I was on an Ortho inpatient placement earlier this year, mainly treating patients who had just had major joint replacements. My patient was a lady in her 70's who just had a TKR, and had a past medical history of arthritis and 2 CABG's ~ 20 years previously. Whenever I brought her to the rehab gym, she was always very stressed and worried that the exercise she was going to do would cause her lots of pain (as she felt pain on movement in bed) but also place so much strain on her heart that she might have a heart attack. Every exercise she completed she did with her hands gripping the edge of the bed and a look of constant fear in the eyes. She also became quite aggressive in her manner towards me, and cried as she wanted to go home.
I'd tried techniques such as ice to reduce her pain and ensured she'd taken her medication prior to her treatment, but still the pain for her was massive. It finally clicked for me that it wasn't her pain, it was her anxiety throughout the treatment that was causing her problems. So, every time I treated her, I talked to her about what her hobbies were, what jobs she'd had etc. in order to distract her from her pain but also to develop a rapport with her. Much to my surprise, it worked! The more we talked to one another, the less her pain and the better quality treatment I was able to give her.
What I learnt form this is that the symptoms that the patient experiences may not necessarily be through injury or surgery, rather the personality or anxiety that the patient has. It was an eye-opener for me, and further reinforced the principle that you treat the WHOLE patient, not just the presenting complaint.
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3 comments:
Well done, it seems as though you found the main source of the problem and used techniques which we haven't learnt from a text book to fix that problem. I found another effective way to treat these sort of patients is to involve them in a group treatment session with one or two other patients who have had similar surgery but are not experiencing such high levels of pain.
Congratulations on figuring a way to treat this particular patient. I have found the same sort of thing how the patients perception of pain is so great that it inhibits them receving the optimal treatment as their so concentrated on the pain. I once told my supervisor about the same problem and they suggested exactly what you did and I agree it works unbelieveably well.
Good job, building a rapport with your patients' is not only going to make their treatment more effective, it is also going to make you feel like you've had a successful experience. Always finding something the patient likes to talk about goes along way towards effective treatment.
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