Recently, on my paediatric placement i encountered a difficult situation which involved finding the balance between being friendly and performing an effective treatment. The situation arose when i was seeing a boy on a school visit. I had seen this boy for 2 half hour sessions a week for 3 weeks and we had developed a fairly good rapport. The previous treatment sessions had run reasonably smoothly, however the boy could be difficult as he has a short attention span and can not normally tolerate more than half an hour of treatment.
The boy has a diagnosis of developmental delay and especially has difficulty with arm movements crossing the midline. Treatment has consisted of practicing various arm movements such as windmills, swimming strokes, throwing and catching. The boy is generally a nice kid but he can be a bit cheeky and its important to stay in control. For the treatment session to be effective the boy needs to understand that you're the boss and not just his friend.
On this particular day it was the boy's birthday and he was turning 9. I started off the session wishing the boy happy birthday asking him what presents he got. After this i told him we still had work to do and that we better get started. Things were going fine until the boy became frustrated trying things that he wasnt very good at and then gave up. The boy said that it was his birthday and that he shouldnt have to do anything hard on his birthday. I told him that we still needed to practice even though it was his birthday.
I was trying to be firm but i still came across as being friendly. We ended up fininshing the session after not much longer as the boy was struggling to stay focused on what we were trying to do. It was taking a lot of bargaining and convincing to get the boy to do anything so i thought it was best that we left it there for the day. After the session my supervisor said that overall it was good but that i needed to be more firm with the boy and take charge.
I thought about the session later that day and realised that even though its good to be friendly, its more important to achieve an effective treatment session. Most of the time its possible to do that in a friendly way, but occasionally you need to be cruel to be kind. Consistently getting the best out of the treatment sessions is always going to be better in the long term. Does anyone else have any ideas, or any suggestions for what you can say to stay in control and take charge?
2 comments:
I think kids generally have a lot less patience and also shorter attention spans. Maybe try with more positive encouragement, more praises on the smallest improvement in an activity, then he may try a little harder for the verbal reward. He may not be able to see any improvement with a few practises, if you are able to point small improvement out to him and encourage him, he may be more involved. Just a suggestion, worked on one of my stroke patients but not sure if kids respond the same way.
i agree sometimes you have to be cruel to be kind to get the full effectiveness of a treatment session. Startegies i have used in the past when i have been presented with a situation is to make everything in your treatment as purposeful as possible and explain why you are making a patient do this in simple terms.. what is the benefit to them now (improve how well you move your arm)... and how in the long term they will benefit from a particular exercise (able to run faster, play footy etc.).Also kids love positive reinforcement and acknowledgement of how much they have improved. Maybe you could bargain a bit and suggest that if the patient works really hard in treatment session after they could tell you all about their birthday. Being to friendly before a session may disract them completely from why they are there in the first place
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