I have another surgical patient who has undergone a major abdominal surgery. I was again the “physio” to mobilize her day 1 post op. This patient has an altered understanding of her post op recovery – she thinks that it was ‘too early’ to mobilize so soon after surgery and she is very dominant in nature. On day 1 post op, her pain was not very well controlled and she was very irritated when we asked her to SOEB at least. She reports subjectively 10/10 pain at rest (using PCA which was not helping at all), however, she was able to talk to us with no cringe in the face, and was able to move her legs freely but was not compliant at all to what we wanted her to do. So, day 1 post op we only managed to give advice/education about breathing ex and circulatory exercises and did a chest assessment with her lying supine. When we returned the next day, her pain was better controlled but she was still reporting high levels of pain but was more compliant this time. She was able to ambulate 1xSB assist with no aids and just needed assistance with pushing the pole with all the attachments on it. She then made comments about not having enough sleep and we shouldn’t make her to this so soon after surgery and asked us not to interrupt her when she is ‘asleep’. I think if she had a better preop (if she had any) education about her operation and recovery period, her attitude will be better and more compliant. What I did was mostly liaising with her a good time to visit and really explaining myself to why we need to mobilize and not to allow the patient to dominant over us !! This patient is progressing really well compared to other patients I’ve seen and she does feel better after moving around, it just takes a bit of convincing and explaining.
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3 comments:
Well done, Candy! I had the same experience when I did my orthopedic inpatients prac at a private hospital. Some patients can be really difficult even without experiencing any pain. As a student especially at the beginning of the year when we just started doing prac with not much experience handling patients, it is always good to approach our supervisor for help and we should even pass on difficult patients back to the supervisor or an alternative physio, as patients who are highly uncooperative and whinge at all times can easily affect our confidence and impede our learning on pracs. Good luck and enjoy the rest of your prac :)
Interesting that you should mention that you think pre op education would assit with patient complience. This does seem obvious, but it actually can reduce length of stay and recovery on certain situations. In particular, I was doing my ortho placment and the clinicians there had a very well structured pre op clinic for people undergoing totla knee and hip replacments. Patients were walking day 1/2 post op woth crutches and did remarkably well, not to mention were sooo easy to treat: they hung off your every word! Everything was explained to them: from surgery to what they would expect form physio day 1. This made me realise just how improtant spending some time explaining things to your patient before treatment is. Since that placement I have made an extra effort to ensure my patients understood the treatment and rationale well, and have hardly ever had a compliance issue. I will continue to apply this in my futir clinical practice.
I think many of us have been in this situation! unfortunately even if a patient has had adequate pre-op education they can sometimes still pretend to be ignorant as to what is expected of them, as they prefer to sleep and not move than mobilise and exercise. I think you did a good job tackling this tough situation. good work!
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