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: Christaberham@northumbria-healthcare.nhs.uk

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