Hi guys - i need some advice on this one please! Im currently on paeds prac and one of my pts is a 6yo aboriginal boy from up north who sustained a transfemoral R amputation after a traumatic accident in march. Following the initial treatment at the local hospital he is now at in perth for stump management and preparation for prosthesis fitting - im seeing him twice daily to strengthen the stump and for gait retraining once its fitted on friday. My problem is that he is an absolute terror at times... and thats on a good day! While bribing him with stickers and computer time seems to get us through some PT sessions im needing advice on how to control him when we visit shents as it will take a few hours for the initial fitting session.
His parents are coming to shents as well (no other hospital staff that i know of) but they are likely to make him worse. In addition to police involvement following the "accident" there are social issues with the parents as they were discharging him from the local hospital against medical advice and not tending to his wound care. They also dont discipline him at all and let him run around as he wishes.
Is it ok that i resort to bribes just to get through each session?? am i allowed to use verbal discipline to assist compliance? so far ive been quite firm with him when needed but it only works sometimes - im reluctant to pick him up (and not sure im allowed to) to make the session easier as he tries to bite staff (and has been diagnosed with alot of nasty bugs) but im at a loss for other strategies to get through each session. He also has urinary and fecal "accidents" on occasion as he knows it will stop the gym session which as you can imagine are frustrating. Should i try and be firm with him and make him comply at the prosthesis fitting infront of the parents when they dont care how difficult he is? So if anyone has young relatives or perhaps works in childcare please offer up any suggestions as to how i might get through PT sessions easier and especially our visit to shents this week. Ok im open to literally ANY suggestions you guys may have, thanks in advance! Em
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3 comments:
hey em, not sure if i can help at all but have been in similar positions before cos i have a younger sister, babysit, teach swimming lessons to similar children and am from a country town :)
i find that the best way to get kids to do what you ask is by becoming friends with them first, and being able to have a laugh and muck around with them a little. obviously there is a very fine line between being friends and being an authority figure, but once you get along him well and can make him have fun, then he will begin to respect you and what you say.
i think trust is very important to families like this, so if you can talk to them as if you are friends and not above them then they may respond to you better.
outline to him the consequences of not listening to you - and exaggerate them a little if you have to! maybe giving him no attention at all for a little bit will stop some of his behaviour, because if you ignore it he may realise that its not getting him anywhere... some kids hate being left by themselves, so he may start listening to you just so that he can have some company.
so try having jokes with him, make him laugh and keep promising him treats if he does what you ask!!
hey emskie, when I was at PMH my head injury patient started walking independently for the first time when bribed with a freddo. I wouldn't say "bribe", rather I'd say...motivation and focussing on the task to meet a goal!
Sorry just realised I used the word bribe with my patient! The patient was motivated with a freddo I meant.
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