Whilst on my cardiopulmonary placement, I was required to see a post-op CABG patient. This patient had been transferred from a primary to a secondary hospital, and was awaiting discharge for home. Despite his relatively good post-op progress, this patient was very anxious and was always very reluctant to do his exercises. He always required constant reassurance and thorough explanations, to educate that he was doing well and that it was ok to move!
As part of his preparation for discharge, my supervisor was keen for this patient to complete a six minute walk test and compare it to previous results. When I mentioned this to the patient, he did NOT want to do this, as he had a bad experience inclusive of heightened chest pain and being “forced” to complete the test. I reassured him that this time would be different and if any of these symptoms were reproduced it would be ok to cease the test. Despite trying to reason with him (and beginning to feel a bit frustrated!), it did not change his outlook.
I informed my supervisor of this, whom said that my reasoning to the patient was sufficient and to see him again in the afternoon. My supervisor informed me to tell the patient that I would not get him to perform the six minute walk test, but rather simply measure how far he could walk in six minutes simply to get a baseline measure for his return to home. Even though essentially I was explaining the same concept to the patient, it was surprising that when I explained it not using the word “test” at all in my explanation, he agreed to do it. I did not use the standardised instructions of the six minute walk test as I wanted it to be performed in a more relaxed environment (due to his heightened anxiety), but still was able to use the essential elements of the test.
As I did not use the standardised instructions, track etc for a six minute walk test, I could not call the results a true reflection, but was at least given a general idea of this patients exercise tolerance. I never really thought that changing my tact ever so slightly (e.g. not using the word “test” or making the environment more relaxed) can influence a patient’s participation in a task to such a large extent. From now on, I will try to be mindful of my explanations to patients and structure these in such a way as to best consider a patients personality and emotional status.
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3 comments:
It sounds like it was a very challenging situation. Does anyone else have any thoughts on other strategies we might be able to use with very anxious patients? Is there anything we as physios could offer?
Its always hard to know what the right thing to do is with an anxious patient! And everyone has their own approach. Ive found (like many situations!) that building a good rapport first is SO important and has helped improve compliance.
Ive found that a simple and clear explanation of an overall goal helps, but to use smaller goals/exercises first. If you can get the patient doing smaller things ie STS, transfer from bed/chair, before attempting things like a longer walk, makes them see that they can actually do some tasks without too much worry! And they also see that you dont have a pushy attitude towards Rx, so are hopefully more likely to comply to further Rx. By being encouraging and listening to them right from the start, will hopefully decrease their anxiety for more intense Rx as they know you will actually listen to them if they have a problem/need to stop ect...
By also being confident and portraying confidence in your own abilities with things such as assisting with transfers, will hopefully put the pt at some ease. I had an anxious 93 y/o pt today who said 'she didnt have faith in her own ability' to move from bed to chair (it was her 1st time in doing so), so my supervisor and I asked her to trust our abililty to help her. It took a bit of coaxing and eventually she worked with us, and it went very well. She said from then on she would feel alot better and trust another person to assist her!
I had a similar experience on my rural practical. I was involved in assessing patients that lived in the residential care part of the hospital. The patients got very anxious when we said we were going to to perform some tests so I reworded it like yourself. I explained that we are just going to have a look at how you're going so we can provide you with the appropriate care and assistance during your daily activities.
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