Tuesday, June 3, 2008

Patient and family frustration

I was on my neurology placement recently working on a stroke rehabilitation ward. One of the patients I was assigned to treat was an elderly man who had a brainstem stroke a few weeks back. He was an extremely patient patient, especially seeing it was my first day and i was a bit unsure of myself! He was my patient for the whole five weeks that I was on placement and the aim of rehab was to get him as strong as possible so that he could cope with surgery to remove some melanomas from his chest wall which was booked for five weeks time.
He did extremely well with rehab, and we built up a strong raport. I also got to know his family quite well over this time and they were present at a lot of the rehab sessions. My patient slowly improved with rehab, and he was very keen and motivated. Over the first three weeks, however, my patient started to change and become more withdrawn and 'down'.
The first time he walked was a happy day for him and his family, and for me as well. However, his progress was slow and wavering. He began to ask why he cant walk as far today as he could yesterday and why his fingers were moving more yesterday than today. He began to get frustrated during rehab sessions and give up a lot earlier than usual. He also stopped eating and his motivation decreased.
I noticed this happening quite early on and so I tried to keep the mood light and keep his spirits up during rehab. Sometimes he would cheer up quite quickly if i took some time to just sit and talk about something totally unrelated. This was easy for me to do as a student as I did not have a full patient load - I doubt it would be as easy if that was not the case. I tried to keep the sessions varied and the environment interesting - even taking him outside for rehab. I found that beginning with something that he was good at was very helpful as it showed him some positive progress that he'd made and then ending on the same note.
I felt a huge sense of empathy towards these patients as I can only imagine how frustrating it must be to go from functioning well to having such a large disability and the huge task of rehab that they face with such courage. I got advice from my supervisor throughout the time and also talked to my peers about ideas that they have. I know that many people have already experienced patient and family frustration in their prac's so I was wondering if anyone has any other strategies to deal with this type of situation.

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