I am currently on my cardiopulmonary placement on the general surgery ward. I was assigned a pt with my partner to mobilize and review deep breathing exercises.
Our pt was a 75 year old, two weeks down the track from an anterior resection of the bowel. On observation and questioning the pt felt fine and confident to go for a walk down the corridor and back. The obs were within normal limits and her attachments were an IDC and IV drip on a pole.
So we trundled down the corridor which is about 50m, on questioning she started feeling tired so we start them down in a chair. After a few deep breathing exercises and a rest we decided to head back. For no physical reason they were unable to stand and refused to get up and walk back. The pt kept on repeating “I can’t do it, I’m going to fall over” despite there being two of us students at hand. So in this dilemma we decided to grab a wheelchair to transfer them to. Attempt number one was unsuccessful as was attempt number two by my fellow student. We were doing everything correct in terms of manual handling skills but the pt just refused to use any of her strength. She still kept repeating “I can’t do it, I’m going to fall”. So my fellow student and I swapped places and I attempted the transfer. I MMT her knee extensors to boost her confidence. After that I looked her in the eye and told them that they CAN stand up and the DO have the strength, they just got to have confidence in themselves and trust in us. On the count of three I stood them up despite much hesitation and physical opposition. The pt felt like a dead weight as they weren’t helping much at all so I had to really facilitate the lean forward stage. Luckily they had a slight build. The third attempt was a success and they were wheeled back to their room.
It just shows that as therapists we face many pts that will lack confidence in their ability to mobilize and be independent. This is especially evident in surgical wards as well as relevant to the increasing number of gerontology patients. It also shows that despite our course giving us a sound background to the theory of manual handling, there is still a huge gap between applying it and learning it in different situation. I put my back at risk during the transfer since the pt refused to help. It also emphasizes the importance of giving the pt confidence and feeding them A LOT of encourage and positive reinforcement. I don’t think our course really prepared us for the psychological side of our job. Do you think this is true?
1 comment:
It isn't easy to convince patients when they have great fears or lack of confidence. They will need +++ encouragement and reassurance as what you have already mentioned. Patients with fears of falling are a challenge to manage. What i found helped was convincing them that you are trained to not let pts fall and that they are strong enough and the only way to overcome the fear is by doing it.
Post a Comment