I've been doing my prac in Geriatrics. Recently came across a 75yo Croatian lady. European, and family was brought up quite wealthy. Her diagnosis was a subarachnoid haemorrhage. She has had prolong stay in ICU and have been on the geriatrics ward for about 1 month now. Pre-adm status (according to the family) was (I) amb and all ADLs. This lady didn't speak english at all, luckily she has 7 daughters, and they all rotate to visit her. Basically there was a family member available from 9am - 9pm each day. They were useful for interpreting. Well that's what we all thought.
Now there are 2 main routes for discharges in hospital from geriatrics- Home or Nursing Home. This 75yo lady's current status is 1x(A) with Amb and T/Fs. She is terrified of falling and walks with a really funny posture. She is fully flexed at hips and her weight are on her heels, so basically she is falling backwards most of the time. It normally takes us 15mins just to convince her to walk. The family negotiates with her...... and this patient is a talker. She just keeps talking even when the family is not there and that we don't understand her.
It was one of the first time i saw her and wanted to get her up and walking, so i went in and told her my plan (Daughter interpret) after 15mins of talking, she agrees to go for a TINY walk, not long! I went to assist her stand, she keeps falling back into the chair not shifting her weight onto her feet (due to fear of falling forwards). So i went to place my hand onto her ischial tuberosity to facilitate the movement. She just went OFF! Point her finger at me. I knew she was telling me off for touching her bottom. I went to ask the daughter what she said, and she says "Oh, she is saying how thankful she is to get physio and think you have beautiful eyes" .... my thoughts were "Bullsh*t!" (seriously). This scenario becomes a common occurence, what the pt said was not what it is relayed back to me. That affects treatment greatly. I did gathered there was a cultural difference, that a 75yo european lady would find it offensive for a 24yo male to be touching her bottom. I continue to treat this pt for the next 5 days and couldn't get any gains. She was later transferred to another ward and was treated by a female PT instead and it seems to be working out better.
With this scenario, i've learnt about cultural differences. It can really affect your treatment
-male treating female
-incorrect interpretation. The family is really nice and didn't want to offend me by what the pt has said (i'm sure it was rude). And that affects treatment, because if i didn't read her non-verbal language and continued to facilitate from ischial tuberosity, i would really put her off physio and further offend her.
-family values: sign of disrespect to send your mother to a nursing home, regardless how dependent she may become.
So for next time, identify the signs earlier and try different avenues (ie. PT of the same sex).
Subscribe to:
Post Comments (Atom)
1 comment:
i think you were in an impossible situation to help this patient: a) you couldnt understand her and (b) her interpreters weren't translating what the patient was telling you. even if it was rude it would have allowed you to address the problems and maybe you could have founded out earlier that she would have preferred a female physio. i think you persevered in a tough situation! did the nurses have the same degree of cooperation from the patient as you?
Post a Comment