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
Podcast: A Nontraditional Student Perspective
Listening Time — 32:40
At age 39, Kelly Clarke became a physical therapist. Despite knowing she wanted to become a physical therapist at the age of 17, Kelly’s life and career took her down a different path. But what Kelly knew the entire time was that the profession of physical therapy was her calling.
By the time she entered physical therapy school, she was what we’re going to call in this episode a “nontraditional student”—older than most of her student peers, having explored other careers before pursuing the physical therapy profession.
In this episode, Kelly talks openly about some of the challenges of that nontraditional student experience. She also advises current and future students that they should never let a lack of encouragement be mistaken for discouragement, believing that if someone puts forward the effort that they too can enter this wonderful profession.
Here’s our conversation with Kelly.
Read Kelly's original blog post, “5 Things I Wish I'd Known Before Starting Physical Therapy School: A Nontraditional Student Perspective,” or visit APTA’s Pulse blog for more articles like this.
APTA Podcasts like this one are available on Apple Podcasts, Google Play, and Spotify, or by visiting APTA.org/Podcasts.
A Struggle I Would Not Change
4 minute read
I am in my 40s. I had a job for 15 years when I decided that I wanted a career change.
I looked around at the people I knew or had met.
I had a 4-year degree, but my degree was not specific enough to use as a tool for gainful employment elsewhere. I knew that I needed more education, either a master's degree or an associate's degree in a trade.
My friend and others, all physical therapists (PTs), impressed me with their skill sets in caring for my daughter with disabilities and teaching me through their work.
We talked about physical therapy, and I researched the time and cost involved for the education. The price tag was too high. I then heard about the physical therapist assistant (PTA) option. I realized that I could get similar professional enjoyment as a PT, but with a smaller price tag on the education. I also felt that I could make the same or more money than I was without the overtime at my current job.
I have a family. My wife and I had been married for 15 years when I started physical therapy school. We have 3 daughters, 1 of who is disabled.
We had a life that we were settled into, struggles and all. Now, I wanted to change things. I needed her support or it wasn't going to work. I had to have a conversation with my wife to see if this was something that we could handle. She said yes.
The prerequisites and the program course load—once accepted—would mean time away from home and money. We understood that I would go from working full-time to working part-time with extra shifts to pay tuition. It was a tall order, but she supported my dream and so did my daughters. Everyone understood that things at home might change while I worked toward becoming a PTA.
Once I began attending classes, I found myself looking at the pictures of past graduates on the walls. I needed to see if there was someone my age or close in the age group. I saw what looked like at least 1 in each class. I was happy to know that, at least historically, I was not alone as far as age was concerned.
I worked hard to maintain a presence at home. I was home with my family, but busy studying. Someone told me that it was good for my kids to see me study because it reinforced the notion when it came to their own schoolwork.
My wife had to pick up the ball on many occasions—getting the kids to school, homework, dinner, and parent–teacher conferences—due to my early class times, studying, and when it came time, clinical shifts. I did my best to help and maintain most of my duties as a parent and a spouse. I guess the good part was that I was actually home more than usual. Normally, I would be at work most days of the week. I would not see my family for days at a time except in the morning before they left for school and work. They actually had to get used to me being home while they were awake. Still, I was gone weekends when I worked my part-time shifts. And I worked holidays for extra money.
My classmates were young and smart and full of energy and plans. I had previously experienced some of their plans, but it was exciting to see the looks on their faces when talking about engagements, planning for a house, moving in with partners, and starting new relationships. All the while, my wife and I were talking about retirement plans and had done estate planning.
I was not the oldest person in my class. It was nice to not be alone in the age department. We had a few conversations about the perception of us in relation to our younger classmates. We talked about future employment and the reasons we went back to school.
I remember when I was a younger student, seeing older adults in my classes and wondering if their life took a wrong turn and now they needed to go back to school. For me, my life was actually okay before I started. I just wanted a change and felt I needed a formal education to do so.
Balancing school, work, and home can be challenging. Everything seems to be at stake. If I fail my classes, it means money wasted.
If my wife handled everything at home without any help, in addition to working full-time, she would be wiped out, and I would feel like I failed home.
If I fell asleep at work from being tired, I'd get fired and be unemployed.
I enjoyed the learning process. And my instructors and classmates were great; however, I felt like I was walking a tightrope the entire time.
It was a struggle from the beginning to the end; something that I would not change.
Waco Porter III, PTA, graduated from MO Western PTA program and now works at PRN for Life Care Centers, Encore, and Reliant Rehabilitation in the Kansas City area. He works with adults with developmental disabilities.