minute/s remaining

They said she was a “screamer.”

And she was on my schedule. She had to be treated in her room because she screamed so much that she couldn’t be brought to the gym. I was looking forward to the challenge. Maybe I could build a relationship with her and get her to trust me so I could help her.

To prepare, I looked at her chart. I noted that she has a broken pelvis and a history of depression and anxiety. She previously lived alone and was independent with everything using a walker. To put myself in her shoes, I guess that she is in a lot pain and was probably grieving the loss of her independence and very scared of the future. With this in mind, I entered the room with a knock.

I asked if I could come in, and she consented. I introduced myself and explained that I was from the PT department. I stepped towards the bed. She started to tense up. And then she screamed. She screamed so loud that a nurse popped her head in the door to make sure she was okay. I stepped back from the bed and in a gentle voice I said,
“May I ask you a question?”
“Why were you screaming?”
“I don’t know.”

I gently explained to her that when she screamed, that people outside the room would think that I was hurting her. She said that she didn’t want that. I asked some questions about what happened to her, about her home, and about her goals for therapy. Once I got her to state what HER goals were (to return home independently), I let her know that we had the same goal.

I asked her if we could just sit on the edge of the bed. She agreed. I knew that she would be anxious, so I told her that I would tell her before I did anything. I asked her if she could think of something else to do besides scream if she was scared or in pain. She said that she could hum. “Good idea!” I said. I asked if I could adjust the bed, and asked if I could remove the blankets and the pillows under her legs.

As I assisted her to sitting, I told her where I was going to touch her and how I was going to move. She hummed and
hummed but was able to sit up. I was able to do some sitting balance activities with her. Before I left, I asked what she thought we should do next time. She said that she wanted to get into the wheelchair.

(That was my plan all along). The next session, she got into that wheelchair, and I shocked everyone when I showed up to the gym with the Screamer! She turned out to be one of my favorite patients as she trusted me to guide her through some very painful and difficult sessions. It was an honor to be a part of helping her heal at a very vulnerable time in her life.

In school, we learn how to rehabilitate the body. We know the right exercises, how to take the measurements, how to facilitate functional movement, and how to alleviate pain. However, we don’t get a lot of instruction on how to help someone like the patient described above. I have often heard patients like her described as “non-compliant”, “unmotivated”, or “a psych case.”

Their charts get filled with refusals and they get discharged. “I am here to work with people who want to get better!” I have heard before. We do our profession, our patients and ourselves a disservice when we choose not to take the time to be empathetic and creative in our approach to patients.

Often, if we take the time to LISTEN to our patients, to ask questions and find out what is important to them, we can turn a refusal into a productive and enjoyable session for ourselves and our patient. We work with people who are almost all grieving in some way. They may be grieving the loss of a limb, the loss of wages, the loss of independence, the loss of dignity, and a big one is the loss of control.

While many of those losses, we cannot correct, we can offer some control in our sessions. We can ask their permission to do things: “Is it okay if I put on this gait belt?”. We can give them choices of times for treatment when we have the opportunity. Perhaps we can give them a choice of activity within our plan of care. Particularly with anxious patients, we need to slow things down and tell them what we are going to do before we do it and give them time if they need to move slow.

If the patient has the idea of what to do next (and it is your idea too! LOL), let them suggest it instead of just telling them what you want them to do. Let them own it and you be there to help them achieve THEIR goal. We work with people who are injured, sick and sometimes dying. They are not always motivated to jump out of bed when we enter the room. Many have underlying mental illness along with having to cope with some kind of loss. With some patience, active listening, and creativity, we can assist them into wanting to participate in therapy. It is amazing when a person who is very anxious and scared starts to trust you to help them do things that are scary to them.

Their trust is a gift they give us when we take the time to empathize with them and see things from their perspective. It takes time to gain that trust, but it is worth it. In some settings, productivity levels and pressure try to take that time away from us, but we must advocate for our patients and give them the time they need.

This article is written by ~ Holly Acosta, PTA, BS

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About the author 

Dr Michael Chua PT, DPT

Dr Michael Chua is a physical therapist practising in Home Health, Skilled Nursing Facilities and Acute Care Hospital. His clinical interest involves pain management, geriatrics and dementia management. He enjoys treating patients and bringing out the best in them using positive treatment approaches, his dynamic work setting in a rural area provides an opportunity to treat a wide range from geriatrics to orthopaedics.

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