I am currently on a neurology ward treating (with another student) an elderly male patient 2 weeks post left MCA stroke. He is a very tall gentleman and though he is not overweight, is extremely heavy and difficult to transfer. The first time we saw the patient was on our first day of placement. We simply observed one of our supervisors (a very experienced clinician) treating him. She was working on sit to stand, standing balance and also a bit of gait. She was effectively able to walk him with only 1 assist. However we have taken over his treatment and are struggling to have him weight shifting to the unaffected side as he displays pushing behaviour and has elements of dyspraxia which makes simple tasks difficult.
Myself and my fellow student are concerned that this patient isn’t getting the most out of his physiotherapy session because we aren’t yet skilled enough with our manual handling to safely facilitate weight shift in standing, or gait.
We discussed the situation with our CCT and mentioned that we had tried techniques such as using visual input (mirror), working on sitting balance immediately prior to standing balance, SIMS to increase afferent feedback from affected side and maybe increase activation and using functional reaching tasks with objects (eg coits) to help address the element of dyspraxia as this patient seemed to perform much better with functional tasks and simple instruction/ demonstrations. The CCT offered some suggestions focussed on preparation and patient confidence/ security during the task.
We persisted with the suggestions of our CCT and his sitting balance is now really good with decent activation of his trunk side flexors, but we are still having difficulty with him in standing.
I know that being on placement is a learning opportunity and in no way do I want to “give up” and let the supervisor treat him because we need to learn somehow, but is it unfair to be learning at the patients physical expense? Effectively you’re playing with their future. Is it ok to say you’re not capable of treating a patient at this stage until your manual handling becomes more effective?
Subscribe to:
Post Comments (Atom)
4 comments:
hi
thats a really interesting issue that youve raised. On one hand everyone has to learn somehow but on the other hand you dont want to be responsible for a patient having a poor recovery due to inadequate treatment.
I think the best thing to do is to try a few different treatment techniques and see if you can find an effective one. If after trying a few different treatments you still dont believe you are effectively treating the patient then i think its perfectly fine to ask for assistance.
Good luck.
Yes I agree. One of the reason that we have outcome measures is to compare effectiveness of techniques on different patients. Especially with neuro patients, even with the same condition, one technique worked fantasically may not work at all on the next patients. It is all part of learning experience. However if non of techniques works, some advice from the supervisor will definitely help. She doesn't have to treat him, just some tips or demonstration of possible patient position, hand position or other forms of techniques etc. I doubt any student is yet very effectiveness in treating neuro patients. Even new grats may not be great. It is an opportunity to become more effectives from other's assistance. Just my two cents
I don’t think it is unfair to be learning at a patient’s expense. I think it is extremely important for all allied health workers to gain practical experience. The best way to learn is to do it yourself in a real life situation. If we didn’t learn this way I’m sure that our standard of health care would be nowhere near what it actually is, and for the future would only get worse. In regards to not treating a patient until your manual handling is good enough, I feel that as long as it is still safe for the patient then we must practice our skills in order to learn and develop them. If we always avoided a situation because we didn’t think we were good enough, then we would never get any better at it.
I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their website www.ultimatelifeclinic.com I can breath much better and It feels comfortable!
Post a Comment