1st Entry- WEEK 1

Situation
On the first week of my placement on the 23/06/10 I was asked to perform a subjective and objective assessment on a 22 year old woman of aboriginal decent. This woman had given birth to a baby girl the day before on the 22/06/10. This was the first baby she had birthed, she had previously miscarried one other child. The baby was 2.956kg but otherwise healthy , the woman had a long second stage of labour ( 1 hour) and she sustained a 3rd degree tear to her perineum, the birthing process was a difficult one and the doctor decided to use forceps to aid in the delivery process. She was resting in bed when I arrived in her room and the baby was asleep in the cot/cubicle.
This was my first practical where I had been exposed to women’s health physiotherapy. I was very unsure about how this session would go.

Task
I was asked to perform a subjective and objective assessment on this 22 year old woman and then proceeded to treat the women with my supervisor.

Action
I went into the room, introduced myself and first began questioning the young aboriginal girl. I asked her about her pain levels, if she was doing anything about her tear, her urine leakage, any back pain she was having, what her usual level of activity was before and during the pregnancy, I also asked her if she had heard about pelvic floor muscles and did she know what pelvic floor exercises were.
I then performed an objective assessment, I then measured her diastases and had a look at her abdominal tone, I also noted her posture during the assessment and how she was breathing. I also noted her level of contraction of transverse abdominus when I taught her a pelvic floor muscle contraction. It would have been good to see her perineum to note the level of tissue injury (I did read in the notes that it was a 3rd degree tear) but she was uncomfortable with this, so we did not perform this part of the assessment.

Result
I performed the subjective and objective assessment and from this accurately found out her problem list so I could develop a treatment plan for this young mother.

Evaluation
I think that the session went poorly I don’t think the young girl trusted me; she seemed very reserved and didn’t really want to talk to me about certain symptoms she was experiencing, for example it took a lot of questioning to find out she was having urine leakage. It took me a very long time to describe the pelvic floor and the reasons for the symptoms she was having. The whole assessment went for 25minuites. It was even difficult to assess her diastases between the rectus abdomens muscles, because she was reluctant to participate in the assessment session.

I think there were only a few strengths with my session. I think I got all the questions out that I needed to ask her. I think I also accurately found out her problems;
1) weak pelvic floor muscles, 2) a large diastisis 3) poor abdominal tone 4) a 3rd degree tear in the perineum.

Strategies

I was thinking of how I could improve next session if I was faced with another young aboriginal mother. I came up with a list of strategies that would help with the subjective and objective part of my session:

1. When dealing with aboriginal people who sometimes don’t have a good grasp of the English language, use simplified descriptions of what is occurring and it’s also helpful to use analogies so they better understand the problem.

2. Ask direct questions; sometimes even explaining why you need to ask them a certain question. ( i.e. if you have to ask if they have had any leakage of urine?; I would explaining to her that “this will tell me if you may have a pelvic floor weakness”.)

3. Keep the questioning as short as possible, often only asking impertinent questions as they can loose attention easily and can get very agitated with all the questioning.

4. Use diagrams and pictures when explaining muscles like the pelvic floor as they are easier explained in a diagram.

5. Try to find a common ground with aboriginal people i.e. develop a report with them so they gain a certain amount of trust in you, and you don’t appear as threatening to them. This also makes it easier when progressing to the treatment phase.

6. When assessing someone who is sitting down if you are standing, always lower yourself to their level or sit lower than them so you don’t seem domineering.