On orthopaedic inpatient placement I treated a male pt a following tib fib # post MVA. On reading the pt’s notes several other physios and nursing staff described the patient as compulsive and continually ignoring nursing and physiotherapy advice post surgery, NWB 6/52 in below knee brace.
The pt was a middle-aged fit martial arts instructor so the D/C planning for the pt was 2 days post op. My aims for day 1 physio session were to mobilise the pt using elbow crutches. On talking to the pt prior to mobilising he told me he had been up and out of bed already hopping around his room. I encouraged him that after my session to start using the elbow crutches depending on wether he was safe enough after the trial.
I wheeled the patient down to the physio gym on the ward and began measuring up elbow crutches. I gave him the elbow crutches and got a pair for myself to demonstrate to the patient. While I turned my back for just a few seconds the pt got up and started ambulating using them. The pt appeared unsteady so I asked him to stop but he continued ambulating. I closely guarded him while he ambulated although continued to instruct him to stop. He eventually returned to his chair and I immediately took the crutches off him.
Once I had the crutches I felt more in control of the pt and was able to give him a demonstration. By the patient not having crutches I felt more in control of the pt and he was too an extent forced to listen to me.
THIS INTERACTION WITH THIS PATIENT HIGHLIGHTED THE IMPORTANCE OF GAINING CONTROL OF THE PHYSIO SESSION BOTH FROM A SAFETY PERSPECTIVE AND ENCOURAGES THE PATIENT TO ENGAGE IN THE PHYSIO SESSION. IN THE FUTURE, WHEN I AM ASKED TO TREAT COMPULSIVE UNCOOPERATIVE PATIENTS IT IS IMPORTANT PARTICULARLY AS A STUDENT TO GAIN CONTROL OF THE SESSION SO THE PATIENT IS SAFE DURING THE SESSION AND GIVE A THOROUGH EXPLANATION AND DEMONSTRATION OF WHAT I EXPECT OF THE PATIENT.
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3 comments:
It's good you were able to take the crutches off him in the end! Brings back fun memories of a hard pt I had that was extremely++ compulsive, except rather than compulsive to walk, he was compulsive to sit down... not fun.We literally had to have 4 staff to walk/transfer him.
I think this highlights the importance of reading patient notes carefully before seeing a patient. Knowing that the patient was compulsive and previously had ignored nursing/physio advice, do you think you could of done anything prior to the incident happening to prevent it from happening in the first place? You also mention the importance of gaining control of the session, can you expand upon how in the future, if faced with a similar patient, you can better control the situation from the outset?
Compulsive patients are a safety risk. I think the best way to deal with these patients is by giving an explanation/demonstration before they are given an opportunity to be compulsive (eg explain before giving him the crutches). I think that this will give you more control of the situation.
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