Anxious Patients

Whilst on my cardiopulmonary placement, I was required to see a post-op CABG patient. This patient had been transferred from a primary to a secondary hospital, and was awaiting discharge for home. Despite his relatively good post-op progress, this patient was very anxious and was always very reluctant to do his exercises. He always required constant reassurance and thorough explanations, to educate that he was doing well and that it was ok to move!

As part of his preparation for discharge, my supervisor was keen for this patient to complete a six minute walk test and compare it to previous results. When I mentioned this to the patient, he did NOT want to do this, as he had a bad experience inclusive of heightened chest pain and being “forced” to complete the test. I reassured him that this time would be different and if any of these symptoms were reproduced it would be ok to cease the test. Despite trying to reason with him (and beginning to feel a bit frustrated!), it did not change his outlook.

I informed my supervisor of this, whom said that my reasoning to the patient was sufficient and to see him again in the afternoon. My supervisor informed me to tell the patient that I would not get him to perform the six minute walk test, but rather simply measure how far he could walk in six minutes simply to get a baseline measure for his return to home. Even though essentially I was explaining the same concept to the patient, it was surprising that when I explained it not using the word “test” at all in my explanation, he agreed to do it. I did not use the standardised instructions of the six minute walk test as I wanted it to be performed in a more relaxed environment (due to his heightened anxiety), but still was able to use the essential elements of the test.

As I did not use the standardised instructions, track etc for a six minute walk test, I could not call the results a true reflection, but was at least given a general idea of this patients exercise tolerance. I never really thought that changing my tact ever so slightly (e.g. not using the word “test” or making the environment more relaxed) can influence a patient’s participation in a task to such a large extent. From now on, I will try to be mindful of my explanations to patients and structure these in such a way as to best consider a patients personality and emotional status.

Time Management

With all experience thus far on clinics i have found it difficult to establish the amount of time to spend with each patient. With musculoskeletal outpatients the time allocations were restricted by appointment schedules however at times by the end of the treatment session their were techniques that you still wished to apply. With experience less time would be spent on assessment, allowing a more productive treatment sessions. I understand it is a delema that will ease with clinical experience.
On placement at ICU I began to question how long to spend bagging, doing viabrations and how many times to suction etc. When the chest is cleared you have a effective treatment session but when you have remaining secretions you wish to give the patient a break from suctioning which is quite an invasive, uncomfortable treatment. With vibes and manual hyperinflation i wasnt too sure of the effective time to spend on each and literature was lacking.
On placement at Graylands i encounted time management problems as you carry out physiotherapy with non compliant patients. It made you question if you should see these patients or spend time with compliant patients. You do not wish to neglect a patient but if they can not maintain your gains with treatment should we discontinue their future treatments.