to push or not to push

I am currently completing my cardiopulmonary practical at a major teaching hospital. As my fellow colleagues will be aware a major the role of a physiotherapist in this setting is encouraging the post operative patient to get up out of bed and begin to mobilise.
I have discovered over the past few days that this task can prove difficult. Let us first look at the situation from a patient’s point of view. Imagine you have undergone major surgery just 24 hours ago, you have woken up in a strange place, there are 3 strangers sharing your small room, your head and body ache, you feel nauseous and a little dizzy, there are ear piercing alarms coming from down the corridor plus you have 3 tubes coming out your body and 2 others going in. At least you feel somewhat safe in the comfort of your bed and finally, after an hour of moving around in the bed you have found a comfortable position when…… in walks the PHYSIO and asks you to get up out of bed and go for a walk.
From a physiotherapists point of view we know that it vitally important for our cardiopulmonary patients to sit upright and mobilise out of bed. We understand the physiology of the lungs, how anaesthetic and bed rest compromise the functioning of this organ, how upright position and deep breathing exercises help to reinflate collapsed alveoli and how clearing secretions can reduce chest infections rates. In a perfect world every set of lungs would sit out of bed day one, ambulate and demonstrate good breathing exercises, however as physios we don’t deal with lungs we treat humans!! And sometimes despite the best education and encouragement that you can give the human will just say “no”. So how do we know when to push for what we want and believe in or when to leave the patient be?? I asked this question of a supervisor of mine and she shed some light on the area, you can’t force anyone to do anything they don’t want to do. However the use of good bargaining and persuasion skills do not go astray, education tailored to the individual is an invaluable tool.
Obviously there are also times that call for compassion and clinical judgement for example, some surgeries on my ward are exploratory procedures, if the results come back with widespread inoperable metastasic disease, it would be inappropriate for a physiotherapist to insist that the patient gets up and walks around the ward shortly after they receive the news.
I have noticed a wide range of ways that different physiotherapists tackle this kind of patient, some are very strict and do all but physically pull the patient out of bed; others seem less keen to upset the patient and don’t really attempt too hard to change the patient’s mind. I guess knowing when to push and when not to push a patient will only come with experience…