I had been treating a patient on my neuro prac who had sustained a R MCA, CVA. She had very mild impairments, with no voluntary control of her R hand the major problem. There were NAD in her R LL. The sensation of her R and was intact, there was just a mild proprioceptive impairment of her R MCPJ JMS and JPS – anyway – the bottom line was she was not a patient who presented with ‘heavy’ stroke symptoms.
This patient was extremely optimistic and always motivated for physio. She was a pleasure to work with and felt I had really good rapport with her. I had been treating this patient since her admission (1 week).
I went to see her on this particular day, she was lying in bed and there was a gentlemen sitting next to her bed on a mobile phone. I didn’t pay much attention to him and was not listening to what he was saying when I went to her bedside. I went in with a big smile as I did everyday and was expecting her to return it as she always did. She looked at me and said “I don’t think I can come to physio today.” I asked how come and she said she had to have an operation on her neck as this was the artery which had caused the stroke.
I then tuned in to what the man on the phone was saying and realised he was talking to her daughter and saying he ‘had explained the procedure and it was scheduled for a few days.” This patient looked at me and burst into tears and said “I don’t want to die.”
I sat with the patient and consoled her until she calmed down, which she said she was very grateful for. I then said we could do physio the next day if she felt up to it. She then looked scared and said “no, I don’t think im meant to move around to much because I might re-stroke”
Not knowing a lot about the carotidendarterectomy procedure, I told her I would find out about still doing physio.
I contacted her docter and asked about continuing physio and he reported that it was completely fine (as long as we didn’t manip her neck) and that it would be beneficial to continue to improve her baseline level in the first place. He wondered why she had the impression she wasn’t allowed to move. I said to him that she may be in a bit of shock and coping with the news and may have misinterpreted him, and asked if he wouldn’t mind reassuring her it was ok to move. (this was the day before the weekend, and I was just imagining this patient not moving her neck or body for the whole weekend out of fear) he said that would be no problem and was happy to see her.
After this, the patient was SO grateful I had asked him and was so excited that she could still come up to physio, and whilst she was still slightly anxious about the op, the routine of doing physio and OT and the ‘normal’ for her during the day appeared to really benefit her.
This taught me firstly to read a patients body language and the situation better, as when I first went in to see her for physio I expected her to be like every other day. In the future I will keep in mind that anything and any news can happen very quickly in a hospital and to be aware that even the most cheerful person may just have received difficult news.
Secondly, by following up with the doctor and asking him to reassure her, had such a huge benefit for this patient and decreased her anxiety immensely. He hadn’t realised she had misunderstood the mobility issue, and by being with someone who deals with that, I was able to follow it up and continue treatment with this lady, which we both enjoyed!!
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2 comments:
Well done, it sounds like you had a really good rapport with your patient and that helped you realise when something had changed.
I have come across similar situations after surgeons rush in during rounds, give the patient some vague instructions about weight bearing status and leave. The patients notes say ambulate NWB but the patient refuses to move as the surgeon said "don't use your leg".
As health professionals seeing these patients everyday we are in a perfect position to clear up any misunderstandings and alert other staff to potential problems, as you did here.
Well done Alli. It would have been quite easy to walk away, thinking 'well, if that's what the doctor said, then I better not move her'. But instead you challenged what you suspecetd to be a misunderstanding and made a really big difference to this patient (and also to her concerned family's) day.
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