I'm in cardiothoracic ward on my cardio prac and got the mid-placement assessment last week. I had 2 sessions with this patient who underwent Ivor Lewis oesophagectomy due to adenocarcinoma 6 days ago.
Subjectively he was quite well and keen on mobilising in the morning, so he ambulated about 100m with only one rest and did DBXs with supportive coughs. When I saw him second time in the afternoon though his face looked quite flushed and anxious. When I was ambulating him, I thought he could at least walk the similar distance which he made in the morning. He sat down in a chair for a short rest after about 25m walk and told me he couldn't do anymore and refused further treatment. I think there is very fine line; when I have to listen to the patient and modify my treatment, and when I push the patient a bit so that he can achieve more than what he is actually capable of. On top of that, he is quite impulsive and anxious. Because he has so many drains and IV lines, I always have to make sure that everything is sorted out on the trolley before he actually gets up, though he tends to stand up too quickly. I should, therefore, make clear instructions and assure him throughout the treatment.
So my point is that I always have to listen to what the patient tells me and be flexible depending on patient's personality and behaviour type. You cannot expect that the patient's condition would be same even on the same day, and every patient is different and individual.
Hope you all are enjoying your prac:)
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Hi In Sun,
I agree that is important to listen to what patient tells me and be flexible. I had very similar experience to ours. On top of that, I think it important to have skills to recognize and interpret patient’s verbal communication (what patient says) and non-verbal communication (how patient reacts, behaves).If there is any discrepancy between verbal and non-verbal communication there is need for appropriate action. For example, patient who reports that is not able to perform independently self-caring activities. However, from observation and nursing staff reports is obvious that patient is independent with self-caring and ambulation but very anxious++ maybe more than more physiotherapy treatment this particular patient needs psychological management to overcome his/her anxiety.
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