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
Subscribe to:
Post Comments (Atom)
2 comments:
I have not yet done a gerontology placement so I can’t really give you any ideas on specific treatment setup ideas that I have used or found effective. I can only give you my thoughts on how I may have approached your situation. I believe that you addressed the situation appropriately given the circumstances. I would have acted very similarly to you in how you assessed and treated your patient. Based on your continual assessment, progressing and challenging the patient would be beneficial for their recovery and function and this is noted as the patient demonstrated significant improvements over the three weeks that you were treating them.
From your description of the patient, your level of assistance would seem suitable during treatment. It was also good that you were positioned on the patients affected side. The fact that they fell towards the unaffected side could not have been predicted by you.
You mentioned that when the patient felt he would loose his balance he would reach forward with his arms. A suggestion I would make is that maybe you could have performed the treatment with the patient positioned with parallel bars in front of them so that if they were to loose their balance and reach forward with their arms they would have something to grab onto to stop them from falling. By standing with a bar infront of a patient it may also decrease their fear of falling if this is an issue, and you may find the patient participates more with some exercises. If it is identified that a patient has poor balance and may fall to either side readily then it is probably appropriate to have another person for assistance on the other side of the patient.
Manual handling is a skill that develops with time and practice and you will most likely be better for it after this experience. It also reiterates to us other students who may find ourselves in a similar situation, the importance of manual handling skills and concentration throughout treatment with patients who may potentially fall.
Hi Rachael, I just wanted to say that I had a similar experience recently. It was on my cardio prac, and I was attempting to walk a patient with COPD excacerbation for the first time since they had been admitted. I did the usual checks to see if she was ok to get up. The patient’s hemoglobin levels were fine, she was saturating well at about 93% on RA, and had no previous cardiac problems. Upon standing she was fine, with no symptoms of dizziness or lightheadedness, so I decided to walk her.
We got about 10 metres down the corridor from her room when the patient rapidly started to desaturate, down to almost 80%. I gave her rest and instructed her to deep breathe, and her sats climbed back to approximately 86%, and wouldn’t go higher. Everytime we attempted to walk back towards her room, within 1 metre the patient would have desaturated to below 80% again, so we would have to stop. It was pretty frightening because I realized that at the rate that we were getting back to the room the patient may just give out in the corridor, and if we tried to walk to fast she would also give out. It took a long time to get the remaining 10 metres back to her room- it seemed very long anyway. Finally we made it back to her room and I put her back to bed.
But it just goes to show that sometimes, you can think that you prepared really well but something untoward can happen and make you panic a bit. I guess it is important for us students to realize that this can happen to anybody, even qualified physios, and that we shouldn’t let it get us down to much.
Post a Comment