Motivation
Hello there, hope every one's pracs are going well, can't believe it's the end of the second week already, we're half way there!! This week my neuro outpatient placement has been a bit frustrating. I am mainly working with patients who have suffered strokes, many of them have had the stroke many years ago so they have been dealing with their symptoms for a while now. I am finding it very hard to motivate my patients during our treatment sessions. As I mentioned, most of the patients have been dealing with their impairments for many years, so they are very set in their ways, especially in their gait pattern. During the treatment session, we seem to make gains and improvements can be seen in their gait patterns, however as soon as the treatment is over they resort back to their old ways. Now I know it is not realistic to think that I can cure them by just seeing them for 3 hours a week, but I feel that they are not benefiting from the treatment. Even though I am encouraging and am providing education about why the things we are doing are beneficial for them, most of the patients are not compliant with their HEP. That is the frustrating part; a large part of a patients recovery comes from self management, and if they are not doing any sort of exercise at home then how can I possibly make any gains with them if I only see them 3 hours a week?
Any one have any suggestions on how to motivate the patients and make sure they are compliant with their exercises?
posted by tam @ 8:41 PM
4 Comments:
Tam,
I am on the same prac as Tam and have very similar questions about just how to motivate these pts who are further down the track. It is especially difficult when they are often on Meds that act as sedatives for thier various other co-morbidities.
I have seen how you, Tam, are genuinely interested in your pts progress and this intent they certainly appreciate. I think this is a big part of it...that the pt feels someone hasn't given up on their opportunity for continued gains.
We can only search for the approaches most effective for each individual client. Sometimes that does mean cracking the whip a bit, giving them a progress report diary to fill or perhaps liasing w social-work to enlist their experience in dealing with such barriers.
I am sure like everything in this field we will slowly get better at increasing motivation and at the end of the day you just gotta say it is ultimately up to them to stay at it. Chao, Matt
I am also on Neuro placement, however I am dealing with inpatients. I can relate to some of the issues you have illustrated. Like Matt and yourself have highlighted, education is a key component. Working on placement I have quickly learned that a major component of treatment in fact is education. To help facilitate treatment and drive results I try to be as objective as I can and be functionally specific. Eg "Last week you were unable to balance feet together (eyes closed), but now you can do it for 3 seconds. Improving your balance with your eyes closed will help when you get up in the night to walk to the toliet, this will reduce the risk of you losing your balance and falling". Also to highlight the importance of balance, gait, postural saving reactions etc, and the devastating impact of fracturing a hip. You may also want to incorporate visual charts so that they can stick up at home, and they can put stickers on to help motivate them. Provide incentives, eg certificates for those that comply with treatment. These are only some suggestions, I am sure you are doing well Tam and its great to hear you are so committed to really trying to make a difference.
Hi Tam,
I did the prac that you are on prior to Christmas, so I can relate to your concerns. It can be very frustrating when you see gains in their function or gait during the session, only for them to revert to their old ways. As you have said, I found that encouraging them and telling them that you have noticed the improvement had the effect of improving their motivation. As Christian said, reminding them at the next session of their improvement reinforced their improvement and aided the following treatment.
I also found that challenging the patient occasionally by progressing the treatment and do something a bit more difficult can demonstrate to the patient that they are progressing, which can improve their sense of well being, and help with their motivation.
Hope it helps
Dale
Hi Tam, you sound really distressed over this issue. Don't be!(Maybe when it's my turn to go over there, I'll need some counselling from you) Guess sometimes we could try listening to the patient and find out what's stopping them(hopefully its not poor memory) from doing their exercises. Maybe find out their interests and modify certain exercises and incorporate them into activities they enjoy. Cos sometimes we are way too engrossed on the technical aspect we forget the fun component. I definitely agree on the "activity/exercise diary checklist" and "give them lots of encouragement" by the other commentators. Stay motivated!
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