I was visiting a day-2 post-natal woman in the inpatient maternity ward, together with my supervisor. As the patient had a prolonged 2nd stage during labour and a 1st degree tear of the perineum, it was essential that we taught her to exercise her pelvic floor muscles (PFM).
We were taught at uni (Task 4 Assessment content sheet in PT prac 352 Women’s health unit) to teach a patient to “close back passage, let go. Close front passage, let go. Close back & front passages, and feel them gently drawing up inside you, hold 2-3 sec, let go. Repeat another 4-6 times.” I taught the patient exactly as we were taught to do. The rationale was to facilitate muscle pump, decrease swelling and increase sensation of the PFM. The aim was to build up muscle endurance (submax hold to 10 sec) as the muscles recover and swelling decrease. However, my supervisor questioned the part where I taught the patient to hold the contraction, as it was not reasonable to hold a contraction at such an acute stage, and muscle pumping effect would be facilitated by just gentle contractions and letting go. She added that holding the contraction could have decreased blood flow to the area, as the blood vessels may be compressed.
Being a student, it has been a frequent battle to know which option to choose when there is a discrepancy between what is taught at uni, and what is being practised by the supervisor. In this instance, the rationale given by both uni and the supervisor are reasonable and trustworthy. Considering that my supervisor has been working in this area for so many years, her rationale would have come from much expertise. In other cases where the advices of the supervisors contradict what were taught at uni, to challenge them might not be the best option.
Being under their supervision, I would choose to follow the advice of my supervisor if such situation arises again. When I graduate and become a qualified practitioner, then will I have the liberty to do what I think may be the best option.
Anyone has other opinion in this?
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3 comments:
It can be difficult when what we are taught at uni is different to the way a supervisor wants you to do things. I think as long as what the supervisor says has good rationale behind it and you can see the reason for it doing things the way they tell you to do it is fine. Then once you are working as a physio you can decide which way you would like to do things. However if what the supervisor is telling you to do seems to be less effective then they way we were taught it may be worth discussing with them how we have been taught and why they think there way is better.
This is a tough situation. You could try and teach different pts to do it different ways and see which one works best clinically? or else you could teach the pt both and see which one causes them less pain.
great helpful ideas! thanks for your comments!
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