Patient non-compliance
I am currently on my Cardio placement and am treating (or lack of) 63 year old woman who was admitted due to feeling unwell on a background of idiopathic thrombocytopenic purpure (low platelets and bruises easy for no known reason). My issue is that she refuses all physio treatment. At home she ambulates independently with a WZF but in the hospital most of the time she refuses to get out of bed. Her excuses range from, not feeling up to it, she might fall over, will do so when she is ready. The more I try to educate her on the benefits of ambulating the more aggravated she gets, in fact she screamed at me last week. Her chest at the moment is clear, however I still think it is an important prophylactic to get her up to ensure she doesn’t get any chest infections. I have tried a number of strategies such as education, idle threats (“the Doctors will get really mad at you”), tried to make compromises and even taken an interest in her scrap booking, however all to no avail. I am now tempted to use a cattle prod to put this woman in motion. If anyone should have any ideas of how I can get this woman up and ambulating with her WZF I would love to hear.

3 Comments:
Hi Christian
I had a similar issue with one patient, also on my cardio placement, although it only happened once, and the other times he was receptive to treatment. That day he was distracted by some other things happening, and he accused me of delving into his personal life and rudely interrupting the social worker that day.
All I can think of is to try different times of day, whether she is better in the morning or afternoon. Perhaps try to time it with the nurses for her morning shower. Find out what her other interests are (such as lawn bowls or something) and encourage her to get up in order to improve her ability to get back to these interests.
Just some ideas.
Cheers,
D
cattle prod sounds like the only solution (only joking).. Sounds to me that you have tried everything Christian. I have had a similiar experience in a prac and it gets to the point where the only thing you can do , is accept that they have chosen to not partake in physio. Of course I did the whole you have to do physio or the doctors will not leave you on this ward/in this hospital. To which the patient asked me if I had a knife.To which I replied, 'no, why".To which he replied 'to cut your head off'.Needless to say I didn't bother him anymore. You can only ever try your best, some people just don't want to be helped.
michelle
Hi all
I was similarly confronted whilst on clinical placements. There is the saying, "you can lead a horse to water, but...". Clearly, as physios we have the best intentions for the well-being of the patient. However, some of these patients are cognitively intact, worldy and are making very conscious decisions for themselves. Certainly we need to be alert to psychological issues (eg depression) that may be contributing to patient non-compliance.
On occasions, if the patient has not given consent to proceed with treatment, and if a few different approaches have not been successful, you may have to walk away on that day.
You will come across physios and other health professionals (including surgeons) who will almost "bully" the patient around. I personally do not take that approach, although some health professionals who do, seem to be valued for their no-nonsense, outcomes focussed approach.
Regards
John
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