A 60 yr old male presented to my ward after having an ORIF on his ankle after suffering a distal fibular fracture 7 days ago. Distal fibular fractures are usually treated conservatively, so when reading the notes I began to wonder why this patient had his injury treated surgically. My aim for the session was to do a subjective and objective assessment and to teach the patient how to use A/C crutches. During my assessment I learnt that the reason this patient had an ORIF on his ankle was because he got a cast on his ankle 5/7 ago and when he got home he decided the cast was to tight so instead of going to hospital he decided to take it off himself, I also learnt that he had been given crutches and had been ambulating on them before the ORIF. So I assumed the patient would know how to use the crutches properly and gave them a brief reminder of how to use the crutches.
As soon as I got the patient ambulating with A/C, he did not listen to any of my instructions about slowing down or about how to turn and as a result nearly fell over twice; I was the only thing that stopped him from falling. By the end of the session I was very stressed as I felt I had lost complete control of the situation; and I didn’t know how to get the patient to listen to my instructions.
After the session I knew I was not clear with my instructions and that I needed to find a way to stop the patient from controlling the session as I deemed it unsafe. Upon reflection I knew next time with this particular patient I would have to come across very confident but I also had to be very clear with my instructions and if the patient didn’t do what I had asked, I was to stop him and explain again what I was expecting.
During the next session with this patient I clearly and confidently explained from a physiotherapy perspective how to use the crutches, how fast I wanted him to ambulate and that if I asked him to change an aspect of his ambulation technique it was for safety reasons and that I expected him to comply. I feel that the key to achieving a safe ambulation technique with this patient was to take complete control on the session and thorough explanation of the consequences was required to get the patient to adopt the correct ambulation technique.
IN THE FUTURE I WILL GIVE A THOUROUGH EXPLAINATION OF CRUTCHES TECHNIQUE AND SAFETY CONCERNS WITH ALL PATIENTS. I AM NOW MORE AWARE THAT SOME PATIENTS ONCE AMBULATING WITH CRUTCHES IGNORE THE PHYSIOTHERAPISTS INSTRUCTIONS AND THAT AS SOON AS I NOTICE THIS CHARACTERISTIC I AM TO STOP THE PATIENT AND EMPHASIS THE IMPORTANCE OF THEM FOLLOWING MY INSTRUCTIONS.
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3 comments:
It’s good that you went back the next session to clarify safety issues with the pt. I think as students, usually much younger than our pts, it can be quite intimidating to explain concepts that might seem so basic to the pt. I have also had similar situations in which pts think they are much more capable than they actually are, and their safety is put at risk. I have found it is often the more elderly pts who tend to get carried away, especially when they get shown a Zimmer frame for the first time! With the elderly pts I have found that by saying that they could fall if they continue to ambulate/transfer the way they are, is usually enough to make them take you seriously and listen. Being able to acknowledge the issue either during or after the session and self reflect has ensured your pt has received adequate intervention.
I think you went about the session well the second time around. I strongly feel that by slowing patient down and expalaining to them that what could possibly go wrong of they do not do something the right way is usually half the battle won. It is not always easy but persistence usually pays off in situations like this. Also be sure and take control of situations as best as you can is the way to go i believe. Well done anyways:)
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