Situation:
A 63 yr old female was transferred to our ward late last week with reduced mobility and behavioural issues. The handover was very unprofessional from the other physio and other allied health team members as they all seemed exceptionally happy to remove the patient off their ward and ‘handball this problematic patient’ over to us. They used words like “bitch” when describing this patient and had seemed to give up on further attempts of actually seeing this patient as she had swore at the physio and had not participated in active treatment for the last week. Before being transferred to our ward, the previous physio had set out a rehabilitation daily exercise schedule with the patient based on activities she would do at home such as “sit out of bed from 0700 – 0930”, “walk to the bathroom and back at 0930”, “sit out of bed from 1100-130” and so on. The patient had to tick off every activity on a sheet of paper every time she completed the tasks in order to show that she could follow a rehab program so she could improve and return home after rehab and not be sent to a hostel of which she expressed no interest in going to. Over the weekend, she had followed the programme minimally and earlier this week she had got into a screaming argument with my supervisor. As I was running the ward on the final day, I decided to see this patient instead of my supervisor to see if I could possibly help this patient actively participate in some physio treatment.
Task:
To take this patient for a walk as apart of her daily rehabilitation exercise programme of which she has been highly reluctant to participate in previously and everyone had seemed to have given up on attempting to deal with her.
Action:
From the feedback I had received about this patient before seeing her, I knew that she was very difficult and rude if you approached her the wrong way or suggested to do something that she did not like. She apparently also became very suspicious if you asked too many questions about her previous or current status and had a history of sticking her fingers in her ears when doctors and the allied health team tried to educate her about the importance of rehabilitation to return home. With this knowledge and advice from the team I knew I had to approach this patient with care and let her make the decisions of when to do the rehab.
To start off, I visited the patient in the morning to tee up a time which we would agree to meet and go for the walk together. Surprisingly the patient was very sweet to me and told me that she was ready “whenever it was best for me”. We lined up 2:30 and I left pleasantly surprised by the patient’s attitude.
When I returned at 2:30 on the dot, the patient sat up from lying in the bed and we discussed how far we were going to walk. I gave specific details about the distance we need to walk and instead of demanding her to get up, we took it slowly and at her pace. I was careful to not ask too many questions or critiqued her too much as I know these are things that have previously not worked for other people. The patient seemed to like me and I built rapport with her during the session by offering her drinks, tissues, discussing other things besides rehab and therefore when we went for the walk she was determined to please me. She said that with me she’ll make a personal best distance and she completed the task without any complaints.
Result:
The patient was very compliant and friendly towards me during the whole treatment session. I build great rapport with the patient and by the end was able to encourage her to do further rehab walking by herself. This subject usually initiates an argument between the patient and the messenger who suggests the motion but with me, she took the education I gave her on board. This treatment session was a positive step towards getting the patient into an actual rehab stream and finally returning home.
Evaluation:
The way I approached this patient was really well done on my behalf. Instead of taking the controlling position that many other people had tried, I instead let her have some control on the rehabilitation herself. The patient may have just been in a better mood today than compared with previous sessions but she was very compliant with me and I felt that I may have judged her before even meeting her. What I’ve learnt from this case was that you have to respect the patient and understand where they’re coming from. It was wrong of the other physios to call her names and pass on negative connotations about the patient, especially when they weren’t constructive or assisted with how we were to approach the patient. I thought it was very unprofessional for the other physios to call a patient a “bitch” and would never handover a patient using those terms.
My supervisor was very impressed with how I was able to interact with the patient and it was not only beneficial to me but the patient as well.
Strategies:
Always respect your patient. Use conflict resolution tactics with them if you know they are going to be difficult. Try building a rapport with the patient first before getting them to participate in your treatment session
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