How far can you or should you try push a pt into complying with your Rx when it’s the last thing they want to do. This is one of the hardest things I find doing, when going to see a pt to do their daily Rx and they say no I’m not doing it today; I don’t want to get up and go for a walk. On two of my placements so far the pts have been post-op and therefore need to get out of bed if medically stable and try go for a short walk. A pt I went to see the other day was going to be moved from my ward to the rehab hospital just after lunch and my supervisor asked me to go see the pt to go through the exercises the pt had been given and to go for a short walk with the pt as they had lost confidence in their walking since their accident. When I went in to see the pt I told the pt the plan of Rx and said I needed to go for a short walk with them. The pt was very frustrated at everything going on around them and having to have to go to the rehab hospital and was just in a really bad mood and said to me ‘I just don’t see why I have to do this right at this moment’. I tried a bit more convincing and encouragement and got the pt's stick for them and they were just about to get up and walk with me when they decided against it again and refused to comply with the Rx. I couldn’t think of anything else to do to convince the pt and the pt’s lungs were clear so I thought there was no use in going further with this pt who had made her refusal very clear. I left the room and went to speak to my supervisor who asked why the pt had refused, my supervisor said her reasons were not good enough and that the pt really needed to go for a walk with us before being transferred. So my supervisor who had seen the pt the previous day came in with me to see if she could get the pt to do what we wanted The pt was still refusing and the pt’s daughter came in and also tried to get the pt to comply with us and this wasn’t working either, and the daughter told us to ‘just leave the pt for today and the pt will continue with the rehab tomorrow’. My supervisors told the pt if the pt did her walking now then the pt wouldn’t have to worry about doing the exercises and walking later when the pt was transferred and could spend the rest of the day relaxing and settling in. The pt eventually gave in and got up but was not happy, when I was asking about symptoms while walking and how the pt was feeling the pt just snapped back at me saying ‘I will tell you if I don’t feel right’
Most of the pts I’ve come across have been very friendly and comply well with their treatment. When a pt is in a bad mood and very negative about everything and not wanting to do anything I find it very hard to convince them to do what I want them to do. Then if they do get up and go for a walk but are in a very bad mood I feel a bit uncomfortable and don’t really know what to talk to them about and then if they have to do other exercises on top of the walking I feel very awkward asking them to do those as well. What I’ve learnt so far is that you have to give the pt a very good explanation about why it is important for them to do what you want them to do. You have to give them the possible consequences if they don’t comply as well as the benefits if they do (e.g. decreased LOS). When a pt refuses you have to think why they are refusing, whether or not their reason is acceptable to you and look at the circumstances of how important is it that this pt gets treated today. If it is crucial that they do what you want them to do then and there you have got to use as much persuasive power as possible and this is something I really need to work on a lot.
Does anyone have any other suggestions or techniques with getting pt compliance after initial refusal?
2 comments:
I must say many of us do struggle with difficult patients like yours. I completely agree with your approach: that we have to explain our purpose of seeing them, and point out the possible consequences if pt fails to comply with Rx (eg physical deconditioning). If all fails, I guess we have to use our creative ideas to give some incentive to the pt (eg goals, small gifts, etc). =)
yeah i also agree that you should always tell the pt the benefits of the treatment session. On my cardio prac if a pt refused to sit out of bed we were told to ask the nurses to tell the pt they needed to change the sheets so the pt had to get out of bed and then they wouldnt put the sheets back on for a few hours. It was a little bit harsh but it always worked because no pt will get back into a bed that has no sheets.
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