I'm on my general surgery placement for cardio. A 73 year old male underwent a laparotomy 2/52 ago. He constantly refused ambulating with the nurses and physios. He also refused any input from physio and OT. We tried educating him on the dangers of prolonged bed rest, and even asked his partner to encourage him to ambulate, but he still refused. He occasionally sat out of bed in the chair, and only transfered to a commode for the shower, but most of the time was spent lying in bed.
It was very difficult to get this patient ambulating, and it would only get harder as time went on. After communicating with his nurse, OT, and my superviser, we decided on all of us to encourage him to ambulate to the shower. Through this, the physio and OT will have a better idea of his mobility, he would have had the exercise he needed, and have a shower aswell. Through this combined effort, I feel it gave us more control of the situation, therefore, making the patient less resistant. We managed to get him ambulating to the shower, which was the furthest he'd walked. I have not seen him since, but in my next session, hopefully he will be aware of what he is capable of doing, and be more compliant with physiotherapy.
USING A COMBINED EFFORT WITH THE WHOLE TEAM IS VERY EFFECTIVE, ESPECIALLY WITH THOSE PATIENTS WHO ARE NOT COMPLIANT. THIS TECHNIQUE NOT ONLY PROVIDES MORE MOTIVATTION TO THE PATIENT, BUT ALSO IS MORE EFFICIENT FOR THE STAFF (IE THE PATIENT HAD HIS PHYSIOTHERAPY AND OT INPUT, ASWELL AS A SHOWER ALL AT ONCE). WHEN COMING ACROSS A SIMILAR SITUATION IN THE FUTURE, I WILL COMMUNICATE WITH THE WHOLE TEAM REGARDING THIS SITUATION, TO TRY AND WORK OUT A SOLUTION TO NOT ONLY GIVE THE PATIENT THE REQUIRED INPUT FROM THE ENTIRE TEAM, BUT ALSO TO MANAGE TIME EFFICIENTLY.
2 comments:
I found that of all placements, the cardioresp placement requires the most team laiasing. It's good laiasing with the nursing staff on prac because then you're helping them out a bit, you get to know them more and then they don't seem as angry at students!!
As a student liasing with the team can be difficult. However its important in situations such as this to gain an understanding of the situation from other staff's point of view. Its also useful to discuss the techniques they have attempted to establish the approach which has been found to be effective. Someone may have discovered something that makes the patient more compliant.
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