On my current gerontology placement I was treating a patient with an AKA for a couple of weeks. When I went to see him a couple of days ago, he refused physiotherapy treatment stating that he was being discharged at 730am the next day and had too much to do. I was unaware of this situation as no discharge date had been organised at the prior allied health meeting and no one in the allied health team had discussed the discharge plan with me. I was unprepared for this development and didn't have adequate time to organise a physiotherapy referral or go through a home exercise program (HEP) with the patient.
Initially I tried to persuade the patient that physiotherapy was important and necessary in order to arrange a HEP. However no matter how I tried to encourage and motivate him he was adamant not to come to physiotherapy. Luckily I had already supplied the patient with an exercise booklet and given the patient these exercises to perform in his room. I was thus able to simply discuss what exercises he could continue with from the booklet at home, based on what he was previously doing independently.
Therefore I have learnt that it is very important to check hospital information boards every day in advance as well as patient notes, to discern future patient developments in order to plan and prioritise treatment sessions and discharge planning. I have also realised that sometimes no matter what you say or do, a patient will refuse treatment and that decision must be respected. I have also come to recognise when a patient can be encouraged and when you just have to cut your loses.
1 comment:
This no doubt has been a learning experience for you. I guess when your dealing with so many patients as part of an allied health team, some decisions can be made without all parties being notified.
Good suggestions in checking hospital information boards daily and patient notes prior to daily Rx, I will remember that.
At least you were familiar with this patient and could ascertain what level he was at for prescription of a HEP. When he attends outpatients they can progress his Rx from their.
Ultimately if a pt requires Rx and they refuse you would instigate other means of persuasion perhaps. Given your dealings with this pt's rehab you knew not to push the issue as you had seen him do enough to warrant a 'let-off'.
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