My recent cardio placement was on a surgical ward which meant that my role as a student physiotherapist was essentially to get the patients up and moving after their surgery. This would then help the patient by minimising the harmful effects of reduced lung volume post-operatively.
Most of the patients i saw were fairly cooperative, this was normally because they either wanted to get out of bed and get moving, or because they knew they had to. However, i did come across a couple of difficult patients which im sure you would find anywhere that you worked.
The particular patient that I wanted to talk about was a fifty year old woman who had endured quite a long stay in hospital. She had been through a number of surgeries and also a few different physio's had seen her while she was in hospital. On one particular morning i was told that i needed to see her to get her up and moving. I entered her room and said that i had come to help her get out of bed and go for a short walk. The patient refused and said she was too tired and didnt want to go. I then said i could come back later and we agreed that 3pm would be a good time. Sure enough, when 3pm came around and i went back to see her she still didnt want to get up. The patient looked at me with disgust when i tried to reason with her and then she started ignoring me. I explained that we needed to at least get her sitting over the edge of the bed so i could listen to her lungs. After much persuasion the patient very reluctantly agreed to that.
I was sympathetic to the fact that being in hospital for a long time would not be much fun but i also had a job to do. I was quite annoyed with how rude the patient was to me but i had an idea to tackle the problem for the next day.
The next day i spoke to a female student who was doing the same placement as me and explained the situation. I asked the other student if she would mind seeing the patient today and she agreed. I felt bad about handballing my worst patient off to another student but i had a feeling this particular patient might respond to females better. Next thing i know i was sitting at the nurse's station writing notes and my patient walked past with the female student and not only that but my patient apologised to me for being soo rude the other day. I was quite shocked but really pleased that the patient had realised that i was only trying to help her and that she went to the trouble of apologising. I felt that the situation was resolved and i was glad that my idea of trying a different approach had worked. This occured at the end of my placemet so i didnt end up seeing this patient again.
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3 comments:
That was great that you picked up that your patient may respond better to a female physio, and you clearly got the desired outcome with your patient up and moving, thereby reducing their risk of devloping a post-op complication. My only concern is that at times on a busy ward there may not always be a physio free to help out. Some strategies I've used to mobilise reluctant patients is taking them for a walk when a family member is there (after you have explained the importance of you're Rx to the family member they are usually great motivators as they want to see their relative get better), also communicating with the nursing staff and timing a walk just before or immediately after a patient is having a shower as they have to be up for that anyway. I'm glad you're patient sought you out to apologise, as its times like those you realise that their comments are not aimed at you personally but at the situation they're in.
I've often been in similar situations where patients feel I'm either too young to know what I'm doing, or too small/ weak to stop them from falling. Sometimes the only option is to "handball" them to another member of staff that the patient will trust and identify with. However, though I know it's not my own fault, nor does the patient have a personal grudge, it's often disheartening when someone else can effectively do the job that you should be capable of doing. I find that I need to remind myself that there have been certain health professionals that I won't be seen/ treated by for my own personal reasons. As discouraging as it may be, it's important to respect the wishes of our patients, whatever they might be.
hey you did really well with managing that situation. dont feel bad about the patient not responding well to you- it happens to everyone sooner or later. when you're suggested intervention is a walk, one thing i've found with patients who aren't very enthusiastic or compliant is to tell that you'll just do a couple of steps. then once they've done a few steps, ask them to do a few more, then a few more etc. by this stage most patients have forgotten that they were only going to walk a few steps and will go quite a way with you.
i think you did really well by remaining objective when the patient was being rude to you, and not responding in kind. this probably played a big part in her apologising to you. that is a really effective strategy for patients such as these.
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