I am currently on my neuro placement where I have been treating a stroke patient. He has very low function and cognitive problems and is unlikely to recover much at all. We are looking to discharge him to home and not a nursing home, but to do this we need to educate the patient’s wife on how to safely transfer him.
The first time we attempted to introduce his wife into the treatment session the patient got upset and aggressive saying he didn’t want her there and refused to let her sit in and learn/help. So what I ask of you guys is strategies that you may have used or seen done to get a patient to except help from a family member.
Strategies that I have thought of are having the family member watch from across the gym to start off with so they can see the gross movements of the transfer. Then at a later stage teach the wife to learn the finer points of the transfer by practicing on you. This may not be optimal because it is not going to be the same feeling moving a completely dependent patient and someone acting dependent, also you would need to watch her transfer her husband before you send them home just to make sure she is safe. A slow progression of introducing the wife into the treatment session where at the start she is only there to drop him off and pick him up so she can see the transfers in and out of the wheelchair. Then progress to her assisting you, to her doing it on her own. Along with this, when the wife is not there, I would be reassuring and educating the patient on how important it is for him to accept his wife’s help. Any advice would be much appreciated.
Dickie
2 comments:
Hi dickie, I encountered a similar situation while working at the quad centre at shents – pts were unable to go on home visits until their family were deemed competent in transferring them and assisting with ADL’s. Im not sure if the pt has any perceptual problems or frontal lobe damage, as this will certainly impact on your ability to rationalise with him and allow the wife to become involved. If you’re able to, try and determine what the biggest issue is for the pt in terms of him allowing her to learn. Is he simply afraid that she will not have the strength/skills to safely transfer him at home, in which case repeated teaching and involvement with the wife will eventually be effective (whilst also educating both of them). However one factor that was a major issue for some pts (and all pts will feel this to some degree) was the change in their relationship– no longer does he feel its husband/wife but now pt/carer. Often the pt is happy to accept the care of staff while in hospital or rehab but once he returns home the change in his wife’s role will be emphasised. One solution was to get assistance such as visiting carers for a certain time each day/week to assist with the wife’s responsibilities, which OT or social work may be able to arrange. Also possibly involving a counsellor (or SW?) might be the best solution help them maintain their relationship as husband and wife alongside the role of pt/carer. Hope this helps a bit, Em
I agree with em, it is important to determine why it is that he is reluctant to accept his wifes help. You can't address the problem until you know what is causing it. All of Em's suggestions are excellent, although it may come down to giving the patient time to adjust to the circumstances. In a situation like this it can be like a grieving process, requiring time and understanding.
Megan
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