Education = Efficiency

This is another reflection from the SDP undertaken in a Fijian Hospital…

During a ward round in the trauma/ortho ward, we questioned what sort of exercises these patients were doing. The patients in question had all sustained high impact fractures, were all in bed traction, and therefore had been, or were going to be on bed rest for anywhere up to 8-10 weeks.

The physio replied vaguely that some of them sometimes do bed exercises, however chest care was done routinely (they considered this of higher importance). We spoke to the patients on the ward, who reported ‘not really doing much’ whilst being in bed. Some had been shown exercises at the beginning of their stay, but had forgotten or not known what they were for, so hadn’t done them.

We were pretty amazed that something that is drummed into us at home in an ortho ward (the importance of bed/maintenance exercises, to prevent deconditioning and speed up recovery) was relatively overlooked at here. We were wondering if it was influenced by the patients wanting to stay in hospital (free accommodation and meals). We have the mentality in Oz that the patient needs to be D/C ASAP to make room for another patient (and how much it costs the government to keep patients in hospital) so we push bed exercises to facilitate D/C.

The time we spent with the patients on the ward, involved not only teaching them relevant bed exercises, but leaving them with hand drawn pictures of the exercises next to their bed and emphasising what they were for and how important they were.

We did appreciate that the physio’s were short staffed and lacked equipment, so we worked on a way that we could educate the local physio’s and make this an area that was done routinely. As efficiently as possible for the physio.

One of the tutorials we ran emphasised the importance of bed exercises and education and demonstrated a “Mobility continuum post orthopaedic injury and discharge facilitation”

A major point emphasised was the fact that education to a patient is SO important, and that they, as physio’s, have a MAJOR role in this education. The patient needs to know why they were given the exercises to increase compliance. The local physio’s, we found, had excellent theoretical knowledge, however there was a gap between this and their clinical application.

There were many areas that needed attention in the hospital, however our supervisor advised us to have a couple of small goals, otherwise you don’t feel like you have achieved anything.

So one goal, that we hope we achieved, was to emphasise the importance of bed exercises and a physio's role in education. We developed 2 patient handout sheets (one each for UL and LL injuries), we photocopied heaps of copies and left them on the ward, easily accessible.

I guess that our recognition that this was a major component lacking in the physio’s treatment, made us realise how important it was to us aswell. We understood the importance of education enough to teach someone else how useful it is.