I had a patient who was very deconditioned and had a history of cancer and current history of Pneumonia. Throughout my prac , I was treating him as a ‘cardio’ patient – doing all the airway clearance techniques etc. Later on in the prac, the Dr has classified him as a patient for palliative care because his cancer has matastasised to other parts of his body. This patient has a very supportive wife and the patient’s mood depends very much on his wife. The wife was sick for a while when I was treating him and she didn’t come in to visit for a few days. During those few days, the patient became very agitated and non compliant with all the staff on the ward. It was very difficult to get the patient to do anything, I tried very hard to explain to the patient that it is important to clear out his secretions and it will make him feel better. I also re-ensured him that his wife will be fine and she will be coming to visit soon. I liaised with the nursing staff so that I can walk him to showers instead of taking him to the shower in a commode – to make the task more functional for him and it will benefit him as well. I also learnt that we have to be forceful to patients sometimes when they are not compliant as long as we know that the task we are trying to do will benefit the patient. There was one treatment session where I asked my supervisor to come along and we had to do a fully dependent transfer to get the patient sitting out of bed. That session ended well and the patient was able to clear out his sputum (quite a large amount as well!). From this experience, I have built my confidence with treating difficult patients and learnt to modify treatment sessions to get the result I want. At the same time, I also learnt to treat the patient with empathy and be understanding to his psychosocial /emotional behaviours. If I was to encounter the same situation again, I will do the same thing and try harder to liaise with nursing staff to get the most effective treatment out of the patient before they get annoyed.
Monday, June 16, 2008
Palliative care patient
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I really like the way you have incorporated your treatment into the patients daily activity, walking hime to the shower. Currently I have a COPD patient with an infective exacerbation that I see at his home and I am having difficulty in getting him mobile he says he knows it will make him feel better but he just feels too unwell and apologises to me for being a cantankerous old man. I too have learnt the need to be more forceful with the noncompliant patient when we know the task will benefit them. We also need to be quite inventive in making the mobilising task seem attractive to the patient.
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