Recently on my cardio general surgery placement i was presented with an 85 year old gentleman who had not had any previous surgery so goals of physiotherapy have been aimed at gaining as much independant function as possible. He presented to ED post fall and reported had had four falls in four days. He is legally blind, has lung cancer, mild dementia, COPD and CRF. Initially he was admitted with a suspected hip fracture but post examination revealed no fractures. Currently doctors are querying a gastrointestinal bleed or metastasis of his cancer causing him to have low haemoglobin levels thereby explaining why he has been falling. At home he has a carer whom assists with most ADLS and ambulates independantly however needing standby assistance when in new environments.
For treatment of this gentlemen as chest physio has not been indicated my focus has been on mobility and encouraging him to be as independant as possible with bed mobility, STS, and ambulation.
On this particular occasion his carer was present during the treatment session. I thought this would be handy as a second pair of hands wouldnt go astray when trying to manage all of his attachments. Also with his carer present i could demonstrate the best ways of assisting the patient with movement as the carer had reported that her job was getting "too difficult" because this patient's condition was deteriorating and he has slowly become less mobile requiring more assistance.
Throughout the treatment session i found it very difficult to gain control of the situation. I was trying to encourage the patient to move as indepednantly as possible and then his carer would intervene grabbing hold of his arm and lifting him out of bed. I would reiterate that it was important for this patient to do as much as possible so he could be discharged home and the carer still persisted to ignore me. I decided to get this patient up for a walk and despite he was quite capable of standing independantly the carer grabbed his arm and pulled him up. To prevent the carer anymore from intervening i told the patient that his carer would direct the IV pole when going for a walk down the ward and i would just provide some manual support around his waist to direct him which direction to steer the wheeled zimmer frame. I noticed the patient was quite independant with this and only needed prompting because he is legally blind and gets uncomfortable with unknown surroundings. I then thanked the carer, wrapped up the session and went to write up his notes.
As i left his room i really started to think about how the carer's approach towards managing this patient was in fact preventing him from becoming more independant. Now top of my priority list with ths patient is to provide the carer with education on appropriate manual handling so this patient can be as independant as possible and the carer can prevent any injuries from the physical exertion of her current ways. Maybe i should have been more firm and assertive with this carer but i did not want to discourage her from participating in the treatment session and being involved in this patient's discharge plan. Any thoughts?
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