In the gerentology area of practice quite frequently you come across pts with dementia. It is often quite difficult to get them to do what you want , whether it s to comply with your assessments or to encourage them to ambulate (as opposed to RIB).
On my placement at the moment I've often come across a patient who has dementia ( which could also be complicated by acute confusion) who simply refuse to get out of bed. One lady Im seeing at the moment has not been out of bed for 2 weeks. Every day she pleads with me "not to ask her to get out of bed" and she is very confused - not orientated to time or place. It did not take me long to realise that certain approaches do not work with her. Ive tried the nice apprach, explaining to her why she needs to get out of bed, so she can go home, Ive tried the stern approach which also didn't work. In the end I realised that because of her dementia and confusion the only way to convince her to get out of bed is to almost trick her with clever wording and reasoning to get her to ambulate. Ive also found with other demented patients that if an approach is not working, quite often, if you leave the room and come back in you get to start over again with a differnet approach because they cannot remember you from just 30 seconds ago.
I feel a bit guilty about taking advantage of the pt s disablilites; however Im acting in the pt s best interest. But how far is too far? Has any one found themselves in a simialr situation?
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3 comments:
Dont feel too bad about the type of approach your taking, because if thats the only way it works, and if its in your patients best interest, then you shouldnt feel bad or feel your taking advantage of their condition. As physios regardless of what area we're working in, if somethings not going to plan, we just have make adjustments and make do with what we have. But saying that, there's always the question about treating without consent. Some experiences i've had where the patient hasnt been in the right frame of mind to make decisions, i've relied on talking to family members, and explaining the situation to them. Alot of the families are very helpful and understanding, and give you the permission to make the judgement whether the patient needs treatment or not. Similarily liaising with the nursing staff, because they know the patient better than anyone else.
Hi Kel, I have also experienced many patients with dementia / deliruim and I agree that it is very hard sometimes to get them to participate in treatment, even when it is no more than taking a few steps out of bed! A technique that I have been employing whilst on my gerontology placement is to come in and see the difficult patient quite early on in my day, then when they predictably refuse treatment say something along the lines of "is this a bad time for me to come in and ask you to ...., is another time better? How about I come back late morning/afternoon to try this with you?" When I come back later they seem a lot more willing to participate, perhaps becuase it makes them feel as if they have some aspect of control over the situation? It is just another thing I find helps in our toolbox of persuasion techniques :)
Hi Kel, I think what you're doing is fine since your intentions are right. Sometimes these patients with dementia/delirium have impaired insight and judgement, and therefore rely on us physios to keep them well ie mobilising. So if it means that if you have to use this means to get what we want - so be it. It'll end up a win-win outcome.
btw...going to the toilet strategy seems to work for me and is my fav way of getting pts out of bed.
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