S- I have been continuing my treatment with Mr B in the neurological inpatient gym every afternoon. Mr B suffered a L pontine stroke on the 12/03/2010 and consequently is experiencing R hemiparesis and hemisensory loss, as well as decreased arousal, mild expressive dysphasia and moderate dysarthria. Mr B is displaying excellent movement return and we have minimised the amount of tone coming in. All in all he is displaying excellent potential for a good recovery!!
However, on Monday and Tuesday we experienced 2 set-backs in therapy. On Monday he had a fall in the PT gym. My supervisor and I were practicing 2 mod A STS with Mr B as this is major goal, he is VERY focussed on achieving this as he wants to be able to transfer without the hoist. Mr B is determined, but if something is too hard he will sit down without any warning to the PT, you just have to be ready. During STS from the W/C, Mr B made it about half way, then just could not straighten his legs any further. He slipped in front of the W/C, and as he weighs 97kg my supervisor and I just could not save him, so we began a controlled lowering to the floor. He then required a 3 max A to get back into the W/C. It turned out fine, but it shattered Mr B's confidence.
The next day, shortly after Mr B's arrival he needed to go to the bathroom. He has suffered some urge incontinence since his stroke so I quickly rushed him up to the ward. Once here, I offered my assistance but as he is a standing hoist t/f the nursing staff declined, they would just have to teach me to use the hoist and he was in a rush. I decided to wait for Mr B so I could take him back to the gym and save the PCA. I was waiting in the office and heard the nursing staff talking about me. It was very unprofessional. They suggested that PT never offer to help, they were run off their feet and I was just sitting down! (Meanwhile, they couldn't have been that busy if 6 people had the time to and around and talk about me.) It really upset me as I try my hardest to be polite and helpful, I would never intentionally not offer my assistance. So, I stood up and joined their conversation...with the end result being me bullied into getting Mr B off the toilet. This was really awkward for him. After the experience, he said he was too embarrassed to come back to phsyio and absolutely dreaded it!!
T-My task was to reinstate some of Mr B's confidence and reassure him about physio generally!
A-I wheeled Mr B back to his room for the day. Once here I shut the curtains to give us some privacy. I sincerely apologised for his experience in the bathroom. I let him know that I wasn't embarrassed and had taken many patients to the bathroom before. He explained that he felt physio's were for therapy only and he was mortified that I had to see him in another light. I empathised with this and understood exactly where he was coming from. We decided to put a few strategies in place to ensure that physio WAS only therapy time. They offer patients drinks while they're in the gym. Mr B felt his drink had upset his stomach, so we opted for water only while exercising. We also pushed back his start time till 2:30. This allowed his lunch to go down (he has just started to eat normal meals so he felt he needed some time getting used to it again.) This also worked well for me, as I had a higher level patient who could come and take Mr B's earlier time slot.
We then talked about his fall. Mr B was so nervous it would happen again, and it was such a struggle for him and us to get him off the floor. I let him know that he shouldn't view the fall as a set-back. If anything, it proves he can transfer from the floor without a hoist. I told him that falls were to be expected ( I had already seen 2 in that gym!) and now hopefully he's had his and that's it! I then really emphasised his great potential for recovery! I related hard-work to his goals and hopefully inspired him not to give up. Only with therapy time will he achieve a stand-step transfer and he has already come so far! I tried not to play into his nervousness and let him know that sometimes these things happen, it is not a reason to stop. I told him that he had to be in control of his rehab, and if he feels tired he has to let us know.
R-I feel that my talk with Mr B went really well. When I left, he was no longer embarrassed and was willing and excited to continue his therapy. He felt happy with the strategies we put in place and felt more in control of his own recovery. I feel that I built on our rapport and our professional relationship had grown. I was really excited to have him back on board, he has to want to be in the gym for us to make any type of improvements!
E-I really feel I handled the situation well. I was just as embarrassed as Mr B and I could have left without talking to him. I was really proud that I was professional enough to sit down with him and analyse the events. I really learnt the importance of listening. I felt Mr B's concerns were valid, and we worked through them appropriately and professionally. I left knowing that Mr B was reassured and had regained some confidence in his abilities (and some more confidence in me!!)
However, I did not handle the situation with the nurses very well!! I felt so worried and flustered when I heard them talking about me so I just stood up and did whatever they said. Looking back, it was definitely bullying, and it was not professional. I did not need to be rude, but I could have been more assertive. I should have reminded them that I did offer assistance and I am more than happy to help out whenever required, especially as I am a student and have more time on my hands, all they needed to do was ask. But I also should have reminded them to listen to the patients wishes, it was clear that he did not want me there and as such I shouldn't have been. In those situations I need to politely point out the facts and not fall into the trap of workplace bullying! I also need to find my voice sometimes and stand up for myself. I am not rude or lazy and shouldn't let people say that about me.
S-When Mr B next comes into the gym I am going to use the following strategies
1. Relate STS practice to his goals
2.Positive feedback to boost his confidence
3.Bolster him in so he feels really safe
4.Have confidence in myself, and let him see that! I can't let him know I'm nervous too because that won't help anyone.
In regards to the situation on the ward, I let my supervisor know what happened so she was informed. We then talked through strategies together on how to deal with anything like that in the future.
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