Patients That Dont Listen

I have just finished my neuro prac and in my final week I had a patient who had just recently had a stroke. Now the patient initially had grade 1 muscle strength globally down one lower limb and grade 2s in his upper limb. Now over the next few days recvoery began to occur quite rapidly in his arm and within 3-4 days it was pretty much back to grade 5 msucle strength. Now since his staic and dynamic sitting balance was perfect our goal of treatment was to fascilitate standing balance and eventually get him back to walking.

Now we began working on his static standing balance using a wheeled zimmer frame for him to hold onto. He was balancing ok in this position but when we tried to correct alignment so to make him have even weightbearing you could see that as we put him more across to his hemi side the more weight he put through his arms. So to finish this sesion we tried to do little weight shift exercises to get him taking small steps on the spot. Doing this exercise every time he needed to put weight through his hemi limb he simply took all of his weight through his arms. However, the fact that he was now standing and to him seemed like he was walking he was pretty happy and just wanted to do mroe and more and even wanted to go for a walk but we had to hold him back and stop him from doing this as he wasnt ready.

So as you could imagine this man was still a 2 person assist for transfers and ambulation. However, even tho we explained to him several times and tried to make it as clear as possible that he not to stand by himself and definitely not to try walking by himself. When we told him this he said he understood but both my supervisor and I werent convinved that he was going to follow our instructions so mentioned it to all of the other staff on the ward. And before we knew it one of the nurses caught him walking around his room with his frame!! So we went back and re-edcuated him about the dangers of him trying to walk etc. We even took his WZF away but before too long he was caught borrowing his roommates WZF and walking with that. On confrontation he simply gave us excuse after excuse as to why he was walking.

So from here we had him moved to a room closer to the nursing head1/4s so he was closer to the more crowded area. We also kept his WZF out of his room so he couldnt use that. So I was wondering if anyone has had patients like this who are at falls risk and dont obey yours or the doctors instructions about things not to do and if so what strategies you used to get around this problem.