My first placement was in a paediatric setting. It was my first time working with neonates in a cardiopulmonany department. I was doing my daily rounds and was assigned to treat a nine month old baby suffering from pneumonia. The aim of the treatment was to try and “clear” the baby’s lungs through percussions/vibrations and suctioning. As it was my intention to achieve the best for the baby, I spent 45 minutes carrying the treatment. My supervisor did not stop me along the way. However, she told me that I could have carried out the treatment in a much shorter time without putting the baby in distress.
As it was only my second week into the placement, I felt quite enthusiastic and was determined to perform a “perfect” treatment. I carried out a full objective assessment on the baby through auscultation and chest expansion. As saturations remained within an acceptable range, I continued with percs/vibs to loosen the secretions, followed by suctioning as there were audible crackles.
Was I wrong to continue with the treatment, or should I have shortened the treatment?
My supervisor commented on my performance and said that I did well. However, due to the age of the patient, too zealous a treatment may not give an optimal outcome. Although the saturations were within an acceptable range, the baby showed signs of distress through nasal flaring, which I did not take note of during the treatment.
Therefore, I learnt from this issue that I should observe the patient holistically instead of looking at only one parameter (ie. Oxygen saturations). In future, when rendering treatment, I should pay more attention to the holistic presentation of the patient and not be too enthusiastic trying to reduce crackles!
2 comments:
I think that on a whole most students in their first week or 2 on a placement tend to do the same thing as you did. We all get too hung up on firstly remembering and then carrying out the absolute perfect Ax and Rx exactly as we have been taught and told to do thinking that this is the thing which the supervisor is looking for where instead being a good PT is being able to treat the patient holistically.
I know I have had the same sort of thing in my 1st week of my paeds placement where I had a baby present with a condition and for the assessment we had an assessment form to fill out and so I just went out all guns blazing trying to complete every single part of the assessment and in doing so also tended to lose sight of how the patient was going. This is especially important with paeds as there is a very fine line where if too much is done then they spit the dummy and you may lose them for the rest of the session.
I've had a similar experience in a clinic of mine. I just finished a placement in ICU and i was treating adults with pneumonia and other cardiopulmonary issues. My treatments usually consisted of vibes/percs with MHI and suctioning, much like what you've described. At the beggining of my prac I found I was doing the same thing and tended to focus on the sats mostly. I think this was also partly due to the fact that I was doing so many new things and concentrating on a lot at one time that i forgot to really monitor the patient holistically. My first treatment lasted half and hour and my supervisor told me that even that was 'a bit too long'. There doesn't seem to be a set time but i think that with acutely ill patients, whether they are paeds or adults it is important to give a treatment that is efficient so they don't fatique.
It is so important for us to learn to treat holistically and not to focus on the problem/pathology but on the whole person. Although it probably wasn't the best treatment to have given the baby, we are going through a learning experience and these are all valuable lessons for us.
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