This week, I learnt the importance of being more assertive with patients.
The patient was a 70 y/o male admitted due to an exacerbation of COPD. His main problems were dyspnoea and decreased exercise tolerance. Treatment included breathing strategies to decrease dyspnoea and ambulation.
The patient had limited English (but was able to understand the bulk of what I said) and was reluctant to comply with physiotherapy treatment.
On the first treatment session, the patient only ambulated 20 metres and refused to go further despite plenty of encouragement, as he was SOB. His exercise tolerance pre-admission was about 20-30 minutes of slow walking in the shops. In subsequent sessions, the patient only ambulated to a maximum of 50 metres. To deal with this, I had to continually state the importance of ambulation. I also made it a point to come in the mornings when the patient was resting in bed and finishing off his breakfast. This was because, I realized that the patient did not want to ambulate after he had been to the toilet or had a shave, as he was feeling SOB. To facilitate the effectiveness of the treatment, I liased with the patient’s daughter, explained the importance of physio and requested that she was there during one of the sessions to assist with translation. That treatment session was very successful, as the patient was able to understand the finer details. The daughter gave further support and encouragement, and the patient ambulated more without complaints.
In addition to his reluctance to ambulate, he absolutely refused to allow me to turn down the oxygen flow. He required only 1L/min at rest. However, he has been insisting that the doctor said he needed 2L/min at all times. On each treatment session, I had to explain clearly the effects of having too much oxygen. After much persuasion, the patient gave in and allowed me to turn down his oxygen to the required amount.
In future, I will be more assertive and persuasive when dealing with more difficult patients. I will explain the benefits and importance of doing physiotherapy (eg: ambulation, deep breathing exercises etc.) Last, I will strive to make the treatments more relevant in the patient’s life so that they will be motivated to do the activities.
2 comments:
You did well. I have already done my cardio placment, and have dealt with a mumber of similar patients. You definatly need to be more assertive and try different strategies to get these patients to exercise. But be aware that sometimes no matter what you try they will not comply. I had a patient in a similar situation that refused treatmetn, no matter waht we tried. He even ended up getting very fustrted at us, and told us to leave him alone (in a much ruder way). So I suppose you need to also know when to stop trying, as at the end of the day, patient's have the right to refuse treatment.
I had this patient for palliative care on my gerontology placement and I had to do cardio on the pt, I found that when family members were around he was more compliant and again what lina said - some patients just won't comply no matter how hard you try.
Maybe you can try and make the ambulation session more goal orientated. eg. walk him early in the morning to the toilet and take him for a long walk before he goes for a shave.
With the above patient, I liased with the nurses and managed to walk the patient to the shower as part of the Rx because no matter how hard I tried during the "physio" session the patient just won't get out of bed if he's not in the mood for it. I found this quiet effective as the patient wanted to shower and we made it that he had to walk to the shower so its win-win result.
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