I am currently on my rural placement in the Kimberley, and it has been the most rewarding and the most frustrating of all my placements so far. I'm learning so much and am really enjoying it. Recently I've had an elderly inpatient from a rural aborigional community admitted post CVA. She presented with right UL paresis but no problems with her LL. This seemed a bit strange to us and the physio wanted to assess her. She told me that she would take on this patient as she was known to be a 'difficult' patient to the people on the ward. After half an hour, the physio came back to me looking quite annoyed and said that the patient had withdrawn from her during the assessment, sitting huddled on her bed and wouldn't look at her. All she was saying is "you talk too much!" The same day the OT got the same reception half way through her session.
When the next morning came and the physio walked into her room she immediately withdrew... so I was asked as a last resort to go and see the patient. I didn't have a great idea of how to approach her but i did know not to talk too much!
I grabbed a stick and casually walked into her room, I said "G'day X, I'm Sophie, here to make the arm better, lets go for a walk" and then I stood there and waited. She looked me up and down and after a strange silent minute or so she sighed, got up and took the stick out of my hand and off she went. I couldn't believe my luck! Neither could the physio. When she was tired she sat down and I sat next to her. I needed to assess her R UL so I said that she did so well I wanted to give her some high fives...she lifted her arm to my hand. I was also able to test her strength and get her a glass of water so that I could assess her ability to perform this activity and the voluntary movement she had in her wrist and fingers. I gave her exercises too. Most of my treatment was done without saying much, but I found she was happy to talk about fishing and hunting and where she was from.
From this encounter I learnt a few things...a lot about communication, how we tend to do so much explaining and talking when really it's not so necessary. I learnt that you really need to get the trust from your patient and build raport...then you'll be able to do almost anything and I've also learnt up here that you have to be a lot more opportunistic whith assessment and treatment of patients.
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2 comments:
Good work. I guess this illustrates that some people are more inclined to want to 'do' rather than 'talk'. Nice strategies for assessing movement and strength. I cause another way would be to get the person to demonstrate activities they partake in such as 'throwing a fishing line' or 'using the hands as in meal preperation'.
We definatley come from a culture that likes to talk, a lot! Sometimes its very hard to know when to keep quiet. You did a very good job at knowing what was important enough to say, and what wasn't. I'll definatley take your advice when next treating an Abourignal patient.
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