Two other clients have also increased my knowledge and understanding of working with clients with dementia. The clients I have referred to in previous blogs were both unaware of where they were. However two clients did know they were in hospital and both were desperate to get out.
The first client had a superior pubic rami fracture but was mobilising with WZF. She had declined physio on a number of occasions but as I walked past her room she called out to me and implored me to help her out of bed. As I wanted her to walk I agreed and assisted her out of bed and she indicated that she wanted to go for a walk. As her gait became more unsteady I asked her to turn around and head back to her room but all she wanted to do was find the exit. I told her we had to go back the other way and when we got to her room she was very upset with me and not easily pacified even with the information that the plan was for her to go home the following day. I found out after that she had previously absconded off the ward and got lost on a locked ward!!
The second client also repeatedly refused physio until I advised her that the doctors had asked me to assess her and would not allow her to go home until that had been done. She then did everything I asked but I felt like I had forced her into consenting and she was merely going through the motions.
When working with patients with dementia I think you need to be quite direct. I have found that asking them to do something usually resulted in them saying no; but telling them that this is what they were going to do usually resulted in compliance - as if they needed instructions to be given to initiate anything.
I think it is also necessary for the physio to be mindful and aware of the fluctuating moods and functional abilities of these clients and be very flexible in their approach and treatments.
I feel more confident of dealing with patients with dementia following these experiences.
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I have experienced similar whilst on a prac earlier this year. It was for my final assessment, and the patient I was seeing was one of very few dementia patients I had seen over the five weeks. However I had noticed earlier in the week that giving very leading suggestions was a lot more effective in gaining compliance. I would get nowhere when asking a patient what they wanted to do, but suggesting we walk into the hall would get me an appropriate response. I also found that repeatedly asking for symptom response in a patient with dementia hinders treatment, and observing for non verbal signs of fatigue or distress were much better cues.
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