The Patient as a Whole
6 minute read
As a student, textbooks and lectures tend to be the main source of learning. Tests, skills check-off lists, and exams for licensure are typically based on them. And yes, learning the facts are an imperative aspect of patient treatment. It allows a clinician to find the source of a physical ailment, offer a skilled service to treat an ailment, and get paid.
However, since becoming a clinician I have learned that effective patient treatment runs much deeper than anatomy. It is multifaceted and includes treatment of the patient as a whole: physical, emotional, advocacy, and compassion.
The foundation of patient treatment is the physical component.
It is why we go to school to become clinicians and learn from the plethora of reading assignments, lectures, exams, and anatomy labs that define education. It truly is much more effective to treat a patient who has suffered from a cerebrovascular accident (CVA) if the clinician knows what part of the brain was affected, typical characteristics that appear with that location, and techniques that are most effective to allow the brain to build new pathways. Every physical impairment has an underlying cause. Education and evidence-based practice equip a clinician to assess and treat the underlying cause.
Next is the emotional component of patient care. Mental health is more of a focus now than it has ever been in the past. As a therapist it is very important to ensure our patients’ emotional health is also being treated. Depending on the setting, this may look a little different. For higher level patients, like those who are in an outpatient setting or a skilled nursing facility recovering from a hip fracture or total knee replacement, they may know that this situation is temporary. They may experience some depression, but providing small goals such as a home exercise program, expectations, and breathing exercises may help give the patient an increased ability to see progress themselves. In other settings, especially those that involve more permanent adaptations, emotional care may expand beyond the patient. For example, in pediatrics, geriatrics, and those with brain or spinal injuries at any age, the plan of care also includes long-term changes and increased burden of care that includes family members and caregivers.
In any situation in which the burden of patient care suddenly changes, the whole family or caregiver dynamic will be affected. It also may affect how a patient behaves and interacts with those around them. Take a potential situation in an assisted living facility, for example. The care aides may approach the physical therapist and report that a new resident is irritable and continues to refuse showers. Transferring the patient to the bathroom requires 2 people because he refuses to cooperate. They may go to his room as little as possible because he does not want any help. He seems like a grumpy old man, right? This is where the emotional portion of treatments plays a huge part. What the care aides may not know is that this man recently received a Parkinson disease diagnosis, his wife of 58 years just passed away, he served in the Air Force for 35 years, and his children decided that it would be best for him to move to an assisted living facility to be closer to them and to prevent his risk of falling. This proud man just lost all control of his life, and it is causing depression, anxiety, and an overall fear of mortality. After speaking with the patient, the therapist finds out that he can actually transfer by himself. It just takes extra time due to his diagnosis. The therapist educates the staff about the best way to approach him, transfers training, personality characteristics, and allows him to have more control of his care, including what time he wants his shower. The resident is now more willing to work with staff because he is seen as a person with needs, not just an old man who has nothing more to offer the world. The family also needs to be educated about characteristics that go along with different diagnoses, plan of care needs that include possible referrals to other specialists, and possible support groups to further cope with changes. Implementing changes that affect the emotional aspect of treatment will help to improve patient progress and retention after discharge.
Advocacy is another important facet of patient care. The therapist follows a plan of care when treating a patient. Anything that impacts that plan of care is the therapist’s responsibility to document it and then follow up. For example, Mrs Jones continues to show up to her outpatient sessions with unsafe high blood pressure, Mr Roberts continues to complain of heel soreness from lying in bed too long, and Ms Smith continues to have a soaked brief every time she receives treatment. All of these situations can impact the health of the patient and their ability to participate in treatment. In Mrs Jones’ case, unsafe blood pressure can lead to a CVA. Her doctor needs to be notified, and she may need to be educated on the importance of taking blood pressure medications on time. In Mr Roberts’ case, his caregiver may need to be educated on the importance of floating heels to prevent pressure ulcers as well as the importance of him getting up and out of bed. If transferring is the issue, then transfer training will need to be completed. How about Ms Smith? How does that impact treatment? Having a soaked brief can cause skin breakdown as well as urinary tract infections that all can delay progress. If she is at a facility, care aides may need to be educated about how often to change briefs because Ms Smith cannot communicate when her brief is wet. All of these issues can cause problems for the patient, but more importantly, can be prevented. Advocating for the patient includes being truthful with the patient, educating the patient as well as any caregivers involved, and informing the appropriate clinician on the care team about concerns.
The “cherry on the top” of patient care is compassion. Compassion, as defined in the Collins English Dictionary, is a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering. When a patient is receiving physical therapy, they are there to get help at a time of misfortune, whether it includes pain, decreased mobility, or whatever the impairment may be. As a physical therapist or physical therapist assistant, it is our duty to show compassion and incorporate it into daily treatment. For example, a patient with vertebral compression fractures is completing supine exercises. In conversation, she mentions how her feet have been itching because they are so dry and the nurse’s aide doesn’t have the time to put lotion on. It is easy to show compassion by applying lotion during a rest break. Can this service be billed? No. Is it taught in school? No. But that patient will believe the clinician truly cares. It will lead to increased participation and a better outcome overall. Always ask, “What else do you need?” before the end of a session. It will lead to a deeper connection with the patient.
Our profession is about serving others physically, emotionally, through advocacy, and compassion. Learning the best techniques and latest research is important, but it is not the only way to impact patient treatment. Be mindful and observant of those in your care. Be ready to learn and ready to teach. It will make you a more well-rounded professional impacting the progress of patients.
Natalie Dorak, PTA