I have spent the last week trying to win over a very non-compliant patient and after 5 days, feel I have started to make some progress.
The patient was admitted with a history of resistance to medical input, and upon reading the notes I could see he had been refusing showers, refusing obs to be taken etc. It had also been requested he have a Physio review. Prior to even meeting this man, I had formed an opinion that he would probably be rude and abrupt and want nothing to do with me or Physio treatment- I was prepared for the worst! My guess was correct, although after lots of complaining I was able to assess his mobility. He was extremely unsteady, which he knew, however he refused an aid or having someone walk with him. He reasoned that this was how he was before he came into hospital, so why should people care now- and promptly put himself back into bed and went to sleep.
After discussing the outcome of my assessment with his nurse and my supervisor, we decided the best way would be to keep a close eye on this patient and ensure standby assistance whenever we saw him ambulating. The next few days he continued to refuse any physio intervention, was non-compliant with having standby assistance and also developed a moist, productive cough. Although Physio intervention was indicated for this patient, my aim each day became to simply have a chat with him to try to build some trust and rapport. Although he refused to participate in any treatment, I liased closely with the nursing and medical staff to monitor his mobility and chest status, and simply had to document the outcome.
At first I was frustrated and found it hard to reason why I should continue to waste my time on a patient who was rude and refusing any help, although I could see he needed it. However, once I had accepted this was his preferred way and changed my aim to simply getting a conversation out of him (where I could at least observe his cough/ sputum/breath sounds) I felt I was beginning to make more progress. Although he still refuses any intervention, I can now actually have a conversation with him, and am hopeful for Monday’s attempt for ambulation.
1 comment:
I also had a patient who had treatment compliance issues. I saw this particular patient for 3 or more weeks during the placement and probably mobilised only 2 in every 5 treatment sessions. My supervisor told me that the one thing that you must do with a patient requiring chest physiotherapy is to ausculate whether they refused other treatment or not. This became the standard of each treatment and I tried a variety of things (explaining exactly what each exercise was for, being firm with the patient, and making compromises) to increase compliance but it was never easy. My most memorable moment from the placement was walking into the patients room and seeing them sitting on the edge of the bed doing deep breathing and leg exercises.
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