On cardio clinic at a large hospital I treated a young lady in her early 20s following drug overdose and subsequent 2 week coma. Following he stay in ICU the patient was discharge to the ward where I began to see her. The lady was quite obviously markedly obese and had developed bilateral foot drop as a result of prolonged positioning in ICU.
The main aim for this patient was to mobilise her, beginning right back with basic bed mobility. This patient was to be seen 3 times per day for physiotherapy. I subsequently devised her a general exercise program which she could perform 3 times per day and on weekends, and would check on her daily. Through the week the patient was obviously very unmotivated to do anything, constantly becoming emotional around medical staff, however I noticed she was totally the opposite when conversing with friends who came to visit or on the phone.
For this patient to get better and leave hospital I thought this lady needs motivation. I proceed to ask her what she wanted to get out of physiotherapy in hospital. She said she would like to get back to ballet. I subsequently used this as a source of motivation throughout her exercise sessions to good effect. I also suggested to the medical team the patient's problem with her weight and the doctor said the patient would have to loose 40-50kg to be considered for gastric banding surgery. So together with the patient wanting to return to ballet and the need for her to loose 40-50kg this made her more motivated to do physiotherapy. I found that I would just need to pop my head in to progress her exercises rather then having to actually go through 3 sets of exercises per day.
THIS SITUATION IDENTIFIED TO ME THE NEED TO SET GOALS FOR PATIENTS. THE GOALS IN THIS CASE SERVED TO MOTIVATE MY PATIENT AND KEEP HER COMPLIANT WITH THE PROGRAM.
IN THE FUTURE I THINK ITS IMPORTANT TO SET GOALS FOR PATIENTS DURING INTIAL TREATMENTS SO THAT THEY FEEL THEY ARE WORKING TOWARDS SOME BIGGER THEN JUST GETTING OUT OF BED OR AMBULATING WHICH IS MORE IMPORTANT TO PHYSIOTHERAPIST IN A WARD BASED SETTING.
2 comments:
Lennon brings up an important issue. Regardless of the setting you work in, collaborative goal setting with the patient is an important aspect of patient management. These goals should be set early, in collaboration with the patient, and be function based, achievable, measurable and realistic. Both short term and long term goals are important. As highlighted in this blog, not only will goals assist in patient motivation but assist with other aspects of patient care such as discharge planning and evidence of continued improvement to justify ongoing physiotherapy.
Wow, that's a top quality comment Michelle! Good work Lennon - I imagine it would have taken considerable rapport for her to admit that ballet was a goal. It made me think that in some cases patients may not tell us their goals even if we ask... but we shouldn't forget to re-try later when they feel more comfortable around us.
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