My next session with Tom* on my orthopaedic inpatient placement I was able to start mobilizing Tom. I saw Tom with my Curtin supervisor for this session. Because of Tom’s complicated and prolonged hospital stay I decided to take quite a cautious approach by explaining to Tom that if at any time he felt dizziness, nauseous or anything else abnormal to let me know immediately. I also explained to Tom that we would take it slow and we go to sitting over the edge of bed, stay there for a little while and then if things were okay there than we would try a stand with the pulpit frame. Tom agreed to all this. We moved to sitting over the edge of the bed and I continued to question Tom regarding dizziness etc and he said he was fine. I decided to try a stand with the pulpit frame, Tom was quite keen and seemed to be a little frustrated at how slow and cautious I was taking things. I explained to Tom how I wanted him to stand up using the pulpit frame by first pushing on the bed with both hands and then once half way up to bring his hands to the pulpit frame and take the weight through his elbows on the pulpit frame.
Tom then stood up but put his hands on pulpit frame too early, he still managed to stand but was not as safely as I had liked so I told him that I wanted him to sit down and try again. Tom was visibly frustrated but my supervisor and I tried to explain to him that it was important that he learn to transfer safely. I then re-explained to Tom how I wanted him to stand safely, and on the second attempt Tom stood safely.
When receiving feedback from my Curtin supervisor she commented that if this session was my final assessment she may be inclined to fail me on a safety issue. This obviously caused me to reflect on what I could have done to prevent this potential safety issue. I first thought about if I had explained how I wanted Tom to stand...yes I explained but I may have not enforced my presence and ‘authority’ enough. Then I reflected on why I didn’t do that and with some discussion from my clinical supervisor I came to the conclusion that it was the fact that I felt inadequate being so forceful when I was still a student. Reflecting on this made me realise that it is of the utmost importance to display confidence in what we are doing and display a sound presence to patients not only to ‘sell’ physio to our patients but to ensure safety at all times. During my next sessions with Tom and other patients I made sure that I displayed a greater presence and confidence in what I was doing.
*Fictitious names used
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2 comments:
Hey trav
i think you have responded appropriatley to the situation, definetley one of the important things i have learnt is learning how to fake confidence even if your not feeling confident you have to fake a prescence for the sake of the patient, even if inside you are in doubt.
Yep. For sure, that's a hard one. It comes as a surprise that we could risk failing an Ax - for failing to "control" what a patient is doing when you are treating them. But it also makes sense somewhat as that is exactly what we'll need to be able to do as therapists, isn't it?
I have learned to do this a little better during this current placement, actually by observing the fellow student I'm on prac with! When a patient rushes ahead and does something she didn't want him to, she very firmly says "No, wait. Stop. Listen to what I want you to do first." and then explains what she wants. Now, I know the real trick is doing that without sounding condescending, which she pulls off beautifully. But I've seen her do it with great results. I think it'd also help to explain WHY you are enforcing what you want. For an ortho inpatient, you could reinforce "You may feel good right now, but you never know what will happen when you stand up."
Anyway, good point, trav. Presence is important.
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