Chronic Pain

I’m sure it’s a situation we are all familiar with… a patient with chronic pain. Current patient- elderly lady, chronic back pain, in rehab hospital due to decreasing mobility and falls, focuses on pain, catastrophizes etc My job is to increase her bed mobility so that she can return home rather than off to a hostel or NH. Her pain is increased +++ with any bed mobility tasks. The first time I saw her and got her to show me how she gets in and out of bed, she cried due to pain, and could not get in or out of bed or roll without x2mod/max assistance, refusing to initiate any rolling herself. Obviously a rapport was not developed between us (as she then associated me with making her to do things that cause her pain). Over the next few days I gradually developed a rapport with her and starting building up to getting her to get in and out of bed independently ie. Activities on the plinth, weight shifting, going down onto her elbow, lifting legs a little bit independently etc. I thought I was doing quite well with her, and we were making progress… however, when my curtin tutor came in on Thursday she told me I wasn’t pushing the patient enough! This was really frustrating because I feel as though I have developed a rapport with the patient and know her quite well and feel that if I pushed her to get in and out of bed she would flatly refuse, cry, catastrophise and refuse any further physio. It seems like such a fine line with these patients… when do we push and when do we take it slowly? I thought I made good clinical judgement with regards to this patient, only to have my judgement questioned by my tutor. Now do I start pushing this patient like my tutor has suggested, or stick to my guns and my own clinical reasoning and do things the way I have been as it does seem to be working (but maybe not working fast enough??). Obviously I want to pass my prac so I will probably do whatever my tutor asks of me, but we are final year students now, almost at the end of the road, so when does our clinical judgement become regarded as highly as an actual physios?? There are 2 students at the hospital who were in the GEM program alongside us (ie graduated a few months ago so don’t really have all that much more experience than us) and I have noticed that their clinical judgements are never questioned!! Geez it’s going to be nice to not be a student…