On my neuro placement, I was in a neurological ward, and I had a few patients on my caseload that had sustained a severe traumatic brain injury. As you would know, in patients with severe traumatic brain injury, often there is little or no voluntary movement present. Some may have even lost the ability to speak, either directly because of the injury, or because they have a tracheostomy in situ. This was the case with a few of my patients. In such cases, obviously the subjective assessment is very limited, with the patients’ inability to communicate being the limiting factor. This often makes it very difficult to identify with the patient, socially, as a person, and to gain a picture of the person they were in your mind. Coupled with this, often upon reading the notes, there is no social backround available beyond the patients name and age, because maybe they have no family to provide this information, or for other reasons. These factors can make it very difficult to understand the person that they were before their injury, and its hard to see beyond the nearly comatose body that lies in the hospital bed.
Added to this, the ward was very fast and demanding, and as it was one of my earlier placements, I was very nervous about my abilities and found that my mind was constantly racing to plan treatments and assessments. With the patients with severe TBI, I apportioned little time to subjective assessments, concentrating on my manual handling and just really trying to remember everything. As such, I became very tunnel-visioned in my assessment and treatments of my patients, partly due to anxiety over this being my neuro placement, and partly because I guess was so focused on what I had to do. I began to see the patient in my mind as “room H: do passive movements, muscles stretches, possibly sit up, remember to keep knees blocked”.
My curtin clinical tutor had a very different perspective. While commending me for my focus on treatment plan and my manual handling, she also gave me constructive feedback regarding my inability to consider the patient as a whole. I noticed that she was very compassionate towards these patients, and thoughtful. She would be very sensitive to the slightest flicker of movement from a patient or the slightest show of will or emotion, and would really try hard to identify with the patient. She would spend a lot of time just speaking to the patient, encouraging them, and trying to get consistent responses from them.
She helped me to see that inside these often comatose looking bodies is a mind that thinks and a person that feels, just like anyone else, and that part of my job was to help these people to break out of the silence and stillness and help them to gain movement again, and be able to express themselves. She taught me to think beyond just the physical impairments and to consider how the patient is feeling, what is going on inside their mind, where they are at emotionally. My tutor helped me to see beyond the condition, to the person.
I realize that from time to time I slip into the frame of seeing the condition rather than the person, and in some patients, maybe this does not matter as much as with others, but since having the neuro prac I am now much more aware that a condition can almost never be separated from a person.
Wednesday, May 28, 2008
Monday, May 26, 2008
Communication with dysphasia
At the moment, I am doing clinical placement at Neuro outpatient. Many of patients there had CVA. One of my patient has L sided stroke. He has R sided weakness, more so in the upper limb, altered sensation of the R side, and so on.
The most significant problem affecting the progress of his rehabilitation is severe allodynia of the right side. He has minimal pain at rest; however has pain with tactile input including light touch, with passive and active movement.
He also has expressive dysphasia, which making communication with him difficult. Generally he is only able to say “yes, no and alright”. He has no apparent problem with understanding instructions. From the notes written by previous student, I grasped that the main strategy to communicate with him is to ask yes and no questions.
His pain is medically managed by gabapellin, however from his medical notes of last appointment, on the pain chart, he pointed to no pain. As a result, his pain medication prescription has not been updated for about 1 month.
As part of his treatment, he received stretches to his R side, especially his wrist and finger flexors, as well as PIP, DIP and MCP joint mobs and exercises for achieving lumbrical grip. Due to his allodynia, I am quite cautious with his stretches, ask if it’s causing him pain frequently and watching his facial expression quite closely. However, sometimes I accidentally ask open ended questions and he would struggle quite a bit to try to say something, but often ended with just a yes. And I have to guess the words he’s trying to say, which is quite difficult.
I am also doing sensory stimulation prior to his lumbrical grip exercises, according to the notes, his allodynia has improved as he can tolerate touching and stretching better.
As an outpatient department it’s more difficult to liaise with other health professional. It would be a good idea if I would attend his speech treatment if he is having one or even just ask for some suggestions from a speech pathologist. I’ll try follow this up.
Just wondering if anyone have any experience with patient with allodynia or dysphasia? Or has any suggestions to improve communication with patients with dysphasia?
The most significant problem affecting the progress of his rehabilitation is severe allodynia of the right side. He has minimal pain at rest; however has pain with tactile input including light touch, with passive and active movement.
He also has expressive dysphasia, which making communication with him difficult. Generally he is only able to say “yes, no and alright”. He has no apparent problem with understanding instructions. From the notes written by previous student, I grasped that the main strategy to communicate with him is to ask yes and no questions.
His pain is medically managed by gabapellin, however from his medical notes of last appointment, on the pain chart, he pointed to no pain. As a result, his pain medication prescription has not been updated for about 1 month.
As part of his treatment, he received stretches to his R side, especially his wrist and finger flexors, as well as PIP, DIP and MCP joint mobs and exercises for achieving lumbrical grip. Due to his allodynia, I am quite cautious with his stretches, ask if it’s causing him pain frequently and watching his facial expression quite closely. However, sometimes I accidentally ask open ended questions and he would struggle quite a bit to try to say something, but often ended with just a yes. And I have to guess the words he’s trying to say, which is quite difficult.
I am also doing sensory stimulation prior to his lumbrical grip exercises, according to the notes, his allodynia has improved as he can tolerate touching and stretching better.
As an outpatient department it’s more difficult to liaise with other health professional. It would be a good idea if I would attend his speech treatment if he is having one or even just ask for some suggestions from a speech pathologist. I’ll try follow this up.
Just wondering if anyone have any experience with patient with allodynia or dysphasia? Or has any suggestions to improve communication with patients with dysphasia?
Sometimes there is only so much you can do
I would like to share my experiences with you with regards to a situation I encountered on my first placement which was a gerontology placement in which one of my patients fell when in my care
I had been treating this patient for three weeks and he had reached a functional level above and beyond the level he was at prior to his hospital admission. I had watched him work extremely hard in the treatments I had provided for him which tested his limits of stability and had become quite accustomed to his balancing strategy behaviours. I knew he was more unstable on his left side due to an arthritic knee and when the patient felt he would loose his balance he would reach forward with arms and need support at the pelvis to bring his centre of mass to directly under his feet. Together with another student we were able to get the client to throw and catch a ball having him reach beyond his base of support. Objectively to test whether out treatment was effective after each treatment session we would check the patients functional reach score to find that the patient was always constantly improving. As students this was very rewarding.
One day the patient however behaved in a way that I did not expect I had the client well supported on his left side with my foot supporting any forward movement and my hand around his opposite pelvis but not bracing the patient so we could challenge his balance. Suddenly after catching the ball thrown to him by the other student the client’s right knee collapsed and the client went plummeting towards the ground directly to the right. As I was prepared for the situation I had hold of the clients waist but realised that no matter what I could possibly physically do to support the client he was going to fall and the best I could do before injuring myself was to slowly let the client fall to the ground. The client landed directly on his hip and upon inspection did not have any injuries. The client was not shaken up by the fall and actually laughed.
Inevitably my initial reaction did prevent the client from sustaining any major injuries but could I have completely have prevented the situation? Did a make a poor judgement? Already I felt I had lost confidence in my own abilities and felt really irresponsible.
My supervising physiotherapist responded to the situation really proactively. She consoled me and reminded me that as a student inevitably I will be exposed to situations for the first time and sometimes an unfortunate outcome is inevitable. No one could have predicted the patient would fall the way he did and all previous treatments with the patient had been conducted in a safe manner. Even though the patient did fall I did the best I could to first initially protect my own body then eased the patient's contact with the ground. This got me thinking that despite we all have an inbuilt fear that a patient could fall or lose balance it does not brand us irresponsible but rather is a learning experiences so we are better prepared for a similar event in the future. As a result of this experience I noticed that I become more specific with my manual handling and was more observant of future patient’s postural adjustments.
I was wondering if anyone had any suggestions on how they have/would manage a client who is a potential falls risk i.e. if you know of any specific treatment set up ideas etc. J
I had been treating this patient for three weeks and he had reached a functional level above and beyond the level he was at prior to his hospital admission. I had watched him work extremely hard in the treatments I had provided for him which tested his limits of stability and had become quite accustomed to his balancing strategy behaviours. I knew he was more unstable on his left side due to an arthritic knee and when the patient felt he would loose his balance he would reach forward with arms and need support at the pelvis to bring his centre of mass to directly under his feet. Together with another student we were able to get the client to throw and catch a ball having him reach beyond his base of support. Objectively to test whether out treatment was effective after each treatment session we would check the patients functional reach score to find that the patient was always constantly improving. As students this was very rewarding.
One day the patient however behaved in a way that I did not expect I had the client well supported on his left side with my foot supporting any forward movement and my hand around his opposite pelvis but not bracing the patient so we could challenge his balance. Suddenly after catching the ball thrown to him by the other student the client’s right knee collapsed and the client went plummeting towards the ground directly to the right. As I was prepared for the situation I had hold of the clients waist but realised that no matter what I could possibly physically do to support the client he was going to fall and the best I could do before injuring myself was to slowly let the client fall to the ground. The client landed directly on his hip and upon inspection did not have any injuries. The client was not shaken up by the fall and actually laughed.
Inevitably my initial reaction did prevent the client from sustaining any major injuries but could I have completely have prevented the situation? Did a make a poor judgement? Already I felt I had lost confidence in my own abilities and felt really irresponsible.
My supervising physiotherapist responded to the situation really proactively. She consoled me and reminded me that as a student inevitably I will be exposed to situations for the first time and sometimes an unfortunate outcome is inevitable. No one could have predicted the patient would fall the way he did and all previous treatments with the patient had been conducted in a safe manner. Even though the patient did fall I did the best I could to first initially protect my own body then eased the patient's contact with the ground. This got me thinking that despite we all have an inbuilt fear that a patient could fall or lose balance it does not brand us irresponsible but rather is a learning experiences so we are better prepared for a similar event in the future. As a result of this experience I noticed that I become more specific with my manual handling and was more observant of future patient’s postural adjustments.
I was wondering if anyone had any suggestions on how they have/would manage a client who is a potential falls risk i.e. if you know of any specific treatment set up ideas etc. J
Patient Communication
I recently saw a 66 year old patient who was a day 1 post-op for a Whipple’s procedure. She also had other co-morbidities in that she was completely deaf in her (L) ear, and had only partial hearing in her (R) ear. The patient also subjectively stated that she used a walking stick at home during ambulation as she had poor strength in her (L) LL and would often “loose her feet” and fall to the left. The patient had been nauseous and vomiting earlier in the morning but felt better later in the morning when I saw her.
From reading the patient notes I identified that communication obviously would be an issue in treating this patient. The nursing staff also mentioned that she displayed some minor cognitive deficits. I planned to address this consideration to treatment by making sure that the patient had their hearing aid switched on at an adequate level, and to make sure that when I was speaking to them that I was talking to her good (R) ear with clear simple language. If it was needed, I was also prepared with a small whiteboard and marker for communicating if there were any hearing or language issues.
I had planned to explain the purpose of physiotherapy after her operation, and then what we aimed to do today. I knew that this would be essential to avoid any confusion once actually mobilising the patient. At the time I believed I had adequately explained everything necessary, the patient seemed to understand everything discussed, and I was ready to ambulate the patient. During ambulation I was conscious to stay on the patient’s weak (L) side that she had already explained occasionally gives way. The problem I encountered that I hadn’t planned for was that although I had adequately explained what we were planning to do prior to standing the patient up, once I was on her (L) side she had great difficulty hearing me even when I spoke with a loud clear voice.
I was asking her questions to monitor how she was feeling as we were ambulating, however, she was not replying and began to look very pale. I sat her down at a chair that I had previously set up as a rest spot if the patient needed, however, we had planned to go to the chair set up further down the hall. Once she was sitting I could get to her favoured side for hearing and she had no other distractions, I was able to communicate effectively with her. She had felt a little bit light headed and was in slight pain but didn’t feel as though she needed to be sick or was going to fall while we were ambulating.
At that point I called one of the nurses over to assist me with ambulating the patient slightly further up the hall and then back to her room, once she started to feel better. By doing this the nurse was able to stand on her (R) side and communicate more effectively with her. After this the patient was actively communicating to us, and later stated that she felt safer when she had the nurse telling her she was doing well. The situation has helped me with planning of similar issues by making sure I consider adequately monitoring patients subjectively, even if it means getting the assistance of someone else in a situation where you may think you can otherwise do it yourself.
From reading the patient notes I identified that communication obviously would be an issue in treating this patient. The nursing staff also mentioned that she displayed some minor cognitive deficits. I planned to address this consideration to treatment by making sure that the patient had their hearing aid switched on at an adequate level, and to make sure that when I was speaking to them that I was talking to her good (R) ear with clear simple language. If it was needed, I was also prepared with a small whiteboard and marker for communicating if there were any hearing or language issues.
I had planned to explain the purpose of physiotherapy after her operation, and then what we aimed to do today. I knew that this would be essential to avoid any confusion once actually mobilising the patient. At the time I believed I had adequately explained everything necessary, the patient seemed to understand everything discussed, and I was ready to ambulate the patient. During ambulation I was conscious to stay on the patient’s weak (L) side that she had already explained occasionally gives way. The problem I encountered that I hadn’t planned for was that although I had adequately explained what we were planning to do prior to standing the patient up, once I was on her (L) side she had great difficulty hearing me even when I spoke with a loud clear voice.
I was asking her questions to monitor how she was feeling as we were ambulating, however, she was not replying and began to look very pale. I sat her down at a chair that I had previously set up as a rest spot if the patient needed, however, we had planned to go to the chair set up further down the hall. Once she was sitting I could get to her favoured side for hearing and she had no other distractions, I was able to communicate effectively with her. She had felt a little bit light headed and was in slight pain but didn’t feel as though she needed to be sick or was going to fall while we were ambulating.
At that point I called one of the nurses over to assist me with ambulating the patient slightly further up the hall and then back to her room, once she started to feel better. By doing this the nurse was able to stand on her (R) side and communicate more effectively with her. After this the patient was actively communicating to us, and later stated that she felt safer when she had the nurse telling her she was doing well. The situation has helped me with planning of similar issues by making sure I consider adequately monitoring patients subjectively, even if it means getting the assistance of someone else in a situation where you may think you can otherwise do it yourself.
Unfriendly patients
My recent cardio placement was on a surgical ward which meant that my role as a student physiotherapist was essentially to get the patients up and moving after their surgery. This would then help the patient by minimising the harmful effects of reduced lung volume post-operatively.
Most of the patients i saw were fairly cooperative, this was normally because they either wanted to get out of bed and get moving, or because they knew they had to. However, i did come across a couple of difficult patients which im sure you would find anywhere that you worked.
The particular patient that I wanted to talk about was a fifty year old woman who had endured quite a long stay in hospital. She had been through a number of surgeries and also a few different physio's had seen her while she was in hospital. On one particular morning i was told that i needed to see her to get her up and moving. I entered her room and said that i had come to help her get out of bed and go for a short walk. The patient refused and said she was too tired and didnt want to go. I then said i could come back later and we agreed that 3pm would be a good time. Sure enough, when 3pm came around and i went back to see her she still didnt want to get up. The patient looked at me with disgust when i tried to reason with her and then she started ignoring me. I explained that we needed to at least get her sitting over the edge of the bed so i could listen to her lungs. After much persuasion the patient very reluctantly agreed to that.
I was sympathetic to the fact that being in hospital for a long time would not be much fun but i also had a job to do. I was quite annoyed with how rude the patient was to me but i had an idea to tackle the problem for the next day.
The next day i spoke to a female student who was doing the same placement as me and explained the situation. I asked the other student if she would mind seeing the patient today and she agreed. I felt bad about handballing my worst patient off to another student but i had a feeling this particular patient might respond to females better. Next thing i know i was sitting at the nurse's station writing notes and my patient walked past with the female student and not only that but my patient apologised to me for being soo rude the other day. I was quite shocked but really pleased that the patient had realised that i was only trying to help her and that she went to the trouble of apologising. I felt that the situation was resolved and i was glad that my idea of trying a different approach had worked. This occured at the end of my placemet so i didnt end up seeing this patient again.
Most of the patients i saw were fairly cooperative, this was normally because they either wanted to get out of bed and get moving, or because they knew they had to. However, i did come across a couple of difficult patients which im sure you would find anywhere that you worked.
The particular patient that I wanted to talk about was a fifty year old woman who had endured quite a long stay in hospital. She had been through a number of surgeries and also a few different physio's had seen her while she was in hospital. On one particular morning i was told that i needed to see her to get her up and moving. I entered her room and said that i had come to help her get out of bed and go for a short walk. The patient refused and said she was too tired and didnt want to go. I then said i could come back later and we agreed that 3pm would be a good time. Sure enough, when 3pm came around and i went back to see her she still didnt want to get up. The patient looked at me with disgust when i tried to reason with her and then she started ignoring me. I explained that we needed to at least get her sitting over the edge of the bed so i could listen to her lungs. After much persuasion the patient very reluctantly agreed to that.
I was sympathetic to the fact that being in hospital for a long time would not be much fun but i also had a job to do. I was quite annoyed with how rude the patient was to me but i had an idea to tackle the problem for the next day.
The next day i spoke to a female student who was doing the same placement as me and explained the situation. I asked the other student if she would mind seeing the patient today and she agreed. I felt bad about handballing my worst patient off to another student but i had a feeling this particular patient might respond to females better. Next thing i know i was sitting at the nurse's station writing notes and my patient walked past with the female student and not only that but my patient apologised to me for being soo rude the other day. I was quite shocked but really pleased that the patient had realised that i was only trying to help her and that she went to the trouble of apologising. I felt that the situation was resolved and i was glad that my idea of trying a different approach had worked. This occured at the end of my placemet so i didnt end up seeing this patient again.
Shock horror: Allied Health Politics
On a recent women’s health placement I was seeing a patient following hysterectomy, who also suffered from Parkinson’s disease, which had been poorly managed (medically) since admission. The patient was previously coping at home with support from her husband, but it had been documented in the notes that nursing staff were struggling to mobilise her for personal care with 2 x max assist and were requiring the assistance of a hoist.
My supervisor and I assessed the mobility of the patient and were able to mobilise approximately 10 steps on the spot with a WZF and 2 x minimal assistance, with lots of verbal encouragement/ reassurance. As we were performing this assessment a member of nursing staff entered the room. She had previously submitted a form/ report stating it was an occupational risk to attempt to mobilise the patient without the use of a hoist. She felt we had undermined her ability/ decision making by not taking into account what she been documented in the medical notes. She became very emotional, raised her voice and used coarse language, stating “what makes you Physio's think you can do it, when we couldn't” and that our input would not mean the patient would return home but rather would still end up in a high care facility – in front of the patient and her family!
My initial reaction was shock. I felt very uncomfortable and slightly embarrassed to be part of a team of health “professionals” when this act was clearly unprofessional. I couldn’t help but feel sympathy for the patient as her feelings and goals had been completely discounted by this nurse. I was also concerned that we had not communicated effectively with other members of staff before beginning assessment/ treatment.
My supervisor took the nurse out of the patients room to calm her down whilst I was left in the room with the patient and her family (on my first day at this facility!). I attempted to apologise to the family who were also shocked, but very understanding, and re-assured them that we were doing everything we could to improve her mobility and discharge her home, rather than to a care facility.
This event highlighted the importance of professional behaviour and not letting “work politics” and personal feelings affect the care of clients.
However, we were also in the wrong. The situation could have been avoided if we had been wise enough to discuss plans/ reasoning for treatment plans with relevant nursing staff and members of the allied health team before executing the treatment rather than “going behind their backs”.
Note: It was later discovered that her Parkinson’s medication had been charted incorrectly, once this was corrected her functional abilities improved enormously. In light of this I think it’s really important to never give up, or sell a patient short and deny them of a fair chance of independence. All patients deserve a chance to reach their most optimal physical state, and it’s our job to explore every possible avenue to help them achieve this.
My supervisor and I assessed the mobility of the patient and were able to mobilise approximately 10 steps on the spot with a WZF and 2 x minimal assistance, with lots of verbal encouragement/ reassurance. As we were performing this assessment a member of nursing staff entered the room. She had previously submitted a form/ report stating it was an occupational risk to attempt to mobilise the patient without the use of a hoist. She felt we had undermined her ability/ decision making by not taking into account what she been documented in the medical notes. She became very emotional, raised her voice and used coarse language, stating “what makes you Physio's think you can do it, when we couldn't” and that our input would not mean the patient would return home but rather would still end up in a high care facility – in front of the patient and her family!
My initial reaction was shock. I felt very uncomfortable and slightly embarrassed to be part of a team of health “professionals” when this act was clearly unprofessional. I couldn’t help but feel sympathy for the patient as her feelings and goals had been completely discounted by this nurse. I was also concerned that we had not communicated effectively with other members of staff before beginning assessment/ treatment.
My supervisor took the nurse out of the patients room to calm her down whilst I was left in the room with the patient and her family (on my first day at this facility!). I attempted to apologise to the family who were also shocked, but very understanding, and re-assured them that we were doing everything we could to improve her mobility and discharge her home, rather than to a care facility.
This event highlighted the importance of professional behaviour and not letting “work politics” and personal feelings affect the care of clients.
However, we were also in the wrong. The situation could have been avoided if we had been wise enough to discuss plans/ reasoning for treatment plans with relevant nursing staff and members of the allied health team before executing the treatment rather than “going behind their backs”.
Note: It was later discovered that her Parkinson’s medication had been charted incorrectly, once this was corrected her functional abilities improved enormously. In light of this I think it’s really important to never give up, or sell a patient short and deny them of a fair chance of independence. All patients deserve a chance to reach their most optimal physical state, and it’s our job to explore every possible avenue to help them achieve this.
Sunday, May 25, 2008
Patient Compliance Issues
I am currently treating a patient whom has sustained a mixture of superficial and deep partial thickness burns to their UL’s following exposure to an electrical fire. The patient cannot speak or understand any English, but follows demonstrations fairly well with facilitation. Prior to last week the patient was compliant and responding well to physiotherapy. Last week the patient had a small SSG on both elbows (roughly the size of a 20c piece). Following the SSG the patient was RIB for 2/7 to allow for the SSG to ‘take’ and then was given the all clear by the surgeon to begin mobilisation. Since their SSG the patient has been non-compliant with physio. They are very tearful during the Rx session and will walk out of the gym on their own accord and go back to their room. As we mobilise their UL’s they repeatedly pull away pointing to the area where the SSG’s are and shake their head. As we do not speak their language and vise versa we were unsure of what they were trying to convey.
Rx of such burns requires fairly aggressive (within reason) stretches and mobilisations so that when the tissue heals there is enough ROM at the joints to allow for function (tissue looses its elasticity when burnt thus the patient is at a high risk of contractures). As a physio student knowing these complications it was very frustrating as we were trying to prevent the patient from losing function, but they didn’t understand this. Reflecting upon the patient’s behaviour I can understand that physio treatment is extremely painful and the patient may feel we are damaging or injuring them. In addition due to language barriers they may be confused as the surgeon (via an interpreter) had informed the patient that they must not move their arms in order for the SSG to heal (I am unsure as to whether a time frame for this immobilisation period was given to the patient). It must have been frightening and frustrating for the patient as they had no control over the situation and all our Rx appeared to do was cause them pain.
Through the week an interpreter has seen the patient with myself and the physio. The patient stated that they understand why they have to move and are now allowed to move, but added that it is very painful. To this we replied that they need to let us move their UL’s and that by moving it will infact decrease their levels of pain. By not moving we explained it will be even more painful in each subsequent physio session. By the end of the session we felt we had conveyed the message across to the patient and the interpreter assured us that the patient understood the importance of the physiotherapy and that pain did not equal damage.
Reflecting upon this situation I realised that communicating and educating the patient is vital for them to be compliant with physiotherapy and any exercises we give them to do during the day. In the future I will organise for an interpreter to see the patient prior to their surgery and them immediately after to explain the physiotherapist’s role in their Rx. In addition whilst the patient’s compliance has improved they are still not doing enough in physio and in their room to prevent contractures of the skin from forming. They currently have the maximum pain relief prior to physio, have their stretches done in their room so they can’t walk out and have had an interpreter speak to them four times in the past week explain the importance of them moving their UL’s. If anyone has any suggestions or thoughts on how to improve the patients compliance they would be much appreciated. Thanks!
Rx of such burns requires fairly aggressive (within reason) stretches and mobilisations so that when the tissue heals there is enough ROM at the joints to allow for function (tissue looses its elasticity when burnt thus the patient is at a high risk of contractures). As a physio student knowing these complications it was very frustrating as we were trying to prevent the patient from losing function, but they didn’t understand this. Reflecting upon the patient’s behaviour I can understand that physio treatment is extremely painful and the patient may feel we are damaging or injuring them. In addition due to language barriers they may be confused as the surgeon (via an interpreter) had informed the patient that they must not move their arms in order for the SSG to heal (I am unsure as to whether a time frame for this immobilisation period was given to the patient). It must have been frightening and frustrating for the patient as they had no control over the situation and all our Rx appeared to do was cause them pain.
Through the week an interpreter has seen the patient with myself and the physio. The patient stated that they understand why they have to move and are now allowed to move, but added that it is very painful. To this we replied that they need to let us move their UL’s and that by moving it will infact decrease their levels of pain. By not moving we explained it will be even more painful in each subsequent physio session. By the end of the session we felt we had conveyed the message across to the patient and the interpreter assured us that the patient understood the importance of the physiotherapy and that pain did not equal damage.
Reflecting upon this situation I realised that communicating and educating the patient is vital for them to be compliant with physiotherapy and any exercises we give them to do during the day. In the future I will organise for an interpreter to see the patient prior to their surgery and them immediately after to explain the physiotherapist’s role in their Rx. In addition whilst the patient’s compliance has improved they are still not doing enough in physio and in their room to prevent contractures of the skin from forming. They currently have the maximum pain relief prior to physio, have their stretches done in their room so they can’t walk out and have had an interpreter speak to them four times in the past week explain the importance of them moving their UL’s. If anyone has any suggestions or thoughts on how to improve the patients compliance they would be much appreciated. Thanks!
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