During the first few weeks of my first placement, Musculo Outpatients, I was daunted by the amount of knowledge and manual handling skills required, as well as the variety of client presentations at the clinic. The musculo tutors always said that we had to be careful about being “too hands on”, and to make sure we always told the patient/client when we were going to be touching them so they didn’t get a shock as we suddenly had our hands on glut max or the ischial tuberosity. Supervising the clients exercise programs and prescribing new exercises was something that I found difficult, probably because rather than being “too hands on”, I was using a more hands-off approach. I felt like I was intruding on their personal space and that some of my clients, especially the older ones, would not appreciate me touching them in order to teach them an exercise. As a result I think that a few of my clients wouldn’t have had an effective HEP, since they wouldn’t have been doing their exercises properly.
I talked to my supervisor about this and she suggested that I talk to my clients about the necessity of touching them in order to teach them an exercise effectively; she told me that I should say something along the lines of “I’m going to place my hands on the muscles that move your shoulder-blade so that I can make sure that the right muscles are working”. By explaining exactly why I was touching the client and how that would help improve the way they were doing their exercises, I made both the client and myself more comfortable.
There are so many physiotherapy techniques that require us to touch our patients/ be “hands on”, and virtually every patient/client will need to disrobe to some degree. A lot of people are uncomfortable with this, especially the older population-which is an increasing percentage of our clients, so it is vital that we are able to properly explain to them why we are asking them to disrobe, and why we need to be in contact with them. This is another reason why it is so important that we build good rapport with our patients. As long as we are professional and communicate effectively, showing care and understanding for our patients, we will make our patients more comfortable, and we will be able to provide more effective treatment.
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2 comments:
I think you've brought up a really good topic. i've just started my musculo placement and I think that sometimes in these situations it just seems easier to be more 'hands off' for both yourself and the client. But it's like you said, unless we put our hands on the home exercises may not always be effective. I think in the situations where you need to get your hands on the patients ischial tuberosity or ask them to disrobe, it's important that you say it with confidence and not seem unsure or embarrassed yourself because a lot of the time this helps the patient to feel at ease as well. In some cases I find it could almost go the opposite way as well. Where we're so used to putting our hands on muscles and digging in to find piriformis when practicing on each other that we forget that the patient may not be so comfortable with that. The patient's comfort and well-being should always be at the fore-front of our minds when treating.
I definitely agree with what you are saying, I am also on my musculo prac at the moment and have found myself in similar awkward situations (especially with the disrobing of female patients), but I have found that if you explain why you are asking them to disrobe (ie. So that you can observe how the segments in their back are moving) they are more comfortable with it. I have also found that if you explain to them that if they bring a sports bra or some shorts next time it will make it a lot easier to treat them, and they are often willing to comply.
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