Week 2 Day 8 Entry 2

Yesterday I observed a significantly different treatment session. The patient was a frail 82yo woman who suffered from severe depression, diabetes, Meniere’s disease, and Parkinson's disease. The patient was reporting frequent urinary urges especially during the night (sometimes getting up 10 or more times in a night), causing her and her husband/primary carer sleeplessness and fatigue. The pt had been referred to a continence nurse, yet the patient's symptoms were persisting. As the pt had significantly reduced mobility and cognition, the husband was required to transfer her out of bed, onto the toilet commode, and then back into bed each time.

It became obvious after initial questioning that the husband was suffering from severe carers stress, and was not coping with his wife's high level care demands. The husband was planning on admitting his wife into hospital so he could have some respite. Therefore the treatment session involved educating the patient and her husband about the possible care options and how to go about applying for a placement at a nursing home, and some emergency respite. My supervisor and I provided the patient with brochures (such as commonwealth care link), spoke with their son and daughter in law, and organised a referral to an ACAT officer/ social worker to make an assessment.

The patient was very weak and fatigued; therefore I considered her health to be unsafe and a contraindication to her treatment program at the clinic. It was necessary to use this session as counselling and education so that the couple had a chance to speak to someone about their troubles and worries (as the social worker has a huge waiting list and would not be able to assess the patient for a few weeks). I think my supervisor and I did the best we could to try and ease their present situation, yet I was still left feeling that we should be able to do more. It is very hard to place a patient into emergency respite, and it takes many weeks for all the complex forms and assessments to be processed and the patient moved into a faculty, so unfortunately this was all we could have done in the circumstances. This experience was also about recognising the boundaries of physiotherapy and where/when a social worker/councillor/psychologist referral should be made.

This situation didn't make me feel confident nor comfortable, as I was aware of the extreme stress and depression that the patient, and to a large degree the husband, was under. I do think, however, that I would have provided the same advice and education to a patient if a similar situation arose. Yet it would be ideal if a social worker was more available and the emergency respite was more accessible.

I learnt from this session that it is essential to recognise and attend to the carer, as their health and well being has a large impact on the welfare of the patient. So I now understand the necessity to treat the patient holistically which includes considering the carer and their environment.

In addition to observing this patient's treatment, I also performed a number of time trials and more objective assessment which has been useful and worthwhile practice for me. Tomorrow I am learning about the government statistics database (AHS) and how to perform phone reviews.