communication goes a long way

One of my placements was in a surgical ward and a lot of what we did in the ward was to get patients ambulating as early as day one post surgery. Majority of the patients there had gastrointestinal tract surgery whereby some required part of their bowel removed and a colostomy bag placed insitu. A colostomy is a pouch that collects feces and is situated at a surgically-created opening in the large intestine where it bypasses the rectum. It is usually a life changing event for many who had undergone this surgery as it leaves them with the inability to empty their bowel naturally and also the need to learn a new skill of managing their stoma bag. In the five weeks I was there, I met patients that dealt with the new change in so many different ways. Many were not very positive about the change an worse still some was very frustrated that they now have an extra “burden” in their life. Mrs A was my patient in the first week of my placement. It was so easy at this early stage of the prac to just get in there and do what I had to do and not pay much attention to the patient as an individual. Mrs A had bowel cancer and underwent surgery to remove part of her bowel, which had left her with a stoma bag. My goal of treatment for day 1 post surgery was to get her out of bed and ambulating for 30m.When I met her I first introduced myself as a PT student and gave her a brief explanation of the treatment session for that day. She was not very responsive to what I had to say and looked unhappy. So, I asked if it was alright for me to begin and she ignored me. Then, I explained further on the importance of ambulating after a major surgery as such. The patient then replied “fine, just get on with it” in a rude tone. All throughout the assessment and treatment, Mrs. A was very reluctant to participate in the session. Although she did not respond well to instructions and was very passive throughout the treatment session, I still went ahead with the treatment as I felt the pressure of performing in front of my supervisor that happened to walk in that very moment as well as trying to keep time with the treatment session. In my mind there was only one thing I wanted to achieve with the patient and that was to get her out of bed and ambulating and I just did what I had to do to achieve that without any consideration of all the other emotional aspects that she might be going through at that point of time. I walked away from that session that day thinking I have achieved my goal of trying to get the patient ambulating but still felt discontented with the session, as if something was missing.
The next day, when I went to see the patient again, she seemed unsettled, anxious and just was not happy to see me as she recognized me from the day before. Then I just decided to have a sit down and have a chat before I started her assessment. I started having a casual conversation with her and asked her how she is feeling and coping generally. She started opening up to me bit by bit and I discovered that she was not coping very well with the new change but kept it to herself. She feels like she is all alone and no family to turn to for support, care and encouragement. Then I recommended that she talk to a counselor to discuss some of the issues that is bothering her. Just by talking to her this time, I felt like I was more in control of the session as she complied with the session better following the talk. I was able to achieve my goals for the treatment session that day feeling as if I have really accomplished it well this time.
I HAVE JUST REALIZED HOW COMMUNICATION GOES A LONG WAY IN TERMS OF ACHIEVING THE TREATMENT GOAL FOR THIS PATIENT. IN THE FUTURE THEREFORE, IF I WAS CONFRONTED WITH A DIFFICULT PATIENT, I NOW HAVE LEARNED THE IMPORTANCE OF TREATING EACH PATIENT AS AN INDIVIDUAL AND TO TAKE A MOMENT TO IDENTIFY THE PATIENTS PROBLEMS BEFORE COMMENCING TREATMENT IN THE HOPE OF CREATING BETTER PATIENT COMPLIANCE IN ACHIEVING INDIVIDUAL PATIENT GOALS.