Hi guys,
this week of placement was pretty uneventful. I had this patient though who had a huge stoma bag post-laparotomy. He complained his stoma bag was leaking and it was only after a few hours that the nurses decided to change his stoma bag. Instead of going for morning tea, i decided to stick around and help out.
The first step was taking off the existing stoma bag. That was ugly business.. and smelly too. The glue had to be removed with special wipes but because the previous nurse didn't shave him, the glue was adhering to the skin and was really painful to remove. The next step was cleaning the area. I helped to suction out some debris but the rest had to be cleaned out with dailee wipes. All this time the patient kept cursing and swearing as it hurt so badly. Then the last step was just shaving him and then putting the new stoma bag on.
Ever since that incident, the patient seemed to be in a really bad mood all the time and has refused physiotherapy even after 2 days. He declined even getting out of bed and requested to be washed in bed instead of ambulating to the shower which he normally does, stating that he just doesn't need physio? (He reports no pain or discomfort and has declined even after my supervisor and i tried to talk to him) And i was wondering why he suddenly changed his attitude (he was previously pretty motivated to ambulate and was walking well with a WZF), and though it sounds a tad silly, if i did anything wrong by helping or if there was anything else i could do to make him change his mind?
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2 comments:
Hi sharon
First of all good on you for staing and helping out...not sure I would have done the same! A thought on why the change of heart re: treatment may be that you were witness to an event that was painful and I can only imagine quite embarrasing for the patient. This is a task normally also performed by nursing staff and not physios. He may be feeling uncomfortable and that you saw him in such a vulnerable position and is having a hard time seeing you in the role of physio again. It could also be that you helped play a role in causing him a great deal of pain and is associating that pain with seeing you and doesnt want to be in pain again. Of course I am only speculating here, but these are the kind of things that may be going through his mind. And unfortunalty I dont really have any suggestions on how to change his mind except talking directly to him and trying to understand how he might be feeling.
Hi Sharon,
I had a few reflections after reading your message.
Personally, I think even that empting/changing a stoma bag is normally performed by nursing staff, it can be beneficial from physio point of view to see at least once this sort of procedure. It can help in better understanding of patient's "others issues" that can influence on physio treatment.So you did very well!
Secondly,if I were in your shoes I would probably start with presenting the pros of mobility and cons of immobility, then I would like to find patient's motives for physical inactivity (pain, fear that stoma bag will leak again etc).When the reason for withdraw from physio is known is easier to figure out a strategy to overcome this issue.
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