Discussing goals with your patient

During my ortho inpatients placement I treated a 60 year old female patient that had been in and out of hospital for the past 3 months because of rare complications from what should of been a simple operation for a NOF fracture. On first impressions this patient was very compliant with physio treatment and was constantly sitting out of bed. The doctors had allowed her to start weight bearing on her affected leg, so the patient had started ambulating with a frame. However one week after getting the patient up out of bed and ambulating the doctors changed her to a non-weight bearing status.

At my next session with the patient, the doctor had just been in and told her that she was not to weight bear on her affected leg. I knew that this would severely affect how well she would progress as she was already very de-conditioned from being in hospital for such a long period of time. Over the next week the patient’s enthusiasm towards physio decreased significantly, whenever she got tired or couldn’t do one of the activities I asked her to try she would cry and give up. At first I felt like it was my fault that she was crying and would tell her that I would be back in the afternoon for another physio session. But as I took this approach the patient would do less and less treatment with me and sometimes refused to get out of bed. At this stage I felt I had failed with the patient and didn’t know how to motivate them to get out of bed.

After much thought I decided to go in and see the patient and for one whole treatment session just sit down and talk to them and find out exactly what they were feeling and what they thought they would be able to achieve. The patient was quite depressed and felt that they would never get out of hospital. After discussing the patient’s issues, I explained to her that if we strengthened her non affected leg, I believed she could hop with a frame. She agreed on the goal and for the next 2 weeks we focused on getting her to hop. By the time I left that placement the patient was back to her original cheerful self and was compliant with physio treatment

AFTER TREATING THIS PATIENT I HAVE LEARNT THAT IT IS VERY IMPORTANT TO WATCH YOUR PATIENTS MOTIVATION TOWARDS PHYSIO AND IF THEIR MOTIVATION DOES CHANGE START ASKING QUESTIONS. I HAVE LEARNT THERE ARE MANY WAYS TO FIND OUT HOW A PATIENT Is COPING ASKING THE NURSE, FAMILY AND THE PATIENT THEMSELVES ARE ALL GOOD WAYS TO FIND OUT HOW A PATIENT IS COPING. NEVER AVOID ISSUES BECAUSE IT DOESN’T BENEFIT YOU OR THE PATIENT!