies.

The compendium is online, and open access
http://www.neuropt.org/education/compendium. Activities may be searched by
elements of the patient management model, by pathology, or by type of
teaching activity. *Activities can be downloaded individually, and
educators may freely adapt or adopt the learning activities while providing
recognition to the Academy and the original authors*.

The Compendium co-chairs would like to recognize the hard work of authors,
editors, and Academy leaders in developing this resource. We hope you find
it useful in planning your curriculum!

*Jody Cormack, PT, DPT, MS Ed, NCS*
* Sue Perry, PT, DPT, MS*
Compendium v.2016 Co-chairs